Louisiana Department of Health and Hospitals Office of Public Health CDC Confirms Rare Ameba in St. Bernard Water System State health department says water is safe to drink, but urges residents to take precautions September 13, 2013 Contact: Media & Communications: Phone: 225.342.1532, E-mail: dhhinfo@la.gov BATON ROUGE, La. Additional test results from the federal Centers for Disease Control and Prevention (CDC) confirm the presence of the rare ameba Naegleria fowleri in four locations of the St. Bernard Parish water system, the Louisiana Department of Health and Hospitals (DHH) announced Thursday. DHH announced last week that the encephalitis death of a child that had visited St. Bernard Parish was connected to the rare ameba, which testing confirmed was present at the home. Because some water samples showed low residual levels of chlorine, DHH sent additional water samples to the CDC for testing last week and St. Bernard parish began flushing its water lines with additional chlorine last week, as a precautionary measure. Assistant Secretary for Public Health J.T. Lane said, "We know that chlorine kills Naegleria fowleri, which is why it was critical that the parish proactively began flushing its water system with additional chlorine last week. The parish will continue this action until it raises chlorine residuals to recommended levels, and this process will continue for several weeks. DHH is working with parish officials to provide assistance and support to the parish's staff to ensure that chlorine levels are being monitored daily." State Health Officer Jimmy Guidry said, "The water is safe to drink and there are basic precautions that families can take -- such as chlorinating their pools and avoiding getting water in their noses -- to protect themselves, though infection from this ameba is very rare." Today's confirmation is from four sites located in Violet and Arabi. DHH scientists pulled samples from hydrants and faucets that connected directly to the water lines. Hundreds of liters of water were filtered in order to capture any amebas that might be present in the water. Naegleria fowleri is a rare infection that has been associated with three deaths traced to water in Louisiana since 2011. Two people died in 2011, in addition to the death being announced last week. The CDC confirmed that Naegleria fowleri was the cause of the death after specialized testing was conducted. PRECAUTIONARY MEASURES FOR FAMILIES According to the CDC, personal actions to reduce the risk of Naegleria fowleri infection should focus on limiting the amount of water going up a person's nose and lowering the chances that Naegleria fowleri may be in the water. For information on preventative measures, please visit the CDC Website here: http://www.cdc.gov/parasites/naegleria/prevention.html To prevent any risk when using drinking water, make sure water does not go up your nose. Some common sense suggestions from the CDC include: DO NOT allow water to go up your nose or sniff water into your nose when bathing, showering, washing your face, or swimming in small hard plastic/blow-up pools. DO NOT jump into or put your head under bathing water (bathtubs, small hard plastic/blow-up pools) - walk or lower yourself in. DO NOT allow children to play unsupervised with hoses or sprinklers, as they may accidentally squirt water up their nose. Avoid slip-n-slides or other activities where it is difficult to prevent water going up the nose.
DO run bath and shower taps and hoses for 5 minutes before use to flush out the pipes. This is most important the first time you use the tap after the water utility raises the disinfectant level. DO keep small hard plastic/blow-up pools clean by emptying, scrubbing, and allowing them to dry after each use. DO use only boiled and cooled, distilled, or sterile water for making sinus rinse solutions for neti pots or performing ritual ablutions. DO keep your swimming pool adequately disinfected before and during use. Adequate disinfection means: o Pools: free chlorine at 1-3 parts per million (ppm) and ph 7.2-7.8 o Hot tubs/spas: free chlorine 2-4 parts per million (ppm) or free bromine 4-6 ppm and ph 7.2-7.8 o If you need to top off the water in your swimming pool with tap water, DO place the hose directly into the skimmer box and ensure that the filter is running. DO NOT top off by placing the hose in the body of the pool. Residents should continue these precautions until extensive testing no longer detects the ameba in the water system. Residents will be made aware when that occurs. ABOUT NAEGLERIA FOWLERI 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 Fahrenheit) enters the nose when people submerge their heads or when people irrigate their sinuses with devices such as a neti pot. People cannot be infected with Naegleria fowleri by drinking water. Naegleria fowleri causes the disease primary amebic meningoencephalitis (PAM), a brain infection that leads to the destruction of brain tissue. In its early stages, symptoms of PAM may be similar to symptoms of bacterial meningitis. Initial symptoms of PAM start one to seven days after infection. The initial symptoms include headache, fever, nausea, vomiting, and stiff neck. Later symptoms include confusion, lack of attention to people and surroundings, loss of balance, seizures, and hallucinations. After the start of symptoms, the disease progresses rapidly and usually causes death within one to 12 days. Naegleria fowleri infections are very rare. In the 10 years from 2001 to 2010, 32 infections were reported in the U.S. Of those cases, 30 people were infected by contaminated recreational water and two people were infected by water from a geothermal drinking water supply. ###
Centers for Disease Control and Prevention http://www.cdc.gov/parasites/naegleria/public-water-systems.html What is Naegleria? Naegleria is an ameba (single-celled living organism) commonly found in warm freshwater (for example, lakes, rivers, and hot springs) and soil. Only one species (type) of Naegleria infects people: Naegleria fowleri. How does infection with Naegleria fowleri occur? Naegleria fowleri infects people when water containing the ameba enters the body through the nose. This typically occurs when people go swimming or diving in warm freshwater places, like lakes and rivers. The Naegleria fowleri ameba then travels up the nose to the brain where it destroys the brain tissue. You cannot be infected with Naegleria fowleri by drinking contaminated water. In very rare instances, Naegleria infections may also occur when contaminated water from other sources (such as inadequately chlorinated swimming pool water or heated and contaminated tap water) enters the nose, for example when people submerge their heads or cleanse during religious practices, and when people irrigate their sinuses (nose) using contaminated tap water. Where is Naegleria fowleri found? Naegleria fowleri is found around the world. In the United States, the majority of infections have been caused by Naegleria fowleri from freshwater located in southern-tier states. The ameba can be found in: Bodies of warm freshwater, such as lakes and rivers Geothermal (naturally hot) water, such as hot springs Warm water discharge from industrial plants Geothermal (naturally hot) drinking water sources Swimming pools that are poorly maintained, minimally-chlorinated, and/or un-chlorinated Water heaters. Naegleria fowleri grows best at higher temperatures up to 115 F (46 C) and can survive for short periods at higher temperatures. Soil Naegleria fowleri is not found in salt water, like the ocean. In what water temperature does Naegleria fowleri cause infection? Naegleria fowleri is a heat-loving (thermophilic) microbe. It grows best at higher temperatures up to 115 F (46 C) and can survive for short periods at higher temperatures. It is less likely to be found in the water as temperatures decline. The ameba can be found in lake or river sediment at temperatures well below where one would find the ameba in the water. What is the source of food for Naegleria fowleri? Naegleria fowleri eats other microbes like bacteria found in the sediment in lakes and rivers. Can I get a Naegleria fowleri infection from a disinfected swimming pool?
No. You cannot get a Naegleria fowleri infection from a properly cleaned, maintained, and disinfected swimming pool. How common are Naegleria fowleri infections in the United States? Naegleria fowleri infections are rare *. In the 10 years from 2003 to 2012, 31 infections were reported in the U.S. Of those cases, 28 people were infected by contaminated recreational water, and 3 people were infected after performing nasal irrigation using contaminated tap water. When do Naegleria fowleri infections most commonly occur? While infections with Naegleria fowleri are rare, they occur mainly during the summer months of July, August, and September. Infections are more likely to occur in southern-tier states, but can also occur in other locations. Infections usually occur when it is hot for prolonged periods of time, which results in higher water temperatures and lower water levels. Can infection be spread from one person to another? No. Naegleria fowleri infection cannot be spread from one person to another. What are the symptoms of Naegleria fowleri infection? Naegleria fowleri causes the disease primary amebic meningoencephalitis (PAM), a brain infection that leads to the destruction of brain tissue. In its early stages, symptoms of PAM may be similar to symptoms of bacterial meningitis. Initial symptoms of PAM start about 5 days (range 1 to 7 days) after infection. The initial symptoms may include headache, fever, nausea, or vomiting. Later symptoms can include stiff neck, confusion, lack of attention to people and surroundings, loss of balance, seizures, and hallucinations. After the start of symptoms, the disease progresses rapidly and usually causes death within about 5 days (range 1 to 12 days). What is the actual mechanism of death from Naegleria fowleri infection? The infection destroys brain tissue causing brain swelling and death. What is the fatality rate for an infected person who begins to show signs and symptoms? The fatality rate is over 99%. Only 1 person out of 128 known infected individuals in the United States from 1962 to 2012 has survived. Is there effective treatment for infection with Naegleria fowleri? It is not clear. Several drugs are effective against Naegleria fowleri in the laboratory. However, their effectiveness is unclear since almost all infections have been fatal, even when people were treated with similar drug combinations. What should I do if I have been swimming or playing in freshwater and now think I have symptoms associated with Naegleria fowleri? Infection with Naegleria fowleri is rare. The early symptoms of Naegleria fowleri infection are similar to those caused by other more common illnesses, such as bacterial meningitis. People should seek medical care immediately whenever they develop a sudden onset of fever, headache, stiff neck, and vomiting, particularly if they have been in warm freshwater recently. How common is Naegleria fowleri in the environment? Naegleria fowleri is commonly found in lakes in southern-tier states during the summer. This means that recreational water users should be aware that there will always be a low level risk of infection when entering these waters. In very rare instances, Naegleria has been identified in water from other sources such as inadequately chlorinated swimming pool water or heated and contaminated tap water. Naegleria fowleri grows best at higher temperatures up to 115 F (46 C) and can survive for short periods at higher temperatures.
Is there a routine and rapid test for Naegleria fowleri in the water? No. It can take weeks to identify the ameba, but new detection tests are under development. Previous water testing has shown that Naegleria fowleri is commonly found in freshwater venues. Therefore, recreational water users should assume that there is a low level of risk when entering all warm freshwater, particularly in southern-tier states. How does the risk of Naegleria fowleri infection compare with other water-related risks? The risk of Naegleria fowleri infection is very low. There have been 31 reported infections in the U.S. in the 10 years from 2003 to 2012, despite millions of recreational water exposures each year. By comparison, in the ten years from 1996 to 2005, there were more than 39,000 drowning deaths in the U.S. What swimming behaviors have been associated with Naegleria fowleri infection? Behaviors associated with the infection include diving or jumping into the water, submerging the head under water or engaging in other water-related activities that cause water to go up the nose. How will the public know if a lake or other water body has Naegleria fowleri? Recreational water users should assume that Naegleria fowleri is present in warm freshwater in southern-tier states. Posting signs based on finding Naegleria fowleri in the water is unlikely to be an effective way to prevent infections. This is because: Naegleria fowleri occurrence is common, infections are rare. The relationship between finding Naegleria fowleri in the water and the occurrence of infections is unclear The location and number of amebae in the water can vary over time within the same lake or river. There are no rapid, standardized testing methods to detect and quantitate Naegleria fowleriin water. Posting signs might create a misconception that bodies of water without signs are Naegleria fowleri-free. How can I reduce the risk of infection with Naegleria fowleri? Naegleria fowleri is found in many warm freshwater lakes and rivers in the United States, particularly in southern-tier states. It is likely that a low risk of Naegleria fowleri infection will always exist with recreational use of warm freshwater lakes, rivers, and hot springs. The low number of infections makes it difficult to know why a few people have been infected compared to the millions of other people using the same or similar waters across the U.S. The only certain way to prevent a Naegleria fowleri infection is to refrain from water-related activities in or with warm, untreated, or poorly treated water. Personal actions to reduce the risk of Naegleria fowleri infection should focus on limiting the amount of water going up the nose and lowering the chances that Naegleria fowleri may be in the water. These actions could include: Swimming-related risk Hold your nose shut, use nose clips, or keep your head above water when taking part in waterrelated activities in bodies of warm freshwater. Avoid putting your head under the water in hot springs and other untreated thermal waters. Avoid water-related activities in warm freshwater during periods of high water temperature and low water levels. Avoid digging in, or stirring up, the sediment while taking part in water-related activities in shallow, warm freshwater areas. These recommendations make common sense but are not based on any scientific testing since the low numbers of infections make it difficult to ever show that they are effective.
Non-swimming-related risk Even more rarely, infections have been reported when people submerge their heads, cleanse during religious practices, or irrigate their sinuses (nose) using heated and contaminated tap water. If you are making a solution for irrigating, flushing, or rinsing your sinuses (for example, by using a neti-pot, sinus rinse bottle or other irrigation device), use water that has been: previously boiled for 1 minute (at elevations above 6,500 feet, boil for 3 minutes) and left to cool OR filtered, using a filter with an absolute pore size of 1 micron or smaller OR purchased with a label specifying that it contains distilled or sterile water Rinse the irrigation device after each use with water that has been previously boiled, filtered, distilled, or sterilized and leave the device open to air dry completely. For more information on neti pots and other nasal rinsing devices, see FDA s Consumer Update: Is Rinsing Your Sinuses Safe? In very rare instances, Naegleria infections may occur when contaminated water enters the nose, for example when people irrigate their sinuses (nose) using a neti pot. If you are making a solution for irrigating, flushing, or rinsing your sinuses (for example, by using a neti pot), use the right kind of water to protect yourself. This information is not meant to be used for self-diagnosis or as a substitute for consultation with a health care provider. If you have any questions about the parasites described above or think that you may have a parasitic infection, consult a health care provider.
Amoeba response protocol Safe drinking water which has the trust of consumers
Contents 1. Background... 2 2. Mode of transmission... 2 3. Protocol for drinking water providers... 3 3.1. Australian Drinking Water Guidelines... 3 3.2. Sampling frequencies... 4 3.3. Reporting protocol... 5 3.4. Amoeba protocol response flowchart... 6 3.5. Drinking water advisory notices and public alerts... 7 3.5.1. Advisory to regional hospitals and district medical officers... 7 3.5.2. Level 2 Amoebic meningitis alert... 8 3.5.3. Level 1 Naegleria fowleri alert... 9 4. Swimming pool media statement... 10 4.1. Amoebic meningitis alert for swimming pools media release... 10 More information Water Unit Environmental Health Directorate Public Health Division Department of Health PO Box 8172 PERTH Business Centre WA 6849 Telephone: (08) 9388 4999 Facsimile: (08) 9388 4910 Email: Web: richard.theobald@health.wa.gov.au www.public.health.wa.gov.au/2/640/2/drinking_water.pm Produced by Environmental Health Directorate Department of Health, Western Australia 2013 1
1. Background Naegleria fowleri is a free-living amoeboflagellate in soil and aquatic habitats. Naegleria infection (amoebic meningitis) is acquired by exposure of the olfactory mucosa high in the nasal passages to contaminated water, most commonly by diving or swimming in fresh water, or inadequately maintained spas, tubs or swimming pools. There have been four recorded cases of amoebic meningitis in Western Australia to 1985. There have been no further cases since this disease became a notifiable disease in May 1985. The infection is fatal in virtually all cases, but can be prevented by adequate disinfection of water to which people may be exposed and through public education. This protocol has been developed by the Department of Health in consultation with the Water Corporation and PathWest to assist with the management of thermophilic amoebae and positively identified Naegleria fowleri from reticulated water supplies. 2. Mode of transmission Graphic courtesy of University of South Carolina School of Medicine [Figure 25E from http://pathmicro.med.sc.edu/parasitology/blood-proto.htm] 2
3. Protocol for drinking water providers 3.1. Australian Drinking Water Guidelines The Australian Drinking Water Guidelines, published by the National Health and Medical Research Council, provides an authoritative reference on what defines safe, good quality water, how it can be achieved and how it can be assured. The Guidelines state: Two groups of free-living amoebae, Naegleria and Acanthamoeba, have been responsible for human infections in Australia. Infection is opportunistic and generally results from contact during recreational bathing, or domestic uses of water other than drinking. Public water supplies can contaminate swimming pools. The occurrence of these organisms is unrelated to faecal contamination and their ecology in aquatic environments is more complex than that of enteric protozoa. Cerebral infection by Naegleria fowleri is strictly waterborne and although rare is usually fatal. Since these amoebae are able to colonise piped water supplies, disinfection at the water source may not adequately control them unless the disinfectant pervades the whole distribution system. Acanthamoeba species cause both cerebral and corneal disease. An environmental source of infection has rarely been identified with certainty. As free-living environmental organisms, Naegleria are not associated with faecal contamination and can be detected in the absence of Escherichia coli. Whilst only Naegleria fowleri has caused amoebic meningitis, other species of thermophilic Naegleria may indicate the potential presence of Naegleria fowleri. Detection of any thermophilic Naegleria in drinking water should therefore initiate corrective actions while speciation is undertaken to determine if Naegleria fowleri is present. A detection of thermophilic Naegleria is likely to indicate that preventive measures and barriers have failed. Naegleria are most likely to enter a water supply system at the source or at breaks in the sealed system such as open reservoirs and tanks. Under favourable conditions, they can proliferate in pipework and tanks. Under unfavourable condition, Naegleria can encyst and when in this state are more resistant to disinfection, readily surviving in tank sediments and pipe biofilm. Unless chlorine residual is continuous, decystation to the active trophozoite form will remain a threat. Free chlorine or chloramine residual at 0.5 mg/l or higher will control Naegleria fowleri, provided the disinfectant residual persists throughout the water supply system at all times. More detailed information can be found in the Acanthamoeba and Naegleria fowleri fact sheets of the Australian Drinking Water Guidelines. More information about amoebic meningitis can be found in the Department s publication Amoebic Meningitis Environmental Health Guide, available from: www.public.health.wa.gov.au/cproot_download/2404/2/amoebic_meningitis.pdf 3
3.2. Sampling frequencies Routine monitoring for thermophilic amoebae (the most significant of which is Naegleria fowleri) is required during the months of the year when water temperatures within the distribution system are likely to exceed 20º C. Drinking water providers are expected to establish and monitor temperature profiles of water within the distribution system to determine the months of the year when the water temperature is likely to exceed 20º C. During these periods amoeba samples should be taken from the distribution system at the same time and place as bacteriological samples, unless an alternative frequency has been agreed with the Department. Greater sampling frequency may be necessary where bacteriological problems are detected or when hazardous events have occurred that may increase the risk of thermophilic amoebae being present in drinking water (the term hazardous event is defined and explained in section 3.2 of the Australian Drinking Water Guidelines). Analysis must be performed by a laboratory that is National Association of Testing Authorities, Australia (NATA) accredited for testing for free living protozoa and the results must be issued on a NATA endorsed report. Water samplers are reminded to ensure that water temperature is recorded with each sample. 4
3.3. Reporting protocol Drinking water providers must notify the Department of Health in accordance with the following table: Reporting Event Report Due Report to Any thermophilic Naegleria tolerant to 42ºC (including repeats) Immediate notification by fax, phone and/or electronic mail to: DWAlert@health.wa.gov.au Director Environmental Health Telephone: (08) 9388 4999 Facsimile: (08) 9388 4910 (if not available during working hours to the Emergency Duty Officer (08) 9328 0553) For additional information please refer to the reporting protocols set out in your Memorandum of Understanding for Drinking Water. Further response shall be in accordance with the response flowchart set out in section 3.4. The alerts and advisories referenced in the flow chart are explained in more detail in section 3.5. The text of the all clear advisory notices, which are to be issued by the Department to regional hospitals, District Medical Officers or affected communities, will be developed considering the circumstances of the event. Please note that for remote community water supplies managed by the Department of Housing under the Remote Areas Essential Services Program, a separate notification procedure applies in the case of thermophilic Naegleria detections. These procedures involve pictograms and a cascading series of notifications by facsimile and telephone to community leaders, local clinics and the Department of Health. 5
3.4. Amoeba protocol response flowchart Start First water sample collected Was Naegleria 42ºC detected? No End Yes DoH fax advisory to regional hospital and district medical officers Chlorination, flushing and scouring of supply Was the 1st water sample N. fowleri? No DoH fax all clear to regional hospital and district medical officers After achieving a disinfectant residual of 0.5 mg/l in the reticulation for at least 12 hours, collect amoeba response samples. Was the 1st water sample N. fowleri? No End Yes Yes Was disinfection over the last 5 days adequate? No Issue Level 2 Amoebic meningitis alert Was Naegleria 42ºC detected in 2nd water sample? Yes No Resume routine monitoring Yes Was disinfection over the last 5 days adequate? No End Issue Level 2 Amoebic meningitis alert Was the result of the 2nd water sample N. fowleri? Yes Issue Level 1 N. fowleri alert No Resume routine monitoring End Review treatment and collect weekly water samples Yes Was Naegleria 42ºC detected in the next water sample? No Stand down advisory issued by DoH End 6
3.5. Drinking water advisory notices and public alerts 3.5.1. Advisory to regional hospitals and district medical officers The Department of Health will circulate, by facsimile or email, an advisory notice to regional hospitals and District Medical Officers based on this template: TO ALL DOCTORS IN THE AREA Dear Doctor DETECTION OF NAEGLERIA IN WATER RETICULATION I write to advise you that the (Drinking Water Provider) have detected an as yet unspeciated Naegleria in the scheme drinking water system of (Locality). The (Drinking Water Provider) has increased disinfection processes and it is unlikely that repeat samples will detect further colonisation. It is also unlikely that this will turn out to be a pathogenic N. fowleri. Although it is unlikely that any human illness will result from this colonisation I am writing to suggest a high index of suspicion if clinically presumptive cases are brought to your attention in the near future. The symptoms of primary amoebic meningoencephalitis (PAM or amoebic meningitis) usually develop three to seven days after infection and include: Severe and persistent headache Sore throat Nausea Vomiting High fever Somnolence. Neck stiffness is a characteristic sign. Recent anosmia or olfactory hallucinations, if present, are strongly suggestive. The cerebrospinal fluid is aseptic on lumbar puncture, and the amoebae may be mistaken for macrophages. Heroic treatment with intravenous and intrathecal amphotericin B and miconazole in conjunction with oral rifampicin is indicated for this usually fatal condition. The disease is urgently notifiable by facsimile to the Department of Health on (08) 9388 4910. Further general information is available on the Department of Health s environmental health website: www.public.health.wa.gov.au/cproot_download/2404/2/amoebic_meningitis.pdf or from local government environmental health staff, or by contacting the Department of Health s Environmental Health Directorate on (08) 9388 4999. Yours faithfully 7
3.5.2. Level 2 Amoebic meningitis alert To be issued either: (a) jointly by the Department of Health and the Drinking Water Provider (refer to the MOU Binding protocols for a list of responsible officers) following JACP meeting if single positive detection of Naegleria fowleri and disinfection over the last five days (prior to sampling) is not adequate. OR (b) by the Department of Health in the event of two consecutive detections of thermophilic Naegleria (where the first was not a Naegleria fowleri) and disinfection over the last five days (prior to sampling) is not adequate. This alert will be circulated to the community and surrounding areas, the relevant local Government authority and the Environmental Health Hazards Unit of the Department s Environmental Health Directorate. Members of the (Named) community and surrounding areas are warned that the recent sustained hot weather and elevated water temperatures have increased the chance of infection from amoebae in water around and within the home. If water containing amoebae goes up the nose, it may lead to the rare but fatal illness amoebic meningitis. As a general precaution, the following advice is provided to prevent water that may contain amoebae going up the nose: DO NOT allow water to go up your nose or sniff water into your nose when bathing, showering or washing your face. DO NOT jump into or duck dive in bathing water walk or lower yourself in. DO NOT allow children to play unsupervised with hoses or sprinklers as they may accidentally squirt water up their nose. DO run bath and shower taps for a few minutes to flush out the pipes. DO swim in and play with safe water only. Stay out of dirty pools, waterholes, dams, incorrectly chlorinated swimming pools, spas etc. DO keep your swimming pool adequately disinfected before and during use. Chlorine is the most effective way to continually disinfect water. DO keep wading pools clean by emptying, scrubbing and allowing them to dry in the sun after each use. If you need to top up the water in your swimming pool with scheme water, DO place the hose directly into the skimmer box and ensure that the filter is running. DO NOT top up by placing the hose in the body of the pool. Further advice for operators of aquatic facilities can be found in the Department s publication Code of Practice for the Design, Operation, Management and Maintenance of Aquatic Facilities, available from: www.public.health.wa.gov.au/3/914/2/code_of_practice.pm General advice about keeping your swimming pool healthy is available from: www.public.health.wa.gov.au/2/641/2/aquatic_facilities.pm 8
3.5.3. Level 1 Naegleria fowleri alert To be issued jointly by the Department of Health and the Drinking Water Provider (refer to the MOU Binding protocols for a list of responsible officers) following JACP meeting, if Naegleria fowleri is detected in the second water sample (regardless of whether the thermophilic Naegleria detected in the first sample was Naegleria fowleri or not). This alert will be circulated to the community and surrounding areas, the relevant local Government authority and the Environmental Health Hazards Unit of the Department s Environmental Health Directorate. The method of distribution (eg media release, letter drop, word of mouth) will be decided at the JACP meeting. Members of the (Named) community are advised that there have recently been detections of the amoeba Naegleria fowleri in the specific locality drinking water supply. Amoebae can occur when there are periods of sustained hot weather (where water temperatures range between 28 o C and 40 o C) and lowered levels of chlorine in the water. Water is safe to drink from the reticulated supply. All actions are being undertaken by the Water Service Provider to maintain an adequate chlorine residual and due to this action the risk to the community is considered to be small. However, as Naegleria fowleri can cause the rare but fatal illness amoebic meningitis (if water containing this amoeba goes up the nose), this alert has been issued. To prevent infection, do not allow water that may contain amoebae to go up the nose. DO NOT allow water to go up your nose or sniff water into your nose when bathing, showering or washing your face. DO NOT jump into or duck dive in bathing water walk or lower yourself in. DO NOT allow children to play unsupervised with hoses or sprinklers as they may accidentally squirt water up their nose. DO run bath and shower taps for a few minutes to flush out the pipes. DO swim in and play with safe water only. Stay out of dirty pools, waterholes, dams, incorrectly chlorinated swimming pools, spas etc. DO keep your swimming pool adequately disinfected before and during use. Chlorine is the most effective way to continually disinfect water. DO keep wading pools clean by emptying, scrubbing and allowing them to dry in the sun after each use. If you need to top up the water in your swimming pool with scheme water, DO place the hose directly into the skimmer box and ensure that the filter is running. DO NOT top up by placing the hose in the body of the pool. Please make sure your next door neighbours know about this alert. Further updates will be issued as results of water samples become available. Further advice for operators of aquatic facilities can be found in the Department s publication Code of Practice for the Design, Operation, Management and Maintenance of Aquatic Facilities, available from: www.public.health.wa.gov.au/3/914/2/code_of_practice.pm General advice about keeping your swimming pool healthy is available from: www.public.health.wa.gov.au/2/641/2/aquatic_facilities.pm 9
4. Swimming pool media statement 4.1. Amoebic meningitis alert for swimming pools media release The Environmental Health Branch of the Department of Health will issue a routine summer alert for swimming pool owners. This alert is usually issued statewide in December of each year. The alert will be based on the following template: Swimming pool owners need to ensure their pools are adequately maintained to prevent amoebic meningitis, following the onset of hot weather. The Director of Environmental Health said swimming pool owners in both country and metropolitan areas should take note of this alert. Sustained hot weather means some pool temperatures will reach and exceed 26 degrees Celsius, creating ideal conditions for amoebae to develop the Director said. If water containing amoebae goes up the nose, it can lead to the deadly illness amoebic meningitis. Swimming pool owners are advised to ensure their facilities are kept clean, free of dirt and leaves, and properly chlorinated. They should test the water in their swimming pools at least twice a day. Where stabiliser is not used, the water should contain at least two milligrams per litre of chlorine, and three milligrams of chlorine per litre where stabiliser is used. As well, the ph should be kept between 7.2 and 7.6. People are also advised not to swim in suspect water such as dirty pools, water holes and dams. It is also important to keep splasher or wading pools clean by emptying, scrubbing and allowing them to dry in the sun after every use. In particular, swimming pool owners and operators of aquatic facilities north of Geraldton are reminded to be constantly alert to the risk of amoebic meningitis from October to April, as water temperatures are always high during these months. The alert will also link to further advice for operators of aquatic facilities in the Department s publication Code of Practice for the Design, Operation, Management and Maintenance of Aquatic Facilities, available from: www.public.health.wa.gov.au/3/914/2/code_of_practice.pm 10