Municipal Sewer & Water magazine recently interviewed Dr. Adrianus Vlugman, a featured speaker at this year’s Water & Wastewater Equipment, Treatment & Transport (WWETT) Show, which will be held Feb. 23-26 at the Indiana Convention Center in Indianapolis. Vlugman is a senior advisor on water, sanitation and environmental health at the World Health Organization, and on Feb. 26, he will speak about the transfer of communicable disease in water and wastewater. Here, he offers a glimpse into his upcoming presentation.

This Q&A with Dr. Vlugman is a four-part series that will run through next week, so check back often.

MSW: How has the topic of disease spread through water and wastewater affected your own life? Why are you passionate about this subject?

Dr. Vlugman: As a young child, I was always fascinated with nature and the interaction between people and their environments. When I was 5 or 6, I asked my father what happened after I flush the toilet, imagining a big heap under the house. He told me about the sewer pipe in the street, leading to a little river a few kilometers downhill. My brother and I followed the sewer to the river only to find a mucky black stream without any life in it.

This “end of the pipe” approach shocked me.

Initially I wanted to study biology, but decided on civil engineering and mastered in environmental health, or sanitary, engineering as this brought all aspects of my interest (biology, nature, health and engineering) together. I wanted to improve the world and living conditions for people. I realized there is no “end of the pipe,” but everything is part of a cycle. That black stream had life, albeit anaerobic life. Waste does not exist, and everything is a resource.

Personal health, public health and the health of the environment are a reflection of how we manage these cycles. The water cycle is a prime example — water is reused over and over, because water is an excellent solvent and medium to transport waste. With basic and simple interventions, one can gain great achievements for the betterment of quality of life, especially health. That’s what I am passionate about.

MSW: Could you provide a global perspective on the scope of disease transfer by way of water and wastewater?

Dr. Vlugman: Many communicable diseases can be spread through water and wastewater, either via the fecal-oral route, via wash water through the skin or eyes, or via water-related insects breeding in or biting near water.

The four major types of human disease-causing organisms (pathogens) that can be found in sewage are: bacteria, viruses, protozoa and parasitic worms. Most of these pathogens in sewage are enteric, which means they come from the intestinal tracts of humans or animals. Such organisms include: Escherichia coli, Salmonella, Shigella (dysentery), Campylobacter, Cryptosporidium, Giardia, Vibreo cholerae and enteric viruses. Exposure could result in disease (e.g., gastroenteritis) and an infected person can spread the disease to others. Such diseases include cholera, typhoid, dysentery, diarrhea, salmonellosis, polio, hepatitis, leptospirosis, worm infections, schistosomiasis, filariasis, etc.

It is estimated that around the world, about 4 percent of all deaths and nearly 6 percent of disability-adjusted life years (DALY), which are considered one lost year of healthy life, are related to poor drinking water, sanitation and hygiene. These figures are highest in Africa and southeast Asia and lowest in Europe.

WHO reports that in 2012, about 600,000 children died from diarrheal diseases, which are strongly associated with poor water, inadequate sanitation and poor personal hygiene.

In 2012, nearly 1 billion people lacked access to safe drinking water, while 2.5 billion people lacked access to improved sanitation. One billion people practiced open defecation.

MSW: What is the nature of diseases most likely to be transmitted through these pathways?

Dr. Vlugman: The symptoms of water-related diseases vary a lot, and can include fever, vomiting, abdominal cramps, diarrhea, malnutrition, lethargy, lung infections, constipation and anorexia. Polio causes paralysis, and filariasis causes elephantiasis or big foot disease due to fluid retention in legs.

Most of these enteric organisms are usually associated with self-limited gastrointestinal illness, but can develop into more serious diseases in sensitive populations such as immunocompromised individuals, infants, young children and especially the elderly. For example, case fatality rate for cholera is less than 2 percent and with prompt and good treatment (rehydration) the chances of survival increase.

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Interested in hearing more from Dr. Vlugman? Then attend the WWETT Show from Feb. 24-26 at the Indiana Convention Center in Indianapolis. For more information on registration, speakers, education opportunities and more, visit www.wwettshow.com.