The Rediscovery of Public Health Microbiology - ACS Publications

No doubt, the advent of water filtration and chlorination and advances in medicine led to the ... First, there is much more travel worldwide today tha...
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ENVIRONMENTAL COMMENT SCIENCE & TECHNOLOGY

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The Rediscovery of Public Health Microbiology

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ost texts on public health or sanitary engineering list the conquest of diseases such as tuberculosis, cholera, and typhoid fever as major triumphs of human civilization. Indeed, these were impressive accomplishments in their day. Few people realize that the rate of death from typhoid fever in the United States was 31.3 per 100,000 people in 1900; by 1940 the rate had dropped to 1.0. These figures correspond to more than 23,000 deaths in 1900 versus 1300 in 1940. By 1961, only 17 people died in the United States of typhoid (A. Greenberg, in Water Chlorination: Environmental Impacts and Health Effects, Vol. 3, Ann Arbor Science Press, 1980, pp. 3-10). No doubt, the advent of water filtration and chlorination and advances in medicine led to the dramatic reductions in this waterborne disease. It is now clear, however, that the celebration may have been premature. Microbial diseases are reemerging worldwide, especially in the developing world: diphtheria in Russia; cholera in Southeast Asia, South America, and lately Zaire; yellow fever in west Africa and the west coast of South America; and plague in India (Chem. Eng. News, Oct. 2, 1995). More frightening, "new" diseases such as the hantavirus and Ebola virus are being recognized that have many environmental vectors. It is clear that the link between sanitation and public health is still valid, but several factors exacerbate the threats of microbiologically mediated diseases. First, there is much more travel worldwide today than in the past, leading to the rapid spread of diseases. Second, many people feel that the early success of antibiotics lulled the public health community into believing that some diseases were virtually eliminated. It may be that the diseases' genetic material was lurking in the background and is now reemerging in the conditions of poor sanitation and pollution that are affecting parts of the world. Finally, we have not given appropriate research emphasis to the possibility of the reemergence of infectious diseases with environmental connections. Our federal research programs in this area have been woefully inadequate. EPA de-emphasized microbiological research in the 1980s, and it has never been fully reinstated in spite of the reemergence of the issue for drinking water (e.g., the Milwaukee Cryptosporidium episode) and repeated warnings from microbiologists. Several years ago scientists convened a workshop in Breckenridge, Colo., and among their recommendations was a call for more research to reduce health risks from microbes in drinking water (Sobsey, JAWWA, March 1993, pp. 44-48). It is now apparent that the research agenda must be even larger, focusing not just on drinking water but on the role of stressed environments on the emergence, alteration, and spread of microbial diseases. Unfortunately even if EPA were to view this as a high priority, there may not be adequate funds to carry it off. Although there is some collaboration between EPA and the Centers for Disease Control and Prevention in this area, both agencies need to do more. Also, the developed nations must assert their influence to set a similar agenda in health agencies worldwide. We must not delay. The stakes are simply too high.

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0013-936X/96/0930-183A$12.00/0 © 1996 American Chemical Society

William H. Glaze Editor VOL. 30, NO. 5, 1996 / ENVIRONMENTAL SCIENCE & TECHNOLOGY / NEWS • 1 8 3 A