In the U.S., approximately one in five water samples collected from private wells were found to be contaminated with at least one chemical at levels high enough to harm health. Given that one in eight U.S. residents obtain their water from a private well, access to safe drinking water is vital. Many private wells are not routinely tested for contaminants, which can be microbiological, chemical, or radiological. Environmental health practitioners serve as a valuable resource, helping their communities to increase well testing, identify contaminants of concern, and understand well water testing results. This month’s column highlights the work of the Centers for Disease Control and Prevention to improve drinking water in private wells.

The article focuses on the environmental health programs for the reduction of harmful exposures from wells and private water systems. Topics include the funding opportunities by the Centers for Disease Control and Prevention (CDC) that focus on identifying and accessing private well data sources, the action of Safe Water for Community Health (Safe WATCH) partners in monitoring the quality of well water, and the importance of high-quality in making important public health decisions.

BACKGROUND: To inform prevention strategies, we assessed the extent of SARS-CoV-2 transmission and settings in which transmission occurred in a Georgia public school district. METHODS: During December 1, 2020-January 22, 2021, SARS-CoV-2-infected index cases and their close contacts in schools were identified by school and public health officials. For in-school contacts, we assessed symptoms and offered SARS-CoV-2 RT-PCR testing; performed epidemiologic investigations and whole-genome sequencing to identify in-school transmission; and calculated secondary attack rate (SAR) by school setting (e.g., sports, elementary school classroom), index case role (i.e., staff, student), and index case symptomatic status. RESULTS: We identified 86 index cases and 1,119 contacts, 688 (63.1%) of whom received testing. Fifty-nine (8.7%) of 679 contacts tested positive; 15 (17.4%) of 86 index cases resulted in ≥2 positive contacts. Among 55 persons testing positive with available symptom data, 31 (56.4%) were asymptomatic. Highest SAR were in indoor, high-contact sports settings (23.8%, 95% confidence interval [CI] 12.7, 33.3), staff meetings/lunches (18.2%, CI 4.5-31.8), and elementary school classrooms (9.5%, CI 6.5-12.5). SAR was higher for staff (13.1%, CI 9.0-17.2) versus student index cases (5.8%, CI 3.6-8.0) and for symptomatic (10.9%, CI 8.1-13.9) versus asymptomatic index cases (3.0%, CI 1.0-5.5). CONCLUSIONS: Indoor sports may pose a risk to the safe operation of in-person learning. Preventing infection in staff members, through measures that include COVID-19 vaccination, is critical to reducing in-school transmission. Because many positive contacts were asymptomatic, contact tracing should be paired with testing, regardless of symptoms.

The Centers for Disease Control and Prevention’s (CDC) National Center for Environmental Health (NCEH) released a free e-learning curriculum in January 2018 titled “Safe Water Program Improvement (SWPI).” With approximately 34 million American residents served by privately owned wells (NGWA, 2016), there is a need for training on how health departments can improve their services to homeowners. CDC developed the curriculum for state, local, tribal and territorial health departments as a resource to improve safe drinking water programs focused on private wells and other federally unregulated drinking water. CDC designed the SWPI curriculum using the 10 Essential Environmental Public Health Services (EEPHSs) (Figure 1) and the Environmental Public Health Performance Standards (CDC, 2014) as frameworks.

Eleven percent of U.S. households (~35 million people) use private drinking water systems that are not covered by the Environmental Protection Agency’s Safe Drinking Water Act (SDWA)i. These drinking water systems are primarily private wells but can also include springs, cisterns, and hauled water systems. There is limited federal guidance and no established uniform standards or approach for monitoring the water quality from these water systems. Where state testing requirements do exist, testing is usually infrequent (e.g., wells must be tested as part of a real estate transaction, new construction, or equipment change). Most private well programs are voluntary and require strong outreach activities to encourage well owners to monitor the safety of their drinking water and accept water program services offered by the local health department. | | To address the need of state, tribal, local, and territorial (STLT) health departments, the Centers for Disease Control and Prevention (CDC) released a funding opportunity announcement in 2013 that built on previous CDC safe drinking water efforts to address drinking water contamination. The 2013–2015 funding initiative supported 11 grantees (9 state and 2 county health departments) to improve state and local capacity to assess and manage risks associated with drinking water systems not covered by the SDWA.

IMPORTANCE: At least 13 medication-associated diethylene glycol (DEG) mass poisonings have occurred since 1937. To our knowledge, this is the first longitudinal study characterizing long-term health outcomes among survivors beyond the acute poisoning period. OBJECTIVE: To characterize renal and neurologic outcomes among survivors of a 2006 DEG mass-poisoning event in Panama for 2 years after exposure. DESIGN, SETTING, AND PARTICIPANTS: This prospective longitudinal study used descriptive statistics and mixed-effects repeated-measures analysis to evaluate DEG-poisoned survivors at 4 consecutive 6-month intervals (0, 6, 12, and 18 months). Case patients included outbreak survivors with a history of (1) ingestion of DEG-contaminated medication, (2) hospitalization for DEG poisoning, and (3) an unexplained serum creatinine level of 1.5 mg/dL or higher (to convert to micromoles per liter, multiply by 88.4) during acute illness or unexplained exacerbation of preexisting end-stage renal disease. MAIN OUTCOMES AND MEASURES: Demographics, mortality, dialysis dependence, renal function, neurologic signs and symptoms, and nerve conduction studies. RESULTS: Of the 32 patients enrolled, 5 (15.6%) died and 1 was lost to follow-up, leaving 26 patients at 18 months. Three (9.4%) missed 1 or more evaluations. The median age was 62 years (range, 15-88 years), and 59.4% were female. Three (9.4%) patients had preexisting renal failure. Enrollment evaluations occurred at a median of 108 days (range, 65-154 days) after acute illness. The median serum creatinine level for the 22 patients who were not dialysis dependent at time 0 was 5.9 mg/dL (range, 1.8-17.1 mg/dL) during acute illness and 1.8 mg/dL (range, 0.9-5.9 mg/dL) at time 0. Among non-dialysis-dependent patients, there were no significant differences in the log of serum creatinine or estimated glomerular filtration rate over time. The number of patients with subjective generalized weakness declined significantly over time (P < .001). A similar finding was observed for any sensory loss (P = .05). The most common deficits at enrollment were bilateral lower extremity numbness in 13 patients (40.6%) and peripheral facial nerve motor deficits in 7 (21.9%). All patients with neurologic deficits at enrollment demonstrated improvement in motor function over time. Among 28 patients (90.3%) with abnormal nerve conduction study findings at enrollment, 10 (35.7%) had motor axonal involvement, the most common primary abnormality. CONCLUSIONS AND RELEVANCE: Neurologic findings of survivors tended to improve over time. Renal function generally improved among non-dialysis-dependent patients between acute illness and the first evaluation with little variability thereafter. No evidence of delayed-onset neurologic or renal disease was observed.

The American Red Cross and U. S. Centers for Disease Control and Prevention collaborated on a sustainability evaluation of post-hurricane water, sanitation and hygiene (WASH) interventions in Central America. In 2006 and 2009, we revisited six study areas in rural El Salvador, Guatemala, Honduras and Nicaragua to assess sustainability of WASH interventions finalized in 2002, after 1998's Hurricane Mitch. We used surveys to collect data, calculate indicators and identify factors that influence sustainability. Regional sustainability indicator results showed there was a statistically significant decline in access to water. The presence of sanitation facilities had not changed since the beginning of the project; however, maintenance and use of latrines declined but continued to meet the goal of 75% use after 7 years. The hygiene indicator, hand washing, initially declined and then increased. Declines in water access were due to operational problems related to storm events and population changes. Sanitation facilities were still present and sometimes used even though they reached or surpassed their original design life. Changes in hygiene practices appeared related to ongoing hygiene promotion from outside organizations. These results provide useful input for making WASH programs more sustainable and informing future, more in-depth research into factors influencing sustainability.

One defi nition of “sustainability” is | the capacity to endure. In the realm | of global environmental health, sustainable health interventions—for example, | water, sanitation, and hygiene education | programs—are community investments that | should not only improve health, but should | continue to provide benefi ts over time. | Goal 7 of the Millennium Development | Goals (MDGs) (United Nations, 2009) by | the United Nations seeks to ensure environmental sustainability and reverse the loss of | environmental resources. Specifi cally, one | target for 2015 is to “reduce by half the proportion of people without sustainable access | to safe drinking water and basic sanitation.” | The problem is that traditionally, after these | interventions have been provided, little information becomes available on the longevity of their health-related effects and behavior changes.