In recent months, news reports from Kerala drew attention to a rare but alarming infection known as Primary Amoebic Meningoencephalitis (PAM). The condition, caused by the amoeba Naegleria fowleri, occurs when contaminated water enters the nose during activities such as swimming in untreated freshwater. Though extremely rare, the infection is often severe and has highlighted an important issue that affects millions of people every year - water safety.

Around the same time, parts of Indore reported a water contamination incident, where residents experienced gastrointestinal illness after consuming polluted municipal water. While these incidents differ in cause and scale, they point toward a common underlying challenge - unsafe water exposure.

In developing countries like India, rapid urbanisation, ageing pipelines, poor sanitation infrastructure, flooding, and improper waste disposal all contribute to contamination of drinking water sources. As a result, millions of people remain vulnerable to waterborne diseases ranging from mild gastrointestinal infections to serious illnesses such as cholera and hepatitis.

Understanding how these diseases spread and how they can be prevented is one of the most effective ways to protect communities from common waterborne diseases, along with practical steps that households and healthcare providers can take to reduce risk.

What Are Waterborne Diseases?

Waterborne diseases are illnesses caused by microorganisms present in contaminated water. These pathogens enter the body primarily through drinking unsafe water or consuming food prepared with contaminated water.

Common types of pathogens responsible include:

• Bacteria – e.g., Vibrio cholerae, Salmonella typhi
• Viruses – e.g., Hepatitis A and Hepatitis E viruses
• Parasites – e.g., Entamoeba histolytica

Water contamination can occur due to several factors such as:

• Poor sanitation infrastructure
• Leakage in sewage and water pipelines
• Flooding and environmental contamination
• Improper water storage practices
• Lack of safe drinking water sources

These diseases can spread quickly and affect a large population in regions where sanitation and water treatment systems are inadequate.

How Do Waterborne Diseases Spread?

Waterborne infections spread when disease-causing organisms contaminate water sources used for drinking, cooking, or washing food.

Common transmission routes include:

• Drinking contaminated water
• Food prepared or washed with contaminated water
• Poor hygiene and sanitation practices
• Contaminated municipal water supply
• Improperly stored drinking water at home

During outbreaks or seasonal flooding, pathogens can easily enter community water systems, increasing the risk of infection.

While most waterborne diseases spread through ingestion of contaminated water, some rare infections related to unsafe water exposure can occur in other ways. For example, Primary Amoebic Meningoencephalitis (PAM) occurs when contaminated water enters the nose during swimming in untreated freshwater.

What Are Some Common Waterborne Diseases?

Below are some of the most common waterborne diseases seen in India and other developing regions.

1. Cholera

Cause: Vibrio cholerae bacteria

Key symptoms:

• Profuse watery diarrhea
• Vomiting
• Severe dehydration
• Muscle cramps

How it spreads:

• Drinking contaminated water
• Eating food washed with contaminated water

Treatment approach:

• Rapid oral rehydration therapy (ORS) is the most important initial treatment to restore lost fluids and electrolytes.
• Intravenous fluids may be required in severe dehydration
• Antibiotics may be prescribed in certain cases

2. Typhoid Fever

Cause: Salmonella Typhi bacteria

Key symptoms:

• Persistent high fever
• Weakness and fatigue
• Abdominal pain
• Headache
• Loss of appetite

How it spreads:

• Drinking contaminated water
• Consuming food handled with poor hygiene

Treatment approach:

• Antibiotic therapy prescribed by a doctor
• Hydration and supportive care
• Monitoring fever using digital thermometers

Early diagnosis and treatment are important to prevent complications.

3. Hepatitis A & Hepatitis E

Cause: Viral infections transmitted through contaminated food and water.

Key symptoms:

• Jaundice (yellowing of skin and eyes)
• Fatigue
• Nausea and vomiting
• Abdominal discomfort
• Dark urine

How it spreads:

• Contaminated drinking water
• Food prepared in unhygienic conditions

Treatment approach:

• Mostly supportive care
• Adequate hydration and rest
• Monitoring liver function in moderate or severe cases

Improving sanitation and safe water access is the most effective prevention strategy.

4. Diarrhea

Diarrhea is one of the most common outcomes of waterborne infections, especially in children.

Possible causes:

• Bacterial infections
• Viral infections
• Parasites

Key symptoms:

• Frequent loose stools
• Abdominal cramps
• Dehydration
• Fatigue

Treatment approach:

• Oral rehydration therapy (ORS) is the first line of treatment
• Zinc supplementation may be recommended in children
• Antibiotics are used only in specific cases

5. Dysentery

Cause:

• Shigella bacteria (bacillary dysentery)
• Entamoeba histolytica parasite (amoebic dysentery)

Key symptoms:

• Blood or mucus in stools
• Severe abdominal cramps
• Fever
• Dehydration

How it spreads:

• Contaminated water and food
• Poor sanitation and hygiene

Treatment approach:

• Antibiotics or antiparasitic medications depending on the cause
• Adequate hydration with oral rehydration solutions
• Medical evaluation in severe cases

6. Gastroenteritis

Gastroenteritis refers to inflammation of the stomach and intestines, commonly caused by contaminated food or water.

Possible causes:

• Viruses (e.g., norovirus, rotavirus)
• Bacteria
• Parasites

Key symptoms:

• Diarrhea
• Vomiting
• Fever
• Stomach cramps

Treatment approach:

• Hydration with oral rehydration solutions
• Rest and supportive care
• Medical consultation if symptoms persist

What Symptoms do most Waterborne Diseases share?

Although different infections have specific features, many waterborne diseases share common symptoms.

Common symptoms include:

• Diarrhea
• Vomiting
• Abdominal cramps
• Fever
• Nausea
• Fatigue
• Dehydration

Warning signs that require medical attention include:

• Persistent vomiting
• Blood in stool
• Severe dehydration
• High fever
• Confusion or extreme weakness

Monitoring body temperature and hydration status can help detect worsening illness early.

How to Prevent Waterborne Diseases

Preventing waterborne diseases largely depends on safe water practices, proper hygiene, and sanitation.

1. Ensure Safe Drinking Water

Always consume water that has been:

• Boiled
• Filtered
• Properly disinfected

In situations where clean water is uncertain, water purification tablets can help disinfect drinking water and reduce microbial contamination.

2. Maintain Good Hand Hygiene

Hand hygiene significantly reduces the risk of infection.

Important practices include:

• Washing hands with antiseptic soap before eating or preparing food
• Washing hands with antiseptic soap after using the toilet
• Maintaining hygiene when handling drinking water

It’s also a good idea to have alcohol-based hand sanitizers on your person at all times.

3. Practice Safe Food Handling

Food safety plays an important role in preventing waterborne infections.

Key precautions include:

• Washing fruits and vegetables with clean water
• Avoiding food prepared in unhygienic conditions
• Cooking food thoroughly
• Avoiding raw or undercooked seafood in high-risk areas

4. Store Drinking Water Safely

Improper storage can contaminate otherwise safe water.

Follow these practices:

• Store water in clean, covered containers
• Avoid dipping hands or unclean utensils into storage containers
• Clean storage vessels regularly

5. Improve Community Sanitation

Public health measures are equally important.

Effective prevention requires:

• Proper sewage treatment systems
• Safe disposal of human waste
• Regular monitoring of municipal water supplies
• Public awareness campaigns on hygiene and sanitation

The good news is that most waterborne diseases are preventable. Simple measures such as drinking safe water, maintaining good hygiene, using water purification methods when necessary, and ensuring proper hydration during illness can significantly reduce risks.

Author Details

Written By -  Dr Afzal Jaleel (BDS)

Reviewed By -  Dr Navami S M (BDS, Product Specialist)