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This is a full transcript of the online presentation. For the presentation itself, go here.

Presented by:
Bart Bibler
Bureau Chief, Bureau of Water Programs
Contact Number: 850-245-4241

Dr. Roberta Hammond
Food and Waterborne Disease Coordinator
Contact Number: 850-245-4116

Hi, I’m Roberta Hammond, I’m the Food and Waterborne Disease Coordinator for the Florida Department of Health. This presentation is meant to give leadership more specific information to help plan for waterborne events in your area. Key points for leadership are that it’s important to have good written plans in place. It’s particularly important to have good surveillance of both water and patients in your area. Surveillance is a key Environmental Health skill.

Let’s begin with surveillance for illness:

Where do waterborne illnesses get reported? They get reported at the health department, the utilities, the inspecting agency (this might be DOH or DEP, poison control centers, newspaper, or health care practitioners (these might be physicians, nurses, or the emergency room).
Be aware that some obstacles exist to confirming waterborne outbreaks. First, there’s poor reporting of cases. Some people don’t go to the doctor, many doctors don’t report, so there’s no medical diagnosis. Often, no clinical samples are taken.
There’s a lack of specialized lab facilities for certain waterborne pathogens. Isolation of some of these pathogens is difficult. Some of these pathogens are emerging pathogen--for which we don’t have much information--and there’s also a lack of data on how pathogens behave water.

So, there’s a need for heightened surveillance throughout the state. Continue ongoing disease surveillance for waterborne diseases, especially those for which baseline data have been obtained. Educate healthcare professionals in your area regarding disease reporting. Call the appropriate authorities when an intentional contamination event is suspected. Security breaches (like break-ins) should trigger heightened surveillance. In case there’s a security breach, you want to know is people are going to start showing up sick in emergency rooms.

Why is surveillance so important? Well, it’s important because you want to prevent further spread of waterborne disease. You want to prevent the occurrence of future outbreaks. We’re looking at trying to identify emerging waterborne pathogens, and we also want to identify intentional contamination events.

So you want to be proactive about surveillance. There are two types of surveillance to increase: Surveillance if Illnesses and Water Quality Monitoring. In terms of illnesses, you want to look for outbreak characteristics. For instance, higher numbers of a specific illness than you would expect. In terms of Water Quality Monitoring, you want to look for both known and emerging pathogens

A new EH database system will track the occurrence of waterborne illness and notify stakeholders when this has occurred. You can contact Environmental Health for more information on this.

You also want to do risk assessments in your area for surveillance for illness. Contact your local hospitals, for instance, to see how they are reporting this data.
What locations are likely to be part of a waterborne outbreak? These could be drinking water or recreational area outbreaks. Where are those patients likely to go? Would they go to specific doctors, pharmacies, hospitals? Hospitals will have more knowledge, but people might not go there first. Also, Hospitals may lack capacity. All of these are your partners in your community effort for preparedness

You need to educate your partners for surveillance for illness based on your Risk Assessment in your community. So, get out into the community, and target educational outreach programs at places victims are most likely to go. Create some quick lists of contact info to make it easier for your partners to contact you with surveillance info.

It’s important to understand that surveillance is a continual, ongoing effort. Once you have baseline data, you can look for spikes in these data. If you see a spike in a kind of illness, go ahead and report it. With these data, you can amalgamate surveillance from across the county since everyone won’t go to a single place.

In conclusion, being proactive can mitigate the outbreak before it spreads – doesn’t matter if it’s unintentional or intentional. Now, Bart Bibler will look at issues surrounding water system preparedness.

I’m Bart Bibler. I’m the Bureau Chief of Water Programs here at Florida’s Department of Health (DOH).  I’d like to discuss with you our preparedness with water system security and your role in that preparedness effort. Water system preparedness is integral to the general level of preparedness at the DOH. The DOH has greatly enhanced that level of preparedness and is continuing to improve upon it.  Some of these measures include: investigation and test kits have been given to all County Health Department’s (CHD’s); laboratory capacity for detecting biological agents has expanded over the past three years; and education and training of health partners throughout the state has been dramatically expanded. The most important preparedness upgrade though, is you. It’s critical that you prepare your area to work as a team, to help prevent and respond to any water system events. 

In terms of water system preparedness, we’ve talked about the Safe Drinking Water Act (SDWA), which now requires water systems to prepare Vulnerability Assessments and Emergency Response Plans. Even within the SDWA, though, different water systems have different levels of security depending on size and funding level. As you begin to assess your area for water security, remember that smaller water systems may need more help in terms of assessing potential health impacts. If they are willing, you can work collaboratively with them to assess potential water threats and solutions to these threats. 

Based on these collaborations or your own assessments, it’s a good idea to produce basic fact sheets which center around general water security guidelines. These could talk about: specific contamination agents that might be possible in your region; security enhancements in your area that make contamination unlikely; backup plans for water service in case basic service is interrupted; and general response guidelines for the public in case of a contamination event. Fact sheets like these can be used as communication tools during a contamination event, as well as giving your staff some specific potential threat information. 

Of course, the DOH would never be responding to a significant event in isolation. Outbreak investigations and water system incident investigations involve many internal and external partners. To be prepared, you must identify these partners before you have an emergency, and ideally meet with them to discuss how best to assist each other in such events. Environmental Health is often at the center of discussions like these and is often charged with bringing different partners to the table. One important piece of information to share is emergency contact information. Keep your emergency contact information updated and ensure that key staff have it available 24/7. Informal contact information and relationships can be as important as formal contact lists. In addition to sharing, it’s important to make sure that your staff knows all the current preparedness information. For instance, be sure you or your staff knows where their water test kits and equipment are stored, how to use them, and that they are kept current for the DOH lab instructions. Know the contact information for local water systems.  Know the most likely types of events that could happen in your area. 

To make sure this knowledge is in place, we encourage you to create a written county-specific plan that addresses a potential large-scale, waterborne outbreak. Try and write it in collaboration with the water system or other area stakeholders, who should already have individual emergency plans in place. Add it as an addendum to your area’s emergency response plan. 

Good surveillance for illness and water system security work together to increase your area’s preparedness. In this surveillance, it’s important to note that smaller water systems might not have the same security capacity as their larger counterparts, even when they are covered by the SDWA. Keeping stakeholders’ communications lines open will help you get the information you need, lower potential public hostility or fear, and better respond and protect the public’s health. This will also ensure your key partners have at least the basic knowledge of waterborne illnesses, and are aware of your capabilities to investigate and respond to them. A water specific plan for your county will help you avoid any pitfalls should an event occur.

Thank you very much for keeping our water supply safe and protecting the public’s health.