1. Surveillance of waterborne diseases Implementation of the Protocol on Water and Health Mihály Kádár National Institute of Environmental Health, Budapest ISEE, Balatonfödvár, 4-6 September, 2003

2. Main objectives of the Protocol To promote prevention, control and reduction of water-related diseases throughout the WHO/Euro region by: –Ensuring adequate drinking water supplies and sanitation; –Effective systems for surveillance and monitoring of water supply and services; –Giving special consideration to vulnerable groups of population; –Providing the public with information and raise public awareness; –Enhancing international cooperation in pursuing the above objectives; –Reviewing and assessment of progress.

3. Footsteps of work under the Protocol –1st Meeting of the Signatories to the Protocol Budapest, November, 2002; –1st Meeting of the Working Group of Water and Health, Budapest, May, 2001; –2nd Meeting of the Working Group of Water and Health, Budapest, October, 2002; –Small WG Meeting on the Evidence Base and Develoment of a Reporting Scheme for WRD; –Experts Worskhop on Goals and Strategies for WRD Surveillance; –Workshop on Health Risks in Aquifer Recharge –Workshop on Rapid Environmental Health Risk Assessment –2nd Meeting of the Signatories to the Protocol, Geneve, July, 2003.

4. Draft Guidelines of the Surveillance for Water Related Diseases (1) Framework: HEALTH TARGETS Risk Managemen t PUBLIC HEALTH STATUS Assessment of Risk

5. Draft Guidelines of the Surveillance for Water Related Diseases (2) General overview: –Reactive system: monitoirng and management of WRD –Proactive systems: monitoring and management of water quality –Multi-level institutional outline and legal-political background Water-borne infectious diseases: –priority groups of pathogens/events in Europe and symptom-based definitions –Managing information: sources and reporting –Outbreak investigation Water-borne diseases caused by chemical substances: –Origin/ways of contamination –Monitoring strategies for chemicals and their health effects

6. Draft Guidelines of the Surveillance for Water Related Diseases (3) Proactive surveillance-monitoring: –HACCP principle as an operational basis –Most important groups of the Critical Control Points of a water supply system: Source and catchment Chain of treatment Distribution system components and environment Domestic plumbing system and points of use

7. WatSan_P1: Waste water treatment coverage Year Percent of population with secondary sewage treatment

8. WatSan_S1:Exceedance of recreational water limit values for microbiological parameters Year Percent of exceedances

9. WatSan_S2: Exceedance of WHO drinking water guidelines for microbiological parameters Percent of exceedances Year

10. WatSan_S3: Exceedance of WHO drinking water guidelines for chemical parameters Year Percent of exceedances

11. WatSan_E1 Outbreaks of waterborne diseases Year Number of outbreaks byNumber of cases by Total Drinking water Recreational water Drinking water Recreational water population 199601 25 10.432.233 199700 10.349.956 199800 10.317.458 199920210 10.267.150 200001 36 10.239.790 20011068 10.203.079

12. WatSan_E2 Diarrhoea morbidity in children Year Case / 100.000

13. THANK YOU FOR YOUR ATTENTION!