Village diseases linked to lack of plumbing

WATER: Pneumonia strains attack infants, elderly; pipes could help.

April 11, 2010 

A new Centers for Disease Control study shows a strong link between a lack of indoor plumbing and high rates of potentially life-threatening diseases such as pneumonia and meningitis among children in the Yukon-Kuskokwim Delta.

"In villages where there was no in-home running water, the rates for disease were about three times higher than they were than in other villages," said Dr. Jay Wenger, lead author of the study.

About 40 percent of households in the region lack water service, which could make it more difficult for people to wash their hands and prevent the spread of bacteria, said Dr. Rosalyn Singleton, immunization program director for the Alaska Native Tribal Health Consortium and a contributor to the report.

The region is home to some of the poorest, most crowded households in the state, the study says. The report found Alaska Native children younger than 5 years old in the Yukon-Kuskokwim region are five to 10 times more likely to suffer from a bacterial illness called Invasive Pneumococcal Disease than other Alaska kids.

The disease can lead to a serious form of pneumonia -- a lung infection that makes up the majority of Yukon-Kuskokwim cases -- as well as meningitis and blood infections, Singleton said.

About 15 percent of Yukon-Kuskokwim babies are hospitalized for some form of pneumonia each year, she said. While a new vaccine appears to be reducing prevalence of the disease, experts said the study highlights the general need for indoor plumbing across Alaska to combat illness.

"We've always known that having running water and flush toilets in your home was beneficial. But now we're starting to learn that the health benefit might be even greater than we've ever known," said Troy Ritter, senior environmental health consultant for the tribal health consortium.

Plumbing projects are expensive and difficult to build in remote villages where materials must be shipped by barge or plane and the frozen or soggy ground prevents easy construction. Alaska leaders have talked about bringing flush toilets and running water to villages for decades but in many corners of the state many families still haul their waste in honey buckets and haul drinking water in plastic drums from central wells or even lakes or rivers.

"Think about when you're camping. If you don't have running water, you don't really have the opportunity to wash your hands as easily," Singleton said.

Published in the March edition of "The Pediatric Infectious Disease Journal," the recent report builds upon a 2008 study that found rural Alaska Natives living in homes without running water suffered higher rates of respiratory-tract and skin infections than Natives in homes where water was readily available.

CASES FELL, THEN ROSE AGAIN

The more recent study found the number of Invasive Pneumococcal Disease cases in Alaska plummeted after 2001, when a vaccine appeared to combat seven common strains of the disease.

But soon the illness returned, this time in strains the old vaccine doesn't target. By 2007 the number of patients in the Yukon-Kuskokwim region again dwarfed other populations around the state and around the country.

The study says Invasive Pneumoccal Disease rates among Alaska Native children were twice as high in villages where fewer than 10 percent of households had in-home piped water, compared to those where most homes have running-water sinks and flush toilets.

The disease rate now appears to be dropping with the appearance of a new vaccine that targets additional strains of the bacteria, Wenger said.

"It's a little too early to say what's going on, but I think the signs are very good that we should see a decrease in IPD and take care of most of the problem with the vaccine," he said.

Between 1.7 and 2.5 percent of Alaska children with Invasive Pneumococcal Disease died between 1996 and 2007, according to the report.

While prevalent among children, the illness is also particularly dangerous for elderly people with chronic lung disease, Wenger said. "It's a nasty bug and it can kill you just by itself if it gets in your (bloodstream)."

Yet another study is in the works tracking four Yukon-Kuskokwim-area villages that have new plumbing systems, so researchers can see how disease rates change in a community after it gets running water, said Ritter, with the tribal health consortium.

In the meantime, the health consortium and state Village Safe Water Program are planning dozens of construction projects this summer with the aid of federal stimulus money to repair or improve existing plumbing systems and build new ones, Ritter said.

"Providing water service in a rural village is very expensive. But so is providing medical treatment," he said.

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