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For the second time this summer, a public utility in Louisiana has reported finding Naegleria Fowleri – the amoebic parasite that causes an almost always fatal brain infection (PAM aka Primary amebic meningoencephalitis) – in the water being supplied to a small community in Ascension Parish.
You may recall that last week we saw the St. Bernard Parish Water Supply Tests Positive for Naegleria Fowleri (Again).
Until a few years ago, nearly all of the Naegleria infections reported in the United States were linked to swimming in warm, stagnant freshwater ponds and lakes (see Naegleria: Rare, 99% Fatal & Preventable)
In 2011, however, we saw two cases reported in Neti pot users from Louisiana, prompting the Louisiana Health Department to recommend that people `use distilled, sterile or previously boiled water to make up the irrigation solution’ (see Neti Pots & Naegleria Fowleri).
While extraordinarily rare in the United States, every year Pakistan reports a dozen or more infections from this `killer amoeba’ , as chlorination of their water supplies is often inadequate, and for many, nasal ablutions are part of their daily ritual.
In 2013, we saw a 4 year-old infected through contact with the municipal water supply while visiting St. Bernard Parish, Louisiana. Subsequently we saw the St. Bernard Parish Water Supply Tests Positive For Naegleria Fowleri, prompting an emergency increase in chlorination and yearly checks of local water supplies.
While the water supply remains safe for drinking, until the water can be treated and tests come back showing the parasite gone, residents are warned to avoid certain activities which might introduce the parasite into their sinuses.
DHH Confirms Naegleria Fowleri Ameba in Ascension Consolidated Utility District 1
Drinking water is safe to consume, but State urges public to take precautions
Tuesday, July 28, 2015 | Contact: Media & Communications: Phone: 225.342.1532, E-mail: dhhinfo@la.gov
Baton Rouge, La.—Tuesday, the Louisiana Department of Health and Hospitals (DHH) confirmed the presence of the Naegleria fowleri ameba in the Ascension Consolidated Utility District 1 at the site 9295 Brou Road. The water system, which serves approximately 1,800 residents in a small community north of Donaldsonville in Ascension Parish, was tested by DHH as part of the State's new public drinking water surveillance program. DHH notified the water system and local officials Tuesday afternoon. The Department asked the water system to conduct a 60-day chlorine burn to ensure that any remaining ameba in the system are eliminated. Parish officials today confirmed that the system would conduct the burn out of an abundance of caution.
The water system was not in compliance with the requirements for chloramine disinfectant levels set forth by the 2013 by emergency rule and additional requirements in 2014 by the Louisiana Legislature at the location where the sample tested positive for the ameba. Three other sites on the system tested negative for the ameba, but did meet the requirement for disinfectant.
Tap water in from the Ascension Consolidated Utility District 1 is safe for residents to drink, but the Department urges residents to avoid getting water in their noses. Naegleria fowleri is an ameba that occurs naturally in freshwater.
As Naegleria fowleri infections are extremely rare, testing for this ameba in public drinking water is still relatively new and evolving. Fewer than 10 deaths in the United States have been traced back to the ameba, with three occurring in Louisiana over the last several years.
DHH conducts sampling of public drinking water systems for Naegleria fowleri each summer when temperatures rise. So far, DHH has tested 12 other systems for the ameba. One positive result was identified on July 22 in St. Bernard Parish. St. Bernard Parish is currently conducting a chlorine burn throughout their water system to eliminate any remaining ameba.
Naegleria fowleri causes a disease called primary amebic meningoencephalitis (PAM), which is a brain infection that leads to the destruction of brain tissue. In its early stages, symptoms of PAM may be similar to bacterial meningitis.
DHH Safe Drinking Water Program staff sampled four sites along the Ascension Consolidated Utility District 1. One of the four sites tested positive for the ameba. One positive test was located at 9295 Brou Road. Chlorine levels at the site of the positive sample were below the 0.5 mg/l requirement. The Department requested that the water system conduct a 60-day free chlorine burn in the water system. The chlorine burn will help reduce biofilm, or organic buildup, throughout the water system and will kill the ameba. The parish has agreed to conduct this precautionary measure.
Precautionary Measures for Families
According to the CDC, every resident can take simple steps to help reduce their risk of Naegleria fowleri infection. Individuals should focus on limiting the amount of water going up their nose. Preventative measures recommended by the CDC include the following:
- 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 five 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:
- Pools: free chlorine at 1 to 3 parts per million (ppm) and pH 7.2 to 7.8, and
- Hot tubs/spas: free chlorine 2 to 4 parts per million (ppm) or free bromine 4 to 6 ppm and pH 7.2 to 7.8.- If you need to top off the water in your swimming pool with tap water, place the hose directly into the skimmer box and ensure that the filter is running. Do not top off the pool by placing the hose in the body of the pool.
Residents should continue these precautions until testing no longer confirms the presence of the ameba in the water system. Residents will be made aware when that occurs. For further information on preventative measures, please visit the CDC website here: http://www.cdc.gov/parasites/naegleria/prevention.html.
Although several states promote Naegleria awareness each summer, one of the best resources available online is http://amoeba-season.com/, a USF Philip T. Gompf Memorial Fund project, which was set up by a pair of Florida doctors who tragically lost their 10 year-old son to this parasite in 2009.
You can also follow this site on twitter at @AmoebaSeason.
