[StBernard] After new deadly amoeba finding, state health department announces stricter chlorine recommendations

[Westley Annis]

After new deadly amoeba finding, state health department announces stricter
chlorine recommendations

Print Benjamin Alexander-Bloch, NOLA.com | The Times-Picayune By Benjamin
Alexander-Bloch, NOLA.com | The Times-Picayune 
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on October 09, 2013 at 10:00 PM, updated October 10, 2013 at 3:11 AM

A day after the announcement that a second Louisiana parish water system had
been found contaminated with a deadly brain-eating amoeba -- and the same
day that a state senator urged Gov. Bobby Jindal to request that state
Department of Health and Hospitals test every public water system in the
state and increase required chlorination levels -- DHH on Wednesday evening
(Oct. 9) announced that it is "now strongly recommending that the 82 water
systems that use chloramines to disinfect their water increase their
residual levels to .5 milligrams per liter throughout their distribution
lines."

That is the level known to control the fatal Naegleria fowleri amoeba.

"Based on DHH's analysis, the St. Bernard and DeSoto water systems have a
common trait in that they disinfect by chloramination," DHH communication's
director Christina Stephens stated on Wednesday evening. "A total of 84
water systems -- including St. Bernard and DeSoto -- disinfect by
chloramination."

In a more formal announcement, DHH on Wednesday evening also stated that it
strongly recommends that the parishes "increase the frequency of testing and
number of samples for chlorine residual levels throughout their distribution
lines."

Chloramine, a common disinfectant for water, contains both chlorine and
ammonia. But, to purge water systems of the amoeba, at least 0.5 milligrams
per liter of free, pure, or residual chlorine -- not the chlorine and
ammonia mixture -- is needed.

The DHH stated that it "will continue to evaluate chlorine residual levels
in other public drinking water systems throughout the state; later
requirements may be issued for systems that utilize free chlorine."

Earlier on Wednesday, state Sen J.P. Morrell, D-New Orleans, urged Jindal to
request DHH to test every public water system in the state for the amoeba
and increase required chlorination levels beyond the current "trace levels"
mandated by state and federal standards.

"It is my intention next legislative session to impose a permanent increase
in chloride levels across the state until a comprehensive review of our
water systems is complete," Morrell wrote in a letter to Jindal. "The new
level should be determined by the Department of Health and Hospitals, the
Center for Disease Control, and the Environmental Protection Agency. ...

"It is important that we deal with this situation swiftly and decisively to
reaffirm our commitment to protect the people that depend on our
leadership."

Current regulations are limited

If sites in parish water supplies test positive for any chlorine levels at
all -- anything above zero chlorine in the water -- they do not currently
come under state or federal enforcement. So, current regulations only
require chlorine levels above zero.

But, to fight the deadly Naegleria fowleri amoeba, the CDC recommends that
municipal water supplies have chlorine levels at 0.5 milligrams per liter or
above.

And while mainly the DHH statement on Wednesday evening used the language
"strongly recommend," at other times it stated that DHH would "require"
parishes with chlromine systems to meet the 0.5 threshold.

"This requirement will exceed the current federal standard issued by the
U.S. Environmental Protection Agency," the DHH announcement stated.

It was not immediately clear on Wednesday evening whether any enforcement
would be carried out if parishes do not meet that 0.5 recommendation or
requirement.

"DHH public health engineers and officials will work closely with water
systems and parish management teams to outline work plans and timelines in
order to achieve required chlorination residuals," according to the DHH
statement. "...The 84 chloraminated water systems required to increase their
chlorine sampling and monitoring frequency will be provided additional
assistance by DHH that could include testing kits and personnel to conduct
monitoring.

"Public health engineers are currently evaluating and monitoring recent
residual chlorine levels for the more than 1,300 drinking water systems
throughout the state."

Morrell: Amoeba causing 'concern and panic'

The DHH announced Tuesday that CDC scientists had confirmed the presence of
amoeba in one of 14 water systems in DeSoto Parish. About a month ago, CDC
confirmed the amoeba's presence in St. Bernard Parish's water system.

The St. Bernard finding came after a 4-year-old Mississippi boy died in
August after he had contracted the fatal bacteria while visiting St.
Bernard.

"The presence of the amoeba in both DeSoto and St. Bernard parishes causes
grave concern," Morrell wrote to Jindal. "There seems to be no singular
variable to explain the existence of this deadly amoeba in these two
disparate environments."

"This public health issue has created concern and panic, and it has
undermined public confidence in government's ability to perform one of its
most basic functions - the delivery of safe drinking water to homes."

Monthly testing of St. Bernard's water had always detected at least some
minimal chlorine levels in recent years, according to DHH and parish
documents. But chlorine at certain sites at times dipped below 0.5 mg/L,
with many sites in Arabi, Violet and Yscloskey regularly hovering around
that dangerous threshold.

And after the 4-year-old boy died in August, more thorough testing by the
CDC revealed many sites with no chlorination at all.

In September, St. Bernard became the first municipality in the United States
to have its treated water system test positive for the rare brain-eating
amoeba, according to the CDC. This week, DeSoto became the second.

The DHH on Tuesday explained that it had tested the DeSoto water system "out
of an abundance of caution" because of that 2011 Naegleria fowleri-related
death. A 51-year-old DeSoto Parish woman died after using tap water in a
neti pot and becoming infected with the deadly amoeba.

A neti pot is a small teapot-shaped container used to rinse the nose and
sinuses with salt water to relieve allergies, colds and sinus trouble.

Also that year, a 28-year-old St. Bernard Parish man died after using tap
water in a neti pot. Those two cases were the only previously recorded
deaths from the amoeba in Louisiana's history, until the boy died in August.

DHH and CDC officials have acknowledged that the amoeba might have remained
in St. Bernard's water system since 2011. And for the past month St. Bernard
has been attempting to kill the amoeba by flushing its water system with
more and more chlorine.

After the 2011 deaths in St. Bernard and DeSoto, DHH and CDC testing found
the amoeba in the homes of the deceased, but could not confirm that the
amoeba was in the parish water systems themselves.

Because of that, officials assumed that the amoeba was not present elsewhere
and instead was confined to the homes' piping.

Improved testing since 2011

Since then, the CDC has developed a much more intricate method to test for
the amoeba.

That new water sampling method uses what's essentially a dialysis filter
that can trap microbes, including parasites, bacteria and viruses. That
method filters much more water than the testing used in 2011.

"It is a lot better," Dr. Raoult Ratard, Louisiana's state epidemiologist,
said last month after St. Bernard tested positive for the microbe. "In 2011,
they had tested something like 1 liter of water (at each site) and now they
are testing 100 or so liters. So, you multiply your chances of finding (the
amoeba) by more than 100 times."

People cannot contract the infection by drinking contaminated water, health
officials said. Naegleria fowleri infects people only by entering the body
through the nose.

There are no known current cases of illness related to the amoeba in DeSoto,
DHH officials said Tuesday. And Wednesday the contaminated water district
began flushing its system with additional chlorine in an attempt to kill the
amoeba, according to DHH.

"We are working closely with the water system and parish officials to ensure
that the chlorine levels are increased to a level that will eliminate the
risk of exposure to the amoeba," DHH Office of Public Health Assistant
Secretary J.T. Lane said Tuesday.

The contaminated DeSoto water district informed DHH late Tuesday that it
would begin a chlorine burn of its water system to achieve a 1
milligram-per-liter free chlorine residual throughout its system. That is
what St. Bernard also currently is attempting to accomplish.

Exposure to Naegleria fowleri typically occurs when people go swimming or
diving in warm freshwater lakes and rivers.

In very rare instances, Naegleria fowleri infections may also occur when
contaminated water from other sources, such as inadequately chlorinated
swimming pool water or heated tap water less than 116.6 degrees, enters the
nose when people submerge their heads or when people irrigate their sinuses
with devices such as a neti pot.

According to the CDC, people can reduce the risk of a Naegleria fowleri
infection by limiting the amount of water going up a person's nose.

For information on preventative measures, visit the CDC website at
http://www.cdc.gov/parasites/naegleria/prevention.html. Safety tips also can
be found at http://www.dhh.la.gov/index.cfm/page/1696 or the public can
email the DHH questions at DHHInfo at la.gov