What are water pollutants?

There are two primary sources of drinking water: surface water and groundwater.  Surface water consists of lakes, streams, and ponds. Ground water consists of water derived from underground sources.  In the U.S., about ½ of our water supply is from ground water and the other ½ is from surface water.

You may get your water from:

• The public water system- surface or ground water sources
• Private wells- ground water source
• Bottled water- usually from ground water sources

Sources of water pollution are referred to as point or nonpoint.  Point sources involve release of contaminants into the water supply from a distinct location.  Examples include industrial dumping and wastewater treatment discharge.  Nonpoint contaminant sources are those resulting from diffuse spread over a large area.  Examples include agricultural runoff, urban runoff, and atmospheric deposition of contaminants into surface water.

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What laws regulate water pollution?

Several federal laws have been passed to protect the U.S. water supply.  These laws fall into two basic categories:

Laws to control what gets released into the water supply (from industry and municipal water treatment plants):

• The Clean Water Act of 1948 established federal regulations for point source waste water treatment discharge into surface waters. (More on EPA website)
• The Water Pollution Control Act of 1972 and the Resource Conservation and Recovery Act of 1976 require industrial and municipal facilities to meet federal standards to prevent contamination of ground water or surface water.

Laws to control what remains in the drinking water after it has been treated:

• In 1974, the U.S. Congress passed the Safe Drinking Water Act.  This act established federal standards for biological and chemical contaminants of the water supply.
• These standards are known as maximum contaminant levels (MCLs).  By law, public water systems must report to the EPA any water contaminant that exceeds its MCL.  These MCLs only apply to public water systems supplying greater than 25 people.  Thus, they do not apply to private wells.
  • According to the EPA, the percent of children served by water systems that exceeded at least one MCL declined from 19% in 1993 to 8% in 1998. [3]

The 1996 revision of the Safe Drinking Water Act also requires that public water utility companies provide Consumer Confidence Reports (CCRs) to the public.  CCRs must contain the following information [1]:

• the source of the water
• whether the water meets all federal standards
• potential health effects if these standards are violated
• possible sources of any contaminant that is discovered
• where consumers can go for more information
• educational information on how to avoid Cryptosporidium for susceptible populations

However, there are several limitations to the water quality information provided by the CCR [1]:

• CCRs are only issued to bill-paying customers of community water supplies.  People drinking well water will not receive these reports.  In addition, those who rent homes or apartments might not have easy access to the CCR.
• CCRs report water quality data from the previous calendar year.  They do not reflect current drinking water conditions.
• Utilities are only required to report on regulated substances in the water supply.  There are many substances that are not regulated.

There are two main types of water pollutants, microbial and chemical.  Microbial contaminants include bacteria, viruses, and parasites.  The most important chemical contaminants of the U.S. water supply include lead, arsenic, nitrates, and disinfection by-products (DBPs).

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How can my family be exposed to water pollutants?

The main routes of exposure to water pollutants include:

• Drinking water
• Eating fish and shellfish caught from contaminated waters
• Absorption across the skin during bathing or swimming
• Inhalation of water vapors (e.g. while bathing)

It is also possible for water pollutants to enter various ecological cycles and become contaminants of soil, food, and air.

Exposure to various biological and chemical water pollutants will be discussed in the following sections on microbial and chemical contaminants:

Microbial contaminants:

Microbial contaminants of the water supply include bacteria, viruses, and parasites (detailed descriptions below).   Microbes are too small to be seen with the naked eye.  The ultimate source of most microbial water contaminants is human or animal feces.

Modern public water treatment systems have greatly reduced the amount of biological contaminants in the public water supply compared with the pre water treatment era.  One study estimates that despite water treatment, about 900 people die and 900,000 fall ill from waterborne biological pollutants each year. [4]

According to Physicians for Social Responsibility (PSR), "cases of waterborne microbial disease that are actually reported represent only the tip of the iceberg." [1]  Surveillance of waterborne microbial outbreaks is a passive process in the U.S.  This means that local health departments must recognize and voluntarily report outbreaks to the Centers for Disease Control and Prevention (CDC).   Therefore, many cases of waterborne microbial outbreaks may go unreported.

Drinking water may be contaminated with microbes in several ways:

• The water treatment facility may not fully treat the source water, leaving microbes remaining in the treated water.
• The water treatment plant did fully treat the source water, but the clean water somehow became contaminated before it reached the public.
• Well water may be contaminated with microbes and may not be treated.

Jump to Health Effects of Microbial Contaminants

Treatment for microbes

There are two main ways that water treatment plants can eliminate microbes from the water supply, disinfection and filtration:

a. Disinfection

This involves using some sort of chemical agent to kill the microbes in the water supply.  The most common disinfectant agent is chlorine.  Another effective option is ozone.  However, using ozone is more expensive than chlorination at present.

b. Filtration

This process does not necessarily kill microbes, but physically removes them from the water supply.  Water treatment plants commonly use layers of sand to filter microbes.

Exposure to the biological contaminants bacteria, viruses, and parasites is discussed in the following passages:

Bacteria

The ultimate source of most bacterial contamination of the water supply is animal feces.  However, human feces may contribute as well.  Since most bacteria are generally sensitive to both disinfection and filtration, they are relatively easy to eliminate from the water supply.

Our understanding of waterborne bacterial outbreaks is better than those from viruses and parasites. [1]  Recent waterborne bacterial outbreaks in the U.S. from 1985- 1992 have been generally due to 2 species (spp) of bacteria, Shigella and Campylobacter.  However, outbreaks have been attributed to E. coli, Mycobacterium avium complex (MAC), as well as Legionella  pneumophila.  [5]

Viruses

The types of viruses that cause waterborne disease are known as enteric viruses (affecting the intestines).  The ultimate source of most enteric viruses is human feces.  In general, enteric viruses are resistant to chemical disinfection and are too small to be mechanically filtered. Thus, enteric viruses are harder to eliminate from the water supply than bacteria.

The following viruses have been associated with waterborne outbreaks: [1]

• norwalk virus
• norwalk-like virus
• rotavirus
• calicivirus
• adenovirus
• hepatitis A

There is relatively little known about the amount of viruses in the water supply.  Compared with those of bacteria, the detection methods for viruses are much less precise.  According to PSR, many outbreaks of unknown cause are likely due to enteric viruses. [1]

Parasites

The types of parasites that have been associated with waterborne illness are called enteric protozoa. Protozoa are single-celled animals that are more complex than bacteria.  An important aspect of protozoa is that they reproduce by producing cysts.  Some of the more important species include Giardia lamblia, Cryptosporidium parvum (Crypto), and Microsporidium.  Giardia is a  known contaminant of ponds and streams.

The reproductive cysts are very hardy in the environment and may be resistant to various forms of disinfection.  They often have to be mechanically filtered by water treat- ment systems.  Thus, they can be difficult to eliminate from the water supply.  The EPA now requires that any water treatment facility serving more than 50,000 people regularly monitor for Crypto oocysts. [1]

Since 1981, enteric protozoa have been the leading cause of waterborne disease outbreaks. [1] Immunocom- promised persons, such as those with HIV, are especially susceptible to contracting Crypto.  However, large-scale out- breaks have been identified among healthy populations. One of the largest of these outbreaks occurred in Milwaukee, WI in 1993.  [51] However, the CDC estimates that the number of cases of illness from Giardia is at least ten times the number from Crypto despite the recent wave of attention on Crypto. [49]

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Chemical Pollutants (lead, arsenic, nitrates, disinfection byproducts)

Lead

Since lead has been banned from use in gasoline in the U.S., exposure from the water supply has become a relatively more important source of exposure.  Many older homes have lead-based pipes or solder joints.  Though the use of lead in pipes was discontinued in the early 20th century, use of lead in solder joints was not stopped until 1986.

Lead can leach into the water supply from lead pipes or solder joints.  Water conditions that increase lead leaching include hot water, low mineral content (soft), and low pH (acidic).  According to the EPA, the number of children served by water systems exceeding the MCL for lead or copper decreased from 9% in 1993 to 5% in 1998. [1]

Arsenic

Arsenic is a metal that is widely distributed in the natural environment. It is found in two basic forms, organic and inorganic.  Sources of arsenic release into the environment include burning of coal, wood preservation, smelting, and pesticide application. These human activities may release 3 times as much arsenic as natural processes.

The main route of human exposure to arsenic is through food and drinking water.  Natural geologic formations high in arsenic content may also be an important contributor to water supplies contaminated with arsenic.  The Western and Northeasters regions of the U.S. tend to have higher levels of arsenic in groundwater. In EPA region 4 (served by the SE PEHSU), only a few areas have elevated arsenic levels: central Florida, Florida panhandle, and east Tennessee.  Click here to see a map of arsenic levels across the U.S. (will exit PEHSU site).

Nitrates

Nitrogen is an essential element that plants secure from the environment in order to grow. Farmers use nitrates to increase crop yields.  As a result, runoff from agricultural pro- ducts has resulted in diffuse nitrate contamination of ground and surface water. [1]

Sources of nitrates in drinking water include:

• nonpoint agricultural runoff
• waste products from livestock
• improperly maintained human septic systems
• municipal waste streams

Shallow, poorly constructed wells in rural areas are at greatest risk for nitrate contamination. [1]

Drinking water is the main source of nitrate exposure to infants.  However, dietary vegetables are the main sources of nitrate exposure in older children and adults. [1]

Although not currently an important source of exposure, in the past, infants have been exposed to nitrates absorbed from contaminated diapers. [7]

Disinfection by-products (DBPs)

Modern water treatment facilities often use chlorine to kill various microbes.  Certain simple organic compounds in the water supply can combine with chlorine to form chlorinated chemicals called disinfection by products (DBPs).  Examples include chloroform, perchloroethyl- ene and trichloroethylene (TCE).

Since chlorine and organic substances are widespread in the water supply, DBPs may be relatively common drinking water contaminants. However, certain DBPs may also be released from industrial dumping. For example, if your Consumer Confidence Report (CCR) shows increased TCE levels, this could truly be a DBP from the water treatment process or could have come from industrial dumping.

Jump to Health Effects of Chemical Pollutants

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What are the health effects of water pollutants?

The health effects of water pollutants will depend on a number of factors:

• The specific type of pollutant(s)
• Level and time course of exposure
• Health status of the individual

Children may be more susceptible to water pollutants than adults because they drink more water per unit of body weight. The health effects of both microbial and chemical pollutants are discussed:

Microbial Contaminants (bacteria, parasites, viruses):

Bacteria

Waterborne bacterial infection usually results in acute gastroenteritis. This is a medical condition resulting from irritation of the digestive tract and may have the following associated symptoms:

• nausea
• vomiting
• diarrhea (non-bloody or bloody)
• abdominal cramping
• loss of appetite

These symptoms generally last a few days and are of mild intensity.  However, several bacterial pathogens can produce life-threatening infections or chronic disease:

• Campylobacter is a common cause of chronic diarrhea in the U.S.
• Salmonella can cause systemic disease character- ized by persistent fever and weight loss.  Once again the strains of Salmonella responsible for systemic disease is not common in the U.S.
• Shigella sp. can cause bloody diarrhea and systemic disease.
• Cholera can cause life-threatening diarrhea.  Cholera is not common in this country.

Parasites

Enteric protozoa also tend to produce some form of gastroenteritis.
Giardia lamblia causes a condition known as giardiasis characterized by:

• Non-bloody diarrhea usually lasting 4-10 days
• Malaise/nausea/vomiting
• Bloating/flatulence
• Decreased appetite

Crytptosporidia causes a condition known as crytposporidiosis, characterized by:

• non-bloody diarrhea lasting 7-20 days.
• nausea/vomiting
• abdominal cramping headache
• fever

Immunocompromised persons may be especially susceptible to waterborne enteric parasitic disease, especially Crypto.

Viruses

Enteric viruses also tend to cause acute gastroenteritis resulting from viral irritation of the gastrointestinal tract. Once again, the following symptoms may be associated

• nausea, vomiting
• diarrhea (usually non-bloody)
• abdominal cramping
• loss of appetite

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Lead

For more information on the health effects of lead exposure, click here.

Arsenic

The toxic health effects of arsenic depend upon what chemical form it is in.  The organic form is less toxic than the inorganic.  Inorganic arsenic may act as an enzyme poison and have health effects on all body systems.  We will discuss the health effects of arsenic with regards to short term effects of high level exposure, chronic effects of intermediate/high level exposure, and chronic effects of low level exposure.

Short-term health effects of high levels of inorganic arsenic:

This type of exposure is very unlikely from the U.S. water supply, even in water supplies heavily contaminated with arsenic.  This type of exposure is much more likely in certain occupational settings involving inorganic arsenic.  Such exposure may cause:

• nausea/vomiting
• severe abdominal pain
• severe diarrhea
• impaired production of red and white blood cells
• damage to blood vessels
• abnormal heart rhythms
• possibly death

Chronic effects of intermediate/high levels of inorganic arsenic:

This type of exposure to inorganic arsenic is unlikely in the U.S. water supply, but may be possible in certain heavily contaminated water supplies in the U.S. (click here to see map of arsenic levels across the U.S.)  Such exposure may cause:

• darkening of skin [21]
• abnormal thickening of skin in palms and soles. [21] These may appear as "warts" or "corns."
• "Blackfoot disease." This condition is a disease in which the blood vessels to the feet are badly damaged and may lead to poor oxygen supply to the feet. This condition has been demonstrated on the southwest coast of Taiwan. [22][23]
• increased risk of skin, liver, kidney, bladder, and lung cancer [26][50] [52-56]

Chronic, lower levels of inorganic arsenic:

Exposure to these levels of inorganic arsenic is more likely to occur in certain contaminated water supplies in the U.S. than the types of exposure previously discussed. The health effects from this type of exposure are not as clearly established as those from higher levels of inorganic arsenic. These possible health effects are:

• lung cancer.  Several human studies have associated with these types of exposure with increased risk of developing lung cancer.  [53][56]
• bladder cancer.  Several human studies suggest that this type of arsenic exposure may increase risk of a certain form of bladder cancer.  [52][54]
• One human study has also associated chronic arsenic exposure with increased risk of kidney dysfunction and prostate cancer among males. [24]
• One human study has suggested arsenic exposure may  increase risk of heart disease.[24]

However, the medical literature concerning health effects of chronic, lower level arsenic exposure is conflicting.  Some studies do not support these relationships. [25]

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Nitrates

Certain bacteria in our intestines convert nitrates to related chemicals called nitrites, which cause the health effects of concern.  Hemoglobin (Hb) is a substance in red blood cells responsible for carrying oxygen to all body tissues. Nitrites can combine with Hb to form a sub- stance called methemoglobin (met Hb).  Met Hb cannot carry oxygen normally.  This abnormal ability to carry oxygen is responsible for most of the health effects from nitrates.

Infants less than 4 months old are at greatest risk of health effects from nitrates because: [2]

• their stomachs have a higher pH (less acid) than older children.  This may create conditions favoring increased growth of the bacteria responsible for converting nitrates to nitrites.
• infants tend to have higher levels of a special form of Hb known as fetal hemoglobin.  Fetal Hb is easier to convert to met Hb than normal hemoglobin.
• infants are not able to restore normal Hb from met Hb as well as older children and adults.

  We will discuss nitrate exposure according to duration and level:

  Acute, high level exposure:

This type of exposure has been largely studied in the settings of accidental nitrate poisoning from concentrated chemicals in the home environment and is unlikely in most U.S. drinking water supplies. People exposed to high levels of nitrates may develop a con- dition known as methemoglobinemia, characterized by:

• blue coloration of the skin known as cyanosis
• severe headache
• fatigue/dizziness
• rapid breathing/ shortness of breath

  Extreme forms of methemoglobinemia may cause

• seizures
• acidosis (buildup of acid in the blood)
• suppression of breathing
• possibly death.

Chronic, low level exposure to nitrates:

This type of nitrate exposure has been studied mostly in general environmental settings. Chronic, low level nitrate exposure is more likely to occur than higher level exposure from certain contaminated water supplies.  The following health effects have been associated with this type of nitrate exposure:

• One human study suggests that expo- sure to nitrates in drinking water may cause recurrent acute respiratory infections. [27]
• Another study suggests that exposure to nitrates may be associated with increased rates of recurrent stomatitis (irritation of mucous membranes in the mouth). [28
• One human study suggests that expo- sure to nitrates increases risk of spontaneous abortions in pregnant mothers. [29]

Disinfection by products (DBPs):

These effects have been studied mostly in general environmental settings.  There is much controversy in the medical literature concerning the health effects from chronic exposure to DBPs from the public water supply.  Chronic exposure to DBPs may produce the following health effects:

Cancer

• A growing body of human evidence suggests that exposure to DBPs increases risk of developing bladder cancer. [11-12][15-16]
• Some human studies have associated DBP exposure with increased risk of colon or rectal cancer. [13-14]
• Some human studies have linked DBP exposure with an increased risk of esophageal cancer. [10][15]
• One human study has associated exposure to DBPs with increased rates of certain forms of brain cancer. [9]
• One human study associated exposure to trichloroethylene(TCE) in the water supply with increased risk of developing certain blood cancers. [58]

Reproductive/Developmental

• Several human studies suggest that maternal exposure to DBPs is associated with low birth weight in the infant. [17][20]
• One human study suggests that DBPs are associated with shortened pregnancies, small head size, and short body length in babies born to exposed mothers. [17]
• One human study suggests that exposure to DBPs may increase risk of neural tube defects (such as spina bifida) in infants. [19]  Neural tube defects occur when parts of the fetal spinal cord fail to grow properly during fetal development.
• The reproductive/developmental effects of DBP exposure are controversial.  Not all studies have supported these relationships. [18]

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How can I tell if my family is being exposed to high levels of water pollutants?

The federal government sets standards for public water systems known as MCLs.  By law, public water systems must report to the EPA any water conta- minant that exceeds its MCL.  In addition, the Safe Drinking Water Act (revised in 1996) requires that utilities report Consumer Confidence Reports to those using public drinking water supplies.  You can check your CCR to see if your drinking water meets federal standards.  Remember that CCRs report water quality data from the previous calendar year.  They do not reflect current drinking water conditions.

For more current information on local and regional drinking quality, contact:

• Your regional EPA office.  You may obtain specific water quality information in your state at http://www.epa.gov/ow/states.html.
• You can also obtain local water information at EPA's Surf Your Watershed database, http://www.epa.gov/surf.

To know whether you or your family has been exposed to specific pollutants, including microbial contaminants and chemical contaminants:

Microbial Contaminants (bacteria, viruses, parasites)

Bacteria

A doctor usually diagnoses acute gastroenteritis based on a patient’s symptoms.  No other laboratory tests are usually needed.

If a doctor suspects an invasive microbe as the cause, routine blood tests including white blood cell counts and white blood cell sub- types can be useful in making the diagnosis.  These tests are widely available.

Your doctor can also order samples of your blood to be cultured to find out which bacteria caused the illness.  This is generally not useful in making an immediate diagnosis, but may be useful for confirmation of the diagnosis.

Some medical tests are also available to test for bacterial antibodies in the blood. Antibodies are substances produced by the body in response to a bacterial infection. Such tests are generally not helpful in the immediate diagnosis of a patient, but rather to confirm the identity of the suspected bacteria.

Also, doctors can test stool samples for the presence of certain bacteria such as Cholera, Salmonella, and Shigella.

Viruses

A doctor usually diagnoses acute gastroenteritis based on a patient’s symptoms.  No other laboratory tests are usually needed.  No other laboratory tests are usually needed.

If an invasive enteric virus is suspected, a patient’s blood can be cultured for viruses.  The culture results often take longer than for bacterial cultures.  As with bacterial cultures, viral cultures are generally not useful in making an immediate diagnosis, but are useful in con- firming the identity of the causal agent.

Also, there are medical tests available to detect the presence of certain viruses in the blood.  These tests may detect antibodies produced by the body in response to viruses or actual parts of the viruses in the bloodstream (called antigens).  Such techniques may be used to confirm infection with Rotavirus, Norwalk virus, Hepatitis spp, and others.

Parasites

A clinician may not be able to differentiate cases of acute gastroenteritis due to parasites from cases due to other causes without lab testing.

A clinician who suspects a parasitic cause of gastroenteritis can order a stool test for parasites and their reproductive units, ova.   This test is widely available.  If a clinician suspects Crypto, a special stool test must be ordered specifically for Crypto oocysts.

Chemical Contaminants (lead, arsenic, nitrates, disinfection byproducts):

Lead

For more information on medical testing of lead exposure, click here.

Arsenic [26]

There are medical tests that can measure arsenic levels in urine, blood, fingernails, and hair.  However, these tests are not routinely performed in a clinician’s office.  The urine test is generally considered the most useful of these tests, but only indicates exposure within the previous few days.

Unlike urine tests, hair and fingernail testing are generally not useful in detecting lower levels of arsenic.  However, they may be able to indicate exposure to high levels of arsenic over the past 6-12 months.

Nitrates

There is a medical test widely available to estimate the amount of exposure to nitrates.  It involves testing the blood for levels of methemoglobin (met Hb). This test indicates exposure within the past few hours.

Disinfection by products (DBPs)

There are medical tests available to determine levels of certain DBPs in the blood.  However, these are useful mainly for research purposes, not for clinical diagnosis of individual patients.  Furthermore, even if these tests indicate high levels of exposure, these results cannot be used to predict health effects.
 

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What can I do to limit my family's exposure to water pollutants?

There is both general advice and advice for limiting exposure to specific pollutants. 

General advice for public water users, private well users, susceptible individuals, parents, bottled water users, and filtration device users:

Public water users

Check with your state EPA office for information regarding your water quality.  You can check the previously mentioned EPA websites for this information as well.  Also, check your local utility company’s latest CCR.

Local media (radio, television, newspaper) may also provide information on local water quality.

Private well users

Since the EPA does not monitor the water quality of homes served by private wells, private homeowners must assume responsibility for testing their wells if needed.  If your home has a well less than 50 feet deep, the American Academy of Pediatrics (AAP) recommends having the well tested yearly for fecal coliform bacteria. [2]  These bacteria may indicate contamination of the water supply with other bacteria.

In agricultural areas, the AAP recommends quarterly testing for nitrates for 1 year, then yearly testing thereafter. [2]

If needed, well testing can be done through the state health/environmental department or by private environmental companies.  In some states, this process may be free of charge if your health care provider recommends it.

Susceptible Individuals

Persons who are immunocompromised (people with HIV/AIDS, organ transplant recipients, chemotherapy recipients, patients taking any medicines affecting the immune system, such as steroids) should take greater care in monitoring the quality of their water supply than those with fully functioning immune systems.  In particular, they should take special precautions to avoid ingesting microbial pathogens from water.

Such persons should consider using a water filter or bottled water for drinking purposes.  Only filters that remove particles one micrometer or less in size should be purchased.  If you choose to buy a filter, be sure to change it regularly in accordance with the manufacturer’s directions.

According to AAP, carbon-based filters that are not changed regularly may serve as breeding grounds for bacteria.  In such filters, the first water draw of the morning may contain unacceptably high levels of bacteria. [2]  If you have a filter, you should therefore consider letting it run for a minute or so before using it for the first time that day.

Infants/Children

Do not boil water for infants unless indicated to do so by your local water supplier or state health/environmental department.  If you receive such instructions, boil the water for only one minute.  Boiling water for more than one minute may concentrate certain chemical contaminants.

Bottled Water

The AAP does not recommend that families buy bottled water unless there is known contamination in their water supply.  Bottled water is not required to meet any higher quality standards than public water, but may cost 500 to 1000 times as much. [2]

If you choose to purchase bottled water, only buy reputable brands.  If you are concerned about the quality of the water, contact the manufacturer and request information on quality standards as well data supporting claims of the water’s source.

Water Filtration Device

The AAP does not recommend water filtration unless there is a known contamination of your water supply. [2]

If you choose to purchase a filter, look for certification from NSF International for the specific contaminant of concern.  Realize that not all filters are useful for all contaminants.

To effectively filter water for Cryptosporidia, look for filters labeled as “absolute” one micrometer pore size filters or certified by NSF for “cyst removal.”  Filters rated as “nominal” may not remove oocysts. [48]

To limit exposure to specific pollutants (microbial contaminants and chemical contaminants):

Microbial Contaminants

As mentioned earlier, most public water supplies contain very little microbial contamination.  Bottled water, water filtration systems, and boiling of tap water are not necessary unless there is known microbial contamination of your water supply.

Chemical Contaminants (lead, arsenic, nitrates, disinfection byproducts)

Lead

For more information on how to minimize your family’s lead exposure, click here.

Arsenic

If you suspect that your public water supply is contaminated with arsenic, check with the previously mentioned agencies for more information on arsenic contamination of state and local water supplies.   Put pressure on local political representatives to correct any problem with the water supply.

If you suspect arsenic contamination of your private well, follow the directions above on how to have the well tested for arsenic.

If you use arsenic-treated wood for home projects, be sure to use protective equipment such as a dust mask and gloves.  Do not burn arsenic-treated wood near the home.

Discourage your children from eating dirt, which may be contaminated with arsenic or other pollutants.

Encourage all family members to wash their hands before meals.

If any adult in the household works with arsenic, be sure they change from their work clothes and work shoes before entering the house.

Nitrates

If you suspect that your public water supply is contaminated with arsenic, check with the previously mentioned agencies for more information on arsenic contamination of state and local water supplies.   Put pressure on local political representatives to have any problem with the water supply corrected.

If you suspect arsenic contamination of your private well, follow the directions previously given on how to have the well tested for nitrates.

In agricultural areas, the American Academy of Pediatrics (AAP) recommends quarterly testing of wells for nitrates for 1 year, and yearly testing thereafter. [2]

DBPs

If you suspect that your public water supply is contaminated with DBPs, check with the previously mentioned agencies for more information on arsenic contamination of state and local water supplies.   Put pressure on local political representatives to have any problem with the water supply corrected.

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References

1] Physicians for Social Responsibility.  Drinking water and disease: what health care providers should know.  PSR, Washington D.C. 2000:1-22.

[2]  Etzel R, Balk, S. Handbook of Pediatric Environmental Health. Water Pollutants. American Academy of Pediatrics  Committee on Environmental Health Affairs, 1999: 315-31.

[3] Environmental Protection Agency.  America’s Children and the Environment: A first view of available measures.  Drinking Water Pollutants.  Washington D.C. 2000:22-25.

[4] American Society for Microbiology (ASM).  Microbial Pollutants of Our Nation’s Water.  ASM, Washington D.C. 1999.

[5] Moe, in Manual of Environmental Microbiology. ASM.  Washington D.C. 1997.

[6] ATSDR ToxFaq’s. Lead. http://www.atsdr.cdc.gov/tfacts13.html

[7] Graubarth J, Bloom C, et al.  Dye poisoning in the nursery: a review of 17 cases.  JAMA 1945;128:1155-57.

[8] Kallen B, Robert E. Drinking water chlorination and delivery outcome-a registry-based study in Sweden. Reproductive Toxicology 2000;14(4):303-9.

[9] Cantor K, Lynch C, et al. Drinking water source and chlorination byproducts in Iowa. III. Risk of brain cancer. American Journal of Epidemiology 1999;150(6):552-60.

[10] Tao X, Zhu H, Matanoski G. Mutagenic drinking water and risk of male esophageal cancer: a population-based case-control study. Journal of Epidemiology 1999;150(5):443-52.

[11] Koivusalo M, Hakulinen T, et al. Drinking water mutagenicity and urinary tract cancers: a population-based case-control study in Finland.  American Journal of Epidemiology 1998;148(7):704-12.

[12] Cantor K, Lynch C, et al. Drinking water source and chlorination byproducts. I. Risk of bladder cancer. Epidemiology 1998;9(1):21-8.

[13] Hildesheim M, Cantor K, et al.  Drinking water source and chlorination byproducts. II. Risk of colon and rectal cancers. Epidemiology 1998;9(1):29-35.

[14] Doyle T, Zheng W, et al. The association of drinking water source and chlorination by-products with cancer incidence among postmenopausal women in Iowa: a prospective cohort study. American Journal of Public Health 1997;87(7):1168-76.

[15] Koivusalo M, Pukkala E, et al. Drinking water chlorination and cancer-a historical cohort study in Finland.  Cancer Causes & Control 1997;8(2):192-200.

[16] King W, Marrett L. Case-control study of bladder cancer and chlorination by-products in treated water (Ontario, Canada). Cancer Causes & Control 1996;7(6):596-604.

[17] Kallen B, Robert E. Drinking water chlorination and delivery outcome-a registry-based study in Sweden. Reproductive Toxicology 2000;14(4):303-9.

[18] Savitz D, Andrews K, Pastore L. Drinking water and pregnancy outcome in central North Carolina: source, amount, and trihalomethane levels. Environmental Health Perspectives 1995;103(6):592-6.

[19] Klotz J, Pyrch L. Neural tube defects and drinking water disinfection by-products. Epidemiology 1999;10(4):383-90.

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[20] Gallagher M, Nuckols J, et al. Exposure to trihalomethanes and adverse pregnancy outcomes. Epidemiology 1998; 9(5):484-9.

[21] Smith A, Arroyo A, et al. Arsenic-induced skin lesions among Atacameno people in Northern Chile despite good nutrition and centuries of exposure. Environmental Health Perspectives 2000;108(7):617-20.

[22] Chen C. Blackfoot disease. Lancet 1990;2:442.

[23] Lu F. Blackfoot disease: arsenic or humic acid? Lancet 1990;336:115-116.

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