Boil Water Advisories Research Articles

Does the public receive and adhere to boil water advisory recommendations? A cross-sectional study in Newfoundland and Labrador, Canada.

BackgroundHighly publicized water supply problems highlight the importance of safe drinking water to the public. Boil water advisories (BWAs) are an important precautionary measure meant to protect public health by ensuring drinking water safety. Newfoundland and Labrador, Canada is a prime location for exploring public notification practices and adherence to recommendations as there were a total of 215 BWAs, affecting 6 % of the provincial population, in 145 communities between April 2006 and March 2007 when data for the present study were collected.MethodsResidents who received household water from a public water supply were randomly selected for a telephone interview. Collected data included participants’ notification of boil water advisory, satisfaction with information provided, and their adherence to recommendations.ResultsMost participants learned that a BWA had been issued or lifted in their community through radio, television, or word of mouth. BWAs were issued for a range of operational reasons. Almost all participants who had experienced a BWA reported wanting more information about the reasons a BWA had been issued. Low adherence to water use recommendations during a BWA was common.ConclusionsThis study is first to report on public adherence to boil water advisory recommendations in Canada. The findings raise public health concerns, particularly given the high number of BWAs issued each year. Further studies in partnership with community stakeholders and government decision-makers responsible for overseeing public water systems are needed to assess the perceptions of BWAs, the reasons for non-adherence, and to identify information dissemination methods to increase information uptake and public adherence with acceptable uses of public drinking water during a BWA.

Getting the Message Out: A Boil Water Advisory and Customer Response

Issuing a boil water advisory presents drinking water utilities with the challenge of telling customers what happened and what to do in a timely way. A survey helped Portland (Ore.) Water Bureau (PWB) determine the best way to reach its customers and meet their expectations.

Do water service provision contracts with neighbouring communities reduce drinking water risk on Canadian reserves?

In 2011, 39% of drinking water systems on Canadian First Nations' reserves were classified as high risk [31]. In recent years some First Nations have contracted water services from neighbouring communities through “Municipal Type Agreements”, or “MTAs”. Using a unique data set of 804 First Nations' water systems, we explore both factors that influence participation in MTAs, and the effect of participation on the likelihood that a First Nations' water system will be under a boil water advisory. Our empirical analysis consists of two probit models. The first model describes the likelihood that a First Nation will participate in a MTA. The second estimates the likelihood that a First Nations' water system will be under a boil water advisory. Our primary finding is that participation in a MTA significantly reduces the likelihood that a First Nations' water system will be under a boil water advisory. This is an important consideration when developing incentives or institutions that influence infrastructure collaboration between First Nations and non-First Nation communities.

A Delphi Technology Foresight Study: Mapping Social Construction of Scientific Evidence on Metagenomics Tests for Water Safety.

Access to clean water is a grand challenge in the 21st century. Water safety testing for pathogens currently depends on surrogate measures such as fecal indicator bacteria (e.g., E. coli). Metagenomics concerns high-throughput, culture-independent, unbiased shotgun sequencing of DNA from environmental samples that might transform water safety by detecting waterborne pathogens directly instead of their surrogates. Yet emerging innovations such as metagenomics are often fiercely contested. Innovations are subject to shaping/construction not only by technology but also social systems/values in which they are embedded, such as experts’ attitudes towards new scientific evidence. We conducted a classic three-round Delphi survey, comprised of 107 questions. A multidisciplinary expert panel (n = 24) representing the continuum of discovery scientists and policymakers evaluated the emergence of metagenomics tests. To the best of our knowledge, we report here the first Delphi foresight study of experts’ attitudes on (1) the top 10 priority evidentiary criteria for adoption of metagenomics tests for water safety, (2) the specific issues critical to governance of metagenomics innovation trajectory where there is consensus or dissensus among experts, (3) the anticipated time lapse from discovery to practice of metagenomics tests, and (4) the role and timing of public engagement in development of metagenomics tests. The ability of a test to distinguish between harmful and benign waterborne organisms, analytical/clinical sensitivity, and reproducibility were the top three evidentiary criteria for adoption of metagenomics. Experts agree that metagenomic testing will provide novel information but there is dissensus on whether metagenomics will replace the current water safety testing methods or impact the public health end points (e.g., reduction in boil water advisories). Interestingly, experts view the publics relevant in a “downstream capacity” for adoption of metagenomics rather than a co-productionist role at the “upstream” scientific design stage of metagenomics tests. In summary, these findings offer strategic foresight to govern metagenomics innovations symmetrically: by identifying areas where acceleration (e.g., consensus areas) and deceleration/reconsideration (e.g., dissensus areas) of the innovation trajectory might be warranted. Additionally, we show how scientific evidence is subject to potential social construction by experts’ value systems and the need for greater upstream public engagement on metagenomics innovations.

Lived experience of acute gastrointestinal illness in Rigolet, Nunatsiavut: “Just suffer through it”

Enteric illness associated with foodborne and waterborne disease is thought to be common in some Canadian Indigenous communities. This study aimed to understand the lived experience of acute gastrointestinal illness (AGI), including symptoms and severity, perceived causes, and healthcare seeking behaviors of AGI in the small Inuit community of Rigolet, Canada.A concurrent mixed quantitative and qualitative methods design was used. Two cross-sectional retrospective surveys provided quantitative data to examine self-reported AGI symptoms and the distribution of potential risk factors in the community. Qualitative data from in-depth interviews with one-third of AGI cases were analyzed using a constant-comparative method to describe symptoms and severity, identify perceived risk factors, and explore health seeking behavior of AGI in Rigolet.Of the survey respondents reporting AGI, most reported symptoms of diarrhea without vomiting, followed by diarrhea with vomiting, and vomiting without diarrhea. The most common secondary symptoms included stomach cramps and abdominal pain, nausea, and extreme tiredness. Community members identified potential risk factors for AGI that reflect the epidemiology triad (host, agent, and environmental factors), including hygiene, retail food, tap water, boil water advisories, and personal stress. Risk aversion and healthcare seeking behaviors reflected the core constructs of the Health Belief Model (perceived susceptibility, severity, and benefits and barriers to action).Understanding community experience, perspectives, and beliefs related to AGI is useful for public health practitioners and health care providers. This information is important especially considering the relatively high estimated burden of AGI and the relatively low healthcare seeking behaviors in some Indigenous communities compared to national estimates. Moreover, the mixed-methods approach used to understand the burden of AGI could be extended to other health research in Indigenous contexts.

Spatial analysis of boil water advisories issued during an extreme weather event in the Hudson River Watershed, USA

Water infrastructure in the United States is aging and vulnerable to extreme weather. In August 2011, Tropical Storm Irene hit the eastern part of New York and surrounding states, causing great damage to public drinking water systems. Several water supply districts issued boil water advisories (BWAs) to their customers as a result of the storm. This study seeks to identify the major factors that lead water supply systems to issue BWAs by assessing watershed characteristics, water supply system characteristics and treatment plant parameters of water districts in the Mohawk-Hudson River watershed in New York. Logistic regression model suggests that the probability of a BWA being issued by a water supply district is enhanced by higher precipitation during the storm, high density of septic systems, lack of recent maintenance and low population density. Interviews with water treatment plant operators suggested physical damage to water distribution systems were the main causes of boil water advisories during storms. BWAs result in additional costs to residents and communities, and the public compliance of the advisory instructions is low, so efforts must be made to minimize their occurrence. Prior investments in infrastructure management can proactively address municipal water supply and quality issues.

The Long Road to Recovery: Environmental Health Impacts of Hurricane Sandy

Building contractor John Pierciey stands in the gutted interior of a 1950s-era home in Manasquan, New Jersey. Wallboard, two layers of wood flooring, a layer of felt—all of it had to be ripped out to rid the house of mold caused by Hurricane Sandy’s storm surge. “This is the sixth house I’ve gutted in a week,” Pierciey says. “Every one is different. You don’t know what you’re going to find until you take them apart.” Residents and volunteers keep warm by a fire barrel in the New Dorp Beach neighborhood of Staten Island, 5 November 2012. Power outages persisted through a cold snap that put temperatures in the single digits. So it is with the environmental health impacts of Hurricane Sandy. Every layer of society, every type of building, has felt the impact of the storm, which struck the U.S. East Coast on 29 October 2012. Incidences of death and illness, though small in number compared with some storms, have come in many forms, the effects still unfolding as time goes by.

A Bridge Over Troubled Waters: Alternative Financing and Delivery of Water and Wastewater Services

Too many drinking water and wastewater systems across Canada threaten public health and the environment. In this report, the author writes that many of the municipally owned and operated systems that treat and distribute drinking water perform poorly and lack the financial resources and expertise to meet the challenges posed by aging infrastructure. Indeed, more than 1,000 systems across Canada violate provincial requirements or are subject to boil-water advisories. Brubaker recommends reforms to the financing and operating of utilities to ensure their long-term sustainability. These include introducing competition for water and wastewater services and taking steps to attract more private expertise and capital investment.

Despite federal promises, First Nations' water problems persist

A year after the federal Conservative government promised to draft drinking water standards for First Nations communities, there is still no bill before the House of Commons — and boil-water advisories remain in place on more than 90 Canadian reserves. Unlike their “do not consume” cousins,

Investigative report: 1766 boil-water advisories now in place across Canada

More than 1760 provincial boil-water advisories are currently in effect in communities and neighbourhoods across Canada, prompting calls from national and municipal advocacy groups for a federal and provincial strategy to ensure safe drinking water for all Canadians. ![Figure][1] An

Thermal Death Point ofBaylisascaris procyonisEggs

To the Editor: In the past 20 years, Baylisascaris procyonis, the common intestinal roundworm of raccoons, has increasingly been recognized as a source of severe human neurologic disease that particularly affects children (1,2). Although human baylisascariasis appears to be rare, the devastating neurologic disease caused by this infection and the lack of effective treatment make it a disease of public health importance (3). Adult raccoons infected with B. procyonis can shed millions of unembryonated eggs in feces daily (4). Once infective, eggs can remain viable in the environment for years and are resistant to most decontamination methods (5). Given the severe and untreatable nature of baylisascariasis, and the hardy nature of B. procyonis eggs, information on optimal methods to inactivate B. procyonis eggs is essential. To guide attempts at environmental decontamination as well as personal protection in the case of accidental or intentional contamination of drinking water supplies, we attempted to determine the thermal death point of B. procyonis eggs. Experiments were conducted in which 150 μL each of embryonated eggs, at a concentration of 100 eggs per μL, were added to six 1-mL polypropylene tubes of sterile water. The 6 tubes were then added to a water bath at 35°C and allowed to sit for 10 min to equilibrate. Then the temperature of the water bath was slowly increased at a rate of ≈5°C per 7 min, and 1 tube was removed at each 5° increment from 37°C to 62°C. Eggs were then examined by light microscopy to determine whether the larvae were still viable, as judged by larval motility (Figure). The experiment was repeated by using a more objective assessment of viability through examination of hatched larvae. Inactivation was measured with a viability dye (methylene blue) exclusion method in which uptake of dye by larvae indicates cell death and inactivation. After the eggs were removed from the heat, the mammilated layer was removed through exposure to undiluted chlorine beach and then washed 5 times in 0.85% saline for 1 min at 600×g. Hatching was achieved by the glass bead method (6,7). Hatched larvae were then removed and mixed 1:1 with a 1:10,000 dilution of methylene blue. Viable larvae remained motile and had an intact cuticle that could not be penetrated by the stain, whereas nonviable larvae took up the methylene blue along the cuticle and stained blue (8). Figure Hatched, stained, nonviable Baylisascaris procyonis larvae (magnification ×10). The experiment was repeated by adding the heated water, in 5° increments between 37°C and 62°C, directly into the tube containing the eggs. The duration of exposure of the eggs to the water was <1 min. The eggs were then processed in the same manner as previously described and examined by light microscopy. All experiments were replicated. All larvae remained viable in water up to 47°C; >75% of the larvae were viable at 52°C and 57°C; complete inactivation occurred at 62°C. When the heated water was added directly to the infectious eggs, all larvae remained viable up to 42°C, and most larvae were observed to be viable at 47°C and 52°C; complete inactivation occurred at 57°C. These preliminary findings indicate that B. procyonis eggs have a thermal death point, <62°C, very similar to the thermal death point of Ascaris lumbricoides and A. suum (9). Given the widespread prevalence of B. procyonis in raccoons, the close association of raccoons with human populations, and the serious nature of infection, identification of the thermal death point of infectious B. procyonis larvae has important implications. Potential for human infection can be mitigated by decontaminating areas where B. procyonis eggs are known to be found. Health authorities and parasitologists are routinely contacted by citizens and organizations regarding concerns about areas that have been contaminated with raccoon feces, including yards, pools, and homes. Unfortunately, no comprehensive studies have been published that describe practical and effective methods for decontamination of areas where B. procyonis eggs are present. The recognition of complete inactivation of eggs at relatively low temperatures will provides guidance in circumstances in which natural or intentional contamination with B. procyonis eggs requires disinfection efforts and indicates that approaches well short of incineration or boiling will be effective. Furthermore, these results suggest that temperatures achievable in point-of-use hot water heaters (household units) can deactivate infectious B. procyonis eggs, thus providing an option for maintaining safe drinking water during a possible event of bioterrorism or a “boil water advisory.” However, further efforts are needed to determine the effectiveness of heat and other disinfection methods on inactivation of eggs in natural circumstances such as in feces or contaminated play areas including soil.

Safe drinking water standards for First Nations communities

The federal government is implementing safe drinking water standards for First Nations communities, 76 of which have boil water advisories in place, Indian Affairs Minister Jim Prentice has announced. The new national standards are the first to govern the quality of drinking water on First Nations

Boil‐water Orders: Beneficial or Hazardous?

This article reports on a study done at the University of Michigan on how boil water advisories may provide little if any protection against thermally resistant bacterial spores (e.g., Bacillus anthracis), and may actually result in much greater inhalation health hazards. The article discusses three characteristics of Bacillus anthracis that make it one of the most likely choices for a bioterrorism attack. Specifically, the objectives of the study were to determine whether the spores of Bacillus subtilis (selected as a nonlethal surrogate for the highly lethal Bacillus anthracis) are inactivated in boiling water and to assess whether aerosols formed in boiling processes create potential routes for dispersal of viable airborne spores. The article discusses materials and methods used in the study, including preparation of spore suspensions, general experimental protocol, thermal inactivation experiments, aerosolation experiments, and viability assessment.

Characterization of Particles in Slow Sand Filtration at North Caribou Water Treatment Plant

Abstract Microscopic analysis of particles in water can indicate the size of filter media required, and can be used to monitor filter performance. This study investigated a malfunctioning slow sand filter in a water treatment facility on a First Nations community in Northern Ontario. There has been a boil-water advisory in the community due to high turbidity in the drinking water since the plant was put into operation. Also, the slow sand filters in the plant clog frequently resulting in outflow volumes significantly below the plant design capacity. On-line particle counts and microscopic analysis of water were conducted in the plant at various points before and after the slow sand filters. Microscopic analysis of the slow sand filter effluent showed that the high water turbidity was due to an increased concentration of particles smaller than 2 µm in size. This observation could not have been made with the particle counter data alone, as it is not capable of measuring particles of that size. Visual inspection of microscopic images of these small particles indicated that they were being washed out from the filter media, and did not originate from the raw water. Significant numbers of large filter-clogging diatoms (up to 50 µm in size) were identified under the microscope; yet, the particle counter did not report particles larger than 15 µm in raw water supply. Turbidimeters and particle counters were found to be unable to identify these diatoms, due to the transparent nature of the cell walls of these microorganisms. It is likely that most of these diatoms originated from sediment accumulated in the raw water intake pipe.

Eliciting public preferences for municipal water supply options

This article presents a multivariate stated preference model, the discrete choice experiment (DCE), as a formal method of assessing the trade-off behaviour of the municipal residents of Thunder Bay, Ontario, Canada for their preferences for the source of municipal water supply. The respondents were asked to choose repeatedly from a set of choice cards, which displayed different configurations of water rates, water pressure, and water taste for three alternative sources of water supply—Bare Point, Loch Lomond (affected by a 1997 Boil Water Advisory, BWA), and a dual source. The survey results indicated that, despite the suggestion of a lower water rate, such as 2.5% over 10 years vs. 5% over 10 years, respondents' preferences for Loch Lomond were significant, if pressure and taste were improved, irrespective of the water rates. This finding documents the potential for discrepancy between the preferences of the public at large and the expert-driven consultation process, which recommended the Bare Point option. Therefore, the article suggests the use of a multivariate research method, such as the DCE, to assess trade-offs of alternative policies in the environmental assessment (EA) process in a more objective and representative manner than the current practice.

Resident participation in a scenic landscape analysis of the North Okanagan Valley, British Columbia

This article presents a multivariate stated preference model, the discrete choice experiment (DCE), as a formal method of assessing the trade-off behaviour of the municipal residents of Thunder Bay, Ontario, Canada for their preferences for the source of municipal water supply. The respondents were asked to choose repeatedly from a set of choice cards, which displayed different configurations of water rates, water pressure, and water taste for three alternative sources of water supply—Bare Point, Loch Lomond (affected by a 1997 Boil Water Advisory, BWA), and a dual source. The survey results indicated that, despite the suggestion of a lower water rate, such as 2.5% over 10 years vs. 5% over 10 years, respondents' preferences for Loch Lomond were significant, if pressure and taste were improved, irrespective of the water rates. This finding documents the potential for discrepancy between the preferences of the public at large and the expert-driven consultation process, which recommended the Bare Point option. Therefore, the article suggests the use of a multivariate research method, such as the DCE, to assess trade-offs of alternative policies in the environmental assessment (EA) process in a more objective and representative manner than the current practice.