“Today, waterborne illnesses due to pathogens in drinking water are endemic in the U.S., numbering 19.5 million cases annually, according to Kelly Reynolds at the University of Arizona. EPA epidemiologist Stephanie DeFlorio-Barker reported that 90 million illnesses were caused by recreational waters, many of which are also drinking water sources.” Dated December 29, 2021 https://www.msn.com/en-us/news/us/congress-must-reform-the-safe-drinking-water-act-to-guarantee-the-public-right-to-know/ar-AASfNAC
"Among drinking water samples the presence of pathogenic bacteria (88%) is alarming for public health authorities. The emergence of resistance and decreasing level of susceptibility of pathogens to a wide spectrum of antimicrobials is a matter of great concern, because it may limit the availability of antimicrobials for clinical management of water born outbreaks in future.” “Pathogens from Drinking Water,” Quetta, Pakistan 2014 https://applications.emro.who.int/imemrf/Professional_Med_J_Q/Professional_Med_J_Q_2014_21_4_760_765.pdf
Back in the 1970’s friends of mine moved to New Orleans. After living there for a few months they wondered why everyone they met drank bottled water. At some point they asked someone why they didn’t drink the tap water in New Orleans. They explained that the tap water was from the surface water of the Mississippi River. New Orleans sits at the mouth of the River. Up and down the River are many chemical plants, agriculture and pesticide industries. Barges and boats carry many consumer goods, and they have at times had oil spills on the River. The main concern was about the cancer causing chemicals in the River contaminating the drinking water. But they also explained that the tap water tasted awful. [According to the records regarding the tap water in New Orleans, there have been no violations of the Safe Drinking Water Act for the last few years. [Safe Drinking Water Act https://www.epa.gov/laws-regulations/summary-safe-drinking-water-act
I suppose that situation described by my friends to me in the seventies made me more aware of some of the contamination issues of municipal water systems. In the 1980’s I bought 5-gallon water bottles rather than drink tap water. Back then the 5-gallon water bottles were glass, and too heavy for me to carry. I don’t remember when those 5-gallon glass water bottles became plastic. But I do remember the change in taste. The water tasted like plastic, particularly if they sat out too long in the Florida heat.
I never thought about possible pathogens in water, my concern at that time was about cancer-causing chemicals. But after doing a search for articles on safe drinking water for this post, I now find myself concerned about the varied media statements regarding the safety of US drinking water, particularly in relationship to the safe preparation of powdered infant formula and the pathogen Cronobacter sakazakii. One article I read quoted Professor Andrew J. Whelton, PhD of Purdue University that water from the tapwater delivered to buildings is not sterile. https://www.insider.com/the-difference-between-purified-distilled-and-tap-water
We know that powdered infant formula is not sterile. Is the pathogen, Cronobacter sakazakii found in water? Yes, “Cronobacter sakazakii also known as Enterobacter sakazakii exists widely in our natural environment; such as water, soil, plant roots, animal intestines, and even processed foods. The vitality of Enterobacter sakazakii is very tenacious. It is resistant to cold, heat drying, acid and alkali, osmotic pressure, and ultraviolet rays. It also has strong resistance to some disinfectants. And if it is under adverse conditions, it will secrete adhesive polysaccharide [biofilms] to protect itself.” And, “It can still survive when the milk powder is brewed with water below 70°C.” https://www.tellerreport.com/news/2022-03-03-cronobacter-was-found-in-milk-powder--can-i-still-drink-it-.Sy-fTPoTeq.html
Do we test for Cronobacter sakazakii in municipal water systems? Not specifically. Cronobacter sakazakii is considered “a yellow pigmented coliform.” United States municipal water systems test for “total coliform.” Total coliform is used as an indicator of bacterial contamination in the drinking water. If the total coliform is too high, communities will get a boil water advisory alert. In my small city in the last couple of months, we have had 3 boil water advisories for different parts of the city. According to some papers I read, it is suppose to be rare to get a boil water advisory. Not too rare this year in my city.
“In the US there are 12-18m [million] cases of human water-borne diseases a year. In developing countries it is possible that one in three hospital cases may be due to contamination of water.” –Professor Joan Rose, microbiologist quoted in the Guardian https://www.theguardian.com/environment/2016/aug/31/cleaning-the-worlds-water-we-are-now-more-polluted-than-we-have-ever-been
Meanwhile, the CDC states, “The United States has one of the safest public drinking water supplies in the world.”—The CDC https://www.cdc.gov/healthywater/drinking/public/water_diseases.html The Environmental Protection Agency (EPA) regulates public drinking water. The US FDA regulates bottled water. (Bottled water has its contamination issues, too. Yahoo News had an article entitled, “The FDA Knew the Bottled Water Was Contaminated. The Public Didn’t.” https://news.yahoo.com/fda-knew-bottled-water-contaminated-150410025.html Well water that serves less than 25 people is not regulated.
In my previous post I wrote about 6 different instructions on the safe preparation of powdered infant formula. The Mayo Clinic on their website gives us another different instruction on safe preparation. https://vwmcclain.blogspot.com/2022/03/the-scandal-of-cronobacter.html
The instructions are longer than what I am quoting. I am focusing on the water preparation.
‘You can use any type of clean water—tap or bottled—to prepare liquid-concentrate or powdered formula. If you’re concerned about the purity of your water supply, talk to your baby’s doctor or your water provider. Many public water systems will test drinking water upon request. If you use well water, boil it for about one minute and cool it to body temperature, 98.6°F (37°C) Measure the water after boiling it.” https://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-depth/infant-formula/art-20045791
The instructions base their information on the belief that public water systems in the United States are the best in the world. Therefore there appears to be little concern about the possibility of pathogens in the water. The quality of municipal drinking water is dependent on where you live in your community, your plumbing, the season, and even what room your tap is located. Here in Florida in the summer months the cold water tap is not cold but lukewarm due to the pipes being very warm in the ground.
Contamination of drinking water has other concerns besides pathogens in the water. There is concerns about lead levels in water, particularly for people who live in older homes or apartment buildings. We know that boiling for longer than a minute (longer for higher elevations) concentrates lead in the water. PFAS chemicals, will also concentrate in water when boiled too long. Nitrates are another contamination issue in areas that reside near agricultural areas. A antimicrobial testing company lists the pathogens of concern in drinking water: E. coli, Campylobacter, Jejune, Hepatitis A, Giardia lamblia, Salmonella, Legionella pneumophilia, Cryptosporidum (a protozoa that chlorine cannot kill). Other concerns are pharmaceutical contamination and uranium in drinking water.
Filtration of tap water is often suggested as a back-up plan for concerns about the safety of drinking water from the tap. But good filters can be costly and must be replaced at certain intervals. It is low income communities who are disproportionally impacted by contamination of their drinking water. There is a need to lower the risk of infant formula. Exclusive breastfeeding should be the answer. But as long as governmental agencies are unwilling to require all states to report Cronobacter sakazakii infections, and not test for Cronobacter sakazakii in water systems, babies will continue to get sick and some will die.
Copyright 2022. Valerie W. McClain
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