Health

1
Health ComfortWater

• Opportunities Problems

2
Water is Life

• Human 65 H2O
• Minimal Daily loss 1 kg H20 / person
• Maximal Hourly loss 10 kg H2O / person
• Loss to be replenished by eating drinking
• Human lt60 H20 in danger zone

3
Potable Water

• Perishable Commodity (lt 24 Hours)
• Keep cool or add Chlorine-derivate
• Keep Running
• Bio-film development on Surfaces

4
Healthy and Sustainable BuildingPotable Water

• Disease Risks
• Veterans Disease caused by Legionella
• - Infections / Intoxications of Household Water
  ( 2nd quality water)
• Prevention
• Keep potable water supply below 18C at all
  times
• Mark each Household Water outlet individually
  and clearly
• Stimulate distinguishable odour and taste of 1st
  2nd quality water
• Make disconnecting of 2nd quality water-systems
  easy
• Inform consumer

5
Healthy and Sustainable BuildingHot Water

• Disease Risks
• Scalding
• Veterans Disease caused by Legionella
• Pontiac Fever caused by Legionella
• Atopic Disease through lack off mite
  extermination at laundering
• Humidifier Disease through antigens of
  micro-organisms
• Prevention
• Install thermostatic mixing faucet
• Replace boiler by geyser with a short hot water
  conduct
• Install facility for washing machine with extra
  water heating (gt60oC)
• Inform consumer

6
Legionella Risk

• Veterans Disease Pontiac Fever
• Lung infection (Shower, Air-Conditioning,
  Cooling Towers)
• 18oC lt Bacterial Growth lt 60oC
• Bacterial Survival up to 65oC
• Viable Legionella present in surface coastal
  waters

7
1000 Legionella-infections

• 950-990x cases of Pontiac Fever
• 9-30x surviving Veteran-Disease patients, but
  with persisting chronic symptoms
• 1-20x fatal cases

Source JEMH van Bronswijk e.a. 1999. Gezond en
Duurzaam Bouwen (GeDuBo). Research Report for the
Netherlands Ministry of Housing
8
Legionellosis Risk Classes
Source CJPA Hoebe, JJM Cluitmans, JHT
Wagenvoort, WJ van Leeuwen, MAJ Bilkert-Mooiman
1999. Koud leidingwater als bron van fatale
nosocomiale pneumonieën door Legionella
pneumophila in een revalidatiekliniek. Nederl.
Tijdschr. Geneesk. 143(20)1041-1045
JEMH van Bronswijk, October 9, 1999
9
Legionellosis

• Since the 1986 report of the Health
  Administration 5,000 preventable deaths occurred
  in NL
• For each Legionella death 50 to 1,000 persons are
  diseased
• Risk in modern dwellings and in hospitals is
  comparable
• Preventive technology is available

10
Legionella extermination

• At temperatures gt64C no breathing of Legionella
  occurs
• No growth lt18C Legionella remains vital
• 0.5 mg free chlorine / l water kills bacteria
• Copper or silver-ions in the water decrease growth

Use a thermostatic mixing tap with automatic
emptying, to prevent both burns and a Legionella
infection! Source Report Gezondheidsraad 1986
Pubmed 1995-1999
11
Waste Water

• Bathroom, Toilet, Kitchen Human pathogens from
  man pets (SARS!)
• (Run-off) Rainwater Human pathogens from birds
  rodents
• Waste water is a breeding ground for biting
  insects a domain of rodents keep is covered

12
Outdoor Water

• Visual Comfort
• Water Management
• Recreation
• Diarrhoea (e.g. Escherichia coli, Salmonella)
• Weils Disease
• Temperate-region Malaria (brackish water)

13
SARS in Hong Kong

• Spread by air and waste water

14
SARS

• Severe Acute Respiratory Syndrome
• SARS Corona virus, a RNA virus
• 2003 908 deaths on 8.422 patients
• Survivors bone degradation due to medication
• Economy disrupted

15
(No Transcript)
16
(No Transcript)
17
SARS events

• Transmission skin contact, inhaling
• Virus Remains viable for months in cool
  circumstances
• Present in waste water
• Spread inside buildings

18
Metropole Hotel, Hong Kong
SARS only at the 9th floor (red room numbers)
coridor infested in front the elevator and door
number 911

• Air speed in feet / min index patient occupied
  red room

19
Amoy Gardens, Hong Kong (1)
Virus transport trough ventilation system start
of epidemic

• Index patient occupied flat 1607 for 2 nights
  red figures are infested floors

20
Amoy Gardens, Hong Kong (2)
Virus transport through waste water system
spread of the epidemic
p.s. also spread through rats and cockroches!

• Waste water aerosol and gass in the bathroom
  toilet rinsed with sea water

21
Causes of Summer FluInfectious Bacterial
Gastro-Enteritis

• Campylobacter jejuni (incubation period 24 - 72
  Hrs) Duration of illness 1 - 4 Days Infected
  food chicken, milk, water
• Vectors fly, rat, mouse, cockroach, rain water,
  2nd quality water
• 2. Clostridium perfringens (incubation period 8
  - 24 Hrs) Duration of illness lt 7 Days Infected
  food too slowly chilled dishes
• Vectors fly, rat, mouse, cockroach, human hands
• 3. Salmonella (incubation period 8-48 Hrs)
• Duration of illness 5 - 7 Days Infected food
  meat dishes, water
• Vectors fly, rat, mouse, cockroach, rain water,
  2nd quality water
• 4. Staphylococcus aureus (incubation period lt 6
  Hrs)
• Duration of illness lt 24 Hrs Infected food
  milk products, meat dishes
• Vectors fly, rat, mouse, cockroach, human hands

Source NRH Burgess 1990. Public Health Pests.
Chapman Hall, London E Eyskens, L Feenstra, AE
Meinders, JP Vandenbroucke 1991. Codex Medicus.
9e druk. Elsevier, Amsterdam
22
Weils Disease

• First described by Adolf Weil (1848-1916) in
  Wiesbaden (Germany)
• Infection with Leptispira ictero-haemorrhagiae
• Human disease after contact with urine of
  infected rodents such as the Norway Rat (Rattus
  norvegicus) most common in Zuid-Holland
• Symptoms and Course incubation period of 2-20
  days followed by 4-9 days with severe flu-like
  symptoms may develop from 6th-12th day of
  illness into meningitis, as well as damage to
  liver, kidneys and heart

23
Preventing Weils Disease

• Minimize open water in residential areas
• Open city water should have steep banks
• Mow banks of city water 2x yearly
• Keep city water deep (gt 3 m)
• Exterminate Rattus sp in residential areas
• Inform consumers

Number of drowned children will decrease
increase
24
Healthy and Sustainable BuildingOpen Water in
Cities Towns

• Disease Risks
• Weils Disease
• Papular Urticaria due to mosquitoes and biting
  flies
• Re-introduction of temperate-region malaria
  (only in brackish areas)
• Prevention
• Fill up marshy fields and stagnant waters in
  living areas
• Refrain from introducing water-purifying marshes
  in living areas
• Can marshes or ponds not be avoided install rat
  mosquito extermination program
• Prevent mosquitoes black flies from entering
  the house (fixed insect screens in windows
  doors)
• Inform consumer

25
(No Transcript)
26
Dutch Anti-malaria Poster from the 1st half of
the 20th century
Ziet gij muggen lang van poot Aarzelt niet, maar
slaat ze dood
Translation Do you see mosquitoes long of legs
? Dont wait, squeeze them to death