1. WASH Cluster – Emergency Training D D31 WASH related diseases Session 3 Categorisation and Transmission

2. WASH Cluster – Emergency Training D D32 2 Session Aim To understand some key issues with respect to Environment/WASH related diseases

3. WASH Cluster – Emergency Training D D33 Session Name here 3 Session Objectives To list the key environment/WASH related diseases in emergencies To describe how such diseases are often categorised To explain how such diseases are transmitted and the key pathogens

4. WASH Cluster – Emergency Training D D34 Session Name here 4 Session Objectives To design a control & prevention strategy for Hepatitis E To discuss the importance of hand washing in preventing diarrhoea

5. WASH Cluster – Emergency Training D D35 WASH related diseases Question to group What are the WASH/Environment related diseases you generally associate with emergency settings? How might you categorise them?

6. WASH Cluster – Emergency Training D D36 Diseases affecting displaced persons in disasters Group to receive a handout Pages 170 and 171 from “Environmental Health in Emergencies and Disasters, Edited by B. Wisner and J.Adams, WHO, 2003 Table 11.1 Diseases affecting displaced populations in disasters

7. WASH Cluster – Emergency Training D D37 Broad Categories of WASH related Diseases 1.Water-borne infections 2.Water-washed infections 3.Vector borne infections 4.Food-borne infections Source: Controlling and Preventing disease

8. WASH Cluster – Emergency Training D D38 Other categorisations Some might refer to: Waterborne diseases Sanitation and Hygiene-Related Diseases Vector or Insect-borne diseases associated with water Neglected Tropical Diseases Source: Centers for Disease Control and Prevention

9. WASH Cluster – Emergency Training D D39 Other categorisations –Water-borne diseases (microbial contamination of drinking water) –Water-washed diseases (sufficient water quantities ) –Water-based diseases (infection through contact with water) –Water-associated vector-borne diseases (ecosystems conducive to vector breeding) Source: WHO

10. WASH Cluster – Emergency Training D D310 Categorisations We will classify into three broad categories 1.Water-borne 2.Sanitation and Hygiene related 3.Insect or Vector borne

11. WASH Cluster – Emergency Training D D311 Waterborne Diseases Waterborne diseases are caused by pathogens that can be directly spread through contaminated water. Most cause diarrhoeal illness spread through the faecal-oral route Examples include: Amoebiasis, Cholera, Cryptosporidiosis, Guinea Worm, Giardiasis, Rotavirus, Schistosomiasis (Bilharzia), Shigellosis and Typhoid Fever.

12. WASH Cluster – Emergency Training D D312 Faecal-oral route Source: WEDC

13. WASH Cluster – Emergency Training D D313 Sanitation and Hygiene Related Diseases Examples include Lice Scabies Soil transmitted helminthiasis (Ascaris, Whipworm, Hookworm) Trachoma

14. WASH Cluster – Emergency Training D D314 Insect or Vector Borne Examples include Dengue/Dengue Haemorrhagic Fever Malaria Yellow Fever Rift Valley Fever Plague

15. WASH Cluster – Emergency Training D D315 http://www.lboro.ac.uk/well/resources/technical-briefs/51-water-sanitation-and-hygiene-understanding.pdf

16. WASH Cluster – Emergency Training D D316 Key Pathogens Question to group What are the key pathogens to be aware of in disaster situations?

17. WASH Cluster – Emergency Training D D317 Key Pathogens Bacteria (e.g. Vibrio cholerae responsible for Cholera, Shigella spp responsible for Shigellosis) Viruses (e.g. Hepatitis A, B, C and E responsible for Hepatitis (viral), Flaviviridae serotypes 1, 2, 3 and 4 responsible for Dengue) Parasites (e.g. Plasmodium falciparum responsible for Malaria, Sarcoptes scabiei responsible for Scabies) Helminths (worms) (e.g. Dracunculus medinensis responsbile for Guinea worm disease) Protozoa (e.g. Leishmania spp responsible for Leishmanisasis) Rickettsia (e.g. Rickettsia mooseri responsible for flea-borne typhus)

18. WASH Cluster – Emergency Training D D318 Group Work - Hepatitis E Divide into groups Each group to receive four one page handouts summarising the problem of Hepatitis E in Darfur and Chad 20 mins plus 20 mins for plenary feedback

19. WASH Cluster – Emergency Training D D319 Group Work -Hepatitis E How would you categorise Hepatitis E? What key control and prevention strategies would you employ?

20. WASH Cluster – Emergency Training D D320 Voting Exercise In terms of preventing diarrhoea please vote on the following in order of importance: Water Quantity Water Quality at Source Water Quality Household Sanitation (Latrines) Handwashing

21. WASH Cluster – Emergency Training D D321 Taken from Hygiene Promotion Briefing Paper prepared for the WASH cluster meeting in February 2008 Sanitation Water Quality Source

22. WASH Cluster – Emergency Training D D322 Handwashing with Soap A recently conducted randomised control trial in Karachi, Pakistan, further confirmed the findings of the two most recent reviews by finding an average reduction of 45% in diarrhoea incidence when handwashing with soap was practised (19). (WELL Factsheet, Health Impact of handwashing with soap)