Guidelines For Drinking Water Quality V3

Guidelines for
Drinking-water Quality
THIRD EDITION
Volume 1
Recommendations
WORLD HEALTH ORGANIZATION

Geneva
2004
WHO Library Cataloguing-in-Publication Data
World Health Organization.
Guidelines for Drinking-water Quality. Vol. 1 : 3 rd ed.
1.Potable water standards 2.Water standards 3.Water quality standards
4.Guidelines I.Title.
ISBN 92 4 154638 7 (NLM Classication: WA 675)
World Health Organization 2004

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Contents
Preface xv
Acknowledgements xviii
Acronyms and abbreviations used in text xx
1. Introduction 1
1.16 General considerations and principles 1
1.1.1 Microbial aspects 3
1.1.2 Disinfection 5
1.1.3 Chemical aspects 6
1.1.4 Radiological aspects 7
1.1.5 Acceptability aspects 7
1.2 Roles and responsibilities in drinking-water safety management 8
1.2.1 Surveillance and quality control 8
1.2.2 Public health authorities 10
1.2.3 Local authorities 11
1.2.4 Water resource management 12
1.2.5 Drinking-water supply agencies 13
1.2.6 Community management 14
1.2.7 Water vendors 15
1.2.8 Individual consumers 15
1.2.9 Certication agencies 16
1.2.10 Plumbing 17
1.3 Supporting documentation to the Guidelines 18
2. The Guidelines: a framework for safe drinking-water 22
2.1 Framework for safe drinking-water: requirements 22
2.1.1 Health-based targets 24
2.1.2 System assessment and design 25
2.1.3 Operational monitoring 26
2.1.4 Management plans, documentation and communication 27
2.1.5 Surveillance of drinking-water quality 28
iii
GUIDELINES FOR DRINKING-WATER QUALITY
2.2 Guidelines for verication 29

2.2.1 Microbial water quality 29
2.2.2 Chemical water quality 30
2.3 National drinking-water policy 31
2.3.1 Laws, regulations and standards 31
2.3.2 Setting national standards 32
2.4 Identifying priority drinking-water quality concerns 34
2.4.1 Assessing microbial priorities 35
2.4.2 Assessing chemical priorities 35
3. Health-based targets 37
3.1 Role and purpose of health-based targets 37
3.2 Types of health-based targets 39
3.2.1 Specied technology targets 41
3.2.2 Performance targets 41
3.2.3 Water quality targets 42
3.2.4 Health outcome targets 43
3.3 General considerations in establishing health-based targets 43
3.3.1 Assessment of risk in the framework for safe
drinking-water 44
3.3.2 Reference level of risk 44
3.3.3 Disability-adjusted life-years (DALYs) 45
4. Water safety plans 48
4.1 System assessment and design 51
4.1.1 New systems 52
4.1.2 Collecting and evaluating available data 53
4.1.3 Resource and source protection 56
4.1.4 Treatment 59
4.1.5 Piped distribution systems 61
4.1.6 Non-piped, community and household systems 64
4.1.7 Validation 67
4.1.8 Upgrade and improvement 67
4.2 Operational monitoring and maintaining control 68
4.2.1 Determining system control measures 68
4.2.2 Selecting operational monitoring parameters 68
4.2.3 Establishing operational and critical limits 70
4.2.4 Non-piped, community and household systems 71
4.3 Verication 71
4.3.1 Verication of microbial quality 72
4.3.2 Verication of chemical quality 73
4.3.3 Water sources 73
4.3.4 Piped distribution systems 74
iv
CONTENTS
4.3.5 Verication for community-managed supplies 74

4.3.6 Quality assurance and quality control 75
4.4 Management procedures for piped distribution systems 76
4.4.1 Predictable incidents (deviations) 77
4.4.2 Unforeseen events 77
4.4.3 Emergencies 78
4.4.4 Closing supply, water avoidance and boil water orders 79
4.4.5 Preparing a monitoring plan 80
4.4.6 Supporting programmes 80
4.5 Management of community and household water supplies 81
4.6 Documentation and communication 82
5. Surveillance 84
5.1 Types of approaches 85
5.1.1 Audit 86
5.1.2 Direct assessment 87
5.2 Adapting approaches to specic circumstances 88
5.2.1 Urban areas in developing countries 88
5.2.2 Surveillance of community drinking-water supplies 88
5.2.3 Surveillance of household treatment and storage systems 89
5.3 Adequacy of supply 90
5.3.1 Quantity (service level) 90
5.3.2 Accessibility 91
5.3.3 Affordability 92
5.3.4 Continuity 92
5.4 Planning and implementation 93
5.5 Reporting and communicating 95
5.5.1 Interaction with community and consumers 96
5.5.2 Regional use of data 96
6. Application of the guidelines in specic circumstances 99
6.1 Large buildings 99
6.1.1 Health risk assessment 100
6.1.2 System assessment 100
6.1.3 Management 101
6.1.4 Monitoring 101
6.1.5 Independent surveillance and supporting programmes 102
6.1.6 Drinking-water quality in health care facilities 102
6.1.7 Drinking-water quality in schools and day care centres 103
6.2 Emergencies and disasters 104
6.2.1 Practical considerations 105
6.2.2 Monitoring 106
6.2.3 Microbial guidelines 107
v
6.2.4 Sanitary inspections and catchment mapping 108

6.2.5 Chemical and radiological guidelines 108
6.2.6 Testing kits and laboratories 109
6.3 Safe drinking-water for travellers 109
6.4 Desalination systems 111
6.5 Packaged drinking-water 113
6.5.1 Safety of packaged drinking-water 113
6.5.2 Potential health benets of bottled drinking-water 114
6.5.3 International standards for bottled drinking-water 114
6.6 Food production and processing 115
6.7 Aircraft and airports 116
6.7.1 Health risks 116
6.7.2 System risk assessment 116
6.7.5 Surveillance 117
6.8 Ships 117
6.8.1 Health risks 117
6.8.2 System risk assessment 118
6.8.5 Surveillance 120
7. Microbial aspects 121
7.1 Microbial hazards associated with drinking-water 121
7.1.1 Waterborne infections 121
7.1.2 Persistence and growth in water 124
7.1.3 Public health aspects 125
7.2 Health-based target setting 126
7.2.1 Health-based targets applied to microbial hazards 126
7.2.2 Risk assessment approach 126
7.2.3 Risk-based performance target setting 131
7.2.4 Presenting the outcome of performance target
development 133
7.2.5 Issues in adapting risk-based performance target setting
to national/local circumstances 133
7.2.6 Health outcome targets 134
7.3 Occurrence and treatment of pathogens 135
7.3.1 Occurrence 136
7.3.2 Treatment 137
7.4 Verication of microbial safety and quality 142
7.5 Methods of detection of faecal indicator bacteria 143
vi
CONTENTS
8. Chemical aspects 145

8.1 Chemical hazards in drinking-water 145
8.2 Derivation of chemical guideline values 147
8.2.1 Approaches taken 148
8.2.2 Threshold chemicals 149
8.2.3 Alternative approaches 152
8.2.4 Non-threshold chemicals 154
8.2.5 Data quality 154
8.2.6 Provisional guideline values 155
8.2.7 Chemicals with effects on acceptability 156
8.2.8 Non-guideline chemicals 156
8.2.9 Mixtures 156
8.3 Analytical aspects 157
8.3.1 Analytical achievability 157
8.3.2 Analytical methods 158
8.4 Treatment 166
8.4.1 Treatment achievability 166
8.4.2 Chlorination 171
8.4.3 Ozonation 172
8.4.4 Other disinfection processes 172
8.4.5 Filtration 173
8.4.6 Aeration 175
8.4.7 Chemical coagulation 175
8.4.8 Activated carbon adsorption 176
8.4.9 Ion exchange 177
8.4.10 Membrane processes 178
8.4.11 Other treatment processes 178
8.4.12 Disinfection by-products process control measures 179
8.4.13 Treatment for corrosion control 180
8.5 Guideline values for individual chemicals, by source category 184
8.5.1 Naturally occurring chemicals 184
8.5.2 Chemicals from industrial sources and human dwellings 185
8.5.3 Chemicals from agricultural activities 187
8.5.4 Chemicals used in water treatment or from materials in
contact with drinking-water 188
8.5.5 Pesticides used in water for public health purposes 190
8.5.6 Cyanobacterial toxins 192
9. Radiological aspects 197
9.1 Sources and health effects of radiation exposure 198
9.1.1 Radiation exposure through drinking-water 200
9.1.2 Radiation-induced health effects through drinking-water 200
vii
9.2 Units of radioactivity and radiation dose 201

9.3 Guidance levels for radionuclides in drinking-water 202
9.4 Monitoring and assessment for dissolved radionuclides 204
9.4.1 Screening of drinking-water supplies 204
9.4.2 Strategy for assessing drinking-water 205
9.4.3 Remedial measures 205
9.5 Radon 206
9.5.1 Radon in air and water 206
9.5.2 Risk 207
9.5.3 Guidance on radon in drinking-water supplies 207
9.6 Sampling, analysis and reporting 207
9.6.1 Measuring gross alpha and gross beta activity
concentrations 207
9.6.2 Measuring potassium-40 208
9.6.3 Measuring radon 208
9.6.4 Sampling 209
9.6.5 Reporting of results 209
10. Acceptability aspects 210

10.1 Taste, odour and appearance 211
10.1.1 Biologically derived contaminants 211
10.1.2 Chemically derived contaminants 213
10.1.3 Treatment of taste, odour and appearance problems 219
10.2 Temperature 220
11. Microbial fact sheets 221

11.1 Bacterial pathogens 222
11.1.1 Acinetobacter 222
11.1.2 Aeromonas 224
11.1.3 Bacillus 225
11.1.4 Burkholderia pseudomallei 226
11.1.5 Campylobacter 228
11.1.6 Escherichia coli pathogenic strains 229
11.1.7 Helicobacter pylori 231
11.1.8 Klebsiella 232
11.1.9 Legionella 233
11.1.10 Mycobacterium 235
11.1.11 Pseudomonas aeruginosa 237
11.1.12 Salmonella 239
11.1.13 Shigella 240
11.1.14 Staphylococcus aureus 242
11.1.15 Tsukamurella 243
viii
CONTENTS
11.1.16 Vibrio 244

11.1.17 Yersinia 246
11.2 Viral pathogens 247
11.2.1 Adenoviruses 248
11.2.2 Astroviruses 250
11.2.3 Caliciviruses 251
11.2.4 Enteroviruses 253
11.2.5 Hepatitis A virus 254
11.2.6 Hepatitis E virus 256
11.2.7 Rotaviruses and orthoreoviruses 257
11.3 Protozoan pathogens 259
11.3.1 Acanthamoeba 259
11.3.2 Balantidium coli 261
11.3.3 Cryptosporidium 262
11.3.4 Cyclospora cayetanensis 264
11.3.5 Entamoeba histolytica 265
11.3.6 Giardia intestinalis 267
11.3.7 Isospora belli 268
11.3.8 Microsporidia 270
11.3.9 Naegleria fowleri 272
11.3.10 Toxoplasma gondii 274
11.4 Helminth pathogens 275
11.4.1 Dracunculus medinensis 276
11.4.2 Fasciola spp. 278
11.5 Toxic cyanobacteria 279
11.6 Indicator and index organisms 281
11.6.1 Total coliform bacteria 282
11.6.2 Escherichia coli and thermotolerant coliform bacteria 284
11.6.3 Heterotrophic plate counts 285
11.6.4 Intestinal enterococci 287
11.6.5 Clostridium perfringens 288
11.6.6 Coliphages 289
11.6.7 Bacteroides fragilis phages 292
11.6.8 Enteric viruses 294
12. Chemical fact sheets 296

12.1 Acrylamide 296
12.2 Alachlor 297
12.3 Aldicarb 298
12.4 Aldrin and dieldrin 300
12.5 Aluminium 301
12.6 Ammonia 303
ix
12.7 Antimony 304

12.8 Arsenic 306
12.9 Asbestos 308
12.10 Atrazine 308
12.11 Barium 310
12.12 Bentazone 311
12.13 Benzene 312
12.14 Boron 313
12.15 Bromate 315
12.16 Brominated acetic acids 316
12.17 Cadmium 317
12.18 Carbofuran 319
12.19 Carbon tetrachloride 320
12.20 Chloral hydrate (trichloroacetaldehyde) 321
12.21 Chlordane 323
12.22 Chloride 324
12.23 Chlorine 325
12.24 Chlorite and chlorate 326
12.25 Chloroacetones 329
12.26 Chlorophenols (2-chlorophenol, 2,4-dichlorophenol,
2,4,6-trichlorophenol) 329
12.27 Chloropicrin 331
12.28 Chlorotoluron 332
12.29 Chlorpyrifos 333
12.30 Chromium 334
12.31 Copper 335
12.32 Cyanazine 337
12.33 Cyanide 339
12.34 Cyanogen chloride 340
12.35 2,4-D (2,4-dichlorophenoxyacetic acid) 340
12.36 2,4-DB 342
12.37 DDT and metabolites 343
12.38 Dialkyltins 345
12.39 1,2-Dibromo-3-chloropropane (DBCP) 346
12.40 1,2-Dibromoethane (ethylene dibromide) 347
12.41 Dichloroacetic acid 349
12.42 Dichlorobenzenes (1,2-dichlorobenzene, 1,3-dichlorobenzene,
1,4-dichlorobenzene) 350
12.43 1,1-Dichloroethane 352
12.44 1,2-Dichloroethane 353
12.45 1,1-Dichloroethene 354
12.46 1,2-Dichloroethene 355
x
CONTENTS
12.47 Dichloromethane 357

12.48 1,2-Dichloropropane (1,2-DCP) 358
12.49 1,3-Dichloropropane 359
12.50 1,3-Dichloropropene 360
12.51 Dichlorprop (2,4-DP) 361
12.52 Di(2-ethylhexyl)adipate 362
12.53 Di(2-ethylhexyl)phthalate 363
12.54 Dimethoate 364
12.55 Diquat 366
12.56 Edetic acid (EDTA) 367
12.57 Endosulfan 368
12.58 Endrin 369
12.59 Epichlorohydrin 370
12.60 Ethylbenzene 372
12.61 Fenitrothion 373
12.62 Fenoprop (2,4,5-TP; 2,4,5-trichlorophenoxy propionic acid) 374
12.63 Fluoride 375
12.64 Formaldehyde 377
12.65 Glyphosate and AMPA 379
12.66 Halogenated acetonitriles (dichloroacetonitrile,
ibromoacetonitrile, bromochloroacetonitrile,
trichloroacetonitrile) 380
12.67 Hardness 382
12.68 Heptachlor and heptachlor epoxide 383
12.69 Hexachlorobenzene (HCB) 385
12.70 Hexachlorobutadiene (HCBD) 386
12.71 Hydrogen sulde 387
12.72 Inorganic tin 388
12.73 Iodine 389
12.74 Iron 390
12.75 Isoproturon 391
12.76 Lead 392
12.77 Lindane 394
12.78 Malathion 396
12.79 Manganese 397
12.80 MCPA [4-(2-methyl-4-chlorophenoxy)acetic acid] 399
12.81 Mecoprop (MCPP; [2(2-methyl-chlorophenoxy) propionic
acid]) 401
12.82 Mercury 402
12.83 Methoxychlor 403
12.84 Methyl parathion 404
12.85 Metolachlor 405
xi
12.86 Microcystin-LR 407

12.87 Molinate 408
12.88 Molybdenum 410
12.89 Monochloramine 411
12.90 Monochloroacetic acid 412
12.91 Monochlorobenzene 413
12.92 MX 414
12.93 Nickel 415
12.94 Nitrate and nitrite 417
12.95 Nitrilotriacetic acid (NTA) 420
12.96 Parathion 421
12.97 Pendimethalin 422
12.98 Pentachlorophenol (PCP) 424
12.99 Permethrin 425
12.100 pH 426
12.101 2-Phenylphenol and its sodium salt 427
12.102 Polynuclear aromatic hydrocarbons (PAHs) 428
12.103 Propanil 430
12.104 Pyriproxyfen 431
12.105 Selenium 432
12.106 Silver 434
12.107 Simazine 435
12.108 Sodium 436
12.109 Styrene 437
12.110 Sulfate 438
12.111 2,4,5-T (2,4,5-Trichlorophenoxyacetic acid) 439
12.112 Terbuthylazine (TBA) 440
12.113 Tetrachloroethene 442
12.114 Toluene 443
12.115 Total dissolved solids (TDS) 444
12.116 Trichloroacetic acid 445
12.117 Trichlorobenzenes (total) 446
12.118 1,1,1-Trichloroethane 447
12.119 Trichloroethene 448
12.120 Triuralin 450
12.121 Trihalomethanes (bromoform, bromodichloromethane,
dibromochloromethane, chloroform) 451
12.122 Uranium 454
12.123 Vinyl chloride 456
12.124 Xylenes 458
12.125 Zinc 459
xii
CONTENTS
Annex 1 Bibliography 461

Annex 2 Contributors to the development of the Third Edition of the
Guidelines for Drinking-water Quality 467
Annex 3 Default assumptions 486
Annex 4 Chemical summary tables 488
Index 494
xiii
Preface
A ccess to safe drinking-water is essential to health, a basic human right and a com-
ponent of effective policy for health protection.
The importance of water, sanitation and hygiene for health and development has
been reected in the outcomes of a series of international policy forums. These have
included health-oriented conferences such as the International Conference on
Primary Health Care, held in Alma-Ata, Kazakhstan (former Soviet Union), in 1978.
They have also included water-oriented conferences such as the 1977 World Water
Conference in Mar del Plata, Argentina, which launched the water supply and sanita-
tion decade of 19811990, as well as the Millennium Declaration goals adopted by
the General Assembly of the United Nations (UN) in 2000 and the outcome of the
Johannesburg World Summit for Sustainable Development in 2002. Most recently,
the UN General Assembly declared the period from 2005 to 2015 as the International
Decade for Action, Water for Life.
Access to safe drinking-water is important as a health and development issue at a
national, regional and local level. In some regions, it has been shown that investments
in water supply and sanitation can yield a net economic benet, since the reductions
in adverse health effects and health care costs outweigh the costs of undertaking the
interventions. This is true for major water supply infrastructure investments through
to water treatment in the home. Experience has also shown that interventions in
improving access to safe water favour the poor in particular, whether in rural or urban
areas, and can be an effective part of poverty alleviation strategies.
In 19831984 and in 19931997, the World Health Organization (WHO) published
the rst and second editions of the Guidelines for Drinking-water Quality in three
volumes as successors to previous WHO International Standards. In 1995, the
decision was made to pursue the further development of the Guidelines through a
process of rolling revision. This led to the publication of addenda to the second edition
of the Guidelines, on chemical and microbial aspects, in 1998, 1999 and 2002; the
publication of a text on Toxic Cyanobacteria in Water; and the preparation of expert
reviews on key issues preparatory to the development of a third edition of the
Guidelines.
xv
In 2000, a detailed plan of work was agreed upon for development of the third
edition of the Guidelines. As with previous editions, this work was shared between
WHO Headquarters and the WHO Regional Ofce for Europe (EURO). Leading the
process of the development of the third edition were the Programme on Water
Sanitation and Health within Headquarters and the European Centre for Environ-
ment and Health, Rome, within EURO. Within WHO Headquarters, the Programme
on Chemical Safety provided inputs on some chemical hazards, and the Programme
on Radiological Safety contributed to the section dealing with radiological aspects. All
six WHO Regional Ofces participated in the process.
This revised Volume 1 of the Guidelines is accompanied by a series of publications
providing information on the assessment and management of risks associated with
microbial hazards and by internationally peer-reviewed risk assessments for specic
chemicals. These replace the corresponding parts of the previous Volume 2. Volume
3 provides guidance on good practice in surveillance, monitoring and assessment of
drinking-water quality in community supplies. The Guidelines are also accompanied
by other publications explaining the scientic basis of their development and pro-
viding guidance on good practice in implementation.
This volume of the Guidelines for Drinking-water Quality explains requirements to
ensure drinking-water safety, including minimum procedures and specic guideline
values, and how those requirements are intended to be used. The volume also
describes the approaches used in deriving the guidelines, including guideline values.
It includes fact sheets on signicant microbial and chemical hazards. The develop-
ment of this third edition of the Guidelines for Drinking-water Quality includes a sub-
stantive revision of approaches to ensuring microbial safety. This takes account of
important developments in microbial risk assessment and its linkages to risk man-
agement. The development of this orientation and content was led over an extended
period by Dr Arie Havelaar (RIVM, Netherlands) and Dr Jamie Bartram (WHO).
Since the second edition of WHOs Guidelines for Drinking-water Quality, there
have been a number of events that have highlighted the importance and furthered
understanding of various aspects of drinking-water quality and health. These are
reected in this third edition of the Guidelines.
These Guidelines supersede those in previous editions (19831984, 19931997 and
addenda in 1998, 1999 and 2002) and previous International Standards (1958, 1963
and 1971). The Guidelines are recognized as representing the position of the UN
system on issues of drinking-water quality and health by UN-Water, the body that
coordinates amongst the 24 UN agencies and programmes concerned with water
issues. This edition of the Guidelines further develops concepts, approaches and infor-
mation in previous editions:
Experience has shown that microbial hazards continue to be the primary concern
in both developing and developed countries. Experience has also shown the value
of a systematic approach towards securing microbial safety. This edition includes
xvi
PREFACE
signicantly expanded guidance on ensuring microbial safety of drinking-water,

building on principles such as the multiple-barrier approach and the importance
of source protection considered in previous editions. The Guidelines are accom-
panied by documentation describing approaches towards fullling requirements
for microbial safety and providing guidance to good practice in ensuring that safety
is achieved.
Information on many chemicals has been revised. This includes information on
chemicals not considered previously; revisions to take account of new scientic
information; and, in some cases, lesser coverage where new information suggests a
lesser priority.
Experience has also shown the necessity of recognizing the important roles of many
different stakeholders in ensuring drinking-water safety. This edition includes dis-
cussion of the roles and responsibilities of key stakeholders in ensuring drinking-
water safety.
The need for different tools and approaches in supporting safe management of
large piped supplies versus small community supplies remains relevant, and this
edition describes the principal characteristics of the different approaches.
There has been increasing recognition that only a few key chemicals cause large-
scale health effects through drinking-water exposure. These include uoride and
arsenic. Other chemicals, such as lead, selenium and uranium, may also be signif-
icant under certain conditions. Interest in chemical hazards in drinking-water was
highlighted by recognition of the scale of arsenic exposure through drinking-water
in Bangladesh and elsewhere. The revised Guidelines and associated publications
provide guidance on identifying local priorities and on management of the chem-
icals associated with large-scale effects.
WHO is frequently approached for guidance on the application of the Guidelines
for Drinking-water Quality to situations other than community supplies or
managed utilities. This revised edition includes information on application of the
Guidelines to several specic circumstances and is accompanied by texts dealing
with some of these in greater detail.
The Guidelines for Drinking-water Quality are kept up to date through a process of
rolling revision, which leads to periodic release of documents that may add to or
supersede information in this volume.
The Guidelines are addressed primarily to water and health regulators, policy-
makers and their advisors, to assist in the development of national standards. The
Guidelines and associated documents are also used by many others as a source of
information on water quality and health and on effective management approaches.
xvii
Acknowledgements
T he preparation of the current edition of the Guidelines for Drinking-water Quality

and supporting documentation covered a period of eight years and involved the
participation of over 490 experts from 90 developing and developed countries. The
contributions of all who participated in the preparation and nalization of the Guide-
lines for Drinking-water Quality, including those individuals listed in Annex 2, are
gratefully acknowledged.
The work of the following Working Groups was crucial to the development of the
third edition of the Guidelines for Drinking-water Quality:
Microbial aspects working group

Ms T. Boonyakarnkul, Department of Health, Thailand (Surveillance and control)
Dr D. Cunliffe, SA Department of Human Services, Australia (Public health)
Prof. W. Grabow, University of Pretoria, South Africa (Pathogen-specic information)
Dr A. Havelaar, RIVM, The Netherlands (Working Group coordinator; Risk
assessment)
Prof. M. Sobsey, University of North Carolina, USA (Risk management)
Chemical aspects working group

Mr J.K. Fawell, United Kingdom (Organic and inorganic constituents)
Ms M. Giddings, Health Canada (Disinfectants and disinfection by-products)
Prof. Y. Magara, Hokkaido University, Japan (Analytical achievability)
Dr E. Ohanian, EPA, USA (Disinfectants and disinfection by-products)
Dr P. Toft, Canada (Pesticides)
Protection and control working group

Dr I. Chorus, Umweltbundesamt, Germany (Resource and source protection)
Dr J. Cotruvo, USA (Materials and additives)
Dr G. Howard, DfID, Bangladesh, and formerly Loughborough University, United
Kingdom (Monitoring and assessment)
Mr P. Jackson, WRc-NSF, United Kingdom (Treatment achievability)
xviii
ACKNOWLEDGEMENTS
The WHO coordinators were:

Dr J. Bartram, Coordinator, Programme on Water Sanitation and Health, WHO Head-
quarters, and formerly WHO European Centre for Environmental Health
Mr P. Callan, Programme on Water Sanitation and Health, WHO Headquarters, on
secondment from National Health and Medical Research Council, Australia
Ms C. Vickers acted as a liaison between the Working Groups and the International
Programme on Chemical Safety, WHO Headquarters.
Ms Marla Sheffer of Ottawa, Canada, was responsible for the editing of the Guide-
lines. Mr Hiroki Hashizume provided support to the work of the Chemical Aspects
Working Group. Ms Mary-Ann Lundby, Ms Grazia Motturi and Ms Penny Ward pro-
vided secretarial and administrative support throughout the process and to individ-
ual meetings.
The preparation of these Guidelines would not have been possible without the gen-
erous support of the following, which is gratefully acknowledged: the Ministry of
Health of Italy; the Ministry of Health, Labour and Welfare of Japan; the National
Health and Medical Research Council, Australia; the Swedish International Develop-
ment Cooperation Agency, Sweden and the United States Environmental Protection
Agency.
xix
Acronyms and abbreviations
used in text
AAS atomic absorption spectrometry

AD Alzheimer disease
ADI acceptable daily intake
AES atomic emission spectrometry
AIDS acquired immunodeciency syndrome
AMPA aminomethylphosphonic acid
BaP benzo[a]pyrene
BDCM bromodichloromethane
BMD benchmark dose
bw body weight
CAC Codex Alimentarius Commission

CAS Chemical Abstracts Service
CICAD Concise International Chemical Assessment Document
CSAF chemical-specic adjustment factor
Ct product of disinfectant concentration and contact time
DAEC diffusely adherent E. coli

DALY disability-adjusted life-year
DBCM dibromochloromethane
DBCP 1,2-dibromo-3-chloropropane
DBP disinfection by-product
DCB dichlorobenzene
DCP dichloropropane
DDT dichlorodiphenyltrichloroethane
DEHA di(2-ethylhexyl)adipate
DEHP di(2-ethylhexyl)phthalate
DNA deoxyribonucleic acid
xx
ACRONYMS AND ABBREVIATIONS USED IN TEXT
EAAS electrothermal atomic absorption spectrometry

EAEC enteroaggregative E. coli
EBCT empty bed contact time
EC electron capture
ECD electron capture detector
EDTA edetic acid; ethylenediaminetetraacetic acid
EHC Environmental Health Criteria monograph
EHEC enterohaemorrhagic E. coli
EIEC enteroinvasive E. coli
ELISA enzyme-linked immunosorbent assay
EPEC enteropathogenic E. coli
ETEC enterotoxigenic E. coli
EURO WHO Regional Ofce for Europe
FAAS ame atomic absorption spectrometry

FAO Food and Agriculture Organization of the United Nations
FD uorescence detector
FID ame ionization detector
FPD ame photodiode detector
GAC granular activated carbon

GAE granulomatous amoebic encephalitis
GC gas chromatography
GL guidance level (used for radionuclides in drinking-water)
GV guideline value
HACCP hazard analysis and critical control points

HAd human adenovirus
HAstV human astrovirus
HAV hepatitis A virus
Hb haemoglobin
HCB hexachlorobenzene
HCBD hexachlorobutadiene
HCH hexachlorocyclohexane
HEV hepatitis E virus
HIV human immunodeciency virus
HPC heterotrophic plate count
HPLC high-performance liquid chromatography
HRV human rotavirus
HuCV human calicivirus
HUS haemolytic uraemic syndrome
xxi
IAEA International Atomic Energy Agency

IARC International Agency for Research on Cancer
IC ion chromatography
ICP inductively coupled plasma
ICRP International Commission on Radiological Protection
IDC individual dose criterion
IPCS International Programme on Chemical Safety
ISO International Organization for Standardization
JECFA Joint FAO/WHO Expert Committee on Food Additives

JMPR Joint FAO/WHO Meeting on Pesticide Residues
Kow octanol/water partition coefcient
LI Langelier Index
LOAEL lowest-observed-adverse-effect level
MCB monochlorobenzene
MCPA 4-(2-methyl-4-chlorophenoxy)acetic acid
MCPP 2(2-methyl-chlorophenoxy) propionic acid; mecoprop
metHb methaemoglobin
MMT methylcyclopentadienyl manganese tricarbonyl
MS mass spectrometry
MX 3-chloro-4-dichloromethyl-5-hydroxy-2(5H)-furanone
NAS National Academy of Sciences (USA)

NOAEL no-observed-adverse-effect level
NOEL no-observed-effect level
NTA nitrilotriacetic acid
NTP National Toxicology Program (USA)
NTU nephelometric turbidity unit
P/A presence/absence
PAC powdered activated carbon
PAH polynuclear aromatic hydrocarbon
PAM primary amoebic meningoencephalitis
PCP pentachlorophenol
PCR polymerase chain reaction
PD photoionization detector
PMTDI provisional maximum tolerable daily intake
PT purge and trap
PTDI provisional tolerable daily intake
xxii
ACRONYMS AND ABBREVIATIONS USED IN TEXT
PTWI provisional tolerable weekly intake

PVC polyvinyl chloride
QMRA quantitative microbial risk assessment
RDL reference dose level

RIVM Rijksinstituut voor Volksgezondheid en Milieu (Dutch National Insti-
tute of Public Health and Environmental Protection)
RNA ribonucleic acid
SI Systme international dunits (International System of Units)

SOP standard operating procedure
SPADNS sulfo phenyl azo dihydroxy naphthalene disulfonic acid
TBA terbuthylazine
TCB trichlorobenzene
TCU true colour unit
TD05 tumorigenic dose05, the intake or exposure associated with a 5% excess
incidence of tumours in experimental studies in animals
TDI tolerable daily intake
TDS total dissolved solids
THM trihalomethane
TID thermal ionization detector
UF uncertainty factor
UNICEF United Nations Childrens Fund
UNSCEAR United Nations Scientic Committee on the Effects of Atomic
Radiation
USA United States of America
US EPA United States Environmental Protection Agency
UV ultraviolet
UVPAD ultraviolet photodiode array detector
WHO World Health Organization

WHOPES World Health Organization Pesticide Evaluation Scheme
WQT water quality target
WSP water safety plan
YLD years of healthy life lost in states of less than full health, i.e., years lived
with a disability
YLL years of life lost by premature mortality
xxiii
1
Introduction
1.1 General considerations and principles
T he primary purpose of the Guidelines for Drinking-water Quality is the protection

of public health.
Water is essential to sustain life, and a
satisfactory (adequate, safe and accessi-
Diseases related to contamination of
ble) supply must be available to all. drinking-water constitute a major burden
Improving access to safe drinking-water on human health. Interventions to im-
can result in tangible benets to health. prove the quality of drinking-water pro-
vide signicant benets to health.
Every effort should be made to achieve
a drinking-water quality as safe as
practicable.
Safe drinking-water, as dened by the Guidelines, does not represent any signi-
cant risk to health over a lifetime of consumption, including different sensitivities that
may occur between life stages. Those at greatest risk of waterborne disease are infants
and young children, people who are debilitated or living under unsanitary conditions
and the elderly. Safe drinking-water is suitable for all usual domestic purposes, includ-
ing personal hygiene. The Guidelines are applicable to packaged water and ice
intended for human consumption. However, water of higher quality may be required
for some special purposes, such as renal dialysis and cleaning of contact lenses, or for
certain purposes in food production and pharmaceutical use. Those who are severely
immunocompromised may need to take additional steps, such as boiling drinking-
water, due to their susceptibility to organisms that would not normally be of concern
through drinking-water. The Guidelines may not be suitable for the protection of
aquatic life, or for some industries.
The Guidelines are intended to support the development and implementation of
risk management strategies that will ensure the safety of drinking-water supplies
through the control of hazardous constituents of water. These strategies may include
national or regional standards developed from the scientic basis provided in the
Guidelines. The Guidelines describe reasonable minimum requirements of safe prac-
tice to protect the health of consumers and/or derive numerical guideline values for
1
constituents of water or indicators of water quality. Neither the minimum safe prac-
tices nor the numeric guideline values are mandatory limits. In order to dene such
limits, it is necessary to consider the guidelines in the context of local or national envi-
ronmental, social, economic and cultural conditions.
The main reason for not promoting the adoption of international standards for
drinking-water quality is the advantage provided by the use of a riskbenet approach
(qualitative or quantitative) in the establishment of national standards and regulations.
Further, the Guidelines are best implemented through an integrated preventive man-
agement framework for safety applied from catchment to consumer. The Guidelines
provide a scientic point of departure for national authorities to develop drinking-
water regulations and standards appropriate for the national situation. In developing
standards and regulations, care should be taken to ensure that scarce resources are not
unnecessarily diverted to the development of standards and the monitoring of sub-
stances of relatively minor importance to public health. The approach followed in these
Guidelines is intended to lead to national standards and regulations that can be readily
implemented and enforced and are protective of public health.
The nature and form of drinking-water standards may vary among countries and
regions. There is no single approach that is universally applicable. It is essential in the
development and implementation of standards that the current and planned legisla-
tion relating to water, health and local government are taken into account and that
the capacity to develop and implement regulations is assessed. Approaches that may
work in one country or region will not necessarily transfer to other countries or
regions. It is essential that each country review its needs and capacities in developing
a regulatory framework.
The judgement of safety or what is an acceptable level of risk in particular cir-
cumstances is a matter in which society as a whole has a role to play. The nal judge-
ment as to whether the benet resulting from the adoption of any of the guidelines
and guideline values as national or local standards justies the cost is for each country
to decide.
Although the Guidelines describe a quality of water that is acceptable for lifelong
consumption, the establishment of these Guidelines, including guideline values,
should not be regarded as implying that the quality of drinking-water may be
degraded to the recommended level. Indeed, a continuous effort should be made to
maintain drinking-water quality at the highest possible level.
An important concept in the allocation of resources to improving drinking-water
safety is that of incremental improvements towards long-term targets. Priorities set
to remedy the most urgent problems (e.g., protection from pathogens; see
section 1.1.1) may be linked to long-term targets of further water quality im-
provements (e.g., improvements in the acceptability of drinking-water; see section
1.1.5).
The basic and essential requirements to ensure the safety of drinking-water are a
framework for safe drinking-water, comprising health-based targets established by
2
1. INTRODUCTION
a competent health authority; adequate and properly managed systems (adequate

infrastructure, proper monitoring and effective planning and management); and a
system of independent surveillance.
A holistic approach to drinking-water supply risk assessment and risk management
increases condence in the safety of drinking-water. This approach entails systematic
assessment of risks throughout a drinking-water supply from the catchment and its
source water through to the consumer and identication of the ways in which these
risks can be managed, including methods to ensure that control measures are working
effectively. It incorporates strategies to deal with day-to-day management of water
quality, including upsets and failures.
The Guidelines are applicable to large metropolitan and small community piped
drinking-water systems and to non-piped drinking-water systems in communities and
in individual dwellings. The Guidelines are also applicable to a range of specic cir-
cumstances, including large buildings, travellers and conveyances.
The great majority of evident water-related health problems are the result of micro-
bial (bacteriological, viral, protozoan or other biological) contamination. Neverthe-
less, an appreciable number of serious health concerns may occur as a result of the
chemical contamination of drinking-water.
1.1.1 Microbial aspects

Securing the microbial safety of drinking-water supplies is based on the use of
multiple barriers, from catchment to consumer, to prevent the contamination of
drinking-water or to reduce contamination to levels not injurious to health. Safety is
increased if multiple barriers are in place, including protection of water resources,
proper selection and operation of a series of treatment steps and management of dis-
tribution systems (piped or otherwise)
to maintain and protect treated water
quality. The preferred strategy is a
The potential health consequences of
management approach that places the microbial contamination are such that
primary emphasis on preventing or its control must always be of para-
reducing the entry of pathogens into mount importance and must never be
compromised.
water sources and reducing reliance on
treatment processes for removal of
pathogens.
In general terms, the greatest microbial risks are associated with ingestion of water
that is contaminated with human or animal (including bird) faeces. Faeces can be a
source of pathogenic bacteria, viruses, protozoa and helminths.
Faecally derived pathogens are the principal concerns in setting health-based
targets for microbial safety. Microbial water quality often varies rapidly and over a
wide range. Short-term peaks in pathogen concentration may increase disease risks
considerably and may trigger outbreaks of waterborne disease. Furthermore, by the
time microbial contamination is detected, many people may have been exposed. For
3
these reasons, reliance cannot be placed solely on end-product testing, even when
frequent, to ensure the microbial safety of drinking-water.
Particular attention should be directed to a water safety framework and imple-
menting comprehensive water safety plans (WSPs) to consistently ensure drinking-
water safety and thereby protect public health (see chapter 4). Management of
microbial drinking-water safety requires a system-wide assessment to determine
potential hazards that can affect the system (see section 4.1); identication of the
control measures needed to reduce or eliminate the hazards, and operational moni-
toring to ensure that barriers within the system are functioning efciently (see section
4.2); and the development of management plans to describe actions taken under both
normal and incident conditions. These are the three components of a WSP.
Failure to ensure drinking-water safety may expose the community to the risk of
outbreaks of intestinal and other infectious diseases. Drinking-water-borne outbreaks
are particularly to be avoided because of their capacity to result in the simultaneous
infection of a large number of persons and potentially a high proportion of the
community.
In addition to faecally borne pathogens, other microbial hazards (e.g., guinea worm
[Dracunculus medinensis], toxic cyanobacteria and Legionella) may be of public health
importance under specic circumstances.
The infective stages of many helminths, such as parasitic roundworms and at-
worms, can be transmitted to humans through drinking-water. As a single mature
larva or fertilized egg can cause infection, these should be absent from drinking-water.
However, the water route is relatively unimportant for helminth infection, except in
the case of the guinea worm.
Legionella bacteria are ubiquitous in the environment and can proliferate at the
higher temperatures experienced at times in piped drinking-water distribution
systems and more commonly in hot and warm water distribution systems. Exposure
to Legionella from drinking-water is through inhalation and can be controlled through
the implementation of basic water quality management measures in buildings and
through the maintenance of disinfection residuals throughout the piped distribution
system.
Public health concern regarding cyanobacteria relates to their potential to produce
a variety of toxins, known as cyanotoxins. In contrast to pathogenic bacteria,
cyanobacteria do not proliferate within the human body after uptake; they prolifer-
ate only in the aquatic environment before intake. While the toxic peptides (e.g.,
microcystins) are usually contained within the cells and thus may be largely elimi-
nated by ltration, toxic alkaloids such as cylindrospermopsin and neurotoxins are
also released into the water and may break through ltration systems.
Some microorganisms will grow as biolms on surfaces in contact with water. With
few exceptions, such as Legionella, most of these organisms do not cause illness in
healthy persons, but they can cause nuisance through generation of tastes and odours
or discoloration of drinking-water supplies. Growth following drinking-water treat-
4
1. INTRODUCTION
ment is often referred to as regrowth. It is typically reected in measurement of

increasing heterotrophic plate counts (HPC) in water samples. Elevated HPC occur
especially in stagnant parts of piped distribution systems, in domestic plumbing, in
some bottled water and in plumbed-in devices such as softeners, carbon lters and
vending machines.
While water can be a very signicant source of infectious organisms, many of the
diseases that may be waterborne may also be transmitted by other routes, including
person-to-person contact, droplets and aerosols and food intake. Depending on cir-
cumstance and in the absence of waterborne outbreaks, these routes may be more
important than waterborne transmission.
Microbial aspects of water quality are considered in more detail in chapter 7, with
fact sheets on specic microorganisms provided in chapter 11.
1.1.2 Disinfection
Disinfection is of unquestionable importance in the supply of safe drinking-water.
The destruction of microbial pathogens is essential and very commonly involves the
use of reactive chemical agents such as chlorine.
Disinfection is an effective barrier to many pathogens (especially bacteria) during
drinking-water treatment and should be used for surface waters and for groundwa-
ter subject to faecal contamination. Residual disinfection is used to provide a partial
safeguard against low-level contamination and growth within the distribution system.
Chemical disinfection of a drinking-water supply that is faecally contaminated will
reduce the overall risk of disease but may not necessarily render the supply safe. For
example, chlorine disinfection of drinking-water has limitations against the proto-
zoan pathogens in particular Cryptosporidium and some viruses. Disinfection ef-
cacy may also be unsatisfactory against pathogens within ocs or particles, which
protect them from disinfectant action. High levels of turbidity can protect microor-
ganisms from the effects of disinfection, stimulate the growth of bacteria and give rise
to a signicant chlorine demand. An effective overall management strategy incorpo-
rates multiple barriers, including source water protection and appropriate treatment
processes, as well as protection during storage and distribution in conjunction with
disinfection to prevent or remove microbial contamination.
The use of chemical disinfectants in water treatment usually results in the forma-
tion of chemical by-products. However, the risks to health from these by-products are
extremely small in comparison with the
risks associated with inadequate disin- Disinfection should not be compromised
fection, and it is important that disinfec- in attempting to control disinfection by-
tion not be compromised in attempting products (DBPs).
to control such by-products.

Some disinfectants such as chlorine can be easily monitored and controlled as a
drinking-water disinfectant, and frequent monitoring is recommended wherever
chlorination is practised.
5
Disinfection of drinking-water is considered in more detail in chapter 8, with fact

sheets on specic disinfectants and DBPs provided in chapter 12.
1.1.3 Chemical aspects

The health concerns associated with chemical constituents of drinking-water differ
from those associated with microbial contamination and arise primarily from the
ability of chemical constituents to cause adverse health effects after prolonged periods
of exposure. There are few chemical constituents of water that can lead to health prob-
lems resulting from a single exposure, except through massive accidental contamina-
tion of a drinking-water supply. Moreover, experience shows that in many, but not all,
such incidents, the water becomes undrinkable owing to unacceptable taste, odour
and appearance.
In situations where short-term exposure is not likely to lead to health impairment,
it is often most effective to concentrate the available resources for remedial action on
nding and eliminating the source of contamination, rather than on installing expen-
sive drinking-water treatment for the removal of the chemical constituent.
There are many chemicals that may occur in drinking-water; however, only a few
are of immediate health concern in any given circumstance. The priority given to both
monitoring and remedial action for chemical contaminants in drinking-water should
be managed to ensure that scarce resources are not unnecessarily directed towards
those of little or no health concern.
Exposure to high levels of uoride, which occurs naturally, can lead to mottling of
teeth and, in severe cases, crippling skeletal uorosis. Similarly, arsenic may occur
naturally, and excess exposure to arsenic in drinking-water may result in a signicant
risk of cancer and skin lesions. Other naturally occurring chemicals, including
uranium and selenium, may also give rise to health concern when they are present in
excess.
The presence of nitrate and nitrite in water has been associated with methaemo-
globinaemia, especially in bottle-fed infants. Nitrate may arise from the excessive
application of fertilizers or from leaching of wastewater or other organic wastes into
surface water and groundwater.
Particularly in areas with aggressive or acidic waters, the use of lead pipes and t-
tings or solder can result in elevated lead levels in drinking-water, which cause adverse
neurological effects.
There are few chemicals for which the contribution from drinking-water to overall
intake is an important factor in preventing disease. One example is the effect of u-
oride in drinking-water in increasing prevention against dental caries. The Guidelines
do not attempt to dene minimum desirable concentrations for chemicals in drink-
ing-water.
Guideline values are derived for many chemical constituents of drinking-water. A
guideline value normally represents the concentration of a constituent that does not
result in any signicant risk to health over a lifetime of consumption. A number of
6
1. INTRODUCTION
provisional guideline values have been established based on the practical level of treat-
ment achievability or analytical achievability. In these cases, the guideline value is
higher than the calculated health-based value.
The chemical aspects of drinking-water quality are considered in more detail in
chapter 8, with fact sheets on specic chemical contaminants provided in chapter 12.
1.1.4 Radiological aspects

The health risk associated with the presence of naturally occurring radionuclides in
drinking-water should also be taken into consideration, although the contribution of
drinking-water to total exposure to radionuclides is very small under normal
circumstances.
Formal guideline values are not set for individual radionuclides in drinking-water.
Rather, the approach used is based on screening drinking-water for gross alpha and
gross beta radiation activity. While nding levels of activity above screening values
does not indicate any immediate risk to health, it should trigger further investigation
into determining the radionuclides responsible and the possible risks, taking into
account local circumstances.
The guidance values recommended in this volume do not apply to drinking-water
supplies contaminated during emergencies arising from accidental releases of radioac-
tive substances to the environment.
Radiological aspects of drinking-water quality are considered in more detail in
chapter 9.
1.1.5 Acceptability aspects

Water should be free of tastes and odours that would be objectionable to the major-
ity of consumers.
In assessing the quality of drinking-water, consumers rely principally upon their
senses. Microbial, chemical and physical water constituents may affect the appearance,
odour or taste of the water, and the consumer will evaluate the quality and accept-
ability of the water on the basis of these criteria. Although these substances may have
no direct health effects, water that is highly turbid, is highly coloured or has an objec-
tionable taste or odour may be regarded by consumers as unsafe and may be rejected.
In extreme cases, consumers may avoid aesthetically unacceptable but otherwise safe
drinking-water in favour of more pleasant but potentially unsafe sources. It is there-
fore wise to be aware of consumer perceptions and to take into account both health-
related guidelines and aesthetic criteria when assessing drinking-water supplies and
developing regulations and standards.
Changes in the normal appearance, odour or taste of a drinking-water supply may
signal changes in the quality of the raw water source or deciencies in the treatment
process and should be investigated.
Acceptability aspects of drinking-water quality are considered in more detail in
chapter 10.
7
1.2 Roles and responsibilities in drinking-water

safety management
Preventive management is the preferred approach to drinking-water safety and should
take account of the characteristics of the drinking-water supply from catchment and
source to its use by consumers. As many aspects of drinking-water quality manage-
ment are often outside the direct responsibility of the water supplier, it is essential that
a collaborative multiagency approach be adopted to ensure that agencies with respon-
sibility for specic areas within the water cycle are involved in the management of
water quality. One example is where catchments and source waters are beyond the
drinking-water suppliers jurisdiction.
Consultation with other authorities will
generally be necessary for other elements A preventive integrated management
approach with collaboration from all rele-
of drinking-water quality management, vant agencies is the preferred approach to
such as monitoring and reporting ensuring drinking-water safety.
requirements, emergency response plans
and communication strategies.
Major stakeholders that could affect or be affected by decisions or activities of the
drinking-water supplier should be encouraged to coordinate their planning and man-
agement activities where appropriate. These could include, for example, health and
resource management agencies, consumers, industry and plumbers. Appropriate
mechanisms and documentation should be established for stakeholder commitment
and involvement.
1.2.1 Surveillance and quality control

In order to protect public health, a dual-role approach, differentiating the roles and
responsibilities of service providers from those of an authority responsible for inde-
pendent oversight protective of public health (drinking-water supply surveillance),
has proven to be effective.
Organizational arrangements for the maintenance and improvement of drinking-
water supply services should take into account the vital and complementary roles of
the agency responsible for surveillance and of the water supplier. The two functions
of surveillance and quality control are best performed by separate and independent
entities because of the conict of interest that arises when the two are combined. In
this:
national agencies provide a framework of targets, standards and legislation to

enable and require suppliers to meet dened obligations;
agencies involved in supplying water for consumption by any means should be
required to ensure and verify that the systems they administer are capable of
delivering safe water and that they routinely achieve this; and
a surveillance agency is responsible for independent (external) surveillance
through periodic audit of all aspects of safety and/or verication testing.
8
1. INTRODUCTION
In practice, there may not always be a clear division of responsibilities between the
surveillance and drinking-water supply agencies. In some cases, the range of profes-
sional, governmental, nongovernmental and private institutions may be wider and
more complex than that discussed above. Whatever the existing framework, it is
important that clear strategies and struc-
tures be developed for implementing
Surveillance of drinking-water quality can
water safety plans, quality control and
be dened as the continuous and vigilant
surveillance, collating and summarizing public health assessment and review of
data, reporting and disseminating the the safety and acceptability of drinking-
ndings and taking remedial action. water supplies (WHO, 1976).
Clear lines of accountability and com-

munication are essential.
Surveillance is an investigative activity undertaken to identify and evaluate poten-
tial health risks associated with drinking-water. Surveillance contributes to the pro-
tection of public health by promoting improvement of the quality, quantity,
accessibility, coverage (i.e., populations with reliable access), affordability and conti-
nuity of drinking-water supplies (termed service indicators). The surveillance
authority must have the authority to determine whether a water supplier is fullling
its obligations.
In most countries, the agency responsible for the surveillance of drinking-water
supply services is the ministry of health (or public health) and its regional or depart-
mental ofces. In some countries, it may be an environmental protection agency; in
others, the environmental health departments of local government may have some
responsibility.
Surveillance requires a systematic programme of surveys, which may include audit-
ing, analysis, sanitary inspection and/or institutional and community aspects. It
should cover the whole of the drinking-water system, including sources and activities
in the catchment, transmission infrastructure, treatment plants, storage reservoirs and
distribution systems (whether piped or unpiped).
Ensuring timely action to prevent problems and ensure the correction of faults
should be an aim of a surveillance programme. There may at times be a need for
penalties to encourage and ensure compliance. The surveillance agency must there-
fore be supported by strong and enforce-
able legislation. However, it is important
Drinking-water suppliers are responsible
that the agency develops a positive and
at all times for the quality and safety of the
supportive relationship with suppliers, water that they produce.
with the application of penalties used as
a last resort.
The surveillance agency should be empowered by law to compel water suppliers to
recommend the boiling of water or other measures when microbial contamination
that could threaten public health is detected.
9
1.2.2 Public health authorities

In order to effectively support the protection of public health, a national entity with
responsibility for public health will normally act in four areas:
Surveillance of health status and trends, including outbreak detection and investi-
gation, generally directly but in some instances through a decentralized body.
Directly establish drinking-water norms and standards. National public health
authorities often have the primary responsibility for setting norms on drinking-
water supply, which may include the setting of water quality targets (WQTs), per-
formance and safety targets and directly specied requirements (e.g., treatment).
Normative activity is not restricted to water quality but also includes, for example,
regulation and approval of materials and chemicals used in the production and dis-
tribution of drinking-water (see section 8.5.4) and establishing minimum stan-
dards in areas such as domestic plumbing (see section 1.2.10). Nor is it a static
activity, because as changes occur in drinking-water supply practice, in technolo-
gies and in materials available (e.g., in plumbing materials and treatment
processes), so health priorities and responses to them will also change.
Representing health concerns in wider policy development, especially health policy
and integrated water resource management (see section 1.2.4). Health concerns will
often suggest a supportive role towards resource allocation to those concerned with
drinking-water supply extension and improvement; will often involve lobbying for
the primary requirement to satisfy drinking-water needs above other priorities; and
may imply involvement in conict resolution.
Direct action, generally through subsidiary bodies (e.g., regional and local envi-
ronmental health administrations) or by providing guidance to other local entities
(e.g., local government) in surveillance of drinking-water supplies. These roles vary
widely according to national and local structures and responsibilities and fre-
quently include a supportive role to community suppliers, where local authorities
often intervene directly.
Public health surveillance (i.e., surveillance of health status and trends) contributes
to verifying drinking-water safety. It takes into consideration disease in the entire pop-
ulation, which may be exposed to pathogenic microorganisms from a range of sources,
not only drinking-water. National public health authorities may also undertake or
direct research to evaluate the role of water as a risk factor in disease for example,
through casecontrol, cohort or intervention studies. Public health surveillance teams
typically operate at national, regional and local levels, as well as in cities and rural
health centres. Routine public health surveillance includes:
ongoing monitoring of reportable diseases, many of which can be caused by

waterborne pathogens;
outbreak detection;
long-term trend analysis;
10
1. INTRODUCTION
geographic and demographic analysis; and

feedback to water authorities.
Public health surveillance can be enhanced in a variety of ways to identify possible
waterborne outbreaks in response to suspicion about unusual disease incidence or fol-
lowing deterioration of water quality. Epidemiological investigations include:
outbreak investigations;
intervention studies to evaluate intervention options; and
casecontrol or cohort studies to evaluate the role of water as a risk factor in
disease.
However, public health surveillance cannot be relied upon to provide information in
a timely manner to enable short-term operational response to control waterborne
disease. Limitations include:
outbreaks of non-reportable disease;
time delay between exposure and illness;
time delay between illness and reporting;
low level of reporting; and
difculties in identifying causative pathogens and sources.
The public health authority operates reactively, as well as proactively, against the back-
ground of overall public health policy and in interaction with all stakeholders. In
accounting for public health context, priority will normally be afforded to disadvan-
taged groups. This will generally entail balancing drinking-water safety management
and improvement with the need to ensure access to reliable supplies of safe drinking-
water in adequate quantities.
In order to develop an understanding of the national drinking-water situation, the
national public health authority should periodically produce reports outlining the
state of national water quality and highlighting public health concerns and priorities
in the context of overall public health priorities. This implies the need for effective
exchange of information between local, regional and national agencies.
National health authorities should lead or participate in formulation and imple-
mentation of policy to ensure access to some form of reliable, safe drinking-water
supply. Where this has not been achieved, appropriate tools and education should be
made available to implement individual or household-level treatment and safe storage.
1.2.3 Local authorities

Local environmental health authorities often play an important role in managing
water resources and drinking-water supplies. This may include catchment inspection
and authorization of activities in the catchment that may impact on source water
quality. It can also include verifying and auditing (surveillance) of the management
of formal drinking-water systems. Local environmental health authorities will also
give specic guidance to communities or individuals in designing and implementing
11
community and household drinking-water systems and correcting deciencies, and

they may also be responsible for surveillance of community and household drinking-
water supplies. They have an important role to play in educating consumers where
household water treatment is necessary.
Management of household and small community drinking-water supplies gener-
ally requires education programmes about drinking-water supply and water quality.
Such programmes should normally include:
water hygiene awareness raising;
basic technical training and technology transfer in drinking-water supply and
management;
consideration of and approaches to overcoming sociocultural barriers to accept-
ance of water quality interventions;
motivation, mobilization and social marketing activities; and
a system of continued support, follow-up and dissemination of the water quality
programme to achieve and maintain sustainability.
These programmes can be administered at the community level by local health
authorities or other entities, such as nongovernmental organizations and the private
sector. If the programme arises from other entities, the involvement of the local health
authority in the development and implementation of the water quality education and
training programme is strongly encouraged.
Approaches to participatory hygiene and sanitation education and training pro-
grammes are described in other WHO documents (see Simpson-Hbert et al., 1996;
Sawyer et al., 1998; Brikk, 2000).
1.2.4 Water resource management

Water resource management is an integral aspect of the preventive management of
drinking-water quality. Prevention of microbial and chemical contamination of
source water is the rst barrier against drinking-water contamination of public health
concern.
Water resource management and potentially polluting human activity in the catch-
ment will inuence water quality downstream and in aquifers. This will impact on
treatment steps required to ensure safe water, and preventive action may be prefer-
able to upgrading treatment.
The inuence of land use on water quality should be assessed as part of water
resource management. This assessment is not normally undertaken by health author-
ities or drinking-water supply agencies alone and should take into consideration:
land cover modication;
extraction activities;
construction/modication of waterways;
application of fertilizers, herbicides, pesticides and other chemicals;
livestock density and application of manure;
12
1. INTRODUCTION
road construction, maintenance and use;

various forms of recreation;
urban or rural residential development, with particular attention to excreta dis-
posal, sanitation, landll and waste disposal; and
other potentially polluting human activities, such as industry, military sites,
etc.
Water resource management may be the responsibility of catchment management

agencies and/or other entities controlling or affecting water resources, such as indus-
trial, agricultural, navigation and ood control entities.
The extent to which the responsibilities of health or drinking-water supply agen-
cies include water resource management varies greatly between countries and com-
munities. Regardless of government structures and sector responsibilities, it is
important that health authorities liaise and collaborate with sectors managing the
water resource and regulating land use in the catchment.
Establishing close collaboration between the public health authority, water supplier
and resource management agency assists recognition of the health hazards potentially
occurring in the system. It is also important for ensuring that the protection of drink-
ing-water resources is considered in decisions for land use or regulations to control
contamination of water resources. Depending on the setting, this may include involve-
ment of further sectors, such as agriculture, trafc, tourism or urban development.
To ensure the adequate protection of drinking-water sources, national authorities
will normally interact with other sectors in formulating national policy for integrated
water resource management. Regional and local structures for implementing the
policy will be set up, and national authorities will guide regional and local authori-
ties by providing tools.
Regional environmental or public health authorities have an important task in par-
ticipating in the preparation of integrated water resource management plans to ensure
the best available drinking-water source quality. For further information, see the sup-
porting documents Protecting Surface Waters for Health and Protecting Groundwaters
for Health (section 1.3).
1.2.5 Drinking-water supply agencies

Drinking-water supplies vary from very large urban systems servicing populations
with tens of millions to small community systems providing water to very small pop-
ulations. In most countries, they include community sources as well as piped means
of supply.
Drinking-water supply agencies are responsible for quality assurance and quality
control (see section 1.2.1). Their key responsibilities are to prepare and implement
WSPs (for more information, see chapter 4).
In many cases, the water supplier is not responsible for the management of the
catchment feeding sources of its supplies. The roles of the water supplier with respect
13
to catchments are to participate in interagency water resource management activities;

to understand the risks arising from potentially contaminating activities and inci-
dents; and to use this information in assessing risks to the drinking-water supply and
developing and applying appropriate management. Although drinking-water suppli-
ers may not undertake catchment surveys and pollution risk assessment alone, their
roles include recognizing the need for them and initiating multiagency collaboration
for example, with health and environmental authorities.
Experience has shown that an association of stakeholders in drinking-water supply
(e.g., operators, managers and specialist groups such as small suppliers, scientists, soci-
ologists, legislators, politicians, etc.) can provide a valuable non-threatening forum
for interchange of ideas.
For further information, see the supporting document Water Safety Plans (section
1.3).
1.2.6 Community management

Community-managed drinking-water systems, with both piped and non-piped dis-
tribution, are common worldwide in both developed and developing countries. The
precise denition of a community drinking-water system will vary. While a denition
based on population size or the type of supply may be appropriate under many con-
ditions, approaches to administration and management provide a distinction between
the drinking-water systems of small communities and those of larger towns and cities.
This includes the increased reliance on often untrained and sometimes unpaid com-
munity members in the administration and operation of community drinking-water
systems. Drinking-water systems in periurban areas in developing countries the
communities surrounding major towns and cities may also have the characteristics
of community systems.
Effective and sustainable programmes for the management of community drink-
ing-water quality require the active support and involvement of local communities.
These communities should be involved at all stages of such programmes, including
initial surveys; decisions on siting of wells, siting of off-takes or establishing protec-
tion zones; monitoring and surveillance of drinking-water supplies; reporting faults,
carrying out maintenance and taking remedial action; and supportive actions, includ-
ing sanitation and hygiene practices.
A community may already be highly organized and taking action on health or drink-
ing-water supply issues. Alternatively, it may lack a well developed drinking-water
system; some sectors of the community, such as women, may be poorly represented;
and there may be disagreements or factional conicts. In this situation, achieving com-
munity participation will take more time and effort to bring people together, resolve
differences, agree on common aims and take action. Visits, possibly over several years,
will often be needed to provide support and encouragement and to ensure that the
structures created for safe drinking-water supply continue to operate. This may involve
setting up hygiene and health educational programmes to ensure that the community:
14
1. INTRODUCTION
is aware of the importance of drinking-water quality and its relation to health

and of the need for safe drinking-water in sufcient quantities for domestic use
for drinking, cooking and hygiene;
recognizes the importance of surveillance and the need for a community
response;
understands and is prepared to play its role in the surveillance process;
has the necessary skills to perform that role; and
is aware of requirements for the protection of drinking-water supplies from
pollution.
For further information, see WHO Guidelines for Drinking-water Quality, second
edition, Volume 3; the supporting document Water Safety Plans (section 1.3);
Simpson-Hbert et al. (1996); Sawyer et al. (1998); and Brikk (2000).
1.2.7 Water vendors

Vendors selling water to households or at collection points are common in many parts
of the world where scarcity of water or faults in or lack of infrastructure limits access
to suitable quantities of drinking-water. Water vendors use a range of modes of trans-
port to carry drinking-water for sale directly to the consumer, including tanker trucks
and wheelbarrows/trolleys. In the context of these Guidelines, water vending does not
include bottled or packaged water (which is considered in section 6.5) or water sold
through vending machines.
There are a number of health concerns associated with water supplied to consumers
by water vendors. These include access to adequate volumes and concern regarding
inadequate treatment or transport in inappropriate containers, which can result in
contamination.
Where the source of water is uncertain or the quality of the water is unknown,
water can be treated or re-treated in small quantities to signicantly improve its
quality and safety. The simplest and most important treatment for microbially con-
taminated water is disinfection. If bulk supplies in tankers are used, sufcient chlo-
rine should be added to ensure that a free residual chlorine concentration of at least
0.5 mg/litre after a contact time of at least 30 min is present at the delivery point.
Tankers should normally be reserved for potable water use. Before use, tankers should
be either chemically disinfected or steam-cleaned.
Local authorities should implement surveillance programmes for water provided
by vendors and, where necessary, develop education programmes to improve the
collection, treatment and distribution of water to prevent contamination.
1.2.8 Individual consumers

Everyone consumes water from one source or another, and consumers often play
important roles in the collection, treatment and storage of water. Consumer actions
may help to ensure the safety of the water they consume and may also contribute to
15
improvement or contamination of the water consumed by others. Consumers have

the responsibility for ensuring that their actions do not impact adversely on water
quality. Installation and maintenance of household plumbing systems should be
undertaken preferably by qualied and authorized plumbers (see section 1.2.10) or
other persons with appropriate expertise to ensure that cross-connection or backow
events do not result in contamination of local water supplies.
In most countries, there are populations whose water is derived from household
sources, such as private wells and rainwater. In households using non-piped water
supplies, appropriate efforts are needed to ensure safe collection, storage and perhaps
treatment of their drinking-water. In some circumstances, households and individ-
uals may wish to treat water in the home to increase their condence in its safety, not
only where community supplies are absent, but also where community supplies are
known to be contaminated or causing waterborne disease (see chapter 7). Public
health, surveillance and/or other local authorities may provide guidance to support
households and individual consumers in ensuring the safety of their drinking-water
(see section 6.3). Such guidance is best provided in the context of a community
education and training programme.
1.2.9 Certication agencies

Certication is used to verify that devices and materials used in the drinking-water
supply meet a given level of quality and safety. Certication is a process in which an
independent organization validates the claims of the manufacturers against a formal
standard or criterion or provides an independent assessment of possible risks of con-
tamination from a material or process. The certication agency may be responsible
for seeking data from manufacturers, generating test results, conducting inspections
and audits and possibly making recommendations on product performance.
Certication has been applied to technologies used at household and community
levels, such as hand pumps; materials used by water supplies, such as treatment chem-
icals; and devices used in the household for collection, treatment and storage.
Certication of products or processes involved in the collection, treatment, storage
and distribution of water can be overseen by government agencies or private
organizations. Certication procedures will depend on the standards against
which the products are certied, certication criteria and the party that performs the
certication.
National, local government or private (third-party auditing) certication pro-
grammes have a number of possible objectives:
certication of products to ensure that their use does not threaten the safety of
the user or the general public, such as by causing contamination of drinking-
water with toxic substances, substances that could affect consumer acceptability
or substances that support the growth of microorganisms;
product testing, to avoid retesting at local levels or prior to each procurement;
16
1. INTRODUCTION
ensuring uniform quality and condition of products;

certication and accreditation of analytical and other testing laboratories;
and
control of materials and chemicals used for the treatment of drinking-water,
including the performance of devices for household use.
An important step in any certication procedure is the establishment of standards,
which must form the basis of assessment of the products. These standards should also
as far as possible contain the criteria for approval. In procedures for certication
on technical aspects, these standards are generally developed in cooperation with the
manufacturers, the certifying agency and the consumers. The national public health
authorities should have responsibility for developing the parts of the approval process
or criteria relating directly to public health. For further information, see section 8.5.4.
1.2.10 Plumbing
Signicant adverse health effects have been associated with inadequate plumbing
systems within public and private buildings arising from poor design, incorrect instal-
lation, alterations and inadequate maintenance.
Numerous factors inuence the quality of water within a buildings piped distri-
bution system and may result in microbial or chemical contamination of drinking-
water. Outbreaks of gastrointestinal disease can occur through faecal contamination
of drinking-water within buildings arising from deciencies in roof storage tanks and
cross-connections with wastewater pipes, for example. Poorly designed plumbing
systems can cause stagnation of water and provide a suitable environment for the pro-
liferation of Legionella. Plumbing materials, pipes, ttings and coatings can result in
elevated heavy metal (e.g., lead) concentrations in drinking-water, and inappropriate
materials can be conducive to bacterial growth. Potential adverse health effects may
not be conned to the individual building. Exposure of other consumers to contam-
inants is possible through contamination of the local public distribution system,
beyond the particular building, through cross-contamination of drinking-water and
backow.
The delivery of water that complies with relevant standards within buildings gen-
erally relies on a plumbing system that is not directly managed by the water supplier.
Reliance is therefore placed on proper installation and servicing of plumbing and, for
larger buildings, on building-specic WSPs (see section 6.1).
To ensure the safety of drinking-water supplies within the building system, plumb-
ing practices must prevent the introduction of hazards to health. This can be achieved
by ensuring that:
pipes carrying either water or wastes are watertight, durable, of smooth and
unobstructed interior and protected against anticipated stresses;
cross-connections between the drinking-water supply and the wastewater
removal systems do not occur;
17
water storage systems are intact and not subject to intrusion of microbial and
chemical contaminants;
hot and cold water systems are designed to minimize the proliferation of
Legionella (see also sections 6.1 and 11.1.9);
appropriate protection is in place to prevent backow;
the system design of multistorey buildings minimizes pressure uctuations;
waste is discharged without contaminating drinking-water; and
plumbing systems function efciently.
It is important that plumbers are appropriately qualied, have the competence

to undertake necessary installation and servicing of plumbing systems to ensure
compliance with local regulations and use only materials approved as safe for use with
drinking-water.
Design of the plumbing systems of new buildings should normally be approved
prior to construction and be inspected by an appropriate regulatory body during con-
struction and prior to commissioning of the buildings.
1.3 Supporting documentation to the guidelines

These Guidelines are accompanied by separate texts that provide background infor-
mation substantiating the derivation of the guidelines and providing guidance on
good practice towards effective implementation. These are available as published texts
and electronically through the Internet (http://www.who.int/water_sanitation_
health/dwq/en/) and CD-ROM. Reference details are provided in Annex 1.
Assessing Microbial Safety of Drinking Water: Improving Approaches and Methods

This book provides a state-of-the-art review of approaches and methods used in
assessing the microbial safety of drinking-water. It offers guidance on the selection
and use of indicators alongside operational monitoring to meet specic informa-
tion needs and looks at potential applications of new technologies and emerging
methods.
Chemical Safety of Drinking-water: Assessing Priorities for Risk Management

This document provides tools that assist users to undertake a systematic assessment
of their water supply system(s) locally, regionally or nationally; to prioritize the
chemicals likely to be of greatest signicance; to consider how these might
be controlled or eliminated; and to review or develop standards that are
appropriate.
Domestic Water Quantity, Service Level and Health

This paper reviews the requirements for water for health-related purposes to deter-
mine acceptable minimum needs for consumption (hydration and food prepara-
tion) and basic hygiene.
18
1. INTRODUCTION
Evaluation of the H2S Method for Detection of Fecal Contamination of Drinking Water
This report critically reviews the scientic basis, validity, available data and other
information concerning the use of H2S tests as measures or indicators of faecal
contamination in drinking-water.
Hazard Characterization for Pathogens in Food and Water: Guidelines

This document provides a practical framework and structured approach for the
characterization of microbial hazards, to assist governmental and research
scientists.
Heterotrophic Plate Counts and Drinking-water Safety: The Signicance of HPCs for
Water Quality and Human Health
This document provides a critical assessment of the role of the HPC measurement
in drinking-water safety management.
Managing Water in the Home: Accelerated Health Gains from Improved Water Supply
This report describes and critically reviews the various methods and systems for
household water collection, treatment and storage. It assesses the ability of house-
hold water treatment and storage methods to provide water with improved micro-
bial quality.
Pathogenic Mycobacteria in Water: A Guide to Public Health Consequences, Monitoring

and Management
This book describes the current knowledge about the distribution of pathogenic
environmental mycobacteria (PEM) in water and other parts of the environment.
Included are discussions of the routes of transmission that lead to human infec-
tion, the most signicant disease symptoms that can follow infection and the clas-
sical and modern methods of analysis of PEM species. The book concludes with a
discussion of the issues surrounding the control of PEM in drinking-water and the
assessment and management of risks.
Quantifying Public Health Risk in the WHO Guidelines for Drinking-water Quality:
A Burden of Disease Approach
This report provides a discussion paper on the concepts and methodology of
Disability Adjusted Life Years (DALYs) as a common public health metric and its
usefulness for drinking-water quality and illustrates the approach for several
drinking-water contaminants already examined using the burden of disease
approach.
Safe Piped Water: Managing Microbial Water Quality in Piped Distribution Systems
The development of pressurized pipe networks for supplying drinking-water to
individual dwellings, buildings and communal taps is an important component in
19
the continuing development and health of many communities. This publication

considers the introduction of microbial contaminants and growth of microorgan-
isms in distribution networks and the practices that contribute to ensuring drink-
ing-water safety in piped distribution systems.
Toxic Cyanobacteria in Water: A Guide to their Public Health Consequences, Monitor-

ing and Management
This book describes the state of knowledge regarding the impact of cyanobacteria
on health through the use of water. It considers aspects of risk management and
details the information needed for protecting drinking-water sources and recre-
ational water bodies from the health hazards caused by cyanobacteria and their
toxins. It also outlines the state of knowledge regarding the principal considera-
tions in the design of programmes and studies for monitoring water resources and
supplies and describes the approaches and procedures used.
Upgrading Water Treatment Plants

This book provides a practical guide to improving the performance of water treat-
ment plants. It will be an invaluable source of information for those who are
responsible for designing, operating, maintaining or upgrading water treatment
plants.
Water Safety Plans

The improvement of water quality control strategies, in conjunction with improve-
ments in excreta disposal and personal hygiene, can be expected to deliver sub-
stantial health gains in the population. This document provides information on
improved strategies for the control and monitoring of drinking-water quality.
Water Treatment and Pathogen Control: Process Efciency in Achieving Safe

Drinking-water
This publication provides a critical analysis of the literature on removal and inac-
tivation of pathogenic microbes in water to aid the water quality specialist and
design engineer in making decisions regarding microbial water quality.
Texts in preparation or in revision:

Arsenic in Drinking-water: Assessing and managing health risks (in preparation)
Desalination for Safe Drinking-water Supply (in preparation)
Guide to Hygiene and Sanitation in Aviation (in revision)
Guide to Ship Sanitation (in revision)
Health Aspects of Plumbing (in preparation)
Legionella and the Prevention of Legionellosis (in nalization)
Protecting Groundwaters for Health Managing the Quality of Drinking-water Sources
(in preparation)
20
1. INTRODUCTION
Protecting Surface Waters for Health Managing the Quality of Drinking-water Sources
(in preparation)
Rapid Assessment of Drinking-water Quality: A Handbook for Implementation (in
preparation)
21
2
The Guidelines: a framework
for safe drinking-water
T he quality of drinking-water may be controlled through a combination of pro-

tection of water sources, control of treatment processes and management of the
distribution and handling of the water. Guidelines must be appropriate for national,
regional and local circumstances, which requires adaptation to environmental, social,
economic and cultural circumstances and priority setting.
2.1 Framework for safe drinking-water: requirements

The Guidelines outline a preventive management framework for safe drinking-
water that comprises ve key components:
health-based targets based on an evaluation of health concerns (chapter 3);
system assessment to determine whether the drinking-water supply (from
source through treatment to the point of consumption) as a whole can deliver
water that meets the health-based targets (section 4.1);
operational monitoring of the control measures in the drinking-water supply
that are of particular importance in securing drinking-water safety (section 4.2);
management plans documenting the system assessment and monitoring plans
and describing actions to be taken in normal operation and incident conditions,
including upgrade and improvement, documentation and communication (sec-
tions 4.44.6); and
a system of independent surveillance that veries that the above are operating
properly (chapter 5).
In support of the framework for safe drinking-water, the Guidelines provide a range
of supporting information, including microbial aspects (chapters 7 and 11), chemi-
cal aspects (chapters 8 and 12), radiological aspects (chapter 9) and acceptability
aspects (chapter 10). Figure 2.1 provides an overview of the interrelationship of the
individual chapters of the Guidelines in ensuring drinking-water safety.
There is a wide range of microbial and chemical constituents of drinking-water
that can cause adverse human health effects. The detection of these constituents in
both raw water and water delivered to consumers is often slow, complex and costly,
22
2. THE GUIDELINES: A FRAMEWORK FOR SAFE DRINKING-WATER
Introduction The guideline requirements

(Chapter 1) (Chapter 2)
FRAMEWORK FOR SAFE DRINKING-WATER SUPPORTING

INFORMATION
Health-based targets Public health context Microbial
(Chapter 3) and health outcome aspects
(Chapters 7 and 11)
Water safety plans Chemical

(Chapter 4) aspects
(Chapters 8 and 12)
System Monitoring Management and
Radiological
assessment communication
aspects
(Chapter 9)
Surveillance Acceptability
(Chapter 5) aspects
(Chapter 10)
Application of the Guidelines

in specific circumstances
(Chapter 6)
Large buildings
Emergencies and disasters
Travellers
Desalination systems
Packaged drinking-water
Food production
Planes and ships
Figure 2.1 Interrelationship of the chapters of the Guidelines for Drinking-water Quality in
ensuring drinking-water safety
which limits early warning capability and affordability. Reliance on water quality
determination alone is insufcient to protect public health. As it is neither physically
nor economically feasible to test for all drinking-water quality parameters, the use of
monitoring effort and resources should be carefully planned and directed at signi-
cant or key characteristics.
Some characteristics not related to health, such as those with signicant impacts
on acceptability of water, may also be of importance. Where water has unacceptable
aesthetic characteristics (e.g., appearance, taste and odour), further investigation may
be required to determine whether there are problems with signicance for health.
The control of the microbial and chemical quality of drinking-water requires the
development of management plans, which, when implemented, provide the basis for
system protection and process control to ensure that numbers of pathogens and con-
centrations of chemicals present a negligible risk to public health and that water is
acceptable to consumers. The management plans developed by water suppliers are
23
best termed water safety plans (WSPs). A WSP comprises system assessment and
design, operational monitoring and management plans, including documentation and
communication. The elements of a WSP build on the multiple-barrier principle, the
principles of hazard analysis and critical control points (HACCP) and other system-
atic management approaches. The plans should address all aspects of the drinking-
water supply and focus on the control of abstraction, treatment and delivery of
drinking-water.
Many drinking-water supplies provide adequate safe drinking-water in the absence
of formalized WSPs. Major benets of developing and implementing a WSP for these
supplies include the systematic and detailed assessment and prioritization of hazards
and the operational monitoring of barriers or control measures. In addition, a WSP
provides for an organized and structured system to minimize the chance of failure
through oversight or lapse of management and for contingency plans to respond to
system failures or unforeseen hazardous events.
2.1.1 Health-based targets

Health-based targets are an essential component of the drinking-water safety frame-
work. They should be established by a high-level authority responsible for health
in consultation with others, including water suppliers and affected communities.
They should take account of the overall public health situation and contribution of
drinking-water quality to disease due to waterborne microbes and chemicals, as a part
of overall water and health policy. They must also take account of the importance of
ensuring access to water, especially among those who are not served.
Health-based targets provide the basis for the application of the Guidelines to all
types of drinking-water supply. Constituents of drinking-water may cause adverse
health effects from single exposures (e.g., microbial pathogens) or long-term expo-
sures (e.g., many chemicals). Due to the range of constituents in water, their mode of
action and the nature of uctuations in their concentration, there are four principal
types of health-based targets used as a basis for identifying safety requirements:
Health outcome targets: In some circumstances, especially where waterborne disease

contributes to a measurable burden, reducing exposure through drinking-water has
the potential to appreciably reduce overall risks of disease. In such circumstances,
it is possible to establish a health-based target in terms of a quantiable reduction
in the overall level of disease. This is most applicable where adverse effects follow
shortly after exposure, where such effects are readily and reliably monitored and
where changes in exposure can also be readily and reliably monitored. This type of
health outcome target is primarily applicable to some microbial hazards in devel-
oping countries and chemical hazards with clearly dened health effects largely
attributable to water (e.g., uoride). In other circumstances, health outcome targets
may be the basis for evaluation of results through quantitative risk assessment
models. In these cases, health outcomes are estimated based on information con-
24
cerning exposure and doseresponse relationships. The results may be employed

directly as a basis for the specication of water quality targets or provide the basis
for development of the other types of health-based targets. Health outcome targets
based on information on the impact of tested interventions on the health of real
populations are ideal but rarely available. More common are health outcome targets
based on dened levels of tolerable risk, either absolute or fractions of total disease
burden, preferably based on epidemiological evidence or, alternatively, risk assess-
ment studies.
Water quality targets (WQTs): WQTs are established for individual drinking-water
constituents that represent a health risk from long-term exposure and where
uctuations in concentration are small or occur over long periods. They are
typically expressed as guideline values (concentrations) of the substances or
chemicals of concern.
Performance targets: Performance targets are employed for constituents where
short-term exposure represents a public health risk or where large uctuations in
numbers or concentration can occur over short periods with signicant health
implications. They are typically expressed in terms of required reductions of the
substance of concern or effectiveness in preventing contamination.
Specied technology targets: National regulatory agencies may establish targets for
specic actions for smaller municipal, community and household drinking-water
supplies. Such targets may identify specic permissible devices or processes for
given situations and/or for generic drinking-water system types.
It is important that health-based targets are realistic under local operating conditions
and are set to protect and improve public health. Health-based targets underpin devel-
opment of WSPs, provide information with which to evaluate the adequacy of exist-
ing installations and assist in identifying the level and type of inspection and analytical
verications that are appropriate.
Most countries apply several types of targets for different types of supply and dif-
ferent contaminants. In order to ensure that they are relevant and supportive, repre-
sentative scenarios should be developed, including description of assumptions,
management options, control measures and indicator systems for verication, where
appropriate. These should be supported by general guidance addressing the identi-
cation of national, regional or local priorities and progressive implementation, thereby
helping to ensure that best use is made of available resources.
Health-based targets are considered in more detail in chapter 3.
2.1.2 System assessment and design

Assessment of the drinking-water system is equally applicable to large utilities with
piped distribution systems, piped and non-piped community supplies, including hand
pumps, and individual domestic supplies. Assessment can be of existing infrastructure
or of plans for new supplies or for upgrading of existing supplies. As drinking-water
25
quality varies throughout the system, the assessment should aim to determine whether
the nal quality of water delivered to the consumer will routinely meet established
health-based targets. Understanding source quality and changes through the system
requires expert input. The assessment of systems should be reviewed periodically.
The system assessment needs to take into consideration the behaviour of selected
constituents or groups of constituents that may inuence water quality. Having iden-
tied and documented actual and potential hazards, including potentially hazardous
events and scenarios that may affect water quality, the level of risk for each hazard
can then be estimated and ranked, based on the likelihood and severity of the
consequences.
Validation is an element of system assessment. It is undertaken to ensure that the
information supporting the plan is correct and is concerned with the assessment of
the scientic and technical inputs into the WSP. Evidence to support the WSP can
come from a wide variety of sources, including scientic literature, trade associations,
regulation and legislation departments, historical data, professional bodies and sup-
plier knowledge.
If the system is theoretically capable of meeting the health-based targets, the WSP
is the management tool that will assist in actually meeting the health-based targets,
and it should be developed following the steps outlined in subsequent sections. If the
system is unlikely to be capable of meeting the health-based targets, a programme of
upgrading (which may include capital investment or training) should be initiated to
ensure that the drinking-water supply would meet the targets. In the interim, every
effort should be made to supply water of the highest achievable quality. Where a sig-
nicant risk to public health exists, additional measures may be appropriate.
Assessment and design are considered in more detail in section 4.1 (see also the
supporting document Upgrading Water Treatment Plants; section 1.3).
2.1.3 Operational monitoring

Control measures are actions implemented in the drinking-water system that prevent,
reduce or eliminate contamination and are identied in system assessment. They
include, for example, catchment management actions, the plinth surrounding a well,
lters and disinfection infrastructure and piped distribution systems. If collectively
operating properly, they would ensure that health-based targets are met.
Operational monitoring is the conduct of planned observations or measurements
to assess whether the control measures in a drinking-water system are operating prop-
erly. It is possible to set limits for control measures, monitor those limits and take cor-
rective action in response to a detected deviation before the water becomes unsafe.
Examples of limits are that the plinth surrounding a hand pump is complete and not
damaged, the turbidity of water following ltration is below a certain value or the
chlorine residual after disinfection plants or at the far point of the distribution system
is above an agreed value.
26
The frequency of operational monitoring varies with the nature of the control
measure for example, checking plinth integrity monthly to yearly, monitoring tur-
bidity on-line or very frequently and monitoring disinfection residual at multiple
points daily or continuously on-line. If monitoring shows that a limit does not meet
specications, then there is the potential for water to be, or to become, unsafe. The
objective is timely monitoring of control measures, with a logically based sampling
plan, to prevent the delivery of potentially unsafe water.
In most cases, operational monitoring will be based on simple and rapid observa-
tions or tests, such as turbidity or structural integrity, rather than complex microbial
or chemical tests. The complex tests are generally applied as part of validation and
verication activities (discussed in sections 4.1.7 and 4.3, respectively) rather than as
part of operational monitoring.
In order not only to have condence that the chain of supply is operating prop-
erly, but to conrm that water quality is being maintained and achieved, it is neces-
sary to carry out verication, as outlined in section 2.2.
The use of indicator bacteria in monitoring of water quality is discussed in the
supporting document Assessing Microbial Safety of Drinking Water (section 1.3), and
operational monitoring is considered in more detail in section 4.2.
2.1.4 Management plans, documentation and communication

A management plan documents system assessment and operational monitoring
and verication plans and describes actions in both normal operation and during
incidents where a loss of control of the system may occur. The management plan
should also outline procedures and other supporting programmes required to ensure
optimal operation of the drinking-water system.
As the management of some aspects of the drinking-water system often falls outside
the responsibility of a single agency, it is essential that the roles, accountabilities and
responsibilities of the various agencies involved be dened in order to coordinate their
planning and management. Appropriate mechanisms and documentation should
therefore be established for ensuring stakeholder involvement and commitment.
This may include establishing working groups, committees or task forces, with
appropriate representatives, and developing partnership agreements, including
for example signed memoranda of understanding (see also section 1.2).
Documentation of all aspects of drinking-water quality management is essential.
Documents should describe activities that are undertaken and how procedures are
performed. They should also include detailed information on:
assessment of the drinking-water system (including ow diagrams and poten-

tial hazards and the outcome of validation);
control measures and operational monitoring and verication plan;
routine operation and management procedures;
27
incident and emergency response plans; and

supporting measures, including:
training programmes
research and development
procedures for evaluating results and reporting
performance evaluations, audits and reviews
communication protocols
community consultation.
Documentation and record systems should be kept as simple and focused as possible.
The level of detail in the documentation of procedures should be sufcient to provide
assurance of operational control when coupled with a suitably qualied and com-
petent operator.
Mechanisms should be established to periodically review and, where necessary,
revise documents to reect changing circumstances. Documents should be assembled
in a manner that will enable any necessary modications to be made easily. A docu-
ment control system should be developed to ensure that current versions are in use
and obsolete documents are discarded.
Appropriate documentation and reporting of incidents or emergencies should also
be established. The organization should learn as much as possible from an incident
to improve preparedness and planning for future events. Review of an incident may
indicate necessary amendments to existing protocols.
Effective communication to increase community awareness and knowledge of
drinking-water quality issues and the various areas of responsibility helps consumers
to understand and contribute to decisions about the service provided by a drinking-
water supplier or land use constraints imposed in catchment areas. A thorough under-
standing of the diversity of views held by individuals or groups in the community is
necessary to satisfy community expectations.
Management, documentation and communication are considered in more detail
in sections 4.4, 4.5 and 4.6.
2.1.5 Surveillance of drinking-water quality

The surveillance agency is responsible for an independent (external) and periodic
review of all aspects of safety, whereas the water supplier is responsible at all times for
regular quality control, for operational monitoring and for ensuring good operating
practice.
Surveillance contributes to the protection of public health by assessing compliance
with WSPs and promoting improvement of the quality, quantity, accessibility, cover-
age, affordability and continuity of drinking-water supplies.
Surveillance requires a systematic programme of surveys that may include audit-
ing of WSPs, analysis, sanitary inspection and institutional and community aspects.
It should cover the whole of the drinking-water system, including sources and activ-
28
ities in the catchment, transmission infrastructure, whether piped or unpiped, treat-

ment plants, storage reservoirs and distribution systems.
Since incremental improvement and prioritizing action in systems presenting
greatest overall risk to public health are important, there are advantages to adopting
a grading scheme for the relative safety of drinking-water supplies (see chapter 4).
More sophisticated grading schemes may be of particular use in community supplies
where the frequency of testing is low and exclusive reliance on analytical results is par-
ticularly inappropriate. Such schemes will typically take account of both analytical
ndings and sanitary inspection through approaches such as those presented in
section 4.1.2.
The role of surveillance is discussed in section 1.2.1 and chapter 5.
2.2 Guidelines for verication

Drinking-water safety is secured by application of a WSP, which includes monitoring
the efciency of control measures using appropriately selected determinants. In addi-
tion to this operational monitoring, a nal verication of quality is required.
Verication is the use of methods, procedures or tests in addition to those used in
operational monitoring to determine if the performance of the drinking-water supply
is in compliance with the stated objectives outlined by the health based targets and/or
whether the WSP needs modication and revalidation.
2.2.1 Microbial water quality

For microbial water quality, verication is likely to include microbiological testing. In
most cases, it will involve the analysis of faecal indicator microorganisms, but in some
circumstances it may also include assessment of specic pathogen densities. Verica-
tion of the microbial quality of drinking-water may be undertaken by the supplier,
surveillance agencies or a combination of the two (see sections 4.3.1 and 7.4).
Approaches to verication include testing of source water, water immediately after
treatment, water in distribution systems or stored household water. Verication of the
microbial quality of drinking-water includes testing for Escherichia coli as an indica-
tor of faecal pollution. E. coli provides conclusive evidence of recent faecal pollution
and should not be present in drinking-water. In practice, testing for thermotolerant
coliform bacteria can be an acceptable alternative in many circumstances. While E.
coli is a useful indicator, it has limitations. Enteric viruses and protozoa are more
resistant to disinfection; consequently, the absence of E. coli will not necessarily indi-
cate freedom from these organisms. Under certain circumstances, it may be desirable
to include more resistant microorganisms, such as bacteriophages and/or bacterial
spores. Such circumstances could include the use of source water known to be con-
taminated with enteric viruses and parasites or high levels of viral and parasitic dis-
eases in the community.
Water quality can vary rapidly, and all systems are subject to occasional failure. For
example, rainfall can greatly increase the levels of microbial contamination in source
29
waters, and waterborne outbreaks often occur following rainfall. Results of analytical
testing must be interpreted taking this into account.
2.2.2 Chemical water quality

Assessment of the adequacy of the chemical quality of drinking-water relies on com-
parison of the results of water quality analysis with guideline values.
For additives (i.e., chemicals deriving primarily from materials and chemicals used
in the production and distribution of drinking-water), emphasis is placed on the
direct control of the quality of these products. In controlling drinking-water addi-
tives, testing procedures typically assess the contribution of the additive to drinking-
water and take account of variations over time in deriving a value that can be
compared with the guideline value (see section 8.5.4).
As indicated in chapter 1, most chemicals are of concern only with long-term expo-
sure; however, some hazardous chemicals that occur in drinking-water are of concern
because of effects arising from sequences of exposures over a short period. Where the
concentration of the chemical of interest varies widely, even a series of analytical
results may fail to fully identify and describe the public health risk (e.g., nitrate, which
is associated with methaemoglobinaemia in bottle-fed infants). In controlling such
hazards, attention must be given to both knowledge of causal factors such as fertilizer
use in agriculture and trends in detected concentrations, since these will indicate
whether a signicant problem may arise in the future. Other hazards may arise inter-
mittently, often associated with seasonal activity or seasonal conditions. One example
is the occurrence of blooms of toxic cyanobacteria in surface water.
A guideline value represents the concentration of a constituent that does not exceed
tolerable risk to the health of the consumer over a lifetime of consumption. Guide-
lines for some chemical contaminants (e.g., lead, nitrate) are set to be protective for
susceptible subpopulations. These guidelines are also protective of the general popu-
lation over a lifetime.
The exceedance of a guideline value does not necessarily result in a signicant risk
to health. Therefore, deviations above the guideline values in either the short or long
term do not necessarily mean that the water is unsuitable for consumption. The
amount by which, and the period for which, any guideline value can be exceeded
without affecting public health depends upon the specic substance involved.
However, exceedance should be a signal:
as a minimum, to investigate the cause with a view to taking remedial action as
necessary; and
to consult with, and seek advice from, the authority responsible for public health.
When a guideline value is exceeded, it is recommended that the authority responsi-
ble for public health be consulted for advice on suitable action, taking into account
the intake of the substance from sources other than drinking-water, the toxicity of the
substance, the likelihood and nature of any adverse effects and the practicality of
30
remedial measures. In applying the guideline values, an important consideration is

that unless there are appropriate alternative supplies available, maintenance of ade-
quate quantities of water is a high priority. The use of the Guidelines in emergencies
is considered in more detail in section 6.2.
It is important that recommended guideline values are both practical and feasible
to implement as well as protective of public health. Guideline values are not normally
set at concentrations lower than the detection limits achievable under routine labo-
ratory operating conditions. Moreover, guideline values are established taking into
account available techniques for controlling, removing or reducing the concentration
of the contaminant to the desired level. In some instances, therefore, provisional guide-
line values have been set for contaminants for which there is some uncertainty in avail-
able information or calculated guideline values are not practically achievable.
2.3 National drinking-water policy

2.3.1 Laws, regulations and standards
The aim of national drinking-water laws and standards should be to ensure that the
consumer enjoys safe potable water, not to shut down decient water supplies.
Effective control of drinking-water quality is supported ideally by adequate legis-
lation, standards and codes and their enforcement. The precise nature of the legisla-
tion in each country will depend on national, constitutional and other considerations.
It will generally outline the responsibility and authority of a number of agencies and
describe the relationship between them, as well as establish basic policy principles
(e.g., water supplied for drinking-water should be safe). The national regulations,
adjusted as necessary, should be applicable to all water supplies. This would normally
embody different approaches to situations where formal responsibility for drinking-
water quality is assigned to a dened entity and situations where community man-
agement prevails.
Legislation should make provision for the establishment and amendment of
drinking-water quality standards and guidelines, as well as for the establishment of
regulations for the development and protection of drinking-water sources and
the treatment, maintenance and distribution of safe drinking-water.
Legislation should establish the legal functions and responsibilities of the water
supplier and would generally specify that the water supplier is legally responsible at
all times for the quality of the water sold and/or supplied to the consumer and for the
proper supervision, inspection, maintenance and safe operation of the drinking-water
system. It is the water supplier that actually provides water to the public the con-
sumer and that should be legally responsible for its quality and safety. The supplier
is responsible for continuous and effective quality assurance and quality control of
water supplies, including inspection, supervision, preventive maintenance, routine
testing of water quality and remedial actions as required. However, the supplier is
normally responsible for the quality of the water only up to a dened point in the
distribution system and may not have responsibility for deterioration of water quality
31
as a result of poor plumbing or unsatisfactory storage tanks in households and

buildings.
Where consecutive agencies manage water for example, a drinking-water whole-
saler, a municipal water supplier and a local water distribution company each agency
should carry responsibility for the quality of the water arising from its actions.
Legal and organizational arrangements aimed at ensuring compliance with the
legislation, standards or codes of practice for drinking-water quality will normally
provide for an independent surveillance agency, as outlined in section 1.2.1 and
chapter 5. The legislation should dene the duties, obligations and powers of the water
surveillance agency. The surveillance agency should preferably be represented at the
national level and should operate at national, regional and local levels. The surveil-
lance agency should be given the necessary powers to administer and enforce laws,
regulations, standards and codes concerned with water quality. It should also be able
to delegate those powers to other specied agencies, such as municipal councils, local
health departments, regional authorities and qualied, government-authorized
private audit or testing services. Its responsibilities should include the surveillance of
water quality to ensure that water delivered to the consumer, through either piped or
non-piped distribution systems, meets drinking-water supply service standards;
approving sources of drinking-water; and surveying the provision of drinking-water
to the population as a whole. There needs to be a high level of knowledge, training
and understanding in such an agency in order that drinking-water supply does not
suffer from inappropriate regulatory action. The surveillance agency should be
empowered by law to compel water suppliers to recommend the boiling of water or
other measures when microbial contamination that could threaten public health is
detected.
Implementation of programmes to provide safe drinking-water should not be
delayed because of a lack of appropriate legislation. Even where legally binding guide-
lines or standards for drinking-water have yet to be promulgated, it may be possible
to encourage, and even enforce, the supply of safe drinking-water through educational
efforts or commercial, contractual arrangements between consumer and supplier
(e.g., based on civil law) or through interim measures, including health, food or
welfare legislation, for example.
Drinking-water quality legislation may usefully provide for interim standards, per-
mitted deviations and exemptions as part of a national or regional policy, rather than
as a result of local initiatives. This can take the form of temporary exemptions for
certain communities or areas for dened periods of time. Short- and medium-term
targets should be set so that the most signicant risks to human health are controlled
rst.
2.3.2 Setting national standards

In countries where universal access to safe drinking-water at an acceptable level of
service has not been achieved, policy should refer to expressed targets for increases in
32
access. Such policy statements should be consistent with achievement of the Millen-
nium Development Goals (http://www.developmentgoals.org/) of the United Nations
(UN) Millennium Declaration and should take account of levels of acceptable access
outlined in General Comment 15 on the Right to Water of the UN Committee
on Economic, Social and Cultural Rights (http://www.unhchr.ch/html/menu2/6/
cescr.htm) and associated documents.
In developing national drinking-water standards based on these Guidelines, it will
be necessary to take account of a variety of environmental, social, cultural, economic,
dietary and other conditions affecting potential exposure. This may lead to national
standards that differ appreciably from these Guidelines. A programme based on
modest but realistic goals including fewer water quality parameters of priority health
concern at attainable levels consistent with providing a reasonable degree of public
health protection in terms of reduction of disease or reduced risk of disease within
the population may achieve more than an overambitious one, especially if targets
are upgraded periodically.
The authority to establish and revise drinking-water standards, codes of practice
and other technical regulations should be delegated to the appropriate government
minister preferably the minister of health who is responsible for ensuring the safety
of water supplies and the protection of public health. The authority to establish and
enforce quality standards and regulations may be vested in a ministry other than the
one usually responsible for public and/or environmental health. Consideration should
then be given to requiring that regulations and standards are promulgated only after
approval by the public health or environmental health authority so as to ensure their
conformity with health protection principles.
Drinking-water supply policy should normally outline the requirements for
protection of water sources and resources, the need for appropriate treatment,
preventive maintenance within distribution systems and requirements to support
maintaining water safety after collection from communal sources.
The basic water legislation should not specify sampling frequencies but should give
the administration the power to establish a list of parameters to be measured and the
frequency and location of such measurements.
Standards and codes should normally specify the quality of the water to be sup-
plied to the consumer, the practices to be followed in selecting and developing water
sources and in treatment processes and distribution or household storage systems,
and procedures for approving water systems in terms of water quality.
Setting national standards should ideally involve consideration of the quality of the
water, the quality of service, target setting and the quality of infrastructure and
systems, as well as enforcement action. For example, national standards should dene
protection zones around water sources, minimum standard specications for operat-
ing systems, hygiene practice standards in construction and minimum standards for
health protection. Some countries include these details in a sanitary code or code
of good practice. It is preferable to include in regulations the requirement to consult
33
with drinking-water supply agencies and appropriate professional bodies, since doing
so makes it more likely that drinking-water controls will be implemented effectively.
The costs associated with drinking-water quality surveillance and control should
be taken into account in developing national legislation and standards.
To ensure that standards are acceptable to consumers, communities served,
together with the major water users, should be involved in the standards-setting
process. Public health agencies may be closer to the community than those responsi-
ble for its drinking-water supply. At a local level, they also interact with other sectors
(e.g., education), and their combined action is essential to ensure active community
involvement.
Other ministries, such as those responsible for public works, housing, natural
resources or the environment, may administer normative and regulatory functions
concerned with the design of drinking-water supply and waste disposal systems,
equipment standards, plumbing codes and rules, water allocation, natural resource
protection and conservation and waste collection, treatment and disposal.
2.4 Identifying priority drinking-water quality concerns

These Guidelines cover a large number of potential constituents in drinking-water in
order to meet the varied needs of countries worldwide. Generally, only a few con-
stituents will be of concern under any given circumstances. It is essential that the
national regulatory agency and local water authorities determine and respond to the
constituents of relevance. This will ensure that efforts and investments can be directed
to those constituents that are of public health signicance.
Guidelines are established for potentially hazardous water constituents and provide
a basis for assessing drinking-water quality. Different parameters may require differ-
ent priorities for management to improve and protect public health. In general, the
order of priority is to:
ensure an adequate supply of microbiologically safe water and maintain accept-
ability to discourage consumers from using potentially less microbiologically
safe water;
manage key chemical contaminants known to cause adverse health effects; and
address other chemical contaminants.
Priority setting should be undertaken on the basis of a systematic assessment based
on collaborative effort among all relevant agencies and may be applied at national and
system-specic levels. It may require the formation of a broad-based interagency
committee including authorities such as health, water resources, drinking-water
supply, environment, agriculture and geological services/mining to establish a
mechanism for sharing information and reaching consensus on drinking-water
quality issues.
Sources of information that should be considered in determining priorities include
catchment type (protected, unprotected), geology, topography, agricultural land use,
34
industrial activities, sanitary surveys, records of previous monitoring, inspections and

local and community knowledge. The wider the range of data sources used, the more
useful the results of the process will be. In many situations, authorities or consumers
may have already identied a number of drinking-water quality problems, particu-
larly where they cause obvious health effects or acceptability problems. These exist-
ing problems would normally be assigned a high priority.
2.4.1 Assessing microbial priorities

The most common and widespread health risk associated with drinking-water is
microbial contamination, the conse-
quences of which mean that its control The most common and widespread
must always be of paramount impor- health risk associated with drinking-
water is microbial contamination, the
tance. Priority needs to be given to consequences of which mean that its
improving and developing the drinking- control must always be of paramount
water supplies that represent the greatest importance.
public health risk.
Microbial contamination of major urban systems has the potential to cause large
outbreaks of waterborne disease. Ensuring quality in such systems is therefore a pri-
ority. Nevertheless, the majority (around 80%) of the global population without
access to improved drinking-water supplies resides in rural areas. Similarly, small and
community supplies in most countries contribute disproportionately to overall drink-
ing-water quality concerns. Identifying local and national priorities should take
factors such as these into account.
Health-based targets for microbial contaminants are discussed in section 3.2, and
a comprehensive consideration of microbial aspects of drinking-water quality is con-
tained in chapter 7.
2.4.2 Assessing chemical priorities

Not all of the chemicals with guideline values will be present in all water supplies or,
indeed, all countries. If they do exist, they may not be found at levels of concern. Con-
versely, some chemicals without guideline values or not addressed in the Guidelines
may nevertheless be of legitimate local concern under special circumstances.
Risk management strategies (as reected in national standards and monitoring
activities) and commitment of resources should give priority to those chemicals that
pose a risk to human health or to those with signicant impacts on acceptability of
water.
Only a few chemicals have been shown to cause widespread health effects in
humans as a consequence of exposure through drinking-water when they are present
in excessive quantities. These include uoride and arsenic. Human health effects have
also been demonstrated in some areas associated with lead (from domestic plumb-
ing), and there is concern because of the potential extent of exposure to selenium and
uranium in some areas at concentrations of human health signicance. Iron and
35
manganese are of widespread signicance because of their effects on acceptability.

These constituents should be taken into consideration as part of any priority-setting
process. In some cases, assessment will indicate that no risk of signicant exposure
exists at the national, regional or system level.
Drinking-water may be only a minor contributor to the overall intake of a
particular chemical, and in some circumstances controlling the levels in drinking-
water, at potentially considerable expense, may have little impact on overall exposure.
Drinking-water risk management strategies should therefore be considered in con-
junction with other potential sources of human exposure.
The process of short-listing chemicals of concern may initially be a simple clas-
sication of high and low risk to identify broad issues. This may be rened using data
from more detailed assessments and analysis and may take into consideration rare
events, variability and uncertainty.
Guidance is provided in the supporting document Chemical Safety of Drinking-
water (section 1.3) on how to undertake prioritization of chemicals in drinking-water.
This deals with issues including:
the probability of exposure (including the period of exposure) of the consumer
to the chemical;
the concentration of the chemical that is likely to give rise to health effects (see
also section 8.5); and
the evidence of health effects or exposure arising through drinking-water, as
opposed to other sources, and relative ease of control of the different sources of
exposure.
Additional information on the hazards and risks of many chemicals not included in
these Guidelines is available from several sources, including WHO Environmental
Health Criteria monographs (EHCs) and Concise International Chemical Assessment
Documents (CICADs) (http://www.who.int/pcs/index.htm), reports by the Joint
FAO/WHO Meeting on Pesticide Residues (JMPR) and Joint FAO/WHO Expert
Committee on Food Additives (JECFA) and information from competent national
authorities, such as the US Environmental Protection Agency (US EPA)
(www.epa.gov/waterscience). These information sources have been peer reviewed and
provide readily accessible information on toxicology, hazards and risks of many less
common contaminants. They can help water suppliers and health ofcials to decide
upon the signicance (if any) of a detected chemical and on the response that might
be appropriate.
36
3
Health-based targets
3.1 Role and purpose of health-based targets
H ealth-based targets should be part of overall public health policy, taking into
account status and trends and the contribution of drinking-water to the trans-
mission of infectious disease and to overall exposure to hazardous chemicals both in
individual settings and within overall health management. The purpose of setting
targets is to mark out milestones to guide and chart progress towards a predetermined
health and/or water safety goal. To ensure effective health protection and improve-
ment, targets need to be realistic and relevant to local conditions (including economic,
environmental, social and cultural conditions) and nancial, technical and institu-
tional resources. This normally implies periodic review and updating of priorities and
targets and, in turn, that norms and standards should be periodically updated to take
account of these factors and the changes in available information (see section 2.3).
Health-based targets provide a benchmark for water suppliers. They provide
information with which to evaluate the adequacy of existing installations and policies
and assist in identifying the level and type of inspection and analytical verication
that are appropriate and in developing auditing schemes. Health-based targets under-
pin the development of WSPs and verication of their successful implementation.
They should lead to improvements in
public health outcomes.
Health-based targets should assist The judgement of safety or what is a
tolerable risk in particular circumstances
in determining specic interventions is a matter in which society as a whole
appropriate to delivering safe drinking- has a role to play. The nal judgement
water, including control measures such as to whether the benet resulting from
the adoption of any of the health-based
as source protection and treatment targets justies the cost is for each
processes. country to decide.
The use of health-based targets is
applicable in countries at all levels of
development. Different types of target will be applicable for different purposes, so that
in most countries several types of target may be used for various purposes. Care must
be taken to develop targets that account for the exposures that contribute most to
37
disease. Care must also be taken to reect the advantages of progressive, incremental
improvement, which will often be based on categorization of public health risk (see
section 4.1.2).
Health-based targets are typically national in character. Using information and
approaches in these Guidelines, national authorities should be able to establish health-
based targets that will protect and improve drinking-water quality and, consequently,
human health and also support the best use of available resources in specic national
and local circumstances.
In order to minimize the likelihood of outbreaks of disease, care is required to
account properly for drinking-water supply performance both in steady state and
during maintenance and periods of short-term water quality deterioration. Perfor-
mance of the drinking-water system during short-term events (such as variation in
source water quality, system challenges and process problems) must therefore be con-
sidered in the development of health-based targets. Both short-term and catastrophic
events can result in periods of very degraded source water quality and greatly
decreased efciency in many processes, both of which provide a logical and sound
justication for the long-established multiple-barrier principle in water safety.
The processes of formulating, implementing and evaluating health-based targets
provide benets to the overall preventive management of drinking-water quality.
These benets are outlined in Table 3.1.
Targets can be a helpful tool both for encouraging and for measuring incremental
progress in improving drinking-water quality management. Improvements can relate
to the scientic basis for target setting, progressive evolution to target types that more
precisely reect the health protection goals and the use of targets in dening and
promoting categorization for progressive improvement, especially of existing water
supplies. Water quality managers, be they suppliers or legislators, should aim at con-
tinuously improving water quality management. An example of phased improvement
Table 3.1 Benets of health-based targets

Target development stage Benet
Formulation Provides insight into the health of the population
Reveals gaps in knowledge
Supports priority setting
Increases the transparency of health policy
Promotes consistency among national health programmes
Stimulates debate
Implementation Inspires and motivates collaborating authorities to take action
Improves commitment
Fosters accountability
Guides the rational allocation of resources
Evaluation Supplies established milestones for incremental improvements
Provides opportunity to take action to correct deciencies and/or
deviations
Identies data needs and discrepancies
38
3. HEALTH-BASED TARGETS
is given in section 5.4. The degree of improvement may be large, as in moving from
the initial phase to the intermediate phase, or relatively small.
Ideally, health-based targets should be set using quantitative risk assessment and
should take into account local conditions and hazards. In practice, however, they may
evolve from epidemiological evidence of waterborne disease based on surveillance,
intervention studies or historical precedent or be adapted from international practice
and guidance.
3.2 Types of health-based targets

The approaches presented here for developing health-based targets are based on a con-
sistent framework applicable to all types of hazards and for all types of water supplies
(see Table 3.2 and below). This offers exibility to account for national priorities and
to support a riskbenet approach. The framework includes different types of health-
based targets. They differ considerably with respect to the amount of resources needed
to develop and implement the targets and in relation to the precision with which the
public health benets of risk management actions can be dened. Target types at the
bottom of Table 3.2 require least interpretation by practitioners in implementation
but depend on a number of assumptions. The targets towards the top of the table
require considerably greater scientic and technical underpinning in order to over-
come the need to make assumptions and are therefore more precisely related to the
level of health protection. The framework is forward looking, in that currently criti-
cal data for developing the next stage of target setting may not be available, and a need
to collect additional data may become obvious.
Establishing health-based targets should take account not only of steady-state
conditions but also the possibility of short-term events (such as variation in envi-
ronmental water quality, system challenges and process problems) that may lead to
signicant risk to public health.
For microbial pathogens, health-based targets will employ groups of selected
pathogens that combine both control challenges and health signicance in terms
of health hazard and other relevant data. More than one pathogen is required in
order to assess the diverse range of challenges to the safeguards available. Where the
burden of waterborne microbial disease is high, health-based targets can be based on
achieving a measurable reduction in the existing levels of community disease, such
as diarrhoea or cholera, as an incremental step in public health improvement of
drinking-water quality. While health-based targets may be expressed in terms of tol-
erable exposure to specic pathogens (i.e., WQTs), care is required in relating this to
overall population exposure, which may be focused on short periods of time, and such
targets are inappropriate for direct pathogen monitoring. These conditions relate
to the recognized phenomenon of short periods of decreased efciency in many
processes and provide a logical justication for the long-established multiple-barrier
principle in water safety. Targets must also account for background rates of disease
during normal conditions of drinking-water supply performance and efciency.
39
Table 3.2 Nature, application and assessment of health-based targets

Type of target Nature of target Typical applications Assessment
Health outcome
epidemiology
based
Reduction in detected
disease incidence or
Microbial or chemical
hazards with high
Public health surveillance
and analytical epidemiology
prevalence measurable disease
burden largely water-
associated
risk
assessment
Tolerable level of risk
from contaminants in
Microbial or chemical
hazards in situations
Quantitative risk assessment
based drinking-water, where disease

absolute or as a burden is low or
fraction of the total cannot be measured
burden by all directly
exposures
Water quality Guideline values Chemical constituents Periodic measurement of
applied to water found in source waters key chemical constituents to
quality assess compliance with
relevant guideline values
(see section 8.5)
Guideline values Chemical additives Testing procedures applied
applied in testing and by-products to the materials and
procedures for chemicals to assess their
materials and contribution to drinking-
chemicals water exposure taking
account of variations over
time (see section 8.5)
Performance Generic performance Microbial Compliance assessment
target for removal of contaminants through system assessment
groups of microbes (see section 4.1) and
operational monitoring (see
section 4.2)
Customized Microbial Individually reviewed by
performance targets contaminants public health authority;
for removal of groups assessment would then
of microbes proceed as above
Guideline values Threshold chemicals Compliance assessment
applied to water with effects on health through system assessment
quality that vary widely (e.g., (see section 4.1) and
nitrate and operational monitoring (see
cyanobacterial toxins) section 4.2)
Specied National authorities Constituents with Compliance assessment
technology specify specic health effect in small through system assessment
processes to municipalities and (see section 4.1) and
adequately address community supplies operational monitoring (see
constituents with section 4.2)
health effects (e.g.,
generic WSPs for an
unprotected
catchment)
Note: Each target type is based on those above it in this table, and assumptions with default values are introduced
in moving down between target types. These assumptions simplify the application of the target and reduce poten-
tial inconsistencies.
40
For chemical constituents of drinking-water, health-based targets can be developed

using the guideline values outlined in section 8.5. These have been established on the
basis of the health effect of the chemical in water. In developing national drinking-
water standards (or health-based targets) based on these guideline values, it will be
necessary to take into consideration a variety of environmental, social, cultural,
economic, dietary and other conditions affecting potential exposure. This may lead
to national targets that differ appreciably from the guideline values.
3.2.1 Specied technology targets

Specied technology targets are most frequently applied to small community supplies
and to devices used at household level. They may take the form of recommendations
concerning technologies applicable in certain circumstances and/or licensing
programmes to restrict access to certain technologies or provide guidance for their
application.
Smaller municipal and community drinking-water suppliers often have limited
resources and ability to develop individual system assessments and/or management
plans. National regulatory agencies may therefore directly specify requirements or
approved options. This may imply, for example, providing guidance notes for protec-
tion of well heads, specic and approved treatment processes in relation to source
types and requirements for protection of drinking-water quality in distribution.
In some circumstances, national or regional authorities may wish to establish
model WSPs to be used by local suppliers either directly or with limited adaptation.
This may be of particular importance when supplies are community managed. In
these circumstances, an approach focusing on ensuring that operators receive ade-
quate training and support to overcome management weaknesses is likely to be more
effective than enforcement of compliance.
3.2.2 Performance targets

Performance targets are most frequently applied to the control of microbial hazards
in piped supplies varying from small to large.
In situations where short-term exposure is relevant to public health, because water
quality varies rapidly or it is not possible to detect hazards between production and
consumption, it is necessary to ensure that control measures are in place and operat-
ing optimally and to verify their effectiveness in order to secure safe drinking-water.
Performance targets assist in the selection and use of control measures that are
capable of preventing pathogens from breaching the barriers of source protection,
treatment and distribution systems or preventing growth within the distribution
system.
Performance targets should dene requirements in relation to source water quality
with prime emphasis on processes and practices that will ensure that the targets can
be routinely achieved. Most commonly, targets for removal of pathogen groups
through water treatment processes will be specied in relation to broad categories of
41
source water quality or source water type and less frequently in relation to specic
data on source water quality. The derivation of performance targets requires the
integration of factors such as tolerable disease burden (tolerable risk), including sever-
ity of disease outcomes and doseresponse relationships for specic pathogens (target
microbes) (see section 7.3).
Performance targets should be developed for target microbes representing groups
of pathogens that combine both control challenges and health signicance. In prac-
tice, more than one target microbe will normally be required in order to properly
reect diverse challenges to the safeguards available. While performance targets may
be derived in relation to exposure to specic pathogens, care is required in relating
this to overall population exposure and risk, which may be concentrated into short
periods of time.
The principal practical application of performance targets for pathogen control is
in assessing the adequacy of drinking-water treatment infrastructure. This is achieved
by using information on performance targets with either specic information on
treatment performance or assumptions regarding performance of technology types
concerning pathogen removal. Examples of performance targets and of treatment
effects on pathogens are given in chapter 7.
Performance requirements are also important in certication of devices for drink-
ing-water treatment and for pipe installation that prevents ingress. Certication of
devices and materials is discussed elsewhere (see section 1.2.9).
3.2.3 Water quality targets

Adverse health consequences may arise from exposure to chemicals following long-
term and, in some cases, short-term exposure. Furthermore, concentrations of most
chemicals in drinking-water do not normally uctuate widely over short periods of
time. Management through periodic analysis of drinking-water quality and compar-
ison with WQTs such as guideline values is therefore commonly applied to many
chemicals in drinking-water where health effects arise from long-term exposure.
While a preventive management approach to water quality should be applied to all
drinking-water systems, the guideline values for individual chemicals described in
section 8.5 provide health-based targets for chemicals in drinking-water.
Where water treatment processes have been put in place to remove specic chem-
icals (see section 8.4), WQTs should be used to determine appropriate treatment
requirements.
It is important that WQTs are established only for those chemicals that, following
rigorous assessment, have been determined to be of health concern or of concern for
the acceptability of the drinking-water to consumers. There is little value in under-
taking measurements for chemicals that are unlikely to be in the system, that will be
present only at concentrations much lower than the guideline value or that have no
human health effects or effects on drinking-water acceptability.
42
WQTs are also used in the certication process for chemicals that occur in water
as a result of treatment processes or from materials in contact with water. In such
applications, assumptions are made in order to derive standards for materials and
chemicals that can be employed in their certication. Generally, allowance must be
made for the incremental increase over levels found in water sources. For some mate-
rials (e.g., domestic plumbing), assumptions must also account for the relatively high
release of some substances for a short period following installation.
For microbial hazards, WQTs in terms of pathogens serve primarily as a step in the
development of performance targets and have no direct application. In some cir-
cumstances, especially where non-conventional technologies are employed in large
facilities, it may be appropriate to establish WQTs for microbial contaminants.
3.2.4 Health outcome targets

In some circumstances, especially where there is a measurable burden of water-related
disease, it is possible to establish a health-based target in terms of a quantiable reduc-
tion in the overall level of disease. This is most applicable where adverse effects soon
follow exposure and are readily and reliably monitored and where changes in expo-
sure can also be readily and reliably monitored. This type of health outcome target is
therefore primarily applicable to microbial hazards in both developing and developed
countries and to chemical hazards with clearly dened health effects largely attribut-
able to water (e.g., uoride).
In other circumstances, health-based targets may be based on the results of quan-
titative risk assessment. In these cases, health outcomes are estimated based on infor-
mation concerning exposure and doseresponse relationships. The results may be
employed directly as a basis to dene WQTs or may provide the basis for development
of performance targets.
There are limitations in the available data and models for quantitative microbial
risk assessment (QMRA). Short-term uctuations in water quality may have a major
impact on overall health risks including those associated with background rates of
disease and outbreaks and are a particular focus of concern in expanding applica-
tion of QMRA. Further developments in these elds will signicantly enhance the
applicability and usefulness of this approach.
3.3 General considerations in establishing health-based targets

While water can be a major source of enteric pathogens and hazardous chemicals, it
is by no means the only source. In setting targets, consideration needs to be given to
other sources of hazards, including food, air and person-to-person contact, as well as
the impact of poor sanitation and personal hygiene. There is limited value in estab-
lishing a strict target concentration for a chemical if drinking-water provides only a
small proportion of total exposure. The cost of meeting such targets could unneces-
sarily divert funding from other, more pressing health interventions. It is important
43
to take account of the impact of the proposed intervention on overall rates of disease.
For some pathogens and their associated diseases, interventions in water quality may
be ineffective and may therefore not be justied. This may be the case where other
routes of exposure dominate. For others, long experience has shown the effectiveness
of drinking-water supply and quality management (e.g., typhoid, dysentery caused by
Shigella).
Health-based targets and water quality improvement programmes in general
should also be viewed in the context of a broader public health policy, including ini-
tiatives to improve sanitation, waste disposal, personal hygiene and public education
on mechanisms for reducing both personal exposure to hazards and the impact
of personal activity on water quality. Improved public health, reduced carriage of
pathogens and reduced human impacts on water resources all contribute to drinking-
water safety (see Howard et al., 2002).
3.3.1 Assessment of risk in the framework for safe drinking-water

In the framework for safe drinking-water, assessment of risk is not a goal in its own
right but is part of an iterative cycle that uses the assessment of risk to derive man-
agement decisions that, when implemented, result in incremental improvements
in water quality. For the purposes of these Guidelines, the emphasis of incremental
improvement is on health. However, in applying the Guidelines to specic circum-
stances, non-health factors should be taken into account, as they may have a consid-
erable impact upon both costs and benets.
3.3.2 Reference level of risk

Descriptions of a reference level of risk in relation to water are typically expressed
in terms of specic health outcomes for example, a maximum frequency of
diarrhoeal disease or cancer incidence or maximum frequency of infection (but not
necessarily disease) with a specic pathogen.
There is a range of water-related illnesses with differing severities, including acute,
delayed and chronic effects and both morbidity and mortality. Effects may be as
diverse as adverse birth outcomes, cancer, cholera, dysentery, infectious hepatitis,
intestinal worms, skeletal uorosis, typhoid and Guillain-Barr syndrome.
Decisions about risk acceptance are highly complex and need to take account of
different dimensions of risk. In addition to the objective dimensions of probability,
severity and duration of an effect, there are important environmental, social, cultural,
economic and political dimensions that play important roles in decision-making.
Negotiations play an important role in these processes, and the outcome may very
well be unique in each situation. Notwithstanding the complexity of decisions about
risk, there is a need for a baseline denition of tolerable risk for the development of
guidelines and as a departure point for decisions in specic situations.
A reference level of risk enables the comparison of water-related diseases with one
another and a consistent approach for dealing with each hazard. For the purposes of
44
these Guidelines, a reference level of risk is used for broad equivalence between the
levels of protection afforded to toxic chemicals and those afforded to microbial
pathogens. For these purposes, only the health effects of waterborne diseases are taken
into account. The reference level of risk is 10-6 disability-adjusted life-years (DALYs)
per person per year, which is approximately equivalent to a lifetime excess cancer risk
of 10-5 (i.e., 1 excess case of cancer per 100 000 of the population ingesting drinking-
water containing the substance at the guideline value over a life span) (see section
3.3.3 for further details). For a pathogen causing watery diarrhoea with a low case
fatality rate (e.g., 1 in 100 000), this reference level of risk would be equivalent to
1/1000 annual risk of disease to an individual (approximately 1/10 over a lifetime).
The reference level of risk can be adapted to local circumstances on the basis of a
riskbenet approach. In particular, account should be taken of the fraction of the
burden of a particular disease that is likely to be associated with drinking-water. Public
health prioritization would normally indicate that major contributors should be dealt
with preferentially, taking account of the costs and impacts of potential interventions.
This is also the rationale underlying the incremental development and application of
standards. The application of DALYs for setting a reference level of risk is a new and
evolving approach. A particular challenge is to dene human health effects associated
with exposure to non-threshold chemicals.
3.3.3 Disability-adjusted life-years (DALYs)

The diverse hazards that may be present in water are associated with very diverse
adverse health outcomes. Some outcomes are acute (diarrhoea, methaemoglobi-
naemia), and others are delayed (cancer by years, infectious hepatitis by weeks);
some are potentially severe (cancer, adverse birth outcomes, typhoid), and others are
typically mild (diarrhoea and dental uorosis); some especially affect certain age
ranges (skeletal uorosis in older adults often arises from exposure in childhood;
infection with hepatitis E virus [HEV] has a very high mortality rate among pregnant
women), and some have very specic concern for certain vulnerable subpopulations
(cryptosporidiosis is mild and self-limiting for the population at large but has a
high mortality rate among those who test positive for human immunodeciency
virus [HIV]). In addition, any one hazard may cause multiple effects (e.g., gastroen-
teritis, Gullain-Barr syndrome, reactive arthritis and mortality associated with
Campylobacter).
In order to be able to objectively compare water-related hazards and the different
outcomes with which they are associated, a common metric that can take account
of differing probabilities, severities and duration of effects is needed. Such a metric
should also be applicable regardless of the type of hazard, applying to microbial,
chemical and radiological hazards. The metric used in the Guidelines for Drinking-
water Quality is the DALY. WHO has quite extensively used DALYs to evaluate public
health priorities and to assess the disease burden associated with environmental
exposures.
45
The basic principle of the DALY is to weight each health effect for its severity from
0 (normal good health) to 1 (death). This weight is multiplied by the duration of the
effect the time in which disease is apparent (when the outcome is death, the dura-
tion is the remaining life expectancy) and by the number of people affected by a
particular outcome. It is then possible to sum the effects of all different outcomes due
to a particular agent.
Thus, the DALY is the sum of years of life lost by premature mortality (YLL) and
years of healthy life lost in states of less than full health, i.e., years lived with a dis-
ability (YLD), which are standardized by means of severity weights. Thus:
DALY = YLL + YLD
Key advantages of using DALYs are its aggregation of different effects and its com-
bining of quality and quantity of life. In addition and because the approaches taken
require explicit recognition of assumptions made it is possible to discuss these
and assess the impact of their variation. The use of an outcome metric also focuses
attention on actual rather than potential hazards and thereby promotes and enables
rational public health priority setting. Most of the difculties in using DALYs
relate to availability of data for example, on exposure and on epidemiological
associations.
DALYs can also be used to compare the health impact of different agents in water.
For example, ozone is a chemical disinfectant that produces bromate as a by-product.
DALYs have been used to compare the risks from Cryptosporidium parvum
and bromate and to assess the net health benets of ozonation in drinking-water
treatment.
In previous editions of the Guidelines for Drinking-water Quality and in many
national drinking-water standards, a tolerable risk of cancer has been used to derive
guideline values for non-threshold chemicals such as genotoxic carcinogens. This is
necessary because there is some (theoretical) risk at any level of exposure. In this and
previous editions of the Guidelines, an upper-bound excess lifetime risk of cancer of
10-5 has been used, while accepting that this is a conservative position and almost
certainly overestimates the true risk.
Different cancers have different severities, manifested mainly by different mortal-
ity rates. A typical example is renal cell cancer, associated with exposure to bromate
in drinking-water. The theoretical disease burden of renal cell cancer, taking into
account an average case:fatality ratio of 0.6 and average age at onset of 65 years, is
11.4 DALYs per case (Havelaar et al., 2000). These data can be used to assess tolera-
ble lifetime cancer risk and a tolerable annual loss of DALYs. Here, we account for the
lifelong exposure to carcinogens by dividing the tolerable risk over a life span of 70
years and multiplying by the disease burden per case: (10-5 cancer cases / 70 years of
life) 11.4 DALYs per case = 1.6 10-6 DALYs per person-year or a tolerable loss of
1.6 healthy life-years in a population of a million over a year.
46
For guideline derivation, the preferred option is to dene an upper level of toler-
able risk that is the same for exposure to each hazard (contaminant or constituent in
water). As noted above, for the purposes of these Guidelines, the reference level of risk
employed is 10-6 DALYs per person-year. This is approximately equivalent to the
10-5 excess lifetime risk of cancer used in this and previous editions of the Guidelines
to determine guideline values for genotoxic carcinogens. For countries that use a
stricter denition of the level of acceptable risk of carcinogens (such as 10-6), the tol-
erable loss will be proportionately lower (such as 10-7 DALYs per person-year).
Further information on the use of DALYs in establishing health-based targets is
included in the supporting document Quantifying Public Health Risk in the WHO
Guidelines for Drinking-water Quality (see section 1.3).
47
4
Water safety plans
T he most effective means of consistently ensuring the safety of a drinking-water

supply is through the use of a comprehensive risk assessment and risk manage-
ment approach that encompasses all steps in water supply from catchment to con-
sumer. In these Guidelines, such approaches are termed water safety plans (WSPs).
The WSP approach has been developed to organize and systematize a long history of
management practices applied to drinking-water and to ensure the applicability of
these practices to the management of drinking-water quality. It draws on many of the
principles and concepts from other risk management approaches, in particular the
multiple-barrier approach and HACCP (as used in the food industry).
This chapter focuses on the principles of WSPs and is not a comprehensive guide
to the application of these practices. Further information on how to develop a WSP
is available in the supporting document Water Safety Plans (section 1.3).
Some elements of a WSP will often be implemented as part of a drinking-water
suppliers usual practice or as part of benchmarked good practice without consolida-
tion into a comprehensive WSP. This may include quality assurance systems (e.g., ISO
9001:2000). Existing good management practices provide a suitable platform for inte-
grating WSP principles. However, existing practices may not include system-tailored
hazard identication and risk assessment as a starting point for system management.
WSPs can vary in complexity, as appropriate for the situation. In many cases, they
will be quite simple, focusing on the key hazards identied for the specic system.
The wide range of examples of control measures given in the following text does not
imply that all of these are appropriate in all cases. WSPs are a powerful tool for the
drinking-water supplier to manage the supply safely. They also assist surveillance by
public health authorities.
WSPs should, by preference, be developed for individual drinking-water systems.
However, for small systems, this may not be realistic, and either specied technology
WSPs or model WSPs with guides for their development are prepared. For smaller
systems, the WSP is likely to be developed by a statutory body or accredited third-
party organization. In these settings, guidance on household water storage, handling
and use may also be required. Plans dealing with household water should be linked
48
4. WATER SAFETY PLANS
to a hygiene education programme and

advice to households in maintaining A WSP comprises, as a minimum, the three
essential actions that are the responsibil-
water safety. ity of the drinking-water supplier in order
A WSP has three key components, to ensure that drinking-water is safe.
which are guided by health-based targets These are:
(see chapter 3) and overseen through a system assessment;
drinking-water supply surveillance (see effective operational monitoring; and
management.
chapter 5). They are:
system assessment to determine
whether the drinking-water supply chain (up to the point of consumption) as
a whole can deliver water of a quality that meets health-based targets. This also
includes the assessment of design criteria of new systems;
identifying control measures in a drinking-water system that will collectively
control identied risks and ensure that the health-based targets are met. For each
control measure identied, an appropriate means of operational monitoring
should be dened that will ensure that any deviation from required perform-
ance is rapidly detected in a timely manner; and
management plans describing actions to be taken during normal operation or
incident conditions and documenting the system assessment (including upgrade
and improvement), monitoring and communication plans and supporting
programmes.
The primary objectives of a WSP in ensuring good drinking-water supply practice are
the minimization of contamination of source waters, the reduction or removal of con-
tamination through treatment processes and the prevention of contamination during
storage, distribution and handling of drinking-water. These objectives are equally
applicable to large piped drinking-water supplies, small community supplies and
household systems and are achieved through:
development of an understanding of the specic system and its capability to
supply water that meets health-based targets;
identication of potential sources of contamination and how they can be
controlled;
validation of control measures employed to control hazards;
implementation of a system for monitoring the control measures within the
water system;
timely corrective actions to ensure that safe water is consistently supplied; and
undertaking verication of drinking-water quality to ensure that the WSP is
being implemented correctly and is achieving the performance required to meet
relevant national, regional and local water quality standards or objectives.
For the WSP to be relied on for controlling the hazards and hazardous events for
which it was set in place, it needs to be supported by accurate and reliable technical
49
Figure 4.1 Overview of the key steps in developing a water safety plan (WSP)
information. This process of obtaining evidence that the WSP is effective is known as
validation. Such information could be obtained from relevant industry bodies, from
partnering and benchmarking with larger authorities (to optimize resource sharing),
from scientic and technical literature and from expert judgement. Assumptions and
manufacturer specications for each piece of equipment and each barrier need to be
validated for each system being studied to ensure that the equipment or barrier is
effective in that system. System-specic validation is essential, as variabilities in water
50
composition, for instance, may have a large impact on the efcacy of certain removal
processes.
Validation normally includes more extensive and intensive monitoring than
routine operational monitoring, in order to determine whether system units are
performing as assumed in the system assessment. This process often leads to
improvements in operating performance through the identication of the most effec-
tive and robust operating modes. Additional benets of the validation process may
include identication of more suitable operational monitoring parameters for unit
performance.
Verication of drinking-water quality provides an indication of the overall per-
formance of the drinking-water system and the ultimate quality of drinking-water
being supplied to consumers. This incorporates monitoring of drinking-water quality
as well as assessment of consumer satisfaction.
Where a dened entity is responsible for a drinking-water supply, its responsibil-
ity should include the preparation and implementation of a WSP. This plan should
normally be reviewed and agreed upon with the authority responsible for protection
of public health to ensure that it will deliver water of a quality consistent with the
health-based targets.
Where there is no formal service provider, the competent national or regional
authority should act as a source of information and guidance on the adequacy of
appropriate management of community and individual drinking-water supplies. This
will include dening requirements for operational monitoring and management.
Approaches to verication in these circumstances will depend on the capacity of local
authorities and communities and should be dened in national policy.
4.1 System assessment and design

The rst stage in developing a WSP is to form a multidisciplinary team of experts with
a thorough understanding of the drinking-water system involved. Typically, such a
team would include individuals involved in each stage of the supply of drinking-water,
such as engineers, catchment and water managers, water quality specialists, environ-
mental or public health or hygienist professionals, operational staff and representa-
tives of consumers. In most settings, the team will include members from several
institutions, and there should be some independent members, such as from profes-
sional organizations or universities.
Effective management of the drinking-water system requires a comprehensive
understanding of the system, the range and magnitude of hazards that may be present
and the ability of existing processes and infrastructure to manage actual or potential
risks. It also requires an assessment of capabilities to meet targets. When a new system
or an upgrade of an existing system is being planned, the rst step in developing a
WSP is the collection and evaluation of all available relevant information and con-
sideration of what risks may arise during delivery of water to the consumer.
51
Effective risk management requires the identication of potential hazards, their sources and
potential hazardous events and an assessment of the level of risk presented by each. In this
context:
a hazard is a biological, chemical, physical or radiological agent that has the potential to
cause harm;
a hazardous event is an incident or situation that can lead to the presence of a hazard (what
can happen and how); and
risk is the likelihood of identied hazards causing harm in exposed populations in a speci-
ed time frame, including the magnitude of that harm and/or the consequences.
Assessment of the drinking-water system supports subsequent steps in the WSP in

which effective strategies for control of hazards are planned and implemented.
The assessment and evaluation of a drinking-water system are enhanced through
the development of a ow diagram. Diagrams provide an overview description of the
drinking-water system, including characterization of the source, identication of
potential pollution sources in the catchment, measures for resource and source pro-
tection, treatment processes, storage and distribution infrastructure. It is essential that
the representation of the drinking-water system is conceptually accurate. If the ow
diagram is not correct, it is possible to overlook potential hazards that may be signif-
icant. To ensure accuracy, the ow diagram should be validated by visually checking
the diagram against features observed on the ground.
Data on the occurrence of pathogens and chemicals in source waters combined
with information concerning the effectiveness of existing controls enable an assess-
ment of whether health-based targets can be achieved with the existing infrastructure.
They also assist in identifying catchment
management measures, treatment It may often be more efcient to invest in
processes and distribution system oper- preventive processes within the catch-
ating conditions that would reasonably ment than to invest in major treatment
infrastructure to manage a hazard.
be expected to achieve those targets if
improvements are required.
To ensure the accuracy of the assessment, it is essential that all elements of the
drinking-water system (resource and source protection, treatment and distribution)
are considered concurrently and that interactions and inuences between each
element and their overall effect are taken into consideration.
4.1.1 New systems

When drinking-water supply sources are being investigated or developed, it is prudent
to undertake a wide range of analyses in order to establish overall safety and to deter-
mine potential sources of contamination of the drinking-water supply source. These
would normally include hydrological analysis, geological assessment and land use
inventories to determine potential chemical and radiological contaminants.
52
When designing new systems, all water quality factors should be taken into account
in selecting technologies for abstraction and treatment of new resources. Variations
in the turbidity and other parameters of raw surface waters can be very great, and
allowance must be made for this. Treatment plants should be designed to take account
of variations known or expected to occur with signicant frequency rather than for
average water quality; otherwise, lters may rapidly become blocked or sedimentation
tanks overloaded. The chemical aggressiveness of some groundwaters may affect the
integrity of borehole casings and pumps, leading to unacceptably high levels of iron
in the supply, eventual breakdown and expensive repair work. Both the quality and
availability of drinking-water may be reduced and public health endangered.
4.1.2 Collecting and evaluating available data

Table 4.1 provides examples of areas that should normally be taken into considera-
tion as part of the assessment of the drinking-water system. In most cases, consulta-
tion with public health and other sectors, including land and water users and all those
who regulate activities in the catchment, will be required for the analysis of catch-
ments. A structured approach is important to ensure that signicant issues are not
overlooked and that areas of greatest risk are identied.
The overall assessment of the drinking-water system should take into considera-
tion any historical water quality data that assist in understanding source water char-
acteristics and drinking-water system performance both over time and following
specic events (e.g., heavy rainfall).
Prioritizing hazards for control

Once potential hazards and their sources have been identied, the risk associated with
each hazard or hazardous event should be compared so that priorities for risk man-
agement can be established and documented. Although there are numerous contam-
inants that can compromise drinking-water quality, not every hazard will require the
same degree of attention.
The risk associated with each hazard or hazardous event may be described by iden-
tifying the likelihood of occurrence (e.g., certain, possible, rare) and evaluating the
severity of consequences if the hazard occurred (e.g., insignicant, major, catastrophic).
The aim should be to distinguish between important and less important hazards or
hazardous events. The approach used typically involves a semiquantitative matrix.
Simple scoring matrices typically apply technical information from guidelines,
scientic literature and industry practice with well informed expert judgement
supported by peer review or benchmarking. Scoring is specic for each drinking-
water system, since each system is unique. Where generic WSPs are developed for
technologies used by small drinking-water systems, the scoring will be specic to the
technology rather than the individual drinking-water system.
By using a semiquantitative scoring, control measures can be ranked in relation to
the most signicant hazards. A variety of approaches to ranking risk can be applied.
53
Table 4.1 Examples of information useful in assessing a drinking-water system

Component of drinking- Information to consider in assessing component of
water system drinking-water system
Catchments Geology and hydrology
Meteorology and weather patterns
General catchment and river health
Wildlife
Competing water uses
Nature and intensity of development and land use
Other activities in the catchment that potentially release
contaminants into source water
Planned future activities
Surface water Description of water body type (e.g., river, reservoir, dam)
Physical characteristics (e.g., size, depth, thermal stratication,
altitude)
Flow and reliability of source water
Retention times
Water constituents (physical, chemical, microbial)
Protection (e.g., enclosures, access)
Recreational and other human activity
Bulk water transport
Groundwater Conned or unconned aquifer
Aquifer hydrogeology
Flow rate and direction
Dilution characteristics
Recharge area
Wellhead protection
Depth of casing
Bulk water transport
Treatment Treatment processes (including optional processes)
Equipment design
Monitoring equipment and automation
Water treatment chemicals used
Treatment efciencies
Disinfection removals of pathogens
Disinfectant residual / contact time
Service reservoirs and Reservoir design
distribution Retention times
Seasonal variations
Protection (e.g., covers, enclosures, access)
Distribution system design
Hydraulic conditions (e.g., water age, pressures, ows)
Backow protection
Disinfectant residuals
An example of an approach is given in Table 4.2. Application of this matrix relies to

a signicant extent on expert opinion to make judgements on the health risk posed
by hazards or hazardous events.
An example of descriptors that can be used to rate the likelihood of occurrence
and severity of consequences is given in Table 4.3. A cut-off point must be deter-
54
Table 4.2 Example of a simple risk scoring matrix for ranking risks
Severity of consequences
Likelihood Insignicant Minor Moderate Major Catastrophic
Almost certain
Likely
Moderately likely
Unlikely
Rare
Table 4.3 Examples of denitions of likelihood and severity categories that can be used in risk
scoring
Item Denition
Likelihood categories
Almost certain Once per day
Likely Once per week
Moderately likely Once per month
Unlikely Once per year
Rare Once every 5 years
Severity categories
Catastrophic Potentially lethal to large population
Major Potentially lethal to small population
Moderate Potentially harmful to large population
Minor Potentially harmful to small population
Insignicant No impact or not detectable
mined, above which all hazards will require immediate attention. There is little value
in expending large amounts of effort to consider very small risks.
Control measures
The assessment and planning of control
measures should ensure that health- Control measures are those steps in
drinking-water supply that directly affect
based targets will be met and should be drinking-water quality and that collec-
based on hazard identication and tively ensure that drinking-water consis-
assessment. The level of control applied tently meets health-based targets. They
are activities and processes applied to
to a hazard should be proportional to prevent hazard occurrence.
the associated ranking. Assessment of
control measures involves:
identifying existing control measures for each signicant hazard or hazardous
event from catchment to consumer;
evaluating whether the control measures, when considered together, are effec-
tive in controlling risk to acceptable levels; and
if improvement is required, evaluating alternative and additional control meas-
ures that could be applied.
55
Identication and implementation of control measures should be based on the

multiple-barrier principle. The strength of this approach is that a failure of one barrier
may be compensated by effective operation of the remaining barriers, thus minimiz-
ing the likelihood of contaminants passing through the entire system and being
present in sufcient amounts to cause harm to consumers. Many control measures
may contribute to control more than one hazard, while some hazards may require
more than one control measure for effective control. Examples of control measures
are provided in the following sections.
All control measures are important and should be afforded ongoing attention. They
should be subject to operational monitoring and control, with the means of moni-
toring and frequency of data collection based on the nature of the control measure
and the rapidity with which change may occur (see section 4.4.3).
4.1.3 Resource and source protection

Effective catchment management has many benets. By decreasing the contamination
of the source water, the amount of treatment required is reduced. This may reduce
the production of treatment by-products and minimize operational costs.
Hazard identication
Understanding the reasons for variations in raw water quality is important, as it will
inuence the requirements for treatment, treatment efciency and the resulting health
risk associated with the nished water. In general, raw water quality is inuenced by
both natural and human use factors. Important natural factors include wildlife,
climate, topography, geology and vegetation. Human use factors include point sources
(e.g., municipal and industrial wastewater discharges) and non-point sources (e.g.,
urban and agricultural runoff, including agrochemicals, livestock or recreational use).
For example, discharges of municipal wastewater can be a major source of pathogens;
urban runoff and livestock can contribute substantial microbial load; body contact
recreation can be a source of faecal contamination; and agricultural runoff can lead
to increased challenges to treatment.
Whether water is drawn from surface or underground sources, it is important that
the characteristics of the local catchment or aquifer are understood and that the sce-
narios that could lead to water pollution are identied and managed. The extent to
which potentially polluting activities in the catchment can be reduced may appear to
be limited by competition for water and pressure for increased development in the
catchment. However, introducing good practice in containment of hazards is often
possible without substantially restricting activities, and collaboration between
stakeholders may be a powerful tool to reduce pollution without reducing benecial
development.
Resource protection and source protection provide the rst barriers in protection
of drinking-water quality. Where catchment management is beyond the jurisdiction
of the drinking-water supplier, the planning and implementation of control measures
56
will require coordination with other agencies. These may include planning authori-
ties, catchment boards, environmental and water resource regulators, road authori-
ties, emergency services and agricultural, industrial and other commercial entities
whose activities have an impact on water quality. It may not be possible to apply all
aspects of resource and source protection initially; nevertheless, priority should be
given to catchment management. This will contribute to a sense of ownership and
joint responsibility for drinking-water resources through multistakeholder bodies that
assess pollution risks and develop plans for improving management practices for
reducing these risks.
Groundwater from depth and conned aquifers is usually microbially safe and
chemically stable in the absence of direct contamination; however, shallow or uncon-
ned aquifers can be subject to contamination from discharges or seepages associated
with agricultural practices (e.g., pathogens, nitrates and pesticides), on-site sanitation
and sewerage (pathogens and nitrates) and industrial wastes. Hazards and hazardous
events that can have an impact on catchments and that should be taken into consid-
eration as part of a hazard assessment include:
rapid variations in raw water quality;
sewage and septic system discharges;
industrial discharges;
chemical use in catchment areas (e.g., use of fertilizers and agricultural
pesticides);
major spills (including relationship to public roads and transport routes), both
accidental and deliberate;
human access (e.g., recreational activity);
wildlife and livestock;
land use (e.g., animal husbandry, agriculture, forestry, industrial area, waste
disposal, mining) and changes in land use;
inadequate buffer zones and vegetation, soil erosion and failure of sediment traps;
stormwater ows and discharges;
active or closed waste disposal or mining sites / contaminated sites / hazardous
wastes;
geology (naturally occurring chemicals);
unconned and shallow aquifer (including groundwater under direct inuence
of surface water);
inadequate wellhead protection, uncased or inadequately cased bores and
unhygienic practices; and
climatic and seasonal variations (e.g., heavy rainfalls, droughts) and natural
disasters.
Further hazards and hazardous situations that can have an impact on storage reser-
voirs and intakes and that should be taken into consideration as part of a hazard
assessment include:
57
human access / absence of exclusion areas;

short circuiting of reservoir;
depletion of reservoir storage;
lack of selective withdrawal;
lack of alternative water sources;
unsuitable intake location;
cyanobacterial blooms;
stratication; and
failure of alarms and monitoring equipment.
Control measures
Effective resource and source protection includes the following elements:
developing and implementing a catchment management plan, which includes
control measures to protect surface water and groundwater sources;
ensuring that planning regulations include the protection of water resources
(land use planning and watershed management) from potentially polluting
activities and are enforced; and
promoting awareness in the community of the impact of human activity on
water quality.
Examples of control measures for effective protection of source water and catchments
include:
designated and limited uses;
registration of chemicals used in catchments;
specic protective requirements (e.g., containment) for chemical industry or
refuelling stations;
reservoir mixing/destratication to reduce growth of cyanobacteria or to reduce
anoxic hypolimnion and solubilization of sedimentary manganese and iron;
pH adjustment of reservoir water;
control of human activities within catchment boundaries;
control of wastewater efuents;
land use planning procedures, use of planning and environmental regulations
to regulate potential water-polluting developments;
regular inspections of catchment areas;
diversion of local stormwater ows;
protection of waterways;
runoff interception; and
security to prevent tampering.
Similarly, control measures for effective protection of water extraction and storage
systems include:
58
use of available water storage during and after periods of heavy rainfall;
appropriate location and protection of intake;
appropriate choice of off-take depth from reservoirs;
proper well construction, including casing, sealing and wellhead security;
proper location of wells;
water storage systems to maximize retention times;
storages and reservoirs with appropriate stormwater collection and drainage;
security from access by animals; and
security to prevent unauthorized access and tampering.
Where a number of water sources are available, there may be exibility in the selec-
tion of water for treatment and supply. It may be possible to avoid taking water
from rivers and streams when water quality is poor (e.g., following heavy rainfall) in
order to reduce risk and prevent potential problems in subsequent treatment processes.
Retention of water in reservoirs can reduce the number of faecal microorganisms
through settling and inactivation, including solar (ultraviolet [UV]) disinfection but
also provides apportunities for contamination to be introduced. Most pathogenic
microorganisms of faecal origin (enteric pathogens) do not survive indenitely in the
environment. Substantial die-off of enteric bacteria will occur over a period of weeks.
Enteric viruses and protozoa will often survive for longer periods (weeks to months)
but are often removed by settling and antagonism from indigenous microbes. Reten-
tion also allows suspended material to settle, which makes subsequent disinfection
more effective and reduces the formation of DBPs.
Control measures for groundwater sources should include protecting the aquifer
and the local area around the borehead from contamination and ensuring the phys-
ical integrity of the bore (surface sealed, casing intact, etc.).
Further information on the use of indicators in catchment characterization is avail-
able in chapter 4 of the supporting document Assessing Microbial Safety of Drinking
Water (section 1.3).
4.1.4 Treatment
After source water protection, the next barriers to contamination of the drinking-
water system are those of water treatment processes, including disinfection and phys-
ical removal of contaminants.
Hazard identication
Hazards may be introduced during treatment, or hazardous circumstances may allow
contaminants to pass through treatment in signicant concentrations. Constituents
of drinking-water can be introduced through the treatment process, including chem-
ical additives used in the treatment process or products in contact with drinking-
water. Sporadic high turbidity in source water can overwhelm treatment processes,
59
allowing enteric pathogens into treated water and the distribution system. Similarly,
suboptimal ltration following lter backwashing can lead to the introduction of
pathogens into the distribution system.
Examples of potential hazards and hazardous events that can have an impact on
the performance of drinking-water treatment include the following:
ow variations outside design limits;

inappropriate or insufcient treatment processes, including disinfection;
inadequate backup (infrastructure, human resources);
process control failure and malfunction or poor reliability of equipment;
use of unapproved or contaminated water treatment chemicals and materials;
chemical dosing failures;
inadequate mixing;
failure of alarms and monitoring equipment;
power failures;
accidental and deliberate pollution;
natural disasters;
formation of DBPs; and
cross-connections to contaminated water/wastewater, internal short circuiting.
Control measures
Control measures may include pretreatment, coagulation/occulation/sedimentation,
ltration and disinfection.
Pretreatment includes processes such as roughing lters, microstrainers, off-stream
storage and bankside ltration. Pretreatment options may be compatible with a
variety of treatment processes ranging in complexity from simple disinfection to
membrane processes. Pretreatment can reduce and/or stabilize the microbial, natural
organic matter and particulate load.
Coagulation, occulation, sedimentation (or otation) and ltration remove par-
ticles, including microorganisms (bacteria, viruses and protozoa). It is important that
processes are optimized and controlled to achieve consistent and reliable perfor-
mance. Chemical coagulation is the most important step in determining the removal
efciency of coagulation/occulation/clarication processes. It also directly affects the
removal efciency of granular media ltration units and has indirect impacts on the
efciency of the disinfection process. While it is unlikely that the coagulation process
itself introduces any new microbial hazards to nished water, a failure or inefciency
in the coagulation process could result in an increased microbial load entering
drinking-water distribution.
Various ltration processes are used in drinking-water treatment, including gran-
ular, slow sand, precoat and membrane (microltration, ultraltration, nanoltration
and reverse osmosis) ltration. With proper design and operation, ltration can act
as a consistent and effective barrier for microbial pathogens and may in some cases
60
be the only treatment barrier (e.g., for removing Cryptosporidium oocysts by direct
ltration when chlorine is used as the sole disinfectant).
Application of an adequate level of disinfection is an essential element for most
treatment systems to achieve the necessary level of microbial risk reduction. Taking
account of the level of microbial inactivation required for the more resistant micro-
bial pathogens through the application of the Ct concept (product of disinfectant con-
centration and contact time) for a particular pH and temperature ensures that other
more sensitive microbes are also effectively controlled. Where disinfection is used,
measures to minimize DBP formation should be taken into consideration.
The most commonly used disinfection process is chlorination. Ozonation, UV irra-
diation, chloramination and application of chlorine dioxide are also used. These
methods are very effective in killing bacteria and can be reasonably effective in inac-
tivating viruses (depending on type) and many protozoa, including Giardia and Cryp-
tosporidium. For effective removal or inactivation of protozoal cysts and oocysts,
ltration with the aid of coagulation/occulation (to reduce particles and turbidity)
followed by disinfection (by one or a combination of disinfectants) is the most prac-
tical method.
Examples of treatment control measures include:
coagulation/occulation and sedimentation;

use of approved water treatment chemicals and materials;
control of water treatment chemicals;
process controls;
availability of backup systems;
water treatment process optimization, including
chemical dosing
lter backwashing
ow rate
use of water in storage in periods of poor-quality raw water; and
security to prevent unauthorized access and tampering.
Storage of water after disinfection and before supply to consumers can improve dis-
infection by increasing disinfectant contact times. This can be particularly important
for more resistant microorganisms, such as Giardia and some viruses.
Further information can be found in the supporting document Water Treatment
and Pathogen Control (section 1.3).
4.1.5 Piped distribution systems

Water treatment should be optimized to prevent microbial growth, corrosion of pipe
materials and the formation of deposits through measures such as:
continuous and reliable elimination of particles and the production of water of
low turbidity;
61
precipitation and removal of dissolved (and particulate) iron and manganese;

minimizing the carry-over of residual coagulant (dissolved, colloidal or partic-
ulate), which may precipitate in reservoirs and pipework;
reducing as far as possible the dissolved organic matter and especially easily
biodegradable organic carbon, which provides nutrients for microorganisms; and
maintaining the corrosion potential within limits that avoid damage to the
structural materials and consumption of disinfectant.
Maintaining good water quality in the distribution system will depend on the design
and operation of the system and on maintenance and survey procedures to prevent
contamination and to prevent and remove accumulation of internal deposits.
Further information is available in the supporting document Safe, Piped Water
(section 1.3).
Hazard identication
The protection of the distribution system is essential for providing safe drinking-
water. Because of the nature of the distribution system, which may include many kilo-
metres of pipe, storage tanks, interconnections with industrial users and the potential
for tampering and vandalism, opportunities for microbial and chemical contamina-
tion exist.
Contamination can occur within the distribution system:
when contaminated water in the subsurface material and especially nearby sewers
surrounding the distribution system enters because of low internal pipe pressure
or through the effect of a pressure wave within the system (inltration/ingress);
when contaminated water is drawn into the distribution system or storage reser-
voir through backow resulting from a reduction in line pressure and a physi-
cal link between contaminated water and the storage or distribution system;
through open or insecure treated water storage reservoirs and aqueducts, which
are potentially vulnerable to surface runoff from the land and to attracting
animals and waterfowl as faecal contamination sources and may be insecure
against vandalism and tampering;
through pipe bursts when existing mains are repaired or replaced or when new
water mains are installed, potentially leading to the introduction of contami-
nated soil or debris into the system;
through human error resulting in the unintentional cross-connection of waste-
water or stormwater pipes to the distribution system or through illegal or unau-
thorized connections;
through leaching of chemicals and heavy metals from materials such as pipes,
solders / jointing compounds, taps and chemicals used in cleaning and disin-
fection of distribution systems; and
when petrol or oil diffuses through plastic pipes.
62
In each case, if the contaminated water contains pathogens or hazardous chemicals,

it is likely that consumers will be exposed to them.
Even where disinfectant residuals are employed to limit microbial occurrence, they
may be inadequate to overcome the contamination or may be ineffective against some
or all of the pathogen types introduced. As a result, pathogens may occur in concen-
trations that could lead to infection and illness.
Where water is supplied intermittently, the resulting low water pressure will allow
the ingress of contaminated water into the system through breaks, cracks, joints and
pinholes. Intermittent supplies are not desirable but are very common in many coun-
tries and are frequently associated with contamination. The control of water quality
in intermittent supplies represents a signicant challenge, as the risks of inltration
and backow increase signicantly. The risks may be elevated seasonally as soil mois-
ture conditions increase the likelihood of a pressure gradient developing from the soil
to the pipe. Where contaminants enter the pipes in an intermittent supply, the charg-
ing of the system when supply is restored may increase risks to consumers, as a con-
centrated slug of contaminated water can be expected to ow through the system.
Where household storage is used to overcome intermittent supply, localized use of
disinfectants to reduce microbial proliferation may be warranted.
Drinking-water entering the distribution system may contain free-living amoebae
and environmental strains of various heterotrophic bacterial and fungal species.
Under favourable conditions, amoebae and heterotrophs, including strains of Cit-
robacter, Enterobacter and Klebsiella, may colonize distribution systems and form
biolms. There is no evidence to implicate the occurrence of most microorganisms
from biolms (excepting, for example, Legionella, which can colonize water systems
in buildings) with adverse health effects in the general population through drinking-
water, with the possible exception of severely immunocompromised people (see
the supporting document Heterotrophic Plate Counts and Drinking-water Safety;
section 1.3).
Water temperatures and nutrient concentrations are not generally elevated enough
within the distribution system to support the growth of E. coli (or enteric pathogenic
bacteria) in biolms. Thus, the presence of E. coli should be considered as evidence
of recent faecal contamination.
Natural disasters, including ood, drought and earth tremors, may signicantly
affect piped water distribution systems.
Control measures
Water entering the distribution system must be microbially safe and ideally should
also be biologically stable. The distribution system itself must provide a secure barrier
to contamination as the water is transported to the user. Maintaining a disinfectant
residual throughout the distribution system can provide some protection against
contamination and limit microbial growth problems. Chloramination has proved
63
successful in controlling Naegleria fowleri in water and sediments in long pipelines

and may reduce regrowth of Legionella within buildings.
Residual disinfectant will provide partial protection against microbial contamina-
tion, but may also mask the detection of contamination through conventional faecal
indicator bacteria such as E. coli, particularly by resistant organisms. Where a disin-
fectant residual is used within a distribution system, measures to minimize DBP pro-
duction should be taken into consideration.
Water distribution systems should be fully enclosed, and storage reservoirs and
tanks should be securely roofed with external drainage to prevent contamination.
Control of short circuiting and prevention of stagnation in both storage and distri-
bution contribute to prevention of microbial growth. A number of strategies can be
adopted to maintain the quality of water within the distribution system, including use
of backow prevention devices, maintaining positive pressure throughout the system
and implementation of efcient maintenance procedures. It is also important that
appropriate security measures be put in place to prevent unauthorized access to or
interference with the drinking-water system infrastructure.
Control measures may include using a more stable secondary disinfecting chemi-
cal (e.g., chloramines instead of free chlorine), undertaking a programme of pipe
replacement, ushing and relining and maintaining positive pressure in the distribu-
tion system. Reducing the time that water is in the system by avoiding stagnation in
storage tanks, loops and dead-end sections will also contribute to maintaining
drinking-water quality.
Other examples of distribution system control measures include the following:
distribution system maintenance;
availability of backup systems (power supply);
maintaining an adequate disinfectant residual;
implementing cross-connection and backow prevention devices;
fully enclosed distribution system and storages;
appropriate repair procedures, including subsequent disinfection of water mains;
maintaining adequate system pressure; and
maintaining security to prevent sabotage, illegal tapping and tampering.
Further information is available in the supporting document Safe, Piped Water
(section 1.3).
4.1.6 Non-piped, community and household systems

Hazard identication
Hazard identication would ideally be on a case-by-case basis. In practice, however,
for non-piped, community and household drinking-water systems, reliance is
typically placed on general assumptions of hazardous conditions that are relevant
for technologies or system types and that may be dened at a national or regional
level.
64
Examples of hazards and hazardous situations potentially associated with various

non-piped sources of water include the following:
tubewell tted with a hand pump

ingress of contaminated surface water directly into borehole
ingress of contaminants due to poor construction or damage to the lining
leaching of microbial contaminants into aquifer
simple protected spring
contamination directly through backll area
contaminated surface water causes rapid recharge
simple dug well
ingress of contaminants due to poor construction or damage to the lining
contamination introduced by buckets
rainwater collection
bird and other animal droppings found on roof or in guttering
rst ush of water can enter storage tank.
Further guidance is provided in the supporting document Water Safety Plans (section
1.3) and in Volume 3 of the Guidelines for Drinking-Water Quality.
Control measures
The control measures required ideally depend on the characteristics of the source
water and the associated catchment; in practice, standard approaches may be applied
for each of these, rather than customized assessment of each system.
Examples of control measures for various non-piped sources include the
following:
tubewell tted with a hand pump

proper wellhead completion measures
provide adequate set-back distances for contaminant sources such as latrines or
animal husbandry, ideally based on travel time
simple protected spring
maintain effective spring protection measures
establish set-back distance based on travel time
simple dug well
proper construction and use of a mortar seal on lining
install and maintain hand pump or other sanitary means of abstraction
rainwater collection
cleaning of roof and gutters
rst-ush diversion unit.
In most cases, contamination of groundwater supplies can be controlled by a combi-
nation of simple measures. In the absence of fractures or ssures, which may allow
rapid transport of contaminants to the source, groundwater in conned or deep
65
aquifers will generally be free of pathogenic microorganisms. Bores should be encased

to a reasonable depth, and boreheads should be sealed to prevent ingress of surface
water or shallow groundwater.
Rainwater systems, particularly those involving storage in above-ground tanks, can
be a relatively safe supply of water. The principal sources of contamination are birds,
small mammals and debris collected on roofs. The impact of these sources can be
minimized by simple measures: guttering should be cleared regularly; overhanging
branches should be kept to a minimum (because they can be a source of debris and
can increase access to roof catchment areas by birds and small mammals); and inlet
pipes to tanks should include leaf litter strainers. First-ush diverters, which prevent
the initial roof-cleaning wash of water (2025 litres) from entering tanks, are recom-
mended. If rst-ush diverters are not available, a detachable downpipe can be used
manually to provide the same result.
In general, surface waters will require at least disinfection, and usually also ltra-
tion, to ensure microbial safety. The rst barrier is based on minimizing contamina-
tion from human waste, livestock and other hazards at the source.
The greater the protection of the water source, the less the reliance on treatment
or disinfection. Water should be protected during storage and delivery to consumers
by ensuring that the distribution and storage systems are enclosed.
This applies to both piped systems (section 4.1.5) and vendor-supplied water
(section 6.5). For water stored in the home, protection from contamination can be
achieved by use of enclosed or otherwise safely designed storage containers that prevent
the introduction of hands, dippers or other extraneous sources of contamination.
For control of chemical hazards, reliance may be placed primarily on initial screen-
ing of sources and on ensuring the quality and performance of treatment chemicals,
materials and devices available for this use, including water storage systems.
Model WSPs are available in the supporting document Water Safety Plans (section
1.3) for the following types of water supply:
groundwater from protected boreholes / wells with mechanized pumping;
conventional treatment of water;
multistage ltration;
storage and distribution through supplier-managed piped systems;
storage and distribution through community-managed piped systems;
water vendors;
water on conveyances (planes, ships and trains);
tubewell from which water is collected by hand;
springs from which water is collected by hand;
simple protected dug wells; and
rainwater catchments.
Guidance is also available regarding how water safety may be assured for household
water collection, transport and storage (see the supporting document Managing Water
66
in the Home; section 1.3). This should be used in conjunction with hygiene education
programmes to support health promotion in order to reduce water-related disease.
4.1.7 Validation
Validation is concerned with obtaining
evidence on the performance of control Validation is an investigative activity to
identify the effectiveness of a control
measures. It should ensure that the measure. It is typically an intensive activ-
information supporting the WSP is ity when a system is initially constructed
correct, thus enabling achievement of or rehabilitated. It provides information
on reliably achievable quality improve-
health-based targets. ment or maintenance to be used in
Validation of treatment processes system assessment in preference to
is required to show that treatment assumed values and also to dene the
operational criteria required to ensure
processes can operate as required. It can
that the control measure contributes to
be undertaken during pilot stage studies effective control of hazards.
and/or during initial implementation
of a new or modied water treatment
system. It is also a useful tool in the optimization of existing treatment processes.
The rst stage of validation is to consider data that already exist. These will include
data from the scientic literature, trade associations, regulation and legislation depart-
ments and professional bodies, historical data and supplier knowledge. This will
inform the testing requirements. Validation is not used for day-to-day management
of drinking-water supplies; as a result, microbial parameters that may be inappro-
priate for operational monitoring can be used, and the lag time for return of results
and additional costs from pathogen measurements can often be tolerated.
4.1.8 Upgrade and improvement

The assessment of the drinking-water system may indicate that existing practices and
technologies may not ensure drinking-water safety. In some instances, all that may be
needed is to review, document and formalize these practices and address any areas
where improvements are required; in others, major infrastructure changes may be
needed. The assessment of the system should be used as a basis to develop a plan to
address identied needs for full implementation of a WSP.
Improvement of the drinking-water system may encompass a wide range of issues,
such as:
capital works;
training;
enhanced operational procedures;
community consultation programmes;
research and development;
developing incident protocols; and
communication and reporting.
67
Upgrade and improvement plans can include short-term (e.g., 1 year) or long-term
programmes. Short-term improvements might include, for example, improvements
to community consultation and the development of community awareness pro-
grammes. Long-term capital works projects could include covering of water storages
or enhanced coagulation and ltration.
Implementation of improvement plans may have signicant budgetary implica-
tions and therefore may require detailed analysis and careful prioritization in accord
with the outcomes of risk assessment. Implementation of plans should be monitored
to conrm that improvements have been made and are effective. Control measures
often require considerable expenditure, and decisions about water quality improve-
ments cannot be made in isolation from other aspects of drinking-water supply that
compete for limited nancial resources. Priorities will need to be established, and
improvements may need to be phased in over a period of time.
4.2 Operational monitoring and maintaining control
Operational monitoring assesses the performance of control measures at appropriate time inter-
vals. The intervals may vary widely for example, from on-line control of residual chlorine to
quarterly verication of the integrity of the plinth surrounding a well.
The objectives of operational monitoring are for the drinking-water supplier to

monitor each control measure in a timely manner to enable effective system man-
agement and to ensure that health-based targets are achieved.
4.2.1 Determining system control measures

The identity and number of control measures are system specic and will be deter-
mined by the number and nature of hazards and magnitude of associated risks.
Control measures should reect the likelihood and consequences of loss of con-
trol. Control measures have a number of operational requirements, including the
following:
operational monitoring parameters that can be measured and for which limits
can be set to dene the operational effectiveness of the activity;
operational monitoring parameters that can be monitored with sufcient fre-
quency to reveal failures in a timely fashion; and
procedures for corrective action that can be implemented in response to devia-
tion from limits.
4.2.2 Selecting operational monitoring parameters

The parameters selected for operational monitoring should reect the effectiveness of
each control measure, provide a timely indication of performance, be readily meas-
ured and provide opportunity for an appropriate response. Examples include meas-
68
urable variables, such as chlorine residuals, pH and turbidity, or observable factors,

such as the integrity of vermin-proong screens.
Enteric pathogens and indicator bacteria are of limited use for operational moni-
toring, because the time taken to process and analyse water samples does not allow
operational adjustments to be made prior to supply.
A range of parameters can be used in operational monitoring:
For source waters, these include turbidity, UV absorbency, algal growth, ow and
retention time, colour, conductivity and local meteorological events (see the sup-
porting documents Protecting Surface Waters for Health and Protecting Groundwa-
ters for Health; section 1.3).
For treatment, parameters may include disinfectant concentration and contact
time, UV intensity, pH, light absorbency, membrane integrity, turbidity and colour
(see the supporting document Water Treatment and Pathogen Control; section
1.3).
In piped distribution systems, operational monitoring parameters may include the
following:
Chlorine residual monitoring provides a rapid indication of problems that will
direct measurement of microbial parameters. A sudden disappearance of an
otherwise stable residual can indicate ingress of contamination. Alternatively,
difculties in maintaining residuals at points in a distribution system or a
gradual disappearance of residual may indicate that the water or pipework has
a high oxidant demand due to growth of bacteria.
The presence or absence of faecal indicator bacteria is another commonly used
operational monitoring parameter. However, there are pathogens that are more
resistant to chlorine disinfection than the most commonly used indicator E.
coli or thermotolerant coliforms. Therefore, the presence of more resistant faecal
indicator bacteria (e.g., intestinal enterococci), Clostridium perfringens spores or
coliphages as an operational monitoring parameter may be more appropriate in
certain circumstances.
Heterotrophic bacteria present in a supply can be a useful indicator of changes,
such as increased microbial growth potential, increased biolm activity,
extended retention times or stagnation and a breakdown of integrity of the
system. The numbers of heterotrophic bacteria present in a supply may reect
the presence of large contact surfaces within the treatment system, such as in-
line lters, and may not be a direct indicator of the condition within the distri-
bution system (see the supporting document Heterotrophic Plate Counts and
Drinking-water Safety; section 1.3).
Pressure measurement and turbidity are also useful operational monitoring
parameters in piped distribution systems.
Guidance for management of distribution system operation and maintenance is avail-
able (see the supporting document Safe, Piped Water; section 1.3) and includes the
69
Table 4.4 Examples of operational monitoring parameters that can be used to monitor control
measures
Sedimentation
Coagulation
Distribution
Disinfection
Raw water
Filtration
system
Operational parameter
pH
Turbidity (or particle count)
Dissolved oxygen
Stream/river ow
Rainfall
Colour
Conductivity (total dissolved solids, or TDS)
Organic carbon
Algae, algal toxins and metabolites
Chemical dosage
Flow rate
Net charge
Streaming current value
Headloss
Cta
Disinfectant residual
DBPs
Hydraulic pressure
a
Ct = Disinfectant concentration contact time.
development of a monitoring programme for water quality and other parameters such
as pressure.
Examples of operational monitoring parameters are provided in Table 4.4.
4.2.3 Establishing operational and critical limits

Control measures need to have dened limits for operational acceptability termed
operational limits that can be applied to operational monitoring parameters. Oper-
ational limits should be dened for parameters applying to each control measure. If
monitoring shows that an operational limit has been exceeded, then predetermined
corrective actions (see section 4.4) need to be applied. The detection of the deviation
and implementation of corrective action(s) should be possible in a time frame ade-
quate to maintain performance and water safety.
For some control measures, a second series of critical limits may also be dened,
outside of which condence in water safety would be lost. Deviations from critical
limits will usually require urgent action, including immediate notication of the
appropriate health authority.
Operational and critical limits can be upper limits, lower limits, a range or an enve-
lope of performance measures.
70
4.2.4 Non-piped, community and household systems

Generally, surface water or shallow groundwater should not be used as a source of
drinking-water without sanitary protection or treatment.
Monitoring of water sources (including rainwater tanks) by community operators
or households will typically involve periodic sanitary inspection. The sanitary inspec-
tion forms used should be comprehensible and easy to use; for instance, the forms
may be pictorial. The risk factors included should be preferably related to activities
that are under the control of the operator and that may affect water quality. The links
to action from the results of operational monitoring should be clear, and training will
be required.
Operators should also undertake regular physical assessments of the water, espe-
cially after heavy rains, to monitor whether any obvious changes in water quality occur
(e.g., changes in colour, odour or turbidity).
Treatment of water from community sources (such as boreholes, wells and springs)
as well as household rainwater collection is rarely practised; however, if treatment is
applied, then operational monitoring is advisable.
Collection, transportation and storage of water in the home

Maintaining the quality of water during collection and manual transport is the
responsibility of the household. Good hygiene practices are required and should be
supported through hygiene education. Hygiene education programmes should
provide households and communities with skills to monitor and manage their water
hygiene.
Household treatment of water has proven to be effective in delivery of public health
gains. Monitoring of treatment processes will be specic to the technology. When
household treatment is introduced, it is essential that information (and, where appro-
priate, training) be provided to users to ensure that they understand basic operational
monitoring requirements.
4.3 Verication
In addition to operational monitoring of the performance of the individual components of

a drinking-water system, it is necessary to undertake nal verication for reassurance that
the system as a whole is operating safely. Verication may be undertaken by the supplier, by an
independent authority or by a combination of these, depending on the administrative regime
in a given country. It typically includes testing for faecal indicator organisms and hazardous
chemicals.
Verication provides a nal check on the overall safety of the drinking-water supply
chain. Verication may be undertaken by the surveillance agency and/or can be a
component of supplier quality control.
71
For microbial verication, testing is typically for faecal indicator bacteria in treated
water and water in distribution. For verication of chemical safety, testing for chem-
icals of concern may be at the end of treatment, in distribution or at the point of
consumption (depending on whether the concentrations are likely to change in
distribution).
Frequencies of sampling should reect the need to balance the benets and costs
of obtaining more information. Sampling frequencies are usually based on the pop-
ulation served or on the volume of water supplied, to reect the increased population
risk. Frequency of testing for individual characteristics will also depend on variabil-
ity. Sampling and analysis are required most frequently for microbial and less often
for chemical constituents. This is because even brief episodes of microbial contami-
nation can lead directly to illness in consumers, whereas episodes of chemical con-
tamination that would constitute an acute health concern, in the absence of a specic
event (e.g., chemical overdosing at a treatment plant), are rare. Sampling frequencies
for water leaving treatment depend on the quality of the water source and the type of
treatment.
4.3.1 Verication of microbial quality

Verication of microbial quality of water in supply must be designed to ensure
the best possible chance of detecting contamination. Sampling should therefore
account for potential variations of water quality in distribution. This will normally
mean taking account of locations and of times of increased likelihood of
contamination.
Faecal contamination will not be distributed evenly throughout a piped distri-
bution system. In systems where water quality is good, this signicantly reduces
the probability of detecting faecal indicator bacteria in the relatively few samples
collected.
The chances of detecting contamination in systems reporting predominantly
negative results for faecal indicator bacteria can be increased by using more frequent
presence/absence (P/A) testing. P/A testing can be simpler, faster and less expensive
than quantitative methods. Comparative studies of the P/A and quantitative methods
demonstrate that the P/A methods can maximize the detection of faecal indicator
bacteria. However, P/A testing is appropriate only in a system where the majority of
tests for indicators provide negative results.
The more frequently the water is examined for faecal indicators, the more likely
it is that contamination will be detected. Frequent examination by a simple
method is more valuable than less frequent examination by a complex test or series
of tests.
The nature and likelihood of contamination can vary seasonally, with rainfall and
with other local conditions. Sampling should normally be random but should be
increased at times of epidemics, ooding or emergency operations or following inter-
ruptions of supply or repair work.
72
4.3.2 Verication of chemical quality

Issues that need to be addressed in developing chemical verication include the
availability of appropriate analytical facilities, the cost of analyses, the possible dete-
rioration of samples, the stability of the contaminant, the likely occurrence
of the contaminant in various supplies, the most suitable point for monitoring and
the frequency of sampling.
For a given chemical, the location and frequency of sampling will be determined
by its principal sources (see chapter 8) and variability. Substances that do not change
signicantly in concentration over time require less frequent sampling than those that
might vary signicantly.
In many cases, source water sampling once per year, or even less, may be adequate,
particularly in stable groundwaters, where the naturally occurring substances of
concern will vary very slowly over time. Surface waters are likely to be more variable
and require a greater number of samples, depending on the contaminant and its
importance.
Sampling locations will depend on the water quality characteristic being examined.
Sampling at the treatment plant or at the head of the distribution system may be suf-
cient for constituents where concentrations do not change during delivery. However,
for those constituents that can change during distribution, sampling should be under-
taken following consideration of the behaviour and/or source of the specic sub-
stance. Samples should include points near the extremities of the distribution system
and taps connected directly to the mains in houses and large multi-occupancy build-
ings. Lead, for example, should be sampled at consumers taps, since the source of lead
is usually service connections or plumbing in buildings.
For further information, see the supporting document Chemical Safety of
Drinking-water (section 1.3).
4.3.3 Water sources

Testing source waters is particularly important where there is no water treatment. It
will also be useful following failure of the treatment process or as part of an investi-
gation of a waterborne disease outbreak. The frequency of testing will depend on the
reason that the sampling is being carried out. Testing frequency may be:
on a regular basis (the frequency of verication testing will depend on several

factors, including the size of the community supplied, the reliability of the quality
of the drinking-water / degree of treatment and the presence of local risk factors);
on an occasional basis (e.g., random or during visits to community-managed
drinking-water supplies); and
increased following degradation of source water quality resulting from pre-
dictable incidents, emergencies or unplanned events considered likely to increase
the potential for a breakthrough in contamination (e.g., following a ood,
upstream spills).
73
Prior to commissioning a new drinking-water supply, a wider range of analyses should

be carried out, including parameters identied as potentially being present from a
review of data from similar supplies or from a risk assessment of the source.
4.3.4 Piped distribution systems

The choice of sampling points will be dependent on the individual water supply. The
nature of the public health risk posed by pathogens and the contamination potential
throughout distribution systems mean that collection of samples for microbial analy-
sis (and associated parameters, such as chlorine residual) will typically be done fre-
quently and from dispersed sampling sites. Careful consideration of sampling points
and frequency is required for chemical constituents that arise from piping and plumb-
ing materials and that are not controlled through their direct regulation and for
constituents that change in distribution, such as trihalomethanes (THMs).
Recommended minimum sample numbers for verication of the microbial quality
of drinking-water are shown in Table 4.5.
The use of stratied random sampling in distribution systems has proven to be
effective.
4.3.5 Verication for community-managed supplies

If the performance of a community drinking-water system is to be properly evalu-
ated, a number of factors must be considered. Some countries that have developed
national strategies for the surveillance and quality control of drinking-water systems
have adopted quantitative service indicators (i.e., quality, quantity, accessibility, cover-
age, affordability and continuity) for application at community, regional and national
levels. Usual practice would be to include the critical parameters for microbial quality
(normally E. coli, chlorine, turbidity and pH) and for a sanitary inspection to be
carried out. Methods for these tests must be standardized and approved. It is recom-
mended that eld test kits be validated for performance against reference or standard
methods and approved for use in verication testing.
Together, service indicators provide a basis for setting targets for community
drinking-water supplies. They serve as a quantitative guide to the adequacy of drink-
Table 4.5 Recommended minimum sample numbers for faecal indicator testing in distribution
systemsa
Population Total number of samples per year
Point sources Progressive sampling of all sources over 3- to 5-year cycles (maximum)
Piped supplies
<5000 12
5000100 000 12 per 5000 head of population
>100 000500 000 12 per 10 000 head of population plus an additional 120 samples
>500 000 12 per 100 000 head of population plus an additional 180 samples
a
Parameters such as chlorine, turbidity and pH should be tested more frequently as part of operational and veri-
cation monitoring.
74
ing-water supplies and provide consumers with an objective measure of the quality
of the overall service and thus the degree of public health protection afforded.
Periodic testing and sanitary inspection of community drinking-water supplies
should typically be undertaken by the surveillance agency and should assess micro-
bial hazards and known problem chemicals (see also chapter 5). Frequent sampling
is unlikely to be possible, and one approach is therefore a rolling programme of visits
to ensure that each supply is visited once every 35 years. The primary purpose is to
inform strategic planning and policy rather than to assess compliance of individual
drinking-water supplies. Comprehensive analysis of chemical quality of all sources is
recommended prior to commissioning as a minimum and preferably every 35 years
thereafter.
Advice on the design of sampling programmes and on the frequency of sampling
is given in ISO standards (Table 4.6).
4.3.6 Quality assurance and quality control

Appropriate quality assurance and analytical quality control procedures should be
implemented for all activities linked to the production of drinking-water quality data.
These procedures will ensure that the data are t for purpose in other words, that
the results produced are of adequate accuracy. Fit for purpose, or adequate accuracy,
will be dened in the water quality monitoring programme, which will include a state-
ment about accuracy and precision of the data. Because of the wide range of sub-
stances, methods, equipment and accuracy requirements likely to be involved in the
monitoring of drinking-water, many detailed, practical aspects of analytical quality
control are concerned. These are beyond the scope of this publication.
The design and implementation of a quality assurance programme for analytical
laboratories are described in detail in Water Quality Monitoring (Bartram & Ballance,
Table 4.6 International Organization for Standardization (ISO) standards for water quality
giving guidance on sampling
ISO standard no. Title (water quality)
56671:1980 Sampling Part 1: Guidance on the design of sampling programmes
56672:1991 Sampling Part 2: Guidance on sampling techniques
56673:1994 Sampling Part 3: Guidance on the preservation and handling of samples
56674:1987 Sampling Part 4: Guidance on sampling from lakes, natural and man-made
56675:1991 Sampling Part 5: Guidance on sampling of drinking-water and water used
for food and beverage processing
56676:1990 Sampling Part 6: Guidance on sampling of rivers and streams
566713:1997 Sampling Part 13: Guidance on sampling of sludges from sewage and
water-treatment works
566714:1998 Sampling Part 14: Guidance on quality assurance of environmental water
sampling and handling
566716:1998 Sampling Part 16: Guidance on biotesting of samples
566817:2000 Sampling Part 17: Guidance on sampling of suspended sediments
13530:1997 Water quality Guide to analytical control for water analysis
75
1996). The relevant chapter draws upon the standard ISO 17025:2000 General require-
ments for the competence of testing and calibration laboratories, which provides a frame-
work for the management of quality in analytical laboratories.
4.4 Management procedures for piped distribution systems
Effective management implies denition of actions to be taken in response to variations that

occur during normal operational conditions; of actions to be taken in specic incident situa-
tions where a loss of control of the system may occur; and of procedures to be followed in unfore-
seen and emergency situations. Management procedures should be documented alongside
system assessment, monitoring plans, supporting programmes and communication required to
ensure safe operation of the system.
Much of a management plan will describe actions to be taken in response to normal

variation in operational monitoring parameters in order to maintain optimal opera-
tion in response to operational monitoring parameters reaching operational limits.
A signicant deviation in operational monitoring where a critical limit is exceeded
(or in verication) is often referred to as an incident. An incident is any situation in
which there is reason to suspect that water being supplied for drinking may be, or
may become, unsafe (i.e., condence in water safety is lost). As part of a WSP, man-
agement procedures should be dened for response to predictable incidents as well as
unpredictable incidents and emergencies. Incident triggers could include:
non-compliance with operational monitoring criteria;
inadequate performance of a sewage treatment plant discharging to source water;
spillage of a hazardous substance into source water;
failure of the power supply to an essential control measure;
extreme rainfall in a catchment;
detection of unusually high turbidity (source or treated water);
unusual taste, odour or appearance of water;
detection of microbial indicator parameters, including unusually high faecal
indicator densities (source or treated water) and unusually high pathogen den-
sities (source water); and
public health indicators or a disease outbreak for which water is a suspect vector.
Incident response plans can have a range of alert levels. These can be minor early
warning, necessitating no more than additional investigation, through to emergency.
Emergencies are likely to require the resources of organizations beyond the drinking-
water supplier, particularly the public health authorities.
Incident response plans typically comprise:
accountabilities and contact details for key personnel, often including several
organizations and individuals;
76
lists of measurable indicators and limit values/conditions that would trigger

incidents, along with a scale of alert levels;
clear description of the actions required in response to alerts;
location and identity of the standard operating procedures (SOPs) and required
equipment;
location of backup equipment;
relevant logistical and technical information; and
checklists and quick reference guides.
The plan may need to be followed at very short notice, so standby rosters, effective
communication systems and up-to-date training and documentation are required.
Staff should be trained in response to ensure that they can manage incidents and/or
emergencies effectively. Incident and emergency response plans should be periodically
reviewed and practised. This improves preparedness and provides opportunities to
improve the effectiveness of plans before an emergency occurs.
Following any incident or emergency, an investigation should be undertaken
involving all concerned staff. The investigation should consider factors such as:
What was the cause of the problem?

How was the problem rst identied or recognized?
What were the most essential actions required?
What communication problems arose, and how were they addressed?
What were the immediate and longer-term consequences?
How well did the emergency response plan function?
Appropriate documentation and reporting of the incident or emergency should also
be established. The organization should learn as much as possible from the incident
or emergency to improve preparedness and planning for future incidents. Review of
the incident or emergency may indicate necessary amendments to existing protocols.
The preparation of clear procedures, denition of accountability and provision of
equipment for the sampling and storing of water in the event of an incident can be
valuable for follow-up epidemiological or other investigations, and the sampling and
storage of water from early on during a suspected incident should be part of the
response plan.
4.4.1 Predictable incidents (deviations)

Many incidents (e.g., exceedance of a critical limit) can be foreseen, and management
plans can specify resulting actions. Actions may include, for example, temporary
change of water sources (if possible), increasing coagulation dose, use of backup
disinfection or increasing disinfectant concentrations in distribution systems.
4.4.2 Unforeseen events

Some scenarios that lead to water being considered potentially unsafe might not be
specically identied within incident response plans. This may be either because the
77
events were unforeseen or because they were considered too unlikely to justify prepar-
ing detailed corrective action plans. To allow for such events, a general incident
response plan should be developed. The plan would be used to provide general
guidance on identifying and handling of incidents along with specic guidance
on responses that would be applied to many different types of incident.
A protocol for situation assessment and declaring incidents would be provided in
a general incident response plan that includes personal accountabilities and categor-
ical selection criteria. The selection criteria may include:
time to effect;
population affected; and
nature of the suspected hazard.
The success of general incident responses depends on the experience, judgement and
skill of the personnel operating and managing the drinking-water systems. However,
generic activities that are common in response to many incidents can be incorporated
within general incident response plans. For example, for piped systems, emergency
ushing SOPs can be prepared and tested for use in the event that contaminated water
needs to be ushed from a piped system. Similarly, SOPs for rapidly changing or
bypassing reservoirs can be prepared, tested and incorporated. The development of
such a toolkit of supporting material limits the likelihood of error and speeds up
responses during incidents.
4.4.3 Emergencies
Water suppliers should develop plans to be invoked in the event of an emergency.
These plans should consider potential natural disasters (e.g., earthquakes, oods,
damage to electrical equipment by lightning strikes), accidents (e.g., spills in the
watershed), damage to treatment plant and distribution system and human actions
(e.g., strikes, sabotage). Emergency plans should clearly specify responsibilities for
coordinating measures to be taken, a communication plan to alert and inform users
of the drinking-water supply and plans for providing and distributing emergency
supplies of drinking-water.
Plans should be developed in consultation with relevant regulatory authorities and
other key agencies and should be consistent with national and local emergency
response arrangements. Key areas to be addressed in emergency response plans
include:
response actions, including increased monitoring;

responsibilities and authorities internal and external to the organization;
plans for emergency drinking-water supplies;
communication protocols and strategies, including notication procedures
(internal, regulatory body, media and public); and
mechanisms for increased public health surveillance.
78
During an emergency in which there is evidence of faecal contamination of the drink-

ing-water supply, it may be necessary either to modify the treatment of existing
sources or to temporarily use alternative sources of drinking-water. It may be neces-
sary to increase disinfection at source or to rechlorinate during distribution.
If microbial quality cannot be maintained, it may be necessary to advise consumers
to boil the water during the emergency (see section 4.4.4). Boiling water itself has
health risks (e.g., scalding), and initiating superchlorination and undertaking imme-
diate corrective measures may be preferable.
In emergencies, such as during outbreaks of potentially waterborne disease or when
faecal contamination of a drinking-water supply is detected, the concentration of free
chlorine should be increased to greater than 0.5 mg/litre throughout the system as a
minimum immediate response.
It is impossible to give general guidance concerning emergencies in which chemi-
cals cause massive contamination of the drinking-water supply, caused either by acci-
dent or by deliberate action. The guideline values recommended in these Guidelines
(see section 8.5 and Annex 4) relate to a level of exposure that is regarded as tolera-
ble throughout life; acute toxic effects are not normally considered. The length of time
during which exposure to a chemical far in excess of the guideline value would be
toxicologically detrimental will depend upon factors that vary from contaminant to
contaminant. In an emergency situation, the public health authorities should be con-
sulted about appropriate action.
4.4.4 Closing supply, water avoidance and boil water orders

Incident response plans for emergencies and unplanned events should include an
evaluation of the basis for issuing water avoidance and boil water orders. The objec-
tive of the order should be taken in the public interest, and the order will typically be
managed by public health authorities.
A decision to close a drinking-water supply carries an obligation to provide an
alternative safe supply and is very rarely justiable because of the adverse effects, espe-
cially to health, of restricting access to water.
Issuing a boil water order is a serious measure that should be undertaken only when
the public health authority, having consulted with the incident response team, is con-
vinced of an ongoing risk to health from drinking water, which outweighs any risk
from the boil water order itself. The public interest is not always best served by boil
water orders, which can have negative public health consequences through scalds and
anxiety. In addition, if boil water notices are issued frequently or are left in place for
long periods, the public response will decrease. If a notice is issued, advice must be
clear and easy to understand, or it may be ignored because of confusion over what to
do. When issuing a boil water notice, it is good practice to establish criteria for remov-
ing the notice.
79
4.4.5 Preparing a monitoring plan

Programs should be developed for operational and verication monitoring and doc-
umented as part of a WSP, detailing the strategies and procedures to follow for mon-
itoring the various aspects of the drinking-water system. The monitoring plans should
be fully documented and should include the following information:
parameters to be monitored;
sampling or assessment location and frequency;
sampling or assessment methods and equipment;
schedules for sampling or assessment;
methods for quality assurance and validation of results;
requirements for checking and interpreting results;
responsibilities and necessary qualications of staff;
requirements for documentation and management of records, including how
monitoring results will be recorded and stored; and
requirements for reporting and communication of results.
4.4.6 Supporting programmes

Many actions are important in ensuring
drinking-water safety but do not directly Actions that are important in ensuring
drinking-water safety but do not directly
affect drinking-water quality and are affect drinking-water quality are referred
therefore not control measures. These to as supporting programmes.
are referred to as supporting pro-
grammes and should also be docu-
mented in a WSP.
Supporting programmes could involve:
controlling access to treatment plants, catchments and reservoirs, and imple-

menting the appropriate security measures to prevent transfer of hazards from
people when they do enter source water;
developing verication protocols for the use of chemicals and materials in the
drinking-water supply for instance, to ensure the use of suppliers that partic-
ipate in quality assurance programmes;
using designated equipment for attending to incidents such as mains bursts (e.g.,
equipment should be designated for potable water work only and not for sewage
work); and
training and educational programmes for personnel involved in activities that
could inuence drinking-water safety; training should be implemented as part
of induction programmes and frequently updated.
Supporting programmes will consist almost entirely of items that drinking-water sup-
pliers and handlers will ordinarily have in place as part of their normal operation. For
most, the implementation of supporting programmes will involve:
80
collation of existing operational and management practices;

initial and, thereafter, periodic review and updating to continually improve
practices;
promotion of good practices to encourage their use; and
audit of practices to check that they are being used, including taking corrective
actions in case of non-conformance.
Codes of good operating and management practice and hygienic working practice are
essential elements of supporting programmes. These are often captured within SOPs.
They include, but are not limited to:
hygienic working practices documented in maintenance SOPs;
attention to personal hygiene;
training and competence of personnel involved in drinking-water supply;
tools for managing the actions of staff, such as quality assurance systems;
securing stakeholder commitment, at all levels, to the provision of safe
drinking-water;
education of communities whose activities may inuence drinking-water
quality;
calibration of monitoring equipment; and
record keeping.
Comparison of one set of supporting programmes with the supporting programmes
of other suppliers, through peer review, benchmarking and personnel or document
exchange, can stimulate ideas for improved practice.
Supporting programmes can be extensive, be varied and involve multiple organi-
zations and individuals. Many supporting programmes involve water resource pro-
tection measures and typically include aspects of land use control. Some water
resource protection measures are engineered, such as efuent treatment processes and
stormwater management practices that may be used as control measures.
4.5 Management of community and household water supplies

Community drinking-water supplies worldwide are more frequently contaminated
than larger drinking-water supplies, may be more prone to operating discontinuously
(or intermittently) and break down or fail more frequently.
To ensure safe drinking-water, the focus in small supplies should be on:
informing the public;
assessing the water supply to determine whether it is able to meet identied
health-based targets (see section 4.1);
monitoring identied control measures and training operators to ensure that all
likely hazards can be controlled and that risks are maintained at a tolerable level
(see section 4.2);
operational monitoring of the drinking-water system (see section 4.2);
81
implementing systematic water quality management procedures (see section

4.4.1), including documentation and communication (see section 4.6);
establishing appropriate incident response protocols (usually encompassing
actions at the individual supply, backed by training of operators, and actions
required by local or national authorities) (see sections 4.4.2, 4.4.3 and 4.4.4);
and
developing programmes to upgrade and improve existing water delivery (usually
dened at a national or regional level rather than at the level of individual
supplies) (see section 4.1.8).
For point sources serving communities or individual households, the emphasis should
be on selecting the best available quality source water and on protecting its quality by
the use of multiple barriers (usually within source protection) and maintenance pro-
grammes. Whatever the source (groundwater, surface water or rainwater tanks), com-
munities and householders should assure themselves that the water is safe to drink.
Generally, surface water and shallow groundwater under the direct inuence of surface
water (which includes shallow groundwater with preferential ow paths) should
receive treatment.
The parameters recommended for the minimum monitoring of community sup-
plies are those that best establish the hygienic state of the water and thus the risk of
waterborne disease. The essential parameters of water quality are E. coli thermotol-
erant (faecal) coliforms are accepted as suitable substitutes and chlorine residual (if
chlorination is practised).
These should be supplemented, where appropriate, by pH adjustment (if chlori-
nation is practised) and measurement of turbidity.
These parameters may be measured on site using relatively unsophisticated testing
equipment. On-site testing is essential for the determination of turbidity and chlo-
rine residual, which change rapidly during transport and storage; it is also important
for the other parameters where laboratory support is lacking or where transportation
problems would render conventional sampling and analysis impractical.
Other health-related parameters of local signicance should also be measured. The
overall approach to control of chemical contamination is outlined in chapter 8.
4.6 Documentation and communication

Documentation of a WSP should include:
description and assessment of the drinking-water system (see section 4.1),

including programmes to upgrade and improve existing water delivery (see
section 4.1.8);
the plan for operational monitoring and verication of the drinking-water
system (see section 4.2);
82
water safety management procedures for normal operation, incidents (specic

and unforeseen) and emergency situations (see sections 4.4.1, 4.4.2 and 4.4.3),
including communication plans; and
description of supporting programmes (see section 4.4.6).
Records are essential to review the adequacy of the WSP and to demonstrate the
adherence of the drinking-water system to the WSP. Five types of records are gener-
ally kept:
supporting documentation for developing the WSP including validation;
records and results generated through operational monitoring and verication;
outcomes of incident investigations;
documentation of methods and procedures used; and
records of employee training programmes.
By tracking records generated through operational monitoring and verication, an
operator or manager can detect that a process is approaching its operational or crit-
ical limit. Review of records can be instrumental in identifying trends and in making
operational adjustments. Periodic review of WSP records is recommended so that
trends can be noted and appropriate actions decided upon and implemented. Records
are also essential when surveillance is implemented through auditing-based
approaches.
Communication strategies should include:
procedures for promptly advising of any signicant incidents within the drink-
ing-water supply, including notication of the public health authority;
summary information to be made available to consumers for example,
through annual reports and on the Internet; and
establishment of mechanisms to receive and actively address community com-
plaints in a timely fashion.
The right of consumers to health-related information on the water supplied to them
for domestic purposes is fundamental. However, in many communities, the simple
right of access to information will not ensure that individuals are aware of the quality
of the water supplied to them; furthermore, the probability of consuming unsafe water
may be relatively high. The agencies responsible for monitoring should therefore
develop strategies for disseminating and explaining the signicance of health-related
information. Further information on communication is provided in section 5.5.
83
5
Surveillance
D rinking-water supply surveillance is the continuous and vigilant public health

assessment and review of the safety and acceptability of drinking-water supplies
(WHO, 1976). This surveillance contributes to the protection of public health by pro-
moting improvement of the quality, quantity, accessibility, coverage, affordability and
continuity of water supplies (known as service indicators) and is complementary to
the quality control function of the drinking-water supplier. Drinking-water supply
surveillance does not remove or replace the responsibility of the drinking-water sup-
plier to ensure that a drinking-water supply is of acceptable quality and meets prede-
termined health-based and other performance targets.
All members of the population receive drinking-water by some means including
the use of piped supplies with or without treatment and with or without pumping
(supplied via domestic connection or public standpipe), delivery by tanker truck or
carriage by beasts of burden or collection from groundwater sources (springs or wells)
or surface sources (lakes, rivers and streams). It is important for the surveillance agency
to build up a picture of the frequency of use of the different types of supply, especially
as a preliminary step in the planning of a surveillance programme. There is little to be
gained from surveillance of piped water supplies alone if these are available to only a
small proportion of the population or if they represent a minority of supplies.
Information alone does not lead to improvement. Instead, the effective manage-
ment and use of the information generated by surveillance make possible the rational
improvement of water supplies where rational implies that available resources are
used for maximum public health benet.
Surveillance is an important element in the development of strategies for incre-
mental improvement of the quality of drinking-water supply services. It is important
that strategies be developed for implementing surveillance, collating, analysing and
summarizing data and reporting and disseminating the ndings and are accompanied
by recommendations for remedial action. Follow-up will be required to ensure that
remedial action is taken.
Surveillance extends beyond drinking-water supplies operated by a discrete
drinking-water supplier to include drinking-water supplies that are managed by
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5. SURVEILLANCE
communities and includes assurance of good hygiene in the collection and storage of
household water.
The surveillance agency must have, or have access to, legal expertise in addition to
expertise on drinking-water and water quality (see section 2.3.1). Drinking-water
supply surveillance is also used to ensure that any transgressions that may occur are
appropriately investigated and resolved. In many cases, it will be more appropriate
to use surveillance as a mechanism for collaboration between public health agencies
and drinking-water suppliers to improve drinking-water supply than to resort to
enforcement, particularly where the problem lies mainly with community-managed
drinking-water supplies.
The authorities responsible for drinking-water supply surveillance may be the
public health ministry or other agency (see section 1.2.1), and their roles encompass
four areas of activity:
public health oversight of organized drinking-water supplies;
public health oversight and information support to populations without access
to organized drinking-water supplies, including communities and households;
consolidation of information from diverse sources to enable understanding of
the overall drinking-water supply situation for a country or region as a whole
as an input to the development of coherent public health-centred policies and
practices; and
participation in the investigation, reporting and compilation of outbreaks of
waterborne disease.
A drinking-water supply surveillance programme should normally include processes
for approval of WSPs. This approval will normally involve review of the system assess-
ment, of the identication of appropriate control measures and supporting pro-
grammes and of operational monitoring and management plans. It should ensure that
the WSP covers normal operating conditions and predictable incidents (deviations)
and has contingency plans in case of an emergency or unforeseen event.
The surveillance agency may also support or undertake the development of WSPs
for community-managed drinking-water supplies and household water storage. Such
plans may be generic for particular technologies rather than specic for individual
systems.
5.1 Types of approaches

There are two types of approaches to surveillance of drinking-water quality: audit-
based approaches and approaches relying on direct assessment. Implementation of
surveillance will generally include a mixture of these approaches according to supply
type and may involve using rolling programmes whereby systems are addressed pro-
gressively. Often it is not possible to undertake extensive surveillance of all commu-
nity or household supplies. In these cases, well designed surveys should be undertaken
in order to understand the situation at the national or regional level.
85
5.1.1 Audit
In the audit approach to surveillance, assessment activities, including verication
testing, are undertaken largely by the supplier, with third-party auditing to verify
compliance. It is increasingly common that analytical services are procured from
accredited external laboratories. Some authorities are also experimenting with the use
of such arrangements for services such as sanitary inspection, sampling and audit
reviews.
An audit approach requires the existence of a stable source of expertise and capac-
ity within the surveillance agency in order to:
review and approve new WSPs;

undertake or oversee auditing of the implementation of individual WSPs as a
programmed routine activity; and
respond to, investigate and provide advice on receipt of reports on signicant
incidents.
Periodic audit of implementation of WSPs is required:
at intervals (the frequency of routine audits will be dependent on factors

such as the size of the population served and the nature and quality of source
water / treatment facilities);
following substantial changes to the source, the distribution or storage system
or treatment process; and
following signicant incidents.
Periodic audit would normally include the following elements, in addition to review
of the WSP:
examination of records to ensure that system management is being carried out

as described in the WSP;
ensuring that operational monitoring parameters are kept within operational
limits and that compliance is being maintained;
ensuring that verication programmes are operated by the water supplier (either
through in-house expertise or through a third-party arrangement);
assessment of supporting programmes and of strategies for improvement and
updating of the WSP; and
in some circumstances, sanitary inspection, which may cover the whole of the
drinking-water system, including sources, transmission infrastructure, treat-
ment plants, storage reservoirs and distribution systems.
In response to reports of signicant incidents, it is necessary to ensure that:
the event is investigated promptly and appropriately;

the cause of the event is determined and corrected;
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5. SURVEILLANCE
the incident and corrective action are documented and reported to appropriate
authorities; and
the WSP is reassessed to avoid the occurrence of a similar situation.
The implementation of an audit-based approach places responsibility on the
drinking-water supplier to provide the surveillance agency with information regard-
ing system performance against agreed indicators. In addition, a programme of
announced and unannounced visits by auditors to drinking-water suppliers should
be implemented to review documentation and records of operational practice in order
to ensure that data submitted are reliable. Such an approach does not necessarily imply
that water suppliers are likely to falsify records, but it does provide an important
means of reassuring consumers that there is true independent verication of the activ-
ities of the water supplier. The surveillance agency will normally retain the authority
to undertake some analysis of drinking-water quality to verify performance or enter
into a third-party arrangement for such analysis.
5.1.2 Direct assessment

It may be appropriate for the drinking-water supply surveillance agency to carry out
independent testing of water supplies. Such an approach often implies that the agency
has access to analytical facilities of its own, with staff trained to carry out sampling,
analysis and sanitary inspection.
Direct assessment also implies that surveillance agencies have the capacity to assess
ndings and to report to and advise suppliers and communities.
A surveillance programme based on direct assessment would normally include:
specied approaches to large municipality / small municipality / community
supplies and individual household supplies;
sanitary inspections to be carried out by qualied personnel;
sampling to be carried out by qualied personnel;
tests to be conducted using suitable methods by accredited laboratories or using
approved eld testing equipment and qualied personnel; and
procedures on reporting ndings and follow-up to ensure that they have been
acted on.
For community-managed drinking-water supplies and where the development of in-
house verication or third-party arrangements is limited, direct assessment may be
used as the principal system of surveillance. This may apply to drinking-water sup-
plies in small towns by small-scale private sector operators or local government. Direct
assessment may lead to the identication of requirements to amend or update the
WSP, and the process to be followed when undertaking such amendments should be
clearly identied.
Where direct assessment is carried out by the surveillance agency, it complements
other verication testing. General guidance on verication testing, which is also appli-
cable to surveillance through direct assessment, is provided in section 4.3.
87
5.2 Adapting approaches to specic circumstances

5.2.1 Urban areas in developing countries
Drinking-water supply arrangements in urban areas of developing countries are typ-
ically complex. There will often be a large piped supply with household and public
connections and a range of alternative drinking-water supplies, including point
sources and vended water. In these situations, the surveillance programme should take
account of the different sources of drinking-water and the potential for deterioration
in quality during collection, storage and use. Furthermore, the population will vary
in terms of socioeconomic status and vulnerability to water-related disease.
In many situations, zoning the urban area on the basis of vulnerability and
drinking-water supply arrangements is required. The zoning system should include
all populations within the urban area, including informal and periurban settlements,
regardless of their legal status, in order to direct resources to where greatest improve-
ments (or benets) to public health will be achieved. This provides a mechanism to
ensure that non-piped drinking-water sources are also included within drinking-water
supply surveillance activities.
Experience has shown that zoning can be developed using qualitative and quanti-
tative methods and is useful in identifying vulnerable groups and priority communi-
ties where drinking-water supply improvements are required.
5.2.2 Surveillance of community drinking-water supplies

Small community-managed drinking-water supplies are found in most countries and
may be the predominant form of drinking-water supply for large sections of the
population. The precise denition of a community drinking-water supply will vary,
but administration and management arrangements are often what set community
supplies apart. Community-managed supplies may include simple piped water
systems or a range of point sources, such as boreholes with hand pumps, dug wells
and protected springs.
The control of water safety and implementation of surveillance programmes for
such supplies often face signicant constraints. These typically include:
limited capacity and skills within the community to undertake process control
and verication; this may increase the need both for surveillance to assess the
state of drinking-water supplies and for surveillance staff to provide training
and support to community members; and
the very large number of widely dispersed supplies, which signicantly increases
overall costs in undertaking surveillance activities.
Furthermore, it is often these supplies that present the greatest water quality
problems.
Experience from both developing and developed countries has shown that sur-
veillance of community-managed drinking-water supplies can be effective when well
designed and when the objectives are geared more towards a supportive role to
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5. SURVEILLANCE
enhance community management and evaluation of overall strategies to their support

than towards enforcement of compliance.
Surveillance of community drinking-water supplies requires a systematic pro-
gramme of surveys that encompass all aspects of the drinking-water supply to the
population as a whole, including sanitary inspection (including catchments) and insti-
tutional and community aspects. Surveillance should address variability in source
water quality, treatment process efcacy and the quality of distributed or household-
treated and household-stored water.
Experience has also shown that the role of surveillance may include health educa-
tion and health promotion activities to improve healthy behaviour and management
of drinking-water supply and sanitation. Participatory activities can include sanitary
inspection by communities and, where appropriate, community-based testing of
drinking-water quality using affordable eld test kits and other accessible testing
resources.
In the evaluation of overall strategies, the principal aim should be to derive overall
lessons for improving water safety for all community supplies, rather than relying on
monitoring the performance of individual supplies.
Frequent visits to every individual supply may be impractical because of the very
large numbers of such supplies and the limitations of resources for such visits.
However, surveillance of large numbers of community supplies can be achieved
through a rolling programme of visits. Commonly, the aim will be to visit each supply
periodically (once every 35 years at a minimum) using either stratied random sam-
pling or cluster sampling to select specic supplies to be visited. During each visit,
sanitary inspection and water quality analysis will normally be done to provide insight
to contamination and its causes.
During each visit, testing of water stored in the home may be undertaken in a
sample of households. The objective for such testing is to determine whether con-
tamination occurs primarily at the source or within the home. This will allow evalu-
ation of the need for investment in supply improvement or education on good hygiene
practices for household treatment and safe storage. Household testing may also be
used to evaluate the impact of a specic hygiene education programme.
5.2.3 Surveillance of household treatment and storage systems

Where water is handled during storage in households, it may be vulnerable to con-
tamination, and sampling of household-stored water is of interest in independent sur-
veillance. It is often undertaken on a survey basis to develop insights into the extent
and nature of prevailing problems.
Surveillance systems managed by public health authorities for drinking-water sup-
plies using household treatment and household storage containers are therefore rec-
ommended. The principal focus of surveillance of household-based interventions will
be assessment of their acceptance and impact through sample surveys so as to evalu-
ate and inform overall strategy development and renement.
89
5.3 Adequacy of supply

As the drinking-water supply surveillance agency has an interest in the health of the
population at large, its interest extends beyond water quality to include all aspects of
the adequacy of drinking-water supply for the protection of public health.
In undertaking an assessment of the adequacy of the drinking-water supply, the
following basic service parameters of a drinking-water supply should normally be
taken into consideration:
Quality: whether the supply has an approved WSP (see chapter 4) that has been
validated and is subject to periodic audit to demonstrate compliance (see chapter
3);
Quantity (service level): the proportion of the population using water from
different levels of drinking-water supply (e.g., no access, basic access, intermediate
access and optimal access)
Accessibility: the percentage of the population that has reasonable access to an
improved drinking-water supply;
Affordability: the tariff paid by domestic consumers; and
Continuity: the percentage of the time during which drinking-water is available
(daily, weekly and seasonally).
5.3.1 Quantity (service level)

The quantity of water collected and used by households has an important inu-
ence on health. There is a basic human physiological requirement for water to
maintain adequate hydration and an additional requirement for food preparation.
There is a further requirement for water to support hygiene, which is necessary for
health.
Estimates of the volume of water needed for health purposes vary widely. In deriv-
ing WHO guideline values, it is assumed that the daily per capita consumption of
drinking-water is approximately 2 litres for adults, although actual consumption
varies according to climate, activity level and diet. Based on currently available data,
a minimum volume of 7.5 litres per capita per day will provide sufcient water for
hydration and incorporation into food for most people under most conditions. In
addition, adequate domestic water is needed for food preparation, laundry and per-
sonal and domestic hygiene, which are also important for health. Water may also be
important in income generation and amenity uses.
The quantities of water collected and used by households are primarily a function
of the distance to the water supply or total collection time required. This broadly
equates to the level of service. Four levels of service can be dened, as shown in
Table 5.1.
Service level is a useful and easily measured indicator that provides a valid surro-
gate for the quantity of water collected by households and is the preferred indicator
for surveillance. Available evidence indicates that health gains accrue from improving
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5. SURVEILLANCE
Table 5.1 Service level and quantity of water collected

Likely volumes of Public health risk Intervention priority
Service level Distance/time water collected from poor hygiene and actions
No access More than 1 km / Very low 5 Very high Very high
more than 30 litres per capita Hygiene practice Provision of basic
min round-trip per day compromised level of service
Basic consumption Hygiene education
may be
compromised
Basic access Within 1 km / Average High High
within 30 min approximately Hygiene may be Hygiene education
round-trip 20 litres per compromised Provision of improved
capita per day Laundry may level of service
occur off-plot
Intermediate Water provided Average Low Low
access on-plot through approximately Hygiene should Hygiene promotion
at least one tap 50 litres per not be still yields health
(yard level) capita per day compromised gains
Laundry likely to Encourage optimal
occur on-plot access
Optimal Supply of water Average Very low Very low
access through multiple 100200 litres Hygiene should Hygiene promotion
taps within the per capita per not be still yields health
house day compromised gains
Laundry will
occur on-plot
Source: Howard & Bartram (2003).
service level in two key stages: the delivery of water within 1 km or 30 min total col-
lection time; and when supplied to a yard level of service. Further health gains are
likely to occur once water is supplied through multiple taps, as this will increase water
availability for diverse hygiene practices. The volume of water collected may also
depend on the reliability and cost of water. Therefore, collection of data on these indi-
cators is important.
5.3.2 Accessibility
From the public health standpoint, the proportion of the population with reliable
access to safe drinking-water is the most important single indicator of the overall
success of a drinking-water supply programme.
There are a number of denitions of access (or coverage), many with qualications
regarding safety or adequacy. The preferred denition is that used by WHO and
UNICEF in their Joint Monitoring Programme, which denes reasonable access
to improved sources as being availability of at least 20 litres per person per day within
one kilometre of the users dwelling. Improved and unimproved water supply tech-
nologies in the WHO/UNICEF Joint Monitoring Programme have been dened in
terms of providing reasonable access, as summarized below:
91
Improved water supply technologies:

Household connection
Public standpipe
Borehole
Protected dug well
Protected spring
Rainwater collection
Unimproved water supply technologies:
Unprotected well
Unprotected spring
Vendor-provided water
Bottled water
Tanker truck provision of water.
5.3.3 Affordability
The affordability of water has a signicant inuence on the use of water and selec-
tion of water sources. Households with the lowest levels of access to safe water supply
frequently pay more for their water than do households connected to a piped water
system. The high cost of water may force households to use alternative sources of water
of poorer quality that represent a greater risk to health. Furthermore, high costs of
water may reduce the volumes of water used by households, which in turn may inu-
ence hygiene practices and increase risks of disease transmission.
When assessing affordability, it is important to collect data on the price at the point
of purchase. Where households are connected to the drinking-water supplier, this will
be the tariff applied. Where water is purchased from public standpipes or from neigh-
bours, the price at the point of purchase may be very different from the drinking-
water supplier tariff. Many alternative water sources (notably vendors) also involve
costs, and these costs should be included in evaluations of affordability. In addition
to recurrent costs, the costs for initial acquisition of a connection should also be con-
sidered when evaluating affordability.
5.3.4 Continuity
Interruptions to drinking-water supply either through intermittent sources or result-
ing from engineering inefciencies are a major determinant of the access to and
quality of drinking-water. Analysis of data on continuity of supply requires the con-
sideration of several components. Continuity can be classied as follows:
year-round service from a reliable source with no interruption of ow at the tap

or source;
year-round service with frequent (daily or weekly) interruptions, of which the most
common causes are:
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5. SURVEILLANCE
restricted pumping regimes in pumped systems, whether planned or due to

power failure or sporadic failure;
peak demand exceeding the ow capacity of the transmission mains or the
capacity of the reservoir;
excessive leakage within the distribution systems;
excessive demands on community-managed point sources;
seasonal service variation resulting from source uctuation, which typically has
three causes:
natural variation in source volume during the year;
volume limitation because of competition with other uses such as irrigation;
periods of high turbidity when the source water may be untreatable; and
compounded frequent and seasonal discontinuity.
This classication reects broad categories of continuity, which are likely to affect
hygiene in different ways. Daily or weekly discontinuity results in low supply pressure
and a consequent risk of in-pipe recontamination. Other consequences include
reduced availability and lower volume use, which adversely affect hygiene. Household
water storage may be necessary, and this may lead to an increase in the risk of con-
tamination during such storage and associated handling. Seasonal discontinuity often
forces users to obtain water from inferior and distant sources. As a consequence,
in addition to the obvious reduction in quality and quantity, time is lost in water
collection.
5.4 Planning and implementation

For drinking-water supply surveillance to lead to improvements in drinking-water
supply, it is vital that the mechanisms for promoting improvement are recognized and
used.
The focus of drinking-water supply improvement (whether as investment priority
at regional or national levels, development of hygiene education programmes or
enforcement of compliance) will depend on the nature of the drinking-water supplies
and the types of problems identied. A checklist of mechanisms for drinking-water
supply improvement based on the output of surveillance is given below:
Establishing national priorities When the most common problems and short-
comings in drinking-water systems have been identied, national strategies can be
formulated for improvements and remedial measures; these might include changes
in training (of managers, administrators, engineers or eld staff), rolling pro-
grammes for rehabilitation or improvement or changes in funding strategies to
target specic needs.
Establishing regional priorities Regional ofces of drinking-water supply agen-
cies can decide which communities to work in and which remedial activities are
priorities; public health criteria should be considered when priorities are set.
93
Establishing hygiene education programmes Not all of the problems revealed

by surveillance are technical in nature, and not all are solved by drinking-water
suppliers; surveillance also looks at problems involving community and household
supplies, water collection and transport and household treatment and storage. The
solutions to many of these problems are likely to require educational and promo-
tional activities.
Auditing of WSPs and upgrading The information generated by surveillance can
be used to audit WSPs and to assess whether these are in compliance. Systems and
their associated WSPs should be upgraded where they are found to be decient,
although feasibility must be considered, and enforcement of upgrading should be
linked to strategies for progressive improvement.
Ensuring community operation and maintenance Support should be provided
by a designated authority to enable community members to be trained so that they
are able to assume responsibility for the operation and maintenance of commu-
nity drinking-water supplies.
Establishing public awareness and information channels Publication of infor-
mation on public health aspects of drinking-water supplies, water quality and the
performance of suppliers can encourage suppliers to follow good practices, mobi-
lize public opinion and response and reduce the need for regulatory enforcement,
which should be an option of last resort.
In order to make best use of limited resources where surveillance is not yet practised,
it is advisable to start with a basic programme that develops in a planned manner.
Activities in the early stages should generate enough useful data to demonstrate the
value of surveillance. Thereafter, the objective should be to progress to more advanced
surveillance as resources and conditions permit.
The activities normally undertaken in the initial, intermediate and advanced stages
of development of drinking-water supply surveillance are summarized as follows:
Initial phase:
Establish requirements for institutional development.
Provide training for staff involved in programme.
Dene the role of participants, e.g., quality assurance / quality control by sup-
plier, surveillance by public health authority.
Develop methodologies suitable for the area.
Commence routine surveillance in priority areas (including inventories).
Limit verication to essential parameters and known problem substances.
Establish reporting, ling and communication systems.
Advocate improvements according to identied priorities.
Establish reporting to local suppliers, communities, media and regional
authorities.
Establish liaison with communities; identify community roles in surveillance
and means of promoting community participation.
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5. SURVEILLANCE
Intermediate phase:
Train staff involved in programme.
Establish and expand systematic routine surveillance.
Expand access to analytical capability (often by means of regional laboratories,
national laboratories being largely responsible for analytical quality control and
training of regional laboratory staff).
Undertake surveys for chemical contaminants using wider range of analytical
methods.
Evaluate all methodologies (sampling, analysis, etc.).
Use appropriate standard methods (e.g., analytical methods, eldwork
procedures).
Develop capacity for statistical analysis of data.
Establish national database.
Identify common problems, promote activities to address them at regional and
national levels.
Expand reporting to include interpretation at national level.
Draft or revise health-based targets as part of framework for safe drinking-water.
Use legal enforcement where necessary.
Involve communities routinely in surveillance implementation.
Advanced phase:
Train staff involved in programme.
Establish routine testing for all health and acceptability parameters at dened
frequencies.
Use full network of national, regional and local laboratories (including analyt-
ical quality control).
Use national framework for drinking-water safety.
Improve water services on the basis of national and local priorities, hygiene
education and enforcement of standards.
Establish regional database archives compatible with national database.
Disseminate data at all levels (local, regional and national).
Involve communities routinely in surveillance implementation.
5.5 Reporting and communicating

An essential element of a successful surveillance programme is the reporting of results
to stakeholders. It is important to establish appropriate systems of reporting to all rel-
evant bodies. Proper reporting and feedback will support the development of effec-
tive remedial strategies. The ability of the surveillance programme to identify and
advocate interventions to improve water supply is highly dependent on the ability to
analyse and present information in a meaningful way to different target audiences.
The target audiences for surveillance information will typically include:
95
public health ofcials at local, regional and national levels;

water suppliers;
local administrations;
communities and water users; and
local, regional and national authorities responsible for development planning
and investment.
5.5.1 Interaction with community and consumers

Community participation is a desirable component of surveillance, particularly
for community and household drinking-water supplies. As primary beneciaries of
improved drinking-water supplies, community members have a right to take part in
decision-making. The community represents a resource that can be drawn upon for
local knowledge and experience. They are the people who are likely to rst notice prob-
lems in the drinking-water supply and therefore can provide an indication of when
immediate remedial action is required. Communication strategies should include:
provision of summary information
to consumers (e.g., through annual
The right of consumers to information on
reports or the Internet); and
the safety of the water supplied to them
establishment and involvement of for domestic purposes is fundamental.
consumer associations at local,
regional and national levels.
However, in many communities, the simple right of access to information will not
ensure that individuals are aware of the quality or safety of the water supplied to them.
The agencies responsible for surveillance should develop strategies for disseminating
and explaining the signicance of results obtained.
It may not be feasible for the surveillance agency to provide feedback information
directly to the entire community. Thus, it may be appropriate to use community
organizations, where these exist, to provide an effective channel for providing
feedback information to users. Some local organizations (e.g., local councils and
community-based organizations, such as womens groups, religious groups and
schools) have regular meetings in the communities that they serve and can therefore
provide a mechanism of relaying important information to a large number of people
within the community. Furthermore, by using local organizations, it is often easier to
initiate a process of discussion and decision-making within the community concern-
ing water quality. The most important elements in working with local organizations
are to ensure that the organization selected can access the whole community and can
initiate discussion on the results of surveillance.
5.5.2 Regional use of data

Strategies for regional prioritization are typically of a medium-term nature and have
specic data requirements. While the management of information at a national level
96
5. SURVEILLANCE
is aimed at highlighting common or recurrent problems, the objective at a regional

level is to assign a degree of priority to individual interventions. It is therefore impor-
tant to derive a relative measure of health risk. While this information cannot be used
on its own to determine which systems should be given immediate attention (which
would also require the analysis of economic, social, environmental and cultural
factors), it provides an extremely important tool for determining regional priorities.
It should be a declared objective to ensure that remedial action is carried out each
year on a predetermined proportion of the systems classied as high risk.
At the regional level, it is also important to monitor the improvement in (or dete-
rioration of) both individual drinking-water supplies and the supplies as a whole. In
this context, simple measures, such as the mean sanitary inspection score of all
systems, the proportion of systems with given degrees of faecal contamination, the
population with different levels of service and the mean cost of domestic consump-
tion, should be calculated yearly and changes monitored.
In many developing and developed countries, a high proportion of small-
community drinking-water systems fail to meet requirements for water safety. In such
circumstances, it is important that realistic goals for progressive improvement are
agreed upon and implemented. It is practical to classify water quality results in terms
of an overall grading for water safety linked to priority for action, as illustrated in
Table 5.2.
Grading schemes may be of particular use in community supplies where the fre-
quency of testing is low and reliance on analytical results alone is especially inappro-
priate. Such schemes will typically take account of both analytical ndings and results
of the sanitary inspection through schema such as illustrated in Figure 5.1.
Combined analysis of sanitary inspection and water quality data can be used to
identify the most important causes of and control measures for contamination. This
is important to support effective and rational decision-making. For instance, it will
be important to know whether on-site or off-site sanitation could be associated with
contamination of drinking-water, as the remedial actions required to address either
source of contamination will be very different. This analysis may also identify other
factors associated with contamination, such as heavy rainfall. As the data will be non-
parametric, suitable methods for analysis include chi-square, odds ratios and logistic
regression models.
Table 5.2 Categorization of drinking-water systems based on compliance with performance

and safety targets (see also table 7.7)
Proportion (%) of samples negative for E. coli
Population size:
Quality of water system <5000 5000100 000 >100 000
Excellent 90 95 99
Good 80 90 95
Fair 70 85 90
Poor 60 80 85
97
Figure 5.1 Example of assessment of priority of remedial actions of community drinking-water

supplies based on a grading system of microbial quality and sanitary inspection
rating or score
98
6
Application of the Guidelines
in specic circumstances
T hese Guidelines provide a generally applicable approach to drinking-water safety.

In chapters 25, approaches and, where appropriate, aspects of their application
to drinking-water supply through piped distribution and through community sup-
plies are described. In applying the Guidelines in specic circumstances, additional
factors may be important. This chapter describes the application of the Guidelines in
some commonly encountered specic circumstances and issues that should be taken
into account in each.
6.1 Large buildings

Responsibility for many actions essential to the control of drinking-water quality
in large buildings may be outside the responsibility of the drinking-water sup-
plier. Signicant contamination can occur because of factors within the built
environment, and specic requirements in the large building environment (includ-
ing hospitals and health care facilities) are distinct from those in the domestic
environment.
General drinking-water safety is assured by maintenance protocols, regular clean-
ing, temperature management and maintenance of a disinfectant residual. For these
reasons, authorities responsible for building safety should be responsible for devel-
oping and implementing WSPs. Regulatory or other appropriate authorities may
provide guidance on the development and application of WSPs for large building
drinking-water systems, which should be implemented by managers.
WSPs for large buildings may usefully address not only drinking-water systems but
also other water systems, such as cooling towers and evaporative condensers of air
conditioning devices.
The regulator can specify compliance requirements for buildings in general or for
individual buildings. Compliance may require that maintenance and monitoring pro-
grammes be carried out through a building-specic WSP. It may be appropriate to
display maintenance and monitoring programmes and certication of compliance
at a conspicuous location within the building. Compliance could be veried and
certied by an independent auditor.
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6.1.1 Health risk assessment

The principal hazards that may accrue in the drinking-water systems of large build-
ings are ingress of microbial contamination (which may affect only the building or
also the wider supply), proliferation and dispersal of bacteria growing on water
contact surfaces (especially Legionella) and addition of chemical substances from
piping, jointing and plumbing materials.
Faecal contamination may occur through cross-connection and backow and from
buried/immersed tanks and pipes, especially if not maintained with positive internal
water pressure.
Legionella bacteria are the cause of legionellosis, including legionnaires disease.
They are ubiquitous in the environment and can proliferate at temperatures experi-
enced at times in piped distribution systems. The route of infection is by inhalation
of droplets or aerosols; however, exposure from piped water systems is preventable
through the implementation of basic water quality management measures, including
maintaining water temperature outside the range at which Legionella proliferates
(2550 C) and maintaining disinfectant residuals throughout the piped distribution
system.
Devices such as cooling towers and hot or warm water systems, if not appropriately
maintained, can provide suitable conditions for the survival and growth of Legionella.
In large buildings, there is increased potential for growth of Legionella in long water
distribution systems, and maintenance of these systems needs particular attention. In
addition to supporting the growth of Legionella, devices such as cooling towers and
hot or warm water systems can disseminate contaminated water in aerosols.
For further information on Legionella in drinking-water, see section 11.1.9 and the
supporting document Legionella and the Prevention of Legionellosis (see section
1.3).
Hospitals, nursing care homes, other health care facilities, schools, hotels and some
other large buildings are high-risk environments, because of both the complex nature
of their drinking-water systems and the sensitivities of their occupants. Requirements
similar to those outlined above for other large buildings apply, but heightened vigi-
lance in control measure monitoring and verication is generally justied.
6.1.2 System assessment

Because WSPs for large buildings are limited to the building environment and since
doseresponse is not easily described for bacteria arising from growth, adequate
control measures are dened in terms of practices that have been shown to be
effective.
In undertaking an assessment of the buildings distribution system, a range of
specic issues must be taken into consideration. These factors relate to ingress and
proliferation of contaminants and include:
pressure of water within the system;
intermittent supplies;
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6. APPLICATION OF THE GUIDELINES IN SPECIFIC CIRCUMSTANCES
temperature of water;
cross-connections, especially in mixed systems;
backow prevention; and
system design to minimize dead/blind ends (i.e., a length of pipe, closed at one
end, through which no water passes) and other areas of potential stagnation.
6.1.3 Management
The aim of a distribution system within a large building is to supply safe drinking-
water at adequate pressure and ow. Pressure is inuenced by the action of friction
at the pipe wall, ow rate and pipe length, gradient and diameter. For the purposes
of maintaining drinking-water quality, it is important to minimize transit times and
avoid low ows and pressures. Pressure at any point in the system should be main-
tained within a range whereby the maximum pressure avoids pipe bursts and the
minimum pressure ensures that water is supplied at adequate ow rates for all
expected demands. In some buildings, this may require pressure boosting in the
network.
Where piped water is stored in tanks to reduce the effect of intermittent supplies,
and particularly where water is supplied directly to equipment, the potential for back-
ow of water into the mains network exists. This may be driven by high pressures
generated in equipment connected to mains water supplies or by low pressures in the
mains. Water quality in intermittent systems may deteriorate on recharging,
where surges may lead to leakage and dislodgement of biolm and acceptability
problems.
A backow event will be a sanitary problem if there is cross-connection between
the potable supply and a source of contamination. Positive pressure should be main-
tained throughout the piped distribution system. Effective maintenance procedures
should be implemented to prevent backow. In situations where backow is of
particular concern, backow prevention devices may be used in addition to the
primary objective of reducing or eliminating backow. Situations presenting a poten-
tially high public health risk (e.g., dental chairs, laboratories) should receive special
attention.
Signicant points of risk exist in areas where pipes carrying drinking-water
pass through drains or other places where stagnant water pools. The risk associated
with ingress of contamination in these situations may be controlled by reducing the
formation of such stagnant pools and by routing pipework to avoid such areas.
The design and management of piped water systems in buildings must also take
into account the impact of slow ows and dead ends.
Wherever possible, drinking-water taps should be situated in areas where the pipes
are well ushed to minimize leaching from pipes, materials and plumbing ttings.
6.1.4 Monitoring
Monitoring of control measures includes:
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temperature, including frequent (e.g., weekly) monitoring of remote areas;

disinfectants and pH, when employed (e.g., weekly to monthly); and
microbial quality of water, particularly following system maintenance or repairs.
Daily monitoring may be necessary in the presence of suspected water-related cases

of illness.
Monitoring of drinking-water quality is required to be more frequent when the
building is new or recently commissioned or following maintenance of the system.
When the buildings drinking-water system has not stabilized, monitoring should be
more frequent until the water quality has stabilized.
6.1.5 Independent surveillance and supporting programmes

Independent surveillance is a desirable element in ensuring continued water safety
within a large building and should be undertaken by the relevant health agency or
other independent authority.
In order to ensure safety of drinking-water within buildings, supportive activities
of national regulatory agencies include the following:
specic attention to application of codes of good practice (e.g., at commission-

ing and in contracting construction and rehabilitation);
suitable training for engineers and plumbers;
regulation of the plumbing community;
effective certication of materials and devices in the marketplace; and
inclusion of WSPs as an essential component of building safety provision.
A WSP would normally document its use of and reliance on such measures for
instance, in using only approved professionals to conduct maintenance and in
insisting on their use of certied materials.
6.1.6 Drinking-water quality in health care facilities

Health care facilities include hospitals, health centres and hospices, residential care,
dental ofces and dialysis units. Drinking-water should be suitable for human con-
sumption and for all usual domestic purposes, including personal hygiene. However,
it may not be suitable for all uses or for some patients within health care facilities,
and further processing or treatment or other safeguards may be required.
Drinking-water can contain a range of microorganisms, including Pseudomonas
aeruginosa, non-tuberculous Mycobacterium spp., Acinetobacter spp., Aeromonas spp.
and Aspergillus. There is no evidence that these microorganisms represent a health
concern through water consumption by the general population, including most
patients in health care facilities. However, additional processing may be required to
ensure safety for consumption by severely immunosuppressed persons, such as those
with neutrophil counts below 500 per ml (see the supporting document Heterotrophic
Plate Counts and Drinking-water Safety; section 1.3).
102
Microorganisms in drinking-water also have the potential to cause infections if

drinking-water is used to wash burns or to wash medical devices such as endoscopes
and catheters. Water used for such purposes needs to be of a higher quality than
described in these Guidelines and may require additional processing, such as micro-
ltration or sterilization, depending on use.
Health care facilities may include environments that support the proliferation and
dissemination of Legionella (see section 11.1.9 and the supporting document
Legionella and the Prevention of Legionellosis; section 1.3).
Renal dialysis requires large volumes of water that exceed the chemical and micro-
bial quality requirements for drinking-water. Water used for dialysis requires special
processing to minimize the presence of microorganisms, endotoxins, toxins and
chemical contaminants. The vulnerability of renal dialysis patients was demonstrated
in 1996 by the death of 50 such patients after exposure to water contaminated by high
levels of microcystin (Jochimsen et al., 1998; Pouria et al., 1998). Dialysis patients are
also sensitive to chloramines, and this needs to be considered when chloramination
is used to disinfect drinking-water supplies, particularly in areas where there are home
dialysis patients.
All health care facilities should have specic WSPs as part of their infection control
programme. These plans should address issues such as water quality and treatment
requirements, cleaning of specialized equipment and control of microbial growth in
water systems and ancillary equipment.
6.1.7 Drinking-water quality in schools and day care centres

A long-term approach to improving hygiene in the community includes working with
children in schools. This enables the concept of good hygiene, of which drinking-water
safety is a part, to become part of a general understanding of health and the inuence
of the environment. Schoolchildren can relay hygiene concepts to family and house-
holds. As young children learn from what they see around them, the school environ-
ment itself should meet the requirements of good hygiene for example, by providing
toilets or latrines, water for hand-washing, generally clean surroundings and hygienic
facilities for the preparation and serving of school meals. Visual demonstration of the
presence of bacteria on unwashed hands has been shown to be valuable (e.g., using
UV uorescence of bacteria or the hydrogen sulde paper strip method).
One of the most important characteristics of effective health education is that it
builds on concepts, ideas and practices that people already have. Hygiene education
programmes should be based on an understanding of the factors that inuence behav-
iour at the community level. These might include:
enabling factors, such as money, materials and time to carry out appropriate
patterns of behaviour;
pressure from particular members of the family and community (e.g., elders,
traditional healers, opinion leaders);
103
beliefs and attitudes among community members with respect to hygienic behav-
iour, especially the perceived benets and disadvantages of taking action; and
the understanding of the relationship between health and hygiene.
An understanding of the factors that inuence hygiene-related behaviours will help
in identifying the resources (e.g., soap, storage containers), the key individuals in the
home and community and the important beliefs that should be taken into account.
This will help to ensure that the content of the hygiene education is relevant to the
community. Good advice should:
result in improved health;
be affordable;
require a minimum of effort and time to put into practice;
be realistic;
be culturally acceptable;
meet a perceived need; and
be easy to understand.
6.2 Emergencies and disasters

Drinking-water safety is one of the most important public health issues in most emer-
gencies and disasters. The greatest waterborne risk to health in most emergencies is the
transmission of faecal pathogens, due to inadequate sanitation, hygiene and protection
of water sources. Some disasters, including those caused by or involving damage
to chemical and nuclear industrial installations or spillage in transport or volcanic
activity, may create acute problems from chemical or radiological water pollution.
Different types of disaster affect water quality in different ways. When people are
displaced by conict and natural disaster, they may move to an area where unpro-
tected water sources are contaminated. When population density is high and sanita-
tion is inadequate, unprotected water sources in and around the temporary settlement
are highly likely to become contaminated. If there is a signicant prevalence of disease
cases and carriers in a population of people with low immunity due to malnutrition
or the burden of other diseases, then the risk of an outbreak of waterborne disease is
increased. The quality of urban drinking-water supplies is particularly at risk follow-
ing earthquakes, mudslides and other structurally damaging disasters. Water treat-
ment works may be damaged, causing untreated or partially treated water to be
distributed, and sewers and water transmission pipes may be broken, causing con-
tamination of drinking-water in the distribution system. Floods may contaminate
wells, boreholes and surface water sources with faecal matter washed from the ground
surface or from overowing latrines and sewers. During droughts, people may be
forced to use unprotected water supplies when normal supplies dry up; as more people
and animals use fewer water sources, the risk of contamination is increased.
Emergency situations that are appropriately managed tend to stabilize after a
matter of days or weeks. Many develop into long-term situations that can last for
104
several years before a permanent solution is found. Water quality concerns may change
over that time, and water quality parameters that pose long-term risks to health may
become more important.
6.2.1 Practical considerations

Available sources of water are very limited in most emergency situations, and
providing a sufcient quantity of water for personal and domestic hygiene as well as
for drinking and cooking is important. Guidelines and national drinking-water
quality standards should therefore be exible, taking into consideration the risks and
benets to health in the short and long term, and should not excessively restrict water
availability for hygiene, as this would often result in an increased overall risk of
disease transmission.
There are a number of factors to take into consideration when providing drinking-
water for a population affected by a disaster, including the following:
The quantity of water available and the reliability of supply This is likely to be the
overriding concern in most emergency situations, as it is usually easier to improve
water quality than to increase its availability or to move the affected population
closer to another water source.
The equitability of access to water Even if sufcient water is available to meet
minimum needs, additional measures may be needed to ensure that access is equi-
table. Unless water points are sufciently close to their dwellings, people will not
be able to collect enough water for their needs. Water may need to be rationed to
ensure that everyones basic needs are met.
The quality of the raw water It is preferable to choose a source of water that
can be supplied with little or no treatment, provided it is available in sufcient
quantity.
Sources of contamination and the possibility of protecting the water source This
should always be a priority in emergencies, whether or not disinfection of the water
supply is considered necessary.
The treatment processes required for rapidly providing a sufcient quantity of potable
water As surface water sources are commonly used to provide water to large pop-
ulations in emergencies, clarication of the raw water for example, by
occulation and sedimentation and/or by ltration is commonly required before
disinfection.
The treatment processes appropriate for post-emergency situations The affordabil-
ity, simplicity and reliability of water treatment processes in the longer term should
be considered early on in the emergency response.
The need to disinfect drinking-water supplies In emergencies, hygiene conditions
are normally poor and the risk of disease outbreaks is high, particularly in
populations with low immunity. It is therefore crucial to disinfect the water
supplies, ensuring a residual disinfection capacity in the water. This practice would
105
considerably reduce the likelihood of disease transmission through contamination

of water in the home.
Acceptability It is important to ensure that drinking-water provided in
emergencies is acceptable to the consumers, or they may resort to water from
unprotected or untreated supplies.
The need for vessels to collect and store water Vessels that are hygienic and appro-
priate to local needs and habits are needed for the collection and storage of water
to be used for washing, cooking and bathing.
Epidemiological considerations Contamination of water may occur during
collection, storage and use in the home, as a result of lack of sanitation or poor
hygiene due to an insufcient quantity of water. Other transmission routes for
major waterborne and sanitation-related diseases in emergencies and disasters
include person-to-person contact, aerosols and food intake. The importance of
all routes should be considered when applying the Guidelines, selecting and
protecting water sources and choosing options for water treatment.
In many emergency situations, water is collected from central water collection points,
stored in containers and then transferred to cooking and drinking vessels by the
affected people. This process provides many opportunities for contamination of the
water after it leaves the supply system. It is therefore important that people are aware
of the risks to health from contamination of water from the point of collection to the
moment of consumption and have the means to reduce or eliminate these risks. When
water sources are close to dwelling areas, they may easily be contaminated through
indiscriminate defecation, which should be strongly discouraged. Establishing and
maintaining water quality in emergencies require the rapid recruitment, training and
management of operations staff and the establishment of systems for maintenance
and repairs, consumable supplies and monitoring. Communication with the affected
population is extremely important for reducing health problems due to poor water
quality. Detailed information may be found in Wisner & Adams (2003).
6.2.2 Monitoring
Water safety should be monitored during emergencies. Monitoring may involve
sanitary inspection and one or more of:
sanitary inspection and water sampling and analysis;

monitoring of water treatment processes, including disinfection;
monitoring of water quality at all water collection points and in a sample of
homes; and
water quality assessment in the investigation of disease outbreaks or the evalu-
ation of hygiene promotion activities, as required.
Monitoring and reporting systems should be designed and managed to ensure that
action is swiftly taken to protect health. Health information should also be monitored
106
to ensure that water quality can be rapidly investigated when there is a possibility that
water quality might contribute to a health problem and that treatment processes
particularly disinfection can be modied as required.
6.2.3 Microbial guidelines

The objective of zero E. coli per 100 ml of water is the goal for all water supplies and
should be the target even in emergencies; however, it may be difcult to achieve
in the immediate post-disaster period. This highlights the need for appropriate
disinfection.
An indication of a certain level of faecal indicator bacteria alone is not a reliable
guide to microbial water safety. Some faecal pathogens, including many viruses and
protozoal cysts and oocysts, may be more resistant to treatment (e.g., by chlorine)
than common faecal indicator bacteria. More generally, if a sanitary survey suggests
the risk of faecal contamination, then even a very low level of faecal contamination
may be considered to present a risk, especially during an outbreak of a potentially
waterborne disease, such as cholera.
Drinking-water should be disinfected in emergency situations, and an adequate
disinfectant residual (e.g., chlorine) should be maintained in the system. Turbid water
should be claried wherever possible to enable disinfection to be effective. Minimum
target concentrations for chlorine at point of delivery are 0.2 mg/litre in normal
circumstances and 0.5 mg/litre in high-risk circumstances.
Where there is a concern about the quality of drinking-water in an emergency
situation that cannot be addressed through central services, then the appropriateness
of household-level treatment should be evaluated, including, for example:
bringing water to a rolling boil and cooling before consumption;
adding sodium or calcium hypochlorite solution, such as household bleach, to
a bucket of water, mixing thoroughly and allowing to stand for about 30 min
prior to consumption; turbid water should be claried by settling and/or ltra-
tion before disinfection;
vigorously shaking small volumes of water in a clean, transparent container, such
as a soft drink bottle, for 20 s and exposing the container to sunlight for at least
6 h;
applying products such as tablets or other dosing techniques to disinfect the
water, with or without clarication by occulation or ltration; and
end-use units and devices for eld treatment of drinking-water.
Emergency decontamination processes may not always accomplish the level of
disinfection recommended for optimal conditions, particularly with regard to resist-
ant pathogens. However, implementation of emergency procedures may reduce
numbers of pathogens to levels at which the risk of waterborne disease is largely
controlled.
107
The parameters most commonly measured to assess microbial safety are as follows:
E. coli (see above): Thermotolerant coliforms may provide a simpler surrogate.

Residual chlorine: Taste does not give a reliable indication of chlorine concentra-
tion. Chlorine content should be tested in the eld with, for example, a colour com-
parator, generally used in the range of 0.21 mg/litre.
pH: It is necessary to know the pH of water, because more alkaline water requires
a longer contact time or a higher free residual chlorine level at the end of the
contact time for adequate disinfection (0.40.5 mg/litre at pH 68, rising to 0.6
mg/litre at pH 89; chlorination may be ineffective above pH 9).
Turbidity: Turbidity adversely affects the efciency of disinfection. Turbidity is also
measured to determine what type and level of treatment are needed. It can be
carried out with a simple turbidity tube that allows a direct reading in nephelo-
metric turbidity units (NTU).
6.2.4 Sanitary inspections and catchment mapping

It is possible to assess the likelihood of faecal contamination of water sources through
a sanitary inspection. Sanitary inspection and water quality testing are complemen-
tary activities; the ndings of each assists the interpretation of the other. Where water
quality analysis cannot be performed, sanitary inspection can still provide valuable
information to support effective decision-making. A sanitary inspection makes it pos-
sible to see what needs to be done to protect the water source. This procedure can be
combined with bacteriological, physical and chemical testing to enable eld teams to
assess and act on risks from contamination and to provide the basis for monitoring
water supplies in the post-disaster period.
Even when it is possible to carry out testing of microbial quality, results are not
instantly available. Thus, the immediate assessment of contamination risk may be
based on gross indicators such as proximity to sources of faecal contamination
(human or animal), colour and smell, the presence of dead sh or animals, the pres-
ence of foreign matter such as ash or debris or the presence of a chemical or radia-
tion hazard or wastewater discharge point upstream. Catchment mapping involving
the identication of sources and pathways of pollution can be an important tool for
assessing the likelihood of contamination of a water source.
It is important to use a standard reporting format for sanitary inspections and
catchment mapping to ensure that information gathered by different staff is reliable
and that information gathered on different water sources may be compared. For an
example format, see WHO (1997) and Davis & Lambert (2002). For more informa-
tion on catchment mapping, see House & Reed (1997).
6.2.5 Chemical and radiological guidelines

Many chemicals in drinking-water are of concern only after extended periods of
exposure. Thus, to reduce the risk of outbreaks of waterborne and water-washed (e.g.,
108
trachoma, scabies, skin infections) disease, it is preferable to supply water in an

emergency, even if it signicantly exceeds the guideline values for some chemical
parameters, rather than restrict access to water, provided the water can be treated to
kill pathogens and can be supplied rapidly to the affected population. Where water
sources are likely to be used for long periods, chemical and radiological contaminants
of more long-term health concern should be given greater attention. In some situa-
tions, this may entail adding treatment processes or seeking alternative sources.
Water from sources that are considered to have a signicant risk of chemical or
radiological contamination should be avoided, even as a temporary measure. In the
long term, achieving the guidelines should be the aim of emergency drinking-water
supply programmes based on the progressive improvement of water quality. Proce-
dures for identifying priority chemicals in drinking-water are outlined in the
supporting document Chemical Safety of Drinking-water (section 1.3).
6.2.6 Testing kits and laboratories

Portable testing kits allow the determination in the eld of key water quality param-
eters, such as thermotolerant coliform count, free residual chlorine, pH, turbidity and
lterability.
Where large numbers of water samples need testing or a broad range of parame-
ters is of interest, laboratory analysis is usually most appropriate. If the drinking-water
suppliers laboratories or laboratories at environmental health ofces and universities
no longer function because of the disaster, then a temporary laboratory may need to
be set up. Where samples are transported to laboratories, handling is important. Poor
handling may lead to meaningless or misleading results.
Workers should be trained in the correct procedures for collecting, labelling,
packing and transporting samples and in supplying supporting information from the
sanitary survey to help interpret laboratory results. For guidance on methods of water
sampling and testing, see WHO (1997) and Bartram & Ballance (1996).
6.3 Safe drinking-water for travellers

Diarrhoea is the most common cause of ill health for travellers; up to 80% of all trav-
ellers are affected in high-risk areas. In localities where the quality of potable water
and sanitation and food hygiene practices are questionable, the numbers of parasites,
bacteria and viruses in water and food can be substantial, and numerous infections
can occur. Cases occur among people staying in resorts and hotels in all categories.
No vaccine is capable of conferring general protection against diarrhoea, which
is caused by many different pathogens. It is important that travellers are aware of
possible risks and take appropriate steps to minimize these.
Contaminated food, water and drinks are the most common sources of infections.
Careful selection of drinking-water sources and appropriate water treatment offer
signicant protection. Preventive measures while living or travelling in areas with
unsafe drinking-water include the following:
109
Always avoid consumption or use of unsafe water (even when brushing teeth) if
you are unsure about water quality.
Avoid unpasteurized juices and ice made from untreated water.
Avoid salads or other uncooked meals that may have been washed or prepared with
unsafe water.
Drink water that you have boiled, ltered and/or treated with chlorine or iodine
and stored in clean containers.
Consume ice only if it is known to be of drinking-water quality.
Drink bottled water if it is known to be safe, carbonated bottled beverages (water
and sodas) only from sealed, tamper-proof containers and pasteurized/canned
juices and pasteurized milk.
Drink coffee and tea made from boiled water and served and stored in clean
containers.
The greatest health risk from drinking-water for travellers is associated with micro-
bial constituents of water. Water can be treated or re-treated in small quantities to
signicantly improve its safety. The simplest and most important benecial treatments
for microbially contaminated water are boiling, disinfection and ltration to inacti-
vate or remove pathogenic microorganisms. These treatments will generally
not reduce most chemical constituents in drinking-water. However, most chemicals
are of health concern only after long-term exposure. Numerous simple treatment
approaches and commercially available technologies are also available to travellers to
treat drinking-water for single-person use.
Bringing water to a rolling boil is the most effective way to kill disease-causing
pathogens, even at high altitudes and even for turbid water. The hot water should be
allowed to cool down on its own without the addition of ice. If water for boiling is to
be claried, this should be done before boiling.
Chemical disinfection is effective for killing bacteria, some viruses and some
protozoa (but not, for example, Cryptosporidium oocysts). Some form of chlorine and
iodine are the chemicals most widely used for disinfection by travellers. After chlori-
nation, a carbon (charcoal) lter may be used to remove excess chlorine taste and, in
the case of iodine treatment, to remove excess iodine. Silver is not very effective for
eliminating disease-causing microorganisms, since silver by itself is slow acting. If
water is turbid (not clear or with suspended solid matter), it should be claried before
disinfection; clarication includes ltration, settling and decanting. Portable ltration
devices that have been tested and rated to remove protozoa and some bacteria are also
available; ceramic lters and some carbon block lters are the most common types.
The lters pore size rating must be 1 mm (absolute) or less to ensure removal of Cryp-
tosporidium oocysts (these very ne lters may require a pre-lter to remove larger
particles in order to avoid clogging the nal lter). A combination of technologies
(ltration followed by chemical disinfection or boiling) is recommended, as most
ltering devices do not remove viruses.
110
For people with weakened immune systems, extra precautions are recommended
to reduce the risk of infection from contaminated water. While drinking boiled water
is safest, certied bottled or mineral water may also be acceptable. Iodine as a water
disinfectant is not recommended for pregnant women, those with a history of thyroid
disease and those with known hypersensitivity to iodine, unless there is also an effec-
tive post-treatment iodine removal system such as granular carbon in use.
6.4 Desalination systems

The principal purpose of desalination is to enable sources of brackish or salty water,
otherwise unacceptable for human consumption, to be used for this purpose.
The use of desalination to provide drinking-water is increasing and is likely
to continue to increase because of water scarcity driven by pressures arising from
population growth, over-exploitation of water resources and pollution of other water
sources. While most (around 60%) of currently constructed capacity is in the eastern
Mediterranean region, desalination facilities exist all over the world, and their use is
likely to increase in all continents.
Most present applications of desalination are for estuarine water, coastal water and
seawater. Desalination may also be applied to brackish inland waters (both surface
water and groundwater) and may be used on board vessels. Small-scale desalination
units also exist for household and community use and present specic challenges to
effective operation and maintenance.
Further guidance on desalination for safe drinking-water supply is available in the
supporting document Desalination for Safe Drinking-water Supply (section 1.3).
In applying the Guidelines to desalinated water supply systems, account should be
taken of certain major differences between these and systems abstracting water from
freshwater sources. These differences include the factors described in section 6.4.1.
Once taken into account, the general requirements of these Guidelines for securing
microbial, chemical and radiological safety should apply.
Brackish water, coastal water and seawater sources may contain hazards not
encountered in freshwater systems. These include diverse harmful algal events
associated with micro- and macroalgae and cyanobacteria; certain free-living
bacteria (including Vibrio spp., such as V. parahaemolyticus and V. cholerae); and some
chemicals, such as boron and bromide, that are more abundant in seawater.
Harmful algal events may be associated with exo- and endotoxins that may not be
destroyed by heating, are inside algal cells or are free in the water. They are usually
non-volatile, and, where they are destroyed by chlorination, this usually requires
extremely long contact times. Although a number of toxins have been identied, it is
possible that there are other unrecognized toxins. Minimizing of the potential for
abstracting water containing toxic algae through location/siting and intake design plus
effective monitoring and intake management is an important control measure.
Other chemical issues, such as control of additives, DBPs and pesticides, are
similar to those encountered in fresh waters (see chapter 8), except that a larger variety
111
and greater quantities may be involved in desalination. Due to the presence of

bromide in seawater, the distribution of DBPs will likely be dominated by brominated
organics.
Approaches to monitoring and assessing the quality of freshwater sources may not
be directly applicable to sources subject to desalination. For example, many faecal
indicator bacteria die off more rapidly than pathogens (especially viruses) in saline
than in fresh water.
The effectiveness of some of the processes employed in desalination to remove
some substances of health concern remains inadequately understood. Examples of
inefciencies include imperfect membrane and/or membrane seal integrity (mem-
brane treatment); bacterial growth through membranes/biolm development on
membranes (in membrane treatment systems); and carry-over, especially of volatile
substances (with vapour).
Because of the apparently high effectiveness of some of the processes used in
removal of both microorganisms and chemical constituents (especially distillation
and reverse osmosis), these processes may be employed as single-stage treatments or
combined with only a low level of residual disinfectant. The absence of multiple bar-
riers places great stress on the continuously safe operation of that process and implies
that even a short-term decrease in effectiveness may present an increased risk to
human health. This, in turn, implies the need for on-line monitoring linked to rapid
management intervention. For further information, see the supporting document
Water Treatment and Pathogen Control (section 1.3).
Water produced by desalination is aggressive towards materials used, for example,
in water supply and domestic plumbing and pipes. Special consideration should
be given to the quality of such materials, and normal procedures for certication of
materials as suitable for potable water use may not be adequate for water that has not
been stabilized.
Because of the aggressivity of desalinated water and because desalinated water may
be considered bland, avourless and unacceptable, desalinated water is commonly
treated by adding chemical constituents such as calcium and magnesium carbonate
with carbon dioxide. Once such treatment has been applied, desalinated waters should
be no more aggressive than waters normally encountered in the drinking-water
supply. Chemicals used in such treatment should be subject to normal procedures for
certication.
Desalinated waters are commonly blended with small volumes of more mineral-
rich waters to improve their acceptability and particularly to reduce their aggressivity
to materials. Blending waters should be fully potable, as described here and elsewhere
in the Guidelines. Where seawater is used for this purpose, the major ions added are
sodium and chloride. This does not contribute to improving hardness or ion balance,
and only small amounts (e.g., 13%) can be added without leading to problems of
acceptability. Blended waters from coastal and estuarine areas may be more suscepti-
ble to contamination with petroleum hydrocarbons, which could give rise to taste and
112
odour problems. Some groundwaters or surface waters, after suitable treatment, may
be employed for blending in higher proportions and may improve hardness and ion
balance.
Desalinated water is a manufactured product. Concern has been expressed about
the impact of extremes of major ion composition or ratios for human health. There
is limited evidence to describe the health risk associated with long-term consumption
of such water, although concerns regarding mineral content may be limited by the
stabilization processes outlined above (see WHO, 2003b).
Desalinated water, by virtue of its manufacture, often contains lower than usual
concentrations of other ions commonly found in water, some of which are essential
elements. Water typically contributes a small proportion of these, and most intake is
through food. Exceptions include uoride, and declining dental health has been
reported from populations consuming desalinated water with very low uoride
content where there is a moderate to high risk of dental caries (WHO, 2003b).
Desalinated water may be more subject to microbial growth problems than other
waters as a result of one or more of the following: higher initial temperature (from
treatment process), higher temperature (application in hot climates) and/or the effect
of aggressivity on materials (thereby releasing nutrients). The direct health signi-
cance of such growth (see the supporting document Heterotrophic Plate Counts and
Drinking-water Safety; section 1.3), with the exception of Legionella (see chapter 11),
is inadequately understood. Nitrite formation by organisms in biolms may prove
problematic where chloramination is practised and excess ammonia is present.
Precaution implies that preventive management should be applied as part of good
management practice.
6.5 Packaged drinking-water

Bottled water and ice are widely available in both industrialized and developing coun-
tries. Consumers may have various reasons for purchasing packaged drinking-water,
such as taste, convenience or fashion; for many consumers, however, safety and poten-
tial health benets are important considerations.
6.5.1 Safety of packaged drinking-water

Water is packaged for consumption in a range of vessels, including cans, laminated
boxes and plastic bags, and as ice prepared for consumption. However, it is most com-
monly prepared in glass or plastic bottles. Bottled water also comes in various sizes,
from single servings to large carboys holding up to 80 litres.
In applying the Guidelines to bottled waters, certain chemical constituents may be
more readily controlled than in piped distribution systems, and stricter standards may
therefore be preferred in order to reduce overall population exposure. Similarly, when
exibility exists regarding the source of the water, stricter standards for certain natu-
rally occurring substances of health concern, such as arsenic, may be more readily
achieved than in piped distribution systems.
113
However, some substances may prove to be more difcult to manage in bottled

water than in tap water. Some hazards may be associated with the nature of the
product (e.g., glass chips and metal fragments). Other problems may arise because
bottled water is stored for longer periods and at higher temperatures than water dis-
tributed in piped distribution systems or because containers and bottles are reused
without adequate cleaning or disinfection. Control of materials used in containers and
closures for bottled water is, therefore, of special concern. Some microorganisms that
are normally of little or no public health signicance may grow to higher levels in
bottled water. This growth appears to occur less frequently in gasied water and in
water bottled in glass containers than in still water and water bottled in plastic con-
tainers. The public health signicance of this microbial growth remains uncertain,
especially for vulnerable individuals, such as bottle-fed infants and immunocompro-
mised individuals. In regard to bottle-fed infants, as bottled water is not sterile, it
should be disinfected for example, by boiling prior to its use in the preparation
of infant formula. For further information, see the supporting document
Heterotrophic Plate Counts and Drinking-water Safety (section 1.3).
6.5.2 Potential health benets of bottled drinking-water

There is a belief by some consumers that natural mineral waters have medicinal prop-
erties or offer other health benets. Such waters are typically of high mineral content,
sometimes signicantly higher than concentrations normally accepted in drinking-
water. Such waters often have a long tradition of use and are often accepted on the
basis that they are considered foods rather than drinking-water per se. Although
certain mineral waters may be useful in providing essential micro-nutrients, such as
calcium, these Guidelines do not make recommendations regarding minimum con-
centrations of essential compounds, because of the uncertainties surrounding mineral
nutrition from drinking-water.
Packaged waters with very low mineral content, such as distilled or demineralized
waters, are also consumed. Rainwater, which is similarly low in minerals, is consumed
by some populations without apparent adverse health effects. There is insufcient
scientic information on the benets or hazards of regularly consuming these types
of bottled waters (see WHO, 2003b).
6.5.3 International standards for bottled drinking-water

The Guidelines for Drinking-water Quality provide a basis for derivation of standards
for all packaged waters. As with other sources of drinking-water, safety is pursued
through a combination of safety management and end product quality standards and
testing. The international framework for packaged water regulation is provided by the
Codex Alimentarius Commission (CAC) of WHO and the FAO. CAC has developed
a Standard for Natural Mineral Waters and an associated Code of Practice. The Stan-
dard describes the product and its compositional and quality factors, including limits
for certain chemicals, hygiene, packaging and labelling. The CAC has also developed
114
a Standard for Bottled/Packaged Waters to cover packaged drinking-water other

than natural mineral waters. Both relevant CAC standards refer directly to these
Guidelines.
The CAC Code of Practice for Collecting, Processing and Marketing of Natural
Mineral Waters provides guidance on a range of good manufacturing practices and
provides a generic WSP applied to packaged drinking-water.
Under the existing CAC Standard for Natural Mineral Waters and associated Code
of Practice, natural mineral waters must conform to strict requirements, including
collection and bottling without further treatment from a natural source, such as a
spring or well. In comparison, the CAC Standard for Bottled/Packaged Waters includes
waters from other sources, in addition to springs and wells, and treatment to improve
their safety and quality. The distinctions between these standards are especially
relevant in regions where natural mineral waters have a long cultural history.
For further information on CAC, its Codex Committee on Natural Mineral Waters,
the CAC Standard for Natural Mineral Waters and its companion Code of Practice,
readers are referred to the CAC website (http://www.codexalimentarius.net/).
6.6 Food production and processing

The quality of water dened by the Guidelines is such that it is suitable for all normal
uses in the food industry. Some processes have special water quality requirements in
order to secure the desired characteristics of the product, and the Guidelines do not
necessarily guarantee that such special requirements are met.
Deterioration in drinking-water quality may have severe impacts on food process-
ing facilities and potentially upon public health. The consequences of a failure to use
water of potable quality will depend on the use of the water and the subsequent
processing of potentially contaminated materials. Variations in water quality that
may be tolerated occasionally in drinking-water supply may be unacceptable for some
uses in the food industry. These variations may result in a signicant nancial impact
on food production for example, through product recalls.
The diverse uses of water in food production and processing have different water
quality requirements. Uses include:
irrigation and livestock watering;
those in which water may be incorporated in or adhere to a product (e.g., as an
ingredient, or where used in washing or refreshing of foods);
misting of salad vegetables in grocery stores; and
those in which contact between the water and foodstuff should be minimal (as
in heating and cooling and cleaning water).
To reduce microbial contamination, specic treatments (e.g., heat) capable of remov-
ing a range of pathogenic organisms of public health concern may be used. The effect
of these treatments should be taken into account when assessing the impacts of
deterioration in drinking-water quality on a food production or processing facility.
115
Information on deterioration of the quality of a drinking-water supply should be

promptly communicated to vulnerable food production facilities.
6.7 Aircraft and airports

6.7.1 Health risks
The importance of water as a potential vehicle for infectious disease transmission on
aircraft has been well documented. In general terms, the greatest microbial risks are
those associated with ingestion of water that is contaminated with human and animal
excreta.
If the source of water used to replenish aircraft supplies is contaminated, and unless
adequate precautions are taken, disease can be spread through the aircraft water. It is
thus imperative that airports comply with Article 14.2 (Part III Health Organiza-
tion) of the International Health Regulations (1969) and be provided with potable
drinking-water from a source approved by the appropriate regulatory agency (WHO,
1983).
A potable water source is not a safeguard if the water is subsequently contaminated
during transfer, storage or distribution in aircraft. Airports usually have special
arrangements for managing water after it has entered the airport. Water may be deliv-
ered to aircraft by water servicing vehicles or water bowsers. Transfer of water from
the water carriers to the aircraft provides the opportunity for microbial or chemical
contamination (e.g., from water hoses).
A WSP covering water management within airports from receipt of the water
through to its transfer to the aircraft, complemented by measures (e.g., safe materials
and good practices in design, construction, operation and maintenance of aircraft
systems) to ensure that water quality is maintained on the aircraft, provides a frame-
work for water safety in aviation.
6.7.2 System risk assessment

In undertaking an assessment of the general airport/aircraft water distribution system,
a range of specic issues must be taken into consideration, including:
quality of source water;

design and construction of airport storage tanks and pipes;
design and construction of water servicing vehicles;
water loading techniques;
any treatment systems on aircraft;
maintenance of on-board plumbing; and
prevention of cross-connections, including backow prevention.

The airport authority has responsibility for safe drinking-water supply, including for
operational monitoring, until water is transferred to the aircraft operator. The primary
116
emphasis of monitoring is as a verication of management processes. Monitoring of

control measures includes:

hydrants, hoses and bowsers for cleanliness and repair;
disinfectant residuals and pH;
backow preventers;
lters; and
microbial quality of water, particularly after maintenance or repairs.
6.7.4 Management
Even if potable water is supplied to the airport, it is necessary to introduce precau-
tions to prevent contamination during the transfer of water to the aircraft and in the
aircraft drinking-water system itself. Staff employed in drinking-water supply must
not be engaged in activities related to aircraft toilet servicing without rst taking all
necessary precautions (e.g., thorough handwashing, change of outer garments).
All water servicing vehicles must be cleansed and disinfected frequently.
Supporting programmes that should be documented as part of a WSP for airports
include:
suitable training for crews dealing with water transfer and treatment; and
effective certication of materials used on aircraft for storage tanks and pipes.
6.7.5 Surveillance
Independent surveillance resembles that described in chapter 5 and is an essential
element in ensuring drinking-water safety in aviation. This implies:
periodic audit and direct assessment;

review and approval of WSPs;
specic attention to the aircraft industrys codes of practice, the supporting doc-
ument Guide to Hygiene and Sanitation in Aviation (section 1.3) and airport
health or airline regulations; and
responding, investigating and providing advice on receipt of report on signi-
cant incidents.
6.8 Ships
6.8.1 Health risks
The importance of water as a vehicle for infectious disease transmission on ships has
been clearly documented. In general terms, the greatest microbial risks are associated
with ingestion of water that is contaminated with human and animal excreta. Water-
borne transmission of the enterotoxigenic E. coli, Norovirus, Vibrio spp., Salmonella
typhi, Salmonella spp. (non-typhi), Shigella spp., Cryptosporidium spp., Giardia
lamblia and Legionella spp. on ships has been conrmed (see Rooney et al., in press).
117
Chemical water poisoning can also occur on ships. For example, one outbreak of
acute chemical poisoning implicated hydroquinone, an ingredient of photo developer,
as the disease-causing agent in the ships potable water supply. Chronic chemical
poisoning on a ship could also occur if crew or passengers were exposed to small doses
of harmful chemicals over long periods of time.
The supporting document Guide to Ship Sanitation (section 1.3) describes the
factors that can be encountered during water treatment, transfer, production, storage
or distribution in ships. This revised Guide includes description of specic features
of the organization of the supply and the regulatory framework.
The organization of water supply systems covering shore facilities and ships differs
considerably from conventional water transfer on land. Even though a port authority
may receive potable water from a municipal or private supply, it usually has special
arrangements for managing the water after it has entered the port. Water is delivered
to ships by hoses or transferred to the ship via water boats or barges. Transfer of
water from shore to ships can provide possibilities for microbial or chemical
contamination.
In contrast to a shore facility, plumbing aboard ships consists of numerous piping
systems, carrying potable water, seawater, sewage and fuel, tted into a relatively con-
ned space. Piping systems are normally extensive and complex, making them dif-
cult to inspect, repair and maintain. A number of waterborne outbreaks on ships have
been caused by contamination of potable water after it had been loaded onto the ship
for example, by sewage or bilge when the water storage systems were not adequately
designed and constructed. During distribution, it may be difcult to prevent water
quality deterioration due to stagnant water and dead ends.
Water distribution on ships may also provide greater opportunities for contami-
nation to occur than onshore, because ship movement increases the possibility of
surge and backow.
6.8.2 System risk assessment

In undertaking an assessment of the ships drinking-water system, a range of specic
issues must be taken into consideration, including:
water loading equipment;
water loading techniques;
design and construction of storage tanks and pipes;
ltration systems and other treatment systems on board the ship;
backow prevention;
pressure of water within the system;
system design to minimize dead ends and areas of stagnation; and
residual disinfection.
118

The ships master is responsible for operational monitoring. The primary emphasis
of monitoring is as a verication of management processes. Monitoring of control
measures includes:
hydrants and hoses for cleanliness and repair;
disinfectant residuals and pH (e.g., daily);
backow prevention devices (e.g., monthly to yearly);
lters (before and during each use); and
microbial quality of treated water, particularly after maintenance or repairs.
The frequency of monitoring should reect the probable rate of change in water
quality. For example, monitoring of drinking-water on ships may be more frequent
when the ship is new or recently commissioned, with frequencies decreasing in the
light of review of results. Similarly, if the ships water system has been out of control,
monitoring following restoration of the system would be more frequent until it is
veried that the system is clearly under control.
6.8.4 Management
The port authority has responsibility for providing safe potable water for loading onto
vessels. The ships master will not normally have direct control of pollution of water
supplied at port. If water is suspected to have come from an unsafe source, the ships
master may have to decide if any additional treatment (e.g., hyperchlorination and/or
ltration) is necessary. When treatment on board or prior to boarding is necessary,
the treatment selected should be that which is best suited to the water and which is
most easily operated and maintained by the ships ofcers and crew.
During transfer from shore to ship and on board, water must be provided with
sanitary safeguards through the shore distribution system, including connections to
the ship system, and throughout the ship system, to prevent contamination of the
water.
Potable water should be stored in one or more tanks that are constructed, located
and protected so as to be safe against contamination. Potable water lines should be
protected and located so that they will not be submerged in bilge water or pass
through tanks storing non-potable liquids.
The ships master should ensure that crew and passengers receive a sufcient and
uninterrupted drinking-water supply and that contamination is not introduced in the
distribution system. The distribution systems on ships are especially vulnerable to
contamination when the pressure falls. Backow prevention devices should be
installed to prevent contamination of water where loss of pressure could result in
backow.
The potable water distribution lines should not be cross-connected with the piping
or storage tanks of any non-potable water system.
119
Water safety is secured through repair and maintenance protocols, including the
ability to contain potential contamination by valving and the cleanliness of person-
nel, their working practices and the materials employed.
Current practice on many ships is to use disinfectant residuals to control the growth
of microorganisms in the distribution system. Residual disinfection alone should not
be relied on to treat contaminated water, since the disinfection can be readily over-
whelmed by contamination.
Supporting programmes that should be documented as part of the WSP for ships
include:
suitable training for crew dealing with water transfer and treatment; and
effective certication of materials used on ships for storage tanks and pipes.
6.8.5 Surveillance
Independent surveillance is a desirable element in ensuring drinking-water safety on
ships. This implies:
periodic audit and direct assessment;
review and approval of WSPs;
specic attention to the shipping industrys codes of practice, the supporting
document Guide to Ship Sanitation (section 1.3) and port health or shipping
regulations; and
responding, investigating and providing advice on receipt of report on signi-
cant incidents.
120
7
Microbial aspects
T he greatest risk from microbes in water is associated with consumption of

drinking-water that is contaminated with human and animal excreta, although
other sources and routes of exposure may also be signicant.
This chapter focuses on organisms for which there is evidence, from outbreak
studies or from prospective studies in non-outbreak situations, of disease being caused
by ingestion of drinking-water, inhalation of droplets or contact with drinking-water;
and their control.
7.1 Microbial hazards associated with drinking-water

Infectious diseases caused by pathogenic bacteria, viruses and parasites (e.g., proto-
zoa and helminths) are the most common and widespread health risk associated
with drinking-water. The public health burden is determined by the severity of the
illness(es) associated with pathogens, their infectivity and the population exposed.
Breakdown in water supply safety may lead to large-scale contamination and
potentially to detectable disease outbreaks. Other breakdowns and low-level, poten-
tially repeated contamination may lead to signicant sporadic disease, but is unlikely
to be associated with the drinking-water source by public health surveillance.
Quantied risk assessment can assist in understanding and managing risks, espe-
cially those associated with sporadic disease.
7.1.1 Waterborne infections

The pathogens that may be transmitted through contaminated drinking-water are
diverse. Table 7.1 and Figure 7.1 provide general information on pathogens that are
of relevance for drinking-water supply management. The spectrum changes in
response to variables such as increases in human and animal populations, escalating
use of wastewater, changes in lifestyles and medical interventions, population move-
ment and travel and selective pressures for new pathogens and mutants or recombi-
nations of existing pathogens. The immunity of individuals also varies considerably,
whether acquired by contact with a pathogen or inuenced by such factors as age, sex,
state of health and living conditions.
121
Table 7.1 Waterborne pathogens and their signicance in water supplies

Persistence Resistance Important
Health in water to Relative animal
Pathogen signicance suppliesa chlorineb infectivityc source
Bacteria
Burkholderia pseudomallei Low May multiply Low Low No
Campylobacter jejuni, C. coli High Moderate Low Moderate Yes
Escherichia coli Pathogenicd High Moderate Low Low Yes
E. coli Enterohaemorrhagic High Moderate Low High Yes
Legionella spp. High Multiply Low Moderate No
Non-tuberculous mycobacteria Low Multiply High Low No
Pseudomonas aeruginosae Moderate May multiply Moderate Low No
Salmonella typhi High Moderate Low Low No
Other salmonellae High May multiply Low Low Yes
Shigella spp. High Short Low Moderate No
Vibrio cholerae High Short Low Low No
Yersinia enterocolitica High Long Low Low Yes
Viruses
Adenoviruses High Long Moderate High No
Enteroviruses High Long Moderate High No
Hepatitis A High Long Moderate High No
Hepatitis E High Long Moderate High Potentially
Noroviruses and Sapoviruses High Long Moderate High Potentially
Rotavirus High Long Moderate High No
Protozoa No
Acanthamoeba spp. High Long High High No
Cryptosporidium parvum High Long High High Yes
Cyclospora cayetanensis High Long High High No
Entamoeba histolytica High Moderate High High No
Giardia intestinalis High Moderate High High Yes
Naegleria fowleri High May multiplyf High High No
Toxoplasma gondii High Long High High Yes
Helminths
Dracunculus medinensis High Moderate Moderate High No
Schistosoma spp. High Short Moderate High Yes
Note: Waterborne transmission of the pathogens listed has been conrmed by epidemiological studies and case his-
tories. Part of the demonstration of pathogenicity involves reproducing the disease in suitable hosts. Experimental
studies in which volunteers are exposed to known numbers of pathogens provide relative information. As most studies
are done with healthy adult volunteers, such data are applicable to only a part of the exposed population, and extrap-
olation to more sensitive groups is an issue that remains to be studied in more detail.
a
Detection period for infective stage in water at 20 C: short, up to 1 week; moderate, 1 week to 1 month; long, over
1 month.
b
When the infective stage is freely suspended in water treated at conventional doses and contact times. Resistance
moderate, agent may not be completely destroyed.
c
From experiments with human volunteers or from epidemiological evidence.
d
Includes enteropathogenic, enterotoxigenic and enteroinvasive.
e
Main route of infection is by skin contact, but can infect immunosuppressed or cancer patients orally.
f
In warm water.
For pathogens transmitted by the faecaloral route, drinking-water is only one

vehicle of transmission. Contamination of food, hands, utensils and clothing can also
play a role, particularly when domestic sanitation and hygiene are poor. Improvements
in the quality and availability of water, in excreta disposal and in general hygiene are
all important in reducing faecaloral disease transmission.
122
7. MICROBIAL ASPECTS
Figure 7.1 Transmission pathways for and examples of water-related pathogens
Drinking-water safety is not related

only to faecal contamination. Some Infectious diseases caused by pathogenic
bacteria, viruses, protozoa and helminths
organisms grow in piped water distribu- are the most common and widespread
tion systems (e.g., Legionella), whereas health risk associated with drinking-water.
others occur in source waters (guinea
worm Dracunculus medinensis) and may
cause outbreaks and individual cases. Some other microbes (e.g., toxic cyanobacteria)
require specic management approaches, which are covered elsewhere in these Guide-
lines (see section 11.5).
Certain serious illnesses result from inhalation of water droplets (aerosols) in
which the causative organisms have multiplied because of warm temperatures and the
presence of nutrients. These include legionellosis and Legionnaires disease, caused by
Legionella spp., and those caused by the amoebae Naegleria fowleri (primary amoebic
meningoencephalitis [PAM]) and Acanthamoeba spp. (amoebic meningitis, pul-
monary infections).
Schistosomiasis (bilharziasis) is a major parasitic disease of tropical and subtropi-
cal regions that is transmitted when the larval stage (cercariae), which is released by
infected aquatic snails, penetrates the skin. It is primarily spread by contact with water.
Ready availability of safe drinking-water contributes to disease prevention by reduc-
ing the need for contact with contaminated water resources for example, when col-
lecting water to carry to the home or when using water for bathing or laundry.
123
It is conceivable that unsafe drinking-water contaminated with soil or faeces could

act as a carrier of other parasitic infections, such as balantidiasis (Balantidium coli)
and certain helminths (species of Fasciola, Fasciolopsis, Echinococcus, Spirometra,
Ascaris, Trichuris, Toxocara, Necator, Ancylostoma, Strongyloides and Taenia solium).
However, in most of these, the normal mode of transmission is ingestion of the eggs
in food contaminated with faeces or faecally contaminated soil (in the case of Taenia
solium, ingestion of the larval cysticercus stage in uncooked pork) rather than inges-
tion of contaminated drinking-water.
Other pathogens that may be naturally present in the environment may be able to
cause disease in people with impaired local or general immune defence mechanisms,
such as the elderly or the very young, patients with burns or extensive wounds, those
undergoing immunosuppressive therapy or those with acquired immunodeciency
syndrome (AIDS). If water used by such persons for drinking or bathing contains suf-
cient numbers of these organisms, they can produce various infections of the skin
and the mucous membranes of the eye, ear, nose and throat. Examples of such agents
are Pseudomonas aeruginosa and species of Flavobacterium, Acinetobacter, Klebsiella,
Serratia, Aeromonas and certain slow-growing (non-tuberculous) mycobacteria (see
the supporting document Pathogenic Mycobacteria in Water; section 1.3).
Most of the human pathogens listed in Table 7.1 (which are described in more
detail in chapter 11) are distributed worldwide; some, however, such as those causing
outbreaks of cholera or guinea worm disease, are regional. Eradication of D.
medinensis is a recognized target of the World Health Assembly (1991).
It is likely that there are pathogens not shown in Table 7.1 that are also trans-
mitted by water. This is because the number of known pathogens for which water is
a transmission route continues to increase as new or previously unrecognized
pathogens continue to be discovered (see WHO, 2003a).
7.1.2 Persistence and growth in water

While typical waterborne pathogens are able to persist in drinking-water, most do not
grow or proliferate in water. Microorganisms like E. coli and Campylobacter can accu-
mulate in sediments and are mobilized when water ow increases.
After leaving the body of their host, most pathogens gradually lose viability and
the ability to infect. The rate of decay is usually exponential, and a pathogen will
become undetectable after a certain period. Pathogens with low persistence must
rapidly nd new hosts and are more likely to be spread by person-to-person contact
or poor personal hygiene than by drinking-water. Persistence is affected by several
factors, of which temperature is the most important. Decay is usually faster at higher
temperatures and may be mediated by the lethal effects of UV radiation in sunlight
acting near the water surface.
The most common waterborne pathogens and parasites are those that have high
infectivity and either can proliferate in water or possess high resistance to decay
outside the body.
124
Viruses and the resting stages of parasites (cysts, oocysts, ova) are unable to mul-
tiply in water. Conversely, relatively high amounts of biodegradable organic carbon,
together with warm temperatures and low residual concentrations of chlorine, can
permit growth of Legionella, V. cholerae, Naegleria fowleri, Acanthamoeba and
nuisance organisms in some surface waters and during water distribution (see also
the supporting document Heterotrophic Plate Counts and Drinking-water Safety;
section 1.3).
Microbial water quality may vary rapidly and widely. Short-term peaks in pathogen
concentration may increase disease risks considerably and may also trigger outbreaks
of waterborne disease. Results of water quality testing for microbes are not normally
available in time to inform management action and prevent the supply of unsafe
water.
7.1.3 Public health aspects

Outbreaks of waterborne disease may affect large numbers of persons, and the rst
priority in developing and applying controls on drinking-water quality should be the
control of such outbreaks. Available evidence also suggests that drinking-water can
contribute to background rates of disease in non-outbreak situations, and control of
drinking-water quality should therefore also address waterborne disease in the general
community.
Experience has shown that systems for the detection of waterborne disease out-
breaks are typically inefcient in countries at all levels of socioeconomic development,
and failure to detect outbreaks is not a guarantee that they do not occur; nor does it
suggest that drinking-water should necessarily be considered safe.
Some of the pathogens that are known to be transmitted through contaminated
drinking-water lead to severe and sometimes life-threatening disease. Examples
include typhoid, cholera, infectious hepatitis (caused by hepatitis A virus [HAV] or
HEV) and disease caused by Shigella spp. and E. coli O157. Others are typically
associated with less severe outcomes, such as self-limiting diarrhoeal disease (e.g.,
Norovirus, Cryptosporidium).
The effects of exposure to pathogens are not the same for all individuals or, as a
consequence, for all populations. Repeated exposure to a pathogen may be associated
with a lower probability or severity of illness because of the effects of acquired immu-
nity. For some pathogens (e.g., HAV), immunity is lifelong, whereas for others (e.g.,
Campylobacter), the protective effects may be restricted to a few months to years. On
the other hand, sensitive subgroups (e.g., the young, the elderly, pregnant women and
the immunocompromised) in the population may have a greater probability of illness
or the illness may be more severe, including mortality. Not all pathogens have greater
effects in all sensitive subgroups.
Not all infected individuals will develop symptomatic disease. The proportion of
the infected population that is asymptomatic (including carriers) differs between
pathogens and also depends on population characteristics, such as prevalence of
125
immunity. Carriers and those with asymptomatic infections as well as individuals

developing symptoms may all contribute to secondary spread of pathogens.
7.2 Health-based target setting

7.2.1 Health-based targets applied to microbial hazards
General approaches to health-based target setting are described in section 2.1.1 and
chapter 3.
Sources of information on health risks may be from both epidemiology and risk
assessment, and typically both are employed as complementary sources.
Health-based targets may also be set using a health outcome approach, where the
waterborne disease burden is believed to be sufciently high to allow measurement
of the impact of interventions i.e., to measure reductions in disease that can be
attributed to drinking-water.
Risk assessment is especially valuable where the fraction of disease that can be
attributed to drinking-water is low or difcult to measure directly through public
health surveillance or analytical epidemiological studies.
Data from both epidemiology and risk assessment with which to develop
health-based targets for many pathogens are limited, but are increasingly being
produced. Locally generated data will always be of great value in setting national
targets.
For the control of microbial hazards, the most frequent form of health-based target
applied is performance targets (see section 3.2.2), which are anchored to a tolerable
burden of disease. WQTs (see section 3.2.3) are typically not developed for pathogens,
because monitoring nished water for pathogens is not considered a feasible or cost-
effective option.
7.2.2 Risk assessment approach

In many circumstances, estimating the effects of improved drinking-water quality on
health risks in the population is possible through constructing and applying risk
assessment models.
QMRA is a rapidly evolving eld that systematically combines available informa-
tion on exposure and doseresponse to produce estimates of the disease burden
associated with exposure to pathogens. Mathematical modelling is used to estimate
the effects of low doses of pathogens in drinking-water on populations and
subpopulations.
Interpreting and applying information from analytical epidemiological studies to
derive health-based targets for application at a national or local level require con-
sideration of a number of factors, including the following:
Are specic estimates of disease reduction or indicative ranges of expected reduc-
tions to be provided?
How representative of the target population was the study sample in order to ensure
condence in the reliability of the results across a wider group?
126
To what extent will minor differences in demographic or socioeconomic conditions

affect expected outcomes?
Risk assessment commences with problem formulation to identify all possible hazards
and their pathways from source(s) to recipient(s). Human exposure to the pathogens
(environmental concentrations and volumes ingested) and doseresponses of these
selected organisms are then combined to characterize the risks. With the use of
additional information (social, cultural, political, economic, environmental, etc.),
management options can be prioritized. To encourage stakeholder support and par-
ticipation, a transparent procedure and active risk communication at each stage of the
process are important. An example of a risk assessment approach is described in Table
7.2 and outlined below.
Problem formulation and hazard identication

All potential hazards, sources and events that can lead to the presence of these hazards
(i.e., what can happen and how) should be identied and documented for each com-
ponent of the drinking-water system, regardless of whether or not the component is
under the direct control of the drinking-water supplier. This includes point sources
of pollution (e.g., human and industrial waste discharge) as well as diffuse sources
(e.g., those arising from agricultural and animal husbandry activities). Continuous,
intermittent or seasonal pollution patterns should also be considered, as well as
extreme and infrequent events, such as droughts and oods.
The broader sense of hazards focuses on hazardous scenarios, which are events that
may lead to exposure of consumers to specic pathogenic microorganisms. In this,
the hazardous event (e.g., peak contamination of source water with domestic waste-
water) may be referred to as the hazard.
Representative organisms are selected that, if controlled, would ensure control of
all pathogens of concern. Typically, this implies inclusion of at least one bacterial
pathogen, virus and protozoan.
Table 7.2 Risk assessment paradigm for pathogen health risks

Step Aim
1. Problem formulation To identify all possible hazards associated with drinking-water that
and hazard would have an adverse public health consequence, as well as their
identication pathways from source(s) to consumer(s)
2. Exposure assessment To determine the size and nature of the population exposed and the
route, amount and duration of the exposure
3. Doseresponse To characterize the relationship between exposure and the incidence of
assessment the health effect
4. Risk characterization To integrate the information from exposure, doseresponse and health
interventions in order to estimate the magnitude of the public health
problem and to evaluate variability and uncertainty
Source: Adapted from Haas et al. (1999).
127
Exposure assessment
Exposure assessment involves estimation of the number of pathogenic microbes to
which an individual is exposed, principally through ingestion. Exposure assessment
is a predictive activity that often involves subjective judgement. It inevitably contains
uncertainty and must account for variability of factors such as concentrations of
microorganisms over time, volumes ingested, etc.
Exposure can be considered as a single dose of pathogens that a consumer ingests
at a certain point of time or the total amount over several exposures (e.g., over a year).
Exposure is determined by the concentration of microbes in drinking-water and the
volume of water consumed.
It is rarely possible or appropriate to directly measure pathogens in drinking-water
on a regular basis. More often, concentrations in source waters are assumed or meas-
ured, and estimated reductions for example, through treatment are applied to esti-
mate the concentration in the water consumed. Pathogen measurement, when
performed, is generally best carried out at the location where the pathogens are at
highest concentration (generally source waters). Estimation of their removal by
sequential control measures is generally achieved by the use of surrogates (such as E.
coli for enteric bacterial pathogens).
The other component of exposure assessment, which is common to all pathogens,
is the volume of unboiled water consumed by the population, including person-to-
person variation in consumption behaviour and especially consumption behaviour of
at-risk groups. For microbial hazards, it is important that the unboiled volume of
drinking-water, both consumed directly and used in food preparation, is used in the
risk assessment, as heating will rapidly inactivate pathogens. This amount is lower
than that used for deriving chemical guideline values and WQTs.
The daily exposure of a consumer can be assessed by multiplying the concentra-
tion of pathogens in drinking-water by the volume of drinking-water consumed. For
the purposes of the Guidelines, unboiled drinking-water consumption is assumed to
be 1 litre of water per day.
Doseresponse assessment
The probability of an adverse health effect following exposure to one or more path-
ogenic organisms is derived from a doseresponse model. Available doseresponse
data have been obtained mainly from studies using healthy adult volunteers. Several
subgroups in the population, such as children, the elderly and immunocompromised
persons, are more sensitive to infectious disease; currently, however, adequate data are
lacking to account for this.
The conceptual basis for the infection model is the observation that exposure to
the described dose leads to the probability of infection as a conditional event. For
infection to occur, one or more viable pathogens must have been ingested. Further-
more, one or more of these ingested pathogens must have survived in the hosts body.
An important concept is the single-hit principle (i.e., that even a single organism may
128
be able to cause infection and disease, possibly with a low probability). This concept
supersedes the concept of (minimum) infectious dose that is frequently used in older
literature (see the supporting document Hazard Characterization for Pathogens in Food
and Water; section 1.3).
In general, well dispersed pathogens in water are considered to be Poisson distrib-
uted. When the individual probability of any organism to survive and start infection
is the same, the doseresponse relation simplies to an exponential function. If,
however, there is heterogeneity in this individual probability, this leads to the beta-
Poisson doseresponse relation, where the beta stands for the distribution of the
individual probabilities among pathogens (and hosts). At low exposures, such as
would typically occur in drinking-water, the doseresponse model is approximately
linear and can be represented simply as the probability of infection resulting from
exposure to a single organism (see the supporting document Hazard Characterization
for Pathogens in Food and Water; section 1.3).
Risk characterization
Risk characterization brings together the data collected on pathogen exposure,
doseresponse, severity and disease burden.
The probability of infection can be estimated as the product of the exposure by
drinking-water and the probability that exposure to one organism would result in
infection. The probability of infection per day is multiplied by 365 to calculate the
probability of infection per year. In doing so, it is assumed that different exposure
events are independent, in that no protective immunity is built up. This simplica-
tion is justied for low risks only.
Not all infected individuals will develop clinical illness; asymptomatic infection is
common for most pathogens. The percentage of infected persons that will develop
clinical illness depends on the pathogen, but also on other factors, such as the immune
status of the host. Risk of illness per year is obtained by multiplying the probability
of infection by the probability of illness given infection.
The low numbers in Table 7.3 can be interpreted to represent the probability that
a single individual will develop illness in a given year. For example, a risk of illness
for Campylobacter of 2.5 10-4 per year indicates that, on average, 1 out of 4000 con-
sumers would contract campylobacteriosis from drinking-water.
To translate the risk of developing a specic illness to disease burden per case, the
metric DALYs is used. This should reect not only the effects of acute end-points (e.g.,
diarrhoeal illness) but also mortality and the effects of more serious end-points (e.g.,
Guillain-Barr syndrome associated with Campylobacter). Disease burden per case
varies widely. For example, the disease burden per 1000 cases of rotavirus diarrhoea
is 480 DALYs in low-income regions, where child mortality frequently occurs.
However, it is only 14 DALYs per 1000 cases in high-income regions, where hospital
facilities are accessible to the great majority of the population (see the supporting
document Quantifying Public Health Risk in the WHO Guidelines for Drinking-water
129
Table 7.3 Linking tolerable disease burden and source water quality for reference pathogens:
example calculation
River water (human
and animal pollution) Cryptosporidium Campylobacter Rotavirusa
Raw water quality (CR) Organisms per litre 10 100 10
Treatment effect Percent reduction 99.994% 99.99987% 99.99968%
needed to reach
tolerable risk (PT)
Drinking-water Organisms per litre 6.3 10-4 1.3 10-4 3.2 10-5
quality (CD)
Consumption of Litres per day 1 1 1
unheated
drinking-water (V)
Exposure by Organisms per day 6.3 10-4 1.3 10-4 3.2 10-5
drinking-water (E)
Doseresponse (r) Probability of 4.0 10-3 1.8 10-2 2.7 10-1
infection per
organism
Risk of infection (Pinf,d) Per day 2.5 10-6 2.3 10-6 8.5 10-6
Risk of infection (Pinf,y) Per year 9.2 10-4 8.3 10-4 3.1 10-3
Risk of (diarrhoeal) 0.7 0.3 0.5
illness given infection
(Pill|inf)
Risk of (diarrhoeal) Per year 6.4 10-4 2.5 10-4 1.6 10-3
illness (Pill)
Disease burden (db) DALYs per case 1.5 10-3 4.6 10-3 1.4 10-2
Susceptible fraction Percentage of 100% 100% 6%
(fs) population
Disease burden (DB) DALYs per year 1 10-6 1 10-6 1 10-6
Formulas: CD = CR (1 - PT)
E = CD V
Pinf,d = E r
a
Data from high-income regions. In low-income regions, severity is typically higher, but drinking-water transmission
is unlikely to dominate.
Quality; section 1.3). This considerable difference in disease burden results in far
stricter treatment requirements in low-income regions for the same source water
quality in order to obtain the same risk (expressed as DALYs per year). Ideally, the
default disease burden estimates in Table 7.3 should be adapted to specic national
situations. In Table 7.3, no accounting is made for effects on immunocompromised
persons (e.g., cryptosporidiosis in HIV/AIDS patients), which is signicant in some
countries. Section 3.3.3 gives more information on the DALY metric and how it is
applied to derive a reference level of risk.
Only a proportion of the population may be susceptible to some pathogens,
because immunity developed after an initial episode of infection or illness may
provide lifelong protection. Examples include HAV and rotaviruses. It is estimated
that in developing countries, all children above the age of 5 years are immune to
rotaviruses because of repeated exposure in the rst years of life. This translates to an
130
average of 17% of the population being susceptible to rotavirus illness. In developed

countries, rotavirus infection is also common in the rst years of life, and the illness
is diagnosed mainly in young children, but the percentage of young children as part
of the total population is lower. This translates to an average of 6% of the population
in developed countries being susceptible.
The uncertainty of the risk estimate is the result of the uncertainty and variability
of the data collected in the various steps of the risk assessment. Risk assessment
models should ideally account for this variability and uncertainty, although here we
present only point estimates (see below).
It is important to choose the most appropriate point estimate for each of the vari-
ables. Theoretical considerations show that risks are directly proportional to the
arithmetic mean of the ingested dose. Hence, arithmetic means of variables such as
concentration in raw water, removal by treatment and consumption of drinking-water
are recommended. This recommendation is different from the usual practice among
microbiologists and engineers of converting concentrations and treatment effects to
log-values and making calculations or specications on the log-scale. Such calcula-
tions result in estimates of the geometric mean rather than the arithmetic mean, and
these may signicantly underestimate risk. Analysing site-specic data may therefore
require going back to the raw data rather than relying on reported log-transformed
values.
7.2.3 Risk-based performance target setting

The process outlined above enables estimation of risk on a population level, taking
account of source water quality and impact of control. This can be compared with
the reference level of risk (see section 3.3.2) or a locally developed tolerable risk. The
calculations enable quantication of the degree of source protection or treatment that
is needed to achieve a specied level of acceptable risk and analysis of the estimated
impact of changes in control measures.
Performance targets are most frequently applied to treatment performance i.e.,
to determine the microbial reduction necessary to ensure water safety. A performance
target may be applied to a specic system (i.e., allow account to be taken of specic
source water characteristics) or generalized (e.g., impose source water quality assump-
tions on all systems of a certain type or abstracting water from a certain type of
source).
Figure 7.2 illustrates the targets for treatment performance for a range of pathogens
occurring in the raw water. For example, 10 microorganisms per litre of source water
will lead to a performance target of 4.2 logs (or 99.994%) for Cryptosporidium or of
5.5 logs (99.99968%) for rotavirus in high-income regions (see also Table 7.4 below).
The difference in performance targets for rotavirus in high- and low-income coun-
tries (5.5 and 7.6 logs; Figure 7.2) is related to the difference in disease severity by this
organism. In low-income countries, the child case fatality rate is relatively high, and,
as a consequence, the disease burden is higher. Also, a larger proportion of the
131
Figure 7.2 Performance targets for selected bacterial, viral and protozoan pathogens
in relation to raw water quality (to achieve 10-6 DALYs per person per year)
Table 7.4 Health-based targets derived from example calculation in Table 7.3
Cryptosporidium Campylobacter Rotavirusa
Organisms per litre in 10 100 10
source water
Health outcome target 10-6 DALYs per 10-6 DALYs per 10-6 DALYs per
person per year person per year person per year
Risk of diarrhoeal illnessb 1 per 1600 per year 1 per 4000 per year 1 per 11 000 per year
Drinking-water quality 1 per 1600 litres 1 per 8000 litres 1 per 32 000 litres
Performance targetc 4.2 log10 units 5.9 log10 units 5.5 log10 units
a
Data from high-income regions. In low-income regions, severity is typically higher, but drinking-water transmission
is unlikely to dominate.
b
For the susceptible population.
c
Performance target is a measure of log reduction of pathogens based on source water quality.
population in low-income countries is under the age of 5 and at risk for rotavirus
infection.
The derivation of these performance targets is described in Table 7.4, which pro-
vides an example of the data and calculations that would normally be used to con-
struct a risk assessment model for waterborne pathogens. The table presents data for
representatives of the three major groups of pathogens (bacteria, viruses and proto-
zoa) from a range of sources. These example calculations aim at achieving the refer-
ence level of risk of 10-6 DALYs per person per year, as described in section 3.3.3. The
132
data in the table illustrate the calculations needed to arrive at a risk estimate and are
not guideline values.
7.2.4 Presenting the outcome of performance target development

Table 7.4 presents some data from Table 7.3 in a format that is more meaningful to
risk managers. The average concentration of pathogens in drinking-water is included
for information. It is not a WQT, nor is it intended to encourage pathogen monitor-
ing in nished water. As an example, a concentration of 6.3 10-4 Cryptosporidium
per litre (see Table 7.3) corresponds to 1 oocyst per 1600 litres (see Table 7.4). The
performance target (in the row Treatment effect in Table 7.3), expressed as a percent
reduction, is the most important management information in the risk assessment
table. It can also be expressed as a log-reduction value. For example, 99.99968% reduc-
tion for rotavirus corresponds to 5.5 log10 units.
7.2.5 Issues in adapting risk-based performance target setting to

national/local circumstances
The choice of pathogens in Table 7.4 was based mainly on availability of data on resist-
ance to water treatment, infectivity and disease burden. The pathogens illustrated may
not be priority pathogens in all regions of the world, although amending pathogen
selection would normally have a small impact on the overall conclusions derived from
applying the model.
Wherever possible, country- or site-specic information should be used in assess-
ments of this type. If no specic data are available, an approximate risk estimate can
be based on default values (see Table 7.5 below).
Table 7.4 accounts only for changes in water quality derived from treatment and
not source protection measures, which are often important contributors to overall
safety, impacting on pathogen concentration and/or variability. The risk estimates pre-
sented in Table 7.3 also assume that there is no degradation of water quality in the
distribution network. These may not be realistic assumptions under all circumstances,
and it is advisable to take these factors into account wherever possible.
Table 7.4 presents point estimates only and does not account for variability and
uncertainty. Full risk assessment models would incorporate such factors by repre-
senting the input variables by statistical distributions rather than by point estimates.
However, such models are currently beyond the means of many countries, and data
to dene such distributions are scarce. Producing such data may involve considerable
efforts in terms of time and resources, but will lead to much improved insight into
the actual source water quality and treatment performance.
The necessary degree of treatment also depends on the values assumed for vari-
ables (e.g., drinking-water consumption, fraction of the population that is suscepti-
ble) that can be taken into account in the risk assessment model. Figure 7.3 shows the
effect of variation in the consumption of unboiled drinking-water on the perform-
ance targets for Cryptosporidium parvum. For example, if the raw water concentration
133
Cryptosporidium parvum
7
2 litres
1 litre
6
0.25 litre
target (log10 reduction)
3
Performance
2
f
0
0.001 0.01 0.1 1 10 100 1000
Raw water quality (organisms per litre)
Figure 7.3 Performance targets for Cryptosporidium parvum in relation to the daily
consumption of unboiled drinking-water (to achieve 10-6 DALYs per person
per year)
is 1 oocyst per litre, the performance target varies between 2.6 and 3.5 log10 units if
consumption values vary between 0.25 and 2 litres per day. Some outbreak data
suggest that in developed countries, a signicant proportion of the population above
5 years of age may not be immune to rotavirus illness. Figure 7.4 shows the effect of
variation in the susceptible fraction of the population. For example, if the raw water
concentration is 10 virus particles per litre, the performance target increases from 5.5
to 6.7 if the susceptible fraction increases from 6 to 100%.
7.2.6 Health outcome targets

Health outcome targets that identify disease reductions in a community may be
applied to the WSPs developed for specied water quality interventions at commu-
nity and household levels. These targets would identify expected disease reductions
in communities receiving the interventions.
The prioritization of water quality interventions should focus on those aspects that
are estimated to contribute more than e.g. 5% of the burden of a given disease (e.g.,
5% of total diarrhoea). In many parts of the world, the implementation of a water
quality intervention that results in an estimated health gain of more than 5% would
134
Rotavirus, high-income countries

9
100% susceptible
8 20% susceptible
6% susceptible
7
target (log10 reduction)
4
Performance
3
f
0
0.001 0.01 0.1 1 10 100 1000
Raw water quality (organisms per litre)
Figure 7.4 Performance targets for rotavirus in relation to the fraction of the population that is
susceptible to illness (to achieve 10-6 DALYs per person per year)
be considered extremely worthwhile. Directly demonstrating the health gains arising

from improving water quality as assessed, for example, by reduced E. coli counts at
the point of consumption may be possible where disease burden is high and effec-
tive interventions are applied and can be a powerful tool to demonstrate a rst step
in incremental water safety improvement.
Where a specied quantied disease reduction is identied as a health outcome
target, it may be advisable to undertake ongoing proactive public health surveillance
among representative communities rather than through passive surveillance.
7.3 Occurrence and treatment of pathogens

As discussed in section 4.1, system assessment involves determining whether the
drinking-water supply chain as a whole can deliver drinking-water quality that meets
identied targets. This requires an understanding of the quality of source water and
the efcacy of control measures.
An understanding of pathogen occurrence in source waters is essential, because it
facilitates selection of the highest-quality source for drinking-water supply, deter-
mines pathogen loads and concentrations in source waters and provides a basis for
establishing treatment requirements to meet health-based targets within a WSP.
135
Understanding the efcacy of control measures includes validation (see sections

2.1.2 and 4.1.7). Validation is important both in ensuring that treatment will achieve
the desired goals (performance targets) and in assessing areas in which efcacy may
be improved (e.g., by comparing performance achieved with that shown to be achiev-
able through well run processes).
7.3.1 Occurrence
The occurrence of pathogens and indicator organisms in groundwater and surface
water sources depends on a number of factors, including intrinsic physical and chem-
ical characteristics of the catchment area and the magnitude and range of human
activities and animal sources that release pathogens to the environment.
In surface waters, potential pathogen sources include point sources, such as munic-
ipal sewerage and urban stormwater overows, as well as non-point sources, such as
contaminated runoff from agricultural areas and areas with sanitation through on-
site septic systems and latrines. Other sources are wildlife and direct access of live-
stock to surface water bodies. Many pathogens in surface water bodies will reduce
in concentration due to dilution, settling and die-off due to environmental effects
(thermal, sunlight, predation, etc.).
Groundwater is often less vulnerable to the immediate inuence of contamination
sources due to the barrier effects provided by the overlying soil and its unsaturated
zone. Groundwater contamination is more frequent where these protective barriers
are breached, allowing direct contamination. This may occur through contaminated
or abandoned wells or underground pollution sources, such as latrines and sewer
lines. However, a number of studies have demonstrated pathogens and indicator
organisms in groundwater, even at depth in the absence of such hazardous circum-
stances, especially where surface contamination is intense, as with land application of
manures or other faecal impacts from intensive animal husbandry (e.g., feedlots).
Impacts of these contamination sources can be greatly reduced by, for example,
aquifer protection measures and proper well design and construction.
For more detailed discussion on both pathogen sources and key factors determin-
ing their fate, refer to the supporting documents Protecting Surface Waters for Health
and Protecting Groundwaters for Health (section 1.3).
Table 7.5 presents estimates of high concentrations of enteric pathogens and micro-
bial indicators in different types of surface waters and groundwaters, derived primarily
from a review of published data. High values have been presented because they repre-
sent higher-risk situations and, therefore, greater degrees of vulnerability. The table
includes two categories of data for rivers and streams: one for impacted sources and
one for less impacted sources. More detailed information about these data is published
in a variety of references, including several papers cited in Dangendorf et al. (2003).
The data in Table 7.5 provide a useful guide to the concentrations of enteric
pathogens and indicator microorganisms in a variety of sources. However, there are
a number of limitations and sources of uncertainty in these data, including:
136
Table 7.5 Examples of high detectable concentrations (per litre) of enteric pathogens and
faecal indicators in different types of source waters from the scientic literature
Pathogen or Lakes and Impacted rivers Wilderness rivers
indicator group reservoirs and streams and streams Groundwater
Campylobacter 20500 902500 01100 010
Salmonella 358 000 14
(31000)a
E. coli (generic) 10 0001 000 000 30 0001 000 000 600030 000 01000
Viruses 110 3060 03 02
Cryptosporidium 4290 2480 2240 01
Giardia 230 1470 12 01
a
Lower range is a more recent measurement.
the lack of knowledge on sampling locations in relation to pollution sources;

concerns about the sensitivity of analytical techniques, particularly for viruses
and protozoa; and
the lack of knowledge about the viability and human infectivity of Cryp-
tosporidium oocysts, Giardia cysts and viruses detected in the different studies,
because the various methods used are based upon non-culture methods (e.g.,
microscopy or molecular/nucleic acid analysis).
While the table provides an indication of concentrations that might be present in
water sources, by far the most accurate way of determining pathogen loads and con-
centrations in specic catchments and other water sources is by analysing water
quality over a period of time, taking care to include consideration of seasonal varia-
tion and peak events such as storms. Direct measurement of pathogens and indica-
tors in the specic source waters for which a WSP and its target pathogens are being
established is recommended wherever possible, because this provides the best esti-
mates of microbial concentrations and loads.
7.3.2 Treatment
Waters of very high quality for example, groundwater from conned aquifers may
rely on source water and distribution system protection as the principal control meas-
ures for provision of safe water. More typically, water treatment is required to remove
or destroy pathogenic microorganisms. In many cases (e.g., poor-quality surface
water), multiple treatment stages are required, including, for example, coagulation,
occulation, sedimentation, ltration and disinfection. Table 7.6 provides a summary
of treatment processes that are commonly used individually or in combination to
achieve microbial reductions.
The microbial reductions presented in Table 7.6 are for broad groups or categories
of microbes: bacteria, viruses and protozoa. This is because it is generally the case that
treatment efcacy for microbial reduction differs among these microbial groups due
to the inherently different properties of the microbes (e.g., size, nature of protective
outer layers, physicochemical surface properties, etc.). Within these microbial groups,
137
Table 7.6 Reductions of bacteria, viruses and protozoa achieved by typical and enhanced
water treatment processes
Enteric
Treatment pathogen
process group Baseline removal Maximum removal possible
Pretreatment
Roughing lters Bacteria 50% Up to 95% if protected from
turbidity spikes by dynamic
lter or if used only when
ripened
Viruses No data available
Protozoa No data available, some removal Performance for protozoan
likely removal likely to correspond
to turbidity removal
Microstraining Bacteria, Zero Generally ineffective
viruses,
protozoa
Off-stream/ All Recontamination may be Avoiding intake at periods of
bankside signicant and add to pollution peak turbidity equivalent to
storage levels in incoming water; growth 90% removal;
of algae may cause deterioration compartmentalized storages
in quality provide 15230 times rates
of removal
Bacteria Zero (assumes short circuiting) 90% removal in 1040 days
actual detention time
Viruses Zero (assumes short circuiting) 93% removal in 100 days
Protozoa Zero (assumes short circuiting) 99% removal in 3 weeks
Bankside Bacteria 99.9% after 2 m
inltration 99.99% after 4 m (minimum
based on virus removal)
Viruses 99.9% after 2 m
99.99% after 4 m
Protozoa 99.99%
Coagulation/occulation/sedimentation
Conventional Bacteria 30% 90% (depending on the
clarication coagulant, pH, temperature,
alkalinity, turbidity)
Viruses 30% 70% (as above)
Protozoa 30% 90% (as above)
High-rate Bacteria At least 30%
clarication Viruses At least 30%
Protozoa 95% 99.99% (depending on use of
appropriate blanket polymer)
Dissolved air Bacteria No data available
otation Viruses No data available
Protozoa 95% 99.9% (depending on pH,
coagulant dose, occulation
time, recycle ratio)
138
Table 7.6 Continued

Enteric
Treatment pathogen
Lime softening Bacteria 20% at pH 9.5 for 6 h at 28 C 99% at pH 11.5 for 6 h at 28 C
Viruses 90% at pH < 11 for 6 h 99.99% at pH > 11, depending
on the virus and on settling
time
Protozoa Low inactivation 99% through precipitative
sedimentation and
inactivation at pH 11.5
Ion exchange
Bacteria Zero
Viruses Zero
Protozoa Zero
Filtration
Granular Bacteria No data available 99% under optimum
high-rate coagulation conditions
ltration Viruses No data available 99.9% under optimum
coagulation conditions
Protozoa 70% 99.9% under optimum
coagulation conditions
Slow sand Bacteria 50% 99.5% under optimum
ltration ripening, cleaning and
relling and in the absence of
short circuiting
Viruses 20% 99.99% under optimum
ripening, cleaning and
relling and in the absence of
short circuiting
Protozoa 50% 99% under optimum ripening,
cleaning and relling and in
the absence of short circuiting
Precoat Bacteria 3050% 9699.9% using chemical
ltration, pretreatment with coagulants
polymers
diatomaceous Viruses 90% 98% using chemical
earth and pretreatment with coagulants
perlite or polymers
Protozoa 99.9% 99.99%, depending on media
grade and ltration rate
Membrane Bacteria 99.999.99%, providing
ltration adequate pretreatment and
microltration membrane integrity conserved
Viruses <90%
Protozoa 99.999.99%, providing
adequate pretreatment and
membrane integrity conserved
Membrane Bacteria Complete removal, providing
ltration adequate pretreatment and
ultraltration, membrane integrity conserved
continued
139
Table 7.6 Continued

Enteric
Treatment pathogen
nanoltration Viruses Complete removal with
and reverse nanolters, with reverse osmosis
osmosis and at lower pore sizes of
ultralters, providing adequate
pretreatment and membrane
integrity conserved
Protozoa Complete removal, providing
adequate pretreatment and
membrane integrity conserved
Disinfection
Chlorine Bacteria Ct99: 0.08 mgmin/litre at 12 C,
pH 7; 3.3 mgmin/litre at 12 C,
pH 8.5
Viruses Ct99: 12 mgmin/litre at 05 C;
8 mgmin/litre at 10 C; both at
pH 77.5
Protozoa Giardia
Ct99: 230 mgmin/litre at 0.5 C;
100 mgmin/litre at 10 C;
41 mgmin/litre at 25 C; all at pH
77.5
Cryptosporidium not killed
Monochloramine Bacteria Ct99: 94 mgmin/litre at 12 C,
pH 7; 278 mgmin/litre at 12 C,
pH 8.5
Viruses Ct99: 1240 mgmin/litre at 1 C;
430 mgmin/litre at 15 C; both
at pH 69
Protozoa Giardia
Ct99: 2550 mgmin/litre at 1 C;
1000 mgmin/litre at 15 C; both
at pH 69
Cryptosporidium not inactivated
Chlorine dioxide Bacteria Ct99: 0.13 mgmin/litre at 12 C,
pH 7; 0.19 mgmin/litre at
12 C, pH 8.5
Viruses Ct99: 8.4 mgmin/litre at 1 C;
2.8 mgmin/litre at 15 C; both
at pH 69
Protozoa Giardia
15 mgmin/litre at 10 C;
7.3 mgmin/litre at 25 C; all at pH
69
Cryptosporidium
Ct99: 40 mgmin/litre at 22 C,
pH 8
140
Table 7.6 Continued

Enteric
Treatment pathogen
Ozone Bacteria Ct99: 0.02 mgmin/litre at 5 C,
pH 67
Viruses Ct99: 0.9 mgmin/litre at 1 C,
0.3 mgmin/litre at 15 C
Protozoa Giardia
Ct99: 1.9 mgmin/litre at 1 C;
0.63 mgmin/litre at 15 C, pH
69
Cryptosporidium
4.4 mgmin/litre at 22 C
UV irradiation Bacteria 99% inactivation: 7 mJ/cm2
Viruses 99% inactivation: 59 mJ/cm2
Protozoa Giardia
99% inactivation: 5 mJ/cm2
Cryptosporidium
99.9% inactivation: 10 mJ/cm2
Note: Ct and UV apply to microorganisms in suspension, not embedded in particles or in biolm.
differences in treatment process efciencies are smaller among the specic species,
types or strains of microbes. Such differences do occur, however, and the table pres-
ents conservative estimates of microbial reductions based on the more resistant or
persistent pathogenic members of that microbial group. Where differences in removal
by treatment between specic members of a microbial group are great, the results for
the individual microbes are presented separately in the table.
Non-piped water supplies such as roof catchments (rainwater harvesting) and
water collected from wells or springs may often be contaminated with pathogens. Such
sources often require treatment and protected storage to achieve safe water. Many of
the processes used for water treatment in households are the same as those used for
community-managed and other piped water supplies (Table 7.6). The performance
of these treatment processes at the household level is likely to be similar to that for
baseline removal of microbes, as shown in Table 7.6. However, there are additional
water treatment technologies recommended for use in non-piped water supplies at
the household level that typically are not used for piped supplies.
Further information about these water treatment processes, their operations and
their performance for pathogen reduction is provided in more detail in supporting
documents (for piped water supplies: Water Treatment and Pathogen Control; for
non-piped [primarily household] water supplies: Managing Water in the Home; see
section 1.3).
141
7.4 Verication of microbial safety and quality

Pathogenic agents have several properties that distinguish them from other drinking-
water contaminants:
Pathogens are discrete and not in solution.

Pathogens are often clumped or adherent to suspended solids in water.
The likelihood of a successful challenge by a pathogen, resulting in infection,
depends upon the invasiveness and virulence of the pathogen, as well as upon the
immunity of the individual.
If infection is established, pathogens multiply in their host. Certain pathogenic bac-
teria are also able to multiply in food or beverages, thereby perpetuating or even
increasing the chances of infection.
Unlike many chemical agents, the doseresponse of pathogens is not cumulative.
Faecal indicator bacteria, including E. coli, are important parameters for verication
of microbial quality (see also section 2.2.1). Such water quality verication comple-
ments operational monitoring and assessments of contamination risks for instance,
through auditing of treatment works, evaluation of process control and sanitary
inspection.
Faecal indicator bacteria should full certain criteria to give meaningful results.
They should be universally present in high numbers in the faeces of humans and other
warm-blooded animals, should be readily detectable by simple methods and should
not grow in natural water.
The indicator organism of choice for faecal pollution is E. coli. Thermotolerant
coliforms can be used as an alternative to the test for E. coli in many circumstances.
Water intended for human consumption should contain no indicator organisms.
In the majority of cases, monitoring for indicator bacteria provides a high degree of
safety because of their large numbers in polluted waters.
Pathogens more resistant to conventional environmental conditions or treatment
technologies may be present in treated drinking-water in the absence of E. coli. Ret-
rospective studies of waterborne disease outbreaks and advances in the understand-
ing of the behaviour of pathogens in water have shown that continued reliance on
assumptions surrounding the absence or presence of E. coli does not ensure that
optimal decisions are made regarding water safety.
Protozoa and some enteroviruses are more resistant to many disinfectants, includ-
ing chlorine, and may remain viable (and pathogenic) in drinking-water following
disinfection. Other organisms may be more appropriate indicators of persistent
microbial hazards, and their selection as additional indicators should be evaluated in
relation to local circumstances and scientic understanding. Therefore, verication
may require analysis of a range of organisms, such as intestinal enterococci, (spores
of) Clostridium perfringens and bacteriophages.
Table 7.7 presents guideline values for verication of microbial quality of
drinking-water. Individual values should not be used directly from the tables. The
142
Table 7.7 Guideline values for verication of microbial qualitya (see also table 5.2)
Organisms Guideline value
All water directly intended for drinking
E. coli or thermotolerant coliform bacteriab,c Must not be detectable in any 100-ml sample
Treated water entering the distribution system
E. coli or thermotolerant coliform bacteriab Must not be detectable in any 100-ml sample
Treated water in the distribution system
E. coli or thermotolerant coliform bacteriab Must not be detectable in any 100-ml sample
a
Immediate investigative action must be taken if E. coli are detected.
b
Although E. coli is the more precise indicator of faecal pollution, the count of thermotolerant coliform bacteria is an
acceptable alternative. If necessary, proper conrmatory tests must be carried out. Total coliform bacteria are not
acceptable indicators of the sanitary quality of water supplies, particularly in tropical areas, where many bacteria of
no sanitary signicance occur in almost all untreated supplies.
c
It is recognized that in the great majority of rural water supplies, especially in developing countries, faecal con-
tamination is widespread. Especially under these conditions, medium-term targets for the progressive improvement
of water supplies should be set.
guidelines values should be used and interpreted in conjunction with the information
contained in these Guidelines and other supporting documentation.
A consequence of variable susceptibility to pathogens is that exposure to drinking-
water of a particular quality may lead to different health effects in different popula-
tions. For guideline derivation, it is necessary to dene reference populations or, in
some cases, to focus on specic sensitive subgroups. National or local authorities may
wish to apply specic characteristics of their populations in deriving national
standards.
7.5 Methods of detection of faecal indicator bacteria

Analysis for faecal indicator bacteria provides a sensitive, although not the most rapid,
indication of pollution of drinking-water supplies. Because the growth medium and
the conditions of incubation, as well as the nature and age of the water sample, can
inuence the species isolated and the count, microbiological examinations may have
variable accuracy. This means that the standardization of methods and of laboratory
procedures is of great importance if criteria for the microbial quality of water are to
be uniform in different laboratories and internationally.
International standard methods should be evaluated under local circumstances
before being adopted. Established standard methods are available, such as those of the
ISO (Table 7.8) or methods of equivalent efcacy and reliability. It is desirable that
established standard methods be used for routine examinations. Whatever method
is chosen for detection of E. coli or thermotolerant coliforms, the importance of
resuscitating or recovering environmentally damaged or disinfectant-damaged
strains must be considered.
143
Table 7.8 International Organization for Standardization (ISO) standards for detection and
enumeration of faecal indicator bacteria in water
ISO standard Title (water quality)
6461-1:1986 Detection and enumeration of the spores of sulte-reducing anaerobes (clostridia)
Part 1: Method by enrichment in a liquid medium
6461-2:1986 Detection and enumeration of the spores of sulte-reducing anaerobes (clostridia)
Part 2: Method by membrane ltration
7704:1985 Evaluation of membrane lters used for microbiological analyses
7899-1:1984 Detection and enumeration of faecal streptococci Part 1: Method by
enrichment in a liquid medium
7899-2:1984 Detection and enumeration of faecal streptococci Part 2: Method by membrane
ltration
9308-1:1990 Detection and enumeration of coliform organisms, thermotolerant coliform
organisms and presumptive Escherichia coli Part 1: Membrane ltration method
9308-2:1990 Detection and enumeration of coliform organisms, thermotolerant coliform
organisms and presumptive Escherichia coli Part 2: Multiple tube (most
probable number) method
144
8
Chemical aspects
M ost chemicals arising in drinking-water are of health concern only after

extended exposure of years, rather than months. The principal exception is
nitrate. Typically, changes in water quality occur progressively, except for those
substances that are discharged or leach intermittently to owing surface waters or
groundwater supplies from, for example, contaminated landll sites.
In some cases, there are groups of chemicals that arise from related sources for
example, the DBPs and it may not be necessary to set standards for all of the sub-
stances for which there are guideline values. If chlorination is practised, the THMs,
of which chloroform is the major component, are likely to be the main DBPs, together
with the chlorinated acetic acids in some instances. In some cases, control of chloro-
form levels and, where appropriate, trichloroacetic acid levels will also provide an
adequate measure of control over other chlorination by-products.
Several of the inorganic elements for which guideline values have been recom-
mended are recognized to be essential elements in human nutrition. No attempt has
been made here at this time to dene a minimum desirable concentration of such
substances in drinking-water.
Fact sheets for individual chemical contaminants are provided in chapter 12.
For those contaminants for which a guideline value has been established, the fact
sheets include a brief toxicological overview of the chemical, the basis for guideline
derivation, treatment achievability and analytical limit of detection. More detailed
chemical reviews are available (http://www.who.int/water_sanitation_health/dwq/
guidelines/en/).
8.1 Chemical hazards in drinking-water

A number of chemical contaminants have been shown to cause adverse health effects
in humans as a consequence of prolonged exposure through drinking-water. However,
this is only a very small proportion of the chemicals that may reach drinking-water
from various sources.
The substances considered here have been assessed for possible health effects, and
guideline values have been proposed only on the basis of health concerns. Additional
145
consideration of the potential effects of

chemical contaminants on the accept- The lists of chemicals addressed in these
Guidelines do not imply that all of these
ability of drinking-water to consumers is chemicals will always be present or that
included in chapter 10. Some substances other chemicals not addressed will be
of health concern have effects on the absent.
acceptability of drinking-water that
would normally lead to rejection of the water at concentrations signicantly lower than
those of health concern. For such substances, health-based guideline values are needed,
for instance, for use in interpreting data collected in response to consumer complaints.
In section 2.3.2, it is indicated that In developing national drinking-water stan-
dards based on these Guidelines, it will be necessary to take account of a variety of
environmental, social, cultural, economic, dietary and other conditions affecting
potential exposure. This may lead to
national standards that differ apprecia-
bly from these Guidelines. This is It is important that chemical contami-
particularly applicable to chemical con- nants be prioritized so that the most
important are considered for inclusion in
taminants, for which there is a long list, national standards and monitoring pro-
and setting standards for, or including, grammes.
all of them in monitoring programmes
is neither feasible nor desirable.
The probability that any particular chemical may occur in signicant concentra-
tions in any particular setting must be assessed on a case-by-case basis. The presence
of certain chemicals may already be known within a particular country, but others
may be more difcult to assess.
In most countries, whether developing or industrialized, water sector profession-
als are likely to be aware of a number of chemicals that are present in signicant con-
centrations in drinking-water supplies. A body of local knowledge that has been built
up by practical experience over a period of time is invaluable. Hence, the presence
of a limited number of chemical contaminants in drinking-water is usually already
known in many countries and in many local systems. Signicant problems, even crises,
can occur, however, when chemicals posing high health risk are widespread but their
presence is unknown because their long-term health effect is caused by chronic expo-
sure as opposed to acute exposure. Such has been the case of arsenic in groundwater
in Bangladesh and West Bengal, for example.
For some contaminants, there will be exposure from sources other than drinking-
water, and this may need to be taken into account when setting standards and con-
sidering the need for standards. It may also be important when considering the need
for monitoring. In some cases, drinking-water will be a minor source of exposure, and
controlling levels in water will have little impact on overall exposure. In other cases,
controlling a contaminant in water may be the most cost-effective way of reducing
exposure. Drinking-water monitoring strategies, therefore, should not be considered
in isolation from other potential routes of exposure to chemicals in the environment.
146
8. CHEMICAL ASPECTS
Table 8.1 Categorization of source of chemical constituents

Source of chemical constituents Examples of sources
Naturally occurring Rocks, soils and the effects of the geological setting
and climate
Industrial sources and human dwellings Mining (extractive industries) and manufacturing and
processing industries, sewage, solid wastes, urban
runoff, fuel leakages
Agricultural activities Manures, fertilizers, intensive animal practices and
pesticides
Water treatment or materials in contact with Coagulants, DBPs, piping materials
drinking-water
Pesticides used in water for public health Larvicides used in the control of insect vectors of
disease
Cyanobacteria Eutrophic lakes
The scientic basis for each of the guideline values is summarized in chapter 12.
This information is important in helping to modify guideline values to suit national
requirements or in assessing the signicance for health of concentrations of a con-
taminant that are greater than the guideline value.
Chemical contaminants in drinking-water may be categorized in various ways;
however, the most appropriate is to consider the primary source of the contaminant
i.e., to group chemicals according to where control may be effectively exercised. This
aids in the development of approaches that are designed to prevent or minimize con-
tamination, rather than those that rely primarily on the measurement of contaminant
levels in nal waters.
In general, approaches to the management of chemical hazards in drinking-water
vary between those where the source water is a signicant contributor (with control
effected, for example, through source water selection, pollution control, treatment or
blending) and those from materials and chemicals used in the production and distri-
bution of drinking-water (controlled by process optimization or product specica-
tion). In these Guidelines, chemicals are therefore divided into six major source
groups, as shown in Table 8.1.
Categories may not always be clear-cut. The group of naturally occurring contami-
nants, for example, includes many inorganic chemicals that are found in drinking-water
as a consequence of release from rocks and soils by rainfall, some of which may become
problematical where there is environmental disturbance, such as in mining areas.
8.2 Derivation of chemical guideline values

The criteria used to decide whether a guideline value is established for a particular
chemical constituent are as follows:
there is credible evidence of occurrence of the chemical in drinking-water, com-
bined with evidence of actual or potential toxicity; or
147
the chemical is of signicant international concern; or

the chemical is being considered for inclusion or is included in the WHO
Pesticide Evaluation Scheme (WHOPES) programme (approval programme for
direct application of pesticides to drinking-water for control of insect vectors of
disease).
Guideline values are derived for many chemical constituents of drinking-water. A

guideline value normally represents the concentration of a constituent that does not
result in any signicant risk to health over a lifetime of consumption. A number of
provisional guideline values have been established at concentrations that are reason-
ably achievable through practical treatment approaches or in analytical laboratories;
in these cases, the guideline value is above the concentration that would normally
represent the calculated health-based value. Guideline values are also designated as
provisional when there is a high degree of uncertainty in the toxicology and health
data (see also section 8.2.6).
There are two principal sources of information on health effects resulting from
exposure to chemicals that can be used in deriving guideline values. The rst and pre-
ferred source is studies on human populations. However, the value of such studies for
many substances is limited, owing to lack of quantitative information on the concen-
tration to which people have been exposed or on simultaneous exposure to other
agents. However, for some substances, such studies are the primary basis on which
guideline values are developed. The second and most frequently used source of infor-
mation is toxicity studies using laboratory animals. The limitations of toxicology
studies include the relatively small number of animals used and the relatively high
doses administered, which create uncertainty as to the relevance of particular nd-
ings to human health. This is because there is a need to extrapolate the results from
animals to humans and to the low doses to which human populations are usually
exposed. In most cases, the study used to derive the guideline value is supported by a
range of other studies, including human data, and these are also considered in carry-
ing out a health risk assessment.
In order to derive a guideline value to protect human health, it is necessary to select
the most suitable study or studies. Data from well conducted studies, where a clear
doseresponse relationship has been demonstrated, are preferred. Expert judgement
was exercised in the selection of the most appropriate study from the range of infor-
mation available.
8.2.1 Approaches taken

Two approaches to the derivation of guideline values are used: one for threshold chem-
icals and the other for non-threshold chemicals (mostly genotoxic carcinogens).
It is generally considered that the initiating event in the process of genotoxic chem-
ical carcinogenesis is the induction of a mutation in the genetic material (DNA) of
somatic cells (i.e., cells other than ova or sperm) and that there is a theoretical risk at
148
8. CHEMICAL ASPECTS
any level of exposure (i.e., no threshold). On the other hand, there are carcinogens
that are capable of producing tumours in animals or humans without exerting a geno-
toxic activity, but acting through an indirect mechanism. It is generally believed that
a demonstrable threshold dose exists for non-genotoxic carcinogens.
In deriving guideline values for carcinogens, consideration was given to the
potential mechanism(s) by which the substance may cause cancer, in order to decide
whether a threshold or non-threshold approach should be used (see sections 8.2.2 and
8.2.4).
The evaluation of the potential carcinogenicity of chemical substances is usually
based on long-term animal studies. Sometimes data are available on carcinogenicity
in humans, mostly from occupational exposure.
On the basis of the available evidence, the International Agency for Research on
Cancer (IARC) categorizes chemical substances with respect to their potential car-
cinogenic risk into the following groups:
Group 1: the agent is carcinogenic to humans

Group 2A: the agent is probably carcinogenic to humans
Group 2B: the agent is possibly carcinogenic to humans
Group 3: the agent is not classiable as to its carcinogenicity to humans
Group 4: the agent is probably not carcinogenic to humans
According to IARC, these classications represent a rst step in carcinogenic risk

assessment, which leads to a second step of quantitative risk assessment where pos-
sible. In establishing guideline values for drinking-water, the IARC evaluation of
carcinogenic compounds, where available, is taken into consideration.
8.2.2 Threshold chemicals

For most kinds of toxicity, it is believed that there is a dose below which no adverse
effect will occur. For chemicals that give rise to such toxic effects, a tolerable daily
intake (TDI) should be derived as follows, using the most sensitive end-point in the
most relevant study, preferably involving administration in drinking-water:
TDI = (NOAEL or LOAEL ) UF
where:
NOAEL = no-observed-adverse-effect level

LOAEL = lowest-observed-adverse-effect level
UF = uncertainty factor
The guideline value (GV) is then derived from the TDI as follows:
GV = (TDI bw P) C
where:
149
bw = body weight (see Annex 3)

P = fraction of the TDI allocated to drinking-water
C = daily drinking-water consumption (see Annex 3)
Tolerable daily intake

The TDI is an estimate of the amount of a substance in food and drinking-water,
expressed on a body weight basis (mg/kg or mg/kg of body weight), that can be
ingested over a lifetime without appreciable health risk.
Acceptable daily intakes (ADIs) are established for food additives and pesticide
residues that occur in food for necessary technological purposes or plant protection
reasons. For chemical contaminants, which usually have no intended function in
drinking-water, the term tolerable daily intake is more appropriate than acceptable
daily intake, as it signies permissibility rather than acceptability.
Over many years, JECFA and JMPR have developed certain principles in the deri-
vation of ADIs. These principles have been adopted where appropriate in the deriva-
tion of TDIs used in developing guideline values for drinking-water quality.
As TDIs are regarded as representing a tolerable intake for a lifetime, they are not
so precise that they cannot be exceeded for short periods of time. Short-term expo-
sure to levels exceeding the TDI is not a cause for concern, provided the individuals
intake averaged over longer periods of time does not appreciably exceed the level set.
The large uncertainty factors generally involved in establishing a TDI (see below) serve
to provide assurance that exposure exceeding the TDI for short periods is unlikely to
have any deleterious effects upon health. However, consideration should be given to
any potential acute effects that may occur if the TDI is substantially exceeded for short
periods of time.
No-observed-adverse-effect level and lowest-observed-adverse-effect level

The NOAEL is dened as the highest dose or concentration of a chemical in a single
study, found by experiment or observation, that causes no detectable adverse health
effect. Wherever possible, the NOAEL is based on long-term studies, preferably of
ingestion in drinking-water. However, NOAELs obtained from short-term studies and
studies using other sources of exposure (e.g., food, air) may also be used.
If a NOAEL is not available, a LOAEL may be used, which is the lowest observed
dose or concentration of a substance at which there is a detectable adverse health
effect. When a LOAEL is used instead of a NOAEL, an additional uncertainty factor
is normally applied (see below).
Uncertainty factors
The application of uncertainty (or safety) factors has been widely used in the deriva-
tion of ADIs and TDIs for food additives, pesticides and environmental contaminants.
The derivation of these factors requires expert judgement and careful consideration
of the available scientic evidence.
150
8. CHEMICAL ASPECTS
Table 8.2 Source of uncertainty in derivation of guideline values

Source of uncertainty Factor
Interspecies variation (animals to humans) 110
Intraspecies variation (individual variations within species) 110
Adequacy of studies or database 110
Nature and severity of effect 110
In the derivation of guideline values, uncertainty factors are applied to the NOAEL
or LOAEL for the response considered to be the most biologically signicant.
In relation to exposure of the general population, the NOAEL for the critical effect
in animals is normally divided by an uncertainty factor of 100. This comprises two
10-fold factors, one for interspecies differences and one for interindividual variabil-
ity in humans (see Table 8.2). Extra uncertainty factors may be incorporated to allow
for database deciencies and for the severity and irreversibility of effects.
Factors lower than 10 were used, for example, for interspecies variation when
humans are known to be less sensitive than the animal species studied. Inadequate
studies or databases include those where a LOAEL was used instead of a NOAEL and
studies considered to be shorter in duration than desirable. Situations in which the
nature or severity of effect might warrant an additional uncertainty factor include
studies in which the end-point was malformation of a fetus or in which the end-point
determining the NOAEL was directly related to possible carcinogenicity. In the latter
case, an additional uncertainty factor was usually applied for carcinogenic compounds
for which the guideline value was derived using a TDI approach rather than a theo-
retical risk extrapolation approach.
For substances for which the uncertainty factors were greater than 1000, guideline
values are designated as provisional in order to emphasize the higher level of uncer-
tainty inherent in these values. A high uncertainty factor indicates that the guideline
value may be considerably lower than the concentration at which health effects would
actually occur in a real human population. Guideline values with high uncertainty are
more likely to be modied as new information becomes available.
The selection and application of uncertainty factors are important in the deriva-
tion of guideline values for chemicals, as they can make a considerable difference in
the values set. For contaminants for which there is sufcient condence in the data-
base, the guideline value was derived using a smaller uncertainty factor. For most
contaminants, however, there is greater scientic uncertainty, and a relatively large
uncertainty factor was used. The use of uncertainty factors enables the particular
attributes of the chemical and the data available to be considered in the derivation of
guideline values.
Allocation of intake
Drinking-water is not usually the sole source of human exposure to the substances
for which guideline values have been set. In many cases, the intake of chemical
151
contaminants from drinking-water is small in comparison with that from other

sources, such as food and air. Guideline values derived using the TDI approach take
into account exposures from all sources by apportioning a percentage of the TDI to
drinking-water. This approach ensures that total daily intake from all sources (includ-
ing drinking-water containing concentrations of the substance at or near the
guideline value) does not exceed the TDI.
Wherever possible, data concerning the proportion of total intake normally
ingested in drinking-water (based on mean levels in food, air and drinking-water) or
intakes estimated on the basis of consideration of physical and chemical properties
were used in the derivation of the guideline values. Where such information was not
available, an arbitrary (default) value of 10% for drinking-water was used. This default
value is, in most cases, sufcient to account for additional routes of intake (i.e., inhala-
tion and dermal absorption) of contaminants in water. In some cases, a specic dis-
cussion is made of the potential for exposure from intake through inhalation and
dermal uptake in bathing and showering where there is evidence that this is likely to
be signicant, usually in circumstances where the allocation of the TDI to drinking-
water is greater than 10%.
It is recognized that exposure from various media may vary with local circum-
stances. It should be emphasized, therefore, that the derived guideline values apply to
a typical exposure scenario or are based on default values that may or may not be
applicable for all areas. In those areas where relevant exposure data are available,
authorities are encouraged to develop context-specic guideline values that are tai-
lored to local circumstances and conditions. For example, in areas where the intake
of a particular contaminant in drinking-water is known to be much greater than that
from other sources (i.e., air and food), it may be appropriate to allocate a greater pro-
portion of the TDI to drinking-water to derive a guideline value more suited to the
local conditions. In addition, in cases in which guideline values are exceeded, efforts
should be made to assess the contribution of other sources to total intake in order to
interpret the health signicance of the exceedance and to orient remedial measures to
sources of exposure that are most relevant.
Signicant gures
The calculated TDI is used to derive the guideline value, which is then rounded to
one signicant gure. In some instances, ADI values with only one signicant gure
set by JECFA or JMPR were used to calculate the guideline value. The guideline value
was generally rounded to one signicant gure to reect the uncertainty in animal
toxicity data and exposure assumptions made.
8.2.3 Alternative approaches

Alternative approaches being considered in the derivation of TDIs for threshold effects
include the benchmark dose (BMD) (IPCS, 1994), categorical regression (IPCS, 1994)
and chemical-specic adjustment factors (CSAF) (IPCS, 2001).
152
8. CHEMICAL ASPECTS
Benchmark dose1
The benchmark dose (BMD) is the lower condence limit of the dose that produces
a small increase in the level of adverse effects (e.g., 5% or 10%; Crump, 1984) to which
uncertainty factors can be applied to develop a tolerable intake.
The BMD has a number of advantages over the NOAEL:
It is derived on the basis of data from the entire doseresponse curve for the
critical effect rather than from the single dose group at the NOAEL (i.e., one of
the few preselected dose levels).
Use of the BMD facilitates the use and comparison of studies on the same agent
or the potencies of different agents.
The BMD can be calculated from data sets in which a NOAEL was not determined,
eliminating the need for an additional uncertainty factor to be applied to the LOAEL.
Denition of the BMD as a lower condence limit accounts for the statistical power
and quality of the data. That is, the condence intervals around the doseresponse
curve for studies with small numbers of animals and, therefore, lower statistical
power would be wide; similarly, condence intervals in studies of poor quality with
highly variable responses would also be wide. In either case, the wider condence
interval would lead to a lower BMD, reecting the greater uncertainty of the data-
base. On the other hand, narrow condence limits (reecting better studies) would
result in higher BMDs.
Categorical regression2
The theory and application of categorical regression have been addressed by Hertzberg
& Miller (1985), Hertzberg (1989), Guth et al. (1991) (inhalation exposure to
methylisocyanate) and Farland & Dourson (1992) (oral exposure to arsenic). Data on
toxicity are classied into one of several categories, such as no-observed-effect level
(NOEL) or NOAEL, or others, as appropriate. These categories are then regressed on
the basis of dose and, if required, duration of exposure. The result is a graph of prob-
ability of a given category of effect with dose or concentration, which is useful in the
analysis of potential risks above the tolerable intake, especially for comparisons among
chemicals.
Depending on the extent of the available data on toxicity, additional estimations
regarding the percentage of individuals with specic adverse effects are possible. Such
estimations require, however, an understanding of the mechanisms of toxicity of the
critical effect, knowledge of the extrapolation between the experimental animal and
humans and/or knowledge of the incidence of specic effects in humans.
Similar to the BMD, categorical regression utilizes information from the entire
doseresponse curve, resulting in more precise estimates of risk when compared
with the current approach (NOAEL-based tolerable intakes). However, categorical
1
This section has been taken from IPCS (1994).
2
This section has been taken from IPCS (1994).
153
regression requires more information than the current tolerable intake method, and
the interpretation of the probability scale can be problematic.
Chemical-specic adjustment factors

Approaches to the derivation of TDIs are increasingly being based on understanding
of a chemicals mode of action in order to reduce reliance on empirical mathemati-
cal modelling and to eliminate the need to determine whether a threshold or non-
threshold approach is more appropriate. This approach provides a departure from
the use of default uncertainty factors and relies on the use of quantitative toxicoki-
netic and toxicodynamic data and chemical-specic adjustment factors (CSAFs)
(IPCS, 2001) to assess interspecies and interindividual extrapolations in dose/
concentrationresponse assessment. Previously, CSAFs were called data-derived
uncertainty factors (Renwick, 1993; IPCS, 1994). The part of the CSAF approach that
is at present best developed is the use of physiologically based pharmacokinetic
models to replace the default values for extrapolation between species and between
routes of exposure.
8.2.4 Non-threshold chemicals

In the case of compounds considered to be genotoxic carcinogens, guideline values
were normally determined using a mathematical model. Although several models
exist, the linearized multistage model was generally adopted. Other models were con-
sidered more appropriate in a few cases. Guideline values presented are the concen-
trations in drinking-water associated with an estimated upper-bound excess lifetime
cancer risk of 10-5 (or one additional cancer per 100 000 of the population ingesting
drinking-water containing the substance at the guideline value for 70 years).
The guideline values for carcinogenic substances have been computed from hypo-
thetical mathematical models that cannot be veried experimentally. These models
do not usually take into account a number of biologically important considerations,
such as pharmacokinetics, DNA repair or protection by the immune system. They
also assume the validity of a linear extrapolation of very high dose exposures in test
animals to very low dose exposures in humans. As a consequence, the models used
are conservative (i.e., err on the side of caution). The guideline values derived using
these models should be interpreted differently from TDI-based values because of the
lack of precision of the models. At best, these values must be regarded as rough esti-
mates of cancer risk. Moderate short-term exposure to levels exceeding the guideline
value for carcinogens does not signicantly affect the risk.
8.2.5 Data quality

The following factors were taken into account in assessing the quality and reliability
of available information:
154
8. CHEMICAL ASPECTS
Oral studies are preferred (in particular, drinking-water studies), using the pure
substance with appropriate dosing regime and a good-quality pathology.
The database should be sufciently broad that all potential toxicological end-points
of concern have been identied.
The quality of the studies is such that they are considered reliable; for example,
there has been adequate consideration of confounding factors in epidemiological
studies.
There is reasonable consistency between studies; the end-point and study used to
derive a guideline value do not contradict the overall weight of evidence.
For inorganic substances, there is some consideration of speciation in drinking-
water.
There is appropriate consideration of multimedia exposure in the case of
epidemiological studies.
In the development of guideline values, existing international approaches were care-
fully considered. In particular, previous risk assessments developed by the Interna-
tional Programme on Chemical Safety (IPCS) in EHC monographs and CICADs,
IARC, JMPR and JECFA were reviewed. These assessments were relied upon except
where new information justied a reassessment, but the quality of new data was crit-
ically evaluated before it was used in any risk assessment. Where international reviews
were not available, other sources of data were used in the derivation of guideline
values, including published reports from peer-reviewed open literature, national
reviews recognized to be of high quality, information submitted by governments and
other interested parties and, to a limited extent, unpublished proprietary data (pri-
marily for the evaluation of pesticides). Future revisions and assessments of pesticides
will take place primarily through WHO/IPCS/JMPR/JECFA processes.
8.2.6 Provisional guideline values

The use and designation of provisional guideline values are outlined in Table 8.3.
For non-threshold substances, in cases in which the concentration associated with
an upper-bound excess lifetime cancer risk of 10-5 is not feasible as a result of inade-
Table 8.3 Use and designation of provisional guideline values

Situations where a provisional guideline applies Designation
Signicant scientic uncertainties regarding derivation of P
health-based guideline value
Calculated guideline value is below the practical A (Guideline value is set at the
quantication level achievable quantication level)
Calculated guideline value is below the level that can be T (Guideline value is set at the practical
achieved through practical treatment methods treatment limit)
Calculated guideline value is likely to be exceeded as a D (Guideline value is set on the basis of
result of disinfection procedures health, but disinfection of
drinking-water remains paramount)
155
quate analytical or treatment technology, a provisional guideline value (designated A

or T, respectively) is recommended at a practicable level.
8.2.7 Chemicals with effects on acceptability

Some substances of health concern have effects on the taste, odour or appearance of
drinking-water that would normally lead to rejection of water at concentrations sig-
nicantly lower than those of concern for health. Such substances are not normally
appropriate for routine monitoring. Nevertheless, health-based guideline values
may be needed for instance, for use in interpreting data collected in response to
consumer complaints. In these circumstances, a health-based summary statement
and guideline value are presented in the usual way. In the summary statement, the
relationship between concentrations relevant to health and those relevant to the
acceptability of the drinking-water is explained. In tables of guideline values, the
health-based guideline values are designated with a C.
8.2.8 Non-guideline chemicals

Additional information on many chemicals not included in these Guidelines is
available from several credible sources, including WHO EHCs and CICADs
(www.who.int/pcs/index), chemical risk assessment reports from JMPR, JECFA and
IARC, and published documents from a number of national sources, such as the US
EPA. Although these information sources may not have been reviewed for these
Guidelines, they have been peer reviewed and provide readily accessible information
on the toxicology of many additional chemicals. They can help drinking-water
suppliers and health ofcials decide upon the signicance (if any) of a detected
chemical and on the response that might be appropriate.
8.2.9 Mixtures
Chemical contaminants of drinking-water supplies are present with numerous other
inorganic and/or organic constituents. The guideline values are calculated separately
for individual substances, without specic consideration of the potential for interac-
tion of each substance with other compounds present. The large margin of uncer-
tainty incorporated in the majority of the guideline values is considered to be
sufcient to account for potential interactions. In addition, the majority of contami-
nants will not be continuously present at concentrations at or near their guideline
value.
For many chemical contaminants, mechanisms of toxicity are different; conse-
quently, there is no reason to assume that there are interactions. There may, however,
be occasions when a number of contaminants with similar toxicological mechanisms
are present at levels near their respective guideline values. In such cases, decisions con-
cerning appropriate action should be made, taking into consideration local circum-
stances. Unless there is evidence to the contrary, it is appropriate to assume that the
toxic effects of these compounds are additive.
156
8. CHEMICAL ASPECTS
8.3 Analytical aspects

As noted above, guideline values are not set at concentrations of substances that
cannot reasonably be measured. In such circumstances, provisional guideline values
are set at the reasonable analytical limits.
Guidance provided in this section is intended to assist readers to select appropri-
ate analytical methods for specic circumstances.
8.3.1 Analytical achievability

Various collections of standard or recommended methods for water analysis are
published by a number of national and international agencies. It is often thought that
adequate analytical accuracy can be achieved provided that all laboratories use the
same standard method. Experience shows that this is not always the case, as a variety
of factors may affect the accuracy of the results. Examples include reagent purity,
apparatus type and performance, degree of modication of the method in a particu-
lar laboratory and the skill and care of the analyst. These factors are likely to vary both
between the laboratories and over time in an individual laboratory. Moreover, the pre-
cision and accuracy that can be achieved with a particular method frequently depend
upon the adequacy of sampling and nature of the sample (matrix). While it is not
essential to use standard methods, it is important that the methods used are properly
validated and precision and accuracy determined before signicant decisions are made
based on the results. In the case of non-specic variables such as taste and odour,
colour and turbidity, the result is method specic, and this needs to be considered
when using the data to make comparisons.
A number of considerations are important in selecting methods:
The overriding consideration is that the method chosen is demonstrated to have

the required accuracy. Other factors, such as speed and convenience, should be con-
sidered only in selecting among methods that meet this primary criterion.
There are a number of markedly different procedures for measuring and report-
ing the errors to which all methods are subject. This complicates and prejudices
the effectiveness of method selection, and suggestions for standardizing such
procedures have been made. It is therefore desirable that details of all analytical
methods are published together with performance characteristics that can be inter-
preted unambiguously.
If the analytical results from one laboratory are to be compared with those from
others and/or with a numerical standard, it is obviously preferable for them not
to have any associated systematic error. In practice, this is not possible, but each
laboratory should select methods whose systematic errors have been thoroughly
evaluated and shown to be acceptably small.
A qualitative ranking of analytical methods based on their degree of technical com-
plexity is given in Table 8.4 for inorganic chemicals and in Table 8.5 for organic chem-
icals. These groups of chemicals are separated, as the analytical methods used differ
157
Table 8.4 Ranking of complexity of analytical methods for inorganic chemicals

Ranking Example of analytical methods
1 Volumetric method, colorimetric method
2 Electrode method
3 Ion chromatography
4 High-performance liquid chromatography (HPLC)
5 Flame atomic absorption spectrometry (FAAS)
6 Electrothermal atomic absorption spectrometry (EAAS)
7 Inductively coupled plasma (ICP)/atomic emission spectrometry (AES)
8 ICP/mass spectrometry (MS)
greatly. The higher the ranking, the more complex the process in terms of equipment
and/or operation. In general, higher rankings are also associated with higher total
costs. Analytical achievabilities of the chemical guideline values based on detection
limits are given in Tables 8.68.10.
There are many kinds of eld test kits that are used for compliance examinations
as well as operational monitoring of drinking-water quality. Although the eld test
kits are generally available at relatively low prices, their analytical accuracy is gener-
ally less than that of the methods shown in Tables 8.4 and 8.5. It is therefore neces-
sary to check the validity of the eld test kit before applying it.
Table 8.5 Ranking of complexity of analytical methods for

organic chemicals
Ranking Example of analytical methods
1 HPLC
2 Gas chromatography (GC)
3 GC/MS
4 Headspace GC/MS
5 Purge-and-trap GC
Purge-and-trap GC/MS
8.3.2 Analytical methods

In volumetric titration, chemicals are analysed by titration with a standardized titrant.
The titration end-point is identied by the development of colour resulting from the
reaction with an indicator, by the change of electrical potential or by the change of
pH value.
Colorimetric methods are based on measuring the intensity of colour of a coloured
target chemical or reaction product. The optical absorbance is measured using light
of a suitable wavelength. The concentration is determined by means of a calibration
curve obtained using known concentrations of the determinant. The UV method is
similar to this method except that UV light is used.
For ionic materials, the ion concentration can be measured using an ion-selective
electrode. The measured potential is proportional to the logarithm of the ion
concentration.
158
8. CHEMICAL ASPECTS
Table 8.6 Analytical achievability for inorganic chemicals for which guideline values have been
established, by source categorya
Field methods Laboratory methods
Col Absor IC FAAS EAAS ICP ICP/MS
Naturally occurring chemicals
Arsenic # +(H) +++++(H) ++(H) +++
Barium + +++ +++ +++
Boron ++ ++ +++
Chromium # + +++ +++ +++
Fluoride # + ++
Manganese + ++ ++ +++ +++ +++
Molybdenum + +++ +++
Selenium # # +++(H) ++(H) +
Uranium + +++
Chemicals from industrial sources and human dwellings
Cadmium # ++ ++ +++
Cyanide # + +
Mercury +
Chemicals from agricultural activities
Nitrate/nitrite +++ +++ #
Chemicals used in water treatment or materials in contact with drinking-water
Antimony # ++(H) ++(H) +++
Copper # +++ +++ +++ +++ +++
Lead # + + ++
Nickel + # + +++ ++
a
For denitions and notes to Table 8.6, see below Table 8.10.
Some organic compounds absorb UV light (wavelength 190380 nm) in propor-

tion to their concentration. UV absorption is useful for qualitative estimation of
organic substances, because a strong correlation may exist between UV absorption
and organic carbon content.
Atomic absorption spectrometry (AAS) is used for determination of metals. It is
based on the phenomenon that the atom in the ground state absorbs the light of wave-
lengths that are characteristic to each element when light is passed through the atoms
in the vapour state. Because this absorption of light depends on the concentration of
atoms in the vapour, the concentration of the target element in the water sample
is determined from the measured absorbance. The Beer-Lambert law describes the
relationship between concentration and absorbance.
In ame atomic absorption spectrometry (FAAS), a sample is aspirated into a ame
and atomized. A light beam from a hollow cathode lamp of the same element as the
target metal is radiated through the ame, and the amount of absorbed light is meas-
ured by the detector. This method is much more sensitive than other methods and
free from spectral or radiation interference by co-existing elements. Pretreatment is
either unnecessary or straightforward. However, it is not suitable for simultaneous
analysis of many elements, because the light source is different for each target element.
159
Table 8.7 Analytical achievability for organic chemicals from industrial sources and human dwellings for which guideline values have been
establisheda
GC/ GC/ GC/ GC/ PT- HPLC/
Col GC GC/PD GC/EC FID FPD TID MS GC/MS HPLC HPLC/FD UVPAD EAAS IC/FD
Benzene ++ + +++
Carbon tetrachloride + +
Di(2-ethylhexyl)phthalate ++
1,2-Dichlorobenzene +++ +++ +++
1,2-Dichloroethane +++ ++
1,1-Dichloroethene +++ + +++
1,2-Dichloroethene ++ ++ +++
160
Dichloromethane # + +++
Edetic acid (EDTA) +++
Ethylbenzene +++ +++ +++
Hexachlorobutadiene +
Nitrilotriacetic acid (NTA) +++
Pentachlorophenol ++ +++ +++
Styrene ++ + +++
Tetrachloroethene +++ + +++

Toluene +++ +++
Trichloroethene +++ + +++ +
Xylenes +++ +++
a
Table 8.8 Analytical achievability for organic chemicals from agricultural activities for which guideline values have been establisheda
GC/ GC/ GC/ GC/ PT- HPLC/
Col GC GC/PD GC/EC FID FPD TID MS GC/MS HPLC HPLC/FD UVPAD EAAS IC/FD
Alachlor +++
Aldicarb +
Aldrin and dieldrin +
Atrazine +++
Carbofuran ++ ++
Chlordane +
Chlorotoluron
Cyanazine ++ +
2,4-D ++ +++
2,4-DB ++ ++
1,2-Dibromo-3-chloropropane +++ ++
1,2-Dibromoethane + +
1,2-Dichloropropane +++ +++
1,3-Dichloropropene +++ +++
161
Dichlorprop (2,4-DP) +++
Dimethoate +++
Endrin + #
8. CHEMICAL ASPECTS
Fenoprop +
Isoproturon + +++
Lindane +
MCPA +++ +++ +++
Mecoprop ++ ++
Methoxychlor +++
Metolachlor +++
Molinate +++
Pendimethalin +++ ++ +++
Simazine + + +++
2,4,5-T + +++
Terbuthylazine (TBA) +++ ++
Triuralin +++ +++ +
a
Table 8.9 Analytical achievability for chemicals used in water treatment or from materials in contact with water for which guideline values have been
establisheda
GC/ GC/ GC/ PT- HPLC/
Col GC GC/PD GC/EC FID FPD TID GC/MS GC/MS HPLC HPLC/FD UVPAD EAAS IC
Disinfectants
Monochloramine +++
Chlorine +++ +++ +++
Disinfection by-products
Bromate +
Bromodichloromethane +++ +++
Bromoform +++ +++
Chloral hydrate + +
(trichloroacetaldehyde)
Chlorate
Chlorite
Chloroform +++ +++
Cyanogen chloride
162
Dibromoacetonitrile
Dibromochloromethane +++ +++
Dichloroacetate
Dichloroacetonitrile +++ +
Formaldehyde
Monochloroacetate ++ ++
Trichloroacetate
2,4,6-Trichlorophenol +++ +++

Trihalomethanesb +++ +++
Organic contaminants from treatment chemicals
Acrylamide + + +
Epichlorohydrin + + +
Organic contaminants from pipes and ttings
Benzo[a]pyrene ++ ++
Vinyl chloride + +
a
b
See also individual THMs.
Table 8.10 Analytical achievability for pesticides used in water for public health purposes for which guideline values have been establisheda
GC/ GC/ GC/ PT- HPLC/
Col GC GC/PD GC/EC FID FPD TID GC/MS GC/MS HPLC HPLC/FD UVPAD EAAS IC/FD
Chlorpyrifos +++ +++ + +++ +++
DDT (and metabolites) +++ +
Pyriproxyfen +++
a
For denitions and notes to Table 8.10, see below.
Denitions to Tables 8.68.10
Col Colorimetry
Absor Absorptiometry
GC Gas chromatography
GC/PD Gas chromatography photoionization detector
GC/EC Gas chromatography electron capture
GC/FID Gas chromatography ame ionization detector
GC/FPD Gas chromatography ame photodiode detector
GC/TID Gas chromatography thermal ionization detector
GC/MS Gas chromatography mass spectrometry
163
PT-GC/MS Purge-and-trap gas chromatography mass spectrometry
HPLC High-performance liquid chromatography
HPLC/FD High-performance liquid chromatography uorescence detector
HPLC/ High-performance liquid chromatography ultraviolet
8. CHEMICAL ASPECTS
UVPAD photodiode array detector

EAAS Electrothermal atomic absorption spectrometry
IC Ion chromatography
ICP Inductively coupled plasma
ICP/MS Inductively coupled plasma mass spectrometry
FAAS Flame atomic absorption spectrometry
IC/FAAS Ion chromatography ame atomic absorption spectrometry
IC/FD Ion chromatography uorescence detector
Notes to Tables 8.68.10
+ The detection limit is between the guideline value and 1/10 of its value.
++ The detection limit is between 1/10 and 1/50 of the guideline value.
+++ The detection limit is under 1/100 of the guideline value.
# The analytical method is available for detection of the concentration of the guideline value, but it is difcult to detect the concentration of 1/10 of the guideline value.
The detection method(s) is/are available for the item.
(H) This method is applicable to the determination by conversion to their hydrides by hydride generator.
Electrothermal atomic absorption spectrometry (EAAS) is based on the same princi-

ple as FAAS, but an electrically heated atomizer or graphite furnace replaces the
standard burner head for determination of metals. In comparison with FAAS, EAAS
gives higher sensitivities and lower detection limits, and a smaller sample volume is
required. EAAS suffers from more interference through light scattering by co-existing
elements and requires a longer analysis time than FAAS.
The principle of inductively coupled plasma/atomic emission spectrometry
(ICP/AES) for determination of metals is as follows. An ICP source consists of a
owing stream of argon gas ionized by an applied radio frequency. A sample aerosol
is generated in a nebulizer and spray chamber and then carried into the plasma
through an injector tube. A sample is heated and excited in the high-temperature
plasma. The high temperature of the plasma causes the atoms to become excited. On
returning to the ground state, the excited atoms produce ionic emission spectra. A
monochromator is used to separate specic wavelengths corresponding to different
elements, and a detector measures the intensity of radiation of each wavelength. A sig-
nicant reduction in chemical interference is achieved. In the case of water with low
pollution, simultaneous or sequential analysis is possible without special pretreatment
to achieve low detection limits for many elements. This, coupled with the extended
dynamic range from three digits to ve digits, means that multi-element determina-
tion of metals can be achieved. ICP/AES has similar sensitivity to FAAS or EAAS.
In inductively coupled plasma/mass spectrometry (ICP/MS), elements are atomized
and excited as in ICP/AES, then passed to a mass spectrometer. Once inside the mass
spectrometer, the ions are accelerated by high voltage and passed through a series of
ion optics, an electrostatic analyser and, nally, a magnet. By varying the strength of
the magnet, ions are separated according to mass/charge ratio and passed through a
slit into the detector, which records only a very small atomic mass range at a given
time. By varying the magnet and electrostatic analyser settings, the entire mass range
can be scanned within a relatively short period of time. In the case of water with low
pollution, simultaneous or sequential analysis is possible without special pretreatment
to achieve low detection limits for many elements. This, coupled with the extended
dynamic range from three digits to ve digits, means that multi-element determina-
tion of metals can be achieved.
Chromatography is a separation method based on the afnity difference between
two phases, the stationary and mobile phases. A sample is injected into a column,
either packed or coated with the stationary phase, and separated by the mobile phase
based on the difference in interaction (distribution or adsorption) between com-
pounds and the stationary phase. Compounds with a low afnity for the stationary
phase move more quickly through the column and elute earlier. The compounds that
elute from the end of the column are determined by a suitable detector.
In ion chromatography, an ion exchanger is used as the stationary phase, and the
eluant for determination of anions is typically a dilute solution of sodium hydrogen
carbonate and sodium carbonate. Colorimetric, electrometric or titrimetric detectors
164
8. CHEMICAL ASPECTS
can be used for determining individual anions. In suppressed ion chromatography,

anions are converted to their highly conductive acid forms; in the carbonate
bicarbonate eluant, anions are converted to weakly conductive carbonic acid. The
separated acid forms are measured by conductivity and identied on the basis of
retention time as compared with their standards.
High-performance liquid chromatography (HPLC) is an analytical technique using
a liquid mobile phase and a column containing a liquid stationary phase. Detection
of the separated compounds is achieved through the use of absorbance detectors for
organic compounds and through conductivity or electrochemical detectors for metal-
lic and inorganic compounds.
Gas chromatography (GC) permits the identication and quantication of trace
organic compounds. In GC, gas is used as the mobile phase, and the stationary phase
is a liquid that is coated either on an inert granular solid or on the walls of a capil-
lary column. When the sample is injected into the column, the organic compounds
are vaporized and moved through the column by the carrier gas at different rates
depending on differences in partition coefcients between the mobile and stationary
phases. The gas exiting the column is passed to a suitable detector. A variety of
detectors can be used, including ame ionization (FID), electron capture (ECD) and
nitrogenphosphorus. Since separation ability is good in this method, mixtures of
substances with similar structure are systematically separated, identied and deter-
mined quantitatively in a single operation.
The gas chromatography/mass spectrometry (GC/MS) method is based on the same
principle as the GC method, using a mass spectrometer as the detector. As the gas
emerges from the end of the GC column opening, it ows through a capillary column
interface into the MS. The sample then enters the ionization chamber, where a colli-
mated beam of electrons impacts the sample molecules, causing ionization and frag-
mentation. The next component is a mass analyser, which uses a magnetic eld to
separate the positively charged particles according to their mass. Several types of sep-
arating techniques exist; the most common are quadrupoles and ion traps. After the
ions are separated according to their masses, they enter a detector.
The purge-and-trap packed-column GC/MS method or purge-and-trap packed-
column GC method is applicable to the determination of various purgeable organic
compounds that are transferred from the aqueous to the vapour phase by bubbling
purge gas through a water sample at ambient temperature. The vapour is trapped with
a cooled trap. The trap is heated and backushed with the same purge gas to desorb
the compounds onto a GC column. The principles of GC or GC/MS are as referred
to above.
The principle of enzyme-linked immunosorbent assay (ELISA) is as follows. The
protein (antibody) against the chemical of interest (antigen) is coated onto the solid
material. The target chemical in the water sample binds to the antibody, and a second
antibody with an enzyme attached is also added that will attach to the chemical of
interest. After washing to remove any of the free reagents, a chromogen is added that
165
will give a colour reaction due to cleavage by the enzyme that is proportional to the
quantity of the chemical of interest. The ELISA method can be used to determine
microcystin and synthetic surfactants.
8.4 Treatment
As noted above, where a health-based guideline value cannot be achieved by reason-
ably practicable treatment, then the guideline value is designated as provisional and
set at the concentration that can be reasonably achieved through treatment.
8.4.1 Treatment achievability

The ability to achieve a guideline value within a drinking-water supply depends on a
number of factors, including:
the concentration of the chemical in the raw water;
control measures employed throughout the drinking-water system;
nature of the raw water (groundwater or surface water, presence of natural back-
ground and other components); and
treatment processes already installed.
If a guideline value cannot be met with the existing system, then additional treatment
may need to be considered, or water should be obtained from alternative sources.
The cost of achieving a guideline value will depend on the complexity of any
additional treatment or other control measures required. It is not possible to provide
general quantitative information on the cost of achieving individual guideline values.
Treatment costs (capital and operating) will depend not only on the factors identied
above, but also on issues such as plant throughput; local costs for labour, civil and
mechanical works, chemicals and electricity; life expectancy of the plant; and so on.
A qualitative ranking of treatment processes based on their degree of technical
complexity is given in Table 8.11. The higher the ranking, the more complex the
Table 8.11 Ranking of technical complexity and cost of water

treatment processes
Ranking Examples of treatment processes
1 Simple chlorination
Plain ltration (rapid sand, slow sand)
2 Pre-chlorination plus ltration
Aeration
3 Chemical coagulation
Process optimization for control of
DBPs
4 Granular activated carbon (GAC) treatment
Ion exchange
5 Ozonation
6 Advanced oxidation processes
Membrane treatment
166
8. CHEMICAL ASPECTS
Table 8.12 Treatment achievability for naturally occurring chemicals for which guideline
values have been establisheda,b
Ion exchange
Precipitation
Chlorination
Coagulation
Membranes
Ozonation
softening
Activated
Activated
alumina
carbon
Arsenic +++ +++ +++ +++ +++
<0.005 <0.005 <0.005 <0.005 <0.005
Fluoride ++ +++ +++
<1 <1
Manganese +++ ++ +++ +++
<0.05 <0.05 <0.05
Selenium ++ +++ +++ +++
<0.01 <0.01 <0.01
Uranium ++ +++ ++ +++
<0.001 <0.001
a
Symbols are as follows:
++ 50% or more removal
+++ 80% or more removal
b
The table includes only those chemicals for which some treatment data are available. A blank entry in the table indi-
cates either that the process is completely ineffective or that there are no data on the effectiveness of the process.
For the most effective process(es), the table indicates the concentration of the chemical, in mg/litre, that should be
achievable.
process in terms of plant and/or operation. In general, higher rankings are also asso-
ciated with higher costs.
Tables 8.128.16 summarize the treatment processes that are capable of removing
chemical contaminants of health signicance. The tables include only those chemi-
cals for which some treatment data are available.
These tables are provided to help inform decisions regarding the ability of existing
treatment to meet guidelines and what additional treatment might need to be
installed. They have been compiled on the basis of published literature, which includes
mainly laboratory experiments, some pilot plant investigations and relatively few full-
scale studies of water treatment processes. Consequently:
Many of the treatments outlined are designed for larger treatment plants and may
not necessarily be appropriate for smaller treatment plants or individual type treat-
ment. In these cases, the choice of technology must be made on a case-by-case basis.
The information is probably best case, since the data would have been obtained
under laboratory conditions or with a carefully controlled plant for the purposes
of experimentation.
Actual process performance will depend on the concentration of the chemical in
the raw water and on general raw water quality. For example, chlorination and
removal of organic chemicals and pesticides using activated carbon or ozonation
will be impaired if there is a high concentration of natural organic matter.
167
Table 8.13 Treatment achievability for chemicals from industrial sources and human dwellings
for which guideline values have been establisheda,b
Ion exchange
Precipitation
Air stripping
Coagulation
Membranes
Ozonation
Advanced
softening
Activated
oxidation
carbon
Cadmium +++ +++ +++ +++
<0.002 <0.002 <0.002 <0.002
Mercury +++ +++ +++ +++
<0.0001 <0.0001 <0.0001 <0.0001
Benzene +++ +++ +++
<0.01 <0.01 <0.01
Carbon tetrachloride +++ + +++ +++
<0.001 <0.001 <0.001
<0.01 <0.01 <0.01
<0.01 <0.01 <0.01
1,2-Dichloroethane + +++ + ++
<0.01
1,2-Dichloroethene +++ +++ +++
<0.01 <0.01 <0.01
1,4-Dioxane +++
no data
Edetic acid (EDTA) +++
<0.01
Ethylbenzene +++ + +++ +++
<0.001 <0.001 <0.001
Hexachlorobutadiene +++
<0.001
Nitrilotriacetic acid +++
(NTA) no data
Pentachlorophenol +++
<0.0004
Styrene +++ +++
<0.02 <0.002
Tetrachloroethene +++ +++
<0.001 <0.001
Toluene +++ +++ +++ +++
<0.001 <0.001 <0.001 <0.001
Trichloroethene +++ +++ +++ +++
<0.02 <0.02 <0.02 <0.02
Xylenes +++ +++ +++
<0.005 <0.005 <0.005
a
+ Limited removal
b
achievable.
168
8. CHEMICAL ASPECTS
Table 8.14 Treatment achievability for chemicals from agricultural activities for which
guideline values have been establisheda,b
Ion exchange
Air stripping
Chlorination
Coagulation
Membranes
Ozonation
treatment
Advanced
Biological
Activated
oxidation
carbon
Nitrate +++ +++ +++
<5 <5 <5
Nitrite +++ +++ +++
<0.1 <0.1<0.1
Alachlor +++ ++ +++
+++
<0.001 <0.001
<0.001
Aldicarb +++ +++ +++ +++
<0.001 <0.001 <0.001 <0.001
Aldrin/dieldrin ++ +++ +++ +++
<0.00002 <0.00002 <0.00002
Atrazine + +++ ++ +++ +++
<0.0001 <0.0001 <0.0001
Carbofuran + +++ +++
<0.001 <0.001
Chlordane +++ +++
<0.0001 <0.0001
Chlorotoluron +++ +++
<0.0001 <0.0001
Cyanazine +++ + +++
<0.0001 <0.0001
2,4-Dichlorophe- + +++ +++
noxyacetic acid <0.001 <0.001
(2,4-D)
1,2-Dibromo-3- ++ +++
chloropropane <0.001 <0.0001
1,2-Dibromoethane +++ +++
<0.0001 <0.0001
1,2-Dichloropropane +++ + +++
(1,2-DCP) <0.001 <0.001
Dimethoate +++ ++ ++
<0.001
Endrin + +++
<0.0002
Isoproturon ++ +++ +++ +++ +++
<0.0001 <0.0001 <0.0001 <0.0001
Lindane +++ ++
<0.0001
MCPA +++ +++
<0.0001 <0.0001
Mecoprop +++ +++
<0.0001 <0.0001
Methoxychlor ++ +++ +++
<0.0001 <0.0001
Metalochlor +++ ++
<0.0001
continued
169
Table 8.14 Continued
Ion exchange
Air stripping
Chlorination
Coagulation
Membranes
Ozonation
treatment
Advanced
Biological
Activated
oxidation
carbon
Simazine + +++ ++ +++ +++
<0.0001 <0.0001 <0.0001
2,4,5-T ++ +++ +
<0.001
Terbuthylazine + +++ ++
(TBA) <0.0001
Triuralin +++ +++
<0.0001 <0.0001
a
+ Limited removal
b
achievable.
For many contaminants, potentially several different processes could be appropri-

ate, and the choice between processes should be made on the basis of technical
complexity and cost, taking into account local circumstances. For example,
membrane processes can remove a broad spectrum of chemicals, but simpler and
cheaper alternatives are effective for the removal of most chemicals.
It is normal practice to use a series of unit processes to achieve desired water quality
objectives (e.g., coagulation, sedimentation, ltration, GAC, chlorination). Each
of these may contribute to the removal of chemicals. It may be technically and
Table 8.15 Treatment achievability for pesticides used in water for public health for which
guideline values have been establisheda,b
Chlorination
Coagulation
Membranes
Ozonation
Advanced
Activated
oxidation
carbon
DDT and metabolites + +++ +++ + +++ +++

<0.0001 <0.0001 <0.0001 <0.0001
Pyriproxyfen +++
<0.001
a
+ Limited removal
b
achievable.
170
8. CHEMICAL ASPECTS
Table 8.16 Treatment achievability for cyanobacterial cells and cyanotoxins for which
guideline values have been establisheda,b,c
Chlorination
Coagulation
Membranes
Ozonation
Advanced
Activated
oxidation
carbon
H
Cyanobacterial cells +++ +++
Cyanotoxins +++ +++ +++ +++
a
Chlorination or ozonation may release cyanotoxins.
b
+++ = 80% or more removal.
c
economically advantageous to use a combination of processes (e.g., ozonation plus

GAC) to remove particular chemicals.
The effectiveness of potential processes should be assessed using laboratory or pilot
plant tests on the actual raw water concerned. These tests should be of sufcient
duration to identify potential seasonal or other temporal variations in contami-
nant concentrations and process performance.
8.4.2 Chlorination
Chlorination can be achieved by using liqueed chlorine gas, sodium hypochlorite
solution or calcium hypochlorite granules and on-site chlorine generators. Liqueed
chlorine gas is supplied in pressurized containers. The gas is withdrawn from the
cylinder and is dosed into water by a chlorinator, which both controls and measures
the gas ow rate. Sodium hypochlorite solution is dosed using a positive-displacement
electric dosing pump or gravity feed system. Calcium hypochlorite has to be dissolved
in water, then mixed with the main supply. Chlorine, whether in the form of chlorine
gas from a cylinder, sodium hypochlorite or calcium hypochlorite, dissolves in water
to form hypochlorous acid (HOCl) and hypochlorite ion (OCl-).
Different techniques of chlorination can be used, including breakpoint chlorina-
tion, marginal chlorination and superchlorination/dechlorination. Breakpoint chlo-
rination is a method in which the chlorine dose is sufcient to rapidly oxidize all the
ammonia nitrogen in the water and to leave a suitable free residual chlorine available
to protect the water against reinfection from the point of chlorination to the point of
use. Superchlorination/dechlorination is the addition of a large dose of chlorine to
effect rapid disinfection and chemical reaction, followed by reduction of excess free
chlorine residual. Removing excess chlorine is important to prevent taste problems.
It is used mainly when the bacterial load is variable or the detention time in a tank is
not enough. Marginal chlorination is used where water supplies are of high quality
and is the simple dosing of chlorine to produce a desired level of free residual chlo-
rine. The chlorine demand in these supplies is very low, and a breakpoint might not
even occur.
171
Chlorination is employed primarily for microbial disinfection. However, chlorine

also acts as an oxidant and can remove or assist in the removal of some chemicals
for example, decomposition of easily oxidized pesticides such as aldicarb; oxidation
of dissolved species (e.g., manganese(II)) to form insoluble products that can be
removed by subsequent ltration; and oxidation of dissolved species to more easily
removable forms (e.g., arsenite to arsenate).
A disadvantage of chlorine is its ability to react with natural organic matter to
produce THMs and other halogenated DBPs. However, by-product formation may be
controlled by optimization of the treatment system.
8.4.3 Ozonation
Ozone is a powerful oxidant and has many uses in water treatment, including oxida-
tion of organic chemicals. Ozone can be used as a primary disinfectant. Ozone gas
(O3) is formed by passing dry air or oxygen through a high-voltage electric eld. The
resultant ozone-enriched air is dosed directly into the water by means of porous dif-
fusers at the base of bafed contactor tanks. The contactor tanks, typically about 5 m
deep, provide 1020 min of contact time. Dissolution of at least 80% of the applied
ozone should be possible, with the remainder contained in the off-gas, which is passed
through an ozone destructor and vented to the atmosphere.
The performance of ozonation relies on achieving the desired concentration after
a given contact period. For oxidation of organic chemicals, such as a few oxidizable
pesticides, a residual of about 0.5 mg/litre after a contact time of up to 20 min is
typically used. The doses required to achieve this vary with the type of water but are
typically in the range 25 mg/litre. Higher doses are needed for untreated waters,
because of the ozone demand of the natural background organics.
Ozone reacts with natural organics to increase their biodegradability, measured as
assimilable organic carbon. To avoid undesirable bacterial growth in distribution,
ozonation is normally used with subsequent treatment, such as ltration or GAC, to
remove biodegradable organics, followed by a chlorine residual, since it does not
provide a disinfectant residual. Ozone is effective for the degradation of a wide range
of pesticides and other organic chemicals.
8.4.4 Other disinfection processes

Other disinfection methods include chloramination, the use of chlorine dioxide, UV
radiation and advanced oxidation processes.
Chloramines (monochloramine, dichloramine and trichloramine, or nitrogen
trichloride) are produced by the reaction of aqueous chlorine with ammonia. Mono-
chloramine is the only useful chloramine disinfectant, and conditions employed for
chloramination are designed to produce only monochloramine. Monochloramine is
a less effective disinfectant than free chlorine, but it is persistent, and it is therefore
an attractive secondary disinfectant for the maintenance of a stable distribution
system residual.
172
8. CHEMICAL ASPECTS
Although historically chlorine dioxide was not widely used for drinking-water dis-
infection, it has been used in recent years because of concerns about THM produc-
tion associated with chlorine disinfection. Typically, chlorine dioxide is generated
immediately prior to application by the addition of chlorine gas or an aqueous chlo-
rine solution to aqueous sodium chlorite. Chlorine dioxide decomposes in water to
form chlorite and chlorate. As chlorine dioxide does not oxidize bromide (in the
absence of sunlight), water treatment with chlorine dioxide will not form bromoform
or bromate.
Use of UV radiation in potable water treatment has typically been restricted to
small facilities. UV radiation, emitted by a low-pressure mercury arc lamp, is biocidal
between wavelengths of 180 and 320 nm. It can be used to inactivate protozoa, bacte-
ria, bacteriophage, yeast, viruses, fungi and algae. Turbidity can inhibit UV disinfec-
tion. UV radiation can act as a strong catalyst in oxidation reactions when used in
conjunction with ozone.
Processes aimed at generating hydroxyl radicals are known collectively as advanced
oxidation processes and can be effective for the destruction of chemicals that are dif-
cult to treat using other methods, such as ozone alone. Chemicals can react either
directly with molecular ozone or with the hydroxyl radical (HO ), which is a product
of the decomposition of ozone in water and is an exceedingly powerful indiscrimi-
nate oxidant that reacts readily with a wide range of organic chemicals. The forma-
tion of hydroxyl radicals can be encouraged by using ozone at high pH. One advanced
oxidation process using ozone plus hydrogen peroxide involves dosing hydrogen
peroxide simultaneously with ozone at a rate of approximately 0.4 mg of hydrogen
peroxide per litre per mg of ozone dosed per litre (the theoretical optimum ratio
for hydroxyl radical production) and bicarbonate.
8.4.5 Filtration
Particulate matter can be removed from raw waters by rapid gravity, horizontal, pres-
sure or slow sand lters. Slow sand ltration is essentially a biological process, whereas
the others are physical treatment processes.
Rapid gravity, horizontal and pressure lters can be used for direct ltration of raw
water, without pretreatment. Rapid gravity and pressure lters are commonly used to
lter water that has been pretreated by coagulation and sedimentation. An alternative
process is direct ltration, in which coagulation is added to the water, which then
passes directly onto the lter where the precipitated oc (with contaminants) is
removed; the application of direct ltration is limited by the available storage within
the lter to accommodate solids.
Rapid gravity lters

Rapid gravity sand lters usually consist of open rectangular tanks (usually <100 m2)
containing silica sand (size range 0.51.0 mm) to a depth of between 0.6 and 2.0 m.
The water ows downwards, and solids become concentrated in the upper layers of
173
the bed. The ow rate is generally in the range 420 m3/m2 h. Treated water is col-
lected via nozzles in the oor of the lter. The accumulated solids are removed peri-
odically by backwashing with treated water, sometimes preceded by scouring of the
sand with air. A dilute sludge that requires disposal is produced.
In addition to single-medium sand lters, dual-media or multimedia lters are used.
Such lters incorporate different materials, such that the structure is from coarse to ne
as the water passes through the lter. Materials of suitable density are used in order to
maintain the segregation of the different layers following backwashing. A common
example of a dual-media lter is the anthracitesand lter, which typically consists
of a 0.2-m-deep layer of 1.5-mm anthracite over a 0.6-m-deep layer of silica sand.
Anthracite, sand and garnet can be used in multimedia lters. The advantage of dual-
and multimedia lters is that there is more efcient use of the whole bed depth for par-
ticle retention the rate of headloss development can be half that of single-medium
lters, which can allow higher ow rates without increasing headloss development.
Rapid gravity lters are most commonly used to remove oc from coagulated
waters (see section 8.4.7). They may also be used to reduce turbidity (including
adsorbed chemicals) and oxidized iron and manganese from raw waters.
Roughing lters
Roughing lters can be applied as pre-lters prior to other processes such as slow sand
lters. Roughing lters with coarse gravel or crushed stones as the lter medium can
successfully treat water of high turbidity (>50 NTU). The main advantage of rough-
ing ltration is that as the water passes through the lter, particles are removed by
both ltration and gravity settling. Horizontal lters can be up to 10 m long and are
operated at ltration rates of 0.31.0 m3/m2 h.
Pressure lters
Pressure lters are sometimes used where it is necessary to maintain head in order to
eliminate the need for pumping into supply. The lter bed is enclosed in a cylindri-
cal shell. Small pressure lters, capable of treating up to about 15 m3/h, can be man-
ufactured in glass-reinforced plastics. Larger pressure lters, up to 4 m in diameter,
are manufactured in specially coated steel. Operation and performance are generally
as described for the rapid gravity lter, and similar facilities are required for back-
washing and disposal of the dilute sludge.
Slow sand lters

Slow sand lters usually consist of tanks containing sand (effective size range 0.15
0.3 mm) to a depth of between 0.5 and 1.5 m. The raw water ows downwards, and
turbidity and microorganisms are removed primarily in the top few centimetres of
the sand. A biological layer, known as the schmutzdecke, develops on the surface of
the lter and can be effective in removing microorganisms. Treated water is collected
in underdrains or pipework at the bottom of the lter. The top few centimetres of
174
8. CHEMICAL ASPECTS
sand containing the accumulated solids are removed and replaced periodically. Slow
sand lters are operated at a water ow rate of between 0.1 and 0.3 m3/m2 h.
Slow sand lters are suitable only for low-turbidity water or water that has been
pre-ltered. They are used to remove algae and microorganisms, including protozoa,
and, if preceded by microstraining or coarse ltration, to reduce turbidity (including
adsorbed chemicals). Slow sand ltration is effective for the removal of organics,
including certain pesticides and ammonia.
8.4.6 Aeration
Aeration processes are designed to achieve removal of gases and volatile compounds
by air stripping. Oxygen transfer can usually be achieved using a simple cascade or
diffusion of air into water, without the need for elaborate equipment. Stripping of
gases or volatile compounds, however, may require a specialized plant that provides
a high degree of mass transfer from the liquid phase to the gas phase.
For oxygen transfer, cascade or step aerators are designed so that water ows in a
thin lm to achieve efcient mass transfer. Cascade aeration may introduce a signif-
icant headloss; design requirements are between 1 and 3 m to provide a loading of
1030 m3/m2 h. Alternatively, compressed air can be diffused through a system of sub-
merged perforated pipes. These types of aerator are used for oxidation and precipi-
tation of iron and manganese.
Air stripping can be used for removal of volatile organics (e.g., solvents), some
taste- and odour-causing compounds and radon. Aeration processes to achieve air
stripping need to be much more elaborate to provide the necessary contact between
the air and water. The most common technique is cascade aeration, usually in packed
towers in which water is allowed to ow in thin lms over plastic media with air blown
counter-current. The required tower height and diameter are functions of the volatil-
ity and concentration of the compounds to be removed and the ow rate.
8.4.7 Chemical coagulation

Chemical coagulation-based treatment is the most common approach for treatment
of surface waters and is almost always based on the following unit processes.
Chemical coagulants, usually salts of aluminium or iron, are dosed to the raw water
under controlled conditions to form a solid occulent metal hydroxide. Typical coag-
ulant doses are 25 mg/litre as aluminium or 410 mg/litre as iron. The precipitated
oc removes suspended and dissolved contaminants by mechanisms of charge neu-
tralization, adsorption and entrapment. The efciency of the coagulation process
depends on raw water quality, the coagulant or coagulant aids used and operational
factors, including mixing conditions, coagulation dose and pH. The oc is removed
from the treated water by subsequent solidliquid separation processes such as sedi-
mentation or otation and/or rapid or pressure gravity ltration.
Effective operation of the coagulation process depends on selection of the optimum
coagulant dose and also the pH value. The required dose and pH can be determined
175
by using small-scale batch coagulation tests, often termed jar tests. Increasing doses
of coagulant are applied to raw water samples that are stirred, then allowed to settle.
The optimum dose is selected as that which achieves adequate removal of colour and
turbidity; the optimum pH can be selected in a similar manner. These tests have to
be conducted at a sufcient frequency to keep pace with changes in raw water quality
and hence coagulant demand.
Powdered activated carbon (PAC) may be dosed during coagulation to adsorb
organic chemicals such as some hydrophobic pesticides. The PAC will be removed as
an integral fraction of the oc and disposed of with the waterworks sludge.
The oc may be removed by sedimentation to reduce the solids loading to the sub-
sequent rapid gravity lters. Sedimentation is most commonly achieved in horizontal
ow or oc blanket clariers. Alternatively, oc may be removed by dissolved air ota-
tion, in which solids are contacted with ne bubbles of air that attach to the oc, causing
them to oat to the surface of the tank, where they are removed periodically as a layer
of sludge. The treated water from either process is passed to rapid gravity lters (see
section 8.4.5), where remaining solids are removed. Filtered water may be passed to a
further stage of treatment, such as additional oxidation and ltration (for removal of
manganese), ozonation and/or GAC adsorption (for removal of pesticides and other
trace organics), prior to nal disinfection before the treated water enters supply.
Coagulation is suitable for removal of certain heavy metals and low-solubility
organic chemicals, such as certain organochlorine pesticides. For other organic chem-
icals, coagulation is generally ineffective, except where the chemical is bound to humic
material or adsorbed onto particulates.
8.4.8 Activated carbon adsorption

Activated carbon is produced by the controlled thermalization of carbonaceous mate-
rial, normally wood, coal, coconut shells or peat. This activation produces a porous
material with a large surface area (5001500 m2/g) and a high afnity for organic com-
pounds. It is normally used either in powdered (PAC) or in granular (GAC) form.
When the adsorption capacity of the carbon is exhausted, it can be reactivated by
burning off the organics in a controlled manner. However, PAC (and some GAC) is
normally used only once before disposal. Different types of activated carbon have dif-
ferent afnities for types of contaminants.
The choice between PAC and GAC will depend upon the frequency and dose
required. PAC would generally be preferred in the case of seasonal or intermittent con-
tamination or where low dosage rates are required.
PAC is dosed as a slurry into the water and is removed by subsequent treatment
processes together with the waterworks sludge. Its use is therefore restricted to surface
water treatment works with existing lters. GAC in xed-bed adsorbers is used much
more efciently than PAC dosed into the water, and the effective carbon use per water
volume treated would be much lower than the dose of PAC required to achieve the
same removal.
176
8. CHEMICAL ASPECTS
GAC is used for taste and odour control. It is normally used in xed beds, either
in purpose-built adsorbers for chemicals or in existing lter shells by replacement of
sand with GAC of a similar particle size. Although at most treatment works it would
be cheaper to convert existing lters rather than build separate adsorbers, use of exist-
ing lters usually allows only short contact times. It is therefore common practice to
install additional GAC adsorbers (in some cases preceded by ozonation) between the
rapid gravity lters and nal disinfection. Most groundwater sources do not have
existing lters, and separate adsorbers would need to be installed.
The service life of a GAC bed is dependent on the capacity of the carbon used and
the contact time between the water and the carbon, the empty bed contact time
(EBCT), controlled by the ow rate of the water. EBCTs are usually in the range 5
30 min. GACs vary considerably in their capacity for specic organic compounds,
which can have a considerable effect upon their service life. A guide to capacity can
be obtained from published isotherm data. Carbon capacity is strongly dependent on
the water source and is greatly reduced by the presence of background organic
compounds. The properties of a chemical that inuence its adsorption onto acti-
vated carbon include the water solubility and octanol/water partition coefcient
(log Kow). As a general rule, chemicals with low solubility and high log Kow are well
adsorbed.
Activated carbon is used for the removal of pesticides and other organic chemicals,
taste and odour compounds, cyanobacterial toxins and total organic carbon.
8.4.9 Ion exchange

Ion exchange is a process in which ions of like charge are exchanged between the water
phase and the solid resin phase. Water softening is achieved by cation exchange. Water
is passed through a bed of cationic resin, and the calcium ions and magnesium ions
in the water are replaced by sodium ions. When the ion exchange resin is exhausted
(i.e., the sodium ions are depleted), it is regenerated using a solution of sodium chlo-
ride. The process of dealkalization can also soften water. Water is passed through a
bed of weakly acidic resin, and the calcium and magnesium ions are replaced by
hydrogen ions. The hydrogen ions react with the carbonate and bicarbonate ions to
produce carbon dioxide. The hardness of the water is thus reduced without any
increase in sodium levels. Anion exchange can be used to remove contaminants such
as nitrate, which is exchanged for chloride. Nitrate-specic resins are available for this
purpose.
An ion exchange plant normally consists of two or more resin beds contained in
pressure shells with appropriate pumps, pipework and ancillary equipment for regen-
eration. The pressure shells are typically up to 4 m in diameter, containing 0.61.5 m
depth of resin.
Cation exchange can be used for removal of certain heavy metals. Potential appli-
cations of anionic resins, in addition to nitrate removal, are for removal of arsenic
and selenium species.
177
8.4.10 Membrane processes

The membrane processes of most signicance in water treatment are reverse osmosis,
ultraltration, microltration and nanoltration. These processes have traditionally
been applied to the production of water for industrial or pharmaceutical applications
but are now being applied to the treatment of drinking-water.
High-pressure processes
If two solutions are separated by a semi-permeable membrane (i.e., a membrane that
allows the passage of the solvent but not of the solute), the solvent will naturally pass
from the lower-concentration solution to the higher-concentration solution. This
process is known as osmosis. It is possible, however, to force the ow of solvent in the
opposite direction, from the higher to the lower concentration, by increasing the pres-
sure on the higher-concentration solution. The required pressure differential is known
as the osmotic pressure, and the process is known as reverse osmosis.
Reverse osmosis results in the production of a treated water stream and a relatively
concentrated waste stream. Typical operating pressures are in the range 1550 bar,
depending on the application. Reverse osmosis rejects monovalent ions and organics
of molecular weight greater than about 50 (membrane pore sizes are less than
0.002 mm). The most common application of reverse osmosis is desalination of brack-
ish water and seawater.
Nanoltration uses a membrane with properties between those of reverse osmosis
and ultraltration membranes; pore sizes are typically 0.0010.01 mm. Nanoltration
membranes allow monovalent ions such as sodium or potassium to pass but reject a
high proportion of divalent ions such as calcium and magnesium and organic mole-
cules of molecular weight greater than 200. Operating pressures are typically about 5
bar. Nanoltration may be effective for the removal of colour and organic compounds.
Lower-pressure processes
Ultraltration is similar in principle to reverse osmosis, but the membranes have
much larger pore sizes (typically 0.0020.03 mm) and operate at lower pressures.
Ultraltration membranes reject organic molecules of molecular weight above about
800 and usually operate at pressures less than 5 bar.
Microltration is a direct extension of conventional ltration into the sub-
micrometre range. Microltration membranes have pore sizes typically in the range
0.0112 mm and do not separate molecules but reject colloidal and suspended mate-
rial at operating pressures of 12 bar. Microltration is capable of sieving out parti-
cles greater than 0.05 mm. It has been used for water treatment in combination with
coagulation or PAC to remove dissolved organic carbon and to improve permeate ux.
8.4.11 Other treatment processes

Other treatment processes that can be used in certain applications include:
178
8. CHEMICAL ASPECTS
precipitation softening (addition of lime, lime plus sodium carbonate or sodium

hydroxide to precipitate hardness at high pH);
biological denitrication for removal of nitrate from surface waters;
biological nitrication for removal of ammonia from surface waters; and
activated alumina (or other adsorbents) for specialized applications, such as
removal of uoride and arsenic.
8.4.12 Disinfection by-products process control measures

All chemical disinfectants produce inor-
ganic and/or organic DBPs that may be
In attempting to control DBP concentra-
of concern. tions, it is of paramount importance that
The principal DBPs formed during the efciency of disinfection is not com-
chlorination are THMs, chlorinated promised and that a suitable residual level
of disinfectant is maintained throughout
acetic acids, chlorinated ketones and the distribution system.
haloacetonitriles, as a result of chlorina-
tion of naturally occurring organic pre-
cursors such as humic substances. Monochloramine produces lower THM
concentrations than chlorine but produces other DBPs, including cyanogen chloride.
Ozone oxidizes bromide to produce hypohalous acids, which react with precursors
to form brominated THMs. A range of other DBPs, including aldehydes and car-
boxylic acids, may also be formed. Of particular concern is bromate, formed by oxi-
dation of bromide. Bromate may also be present in some sources of hypochlorite, but
usually at concentrations that will give rise to levels in nal water that are below the
guideline value.
The main by-products from the use of chlorine dioxide are chlorite ion, which is
an inevitable decomposition product, and chlorate ion. Chlorate is also produced in
hypochlorate as it ages.
The basic strategies that can be adopted for reducing the concentrations of DBPs
are:
changing process conditions (including removal of precursor compounds prior

to application);
using a different chemical disinfectant with a lower propensity to produce by-
products with the source water;
using non-chemical disinfection; and/or
removing DBPs prior to distribution.
Changes to process conditions

The formation of THMs during chlorination can be reduced by removing precursors
prior to contact with chlorine for example, by installing or enhancing coagulation
(this may involve using higher coagulant doses and/or lower coagulation pH than are
179
applied conventionally). DBP formation can also be reduced by lowering the applied
chlorine dose; if this is done, it must be ensured that disinfection is still effective.
The pH value during chlorination affects the distribution of chlorinated by-
products. Reducing the pH lowers the THM concentration, but at the expense of
increased formation of haloacetic acids. Conversely, increasing the pH reduces
haloacetic acid production but leads to increased THM formation.
The formation of bromate during ozonation depends on several factors, including
concentrations of bromide and ozone and the pH. It is not practicable to remove
bromide from raw water, and it is difcult to remove bromate once formed, although
GAC ltration has been reported to be effective under certain circumstances. Bromate
formation can be minimized by using lower ozone dose, shorter contact time and a
lower residual ozone concentration. Operating at lower pH (e.g., pH 6.5) followed
by raising the pH after ozonation also reduces bromate formation, and addition of
ammonia can also be effective. Addition of hydrogen peroxide can increase or decrease
bromate formation.
Changing disinfectants
It may be feasible to change disinfectant in order to achieve guideline values for DBPs.
The extent to which this is possible will be dependent on raw water quality and
installed treatment (e.g., for precursor removal).
It may be effective to change from chlorine to monochloramine, at least to provide
a residual disinfectant within distribution, in order to reduce THM formation and
subsequent development within the distribution system. While monochloramine pro-
vides a more stable residual within distribution, it is a less powerful disinfectant and
should not be used as a primary disinfectant.
Chlorine dioxide can be considered as a potential alternative to both chlorine and
ozone disinfection, although it does not provide a residual effect. The main concerns
with chlorine dioxide are with the residual concentrations of chlorine dioxide and the
by-products chlorite and chlorate. These can be addressed by controlling the dose of
chlorine dioxide at the treatment plant.
Non-chemical disinfection
UV irradiation or membrane processes can be considered as alternatives to chemical
disinfection. Neither of these provides any residual disinfection, and it may be con-
sidered appropriate to add a small dose of a persistent disinfectant such as chlorine
or monochloramine to act as a preservative during distribution.
8.4.13 Treatment for corrosion control

General
Corrosion is the partial dissolution of the materials constituting the treatment and
supply systems, tanks, pipes, valves and pumps. It may lead to structural failure, leaks,
loss of capacity and deterioration of chemical and microbial water quality. The inter-
180
8. CHEMICAL ASPECTS
nal corrosion of pipes and ttings can have a direct impact on the concentration of
some water constituents, including lead and copper. Corrosion control is therefore an
important aspect of the management of a drinking-water system for safety.
Corrosion control involves many parameters, including the concentrations of
calcium, bicarbonate, carbonate and dissolved oxygen, as well as pH. The detailed
requirements differ depending on water quality and the materials used in the distri-
bution system. The pH controls the solubility and rate of reaction of most of the metal
species involved in corrosion reactions. It is particularly important in relation to the
formation of a protective lm at the metal surface. For some metals, alkalinity (car-
bonate and bicarbonate) and calcium (hardness) also affect corrosion rates.
Iron
Iron is frequently used in water distribution systems, and its corrosion is of concern.
While structural failure as a result of iron corrosion is rare, water quality problems
(e.g., red water) can arise as a result of excessive corrosion of iron pipes. The cor-
rosion of iron is a complex process that involves the oxidation of the metal, normally
by dissolved oxygen, ultimately to form a precipitate of iron(III). This leads to the for-
mation of tubercules on the pipe surface. The major water quality factors that deter-
mine whether the precipitate forms a protective scale are pH and alkalinity. The
concentrations of calcium, chloride and sulfate also inuence iron corrosion. Suc-
cessful control of iron corrosion has been achieved by adjusting the pH to the range
6.87.3, hardness and alkalinity to at least 40 mg/litre (as calcium carbonate), over-
saturation with calcium carbonate of 410 mg/litre and a ratio of alkalinity to Cl- +
SO42- of at least 5 (when both are expressed as calcium carbonate).
Silicates and polyphosphates are often described as corrosion inhibitors, but there
is no guarantee that they will inhibit corrosion in water distribution systems. However,
they can complex dissolved iron (in the iron(II) state) and prevent its precipitation
as visibly obvious red rust. These compounds may act by masking the effects of cor-
rosion rather than by preventing it. Orthophosphate is a possible corrosion inhibitor
and, like polyphosphates, is used to prevent red water.
Lead
Lead corrosion (plumbosolvency) is of particular concern. Lead piping is still
common in old houses in some countries, and lead solders have been used widely
for jointing copper tube. The solubility of lead is governed by the formation of
lead carbonates as pipe deposits. Wherever practicable, lead pipework should be
replaced.
The solubility of lead increases markedly as the pH is reduced below 8 because of
the substantial decrease in the equilibrium carbonate concentration. Thus, plumbo-
solvency tends to be at a maximum in waters with a low pH and low alkalinity, and
a useful interim control procedure pending pipe replacement is to increase the pH to
8.08.5 after chlorination, and possibly to dose orthophosphate.
181
Lead can corrode more rapidly when it is coupled to copper. The rate of such gal-
vanic corrosion is faster than that of simple oxidative corrosion, and lead concentra-
tions are not limited by the solubility of the corrosion products. The rate of galvanic
corrosion is affected principally by chloride concentration. Galvanic corrosion is less
easily controlled but can be reduced by dosing zinc in conjunction with orthophos-
phate and by adjustment of pH.
Treatment to reduce plumbosolvency usually involves pH adjustment. When
the water is very soft (less than 50 mg of calcium carbonate per litre), the optimum
pH is about 8.08.5. Alternatively, dosing with orthophosphoric acid or sodium
orthophosphate might be more effective, particularly when plumbosolvency occurs
in non-acidic waters.
Copper
The corrosion of copper pipework and hot water cylinders can cause blue water, blue
or green staining of bathroom ttings and, occasionally, taste problems. Copper tubing
may be subject to general corrosion, impingement attack and pitting corrosion.
General corrosion is most often associated with soft, acidic waters; waters with pH
below 6.5 and hardness of less than 60 mg of calcium carbonate per litre are very
aggressive to copper. Copper, like lead, can enter water by dissolution of the corro-
sion product, basic copper carbonate. The solubility is mainly a function of pH and
total inorganic carbon. Solubility decreases with increase in pH, but increases with
increase in concentrations of carbonate species. Raising the pH to between 8 and 8.5
is the usual procedure to overcome these difculties.
Impingement attack is the result of excessive ow velocities and is aggravated in
soft water at high temperature and low pH.
The pitting of copper is commonly associated with hard groundwaters having a
carbon dioxide concentration above 5 mg/litre and high dissolved oxygen. Surface
waters with organic colour may also be associated with pitting corrosion. Copper
pipes can fail by pitting corrosion, which involves highly localized attacks leading to
perforations with negligible loss of metal. Two main types of attack are recognized.
Type I pitting affects cold water systems (below 40 C) and is associated, particularly,
with hard borehole waters and the presence of a carbon lm in the bore of the pipe,
derived from the manufacturing process. Tubes that have had the carbon removed by
cleaning are immune from Type I pitting. Type II pitting occurs in hot water systems
(above 60 C) and is associated with soft waters. A high proportion of general and
pitting corrosion problems are associated with new pipe in which a protective oxide
layer has not yet formed.
Brass
The main corrosion problem with brasses is dezincication, which is the selective dis-
solution of zinc from duplex brass, leaving behind copper as a porous mass of low
mechanical strength. Meringue dezincication, in which a voluminous corrosion
182
8. CHEMICAL ASPECTS
product of basic zinc carbonate forms on the brass surface, largely depends on the
ratio of chloride to alkalinity. Meringue dezincication can be controlled by main-
taining a low zinc to copper ratio (1 : 3 or lower) and by keeping pH below 8.3.
General dissolution of brass can also occur, releasing metals, including lead, into
the water. Impingement attack can occur under conditions of high water velocity with
waters that form poorly protective corrosion product layers and that contain large
amounts of dissolved or entrained air.
Zinc
The solubility of zinc in water is a function of pH and total inorganic carbon con-
centrations; the solubility of basic zinc carbonate decreases with increase in pH and
concentrations of carbonate species. For low-alkalinity waters, an increase of pH to
8.5 should be sufcient to control the dissolution of zinc.
With galvanized iron, the zinc layer initially protects the steel by corroding prefer-
entially. In the long term, a protective deposit of basic zinc carbonate forms. Protec-
tive deposits do not form in soft waters where the alkalinity is less than 50 mg/litre
as calcium carbonate or waters containing high carbon dioxide concentrations
(>25 mg/litre as carbon dioxide), and galvanized steel is unsuitable for these waters.
The corrosion of galvanized steel increases when it is coupled with copper tubing.
Nickel
Nickel may arise due to the leaching of nickel from new nickel/chromium-plated taps.
Low concentrations may also arise from stainless steel pipes and ttings. Nickel leach-
ing falls off over time. An increase of pH to control corrosion of other materials should
also reduce leaching of nickel.
Concrete and cement

Concrete is a composite material consisting of a cement binder in which an inert
aggregate is embedded. Cement is primarily a mixture of calcium silicates and alu-
minates together with some free lime. Cement mortar, in which the aggregate is ne
sand, is used as a protective lining in iron and steel water pipes. In asbestoscement
pipe, the aggregate is asbestos bres. Cement is subject to deterioration on prolonged
exposure to aggressive water, due either to the dissolution of lime and other soluble
compounds or to chemical attack by aggressive ions such as chloride or sulfate, and
this may result in structural failure. Cement contains a variety of metals that can be
leached into the water. Aggressiveness to cement is related to the aggressivity index,
which has been used specically to assess the potential for the dissolution of concrete.
A pH of 8.5 or higher may be necessary to control cement corrosion.
Characterizing corrosivity
Most of the indices that have been developed to characterize the corrosion potential
of waters are based on the assumption that water with a tendency to deposit a calcium
183
carbonate scale on metal surfaces will be less corrosive. The Langelier Index (LI) is
the difference between the actual pH of a water and its saturation pH, this being the
pH at which a water of the same alkalinity and calcium hardness would be at equi-
librium with solid calcium carbonate. Waters with positive LI are capable of deposit-
ing calcium carbonate scale from solution.
There is no corrosion index that applies to all materials, and corrosion indices, par-
ticularly those related to calcium carbonate saturation, have given mixed results. The
parameters related to calcium carbonate saturation status are, strictly speaking,
indicators of the tendency to deposit or dissolve calcium carbonate (calcite) scale,
not indicators of the corrosivity of a water. For example, there are many waters with
negative LI that are non-corrosive and many with positive LI that are corrosive. Nev-
ertheless, there are many documented instances of the use of saturation indices for
corrosion control based on the concept of laying down a protective eggshell scale of
calcite in iron pipes. In general, waters with high pH, calcium and alkalinity are less
corrosive, and this tends to be correlated with a positive LI.
The ratio of the chloride and sulfate concentrations to the bicarbonate concentra-
tion (Larson ratio) has been shown to be helpful in assessing the corrosiveness of water
to cast iron and steel. A similar approach has been used in studying zinc dissolution
from brass ttings the Turner diagram.
Water treatment for corrosion control

To control corrosion in water distribution networks, the methods most commonly
applied are adjusting pH, increasing the alkalinity and/or hardness or adding corro-
sion inhibitors, such as polyphosphates, silicates and orthophosphates. The quality
and maximum dose to be used should be in line with specications for such water
treatment chemicals. Although pH adjustment is an important approach, its possible
impact on other aspects of water supply technology, including disinfection, must
always be taken into account.
It is not always possible to achieve the desired values for all parameters. For
example, the pH of hard waters cannot be increased too much, or softening will occur.
The application of lime and carbon dioxide to soft waters can be used to increase both
the calcium concentration and the alkalinity to at least 40 mg/litre as calcium
carbonate.
8.5 Guideline values for individual chemicals, by source category

8.5.1 Naturally occurring chemicals
There are a number of sources of naturally occurring chemicals in drinking-water. All
natural water contains a range of inorganic and organic chemicals. The former derive
from the rocks and soil through which water percolates or over which it ows. The
latter derive from the breakdown of plant material or from algae and other microor-
ganisms that grow in the water or on sediments. Most of the naturally occurring
chemicals for which guideline values have been derived or that have been considered
184
8. CHEMICAL ASPECTS
for guideline value derivation are inorganic. Only one, microcystin-LR, a toxin pro-
duced by cyanobacteria or blue-green algae, is organic; it is discussed in section 8.5.6.
The approach to dealing with naturally occurring chemicals will vary according to
the nature of the chemical and the source. For inorganic contaminants that arise from
rocks and sediments, it is important to screen possible water sources to determine
whether the source is suitable for use or whether it will be necessary to treat the water
to remove the contaminants of concern along with microbial contaminants. In some
cases, where a number of sources may be available, dilution or blending of the water
containing high levels of a contaminant with a water containing much lower levels
may achieve the desired result.
A number of the most important chemical contaminants (i.e., those that have
been shown to cause adverse health effects as a consequence of exposure through
drinking-water) fall into the category of naturally occurring chemicals. Some natu-
rally occurring chemicals have other primary sources and are therefore discussed in
other sections of this chapter.
Guideline values have not been established for the chemicals listed in Table 8.17
for the reasons indicated in the table. Summary statements are included in
chapter 12.
Guideline values have been established for the chemicals listed in Table 8.18,
which meet the criteria for inclusion. Summary statements are included for each in
chapter 12.
8.5.2 Chemicals from industrial sources and human dwellings

Chemicals from industrial sources can reach drinking-water directly from discharges
or indirectly from diffuse sources arising from the use and disposal of materials and
products containing the chemical. In some cases, inappropriate handling and disposal
may lead to contamination, e.g., degreasing agents that are allowed to reach ground-
Table 8.17 Naturally occurring chemicals for which guideline values have not been established
Chemical Reason for not establishing a guideline value Remarks
Chloride Occurs in drinking-water at concentrations well May affect acceptability of
below those at which toxic effects may occur drinking-water (see chapter 10)
Hardness Occurs in drinking-water at concentrations well May affect acceptability of
Hydrogen Occurs in drinking-water at concentrations well May affect acceptability of
sulde belowthose at which toxic effects may occur drinking-water (see chapter 10)
pH Values in drinking-water are well below those at An important operational
which toxic effects may occur water quality parameter
Sodium Occurs in drinking-water at concentrations well May affect acceptability of
Sulfate Occurs in drinking-water at concentrations well May affect acceptability of
Total dissolved Occurs in drinking-water at concentrations well May affect acceptability of
solids (TDS) below those at which toxic effects may occur drinking-water (see chapter 10)
185
Table 8.18 Guideline values for naturally occurring chemicals that are of health signicance in
drinking-water
Guideline valuea
Chemical (mg/litre) Remarks
Arsenic 0.01 (P)
Barium 0.7
Boron 0.5 (T)
Chromium 0.05 (P) For total chromium
Fluoride 1.5 Volume of water consumed and intake from other sources
should be considered when setting national standards
Manganese 0.4 (C)
Molybdenum 0.07
Selenium 0.01
Uranium 0.015 (P, T) Only chemical aspects of uranium addressed
a
P = provisional guideline value, as there is evidence of a hazard, but the available information on health effects is
limited; T = provisional guideline value because calculated guideline value is below the level that can be achieved
through practical treatment methods, source protection, etc.; C = concentrations of the substance at or below the
health-based guideline value may affect the appearance, taste or odour of the water, resulting in consumer
complaints.
water. Some of these chemicals, particularly inorganic substances, may also be

encountered as a consequence of natural contamination, but this may also be a by-
product of industrial activity, such as mining, that changes drainage patterns. Many
of these chemicals are used in small industrial units within human settlements, and,
particularly where such units are found in groups of similar enterprises, they may be
a signicant source of pollution. Petroleum oils are widely used in human settlements,
and improper handling or disposal can lead to signicant pollution of surface water
and groundwater. Where plastic pipes are used, the smaller aromatic molecules in
petroleum oils can sometimes penetrate the pipes where they are surrounded by earth
soaked in the oil, with subsequent pollution of the local water supply.
A number of chemicals can reach water as a consequence of disposal of general
household chemicals; in particular, a number of heavy metals may be found in domes-
tic wastewater. Where wastewater is treated, these will usually partition out into the
sludge. Some chemicals that are widely used both in industry and in materials used
in a domestic setting are found widely in the environment, e.g., di(2-ethylhexyl)phtha-
late, and these may be found in water sources, although usually at low concentrations.
Some chemicals that reach drinking-water from industrial sources or human set-
tlements have other primary sources and are therefore discussed in other sections of
this chapter. Where latrines and septic tanks are poorly sited, these can lead to con-
tamination of drinking-water sources with nitrate (see section 8.5.3).
Identication of the potential for contamination by chemicals from industrial
activities and human dwellings requires assessment of activities in the catchment
and of the risk that particular contaminants may reach water sources. The primary
approach to addressing these contaminants is prevention of contamination by encour-
aging good practices. However, if contamination has occurred, then it may be neces-
sary to consider the introduction of treatment.
186
8. CHEMICAL ASPECTS
Table 8.19 Chemicals from industrial sources and human

dwellings excluded from guideline value derivation
Chemical Reason for exclusion
Beryllium Unlikely to occur in drinking-water
The chemical listed in Table 8.19 has been excluded from guideline value deriva-
tion, as a review of the literature on occurrence and/or credibility of occurrence in
drinking-water has shown evidence that it does not occur in drinking-water.
for the reasons indicated in the table. Summary statements for each are included in
chapter 12.
Guideline values have been established for the chemicals listed in Table 8.21, which
meet all of the criteria for inclusion. Summary statements are included in chapter 12.
8.5.3 Chemicals from agricultural activities

Chemicals are used in agriculture on crops and in animal husbandry. Nitrate may be
present as a consequence of tillage when there is no growth to take up nitrate released
from decomposing plants, from the application of excess inorganic or organic fertil-
izer and in slurry from animal production. Most chemicals that may arise from agri-
culture are pesticides, although their presence will depend on many factors, and not
all pesticides are used in all circumstances or climates. Contamination can result from
application and subsequent movement following rainfall or from inappropriate dis-
posal methods.
Some pesticides are also used in non-agricultural circumstances, such as the control
of weeds on roads and railway lines. These pesticides are also included in this section.
Table 8.20 Chemicals from industrial sources and human dwellings for which guideline values
have not been established
Chemical Reason for not establishing a guideline value
Dichlorobenzene, 1,3- Toxicological data are insufcient to permit derivation of health-based
guideline value
Dichloroethane, 1,1- Very limited database on toxicity and carcinogenicity
Di(2-ethylhexyl)adipate Occurs in drinking-water at concentrations well below those at which
toxic effects may occur
Hexachlorobenzene Occurs in drinking-water at concentrations well below those at which
Monochlorobenzene Occurs in drinking-water at concentrations well below those at which
toxic effects may occur, and health-based value would far exceed lowest
reported taste and odour threshold
Trichlorobenzenes (total) Occur in drinking-water at concentrations well below those at which toxic
effects may occur, and health-based value would exceed lowest reported
odour threshold
Trichloroethane, 1,1,1- Occurs in drinking-water at concentrations well below those at which
187
Table 8.21 Guideline values for chemicals from industrial sources and human dwellings that
are of health signicance in drinking-water
Inorganics Guideline value (mg/litre) Remarks
Cadmium 0.003
Cyanide 0.07
Mercury 0.001 For total mercury (inorganic plus organic)
Guideline valuea
Organics (mg/litre) Remarks
b
Benzene 10
Carbon tetrachloride 4
Di(2-ethylhexyl)phthalate 8
Dichlorobenzene, 1,2- 1000 (C)
Dichloroethane, 1,2- 30b
Dichloroethene, 1,1- 30
Dichloroethene, 1,2- 50
Dichloromethane 20
Edetic acid (EDTA) 600 Applies to the free acid
Ethylbenzene 300 (C)
Hexachlorobutadiene 0.6
Nitrilotriacetic acid (NTA) 200
Pentachlorophenol 9b (P)
Styrene 20 (C)
Tetrachloroethene 40
Toluene 700 (C)
Trichloroethene 70 (P)
Xylenes 500 (C)
a
limited; C = concentrations of the substance at or below the health-based guideline value may affect the appear-
ance, taste or odour of the water, leading to consumer complaints.
b
For non-threshold substances, the guideline value is the concentration in drinking-water associated with an upper-
bound excess lifetime cancer risk of 10-5 (one additional cancer per 100 000 of the population ingesting drinking-
water containing the substance at the guideline value for 70 years). Concentrations associated with estimated
upper-bound excess lifetime cancer risks of 10-4 and 10-6 can be calculated by multiplying and dividing, respec-
tively, the guideline value by 10.
Guideline values have not been established for the chemicals listed in Table 8.22,
as a review of the literature on occurrence and/or credibility of occurrence in
drinking-water has shown evidence that the chemicals do not occur in drinking-water.
for the reasons indicated in the table. Summary statements are included in
chapter 12.
meet the criteria for inclusion. Summary statements are included in chapter 12.
8.5.4 Chemicals used in water treatment or from materials in contact with

drinking-water
Chemicals are used in water treatment and may give rise to residuals in the nal water.
In some cases, such as monochloramine and chlorine, this is intentional, and their
188
8. CHEMICAL ASPECTS
Table 8.22 Chemicals from agricultural activities excluded from guideline value derivation
Amitraz Degrades rapidly in the environment and is not expected to occur at
measurable concentrations in drinking-water supplies
Chlorobenzilate Unlikely to occur in drinking-water
Chlorothalonil Unlikely to occur in drinking-water
Cypermethrin Unlikely to occur in drinking-water
Diazinon Unlikely to occur in drinking-water
Dinoseb Unlikely to occur in drinking-water
Ethylene thiourea Unlikely to occur in drinking-water
Fenamiphos Unlikely to occur in drinking-water
Formothion Unlikely to occur in drinking-water
Hexachlorocyclohexanes Unlikely to occur in drinking-water
(mixed isomers)
MCPB Unlikely to occur in drinking-water
Methamidophos Unlikely to occur in drinking-water
Methomyl Unlikely to occur in drinking-water
Mirex Unlikely to occur in drinking-water
Monocrotophos Has been withdrawn from use in many countries and is unlikely to
occur in drinking-water
Oxamyl Unlikely to occur in drinking-water
Phorate Unlikely to occur in drinking-water
Propoxur Unlikely to occur in drinking-water
Pyridate Not persistent and only rarely found in drinking-water
Quintozene Unlikely to occur in drinking-water
Toxaphene Unlikely to occur in drinking-water
Triazophos Unlikely to occur in drinking-water
Tributyltin oxide Unlikely to occur in drinking-water
Trichlorfon Unlikely to occur in drinking-water
presence confers a direct benet to the consumer. Some arise as unwanted by-
products of the disinfection process (see Table 8.25) and some as residuals from other
parts of the treatment process, such as coagulation. Some may arise as contaminants
in treatment chemicals, and others may arise as contaminants in, or as corrosion
products from, materials used as pipes or in other parts of the drinking-water system.
Some chemicals used in water treatment (e.g., uoride) or in materials in contact
with drinking-water (e.g., styrene) have other primary sources and are therefore dis-
cussed in detail in other sections of this chapter.
The approach to monitoring and management is preferably through control of the
material or chemical, and this is covered in more detail in section 4.2. It is also impor-
tant to optimize treatment processes and to ensure that such processes remain opti-
mized in order to control residuals of chemicals used in treatment and to control the
formation of DBPs.
for the reasons indicated in the table. Summary statements are included in chapter
12.
189
Table 8.23 Chemicals from agricultural activities for which guideline values have not been
established
Ammonia Occurs in drinking-water at concentrations well below those at which toxic
effects may occur
Bentazone Occurs in drinking-water at concentrations well below those at which toxic
effects may occur
Dichloropropane, 1,3- Data insufcient to permit derivation of health-based guideline value
Diquat Rarely found in drinking-water, but may be used as an aquatic herbicide
for the control of free-oating and submerged aquatic weeds in ponds,
lakes and irrigation ditches
Endosulfan Occurs in drinking-water at concentrations well below those at which toxic
effects may occur
Fenitrothion Occurs in drinking-water at concentrations well below those at which toxic
effects may occur
Glyphosate and AMPA Occurs in drinking-water at concentrations well below those at which toxic
effects may occur
Heptachlor and Occurs in drinking-water at concentrations well below those at which toxic
heptachlor epoxide effects may occur
Malathion Occurs in drinking-water at concentrations well below those at which toxic
effects may occur
Methyl parathion Occurs in drinking-water at concentrations well below those at which toxic
effects may occur
Parathion Occurs in drinking-water at concentrations well below those at which toxic
effects may occur
Permethrin Occurs in drinking-water at concentrations well below those at which toxic
effects may occur
Phenylphenol, 2- Occurs in drinking-water at concentrations well below those at which toxic
and its sodium salt effects may occur
Propanil Readily transformed into metabolites that are more toxic; a guideline value
for the parent compound is considered inappropriate, and there are
inadequate data to enable the derivation of guideline values for the
metabolites
meet the criteria for inclusion. Summary statements are included in chapter 12.
8.5.5 Pesticides used in water for public health purposes

Some pesticides are used for public health purposes, including the addition to water
to control the aquatic larval stages of insects of public health signicance (e.g., mos-
quitos for the control of malaria and typhus). There are currently four insecticide
compounds and a bacterial larvicide recommended by WHO (under WHOPES) for
addition to drinking-water as larvicides: temephos, methoprene, pyriproxyfen, per-
methrin and Bacillus thuringiensis israelensis. Of these, only pyriproxyfen has been
reviewed to date. Other insecticides that are not recommended for addition to water
for public health purposes by WHOPES but may be used in some countries as aquatic
larvicides, or have been used as such in the past, include chlorpyrifos and DDT.
190
8. CHEMICAL ASPECTS
Table 8.24 Guideline values for chemicals from agricultural activities that are of health
signicance in drinking-water
Non-pesticides Guideline valuea (mg/litre) Remarks
Nitrate (as NO3-) 50 Short-term exposure
Nitrite (as NO2-) 3 Short-term exposure
0.2 (P) Long-term exposure
Pesticides used in agriculture Guideline valuea (mg/litre) Remarks
Alachlor 20b
Aldicarb 10 Applies to aldicarb sulfoxide
and aldicarb sulfone
Aldrin and dieldrin 0.03 For combined aldrin plus
dieldrin
Atrazine 2
Carbofuran 7
Chlordane 0.2
Chlorotoluron 30
Cyanazine 0.6
2,4-D (2,4-dichlorophenoxyacetic 30 Applies to free acid
acid)
2,4-DB 90
1,2-Dibromo-3-chloropropane 1b
1,2-Dibromoethane 0.4b (P)
1,2-Dichloropropane (1,2-DCP) 40 (P)
1,3-Dichloropropene 20b
Dichlorprop 100
Dimethoate 6
Endrin 0.6
Fenoprop 9
Isoproturon 9
Lindane 2
MCPA 2
Mecoprop 10
Methoxychlor 20
Metolachlor 10
Molinate 6
Pendimethalin 20
Simazine 2
2,4,5-T 9
Terbuthylazine 7
Triuralin 20
a
limited.
b
For substances that are considered to be carcinogenic, the guideline value is the concentration in drinking-water
associated with an upper-bound excess lifetime cancer risk of 10-5 (one additional cancer per 100 000 of the pop-
ulation ingesting drinking-water containing the substance at the guideline value for 70 years). Concentrations asso-
ciated with estimated upper-bound excess lifetime cancer risks of 10-4 and 10-6 can be calculated by multiplying
and dividing, respectively, the guideline value by 10.
In considering those pesticides that may be added to water used for drinking-water
for purposes of protection of public health, every effort should be made not to develop
guidelines that are unnecessarily stringent as to impede their use. This approach
enables a suitable balance to be achieved between the protection of drinking-water
191
Table 8.25 Disinfection by-products present in disinfected waters (from IPCS, 2000)
Signicant organohalogen Signicant inorganic Signicant non-
Disinfectant products products halogenated products
Chlorine/ THMs, haloacetic acids, chlorate (mostly from aldehydes, cyanoalkanoic
hypochlorous haloacetonitriles, chloral hypochlorite use) acids, alkanoic acids,
acid hydrate, chloropicrin, benzene, carboxylic acids
chlorophenols, N-chloramines,
halofuranones, bromohydrins
Chlorine chlorite, chlorate unknown
dioxide
Chloramine haloacetonitriles, cyanogen nitrate, nitrite, aldehydes, ketones
chloride, organic chloramines, chlorate, hydrazine
chloramino acids, chloral
hydrate, haloketones
Ozone bromoform, monobromoacetic chlorate, iodate, aldehydes, ketoacids,
acid, dibromoacetic acid, bromate, hydrogen ketones, carboxylic acids
dibromoacetone, cyanogen peroxide,
bromide hypobromous acid,
epoxides, ozonates
quality and the control of insects of public health signicance. However, it is stressed
that every effort should be made to keep overall exposure and the concentration of
any larvicide as low as possible.
As for the other groups of chemicals discussed in this chapter, this category is not
clear-cut. It includes pesticides that are extensively used for purposes other than public
health protection for example, agricultural purposes, in the case of chlorpyrifos.
Guideline values that have been derived for these larvicides are provided in Table
8.28. Summary statements are included in chapter 12.
8.5.6 Cyanobacterial toxins

Cyanobacteria (see also section 11.5) occur widely in lakes, reservoirs, ponds and
slow-owing rivers. Many species are known to produce toxins, i.e., cyanotoxins, a
number of which are of concern for health. Cyanotoxins vary in structure and may
be found within cells or released into water. There is wide variation in the toxicity of
recognized cyanotoxins (including different structural variants within a group, e.g.,
microcystins), and it is likely that further toxins remain unrecognized.
The toxins are classied, according to their mode of action, as hepatotoxins
(microcystins and cylindrospermopsins), neurotoxins (anatoxin-a, saxitoxins and
anatoxin-a(S)) and irritants or inammatory agents (lipopolysaccharides). The hepa-
totoxins are produced by various species within the genera Microcystis, Planktothrix,
Anabaena, Aphanizomenon, Nodularia, Nostoc, Cylindrospermopsis and Umezakia. The
cyanotoxins occurring most frequently in elevated concentrations (i.e., >1 mg/litre)
seem to be microcystins (oligopeptides) and cylindrospermopsin (an alkaloid),
whereas the cyanobacterial neurotoxins appear to occur in high concentrations only
occasionally.
192
8. CHEMICAL ASPECTS
Table 8.26 Chemicals used in water treatment or materials in contact with drinking-water for
which guideline values have not been established
Disinfectants
Chlorine dioxide Rapid breakdown of chlorine dioxide; also, the chlorite provisional
guideline value is protective for potential toxicity from chlorine dioxide
Dichloramine Available data inadequate to permit derivation of health-based guideline
value
Iodine Available data inadequate to permit derivation of health-based guideline
value, and lifetime exposure to iodine through water disinfection is
unlikely
Silver Available data inadequate to permit derivation of health-based guideline
value
Trichloramine Available data inadequate to permit derivation of health-based guideline
value
Disinfection by-products
Bromochloroacetate Available data inadequate to permit derivation of health-based guideline
value
Bromochloroacetonitrile Available data inadequate to permit derivation of health-based guideline
value
Chloroacetones Available data inadequate to permit derivation of health-based guideline
values for any of the chloroacetones
Chlorophenol, 2- Available data inadequate to permit derivation of health-based guideline
value
Chloropicrin Available data inadequate to permit derivation of health-based guideline
value
Dibromoacetate Available data inadequate to permit derivation of health-based guideline
value
Dichlorophenol, 2,4- Available data inadequate to permit derivation of health-based guideline
value
Monobromoacetate Available data inadequate to permit derivation of health-based guideline
value
MX Occurs in drinking-water at concentrations well below those at which
Trichloroacetonitrile Available data inadequate to permit derivation of health-based guideline
value
Contaminants from treatment chemicals
Aluminium Owing to limitations in the animal data as a model for humans and the
uncertainty surrounding the human data, a health-based guideline value
cannot be derived; however, practicable levels based on optimization of
the coagulation process in drinking-water plants using aluminium-based
coagulants are derived: 0.1 mg/litre or less in large water treatment
facilities, and 0.2 mg/litre or less in small facilities
Iron Not of health concern at concentrations normally observed in drinking-
water, and taste and appearance of water are affected at concentrations
below the health-based value
Contaminants from pipes and ttings
Asbestos No consistent evidence that ingested asbestos is hazardous to health
Dialkyltins Available data inadequate to permit derivation of health-based guideline
values for any of the dialkyltins
Fluoranthene Occurs in drinking-water at concentrations well below those at which
Inorganic tin Occurs in drinking-water at concentrations well below those at which
Zinc Not of health concern at concentrations normally observed in drinking-
water, but may affect the acceptability of water
193
Table 8.27 Guideline values for chemicals used in water treatment or materials in contact with
drinking-water that are of health signicance in drinking-water
Guideline valuea
Disinfectants (mg/litre) Remarks
Chlorine 5 (C) For effective disinfection, there should be a residual
concentration of free chlorine of 0.5 mg/litre after
at least 30 min contact time at pH <8.0
Monochloramine 3
Guideline valuea
Disinfection by-products (mg/litre) Remarks
b
Bromate 10 (A, T)
Bromodichloromethane 60b
Bromoform 100
Chloral hydrate 10 (P)
Chlorate 700 (D)
Chlorite 700 (D)
Chloroform 200
Cyanogen chloride 70 For cyanide as total cyanogenic compounds
Dibromoacetonitrile 70
Dibromochloromethane 100
Dichloroacetate 50 (T, D)
Dichloroacetonitrile 20 (P)
Formaldehyde 900
Monochloroacetate 20
Trichloroacetate 200
Trichlorophenol, 2,4,6- 200b (C)
Trihalomethanes The sum of the ratio of the concentration of each to
its respective guideline value should not exceed 1
Contaminants from Guideline valuea
treatment chemicals (mg/litre) Remarks
b
Acrylamide 0.5
Epichlorohydrin 0.4 (P)
Contaminants from pipes Guideline valuea
and ttings (mg/litre) Remarks
Antimony 20
Benzo[a]pyrene 0.7b
Copper 2000 Staining of laundry and sanitary ware may occur
below guideline value
Lead 10
Nickel 20 (P)
Vinyl chloride 0.3b
a
limited; A = provisional guideline value because calculated guideline value is below the practical quantication level;
T = provisional guideline value because calculated guideline value is below the level that can be achieved through
practical treatment methods, source control, etc.; D = provisional guideline value because disinfection is likely to
result in the guideline value being exceeded; C = concentrations of the substance at or below the health-based
guideline value may affect the appearance, taste or odour of the water, causing consumer complaints.
b
associated with an upper-bound excess lifetime cancer risk of 10-5 (one additional cancer per 100 000 of the
population ingesting drinking-water containing the substance at the guideline value for 70 years). Concentrations
associated with estimated upper-bound excess lifetime cancer risks of 10-4 and 10-6 can be calculated by multi-
plying and dividing, respectively, the guideline value by 10.
194
8. CHEMICAL ASPECTS
Table 8.28 Guideline values for pesticides used in water for public health purposes that are of
health signicance in drinking-water
Pesticides used in water for public health purposesa Guideline value (mg/litre)
Chlorpyrifos 30
DDT and metabolites 1
Pyriproxyfen 300
a
Only pyriproxyfen is recommended by WHOPES for addition to water for public health purposes.
Table 8.29. Guideline values for cyanotoxins that are of health signicance in drinking-water
Guideline valuea
(mg/litre) Remarks
Microcystin-LR 1 (P) For total microcystin-LR (free plus cell-bound)
a
limited.
Cyanotoxins can reach concentrations potentially hazardous to human health pri-

marily in situations of high cell density through excessive growth, sometimes termed
bloom events. These occur in response to elevated concentrations of nutrients
(phosphorus and sometimes nitrogen) and may be triggered by conditions such as
water body stratication and sufciently high temperature. Blooms tend to recur in
the same water bodies. Cells of some cyanobacterial species may accumulate at the
surface as scums or at the theromocline of thermally stratied reservoirs. Such accu-
mulations may develop rapidly, and they may be of short duration. In many circum-
stances, blooms and accumulations are seasonal.
A variety of resource protection and source management actions are available to
decrease the probability of bloom occurrence, and some treatment methods, includ-
ing ltration and chlorination, are available for removal of cyanobacteria and cyan-
otoxins. Filtration can effectively remove cyanobacterial cells and, with that, often a
high share of the toxins. Oxidation through ozone or chlorine at sufcient concen-
trations and contact times can effectively remove most cyanotoxins dissolved in water.
Chemical analysis of cyanotoxins is not the preferred focus of routine monitoring.
The preferred approach is monitoring of source water for evidence of blooms, or
bloom-forming potential, and increased vigilance where such events occur. Analysis
of cyanotoxins requires time, equipment and expertise, and quantitative analysis of
some cyanotoxins is hampered by the lack of analytical standards. However, rapid
methods, such as ELISA and enzyme assays, are becoming available for a small
number, e.g., microcystins.
Chemical analysis of cyanotoxins is useful for assessing the efcacy of treatment
and preventive strategies, i.e., as validation of control measures in a WSP (see chapter
4). While guideline values are derived where sufcient data exist, they are primarily
intended to inform setting targets for control measures.
A provisional guideline value has been established for microcystin-LR, which meets
the criteria for inclusion (see Table 8.29). Microcystin-LR is one of the most toxic of
195
more than 70 structural variants of microcystin. Although, on a global scale, it appears

to be one of the most widespread microcystins, in many regions it is not the most
commonly occurring variant, and others may well be less toxic. If the provisional
guideline value for microcystin-LR is used as a surrogate for their assessment and for
setting targets, this serves as a worst-case estimate. A more detailed discussion of using
concentration equivalents or toxicity equivalents for relating microcystins to
microcystin-LR is given in Chorus & Bartram (1999).
196
9
Radiological aspects
T he objective of this chapter is to provide criteria with which to assess the safety of
drinking-water with respect to its radionuclide content. The Guidelines do not
differentiate between naturally occurring and articial or human-made radionuclides.
The guidance values for radioactivity in drinking-water recommended in the rst
edition of the Guidelines were based on the risks of exposure to radiation sources and
the health consequences of exposure to radiation. The second edition of the Guidelines
incorporated the 1990 recommendations of the International Commission on Radio-
logical Protection (ICRP, 1991). The third edition incorporates recent developments,
including the ICRP publications on prolonged exposures and on dose coefcients.
Radiological hazards may derive from ionizing radiation emitted by a number of
radioactive substances (chemicals) in drinking-water. Such hazards from drinking-
water are rarely of public health signicance, and radiation exposure from drinking-
water must be assessed alongside exposure from other sources.
The approach taken in the Guidelines for controlling radiological hazards has two
stages:
initial screening for gross alpha and/or beta activity to determine whether the
activity concentrations (in Bq/litre) are below levels at which no further action
is required; and
if these screening levels are exceeded, investigation of the concentrations of indi-
vidual radionuclides and comparison with specic guidance levels.
The risk due to radon in drinking-water derived from groundwater is typically low
compared with that due to total inhaled radon but is distinct, as exposure occurs
through both consumption of dissolved gas and inhalation of released radon and its
daughter radionuclides. Greatest exposure is general ambient inhalation and inhala-
tion from terrestrial sources, where the gas is inltrating into dwellings, especially into
basements. Radon of groundwater origin would usually be a small increment of the
total, but may indicate deposits in the region that are emitting into basements.
The screening and guidance levels apply to routine (normal) operational condi-
tions of existing or new drinking-water supplies. They do not apply to a water supply
197
contaminated during an emergency involving the release of radionuclides into the

environment. Guidance and generic action levels covering emergency situations are
available elsewhere (IAEA, 1996, 1997, 1999, 2002).
The current Guidelines are based on:
a recommended reference dose level (RDL) of the committed effective dose, equal
to 0.1 mSv from 1 years consumption of drinking-water (from the possible total
radioactive contamination of the annual drinking-water consumption). This
comprises 10% of the intervention exemption level recommended by the ICRP
for dominant commodities (e.g., food and drinking-water) for prolonged expo-
sure situations, which is most relevant to long-term consumption of drinking-
water by the public (ICRP, 2000). The RDL of 0.1 mSv is also equal to 10% of the
dose limit for members of the population, recommended by both the ICRP (1991)
and the International Basic Safety Standards (IAEA, 1996). These are accepted by
most WHO Member States, the European Commission, FAO and WHO.
dose coefcients for adults, provided by the ICRP.
The additional risk to health from exposure to an annual dose of 0.1 mSv associated
with the intake of radionuclides from drinking-water is considered to be low for the
following reasons:
The nominal probability coefcient for radiation-induced stochastic health effects,

which include fatal cancer, non-fatal cancer and severe hereditary effects for the
whole population, is 7.3 10-2/Sv (ICRP, 1991). Multiplying this by an RDL equal
to 0.1 mSv annual exposure via drinking-water gives an estimated lifetime risk of
stochastic health effects of 10-5, which can be considered small in comparison with
other health risks. This risk level is comparable to the reference level of risk used
elsewhere in these Guidelines.
Background radiation exposures vary widely across the Earth, but the average is
about 2.4 mSv/year, with the highest local levels being up to 10 times higher without
any apparent health consequences; 0.1 mSv therefore represents a small addition to
background levels.
Despite the uncertainties in the determination of risk from radiation exposure at
low levels, radiation risks are probably well below those due to microbes and some
chemicals in drinking-water.
9.1 Sources and health effects of radiation exposure

Environmental radiation originates from a number of naturally occurring and
human-made sources. Radioactive materials occur naturally everywhere in the en-
vironment (e.g., uranium, thorium and potassium-40). By far the largest proportion
of human exposure to radiation comes from natural sources from external sources
of radiation, including cosmic and terrestrial radiation, and from inhalation or inges-
tion of radioactive materials (Figure 9.1). The United Nations Scientic Committee
198
9. RADIOLOGICAL ASPECTS
Radon (natural
internal exposure)
Other artificial 43%
(human-made)
sources
1%
Food, water
(natural internal
exposure)
8%
Earth gamma
radiation
(natural external
exposure)
15%
Medical exposure
20%
Cosmic rays
(natural external exposure)
13%
Figure 9.1 Sources and distribution of average radiation exposure for the world population
on the Effects of Atomic Radiation (UNSCEAR, 2000) has estimated that the global
average annual human exposure from natural sources is 2.4 mSv/year (Table 9.1).
Some sources (e.g., uranium) can be concentrated during extraction by mining and
other industrial activities.
There are large local variations in human exposure to radiation, depending on a
number of factors, such as height above sea level, the amount and type of radio-
nuclides in the soil (terrestrial exposure), the composition of radionuclides in the air,
food and drinking-water and the amount taken into the body via inhalation or inges-
tion. There are certain areas of the world, such as parts of the Kerala state in India
and the Pocos del Caldas plateau in Brazil, where levels of background radiation are
Table 9.1 Average radiation dose from natural sources

Worldwide average
annual effective dose Typical range
Source (mSv) (mSv)
External exposure
Cosmic rays 0.4 0.31.0
Terrestrial gamma raysa 0.5 0.30.6
Internal exposure
Inhalation (mainly radon) 1.2 0.210b
Ingestion (food and drinking-water) 0.3 0.20.8
Total 2.4 110
a
Terrestrial exposure is due to radionuclides in the soil and building materials.
b
Dose from inhalation of radon may exceed 10 mSv/year in certain residential areas.
Source: UNSCEAR (2000).
199
relatively high. Levels of exposure for the general population in such areas may be up
to 10 times higher than the average background level of 2.4 mSv given in Table 9.1.
No deleterious health effects associated with this elevated radiation exposure have
been detected.
Several radioactive compounds may be released into the environment, and hence
into drinking-water supplies, from human activities and human-made sources (e.g.,
from medical or industrial use of radioactive sources). The worldwide per capita effec-
tive dose from diagnostic medical examination in 2000 was 0.4 mSv/year (typical
range is 0.041.0 mSv/year, depending on level of health care). There is only a very
small worldwide contribution from nuclear power production and nuclear weapons
testing. The worldwide annual per capita effective dose from nuclear weapons testing
in 2000 was estimated at 0.005 mSv; from the Chernobyl accident, 0.002 mSv; and
from nuclear power production, 0.0002 mSv (UNSCEAR, 2000).
9.1.1 Radiation exposure through drinking-water

Radioactive constituents of drinking-water can result from:
naturally occurring radioactive species (e.g., radionuclides of the thorium and
uranium decay series in drinking-water sources), in particular radium-226/228
and a few others;
technological processes involving naturally occurring radioactive materials (e.g.,
the mining and processing of mineral sands or phosphate fertilizer production);
radionuclides discharged from nuclear fuel cycle facilities;
manufactured radionuclides (produced and used in unsealed form), which
might enter drinking-water supplies as a result of regular discharges and, in par-
ticular, in case of improper medical or industrial use and disposal of radioac-
tive materials; such incidents are different from emergencies, which are outside
the scope of these Guidelines; and
past releases of radionuclides into the environment, including water sources.
The contribution of drinking-water to total exposure is typically very small and is due
largely to naturally occurring radionuclides in the uranium and thorium decay series.
Radionuclides from the nuclear fuel cycle and from medical and other uses of radio-
active materials may, however, enter drinking-water supplies. The contributions from
these sources are normally limited by regulatory control of the source or practice, and
it is normally through this regulatory mechanism that remedial action should be taken
in the event that such sources cause concern by contaminating drinking-water.
9.1.2 Radiation-induced health effects through drinking-water

There is evidence from both human and animal studies that radiation exposure at low
to moderate doses may increase the long-term incidence of cancer. Animal studies in
particular suggest that the rate of genetic malformations may be increased by radia-
tion exposure.
200
No deleterious radiological health effects are expected from consumption of

drinking-water if the concentrations of radionuclides are below the guidance levels
(equivalent to a committed effective dose below 0.1 mSv/year).
Acute health effects of radiation, leading to reduced blood cell counts and, in very
severe cases, death, occur at very high doses of exposure of the whole body or large
part of the body (IAEA, 1998). Due to the low levels of radionuclides typically found
in drinking-water supplies, acute health effects of radiation are not a concern for
9.2 Units of radioactivity and radiation dose

The SI unit of radioactivity is the becquerel (Bq), where 1 Bq = 1 disintegration per
second. Guidance levels for drinking-water are given as the activity of the radio-
nuclide per litre, called the activity concentration (Bq/litre). The radiation dose
resulting from ingestion of a radionuclide depends on a number of chemical and
biological factors. These include the fraction of the intake that is absorbed from the
gut, the organs or tissues to which the radionuclide is transported and the time during
which the radionuclide remains in the organ or tissue before excretion. The nature of
the radiation emitted on decay and the sensitivity of the irradiated organs or tissues
to radiation must also be considered.
The absorbed dose refers to how much energy is deposited in material by the radi-
ation. The SI unit for absorbed dose is the gray (Gy), where 1 Gy = 1 J/kg (joule per
kilogram).
The equivalent dose is the product of the absorbed dose and a factor related to the
particular type of radiation (depending on the ionizing capacity and density).
The effective dose of radiation received by a person is, in simple terms, the sum of
the equivalent doses received by all tissues or organs, weighted for tissue weighting
factors. These reect different sensitivities to radiation of different organs and tissues
in the human body. The SI unit for the equivalent and effective dose is the sievert (Sv),
where 1 Sv = 1 J/kg.
To reect the persistence of radionuclides in the body once ingested, the committed
effective dose is a measure of the total effective dose received over a lifetime (70 years)
following intake of a radionuclide (internal exposure).
The term dose may be used as a general term to mean either absorbed dose (Gy)
or effective dose (Sv), depending on the situation. For monitoring purposes, doses are
determined from the activity concentration of the radionuclide in a given material.
In the case of water, activity concentration is given in becquerels per litre (Bq/litre).
This value can be related to an effective dose per year (mSv/year) using a dose coef-
cient (mSv/Bq) and the average annual consumption of water (litres/year).
The effective dose arising from the ingestion of a radioisotope in a particular
chemical form can be estimated using a dose coefcient. Data for age-related dose
coefcients for ingestion of radionuclides have been published by the ICRP and the
International Atomic Energy Agency (IAEA). Table 9.2 shows the dose coefcients for
201
Table 9.2 Dose coefcients for ingestion of radionuclides by adult members of the public
Category Radionuclide Dose coefcient (mSv/Bq)
Natural uranium series Uranium-238 4.5 10-5
Uranium-234 4.9 10-5
Thorium-230 2.1 10-4
Radium-226 2.8 10-4
Lead-210 6.9 10-4
Polonium-210 1.2 10-3
Natural thorium series Thorium-232 2.3 10-4
Radium-228 6.9 10-4
Thorium-228 7.2 10-5
Fission products Caesium-134 1.9 10-5
Caesium-137 1.3 10-5
Strontium-90 2.8 10-5
Iodine-131 2.2 10-5
Other radionuclides Tritium 1.8 10-8
Carbon-14 5.8 10-7
Plutonium-239 2.5 10-4
Americium-241 2.0 10-4
naturally occurring radionuclides or those arising from human activities that might
be found in drinking-water supplies (IAEA, 1996; ICRP, 1996).
9.3 Guidance levels for radionuclides in drinking-water

The guidance levels for radionuclides in drinking-water are presented in Table 9.3 for
radionuclides originating from natural sources or discharged into the environment as
the result of current or past activities. These levels also apply to radionuclides released
due to nuclear accidents that occurred more than 1 year previously. The activity con-
centration values in Table 9.3 correspond to an RDL of 0.1 mSv/year from each
radionuclide listed if their concentration in the drinking-water consumed during the
year does not exceed these values. The associated risk estimate was given at the begin-
ning of this chapter. However, for the rst year immediately after an accident, generic
action levels for foodstuffs apply as described in the International Basic Safety
Standards (IAEA, 1996) and other relevant WHO and IAEA publications (WHO,
1988; IAEA, 1997, 1999).
The guidance levels for radionuclides in drinking-water were calculated by the
following equation:
GL = IDC (h ingq )
where:
GL = guidance level of radionuclide in drinking-water (Bq/litre),
IDC = individual dose criterion, equal to 0.1 mSv/year for this calculation,
hing = dose coefcient for ingestion by adults (mSv/Bq),
q = annual ingested volume of drinking-water, assumed to be 730 litres/year.
202
Table 9.3 Guidance levels for radionuclides in drinking-water

Guidance Guidance Guidance
level level level
Radionuclides (Bq/litre)a Radionuclides (Bq/litre)a Radionuclides (Bq/litre)a
3 93 140
H 10 000 Mo 100 La 100
7 99 139
Be 10 000 Mo 100 Ce 1000
14 96 141
C 100 Tc 100 Ce 100
22 97 143
Na 100 Tc 1000 Ce 100
32 97m 144
P 100 Tc 100 Ce 10
33 99 143
P 1 000 Tc 100 Pr 100
35 97 147
S 100 Ru 1000 Nd 100
36 103 147
Cl 100 Ru 100 Pm 1000
45 106 149
Ca 100 Ru 10 Pm 100
47 105 151
Ca 100 Rh 1000 Sm 1000
46 103 153
Sc 100 Pd 1000 Sm 100
47 105 152
Sc 100 Ag 100 Eu 100
48 110m 154
Sc 100 Ag 100 Eu 100
48 111 155
V 100 Ag 100 Eu 1000
51 109 153
Cr 10 000 Cd 100 Gd 1000
52 115 160
Mn 100 Cd 100 Tb 100
53 115m 169
Mn 10 000 Cd 100 Er 1000
54 111 171
Mn 100 In 1000 Tm 1000
55 114m 175
Fe 1 000 In 100 Yb 1000
59 113 182
Fe 100 Sn 100 Ta 100
56 125 181
Co 100 Sn 100 W 1000
57 122 185
Co 1 000 Sb 100 W 1000
58 124 186
Co 100 Sb 100 Re 100
60 125 185
Co 100 Sb 100 Os 100
59 123m 191
Ni 1 000 Te 100 Os 100
63 127 193
Ni 1 000 Te 1000 Os 100
65 127m 190
Zn 100 Te 100 Ir 100
71 129 192
Ge 10 000 Te 1000 Ir 100
73 129m 191
As 1 000 Te 100 Pt 1000
74 131 193m
As 100 Te 1000 Pt 1000
76 131m 198
As 100 Te 100 Au 100
77 132 199
As 1 000 Te 100 Au 1000
75 125 197
Se 100 I 10 Hg 1000
82 126 203
Br 100 I 10 Hg 100
86 129 200
Rb 100 I 1000 Tl 1000
85 131 201
Sr 100 I 10 Tl 1000
89 129 202
Sr 100 Cs 1000 Tl 1000
90 131 204
Sr 10 Cs 1000 Tl 100
90 132 203
Y 100 Cs 100 Pb 1000
91 134 206
Y 100 Cs 10 Bi 100
93 135 207
Zr 100 Cs 100 Bi 100
95 136 210 b
Zr 100 Cs 100 Bi 100
93m 137 210
Nb 1 000 Cs 10 Pbb 0.1
94 131 210
Nb 100 Ba 1000 Pob 0.1
95 140 223
Nb 100 Ba 100 Rab 1
224
Rab 1 235 b
U 1 242
Cm 10
225 236 b 243
Ra 1 U 1 Cm 1
226
Rab 1 237
U 100 244
Cm 1
228
Rab 0.1 238 b,c
U 10 245
Cm 1
continued
203
Table 9.3 Continued

Guidance Guidance Guidance
level level level
Radionuclides (Bq/litre) Radionuclides (Bq/litre) Radionuclides (Bq/litre)
227 b 237 246
Th 10 Np 1 Cm 1
228
Thb 1 239
Np 100 247
Cm 1
229 236 248
Th 0.1 Pu 1 Cm 0.1
230
Thb 1 237
Pu 1000 249
Bk 100
231
Thb 1 000 238
Pu 1 246
Cf 100
232
Thb 1 239
Pu 1 248
Cf 10
234
Thb 100 240
Pu 1 249
Cf 1
230 241 250
Pa 100 Pu 10 Cf 1
231
Pab 0.1 242
Pu 1 251
Cf 1
233 244 252
Pa 100 Pu 1 Cf 1
230 241 253
U 1 Am 1 Cf 100
231 242 254
U 1 000 Am 1000 Cf 1
232 242m 253
U 1 Am 1 Es 10
233 243 254
U 1 Am 1 Es 10
234 b 254m
U 10 Es 100
a
Guidance levels are rounded according to averaging the log scale values (to 10n if the calculated value was below
3 10n and above 3 10n-1).
b
Natural radionuclides.
c
The provisional guideline value for uranium in drinking-water is 15 mg/litre based on its chemical toxicity for the
kidney (see section 8.5).
The higher age-dependent dose coefcients calculated for children (accounting for
the higher uptake and/or metabolic rates) do not lead to signicantly higher doses
due to the lower mean volume of drinking-water consumed by infants and children.
Consequently, the recommended RDL of committed effective dose of 0.1 mSv/year
from 1 years consumption of drinking-water applies independently of age.
9.4 Monitoring and assessment for dissolved radionuclides

9.4.1 Screening of drinking-water supplies
The process of identifying individual radioactive species and determining their con-
centration requires sophisticated and expensive analysis, which is normally not justi-
ed, because the concentrations of radionuclides in most circumstances are very low.
A more practical approach is to use a screening procedure, where the total radioac-
tivity present in the form of alpha and beta radiation is rst determined, without
regard to the identity of specic radionuclides.
Screening levels for drinking-water below which no further action is required are
0.5 Bq/litre for gross alpha activity and 1 Bq/litre for gross beta activity. The gross beta
activity screening level was published in the second edition of the Guidelines and,
in the worse case (radium-222), would lead to a dose close to the guidance RDL of
0.1 mSv/year. The screening level for gross alpha activity is 0.5 Bq/litre (instead of
the former 0.1 Bq/litre), as this activity concentration reects values nearer the
radionuclide-specic guidance RDL.
204
9.4.2 Strategy for assessing drinking-water

If either of the screening levels is exceeded, then the specic radionuclides producing
this activity should be identied and their individual activity concentrations meas-
ured. From these data, an estimate of committed effective dose for each radionuclide
should be made and the sum of these doses determined. If the following additive
formula is satised, no further action is required:
Ci
1
i GLi
where:
Ci = the measured activity concentration of radionuclide i, and
GLi = the guidance level value (see Table 9.3) of radionuclide i that, at an intake of
2 litres/day for 1 year, will result in a committed effective dose of 0.1 mSv/year.
Where the sum exceeds unity for a single sample, the RDL of 0.1 mSv would be
exceeded only if the exposure to the same measured concentrations were to continue
for a full year. Hence, such a sample does not in itself imply that the water is unsuitable
for consumption but should be regarded as an indication that further investigation,
including additional sampling, is needed. Gross beta and gross alpha activity screen-
ing has to be repeated rst, then radionuclide-specic analysis conducted only if sub-
sequently measured gross values exceed the recommended practical screening values
(1 Bq/litre and 0.5 Bq/litre, respectively).
The application of these recommendations is summarized in Figure 9.2.
The gross beta measurement includes a contribution from potassium-40, a beta
emitter that occurs naturally in a xed ratio to stable potassium. Potassium is an essen-
tial element for humans and is absorbed mainly from ingested food. Potassium-40
does not accumulate in the body but is maintained at a constant level independent of
intake. The contribution of potassium-40 to beta activity should therefore be sub-
tracted following a separate determination of total potassium. The specic activity of
potassium-40 is 30.7 Bq/g of potassium. However, not all the radiation from
potassium-40 appears as beta activity. The beta activity of potassium-40 is 27.6 Bq/g
of stable potassium, which is the factor that should be used to calculate the beta
activity due to potassium-40.
9.4.3 Remedial measures

If the RDL of 0.1 mSv/year is being exceeded on aggregate, then the options available
to the competent authority to reduce the dose should be examined. Where remedial
measures are contemplated, any strategy considered should rst be justied (in the
sense that it achieves a net benet) and then optimized in accordance with the
recommendations of ICRP (1989, 1991) in order to produce the maximum net
benet.
205
Determine gross
and gross activity
Gross 0.5 Bq/litre Gross > 0.5 Bq/litre

and or
Gross 1 Bq/litre Gross > 1 Bq/litre
Determine individual
radionuclide concentrations
and compare with
guidance levels
Dose 0.1 mSv Dose > 0.1 mSv
Water suitable, Consider and,

no further action when justified, take
necessary remedial action to
reduce dose
Figure 9.2 Application of screening and guidance levels for radionuclides in drinking-water
9.5 Radon
9.5.1 Radon in air and water
The largest fraction of natural radiation exposure comes from radon, a radioactive
gas (see Table 9.1 and Figure 9.1), due to decay of radium contained in rocks and soil
as part of the uranium radionuclide chain. The term radon in general refers mostly
to radon-222. Radon is present virtually everywhere on Earth, but particularly in the
air over land and in buildings.
Underground rock containing natural uranium continuously releases radon into
water in contact with it (groundwater). Radon is readily released from surface water;
consequently, groundwater normally has much higher concentrations of radon than
surface water. The average concentration of radon is usually less than 0.4 Bq/litre in
public water supplies derived from surface waters and about 20 Bq/litre from ground-
water sources. However, some wells have been identied with higher concentrations,
up to 400 times the average, and in rare cases exceeding 10 kBq/litre.
For assessing the dose from radon ingestion, it is important that water processing
technology before consumption is taken into account. Moreover, the use of some
groundwater supplies for general domestic purposes will increase the levels of radon
in the air, thus increasing the dose from inhalation. This dose depends markedly on
the form of domestic usage and housing construction (NCRP, 1989). The amount and
206
form of water intake, the other domestic uses of water and the construction of houses
vary widely throughout the world.
UNSCEAR (2000) refers to a US NAS (1999) report and calculates the average
doses from radon in drinking water to be as low as 0.025 mSv/year via inhalation and
0.002 mSv/year from ingestion compared with the inhalation dose of 1.1 mSv/year
from radon and its decay products in air.
9.5.2 Risk
One report estimates that 12% of lung cancer deaths in the USA are linked to radon
(radon-222 and its short-lived decay products) in indoor air (US NAS, 1999). Thus,
radon causes about 19 000 deaths (in the range of 15 00022 000) due to lung cancer
annually out of a total of about 160 000 deaths from lung cancer, which are mainly as
a result of smoking tobacco (US NRC, 1999).
US NAS (1999) reports an approximately 100-fold smaller risk from exposure to
radon in drinking-water (i.e., 183 deaths each year). In addition to the 19 000 deaths
from lung cancer caused by radon in indoor air, a further 160 were estimated to result
from inhaling radon that was emitted from water used in the home. For comparison,
about 700 lung cancer deaths each year were attributed to exposure to natural levels
of radon while people are outdoors.
The US NAS (1999) also assessed that the risk of stomach cancer caused by
drinking-water that contains dissolved radon is extremely small, with the probability
of about 20 deaths annually compared with the 13 000 deaths from stomach cancer
that arise each year from other causes in the USA.
9.5.3 Guidance on radon in drinking-water supplies

Controls should be implemented if the radon concentration of drinking-water for
public water supplies exceeds 100 Bq/litre. Any new drinking-water supply should be
tested prior to being used for general consumption. If the radon concentration exceeds
100 Bq/litre, treatment of the water source should be undertaken to reduce the radon
levels to well below 100 Bq/litre. If there are signicant amounts of radon-producing
minerals around the water source, then it may be appropriate for larger drinking-
water supplies to test for radon concentration periodically for example, every 5 years.
9.6 Sampling, analysis and reporting

9.6.1 Measuring gross alpha and gross beta activity concentrations
To analyse drinking-water for gross alpha and gross beta activities (excluding radon),
the most common approach is to evaporate a known volume of the sample to dryness
and measure the activity of the residue. As alpha radiation is easily absorbed within
a thin layer of solid material, the reliability and sensitivity of the method for alpha
determination may be reduced in samples with a high TDS content.
207
Table 9.4 Methods for the analysis of gross alpha and gross beta activities in drinking-water
Method, reference Technique Detection limit Application
International Organization Evaporation 0.020.1 Bq/litre Groundwater with TDS greater
for Standardization: than 0.1 g/litre
ISO-9695 (for gross beta)
ISO-9696 (gross alpha)
(ISO, 1991a, 1991b)
American Public Health Co-precipitation 0.02 Bq/litre Surface water and groundwater
Association (APHA, 1998) (TDS is not a factor)
Where possible, standardized methods should be used to determine concentrations

of gross alpha and gross beta activities. Three procedures for this analysis are listed in
Table 9.4.
The determination of gross beta activity using the evaporation method includes
the contribution from potassium-40. An additional analysis of total potassium is
therefore required if the gross beta screening value is exceeded.
The co-precipitation technique (APHA, 1998) excludes the contribution due to
potassium-40; therefore, determination of total potassium is not necessary. This
method is not applicable to assessment of water samples containing certain ssion
products, such as caesium-137. However, under normal circumstances, concentrations
of ssion products in drinking-water supplies are extremely low.
9.6.2 Measuring potassium-40

It is impractical to use a radioactive measurement technique to determine the con-
centration of potassium-40 in a water sample due to the lack of sensitivity in gamma-
ray analysis and the difculty of chemically isolating the radionuclide from solution.
Because of the xed ratio between potassium-40 and stable potassium, chemical
analysis for potassium is recommended. A measurement sensitivity of 1 mg/litre for
potassium is adequate, and suitable techniques that can readily achieve this are atomic
absorption spectrophotometry and specic ion analysis. The activity due to potas-
sium-40 can then be calculated using a factor of 27.6 Bq of beta activity per gram of
total potassium.
9.6.3 Measuring radon

There are difculties in deriving activity concentrations of radon-222 in drinking-
water arising from the ease with which radon is released from water during handling.
Stirring and transferring water from one container to another will liberate dissolved
radon. According to the widely used Pylon technique (Pylon, 1989, 2003), detection
of radon in drinking-water is performed using a water degassing unit and Lucas scin-
tillation chambers. Water that has been left to stand will have reduced radon activity,
and boiling will remove radon completely.
208
9.6.4 Sampling
New water sources should be sampled (e.g., every 3 months for the rst 12 months)
to determine their suitability for drinking-water supply before design and construc-
tion to characterize the radiological quality of the water supply and to assess any sea-
sonal variation in radionuclide concentrations. This should include analysis for radon
and radon daughters.
Once measurements indicate the normal range of the supply, then the sampling
frequency can be reduced to, for example, annually or every 5 years. However, if
sources of potential radionuclide contamination exist nearby (e.g., mining activity or
nuclear reactors), then sampling should be more frequent. Less signicant surface and
underground water supplies can be sampled less frequently.
Levels of radon and radon daughters in groundwater supplies are usually stable
over time. Monitoring of water for radon and its daughters can therefore be relatively
infrequent. Knowledge of the geology of the area should be considered in determin-
ing whether the source is likely to contain signicant concentrations of radon and
radon daughters. An additional risk factor would be the presence of mining in the
vicinity; in such circumstances, more frequent monitoring may be appropriate.
Guidance on assessing water quality, sampling techniques and programmes and the
preservation and handling of samples is given in the Australian and New Zealand
Standard (AS, 1998).
9.6.5 Reporting of results

The analytical results for each sample should contain the following information:
sample identifying code or information;
reference date and time for the reported results (e.g., sample collection date);
identication of the standard analytical method used or a brief description of
any non-standard method used;
identication of the radionuclide(s) or type and total radioactivity determined;
measurement-based concentration or activity value calculated using the appro-
priate blank for each radionuclide;
estimates of the counting uncertainty and total projected uncertainty; and
minimum detectable concentration for each radionuclide or parameter
analysed.
The estimate of total projected uncertainty of the reported result should include the
contributions from all the parameters within the analytical method (i.e., counting and
other random and systematic uncertainties or errors).
209
10
Acceptability aspects
T he most undesirable constituents of drinking-water are those capable of having

a direct adverse impact on public health. Many of these are described in other
chapters of these Guidelines.
To a large extent, consumers have no means of judging the safety of their
drinking-water themselves, but their attitude towards their drinking-water supply and
their drinking-water suppliers will be affected to a considerable extent by the aspects
of water quality that they are able to perceive with their own senses. It is natural for
consumers to regard with suspicion water that appears dirty or discoloured or that
has an unpleasant taste or smell, even though these characteristics may not in them-
selves be of direct consequence to health.
The provision of drinking-water that is not only safe but also acceptable in appear-
ance, taste and odour is of high priority.
Water that is aesthetically unacceptable
The appearance, taste and odour of
will undermine the condence of con-
drinking-water should be acceptable to
sumers, lead to complaints and, more the consumer.
importantly, possibly lead to the use of
water from sources that are less safe.
It is important to consider whether existing or proposed water treatment and
distribution practices can affect the acceptability of drinking-water. For example, a
change in disinfection practice may generate an odorous compound such as trichlo-
ramine in the treated water. Other effects may be indirect, such as the disturbance of
internal pipe deposits and biolms when changing between or blending waters from
different sources in distribution systems.
The acceptability of drinking-water to consumers is subjective and can be inu-
enced by many different constituents. The concentration at which constituents are
objectionable to consumers is variable and dependent on individual and local factors,
including the quality of the water to which the community is accustomed and a variety
of social, environmental and cultural considerations. Guideline values have not been
established for constituents inuencing water quality that have no direct link to
adverse health impacts.
210
10
Acceptability aspects
T he most undesirable constituents of drinking-water are those capable of having

a direct adverse impact on public health. Many of these are described in other
chapters of these Guidelines.
To a large extent, consumers have no means of judging the safety of their
drinking-water themselves, but their attitude towards their drinking-water supply and
their drinking-water suppliers will be affected to a considerable extent by the aspects
of water quality that they are able to perceive with their own senses. It is natural for
consumers to regard with suspicion water that appears dirty or discoloured or that
has an unpleasant taste or smell, even though these characteristics may not in them-
selves be of direct consequence to health.
The provision of drinking-water that is not only safe but also acceptable in appear-
ance, taste and odour is of high priority.
Water that is aesthetically unacceptable
The appearance, taste and odour of
will undermine the condence of con-
drinking-water should be acceptable to
sumers, lead to complaints and, more the consumer.
importantly, possibly lead to the use of
water from sources that are less safe.
It is important to consider whether existing or proposed water treatment and
distribution practices can affect the acceptability of drinking-water. For example, a
change in disinfection practice may generate an odorous compound such as trichlo-
ramine in the treated water. Other effects may be indirect, such as the disturbance of
internal pipe deposits and biolms when changing between or blending waters from
different sources in distribution systems.
The acceptability of drinking-water to consumers is subjective and can be inu-
enced by many different constituents. The concentration at which constituents are
objectionable to consumers is variable and dependent on individual and local factors,
including the quality of the water to which the community is accustomed and a variety
of social, environmental and cultural considerations. Guideline values have not been
established for constituents inuencing water quality that have no direct link to
adverse health impacts.
210
10. ACCEPTABILITY ASPECTS
In the summaries in this chapter and chapter 12, reference is made to levels likely
to give rise to complaints from consumers. These are not precise numbers, and
problems may occur at lower or higher levels, depending on individual and local
circumstances.
It is not normally appropriate to directly regulate or monitor substances of health
concern whose effects on the acceptability of water would normally lead to rejection
of the water at concentrations signicantly lower than those of concern for health;
rather, these substances may be addressed through a general requirement that water
be acceptable to the majority of consumers. For such substances, a health-based
summary statement and guideline value are derived in these Guidelines in the usual
way. In the summary statement, this is explained, and information on acceptability is
described. In the tables of guideline values (see chapter 8 and Annex 4), the health-
based guideline value is designated with a C, with a footnote explaining that while
the substance is of health signicance, water would normally be rejected by consumers
at concentrations well below the health-based guideline value. Monitoring of such
substances should be undertaken in response to consumer complaints.
There are other water constituents that are of no direct consequence to health at
the concentrations at which they normally occur in water but which nevertheless may
be objectionable to consumers for various reasons.
10.1 Taste, odour and appearance

Taste and odour can originate from natural inorganic and organic chemical con-
taminants and biological sources or processes (e.g., aquatic microorganisms), from
contamination by synthetic chemicals, from corrosion or as a result of water treat-
ment (e.g., chlorination). Taste and odour may also develop during storage and dis-
tribution due to microbial activity.
Taste and odour in drinking-water may be indicative of some form of pollution or
of a malfunction during water treatment or distribution. It may therefore be an
indication of the presence of potentially harmful substances. The cause should be
investigated and the appropriate health authorities should be consulted, particularly
if there is a sudden or substantial change.
Colour, cloudiness, particulate matter and visible organisms may also be noticed
by consumers and may create concerns about the quality and acceptability of a
drinking-water supply.
10.1.1 Biologically derived contaminants

There are a number of diverse organisms that may have no public health signicance
but which are undesirable because they produce taste and odour. As well as affecting
the acceptability of the water, they indicate that water treatment and/or the state of
maintenance and repair of the distribution system are insufcient.
211
Actinomycetes and fungi

Actinomycetes and fungi can be abundant in surface water sources, including reser-
voirs, and they also can grow on unsuitable materials in the water supply distribution
systems, such as rubber. They can give rise to geosmin, 2-methyl isoborneol and other
substances, resulting in objectionable tastes and odours in the drinking-water.
Animal life1
Invertebrate animals are naturally present in many water resources used as sources for
the supply of drinking-water and often infest shallow, open wells. Small numbers of
invertebrates may also pass through water treatment works where the barriers to par-
ticulate matter are not completely effective and colonize the distribution system. Their
motility may enable them and their larvae to penetrate lters at the treatment works
and vents on storage reservoirs.
The types of animal concerned can be considered, for control purposes, as belong-
ing to two groups. First, there are free-swimming organisms in the water itself or
on water surfaces, such as the crustaceans Gammarus pulex (freshwater shrimp),
Crangonyx pseudogracilis, Cyclops spp. and Chydorus sphaericus. Second, there are
other animals that either move along surfaces or are anchored to them (e.g., water
louse Asellus aquaticus, snails, zebra mussel Dreissena polymorpha, other bivalve mol-
luscs and the bryozoan Plumatella sp.) or inhabit slimes (e.g., Nais spp., nematodes
and the larvae of chironomids). In warm weather, slow sand lters can sometimes
discharge the larvae of gnats (Chironomus and Culex spp.) into the water.
Many of these animals can survive, deriving food from bacteria, algae and pro-
tozoa in the water or present on slimes on pipe and tank surfaces. Few, if any, water
distribution systems are completely free of animals. However, the density and com-
position of animal populations vary widely, from heavy infestations, including readily
visible species that are objectionable to consumers, to sparse occurrences of micro-
scopic species.
The presence of animals has largely been regarded by piped drinking-water sup-
pliers in temperate regions as an acceptability problem, either directly or through their
association with discoloured water. In tropical and subtropical countries, on the other
hand, there are species of aquatic animal that act as secondary hosts for parasites. For
example, the small crustacean Cyclops is the intermediate host of the guinea worm
Dracunculus medinensis (see sections 7.1.1 and 11.4). However, there is no evidence
that guinea worm transmission occurs from piped drinking-water supplies. The
presence of animals in drinking-water, especially if visible, raises consumer concern
about the quality of the drinking-water supply and should be controlled.
Penetration of waterworks and mains is more likely to be a problem when low-
quality raw waters are abstracted and high-rate ltration processes are used.
Pre-chlorination assists in destroying animal life and in its removal by ltration.
1
The section was drawn largely from Evins (2004).
212
Production of high-quality water, maintenance of chlorine residuals in the distribu-

tion system and the regular cleaning of water mains by ushing or swabbing will
usually control infestation.
Treatment of invertebrate infestations in piped distribution systems is discussed in
detail in chapter 6 of the supporting document Safe, Piped Water (section 1.3).
Cyanobacteria and algae

Blooms of cyanobacteria and other algae in reservoirs and in river waters may impede
coagulation and ltration, causing coloration and turbidity of water after ltration.
They can also give rise to geosmin, 2-methyl isoborneol and other chemicals, which
have taste thresholds in drinking-water of a few nanograms per litre. Some cyanobac-
terial products cyanotoxins are also of direct health signicance (see section
8.5.6).
Iron bacteria
In waters containing ferrous and manganous salts, oxidation by iron bacteria (or by
exposure to air) may cause rust-coloured deposits on the walls of tanks, pipes and
channels and carry-over of deposits into the water.
10.1.2 Chemically derived contaminants

Aluminium
Naturally occurring aluminium as well as aluminium salts used as coagulants in
drinking-water treatment are the most common sources of aluminium in drinking-
water. The presence of aluminium at concentrations in excess of 0.10.2 mg/litre often
leads to consumer complaints as a result of deposition of aluminium hydroxide oc
in distribution systems and the exacerbation of discoloration of water by iron. It is
therefore important to optimize treatment processes in order to minimize any resid-
ual aluminium entering the supply. Under good operating conditions, aluminium
concentrations of less than 0.1 mg/litre are achievable in many circumstances. Avail-
able evidence does not support the derivation of a health-based guideline value for
aluminium in drinking-water (see sections 8.5.4 and 12.5).
Ammonia
The threshold odour concentration of ammonia at alkaline pH is approximately
1.5 mg/litre, and a taste threshold of 35 mg/litre has been proposed for the ammo-
nium cation. Ammonia is not of direct relevance to health at these levels, and no
health-based guideline value has been proposed (see sections 8.5.3 and 12.6).
Chloride
High concentrations of chloride give a salty taste to water and beverages. Taste thresh-
olds for the chloride anion depend on the associated cation and are in the range of
200300 mg/litre for sodium, potassium and calcium chloride. Concentrations in
213
excess of 250 mg/litre are increasingly likely to be detected by taste, but some con-
sumers may become accustomed to low levels of chloride-induced taste. No health-
based guideline value is proposed for chloride in drinking-water (see sections 8.5.4
and 12.22).
Chlorine
Most individuals are able to taste or smell chlorine in drinking-water at concentra-
tions well below 5 mg/litre, and some at levels as low as 0.3 mg/litre. At a residual free
chlorine concentration of between 0.6 and 1.0 mg/litre, there is an increasing likeli-
hood that some consumers may object to the taste. The taste threshold for chlorine
is below the health-based guideline value (see sections 8.5.4 and 12.23).
Chlorophenols
Chlorophenols generally have very low taste and odour thresholds. The taste thresh-
olds in water for 2-chlorophenol, 2,4-dichlorophenol and 2,4,6-trichlorophenol are
0.1, 0.3 and 2 mg/litre, respectively. Odour thresholds are 10, 40 and 300 mg/litre,
respectively. If water containing 2,4,6-trichlorophenol is free from taste, it is unlikely
to present a signicant risk to health (see section 12.26). Microorganisms in distri-
bution systems may sometimes methylate chlorophenols to produce chlorinated
anisoles, for which the odour threshold is considerably lower.
Colour
Drinking-water should ideally have no visible colour. Colour in drinking-water is
usually due to the presence of coloured organic matter (primarily humic and fulvic
acids) associated with the humus fraction of soil. Colour is also strongly inuenced
by the presence of iron and other metals, either as natural impurities or as corrosion
products. It may also result from the contamination of the water source with indus-
trial efuents and may be the rst indication of a hazardous situation. The source of
colour in a drinking-water supply should be investigated, particularly if a substantial
change has taken place.
Most people can detect colours above 15 true colour units (TCU) in a glass of water.
Levels of colour below 15 TCU are usually acceptable to consumers, but acceptability
may vary. High colour could also indicate a high propensity to produce by-products
from disinfection processes. No health-based guideline value is proposed for colour
in drinking-water.
Copper
Copper in a drinking-water supply usually arises from the corrosive action of water
leaching copper from copper pipes. Concentrations can vary signicantly with the
period of time the water has been standing in contact with the pipes; for example,
rst-draw water would be expected to have a higher copper concentration than a fully
ushed sample. High concentrations can interfere with the intended domestic uses of
214
the water. Copper in drinking-water may increase the corrosion of galvanized iron
and steel ttings. Staining of laundry and sanitary ware occurs at copper concentra-
tions above 1 mg/litre. At levels above 5 mg/litre, copper also imparts a colour and an
undesirable bitter taste to water. Although copper can give rise to taste, it should be
acceptable at the health-based guideline value (see sections 8.5.4 and 12.31).
Dichlorobenzenes
Odour thresholds of 210 and 0.330 mg/litre have been reported for 1,2- and 1,4-
dichlorobenzene, respectively. Taste thresholds of 1 and 6 mg/litre have been reported
for 1,2- and 1,4-dichlorobenzene, respectively. The health-based guideline values
derived for 1,2- and 1,4-dichlorobenzene (see sections 8.5.4 and 12.42) far exceed the
lowest reported taste and odour thresholds for these compounds.
Dissolved oxygen
The dissolved oxygen content of water is inuenced by the source, raw water temper-
ature, treatment and chemical or biological processes taking place in the distribution
system. Depletion of dissolved oxygen in water supplies can encourage the microbial
reduction of nitrate to nitrite and sulfate to sulde. It can also cause an increase in the
concentration of ferrous iron in solution, with subsequent discoloration at the tap
when the water is aerated. No health-based guideline value is recommended.
Ethylbenzene
Ethylbenzene has an aromatic odour; the reported odour threshold in water ranges
from 2 to 130 mg/litre. The lowest reported odour threshold is 100-fold lower than the
health-based guideline value (see sections 8.5.4 and 12.60). The taste threshold ranges
from 72 to 200 mg/litre.
Hardness
Hardness caused by calcium and magnesium is usually indicated by precipitation of
soap scum and the need for excess use of soap to achieve cleaning. Public acceptabil-
ity of the degree of hardness of water may vary considerably from one community to
another, depending on local conditions. In particular, consumers are likely to notice
changes in hardness.
The taste threshold for the calcium ion is in the range of 100300 mg/litre, depend-
ing on the associated anion, and the taste threshold for magnesium is probably lower
than that for calcium. In some instances, consumers tolerate water hardness in excess
of 500 mg/litre.
Depending on the interaction of other factors, such as pH and alkalinity, water with
a hardness above approximately 200 mg/litre may cause scale deposition in the treat-
ment works, distribution system and pipework and tanks within buildings. It will also
result in excessive soap consumption and subsequent scum formation. On heating,
hard waters form deposits of calcium carbonate scale. Soft water, with a hardness of
215
less than 100 mg/litre, may, on the other hand, have a low buffering capacity and so
be more corrosive for water pipes.
No health-based guideline value is proposed for hardness in drinking-water.
Hydrogen sulde
The taste and odour thresholds of hydrogen sulde in water are estimated to be
between 0.05 and 0.1 mg/litre. The rotten eggs odour of hydrogen sulde is par-
ticularly noticeable in some groundwaters and in stagnant drinking-water in the
distribution system, as a result of oxygen depletion and the subsequent reduction of
sulfate by bacterial activity.
Sulde is oxidized rapidly to sulfate in well aerated or chlorinated water, and hydro-
gen sulde levels in oxygenated water supplies are normally very low. The presence of
hydrogen sulde in drinking-water can be easily detected by the consumer and
requires immediate corrective action. It is unlikely that a person could consume a
harmful dose of hydrogen sulde from drinking-water, and hence a health-based
guideline value has not been derived for this compound (see sections 8.5.1 and 12.71).
Iron
Anaerobic groundwater may contain ferrous iron at concentrations of up to several
milligrams per litre without discoloration or turbidity in the water when directly
pumped from a well. On exposure to the atmosphere, however, the ferrous iron oxi-
dizes to ferric iron, giving an objectionable reddish-brown colour to the water.
Iron also promotes the growth of iron bacteria, which derive their energy from
the oxidation of ferrous iron to ferric iron and in the process deposit a slimy coating
on the piping. At levels above 0.3 mg/litre, iron stains laundry and plumbing xtures.
There is usually no noticeable taste at iron concentrations below 0.3 mg/litre, although
turbidity and colour may develop. No health-based guideline value is proposed for
iron (see sections 8.5.4 and 12.74).
Manganese
At levels exceeding 0.1 mg/litre, manganese in water supplies causes an undesirable
taste in beverages and stains sanitary ware and laundry. The presence of manganese
in drinking-water, like that of iron, may lead to the accumulation of deposits in the
distribution system. Concentrations below 0.1 mg/litre are usually acceptable to con-
sumers. Even at a concentration of 0.2 mg/litre, manganese will often form a coating
on pipes, which may slough off as a black precipitate. The health-based guideline value
for manganese is 4 times higher than this acceptability threshold of 0.1 mg/litre (see
sections 8.5.1 and 12.79).
Monochloramine
Most individuals are able to taste or smell monochloramine, generated from the
reaction of chlorine with ammonia, in drinking-water at concentrations well below
216
5 mg/litre, and some at levels as low as 0.3 mg/litre. The taste threshold for mono-
chloramine is below the health-based guideline value (see sections 8.5.4 and 12.89).
Monochlorobenzene
Taste and odour thresholds of 1020 mg/litre and odour thresholds ranging from 40
to 120 mg/litre have been reported for monochlorobenzene. A health-based guideline
value has not been derived for monochlorobenzene (see sections 8.5.4 and 12.91),
although the health-based value that could be derived far exceeds the lowest reported
taste and odour threshold in water.
Petroleum oils
Petroleum oils can give rise to the presence of a number of low molecular weight
hydrocarbons that have low odour thresholds in drinking-water. Although there are
no formal data, experience indicates that these may have lower odour thresholds when
several are present as a mixture. Benzene, toluene, ethylbenzene and xylenes are con-
sidered individually in this section, as health-based guideline values have been derived
for these chemicals. However, a number of other hydrocarbons, particularly alkyl-
benzenes such as trimethylbenzene, may give rise to a very unpleasant diesel-like
odour at concentrations of a few micrograms per litre.
pH and corrosion
Although pH usually has no direct impact on consumers, it is one of the most impor-
tant operational water quality parameters. Careful attention to pH control is neces-
sary at all stages of water treatment to ensure satisfactory water clarication and
disinfection (see the supporting document Safe, Piped Water; section 1.3). For effec-
tive disinfection with chlorine, the pH should preferably be less than 8; however,
lower-pH water is likely to be corrosive. The pH of the water entering the distribu-
tion system must be controlled to minimize the corrosion of water mains and pipes
in household water systems. Alkalinity and calcium management also contribute to
the stability of water and control its aggressiveness to pipe and appliance. Failure to
minimize corrosion can result in the contamination of drinking-water and in adverse
effects on its taste and appearance. The optimum pH required will vary in different
supplies according to the composition of the water and the nature of the construc-
tion materials used in the distribution system, but it is usually in the range 6.58.
Extreme values of pH can result from accidental spills, treatment breakdowns and
insufciently cured cement mortar pipe linings or cement mortar linings applied
when the alkalinity of the water is low. No health-based guideline value has been pro-
posed for pH (see sections 8.5.1 and 12.100).
Sodium
The taste threshold concentration of sodium in water depends on the associated anion
and the temperature of the solution. At room temperature, the average taste thresh-
217
old for sodium is about 200 mg/litre. No health-based guideline value has been derived
(see sections 8.5.1 and 12.108).
Styrene
Styrene has a sweet odour, and reported odour thresholds for styrene in water range
from 4 to 2600 mg/litre, depending on temperature. Styrene may therefore be detected
in water at concentrations below its health-based guideline value (see sections 8.5.2
and 12.109).
Sulfate
The presence of sulfate in drinking-water can cause noticeable taste, and very high
levels might cause a laxative effect in unaccustomed consumers. Taste impairment
varies with the nature of the associated cation; taste thresholds have been found to
range from 250 mg/litre for sodium sulfate to 1000 mg/litre for calcium sulfate. It is
generally considered that taste impairment is minimal at levels below 250 mg/litre. No
health-based guideline value has been derived for sulfate (see sections 8.5.1 and
12.110).
Synthetic detergents
In many countries, persistent types of anionic detergent have been replaced by others
that are more easily biodegraded, and hence the levels found in water sources have
decreased substantially. The concentration of detergents in drinking-water should
not be allowed to reach levels giving rise to either foaming or taste problems. The
presence of any detergent may indicate sanitary contamination of source water.
Toluene
Toluene has a sweet, pungent, benzene-like odour. The reported taste threshold ranges
from 40 to 120 mg/litre. The reported odour threshold for toluene in water ranges from
24 to 170 mg/litre. Toluene may therefore affect the acceptability of water at concen-
trations below its health-based guideline value (see sections 8.5.2 and 12.114).
Total dissolved solids

The palatability of water with a TDS level of less than 600 mg/litre is generally con-
sidered to be good; drinking-water becomes signicantly and increasingly unpalat-
able at TDS levels greater than about 1000 mg/litre. The presence of high levels of TDS
may also be objectionable to consumers, owing to excessive scaling in water pipes,
heaters, boilers and household appliances. No health-based guideline value for TDS
has been proposed (see sections 8.5.1 and 12.115).
Trichlorobenzenes
Odour thresholds of 10, 530 and 50 mg/litre have been reported for 1,2,3-, 1,2,4- and
1,3,5-trichlorobenzene, respectively. A taste and odour threshold concentration of
218
30 mg/litre has been reported for 1,2,4-trichlorobenzene. A health-based guideline

value was not derived for trichlorobenzenes, although the health-based value that
could be derived (see sections 8.5.2 and 12.117) exceeds the lowest reported odour
threshold in water of 5 mg/litre.
Turbidity
Turbidity in drinking-water is caused by particulate matter that may be present from
source water as a consequence of inadequate ltration or from resuspension of sedi-
ment in the distribution system. It may also be due to the presence of inorganic par-
ticulate matter in some groundwaters or sloughing of biolm within the distribution
system. The appearance of water with a turbidity of less than 5 NTU is usually accept-
able to consumers, although this may vary with local circumstances.
Particulates can protect microorganisms from the effects of disinfection and can
stimulate bacterial growth. In all cases where water is disinfected, the turbidity must
be low so that disinfection can be effective. The impact of turbidity on disinfection
efciency is discussed in more detail in section 4.1.
Turbidity is also an important operational parameter in process control and can
indicate problems with treatment processes, particularly coagulation/sedimentation
and ltration.
No health-based guideline value for turbidity has been proposed; ideally, however,
median turbidity should be below 0.1 NTU for effective disinfection, and changes in
turbidity are an important process control parameter.
Xylenes
Xylene concentrations in the range of 300 mg/litre produce a detectable taste and
odour. The odour threshold for xylene isomers in water has been reported to range
from 20 to 1800 mg/litre. The lowest odour threshold is well below the health-based
guideline value derived for the compound (see sections 8.5.2 and 12.124).
Zinc
Zinc imparts an undesirable astringent taste to water at a taste threshold concentra-
tion of about 4 mg/litre (as zinc sulfate). Water containing zinc at concentrations in
excess of 35 mg/litre may appear opalescent and develop a greasy lm on boiling.
Although drinking-water seldom contains zinc at concentrations above 0.1 mg/litre,
levels in tap water can be considerably higher because of the zinc used in older gal-
vanized plumbing materials. No health-based guideline value has been proposed for
zinc in drinking-water (see sections 8.5.4 and 12.125).
10.1.3 Treatment of taste, odour and appearance problems

The following water treatment techniques are generally effective in removing organic
chemicals that cause tastes and odours:
219
aeration (see section 8.4.6);

activated carbon (GAC or PAC) (see section 8.4.8); and
ozonation (see section 8.4.3).
Tastes and odours caused by disinfectants and DBPs are best controlled through
careful operation of the disinfection process. In principle, they can be removed by
activated carbon.
Manganese can be removed by chlorination followed by ltration. Techniques for
removing hydrogen sulde include aeration, GAC, ltration and oxidation. Ammonia
can be removed by biological nitrication. Precipitation softening or cation exchange
can reduce hardness. Other taste- and odour-causing inorganic chemicals (e.g.,
chloride and sulfate) are generally not amenable to treatment (see the supporting
document Chemical Safety of Drinking-water; section 1.3).
10.2 Temperature
Cool water is generally more palatable than warm water, and temperature will impact
on the acceptability of a number of other inorganic constituents and chemical con-
taminants that may affect taste. High water temperature enhances the growth of
microorganisms and may increase taste, odour, colour and corrosion problems.
220
11
Microbial fact sheets
F act sheets are provided on potential waterborne pathogens as well as on indicator

and index microorganisms.
The potential waterborne pathogens include:
bacteria, viruses, protozoa and helminths identied in Table 7.1 and Figure 7.1,
with the exception of Schistosoma, which is primarily spread by contact with
contaminated surface water during bathing and washing;
potentially emerging pathogens, including Helicobacter pylori, Tsukamurella,
Isospora belli and microsporidia, for which waterborne transmission is plausi-
ble but unconrmed;
Bacillus, which includes the foodborne pathogenic species Bacillus cereus but for
which there is no evidence at this time of waterborne transmission; and
hazardous cyanobacteria.
The human health effects caused by waterborne transmission vary in severity from
mild gastroenteritis to severe and sometimes fatal diarrhoea, dysentery, hepatitis and
typhoid fever. Contaminated water can be the source of large outbreaks of disease,
including cholera, dysentery and cryptosporidiosis; for the majority of waterborne
pathogens, however, there are other important sources of infection, such as person-
to-person contact and food.
Most waterborne pathogens are introduced into drinking-water supplies in human
or animal faeces, do not grow in water and initiate infection in the gastrointestinal
tract following ingestion. However, Legionella, atypical mycobacteria, Burkholderia
pseudomallei and Naegleria fowleri are environmental organisms that can grow in
water and soil. Besides ingestion, other routes of transmission can include inhalation,
leading to infections of the respiratory tract (e.g., Legionella, atypical mycobacteria),
and contact, leading to infections at sites as diverse as the skin and brain (e.g.,
Naegleria fowleri, Burkholderia pseudomallei).
Of all the waterborne pathogens, the helminth Dracunculus medinensis is
unique in that it is the only pathogen that is solely transmitted through drinking-
water.
221
The fact sheets on potential pathogens include information on human health

effects, sources and occurrence, routes of transmission and the signicance of drink-
ing-water as a source of infection. The fact sheets on microorganisms that can be used
as indicators of the effectiveness of control measures or as indices for the potential
presence of pathogenic microorganisms provide information on indicator value,
source and occurrence, application and signicance of detection.
11.1 Bacterial pathogens

Most bacterial pathogens potentially transmitted by water infect the gastrointestinal
tract and are excreted in the faeces of infected humans and other animals. However,
there are also some waterborne bacterial pathogens, such as Legionella, Burkholderia
pseudomallei and atypical mycobacteria, that can grow in water and soil. The routes
of transmission of these bacteria include inhalation and contact (bathing), with infec-
tions occurring in the respiratory tract, in skin lesions or in the brain.
11.1.1 Acinetobacter
General description
Acinetobacter spp. are Gram-negative, oxidase-negative, non-motile coccobacilli
(short plump rods). Owing to difculties in naming individual species and biovars,
the term Acinetobacter calcoaceticus baumannii complex is used in some classication
schemes to cover all subgroups of this species, such as A. baumannii, A. iwofi and A.
junii.
Human health effects

Acinetobacter spp. are usually commensal organisms, but they occasionally cause
infections, predominantly in susceptible patients in hospitals. They are opportunistic
pathogens that may cause urinary tract infections, pneumonia, bacteraemia, second-
ary meningitis and wound infections. These diseases are predisposed by factors
such as malignancy, burns, major surgery and weakened immune systems, such as in
neonates and elderly individuals. The emergence and rapid spread of multidrug-
resistant A. calcoaceticus baumannii complex, causing nosocomial infections, are of
concern in health care facilities.
Source and occurrence

Acinetobacter spp. are ubiquitous inhabitants of soil, water and sewage environments.
Acinetobacter has been isolated from 97% of natural surface water samples in numbers
of up to 100/ml. The organisms have been found to represent 1.05.5% of the HPC
ora in drinking-water samples and have been isolated from 592% of distribution
water samples. In a survey of untreated groundwater supplies in the USA, Acineto-
bacter spp. were detected in 38% of the groundwater supplies at an arithmetic mean
density of 8/100 ml. The study also revealed that slime production, a virulence factor
for A. calcoaceticus, was not signicantly different between well water isolates and
222
11. MICROBIAL FACT SHEETS
clinical strains, suggesting some degree of pathogenic potential for strains isolated
from groundwater. Acinetobacter spp. are part of the natural microbial ora of the
skin and occasionally the respiratory tract of healthy individuals.
Routes of exposure
Environmental sources within hospitals and person-to-person transmission are the
likely sources for most outbreaks of hospital infections. Infection is most commonly
associated with contact with wounds and burns or inhalation by susceptible individ-
uals. In patients with Acinetobacter bacteraemia, intravenous catheters have also been
identied as a source of infection. Outbreaks of infection have been associated with
water baths and room humidiers. Ingestion is not a usual source of infection.
Signicance in drinking-water
While Acinetobacter spp. are often detected in treated drinking-water supplies, an asso-
ciation between the presence of Acinetobacter spp. in drinking-water and clinical
disease has not been conrmed. There is no evidence of gastrointestinal infection
through ingestion of Acinetobacter spp. in drinking-water among the general popula-
tion. However, transmission of non-gastrointestinal infections by drinking-water may
be possible in susceptible individuals, particularly in settings such as health care facil-
ities and hospitals. As discussed in chapter 6, specic WSPs should be developed for
buildings, including hospitals and other health care facilities. These plans need to
take account of particular sensitivities of occupants. Acinetobacter spp. are sensitive
to disinfectants such as chlorine, and numbers will be low in the presence of a dis-
infectant residual. Control measures that can limit growth of the bacteria in distri-
bution systems include treatment to optimize organic carbon removal, restriction
of the residence time of water in distribution systems and maintenance of dis-
infectant residuals. Acinetobacter spp. are detected by HPC, which can be used
together with parameters such as disinfectant residuals to indicate conditions that
could support growth of these organisms. However, E. coli (or, alternatively, thermo-
tolerant coliforms) cannot be used as an index for the presence/absence of Acineto-
bacter spp.
Selected bibliography
Bartram J et al., eds. (2003) Heterotrophic plate counts and drinking-water safety: the
signicance of HPCs for water quality and human health. WHO Emerging Issues in
Water and Infectious Disease Series. London, IWA Publishing.
Bergogne-Berezin E, Towner KJ (1996) Acinetobacter as nosocomial pathogens: micro-
biological, clinical and epidemiological features. Clinical Microbiology Reviews,
9:148165.
Bifulco JM, Shirey JJ, Bissonnette GK (1989) Detection of Acinetobacter spp. in rural
drinking water supplies. Applied and Environmental Microbiology, 55:2214
2219.
223
Jellison TK, McKinnon PS, Rybak MJ (2001) Epidemiology, resistance and outcomes
of Acinetobacter baumannii bacteremia treated with imipenem-cilastatin or
ampicillin-sulbactam. Pharmacotherapy, 21:142148.
Rusin PA et al. (1997) Risk assessment of opportunistic bacterial pathogens in drink-
ing-water. Reviews of Environmental Contamination and Toxicology, 152:5783.
11.1.2 Aeromonas
General description
Aeromonas spp. are Gram-negative, non-spore-forming, facultative anaerobic bacilli
belonging to the family Vibrionaceae. They bear many similarities to the Enterobac-
teriaceae. The genus is divided into two groups. The group of psychrophilic non-
motile aeromonads consists of only one species, A. salmonicida, an obligate sh
pathogen that is not considered further here. The group of mesophilic motile (single
polar agellum) aeromonads is considered of potential human health signicance and
consists of the species A. hydrophila, A. caviae, A. veronii subsp. sobria, A. jandaei, A.
veronii subsp. veronii and A. schubertii. The bacteria are normal inhabitants of fresh
water and occur in water, soil and many foods, particularly meat and milk.

Aeromonas spp. can cause infections in humans, including septicaemia, particularly
in immunocompromised patients, wound infections and respiratory tract infections.
There have been some claims that Aeromonas spp. can cause gastrointestinal illness,
but epidemiological evidence is not consistent. Despite marked toxin production by
Aeromonas spp. in vitro, diarrhoea has not yet been introduced in test animals or
human volunteers.

Aeromonas spp. occur in water, soil and food, particularly meat, sh and milk.
Aeromonas spp. are generally readily found in most fresh waters, and they have been
detected in many treated drinking-water supplies, mainly as a result of growth in dis-
tribution systems. The factors that affect the occurrence of Aeromonas spp. in water
distribution systems are not fully understood, but organic content, temperature, the
residence time of water in the distribution network and the presence of residual
chlorine have been shown to inuence population sizes.
Routes of exposure
Wound infections have been associated with contaminated soil and water-related
activities, such as swimming, diving, boating and shing. Septicaemia can follow from
such wound infections. In immunocompromised individuals, septicaemia may arise
from aeromonads present in their own gastrointestinal tract.
224
Despite frequent isolation of Aeromonas spp. from drinking-water, the body of
evidence does not provide signicant support for waterborne transmission.
Aeromonads typically found in drinking-water do not belong to the same DNA
homology groups as those associated with cases of gastroenteritis. The presence of
Aeromonas spp. in drinking-water supplies is generally considered a nuisance. Entry
of aeromonads into distribution systems can be minimized by adequate disinfection.
Control measures that can limit growth of the bacteria in distribution systems include
treatment to optimize organic carbon removal, restriction of the residence time of
water in distribution systems and maintenance of disinfectant residuals. Aeromonas
spp. are detected by HPC, which can be used together with parameters such as disin-
fectant residuals to indicate conditions that could support growth of these organisms.
However, E. coli (or, alternatively, thermotolerant coliforms) cannot be used as an
index for the presence/absence of Aeromonas spp.
Borchardt MA, Stemper ME, Standridge JH (2003) Aeromonas isolates from human
diarrheic stool and groundwater compared by pulsed-eld gel electrophoresis.
Emerging Infectious Diseases, 9:224228.
WHO (2002) Aeromonas. In: Guidelines for drinking-water quality, 2nd ed. Addendum:
Microbiological agents in drinking water. Geneva, World Health Organization.
11.1.3 Bacillus
General description
Bacillus spp. are large (410 mm), Gram-positive, strictly aerobic or facultatively anaer-
obic encapsulated bacilli. They have the important feature of producing spores that
are exceptionally resistant to unfavourable conditions. Bacillus spp. are classied into
the subgroups B. polymyxa, B. subtilis (which includes B. cereus and B. licheniformis),
B. brevis and B. anthracis.

Although most Bacillus spp. are harmless, a few are pathogenic to humans and
animals. Bacillus cereus causes food poisoning similar to staphylococcal food poison-
ing. Some strains produce heat-stable toxin in food that is associated with spore
germination and gives rise to a syndrome of vomiting within 15 h of ingestion. Other
strains produce a heat-labile enterotoxin after ingestion that causes diarrhoea within
1015 h. Bacillus cereus is known to cause bacteraemia in immunocompromised
patients as well as symptoms such as vomiting and diarrhoea. Bacillus anthracis causes
anthrax in humans and animals.
225

Bacillus spp. commonly occur in a wide range of natural environments, such as soil
and water. They form part of the HPC bacteria, which are readily detected in most
Routes of exposure
Infection with Bacillus spp. is associated with the consumption of a variety of foods,
especially rice, pastas and vegetables, as well as raw milk and meat products. Disease
may result from the ingestion of the organisms or toxins produced by the organisms.
Drinking-water has not been identied as a source of infection of pathogenic Bacil-
lus spp., including Bacillus cereus. Waterborne transmission of Bacillus gastroenteritis
has not been conrmed.
Bacillus spp. are often detected in drinking-water supplies, even supplies treated and
disinfected by acceptable procedures. This is largely due to the resistance of spores to
disinfection processes. Owing to a lack of evidence that waterborne Bacillus spp. are
clinically signicant, specic management strategies are not required.
11.1.4 Burkholderia pseudomallei

General description
Burkholderia pseudomallei is a Gram-negative bacillus commonly found in soil and
muddy water, predominantly in tropical regions such as northern Australia and south-
east Asia. The organism is acid tolerant and survives in water for prolonged periods
in the absence of nutrients.

Burkholderia pseudomallei can cause the disease melioidosis, which is endemic in
northern Australia and other tropical regions. The most common clinical manifesta-
tion is pneumonia, which may be fatal. In some of these areas, melioidosis is the most
common cause of community-acquired pneumonia. Cases appear throughout the
year but peak during the rainy season. Many patients present with milder forms of
pneumonia, which respond well to appropriate antibiotics, but some may present with
a severe septicaemic pneumonia. Other symptoms include skin abscesses or ulcers,
abscesses in internal organs and unusual neurological illnesses, such as brainstem
encephalitis and acute paraplegia. Although melioidosis can occur in healthy children
and adults, it occurs mainly in people whose defence mechanisms against infection
226
are impaired by underlying conditions or poor general health associated with poor
nutrition or living conditions.

The organism occurs predominantly in tropical regions, typically in soil or surface-
accumulated muddy water, from where it may reach raw water sources and also drink-
ing-water supplies. The number of organisms in drinking-water that would constitute
a signicant risk of infection is not known.
Routes of exposure
Most infections appear to be through contact of skin cuts or abrasions with contam-
inated water. In south-east Asia, rice paddies represent a signicant source of infec-
tion. Infection may also occur via other routes, particularly through inhalation or
ingestion. The relative importance of these routes of infection is not known.
In two Australian outbreaks of melioidosis, indistinguishable isolates of B. pseudo-
mallei were cultured from cases and the drinking-water supply. The detection of
the organisms in one drinking-water supply followed replacement of water pipes and
chlorination failure, while the second supply was unchlorinated. Within a WSP,
control measures that should provide effective protection against this organism
include application of established treatment and disinfection processes for drinking-
water coupled with protection of the distribution system from contamination, includ-
ing during repairs and maintenance. HPC and disinfectant residual as measures of
water treatment effectiveness and application of appropriate mains repair procedures
could be used to indicate protection against B. pseudomallei. Because of the environ-
mental occurrence of B. pseudomallei, E. coli (or, alternatively, thermotolerant
coliforms) is not a suitable index for the presence/absence of this organism.
Ainsworth R, ed. (2004) Safe, piped water: Managing microbial water quality in piped
distribution systems. IWA Publishing, London, for the World Health Organization,
Geneva.
Currie BJ (2000) The epidemiology of melioidosis in Australia and Papua New
Guinea. Acta Tropica, 74:121127.
Currie BJ et al. (2001) A cluster of melioidosis cases from an endemic region is clonal
and is linked to the water supply using molecular typing of Burkholderia pseudo-
mallei isolates. American Journal of Tropical Medicine and Hygiene, 65:177179.
Inglis TJJ et al. (2000) Outbreak strain of Burkholderia pseudomallei traced to water
treatment plant. Emerging Infectious Diseases, 6:5659.
227
11.1.5 Campylobacter
General description
Campylobacter spp. are microaerophilic (require decreased oxygen) and capnophilic
(require increased carbon dioxide), Gram-negative, curved spiral rods with a single
unsheathed polar agellum. Campylobacter spp. are one of the most important causes
of acute gastroenteritis worldwide. Campylobacter jejuni is the most frequently
isolated species from patients with acute diarrhoeal disease, whereas C. coli, C. laridis
and C. fetus have also been isolated in a small proportion of cases. Two closely related
genera, Helicobacter and Archobacter, include species previously classied as Campy-
lobacter spp.

An important feature of C. jejuni is relatively high infectivity compared with other
bacterial pathogens. As few as 1000 organisms can cause infection. Most symptomatic
infections occur in infancy and early childhood. The incubation period is usually 24
days. Clinical symptoms of C. jejuni infection are characterized by abdominal pain,
diarrhoea (with or without blood or faecal leukocytes), vomiting, chills and fever. The
infection is self-limited and resolves in 37 days. Relapses may occur in 510% of
untreated patients. Other clinical manifestations of C. jejuni infections in humans
include reactive arthritis and meningitis. Several reports have associated C. jejuni
infection with Guillain-Barr syndrome, an acute demyelinating disease of the periph-
eral nerves.

Campylobacter spp. occur in a variety of environments. Wild and domestic animals,
especially poultry, wild birds and cattle, are important reservoirs. Pets and other
animals may also be reservoirs. Food, including meat and unpasteurized milk, are
important sources of Campylobacter infections. Water is also a signicant source. The
occurrence of the organisms in surface waters has proved to be strongly dependent
on rainfall, water temperature and the presence of waterfowl.
Routes of exposure
Most Campylobacter infections are reported as sporadic in nature, with food consid-
ered a common source of infection. Transmission to humans typically occurs by the
consumption of animal products. Meat, particularly poultry products, and unpas-
teurized milk are important sources of infection. Contaminated drinking-water sup-
plies have been identied as a source of outbreaks. The number of cases in these
outbreaks ranged from a few to several thousand, with sources including unchlori-
nated or inadequately chlorinated surface water supplies and faecal contamination of
water storage reservoirs by wild birds.
228
Contaminated drinking-water supplies have been identied as a signicant source of
outbreaks of campylobacteriosis. The detection of waterborne outbreaks and cases
appears to be increasing. Waterborne transmission has been conrmed by the isola-
tion of the same strains from patients and drinking-water they had consumed. Within
a WSP, control measures that can be applied to manage potential risk from Campy-
lobacter spp. include protection of raw water supplies from animal and human waste,
adequate treatment and protection of water during distribution. Storages of treated
and disinfected water should be protected from bird faeces. Campylobacter spp. are
faecally borne pathogens and are not particularly resistant to disinfection. Hence, E.
coli (or thermotolerant coliforms) is an appropriate indicator for the presence/absence
of Campylobacter spp. in drinking-water supplies.
Frost JA (2001) Current epidemiological issues in human campylobacteriosis. Journal
of Applied Microbiology, 90:85S95S.
Koenraad PMFJ, Rombouts FM, Notermans SHW (1997) Epidemiological aspects of
thermophilic Campylobacter in water-related environments: A review. Water
Environment Research, 69:5263.
Kuroki S et al. (1991) Guillain-Barr syndrome associated with Campylobacter infec-
tion. Pediatric Infectious Diseases Journal, 10:149151.
11.1.6 Escherichia coli pathogenic strains

General description
Escherichia coli is present in large numbers in the normal intestinal ora of humans
and animals, where it generally causes no harm. However, in other parts of the body,
E. coli can cause serious disease, such as urinary tract infections, bacteraemia and
meningitis. A limited number of enteropathogenic strains can cause acute diarrhoea.
Several classes of enteropathogenic E. coli have been identied on the basis of differ-
ent virulence factors, including enterohaemorrhagic E. coli (EHEC), enterotoxigenic
E. coli (ETEC), enteropathogenic E. coli (EPEC), enteroinvasive E. coli (EIEC),
enteroaggregative E. coli (EAEC) and diffusely adherent E. coli (DAEC). More is
known about the rst four classes named; the pathogenicity and prevalence of EAEC
and DAEC strains are less well established.

EHEC serotypes, such as E. coli O157:H7 and E. coli O111, cause diarrhoea that ranges
from mild and non-bloody to highly bloody, which is indistinguishable from haem-
orrhagic colitis. Between 2% and 7% of cases can develop the potentially fatal
haemolytic uraemic syndrome (HUS), which is characterized by acute renal failure
and haemolytic anaemia. Children under 5 years of age are at most risk of develop-
ing HUS. The infectivity of EHEC strains is substantially higher than that of the other
229
strains. As few as 100 EHEC organisms can cause infection. ETEC produces heat-labile
or heat-stable E. coli enterotoxin, or both toxins simultaneously, and is an important
cause of diarrhoea in developing countries, especially in young children. Symptoms
of ETEC infection include mild watery diarrhoea, abdominal cramps, nausea and
headache. Infection with EPEC has been associated with severe, chronic, non-bloody
diarrhoea, vomiting and fever in infants. EPEC infections are rare in developed coun-
tries, but occur commonly in developing countries, with infants presenting with mal-
nutrition, weight loss and growth retardation. EIEC causes watery and occasionally
bloody diarrhoea where strains invade colon cells by a pathogenic mechanism similar
to that of Shigella.

Enteropathogenic E. coli are enteric organisms, and humans are the major reservoir,
particularly of EPEC, ETEC and EIEC strains. Livestock, such as cattle and sheep and,
to a lesser extent, goats, pigs and chickens, are a major source of EHEC strains.
The latter have also been associated with raw vegetables, such as bean sprouts. The
pathogens have been detected in a variety of water environments.
Routes of exposure
Infection is associated with person-to-person transmission, contact with animals,
food and consumption of contaminated water. Person-to-person transmissions are
particularly prevalent in communities where there is close contact between individu-
als, such as nursing homes and day care centres.
Waterborne transmission of pathogenic E. coli has been well documented for recre-
ational waters and contaminated drinking-water. A well publicized waterborne out-
break of illness caused by E. coli O157:H7 (and Campylobacter jejuni) occurred in the
farming community of Walkerton in Ontario, Canada. The outbreak took place in
May 2000 and led to 7 deaths and more than 2300 illnesses. The drinking-water supply
was contaminated by rainwater runoff containing cattle excreta. Within a WSP, control
measures that can be applied to manage potential risk from enteropathogenic E. coli
include protection of raw water supplies from animal and human waste, adequate
treatment and protection of water during distribution. There is no indication that the
response of enteropathogenic strains of E. coli to water treatment and disinfection
procedures differs from that of other E. coli. Hence, conventional testing for E. coli
(or, alternatively, thermotolerant coliform bacteria) provides an appropriate index for
the enteropathogenic serotypes in drinking-water. This applies even though standard
tests will generally not detect EHEC strains.
230
Nataro JP, Kaper JB (1998) Diarrheagenic Escherichia coli. Clinical Microbiology
Reviews, 11:142201.
OConnor DR (2002) Report of the Walkerton Inquiry: The events of May 2000 and
related issues. Part 1: A summary. Toronto, Ontario, Ontario Ministry of the
Attorney General, Queens Printer for Ontario.
11.1.7 Helicobacter pylori

General description
Helicobacter pylori, originally classied as Campylobacter pylori, is a Gram-negative,
microaerophilic, spiral-shaped, motile bacterium. There are at least 14 species of
Helicobacter, but only H. pylori has been identied as a human pathogen.

Helicobacter pylori is found in the stomach; although most infections are asympto-
matic, the organism is associated with chronic gastritis, which may lead to complica-
tions such as peptic and duodenal ulcer disease and gastric cancer. Whether the
organism is truly the cause of these conditions remains unclear. The majority of H.
pylori infections are initiated in childhood and without treatment are chronic. The
infections are more prevalent in developing countries and are associated with
overcrowded living conditions. Interfamilial clustering is common.

Humans appear to be the primary host of H. pylori. Other hosts may include domes-
tic cats. There is evidence that H. pylori is sensitive to bile salts, which would reduce
the likelihood of faecal excretion, although it has been isolated from faeces of young
children. Helicobacter pylori has been detected in water. Although H. pylori is unlikely
to grow in the environment, it has been found to survive for 3 weeks in biolms and
up to 2030 days in surface waters. In a study conducted in the USA, H. pylori was
found in the majority of surface water and shallow groundwater samples. The pres-
ence of H. pylori was not correlated with the presence of E. coli. Possible contamina-
tion of the environment can be through children with diarrhoea or through vomiting
by children as well as adults.
Routes of exposure
Person-to-person contact within families has been identied as the most likely source
of infection through oraloral transmission. Helicobacter pylori can survive well in
mucus or vomit. However, it is difcult to detect in mouth or faecal samples.
Faecaloral transmission is also considered possible.
231
Consumption of contaminated drinking-water has been suggested as a potential
source of infection, but further investigation is required to establish any link with
waterborne transmission. Humans are the principal source of H. pylori, and the organ-
ism is sensitive to oxidizing disinfectants. Hence, control measures that can be applied
to protect drinking-water supplies from H. pylori include preventing contamination
by human waste and adequate disinfection. Escherichia coli (or, alternatively, thermo-
tolerant coliforms) is not a reliable index for the presence/absence of this organism.
Dunn BE, Cohen H, Blaser MJ (1997) Helicobacter pylori. Clinical Microbiology
Reviews, 10:720741.
Hegarty JP, Dowd MT, Baker KH (1999) Occurrence of Helicobacter pylori in surface
water in the United States. Journal of Applied Microbiology, 87:697701.
Hulten K et al. (1996) Helicobacter pylori in drinking-water in Peru. Gastroenterology,
110:10311035.
Mazari-Hiriart M, Lpez-Vidal Y, Calva JJ (2001) Helicobacter pylori in water systems
for human use in Mexico City. Water Science and Technology, 43:9398.
11.1.8 Klebsiella
General description
Klebsiella spp. are Gram-negative, non-motile bacilli that belong to the family Enter-
obacteriaceae. The genus Klebsiella consists of a number of species, including K.
pneumoniae, K. oxytoca, K. planticola and K. terrigena. The outermost layer of Kleb-
siella spp. consists of a large polysaccharide capsule that distinguishes the organisms
from other members of the family. Approximately 6080% of all Klebsiella spp.
isolated from faeces and clinical specimens are K. pneumoniae and are positive in the
thermotolerant coliform test. Klebsiella oxytoca has also been identied as a pathogen.

Klebsiella spp. have been identied as colonizing hospital patients, where spread is
associated with the frequent handling of patients (e.g., in intensive care units). Patients
at highest risk are those with impaired immune systems, such as the elderly or very
young, patients with burns or excessive wounds, those undergoing immunosuppres-
sive therapy or those with HIV/AIDS infection. Colonization may lead to invasive
infections. On rare occasions, Klebsiella spp., notably K. pneumoniae and K. oxytoca,
may cause serious infections, such as destructive pneumonia.

Klebsiella spp. are natural inhabitants of many water environments, and they may mul-
tiply to high numbers in waters rich in nutrients, such as pulp mill wastes, textile n-
ishing plants and sugar-cane processing operations. In drinking-water distribution
232
systems, they are known to colonize washers in taps. The organisms can grow in water
distribution systems. Klebsiella spp. are also excreted in the faeces of many healthy
humans and animals, and they are readily detected in sewage-polluted water.
Routes of exposure
Klebsiella can cause nosocomial infections, and contaminated water and aerosols may
be a potential source of the organisms in hospital environments and other health care
facilities.
Klebsiella spp. are not considered to represent a source of gastrointestinal illness in the
general population through ingestion of drinking-water. Klebsiella spp. detected in
drinking-water are generally biolm organisms and are unlikely to represent a health
risk. The organisms are reasonably sensitive to disinfectants, and entry into distribu-
tion systems can be prevented by adequate treatment. Growth within distribution
systems can be minimized by strategies that are designed to minimize biolm growth,
including treatment to optimize organic carbon removal, restriction of the residence
time of water in distribution systems and maintenance of disinfectant residuals.
Klebsiella is a coliform and can be detected by traditional tests for total coliforms.
Ainsworth R, ed. (2004) Safe, piped water: Managing microbial water quality in piped
Geneva.
11.1.9 Legionella
General description
The genus Legionella, a member of the family Legionellaceae, has at least 42 species.
Legionellae are Gram-negative, rod-shaped, non-spore-forming bacteria that require
L-cysteine for growth and primary isolation. Legionella spp. are heterotrophic bacte-
ria found in a wide range of water environments and can proliferate at temperatures
above 25 C.

Although all Legionella spp. are considered potentially pathogenic for humans, L.
pneumophila is the major waterborne pathogen responsible for legionellosis, of which
two clinical forms are known: Legionnaires disease and Pontiac fever. The former is
a pneumonic illness with an incubation period of 36 days. Host factors inuence the
likelihood of illness: males are more frequently affected than females, and most cases
233
occur in the 40- to 70-year age group. Risk factors include smoking, alcohol abuse,
cancer, diabetes, chronic respiratory or kidney disease and immunosuppression, as in
transplant recipients. Pontiac fever is a milder, self-limiting disease with a high attack
rate and an onset (5 h to 3 days) and symptoms similar to those of inuenza: fever,
headache, nausea, vomiting, aching muscles and coughing. Studies of seroprevalence
of antibodies indicate that many infections are asymptomatic.

Legionella spp. are members of the natural ora of many freshwater environments,
such as rivers, streams and impoundments, where they occur in relatively low
numbers. However, they thrive in certain human-made water environments, such as
water cooling devices (cooling towers and evaporative condensers) associated with air
conditioning systems, hot water distribution systems and spas, which provide suitable
temperatures (2550 C) and conditions for their multiplication. Devices that support
multiplication of Legionella have been associated with outbreaks of Legionnaires
disease. Legionella survive and grow in biolms and sediments and are more easily
detected from swab samples than from owing water. Legionellae can be ingested by
trophozoites of certain amoebae such as Acanthamoeba, Hartmanella and Naegleria,
which may play a role in their persistence in water environments.
Routes of exposure
The most common route of infection is the inhalation of aerosols containing the bac-
teria. Such aerosols can be generated by contaminated cooling towers, warm water
showers, humidiers and spas. Aspiration has also been identied as a route of infec-
tion in some cases associated with contaminated water, food and ice. There is no
evidence of person-to-person transmission.
Legionella spp. are common waterborne organisms, and devices such as cooling
towers, hot water systems and spas that utilize mains water have been associated with
outbreaks of infection. Owing to the prevalence of Legionella, the potential for ingress
into drinking-water systems should be considered as a possibility, and control meas-
ures should be employed to reduce the likelihood of survival and multiplication.
Disinfection strategies designed to minimize biolm growth and temperature control
can minimize the potential risk from Legionella spp. The organisms are sensitive to
disinfection. Monochloramine has been shown to be particularly effective, probably
due to its stability and greater effectiveness against biolms. Water temperature is an
important element of control strategies. Wherever possible, water temperatures
should be kept outside the range of 2550 C. In hot water systems, storages should
be maintained above 55 C, and similar temperatures throughout associated pipework
will prevent growth of the organism. However, maintaining temperatures of hot water
above 50 C may represent a scalding risk in young children, the elderly and other vul-
234
nerable groups. Where temperatures in hot or cold water distribution systems cannot
be maintained outside the range of 2550 C, greater attention to disinfection and
strategies aimed at limiting development of biolms are required. Accumulation of
sludge, scale, rust, algae or slime deposits in water distribution systems supports the
growth of Legionella spp., as does stagnant water. Systems that are kept clean and
owing are less likely to support excess growth of Legionella spp. Care should also be
taken to select plumbing materials that do not support microbial growth and the
development of biolms.
Legionella spp. represent a particular concern in devices such as cooling towers and
hot water systems in large buildings. As discussed in chapter 6, specic WSPs incor-
porating control measures for Legionella spp. should be developed for these buildings.
Legionella are not detected by HPC techniques, and E. coli (or, alternatively, thermo-
tolerant coliforms) is not a suitable index for the presence/absence of this organism.
Codony F et al. (2002) Factors promoting colonization by legionellae in residential
water distribution systems: an environmental casecontrol survey. European
Journal of Clinical Microbiology and Infectious Diseases, 21:717721.
Emmerson AM (2001) Emerging waterborne infections in health-care settings. Emerg-
ing Infectious Diseases, 7:272276.
WHO (in preparation) Legionella and the prevention of legionellosis. Geneva, World
Health Organization.
11.1.10 Mycobacterium
General description
The tuberculous or typical species of Mycobacterium, such as M. tuberculosis, M.
bovis, M. africanum and M. leprae, have only human or animal reservoirs and are not
transmitted by water. In contrast, the non-tuberculous or atypical species of
Mycobacterium are natural inhabitants of a variety of water environments. These
aerobic, rod-shaped and acid-fast bacteria grow slowly in suitable water environments
and on culture media. Typical examples include the species M. gordonae, M. kansasii,
M. marinum, M. scrofulaceum, M. xenopi, M. intracellulare and M. avium and the more
rapid growers M. chelonae and M. fortuitum. The term M. avium complex has
been used to describe a group of pathogenic species including M. avium and M.
intracellulare. However, other atypical mycobacteria are also pathogenic. A distinct
feature of all Mycobacterium spp. is a cell wall with high lipid content, which is used
in identication of the organisms using acid-fast staining.
235

Atypical Mycobacterium spp. can cause a range of diseases involving the skeleton,
lymph nodes, skin and soft tissues, as well as the respiratory, gastrointestinal and
genitourinary tracts. Manifestations include pulmonary disease, Buruli ulcer,
osteomyelitis and septic arthritis in people with no known predisposing factors. These
bacteria are a major cause of disseminated infections in immunocompromised
patients and are a common cause of death in HIV-positive persons.

Atypical Mycobacterium spp. multiply in a variety of suitable water environments,
notably biolms. One of the most commonly occurring species is M. gordonae. Other
species have also been isolated from water, including M. avium, M. intracellulare, M.
kansasii, M. fortuitum and M. chelonae. High numbers of atypical Mycobacterium spp.
may occur in distribution systems after events that dislodge biolms, such as ushing
or ow reversals. They are relatively resistant to treatment and disinfection and have
been detected in well operated and maintained drinking-water supplies with HPC less
than 500/ml and total chlorine residuals of up to 2.8 mg/litre. The growth of these
organisms in biolms reduces the effectiveness of disinfection. In one survey, the
organisms were detected in 54% of ice and 35% of public drinking-water samples.
Routes of exposure
Principal routes of infection appear to be inhalation, contact and ingestion of con-
taminated water. Infections by various species have been associated with their pres-
ence in drinking-water supplies. In 1968, an endemic of M. kansasii infections was
associated with the presence of the organisms in the drinking-water supply, and
the spread of the organisms was associated with aerosols from showerheads. In
Rotterdam, Netherlands, an investigation into the frequent isolation of M. kansasii
from clinical specimens revealed the presence of the same strains, conrmed by phage
type and weak nitrase activity, in tap water. An increase in numbers of infections by
the M. avium complex in Massachusetts, USA, has also been attributed to their inci-
dence in drinking-water. In all these cases, there is only circumstantial evidence of a
causal relationship between the occurrence of the bacteria in drinking-water and
human disease. Infections have been linked to contaminated water in spas.
Detections of atypical mycobacteria in drinking-water and the identied routes of
transmission suggest that drinking-water supplies are a plausible source of infection.
There are limited data on the effectiveness of control measures that could be applied
to reduce the potential risk from these organisms. One study showed that a water
treatment plant could achieve a 99% reduction in numbers of mycobacteria from raw
water. Atypical mycobacteria are relatively resistant to disinfection. Persistent residual
disinfectant should reduce numbers of mycobacteria in the water column but is
236
unlikely to be effective against organisms present in biolms. Control measures that

are designed to minimize biolm growth, including treatment to optimize organic
carbon removal, restriction of the residence time of water in distribution systems and
maintenance of disinfectant residuals, could result in less growth of these organisms.
Mycobacteria are not detected by HPC techniques, and E. coli (or, alternatively,
thermotolerant coliforms) is not a suitable index for the presence/absence of this
organism.
Bartram J et al., eds. (2004) Pathogenic mycobacteria in water: A guide to public health
consequences, monitoring and management. Geneva, World Health Organization.
Covert TC et al. (1999) Occurrence of nontuberculous mycobacteria in environmen-
tal samples. Applied and Environmental Microbiology, 65:24922496.
Falkinham JO, Norton CD, LeChevallier MW (2001) Factors inuencing numbers of
Mycobacterium avium, Mycobacterium intracellulare and other mycobacteria in
drinking water distribution systems. Applied and Environmental Microbiology,
66:12251231.
Grabow WOK (1996) Waterborne diseases: Update on water quality assessment and
control. Water SA, 22:193202.
Singh N, Yu VL (1994) Potable water and Mycobacterium avium complex in HIV
patients: is prevention possible? Lancet, 343:11101111.
Von Reyn CF et al. (1994) Persistent colonization of potable water as a source of
Mycobacterium avium infection in AIDS. Lancet, 343:11371141.
11.1.11 Pseudomonas aeruginosa

General description
Pseudomonas aeruginosa is a member of the family Pseudomonadaceae and is a polarly
agellated, aerobic, Gram-negative rod. When grown in suitable media, it produces
the non-uorescent bluish pigment pyocyanin. Many strains also produce the uo-
rescent green pigment pyoverdin. Pseudomonas aeruginosa, like other uorescent
pseudomonads, produces catalase, oxidase and ammonia from arginine and can grow
on citrate as the sole source of carbon.

Pseudomonas aeruginosa can cause a range of infections but rarely causes serious
illness in healthy individuals without some predisposing factor. It predominantly col-
onizes damaged sites such as burn and surgical wounds, the respiratory tract of people
237
with underlying disease and physically damaged eyes. From these sites, it may invade
the body, causing destructive lesions or septicaemia and meningitis. Cystic brosis and
immunocompromised patients are prone to colonization with P. aeruginosa, which
may lead to serious progressive pulmonary infections. Water-related folliculitis and
ear infections are associated with warm, moist environments such as swimming pools
and spas. Many strains are resistant to a range of antimicrobial agents, which can
increase the signicance of the organism in hospital settings.

Pseudomonas aeruginosa is a common environmental organism and can be found in
faeces, soil, water and sewage. It can multiply in water environments and also on the
surface of suitable organic materials in contact with water. Pseudomonas aeruginosa is
a recognized cause of hospital-acquired infections with potentially serious complica-
tions. It has been isolated from a range of moist environments such as sinks, water
baths, hot water systems, showers and spa pools.
Routes of exposure
The main route of infection is by exposure of susceptible tissue, notably wounds and
mucous membranes, to contaminated water or contamination of surgical instru-
ments. Cleaning of contact lenses with contaminated water can cause a form of
keratitis. Ingestion of drinking-water is not an important source of infection.
Although P. aeruginosa can be signicant in certain settings such as health care facil-
ities, there is no evidence that normal uses of drinking-water supplies are a source
of infection in the general population. However, the presence of high numbers of
P. aeruginosa in potable water, notably in packaged water, can be associated with
complaints about taste, odour and turbidity. Pseudomonas aeruginosa is sensitive to
disinfection, and entry into distribution systems can be minimized by adequate dis-
infection. Control measures that are designed to minimize biolm growth, including
treatment to optimize organic carbon removal, restriction of the residence time of
water in distribution systems and maintenance of disinfectant residuals, should reduce
the growth of these organisms. Pseudomonas aeruginosa is detected by HPC, which
can be used together with parameters such as disinfectant residuals to indicate con-
ditions that could support growth of these organisms. However, as P. aeruginosa is a
common environmental organism, E. coli (or, alternatively, thermotolerant coliforms)
cannot be used for this purpose.
238
de Victorica J, Galvn M (2001) Pseudomonas aeruginosa as an indicator of health risk

in water for human consumption. Water Science and Technology, 43:4952.
Hardalo C, Edberg SC (1997) Pseudomonas aeruginosa: Assessment of risk from drink-
ing-water. Critical Reviews in Microbiology, 23:4775.
11.1.12 Salmonella
General description
Salmonella spp. belong to the family Enterobacteriaceae. They are motile, Gram-
negative bacilli that do not ferment lactose, but most produce hydrogen sulde
or gas from carbohydrate fermentation. Originally, they were grouped into more than
2000 species (serotypes) according to their somatic (O) and agellar (H) antigens
(Kauffmann-White classication). It is now considered that this classication is
below species level and that there are actually no more than 23 species (Salmonella
enterica or Salmonella choleraesuis, Salmonella bongori and Salmonella typhi), with the
serovars being subspecies. All of the enteric pathogens except S. typhi are members of
the species S. enterica. Convention has dictated that subspecies are abbreviated, so that
S. enterica serovar Paratyphi A becomes S. Paratyphi A.

Salmonella infections typically cause four clinical manifestations: gastroenteritis
(ranging from mild to fulminant diarrhoea, nausea and vomiting), bacteraemia or
septicaemia (high spiking fever with positive blood cultures), typhoid fever / enteric
fever (sustained fever with or without diarrhoea) and a carrier state in persons with
previous infections. In regard to enteric illness, Salmonella spp. can be divided into
two fairly distinct groups: the typhoidal species/serovars (Salmonella typhi and S.
Paratyphi) and the remaining non-typhoidal species/serovars. Symptoms of non-
typhoidal gastroenteritis appear from 6 to 72 h after ingestion of contaminated food
or water. Diarrhoea lasts 35 days and is accompanied by fever and abdominal pain.
Usually the disease is self-limiting. The incubation period for typhoid fever can be
114 days but is usually 35 days. Typhoid fever is a more severe illness and can be
fatal. Although typhoid is uncommon in areas with good sanitary systems, it is still
prevalent elsewhere, and there are many millions of cases each year.

Salmonella spp. are widely distributed in the environment, but some species or
serovars show host specicity. Notably, S. typhi and generally S. Paratyphi are
restricted to humans, although livestock can occasionally be a source of S. Paratyphi.
A large number of serovars, including S. Typhimurium and S. Enteritidis, infect
humans and also a wide range of animals, including poultry, cows, pigs, sheep, birds
and even reptiles. The pathogens typically gain entry into water systems through faecal
contamination from sewage discharges, livestock and wild animals. Contamination
has been detected in a wide variety of foods and milk.
239
Routes of exposure
Salmonella is spread by the faecaloral route. Infections with non-typhoidal serovars
are primarily associated with person-to-person contact, the consumption of a variety
of contaminated foods and exposure to animals. Infection by typhoid species is asso-
ciated with the consumption of contaminated water or food, with direct person-to-
person spread being uncommon.
Waterborne typhoid fever outbreaks have devastating public health implications.
However, despite their widespread occurrence, non-typhoidal Salmonella spp. rarely
cause drinking-water-borne outbreaks. Transmission, most commonly involving S.
Typhimurium, has been associated with the consumption of contaminated ground-
water and surface water supplies. In an outbreak of illness associated with a commu-
nal rainwater supply, bird faeces were implicated as a source of contamination.
Salmonella spp. are relatively sensitive to disinfection. Within a WSP, control meas-
ures that can be applied to manage risk include protection of raw water supplies from
animal and human waste, adequate treatment and protection of water during distri-
bution. Escherichia coli (or, alternatively, thermotolerant coliforms) is a generally
reliable index for Salmonella spp. in drinking-water supplies.
Angulo FJ et al. (1997) A community waterborne outbreak of salmonellosis and the
effectiveness of a boil water order. American Journal of Public Health, 87:580584.
Escartin EF et al. (2002) Potential Salmonella transmission from ornamental foun-
tains. Journal of Environmental Health, 65:912.
Koplan JP et al. (1978) Contaminated roof-collected rainwater as a possible cause of
an outbreak of salmonellosis. Journal of Hygiene, 81:303309.
11.1.13 Shigella
General description
Shigella spp. are Gram-negative, non-spore-forming, non-motile, rod-like members
of the family Enterobacteriaceae, which grow in the presence or absence of oxygen.
Members of the genus have a complex antigenic pattern, and classication is based
on their somatic O antigens, many of which are shared with other enteric bacilli,
including E. coli. There are four species: S. dysenteriae, S. exneri, S. boydii and S.
sonnei.

Shigella spp. can cause serious intestinal diseases, including bacillary dysentery. Over
2 million infections occur each year, resulting in about 600 000 deaths, predominantly
in developing countries. Most cases of Shigella infection occur in children under 10
years of age. The incubation period for shigellosis is usually 2472 h. Ingestion of as
240
few as 10100 organisms may lead to infection, which is substantially less than the
infective dose of most other enteric bacteria. Abdominal cramps, fever and watery
diarrhoea occur early in the disease. All species can produce severe disease, but illness
due to S. sonnei is usually relatively mild and self-limiting. In the case of S. dysente-
riae, clinical manifestations may proceed to an ulceration process, with bloody diar-
rhoea and high concentrations of neutrols in the stool. The production of Shiga toxin
by the pathogen plays an important role in this outcome. Shigella spp. seem to be
better adapted to cause human disease than most other enteric bacterial pathogens.

Humans and other higher primates appear to be the only natural hosts for the shigel-
lae. The bacteria remain localized in the intestinal epithelial cells of their hosts.
Epidemics of shigellosis occur in crowded communities and where hygiene is poor.
Many cases of shigellosis are associated with day care centres, prisons and psychiatric
institutions. Military eld groups and travellers to areas with poor sanitation are also
prone to infection.
Routes of exposure
Shigella spp. are enteric pathogens predominantly transmitted by the faecaloral route
through person-to-person contact, contaminated food and water. Flies have also been
identied as a transmission vector from contaminated faecal waste.
A number of large waterborne outbreaks of shigellosis have been recorded. As the
organisms are not particularly stable in water environments, their presence in drink-
ing-water indicates recent human faecal pollution. Available data on prevalence in
water supplies may be an underestimate, because detection techniques generally used
can have a relatively low sensitivity and reliability. The control of Shigella spp. in drink-
ing-water supplies is of special public health importance in view of the severity of the
disease caused. Shigella spp. are relatively sensitive to disinfection. Within a WSP,
control measures that can be applied to manage potential risk include protection of
raw water supplies from human waste, adequate treatment and protection of water
during distribution. Escherichia coli (or, alternatively, thermotolerant coliforms) is a
generally reliable index for Shigella spp. in drinking-water supplies.
Alamanos Y et al. (2000) A community waterborne outbreak of gastro-enteritis attrib-
uted to Shigella sonnei. Epidemiology and Infection, 125:499503.
Pegram GC, Rollins N, Espay Q (1998) Estimating the cost of diarrhoea and epidemic
dysentery in Kwa-Zulu-Natal and South Africa. Water SA, 24:1120.
241
11.1.14 Staphylococcus aureus

General description
Staphylococcus aureus is an aerobic or anaerobic, non-motile, non-spore-forming,
catalase- and coagulase-positive, Gram-positive coccus, usually arranged in grapelike
irregular clusters. The genus Staphylococcus contains at least 15 different species. Apart
from S. aureus, the species S. epidermidis and S. saprophyticus are also associated with
disease in humans.

Although Staphylococcus aureus is a common member of the human microora, it can
produce disease through two different mechanisms. One is based on the ability of the
organisms to multiply and spread widely in tissues, and the other is based on the
ability of the organisms to produce extracellular enzymes and toxins. Infections based
on the multiplication of the organisms are a signicant problem in hospitals and other
health care facilities. Multiplication in tissues can result in manifestations such as
boils, skin sepsis, post-operative wound infections, enteric infections, septicaemia,
endocarditis, osteomyelitis and pneumonia. The onset of clinical symptoms for these
infections is relatively long, usually several days. Gastrointestinal disease (enterocoli-
tis or food poisoning) is caused by a heat-stable staphylococcal enterotoxin and char-
acterized by projectile vomiting, diarrhoea, fever, abdominal cramps, electrolyte
imbalance and loss of uids. Onset of disease in this case has a characteristic short
incubation period of 18 h. The same applies to the toxic shock syndrome caused by
toxic shock syndrome toxin-1.

Staphylococcus aureus is relatively widespread in the environment but is found mainly
on the skin and mucous membranes of animals. The organism is a member of the
normal microbial ora of the human skin and is found in the nasopharynx of 2030%
of adults at any one time. Staphylococci are occasionally detected in the gastroin-
testinal tract and can be detected in sewage. Staphylococcus aureus can be released by
human contact into water environments such as swimming pools, spa pools and other
recreational waters. It has also been detected in drinking-water supplies.
Routes of exposure
Hand contact is by far the most common route of transmission. Inadequate hygiene
can lead to contamination of food. Foods such as ham, poultry and potato and egg
salads kept at room or higher temperature offer an ideal environment for the multi-
plication of S. aureus and the release of toxins. The consumption of foods containing
S. aureus toxins can lead to enterotoxin food poisoning within a few hours.
242
Although S. aureus can occur in drinking-water supplies, there is no evidence of trans-
mission through the consumption of such water. Although staphylococci are slightly
more resistant to chlorine residuals than E. coli, their presence in water is readily con-
trolled by conventional treatment and disinfection processes. Since faecal material
is not their usual source, E. coli (or, alternatively, thermotolerant coliforms) is not a
suitable index for S. aureus in drinking-water supplies.
Antai SP (1987) Incidence of Staphylococcus aureus, coliforms and antibiotic-resistant
strains of Escherichia coli in rural water supplies in Port Harcourt. Journal of Applied
Bacteriology, 62:371375.
LeChevallier MW, Seidler RJ (1980) Staphylococcus aureus in rural drinking-water.
Applied and Environmental Microbiology, 39:739742.
11.1.15 Tsukamurella
General description
The genus Tsukamurella belongs to the family Nocardiaceae. Tsukamurella spp. are
Gram-positive, weakly or variably acid-fast, non-motile, obligate aerobic, irregular
rod-shaped bacteria. They are actinomycetes related to Rhodococcus, Nocardia and
Mycobacterium. The genus was created in 1988 to accommodate a group of chemi-
cally unique organisms characterized by a series of very long chain (6876 carbons),
highly unsaturated mycolic acids, meso-diaminopimelic acid and arabinogalactan,
common to the genus Corynebacterium. The type species is T. paurometabola, and
the following additional species were proposed in the 1990s: T. wratislaviensis, T.
inchonensis, T. pulmonis, T. tyrosinosolvens and T. strandjordae.

Tsukamurella spp. cause disease mainly in immunocompromised individuals. Infec-
tions with these microorganisms have been associated with chronic lung diseases,
immune suppression (leukaemia, tumours, HIV/AIDS infection) and post-operative
wound infections. Tsukamurella were reported in four cases of catheter-related
bacteraemia and in individual cases including chronic lung infection, necrotizing
tenosynovitis with subcutaneous abscesses, cutaneous and bone infections, meningi-
tis and peritonitis.

Tsukamurella spp. exist primarily as environmental saprophytes in soil, water and
foam (thick stable scum on aeration vessels and sedimentation tanks) of activated
sludge. Tsukamurella are represented in HPC populations in drinking-water.
243
Routes of exposure
Tsukamurella spp. appear to be transmitted through devices such as catheters or
lesions. The original source of the contaminating organisms is unknown.
Tsukamurella organisms have been detected in drinking-water supplies, but the sig-
nicance is unclear. There is no evidence of a link between organisms in water and
illness. As Tsukamurella is an environmental organism, E. coli (or, alternatively,
thermotolerant coliforms) is not a suitable index for this organism.
Kattar MM et al. (2001) Tsukamurella strandjordae sp. nov., a proposed new species
causing sepsis. Journal of Clinical Microbiology, 39:14671476.
Larkin JA et al. (1999) Infection of a knee prosthesis with Tsukamurella species. South-
ern Medical Journal, 92:831832.
11.1.16 Vibrio
General description
Vibrio spp. are small, curved (comma-shaped), Gram-negative bacteria with a single
polar agellum. Species are typed according to their O antigens. There are a number
of pathogenic species, including V. cholerae, V. parahaemolyticus and V. vulnicus.
Vibrio cholerae is the only pathogenic species of signicance from freshwater envi-
ronments. While a number of serotypes can cause diarrhoea, only O1 and O139 cur-
rently cause the classical cholera symptoms in which a proportion of cases suffer
fulminating and severe watery diarrhoea. The O1 serovar has been further divided
into classical and El Tor biotypes. The latter is distinguished by features such as
the ability to produce a dialysable heat-labile haemolysin, active against sheep and
goat red blood cells. The classical biotype is considered responsible for the rst six
cholera pandemics, while the El Tor biotype is responsible for the seventh pandemic
that commenced in 1961. Strains of V. cholerae O1 and O139 that cause cholera
produce an enterotoxin (cholera toxin) that alters the ionic uxes across the intestinal
mucosa, resulting in substantial loss of water and electrolytes in liquid stools. Other
factors associated with infection are an adhesion factor and an attachment pilus. Not
all strains of serotypes O1 or O139 possess the virulence factors, and they are rarely
possessed by non-O1/O139 strains.

Cholera outbreaks continue to occur in many areas of the developing world. Symp-
toms are caused by heat-labile cholera enterotoxin carried by toxigenic strains of V.
244
cholerae O1/O139. A large percentage of infected persons do not develop illness; about
60% of the classical and 75% of the El Tor group infections are asymptomatic. Symp-
tomatic illness ranges from mild or moderate to severe disease. The initial symptoms
of cholera are an increase in peristalses followed by loose, watery and mucus-ecked
rice-water stools that may cause a patient to lose as much as 1015 litres of liquid
per day. Decreasing gastric acidity by administration of sodium bicarbonate reduces
the infective dose of V. cholerae O1 from more than 108 to about 104 organisms. Case
fatality rates vary according to facilities and preparedness. As many as 60% of
untreated patients may die as a result of severe dehydration and loss of electrolytes,
but well established diarrhoeal disease control programmes can reduce fatalities to
less than 1%. Non-toxigenic strains of V. cholerae can cause self-limiting gastroen-
teritis, wound infections and bacteraemia.

Non-toxigenic V. cholerae is widely distributed in water environments, but toxigenic
strains are not distributed as widely. Humans are an established source of toxigenic
V. cholerae; in the presence of disease, the organism can be detected in sewage.
Although V. cholerae O1 can be isolated from water in areas without disease, the
strains are not generally toxigenic. Toxigenic V. cholerae has also been found
in association with live copepods as well as other aquatic organisms, including
molluscs, crustaceans, plants, algae and cyanobacteria. Numbers associated with these
aquatic organisms are often higher than in the water column. Non-toxigenic V.
cholerae has been isolated from birds and herbivores in areas far away from marine
and coastal waters. The prevalence of V. cholerae decreases as water temperatures fall
below 20 C.
Routes of exposure
Cholera is typically transmitted by the faecaloral route, and the infection is pre-
dominantly contracted by the ingestion of faecally contaminated water and food. The
high numbers required to cause infection make person-to-person contact an unlikely
route of transmission.
Contamination of water due to poor sanitation is largely responsible for transmission,
but this does not fully explain the seasonality of recurrence, and factors other than
poor sanitation must play a role. The presence of the pathogenic V. cholerae O1 and
O139 serotypes in drinking-water supplies is of major public health importance and
can have serious health and economic implications in the affected communities.
Vibrio cholerae is highly sensitive to disinfection processes. Within a WSP, control
measures that can be applied to manage potential risk from toxigenic V. cholerae
include protection of raw water supplies from human waste, adequate treatment and
protection of water during distribution. Vibrio cholerae O1 and non-O1 have been
245
detected in the absence of E. coli, and this organism (or, alternatively, thermotolerant
coliforms) is not a reliable index for V. cholerae in drinking-water.
Kaper JB, Morris JG, Levine MM (1995) Cholera. Clinical Microbiology Reviews,
8:4886.
Ogg JE, Ryder RA, Smith HL (1989) Isolation of Vibrio cholerae from aquatic birds in
Colorado and Utah. Applied and Environmental Microbiology, 55:9599.
Rhodes JB, Schweitzer D, Ogg JE (1985) Isolation of non-O1 Vibrio cholerae associ-
ated with enteric disease of herbivores in western Colorado. Journal of Clinical
Microbiology, 22:572575.
WHO (2002) Vibrio cholerae. In: Guidelines for drinking-water quality, 2nd ed. Adden-
dum: Microbiological agents in drinking water. Geneva, World Health Organization,
pp. 119142.
11.1.17 Yersinia
General description
The genus Yersinia is classied in the family Enterobacteriaceae and comprises seven
species. The species Y. pestis, Y. pseudotuberculosis and certain serotypes of Y. entero-
colitica are pathogens for humans. Yersinia pestis is the cause of bubonic plague
through contact with rodents and their eas. Yersinia spp. are Gram-negative rods that
are motile at 25 C but not at 37 C.

Yersinia enterocolitica penetrates cells of the intestinal mucosa, causing ulcerations
of the terminal ilium. Yersiniosis generally presents as an acute gastroenteritis with
diarrhoea, fever and abdominal pain. Other clinical manifestations include greatly
enlarged painful lymph nodes referred to as buboes. The disease seems to be more
acute in children than in adults.

Domestic and wild animals are the principal reservoir for Yersinia spp.; pigs are the
major reservoir of pathogenic Y. enterocolitica, whereas rodents and small animals
are the major reservoir of Y. pseudotuberculosis. Pathogenic Y. enterocolitica has been
detected in sewage and polluted surface waters. However, Y. enterocolitica strains
detected in drinking-water are more commonly non-pathogenic strains of probable
environmental origin. At least some species and strains of Yersinia seem to be able to
replicate in water environments if at least trace amounts of organic nitrogen are
present, even at temperatures as low as 4 C.
246
Routes of exposure
Yersinia spp. are transmitted by the faecaloral route, with the major source of infec-
tion considered to be foods, particularly meat and meat products, milk and dairy
products. Ingestion of contaminated water is also a potential source of infection.
Direct transmission from person to person and from animals to humans is also known
to occur.
Although most Yersinia spp. detected in water are probably non-pathogenic, circum-
stantial evidence has been presented to support transmission of Y. enterocolitica and
Y. pseudotuberculosis to humans from untreated drinking-water. The most likely
source of pathogenic Yersinia spp. is human or animal waste. The organisms are
sensitive to disinfection processes. Within a WSP, control measures that can be used
to minimize the presence of pathogenic Yersinia spp. in drinking-water supplies
include protection of raw water supplies from human and animal waste, adequate dis-
infection and protection of water during distribution. Owing to the long survival
and/or growth of some strains of Yersinia spp. in water, E. coli (or, alternatively, ther-
motolerant coliforms) is not a suitable index for the presence/absence of these organ-
isms in drinking-water.
Aleksic S, Bockemuhl J (1988) Serological and biochemical characteristics of 416
Yersinia strains from well water and drinking water plants in the Federal Republic
of Germany: lack of evidence that these strains are of public health signicance.
Zentralblatt fr Bakteriologie, Mikrobiologie und Hygiene B, 185:527533.
Inoue M et al. (1988) Three outbreaks of Yersinia pseudotuberculosis infection.
Zentralblatt fr Bakteriologie, Mikrobiologie und Hygiene B, 186:504511.
Ostroff SM et al. (1994) Sources of sporadic Yersinia enterocolitica infections in
Norway: a prospective case control study. Epidemiology and Infection, 112:133
141.
Waage AS et al. (1999) Detection of low numbers of pathogenic Yersinia enterocolit-
ica in environmental water and sewage samples by nested polymerase chain reac-
tion. Journal of Applied Microbiology, 87:814821.
11.2 Viral pathogens

Viruses associated with waterborne transmission are predominantly those that can
infect the gastrointestinal tract and are excreted in the faeces of infected humans
(enteric viruses). With the exception of hepatitis E, humans are considered to be the
only source of human infectious species. Enteric viruses typically cause acute disease
with a short incubation period. Water may also play a role in the transmission of other
viruses with different modes of action. As a group, viruses can cause a wide variety of
infections and symptoms involving different routes of transmission, routes and sites
247
of infection and routes of excretion. The combination of these routes and sites of
infection can vary and will not always follow expected patterns. For example, viruses
that are considered to primarily cause respiratory infections and symptoms are usually
transmitted by person-to-person spread of respiratory droplets. However, some of
these respiratory viruses may be discharged in faeces, leading to potential contami-
nation of water and subsequent transmission through aerosols and droplets. Another
example is viruses excreted in urine, such as polyomaviruses, which could contami-
nate and then be potentially transmitted by water, with possible long-term health
effects, such as cancer, that are not readily associated epidemiologically with water-
borne transmission.
11.2.1 Adenoviruses
General description
The family Adenoviridae is classied into the two genera Mastadenovirus (mammal
hosts) and Aviadenovirus (avian hosts). Adenoviruses are widespread in nature, infect-
ing birds, mammals and amphibians. To date, 51 antigenic types of human aden-
oviruses (HAds) have been described. HAds have been classied into six groups (AF)
on the basis of their physical, chemical and biological properties. Adenoviruses consist
of a double-stranded DNA genome in a non-enveloped icosahedral capsid with a
diameter of about 80 nm and unique bres. The subgroups AE grow readily in cell
culture, but serotypes 40 and 41 are fastidious and do not grow well. Identication of
serotypes 40 and 41 in environmental samples is generally based on polymerase chain
reaction (PCR) techniques with or without initial cell culture amplication.

HAds cause a wide range of infections with a spectrum of clinical manifestations.
These include infections of the gastrointestinal tract (gastroenteritis), the respiratory
tract (acute respiratory diseases, pneumonia, pharyngoconjunctival fever), the urinary
tract (cervicitis, urethritis, haemorrhagic cystitis) and the eyes (epidemic keratocon-
junctivitis, also known as shipyard eye; pharyngoconjunctival fever, also known as
swimming pool conjunctivitis). Different serotypes are associated with specic ill-
nesses; for example, types 40 and 41 are the main cause of enteric illness. Adenoviruses
are an important source of childhood gastroenteritis. In general, infants and children
are most susceptible to adenovirus infections, and many infections are asymptomatic.
High attack rates in outbreaks imply that infecting doses are low.

Adenoviruses are excreted in large numbers in human faeces and are known to occur
in sewage, raw water sources and treated drinking-water supplies worldwide. Although
the subgroup of enteric adenoviruses (mainly types 40 and 41) is a major cause of
gastroenteritis worldwide, notably in developing communities, little is known about
the prevalence of these enteric adenoviruses in water sources. The limited availability
248
of information on enteric adenoviruses is largely due to the fact that they are not
detectable by conventional cell culture isolation.
Routes of exposure
Owing to the diverse epidemiology of the wide spectrum of HAds, exposure and infec-
tion are possible by a variety of routes. Person-to-person contact plays a major role
in the transmission of illness; depending on the nature of illness, this can include
faecaloral, oraloral and handeye contact transmission, as well as indirect transfer
through contaminated surfaces or shared utensils. There have been numerous
outbreaks associated with hospitals, military establishments, child care centres and
schools. Symptoms recorded in most outbreaks were acute respiratory disease,
keratoconjunctivitis and conjunctivitis. Outbreaks of gastroenteritis have also been
reported. The consumption of contaminated food or water may be an important
source of enteric illness, although there is no substantial evidence supporting this
route of transmission. Eye infections may be contracted by the exposure of eyes to
contaminated water, the sharing of towels at swimming pools or the sharing of
goggles, as in the case of shipyard eye. Conrmed outbreaks of adenovirus infec-
tions associated with water have been limited to pharyngitis and/or conjunctivitis,
with exposure arising from use of swimming pools.
HAds have been shown to occur in substantial numbers in raw water sources and
treated drinking-water supplies. In one study, the incidence of HAds in such waters
was exceeded only by the group of enteroviruses among viruses detectable by PCR-
based techniques. In view of their prevalence as an enteric pathogen and detection in
water, contaminated drinking-water represents a likely but unconrmed source of
HAd infections. HAds are also considered important because they are exceptionally
resistant to some water treatment and disinfection processes, notably UV light irra-
diation. HAds have been detected in drinking-water supplies that met accepted spec-
ications for treatment, disinfection and conventional indicator organisms. Within a
WSP, control measures to reduce potential risk from HAds should focus on preven-
tion of source water contamination by human waste, followed by adequate treatment
and disinfection. The effectiveness of treatment processes used to remove HAds will
require validation. Drinking-water supplies should also be protected from contami-
nation during distribution. Because of the high resistance of the viruses to disinfec-
tion, E. coli (or, alternatively, thermotolerant coliforms) is not a reliable index of the
presence/absence of HAds in drinking-water supplies.
Chapron CD et al. (2000) Detection of astroviruses, enteroviruses and adenoviruses
types 40 and 41 in surface waters collected and evaluated by the information
249
collection rule and integrated cell culture-nested PCR procedure. Applied and
Environmental Microbiology, 66:25202525.
DAngelo LJ et al. (1979) Pharyngoconjunctival fever caused by adenovirus type 4:
Report of a swimming pool-related outbreak with recovery of virus from pool
water. Journal of Infectious Diseases, 140:4247.
Grabow WOK, Taylor MB, de Villiers JC (2001) New methods for the detection
of viruses: call for review of drinking water quality guidelines. Water Science and
Technology, 43:18.
Puig M et al. (1994) Detection of adenoviruses and enteroviruses in polluted water
by nested PCR amplication. Applied and Environmental Microbiology,
60:29632970.
11.2.2 Astroviruses
General description
Human and animal strains of astroviruses are single-stranded RNA viruses classied
in the family Astroviridae. Astroviruses consist of a single-stranded RNA genome in
a non-enveloped icosahedral capsid with a diameter of about 28 nm. In a proportion
of the particles, a distinct surface star-shaped structure can be seen by electron
microscopy. Eight different serotypes of human astroviruses (HAstVs) have been
described. The most commonly identied is HAstV serotype 1. HAstVs can be
detected in environmental samples using PCR techniques with or without initial cell
culture amplication.

HAstVs cause gastroenteritis, predominantly diarrhoea, mainly in children under 5
years of age, although it has also been reported in adults. Seroprevalence studies
showed that more than 80% of children between 5 and 10 years of age have antibod-
ies against HAstVs. Occasional outbreaks in schools, nurseries and families have been
reported. The illness is self-limiting, is of short duration and has a peak incidence in
the winter. HAstVs are the cause of only a small proportion of reported gastroenteri-
tis infections. However, the number of infections may be underestimated, since the
illness is usually mild, and many cases will go unreported.

Infected individuals generally excrete large numbers of HAstVs in faeces; hence, the
viruses will be present in sewage. HAstVs have been detected in water sources and in
Routes of exposure
HAstVs are transmitted by the faecaloral route. Person-to-person spread is consid-
ered the most common route of transmission, and clusters of cases are seen in child
250
care centres, paediatric wards, families, homes for the elderly and military establish-
ments. Ingestion of contaminated food or water could also be important.
The presence of HAstVs in treated drinking-water supplies has been conrmed. Since
the viruses are typically transmitted by the faecaloral route, transmission by drink-
ing-water seems likely, but has not been conrmed. HAstVs have been detected in
drinking-water supplies that met accepted specications for treatment, disinfection
and conventional indicator organisms. Within a WSP, control measures to reduce
potential risk from HAstVs should focus on prevention of source water contamina-
tion by human waste, followed by adequate treatment and disinfection. The effec-
tiveness of treatment processes used to remove HAstVs will require validation.
Drinking-water supplies should also be protected from contamination during distri-
bution. Owing to the higher resistance of the viruses to disinfection, E. coli (or, alter-
natively, thermotolerant coliforms) is not a reliable index of the presence/absence of
HAstVs in drinking-water supplies.
Grabow WOK, Taylor MB, de Villiers JC (2001) New methods for the detection
of viruses: call for review of drinking water quality guidelines. Water Science and
Technology, 43:18.
Nadan S et al. (2003) Molecular characterization of astroviruses by reverse transcrip-
tase PCR and sequence analysis: comparison of clinical and environmental isolates
from South Africa. Applied and Environmental Microbiology, 69:747753.
Pint RM et al. (2001) Astrovirus detection in wastewater. Water Science and
Technology, 43:7377.
11.2.3 Caliciviruses
General description
The family Caliciviridae consists of four genera of single-stranded RNA viruses with
a non-enveloped capsid (diameter 3540 nm), which generally displays a typical
surface morphology resembling cup-like structures. Human caliciviruses (HuCVs)
include the genera Norovirus (Norwalk-like viruses) and Sapovirus (Sapporo-like
viruses). Sapovirus spp. demonstrate the typical calicivirus morphology and are called
classical caliciviruses. Noroviruses generally fail to reveal the typical morphology and
were in the past referred to as small round-structured viruses. The remaining two
genera of the family contain viruses that infect animals other than humans. HuCVs
cannot be propagated in available cell culture systems. The viruses were originally dis-
covered by electron microscopy. Some Norovirus spp. can be detected by ELISA using
antibodies raised against baculovirus-expressed Norovirus capsid proteins. Several
reverse transcriptase PCR procedures have been described for the detection of HuCVs.
251

HuCVs are a major cause of acute viral gastroenteritis in all age groups. Symptoms
include nausea, vomiting and abdominal cramps. Usually about 40% of infected indi-
viduals present with diarrhoea; some have fever, chills, headache and muscular pain.
Since some cases present with vomiting only and no diarrhoea, the condition is also
known as winter vomiting disease. Infections by HuCVs induce a short-lived immu-
nity. The symptoms are usually relatively mild and rarely last for more than 3 days.
High attack rates in outbreaks indicate that the infecting dose is low.

HuCVs are excreted in faeces of infected individuals and will therefore be present in
domestic wastewaters as well as faecally contaminated food and water, including
Routes of exposure
The epidemiology of the disease indicates that person-to-person contact and the
inhalation of contaminated aerosols and dust particles, as well as airborne particles
of vomitus, are the most common routes of transmission. Drinking-water and a wide
variety of foods contaminated with human faeces have been conrmed as major
sources of exposure. Numerous outbreaks have been associated with contaminated
drinking-water, ice, water on cruise ships and recreational waters. Shellsh harvested
from sewage-contaminated waters have also been identied as a source of outbreaks.
Many HuCV outbreaks have been epidemiologically linked to contaminated drink-
ing-water supplies. Within a WSP, control measures to reduce potential risk from
HuCV should focus on prevention of source water contamination by human waste,
followed by adequate treatment and disinfection. The effectiveness of treatment
processes used to remove HuCV will require validation. Drinking-water supplies
should also be protected from contamination during distribution. Owing to the
higher resistance of the viruses to disinfection, E. coli (or, alternatively, thermotoler-
ant coliforms) is not a reliable index of the presence/absence of HuCVs in drinking-
water supplies.
Berke T et al. (1997) Phylogenetic analysis of the Caliciviridae. Journal of Medical
Virology, 52:419424.
Jiang X et al. (1999) Design and evaluation of a primer pair that detects both Norwalk-
and Sapporo-like caliciviruses by RT-PCR. Journal of Virological Methods,
83:145154.
252
Mauer AM, Sturchler DA (2000) A waterborne outbreak of small round-structured

virus, Campylobacter and Shigella co-infections in La Neuveville, Switzerland, 1998.
Epidemiology and Infection, 125:325332.
Monroe SS, Ando T, Glass R (2000) Introduction: Human enteric caliciviruses An
emerging pathogen whose time has come. Journal of Infectious Diseases, 181(Suppl.
2):S249251.
11.2.4 Enteroviruses
General description
The genus Enterovirus is a member of the family Picornaviridae. This genus consists
of 69 serotypes (species) that infect humans: poliovirus types 13, coxsackievirus
types A1A24, coxsackievirus types B1B6, echovirus types 133 and the numbered
enterovirus types EV68EV73. Members of the genus are collectively referred to as
enteroviruses. Other species of the genus infect animals other than humans for
instance, the bovine group of enteroviruses. Enteroviruses are among the smallest
known viruses and consist of a single-stranded RNA genome in a non-enveloped
icosahedral capsid with a diameter of 2030 nm. Some members of the genus are
readily isolated by cytopathogenic effect in cell cultures, notably poliovirus, coxsack-
ievirus B, echovirus and enterovirus.

Enteroviruses are one of the most common causes of human infections. They have
been estimated to cause about 30 million infections in the USA each year. The spec-
trum of diseases caused by enteroviruses is broad and ranges from a mild febrile illness
to myocarditis, meningoencephalitis, poliomyelitis, herpangina, hand-foot-and-
mouth disease and neonatal multi-organ failure. The persistence of the viruses in
chronic conditions such as polymyositis, dilated cardiomyopathy and chronic fatigue
syndrome has been described. Most infections, particularly in children, are asympto-
matic, but still lead to the excretion of large numbers of the viruses, which may cause
clinical disease in other individuals.

Enteroviruses are excreted in the faeces of infected individuals. Among the types of
viruses detectable by conventional cell culture isolation, enteroviruses are generally
the most numerous in sewage, water resources and treated drinking-water supplies.
The viruses are also readily detected in many foods.
Routes of exposure
Person-to-person contact and inhalation of airborne viruses or viruses in respiratory
droplets are considered to be the predominant routes of transmission of enteroviruses
in communities. Transmission from drinking-water could also be important, but this
has not yet been conrmed. Waterborne transmission of enteroviruses (coxsackievirus
253
A16 and B5) has been epidemiologically conrmed for only two outbreaks, and these
were associated with children bathing in lake water in the 1970s.
Enteroviruses have been shown to occur in substantial numbers in raw water sources
and treated drinking-water supplies. In view of their prevalence, drinking-water
represents a likely, although unconrmed, source of enterovirus infection. The limited
knowledge on the role of waterborne transmission could be related to a number of
factors, including the wide range of clinical symptoms, frequent asymptomatic infec-
tion, the diversity of serotypes and the dominance of person-to-person spread.
Enteroviruses have been detected in drinking-water supplies that met accepted spec-
ications for treatment, disinfection and conventional indicator organisms. Within a
WSP, control measures to reduce potential risk from enteroviruses should focus on
prevention of source water contamination by human waste, followed by adequate
treatment and disinfection. The effectiveness of treatment processes used to remove
enteroviruses will require validation. Drinking-water supplies should also be pro-
tected from contamination during distribution. Owing to the higher resistance of the
viruses to disinfection, E. coli (or, alternatively, thermotolerant coliforms) is not a reli-
able index of the presence/absence of enteroviruses in drinking-water supplies.
Grabow WOK, Taylor MB, de Villiers JC (2001) New methods for the detection of
viruses: call for review of drinking water quality guidelines. Water Science and
Technology, 43:18.
Hawley HB et al. (1973) Coxsackie B epidemic at a boys summer camp. Journal of the
American Medical Association, 226:3336.
11.2.5 Hepatitis A virus

General description
HAV is the only species of the genus Hepatovirus in the family Picornaviridae. The
virus shares basic structural and morphological features with other members of the
family, as described for enteroviruses. Human and simian HAVs are genotypically dis-
tinguishable. HAV cannot be readily detected or cultivated in conventional cell culture
systems, and identication in environmental samples is based on the use of PCR
techniques.

HAV is highly infectious, and the infecting dose is considered to be low. The virus
causes the disease hepatitis A, commonly known as infectious hepatitis. Like other
members of the group enteric viruses, HAV enters the gastrointestinal tract by inges-
tion, where it infects epithelial cells. From here, the virus enters the bloodstream and
reaches the liver, where it may cause severe damage to liver cells. In as many as 90%
254
of cases, particularly in children, there is little, if any, liver damage, and the infection
passes without clinical symptoms and elicits lifelong immunity. In general, the sever-
ity of illness increases with age. The damage to liver cells results in the release of liver-
specic enzymes such as aspartate aminotransferase, which are detectable in the
bloodstream and used as a diagnostic tool. The damage also results in the failure of
the liver to remove bilirubin from the bloodstream; the accumulation of bilirubin
causes the typical symptoms of jaundice and dark urine. After a relatively long incu-
bation period of 2830 days on average, there is a characteristic sudden onset of
illness, including symptoms such as fever, malaise, nausea, anorexia, abdominal dis-
comfort and eventually jaundice. Although mortality is generally less than 1%, repair
of the liver damage is a slow process that may keep patients incapacitated for 6 weeks
or longer. This has substantial burden of disease implications. Mortality is higher in
those over 50 years of age.

HAV occurs worldwide, but the prevalence of clinical disease has typical geographi-
cally based characteristics. HAV is excreted in faecal material of infected people, and
there is strong epidemiological evidence that faecally contaminated food and water
are common sources of the virus. In areas with poor sanitation, children are often
infected at a very early age and become immune for life without clinical symptoms
of disease. In areas with good sanitation, infection tends to occur later in life.
Routes of exposure
Person-to-person spread is probably the most common route of transmission, but
contaminated food and water are important sources of infection. There is stronger
epidemiological evidence for waterborne transmission of HAV than for any other
virus. Foodborne outbreaks are also relatively common, with sources of infection
including infected food handlers, shellsh harvested from contaminated water and
contaminated produce. Travel of people from areas with good sanitation to those with
poor sanitation provides a high risk of infection. Infection can also be spread in
association with injecting and non-injecting drug use.
The transmission of HAV by drinking-water supplies is well established, and the pres-
ence of HAV in drinking-water constitutes a substantial health risk. Within a WSP,
control measures to reduce potential risk from HAV should focus on prevention of
source water contamination by human waste, followed by adequate treatment and dis-
infection. The effectiveness of treatment processes used to remove HAV will require
validation. Drinking-water supplies should also be protected from contamination
during distribution. Owing to the higher resistance of the viruses to disinfection,
E. coli (or, alternatively, thermotolerant coliforms) is not a reliable index of the
presence/absence of HAV in drinking-water supplies.
255
Cuthbert JA (2001) Hepatitis A: Old and new. Clinical Microbiology Reviews, 14:3858.
WHO (2002) Enteric hepatitis viruses. In: Guidelines for drinking-water quality, 2nd
ed. Addendum: Microbiological agents in drinking water. Geneva, World Health
Organization, pp. 1839.
11.2.6 Hepatitis E virus

General description
HEV consists of a single-stranded RNA genome in a non-enveloped icosahedral
capsid with a diameter of 2734 nm. HEV shares properties with a number of viruses,
and classication is a challenge. At one stage, HEV was classied as a member of the
family Caliciviridae, but most recently it has been placed in a separate family called
hepatitis E-like viruses. There are indications of antigenic variation, and possibly even
differences in serotypes of the virus, whereas human HAV consists of only one clearly
dened serotype. HEV cannot be readily detected or cultivated in conventional cell
culture systems, and identication in environmental samples is based on the use of
PCR techniques.

HEV causes hepatitis that is in many respects similar to that caused by HAV. However,
the incubation period tends to be longer (average 40 days), and infections typically
have a mortality rate of up to 25% in pregnant women. In endemic regions, rst infec-
tions are typically seen in young adults rather than young children. Despite evidence
of antigenic variation, single infection appears to provide lifelong immunity to HEV.
Global prevalence has a characteristic geographic distribution. HEV is endemic and
causes clinical diseases in certain developing parts of the world, such as India, Nepal,
central Asia, Mexico and parts of Africa. In many of these areas, HEV is the most
important cause of viral hepatitis. Although seroprevalence can be high, clinical cases
and outbreaks are rare in certain parts of the world, such as Japan, South Africa, the
United Kingdom, North and South America, Australasia and central Europe. The
reason for the lack of clinical cases in the presence of the virus is unknown.

HEV is excreted in faeces of infected people, and the virus has been detected in raw
and treated sewage. Contaminated water has been associated with very large out-
breaks. HEV is distinctive, in that it is the only enteric virus with a meaningful animal
reservoir, including domestic animals, particularly pigs, as well as cattle, goats and
even rodents.
Routes of exposure
Secondary transmission of HEV from cases to contacts and particularly nursing staff
has been reported, but appears to be much less common than for HAV. The lower
256
level of person-to-person spread suggests that faecally polluted water could play a
much more important role in the spread of HEV than of HAV. Waterborne outbreaks
involving thousands of cases are on record. These include one outbreak in 1954 with
approximately 40 000 cases in Delhi, India; one with more than 100 000 cases in
19861988 in the Xinjiang Uighar region of China; and one in 1991 with some 79 000
cases in Kanpur, India. Animal reservoirs may also serve as a route of exposure, but
the extent to which humans contract HEV infection from animals remains to be
elucidated.
The role of contaminated water as a source of HEV has been conrmed, and the pres-
ence of the virus in drinking-water constitutes a major health risk. There is no labo-
ratory information on the resistance of the virus to disinfection processes, but data
on waterborne outbreaks suggest that HEV may be as resistant as other enteric viruses.
Within a WSP, control measures to reduce potential risk from HEV should focus on
prevention of source water contamination by human and animal waste, followed by
adequate treatment and disinfection. The effectiveness of treatment processes used to
remove HEV will require validation. Drinking-water supplies should also be protected
from contamination during distribution. Due to the likelihood that the virus has a
higher resistance to disinfection, E. coli (or, alternatively, thermotolerant coliforms) is
not a reliable index of the presence/absence of HEV in drinking-water supplies.
Pina S et al. (1998) Characterization of a strain of infectious hepatitis E virus isolated
from sewage in an area where hepatitis E is not endemic. Applied and Environmental
Microbiology, 64:44854488.
Van der Poel WHM et al. (2001) Hepatitis E virus sequence in swine related to
sequences in humans, the Netherlands. Emerging Infectious Diseases, 7:970976.
WHO (2002) Enteric hepatitis viruses. In: Guidelines for drinking-water quality, 2nd
ed. Addendum: Microbiological agents in drinking water. Geneva, World Health
Organization, pp. 1839.
11.2.7 Rotaviruses and orthoreoviruses

General description
Members of the genus Rotavirus consist of a segmented double-stranded RNA genome
in a non-enveloped icosahedral capsid with a diameter of 5065 nm. This capsid is
surrounded by a double-layered shell, giving the virus the appearance of a wheel
hence the name rotavirus. The diameter of the entire virus is about 80 nm. Rotavirus
and Orthoreovirus are the two genera of the family Reoviridae typically associated with
human infection. Orthoreoviruses are readily isolated by cytopathogenic effect on cell
cultures. The genus Rotavirus is serologically divided into seven groups, AG, each of
which consists of a number of subgroups; some of these subgroups specically infect
257
humans, whereas others infect a wide spectrum of animals. Groups AC are found in
humans, with group A being the most important human pathogens. Wild-type strains
of rotavirus group A are not readily grown in cell culture, but there are a number of
PCR-based detection methods available for testing environmental samples.

Human rotaviruses (HRVs) are the most important single cause of infant death in the
world. Typically, 5060% of cases of acute gastroenteritis of hospitalized children
throughout the world are caused by HRVs. The viruses infect cells in the villi of the
small intestine, with disruption of sodium and glucose transport. Acute infection has
an abrupt onset of severe watery diarrhoea with fever, abdominal pain and vomiting;
dehydration and metabolic acidosis may develop, and the outcome may be fatal if the
infection is not appropriately treated. The burden of disease of rotavirus infections is
extremely high. Members of the genus Orthoreovirus infect many humans, but they
are typical orphan viruses and not associated with any meaningful disease.

HRVs are excreted by patients in numbers up to 1011 per gram of faeces for periods
of about 8 days. This implies that domestic sewage and any environments polluted
with the human faeces are likely to contain large numbers of HRVs. The viruses have
been detected in sewage, rivers, lakes and treated drinking-water. Orthoreoviruses
generally occur in wastewater in substantial numbers.
Routes of exposure
HRVs are transmitted by the faecaloral route. Person-to-person transmission and the
inhalation of airborne HRVs or aerosols containing the viruses would appear to play
a much more important role than ingestion of contaminated food or water. This is
conrmed by the spread of infections in childrens wards in hospitals, which takes
place much faster than can be accounted for by the ingestion of food or water con-
taminated by the faeces of infected patients. The role of contaminated water in trans-
mission is lower than expected, given the prevalence of HRV infections and presence
in contaminated water. However, occasional waterborne and foodborne outbreaks
have been described. Two large outbreaks in China in 19821983 were linked to con-
taminated water supplies.
Although ingestion of drinking-water is not the most common route of transmission,
the presence of HRVs in drinking-water constitutes a public health risk. There is some
evidence that the rotaviruses are more resistant to disinfection than other enteric
viruses. Within a WSP, control measures to reduce potential risk from HRVs should
focus on prevention of source water contamination by human waste, followed by ade-
quate treatment and disinfection. The effectiveness of treatment processes used to
258
remove HRVs will require validation. Drinking-water supplies should also be pro-
tected from contamination during distribution. Due to a higher resistance of the
viruses to disinfection, E. coli (or, alternatively, thermotolerant coliforms) is not a
reliable index of the presence/absence of HRVs in drinking-water supplies.
Baggi F, Peduzzi R (2000) Genotyping of rotaviruses in environmental water and stool
samples in southern Switzerland by nucleotide sequence analysis of 189 base pairs
at the 5 end of the VP7 gene. Journal of Clinical Microbiology, 38:36813685.
Gerba CP et al. (1996) Waterborne rotavirus: a risk assessment. Water Research,
30:29292940.
Hopkins RS et al. (1984) A community waterborne gastroenteritis outbreak: evidence
for rotavirus as the agent. American Journal of Public Health, 74:263265.
Hung T et al. (1984) Waterborne outbreak of rotavirus diarrhoea in adults in China
caused by a novel rotavirus. Lancet, i:11391142.
Sattar SA, Raphael RA, Springthorpe VS (1984) Rotavirus survival in conventionally
treated drinking water. Canadian Journal of Microbiology, 30:653656.
11.3 Protozoan pathogens

Protozoa and helminths are among the most common causes of infection and disease
in humans and other animals. The diseases have a major public health and socioeco-
nomic impact. Water plays an important role in the transmission of some of these
pathogens. The control of waterborne transmission presents real challenges, because
most of the pathogens produce cysts, oocysts or eggs that are extremely resistant to
processes generally used for the disinfection of water and in some cases can be dif-
cult to remove by ltration processes. Some of these organisms cause emerging dis-
eases. In the last 25 years, the most notable example of an emerging disease caused
by a protozoan pathogen is cryptosporidiosis. Other examples are diseases caused by
microsporidia and Cyclospora. As evidence for waterborne transmission of emerging
diseases has been reported relatively recently, some questions about their epidemiol-
ogy and behaviour in water treatment and disinfection processes remain to be eluci-
dated. It would appear that the role of water in the transmission of this group of
pathogens may increase substantially in importance and complexity as human and
animal populations grow and the demands for potable drinking-water escalate.
Further information on emerging diseases is provided in Emerging Issues in Water
and Infectious Disease (WHO, 2003) and associated texts.
11.3.1 Acanthamoeba
General description
Acanthamoeba spp. are free-living amoebae (1050 mm in diameter) common in
aquatic environments and one of the prominent protozoa in soil. The genus contains
some 20 species, of which A. castellanii, A. polyphaga and A. culbertsoni are known to
259
be human pathogens. However, the taxonomy of the genus may change substantially
when evolving molecular biological knowledge is taken into consideration.
Acanthamoeba has a feeding, replicative trophozoite, which, under unfavourable
conditions, such as an anaerobic environment, will develop into a dormant cyst that
can withstand extremes of temperature (-20 to 56 C), disinfection and desiccation.

Acanthamoeba culbertsoni causes granulomatous amoebic encephalitis (GAE),
whereas A. castellanii and A. polyphaga are associated with acanthamoebic keratitis
and acanthamoebic uveitis.
GAE is a multifocal, haemorrhagic and necrotizing encephalitis that is generally
seen only in debilitated or immunodecient persons. It is a rare but usually fatal
disease. Early symptoms include drowsiness, personality changes, intense headaches,
stiff neck, nausea, vomiting, sporadic low fevers, focal neurological changes, hemi-
paresis and seizures. This is followed by an altered mental status, diplopia, paresis,
lethargy, cerebellar ataxia and coma. Death follows within a week to a year after the
appearance of the rst symptoms, usually as a result of bronchopneumonia. Associ-
ated disorders of GAE include skin ulcers, liver disease, pneumonitis, renal failure and
pharyngitis.
Acanthamoebic keratitis is a painful infection of the cornea and can occur in
healthy individuals, especially among contact lens wearers. It is a rare disease that may
lead to impaired vision, permanent blindness and loss of the eye. The prevalence of
antibodies to Acanthamoeba and the detection of the organism in the upper airways
of healthy persons suggest that infection may be common with few apparent symp-
toms in the vast majority of cases.

The wide distribution of Acanthamoeba in the natural environment makes soil, air-
borne dust and water all potential sources. Acanthamoeba can be found in many types
of aquatic environments, including surface water, tap water, swimming pools and
contact lens solutions. Depending on the species, Acanthamoeba can grow over a wide
temperature range in water, with the optimum temperature for pathogenic species
being 30 C. Trophozoites can exist and replicate in water while feeding on bacteria,
yeasts and other organisms. Infections occur in most temperate and tropical regions
of the world.
Routes of exposure
Acanthamoebic keratitis has been associated with soft contact lenses being washed
with contaminated home-made saline solutions or contamination of the contact lens
containers. Although the source of the contaminating organisms has not been estab-
lished, tap water is one possibility. Warnings have been issued by a number of health
agencies that only sterile water should be used to prepare wash solutions for contact
260
lenses. The mode of transmission of GAE has not been established, but water is not
considered to be a source of infection. The more likely routes of transmission are via
the blood from other sites of colonization, such as skin lesions or lungs.
Cases of acanthamoebic keratitis have been associated with drinking-water due to use
of tap water in preparing solutions for washing contact lenses. Cleaning of contact
lenses is not considered to be a normal use for tap water, and a higher-quality water
may be required. Compared with Cryptosporidium and Giardia, Acanthamoeba is
relatively large and is amenable to removal from raw water by ltration. Reducing the
presence of biolm organisms is likely to reduce food sources and growth of the
organism in distribution systems, but the organism is highly resistant to disinfection.
However, as normal uses of drinking-water lack signicance as a source of infection,
setting a health-based target for Acanthamoeba spp. is not warranted.
Marshall MM et al. (1997) Waterborne protozoan pathogens. Clinical Microbiology
Reviews, 10:6785.
Yagita K, Endo T, De Jonckheere JF (1999) Clustering of Acanthamoeba isolates from
human eye infections by means of mitochondrial DNA digestion patterns.
Parasitology Research, 85:284289.
11.3.2 Balantidium coli

General description
Balantidium coli is a unicellular protozoan parasite with a length up to 200 mm,
making it the largest of the human intestinal protozoa. The trophozoites are oval in
shape and covered with cilia for motility. The cysts are 6070 mm in length and resist-
ant to unfavourable environmental conditions, such as pH and temperature extremes.
Balantidium coli belongs to the largest protozoan group, the ciliates, with about 7200
species, of which only B. coli is known to infect humans.

Infections in humans are relatively rare, and most are asymptomatic. The trophozoites
invade the mucosa and submucosa of the large intestine and destroy the host cells
when multiplying. The multiplying parasites form nests and small abscesses that break
down into oval, irregular ulcers. Clinical symptoms may include dysentery similar to
amoebiasis, colitis, diarrhoea, nausea, vomiting, headache and anorexia. The infec-
tions are generally self-limiting, with complete recovery.

Humans seem to be the most important host of B. coli, and the organism can be
detected in domestic sewage. Animal reservoirs, particularly swine, also contribute to
261
the prevalence of the cysts in the environment. The cysts have been detected in water
sources, but the prevalence in tap water is unknown.
Routes of exposure
Transmission of B. coli is by the faecaloral route, from person to person, from contact
with infected swine or by consumption of contaminated water or food. One water-
borne outbreak of balantidiasis has been reported. This outbreak occurred in 1971
when a drinking-water supply was contaminated with stormwater runoff containing
swine faeces after a typhoon.
Although water does not appear to play an important role in the spread of this organ-
ism, one waterborne outbreak is on record. Balantidium coli is large and amenable to
removal by ltration, but cysts are highly resistant to disinfection. Within a WSP,
control measures to reduce potential risk from B. coli should focus on prevention
of source water contamination by human and swine waste, followed by adequate
treatment. Due to resistance to disinfection, E. coli (or, alternatively, thermotolerant
coliforms) is not a reliable index for the presence/absence of B. coli in drinking-water
supplies.
Garcia LS (1999) Flagellates and ciliates. Clinics in Laboratory Medicine, 19:621638.
Walzer PD et al. (1973) Balantidiasis outbreak in Truk. American Journal of Tropical
Medicine and Hygiene, 22:3341.
11.3.3 Cryptosporidium
General description
Cryptosporidium is an obligate, intracellular, coccidian parasite with a complex life
cycle including sexual and asexual replication. Thick-walled oocysts with a diameter
of 46 mm are shed in faeces. The genus Cryptosporidium has about eight species, of
which C. parvum is responsible for most human infections, although other species
can cause illness. Cryptosporidium is one of the best examples of an emerging
disease-causing organism. It was discovered to infect humans only in 1976, and
waterborne transmission was conrmed for the rst time in 1984.

Cryptosporidium generally causes a self-limiting diarrhoea, sometimes including
nausea, vomiting and fever, which usually resolves within a week in normally healthy
people, but can last for a month or more. Severity of cryptosporidiosis varies accord-
ing to age and immune status, and infections in severely immunocompromised people
can be life-threatening. The impact of cryptosporidiosis outbreaks is relatively high
due to the large numbers of people that may be involved and the associated socioe-
262
conomic implications. The total cost of illness associated with the 1993 outbreak in
Milwaukee, USA, has been estimated at US$96.2 million.

A large range of animals are reservoirs of C. parvum, but humans and livestock,
particularly young animals, are the most signicant source of human infectious
organisms. Calves can excrete 1010 oocysts per day. Concentrations of oocysts as high
as 14 000 per litre for raw sewage and 5800 per litre for surface water have been
reported. Oocysts can survive for weeks to months in fresh water. Cryptosporidium
oocysts have been detected in many drinking-water supplies. However, in most cases,
there is little information about whether human infectious species were present. The
currently available standard analytical techniques provide an indirect measure of via-
bility and no indication of human infectivity. Oocysts also occur in recreational
waters.
Routes of exposure
Cryptosporidium is transmitted by the faecaloral route. The major route of infection
is person-to-person contact. Other sources of infection include the consumption of
contaminated food and water and direct contact with infected farm animals and pos-
sibly domestic pets. Contaminated drinking-water, recreational water and, to a lesser
extent, food have been associated with outbreaks. In 1993, Cryptosporidium caused
the largest waterborne outbreak of disease on record, when more than 400 000 people
were infected by the drinking-water supply of Milwaukee, USA. The infectivity of
Cryptosporidium oocysts is relatively high. Studies on healthy human volunteers
revealed that ingestion of fewer than 10 oocysts can lead to infection.
The role of drinking-water in the transmission of Cryptosporidium, including in large
outbreaks, is well established. Attention to these organisms is therefore important.
The oocysts are extremely resistant to oxidizing disinfectants such as chlorine, but
investigations based on assays for infectivity have shown that UV light irradiation
inactivates oocysts. Within a WSP, control measures to reduce potential risk from
Cryptosporidium should focus on prevention of source water contamination by
human and livestock waste, adequate treatment and protection of water during dis-
tribution. Because of their relatively small size, the oocysts represent a challenge for
removal by conventional granular media-based ltration processes. Acceptable
removal requires well designed and operated systems. Membrane ltration processes
that provide a direct physical barrier may represent a viable alternative for the effec-
tive removal of Cryptosporidium oocysts. Owing to the exceptional resistance of the
oocysts to disinfectants, E. coli (or, alternatively, thermotolerant coliforms) cannot
be relied upon as an index for the presence/absence of Cryptosporidium oocysts in
263
Corso PS et al. (2003) Cost of illness in the 1993 waterborne Cryptosporidium
outbreak, Milwaukee, Wisconsin. Emerging Infectious Diseases, 9:426431.
Haas CN et al. (1996) Risk assessment of Cryptosporidium parvum oocysts in drink-
ing water. Journal of the American Water Works Association, 88:131136.
Leav BA, Mackay M, Ward HD (2003) Cryptosporidium species: new insight and old
challenges. Clinical Infectious Diseases, 36:903908.
Linden KG, Shin G, Sobsey MD (2001) Comparative effectiveness of UV wavelengths
for the inactivation of Cryptosporidium parvum oocysts in water. Water Science and
Okhuysen PC et al. (1999) Virulence of three distinct Cryptosporidium parvum
isolates for healthy adults. Journal of Infectious Diseases, 180:12751281.
WHO (2002) Protozoan parasites (Cryptosporidium, Giardia, Cyclospora). In: Guide-
lines for drinking-water quality, 2nd ed. Addendum: Microbiological agents in drink-
ing water. Geneva, World Health Organization, pp. 70118.
11.3.4 Cyclospora cayetanensis

General description
Cyclospora cayetanensis is a single-cell, obligate, intracellular, coccidian protozoan par-
asite, which belongs to the family Eimeriidae. It produces thick-walled oocysts of 810
mm in diameter that are excreted in the faeces of infected individuals. Cyclospora
cayetanensis is considered an emerging waterborne pathogen.

Sporozoites are released from the oocysts when ingested and penetrate epithelial cells
in the small intestine of susceptible individuals. Clinical symptoms of cyclosporiasis
include watery diarrhoea, abdominal cramping, weight loss, anorexia, myalgia and
occasionally vomiting and/or fever. Relapsing illness often occurs.

Humans are the only host identied for this parasite. The unsporulated oocysts pass
into the external environment with faeces and undergo sporulation, which is com-
plete in 712 days, depending on environmental conditions. Only the sporulated
oocysts are infectious. Due to the lack of a quantication technique, there is limited
information on the prevalence of Cyclospora in water environments. However,
Cyclospora has been detected in sewage and water sources.
Routes of exposure
Cyclospora cayetanensis is transmitted by the faecaloral route. Person-to-person
transmission is virtually impossible, because the oocysts must sporulate outside the
host to become infectious. The primary routes of exposure are contaminated water
and food. The initial source of organisms in foodborne outbreaks has generally not
264
been established, but contaminated water has been implicated in several cases. Drink-
ing-water has also been implicated as a cause of outbreaks. The rst report was among
staff of a hospital in Chicago, USA, in 1990. The infections were associated with drink-
ing tap water that had possibly been contaminated with stagnant water from a rooftop
storage reservoir. Another outbreak was reported from Nepal, where drinking-water
consisting of a mixture of river and municipal water was associated with infections
in 12 of 14 soldiers.
Transmission of the pathogens by drinking-water has been conrmed. The oocysts
are resistant to disinfection and are not inactivated by chlorination practices gener-
ally applied in the production of drinking-water. Within a WSP, control measures that
can be applied to manage potential risk from Cyclospora include prevention of source
water contamination by human waste, followed by adequate treatment and protec-
tion of water during distribution. Owing to the resistance of the oocysts to disinfec-
tants, E. coli (or, alternatively, thermotolerant coliforms) cannot be relied upon as an
index of the presence/absence of Cyclospora in drinking-water supplies.
Curry A, Smith HV (1998) Emerging pathogens: Isospora, Cyclospora and
microsporidia. Parasitology, 117:S143159.
Dowd SE et al. (2003) Conrmed detection of Cyclospora cayetanensis, Encephalito-
zoon intestinalis and Cryptosporidium parvum in water used for drinking. Journal
of Water and Health, 1:117123.
Goodgame R (2003) Emerging causes of travellers diarrhea: Cryptosporidium,
Cyclospora, Isospora and microsporidia. Current Infectious Disease Reports, 5:66
73.
Herwaldt BL (2000) Cyclospora cayetanensis: A review, focusing on the outbreaks of
cyclosporiasis in the 1990s. Clinical Infectious Diseases, 31:10401057.
Rabold JG et al. (1994) Cyclospora outbreak associated with chlorinated drinking-
water [letter]. Lancet, 344:13601361.
11.3.5 Entamoeba histolytica

General description
Entamoeba histolytica is the most prevalent intestinal protozoan pathogen worldwide
and belongs to the superclass Rhizopoda in the subphylum Sarcodina. Entamoeba has
a feeding, replicative trophozoite (diameter 1060 mm), which, under unfavourable
conditions, will develop into a dormant cyst (diameter 1020 mm). Infection is con-
tracted by the ingestion of cysts. Recent studies with RNA and DNA probes demon-
265
strated genetic differences between pathogenic and non-pathogenic E. histolytica; the

latter has been separated and reclassied as E. dispar.

About 8595% of human infections with E. histolytica are asymptomatic. Acute intes-
tinal amoebiasis has an incubation period of 114 weeks. Clinical disease results from
the penetration of the epithelial cells in the gastrointestinal tract by the amoebic
trophozoites. Approximately 10% of infected individuals present with dysentery or
colitis. Symptoms of amoebic dysentery include diarrhoea with cramping, lower
abdominal pain, low-grade fever and the presence of blood and mucus in the stool.
The ulcers produced by the invasion of the trophozoites may deepen into the classic
ask-shaped ulcers of amoebic colitis. Entamoeba histolytica may invade other parts
of the body, such as the liver, lungs and brain, sometimes with fatal outcome.

Humans are the reservoir of infection, and there would not appear to be other mean-
ingful animal reservoirs of E. histolytica. In the acute phase of infection, patients
excrete only trophozoites that are not infectious. Chronic cases and asymptomatic car-
riers who excrete cysts are more important sources of infection and can discharge
up to 1.5 107 cysts daily. Entamoeba histolytica can be present in sewage and
contaminated water. Cysts may remain viable in suitable aquatic environments for
several months at low temperature. The potential for waterborne transmission is
greater in the tropics, where the carrier rate sometimes exceeds 50%, compared with
more temperate regions, where the prevalence in the general population may be less
than 10%.
Routes of exposure
Person-to-person contact and contamination of food by infected food handlers
appear to be the most signicant means of transmission, although contaminated water
also plays a substantial role. Ingestion of faecally contaminated water and consump-
tion of food crops irrigated with contaminated water can both lead to transmission
of amoebiasis. Sexual transmission, particularly among male homosexuals, has also
been documented.
The transmission of E. histolytica by contaminated drinking-water has been con-
rmed. The cysts are relatively resistant to disinfection and may not be inactivated by
chlorination practices generally applied in the production of drinking-water. Within
a WSP, control measures that can be applied to manage potential risk from E.
histolytica include prevention of source water contamination by human waste, fol-
lowed by adequate treatment and protection of water during distribution. Owing to
the resistance of the oocysts to disinfectants, E. coli (or, alternatively, thermotolerant
266
coliforms) cannot be relied upon as an index of the presence/absence of E. histolytica

in drinking-water supplies.
Marshall MM et al. (1997) Waterborne protozoan pathogens. Clinical Microbiology
Reviews, 10:6785.
11.3.6 Giardia intestinalis

General description
Giardia spp. are agellated protozoa that parasitize the gastrointestinal tract of
humans and certain animals. The genus Giardia consists of a number of species, but
human infection (giardiasis) is usually assigned to G. intestinalis, also known as G.
lamblia or G. duodenalis. Giardia has a relatively simple life cycle consisting of a ag-
ellate trophozoite that multiplies in the gastrointestinal tract and an infective thick-
walled cyst that is shed intermittently but in large numbers in faeces. The trophozoites
are bilaterally symmetrical and ellipsoidal in shape. The cysts are ovoid in shape and
812 mm in diameter.

Giardia has been known as a human parasite for 200 years. After ingestion and excys-
tation of cysts, the trophozoites attach to surfaces of the gastrointestinal tract. Infec-
tions in both children and adults may be asymptomatic. In day care centres, as many
as 20% of children may carry Giardia and excrete cysts without clinical symptoms.
The symptoms of giardiasis may result from damage caused by the trophozoites,
although the mechanisms by which Giardia causes diarrhoea and intestinal malab-
sorption remain controversial. Symptoms generally include diarrhoea and abdominal
cramps; in severe cases, however, malabsorption deciencies in the small intestine may
be present, mostly among young children. Giardiasis is self-limiting in most cases, but
it may be chronic in some patients, lasting more than 1 year, even in otherwise healthy
people. Studies on human volunteers revealed that fewer than 10 cysts constitute a
meaningful risk of infection.

Giardia can multiply in a wide range of animal species, including humans, which
excrete cysts into the environment. Numbers of cysts as high as 88 000 per litre in raw
sewage and 240 per litre in surface water resources have been reported. These cysts
are robust and can survive for weeks to months in fresh water. The presence of cysts
in raw water sources and drinking-water supplies has been conrmed. However, there
is no information on whether human infectious species were present. The currently
available standard analytical techniques provide an indirect measure of viability and
no indication of human infectivity. Cysts also occur in recreational waters and
contaminated food.
267
Routes of exposure
By far the most common route of transmission of Giardia is person-to-person contact,
particularly between children. Contaminated drinking-water, recreational water and,
to a lesser extent, food have been associated with outbreaks. Animals have been impli-
cated as a source of human infectious G. intestinalis, but further investigations are
required to determine their role.
Waterborne outbreaks of giardiasis have been associated with drinking-water supplies
for over 30 years; at one stage, Giardia was the most commonly identied cause of
waterborne outbreaks in the USA. Giardia cysts are more resistant than enteric
bacteria to oxidative disinfectants such as chlorine, but they are not as resistant as
Cryptosporidium oocysts. The time required for 90% inactivation at a free chlorine
residual of 1 mg/litre is about 2530 min. Within a WSP, control measures that can be
applied to manage potential risk from Giardia include prevention of source water con-
tamination by human and animal waste, followed by adequate treatment and disin-
fection and protection of water during distribution. Owing to the resistance of the
cysts to disinfectants, E. coli (or, alternatively, thermotolerant coliforms) cannot be
relied upon as an index of the presence/absence of Giardia in drinking-water supplies.
LeChevallier MW, Norton WD, Lee RG (1991) Occurrence of Giardia and Cryp-
tosporidium species in surface water supplies. Applied and Environmental Microbi-
ology, 57:26102616.
Ong C et al. (1996) Studies of Giardia spp. and Cryptosporidium spp. in two adjacent
watersheds. Applied and Environmental Microbiology, 62:27982805.
Rimhanen-Finne R et al. (2002) An IC-PCR method for detection of Cryptosporid-
ium and Giardia in natural surface waters in Finland. Journal of Microbiological
Methods, 50:299303.
Slifko TR, Smith HV, Rose JB (2000) Emerging parasite zoonoses associated with water
and food. International Journal for Parasitology, 30:13791393.
Stuart JM et al. (2003) Risk factors for sporadic giardiasis: a casecontrol study in
southwestern England. Emerging Infectious Diseases, 9:229233.
11.3.7 Isospora belli

General description
Isospora is a coccidian, single-celled, obligate parasite related to Cryptosporidium and
Cyclospora. There are many species of Isospora that infect animals, but only I. belli is
known to infect humans, the only known host for this species. Isospora belli is one of
268
the few coccidia that undergo sexual reproduction in the human intestine. Sporulated
oocysts are ingested, and, after complete asexual and sexual life cycles in the mucosal
epithelium of the upper small intestine, unsporulated oocysts are released in faeces.

Illness caused by I. belli is similar to that caused by Cryptosporidium and Giardia.
About 1 week after ingestion of viable cysts, a low-grade fever, lassitude and malaise
may appear, followed soon by mild diarrhoea and vague abdominal pain. The infec-
tion is usually self-limited after 12 weeks, but occasionally diarrhoea, weight loss and
fever may last for 6 weeks to 6 months. Symptomatic isosporiasis is more common in
children than in adults. Infection is often associated with immunocompromised
patients, in whom symptoms are more severe and likely to be recurrent or chronic,
leading to malabsorption and weight loss. Infections are usually sporadic and most
common in the tropics and subtropics, although they also occur elsewhere, including
industrialized countries. They have been reported from Central and South America,
Africa and south-east Asia.

Unsporulated oocysts are excreted in the faeces of infected individuals. The oocysts
sporulate within 12 days in the environment to produce the potentially infectious
form of the organism. Few data are available on numbers of oocysts in sewage and
raw and treated water sources. This is largely because sensitive and reliable techniques
for the quantitative enumeration of oocysts in water environments are not available.
Little is known about the survival of oocysts in water and related environments.
Routes of exposure
Poor sanitation and faecally contaminated food and water are the most likely sources
of infection, but waterborne transmission has not been conrmed. The oocysts are
less likely than Cryptosporidium oocysts or Giardia cysts to be transmitted directly
from person to person, because freshly shed I. belli oocysts require 12 days in the
environment to sporulate before they are capable of infecting humans.
The characteristics of I. belli suggest that illness could be transmitted by contaminated
drinking-water supplies, but this has not been conrmed. No information is available
on the effectiveness of water treatment processes for removal of I. belli, but it is likely
that the organism is relatively resistant to disinfectants. It is considerably larger than
Cryptosporidium and should be easier to remove by ltration. Within a WSP, control
measures that can be applied to manage potential risk from I. belli include prevention
of source water contamination by human waste, followed by adequate treatment and
disinfection and protection of water during distribution. Owing to the likely resist-
ance of the oocysts to disinfectants, E. coli (or, alternatively, thermotolerant coliforms)
269
cannot be relied upon as an index of the presence/absence of I. belli in drinking-water

supplies.
Ballal M et al. (1999) Cryptosporidium and Isospora belli diarrhoea in immunocom-
promised hosts. Indian Journal of Cancer, 36:3842.
Bialek R et al. (2002) Comparison of autouorescence and iodine staining for detec-
tion of Isospora belli in feces. American Journal of Tropical Medicine and Hygiene,
67:304305.
Curry A, Smith HV (1998) Emerging pathogens: Isospora, Cyclospora and
microsporidia. Parasitology, 117:S143159.
Cyclospora, Isospora and microsporidia. Current Infectious Disease Reports, 5:6673.
11.3.8 Microsporidia
General description
The term microsporidia is a non-taxonomic designation commonly used to describe
a group of obligate intracellular protozoa belonging to the phylum Microspora. More
than 100 microsporidial genera and almost 1000 species have been identied. Infec-
tions occur in every major animal group, including vertebrates and invertebrates. A
number of genera have been implicated in human infections, including Enterocyto-
zoon, Encephalitozoon (including Septata), Nosema, Pleistophora, Vittaforma and Tra-
chipleistophora, as well as a collective group of unclassied microsporidia referred to
as microsporidium. Microsporidia are among the smallest eukaryotes. They produce
unicellular spores with a diameter of 1.04.5 mm and a characteristic coiled polar l-
ament for injecting the sporoplasm into a host cell to initiate infection. Within an
infected cell, a complex process of multiplication takes place, and new spores are pro-
duced and released in faeces, urine, respiratory secretions or other body uids,
depending on the type of species and the site of infection.

Microsporidia are emerging human pathogens identied predominantly in persons
with AIDS, but their ability to cause disease in immunologically normal hosts has
been recognized. Reported human infections are globally dispersed and have been
documented in persons from all continents. The most common clinical manifestation
in AIDS patients is a severe enteritis involving chronic diarrhoea, dehydration and
weight loss. Prolonged illness for up to 48 months has been reported. Infections in
the general population are less pronounced. Enterocytozoon infection generally
appears to be limited to intestinal enterocytes and biliary epithelium. Encephalitozoon
spp. infect a variety of cells, including epithelial and endothelial cells, broblasts,
kidney tubule cells, macrophages and possibly other cell types. Unusual complications
include keratoconjunctivitis, myositis and hepatitis.
270

The sources of microsporidia infecting humans are uncertain. Spores are likely to be
excreted in faeces and are also excreted in urine and respiratory secretions. Due to the
lack of a quantication technique, there is limited information on the prevalence of
microsporidia spores in water environments. However, microsporidia have been
detected in sewage and water sources. Indications are that their numbers in raw sewage
may be similar to those of Cryptosporidium and Giardia, and they may survive in
certain water environments for many months. Certain animals, notably swine, may
serve as a host for human infectious species.
Routes of exposure
Little is known about transmission of microsporidia. Person-to-person contact and
ingestion of spores in water or food contaminated with human faeces or urine are
probably important routes of exposure. A waterborne outbreak of microsporidiosis
has been reported involving about 200 cases in Lyon, France, during the summer of
1995. However, the source of the organism and faecal contamination of the drinking-
water supply were not demonstrated. Transmission by the inhalation of airborne
spores or aerosols containing spores seems possible. The role of animals in transmis-
sion to humans remains unclear. Epidemiological and experimental studies in
mammals suggest that Encephalitozoon spp. can be transmitted transplacentally from
mother to offspring. No information is available on the infectivity of the spores.
However, in view of the infectivity of spores of closely related species, the infectivity
of microsporidia may be high.
Waterborne transmission has been reported, and infection arising from contaminated
drinking-water is plausible but unconrmed. Little is known about the response of
microsporidia to water treatment processes. One study has suggested that the spores
may be susceptible to chlorine. The small size of the organism is likely to make
them difcult to remove by ltration processes. Within a WSP, control measures
that can be applied to manage potential risk from microsporidia include prevention
of source water contamination by human and animal waste, followed by adequate
treatment and disinfection and protection of water during distribution. Owing to the
lack of information on sensitivity of infectious species of microsporidia to disinfec-
tion, the reliability of E. coli (or, alternatively, thermotolerant coliforms) as an index
for the presence/absence of these organisms from drinking-water supplies is
unknown.
Coote L et al. (2000) Waterborne outbreak of intestinal microsporidiosis in persons
with and without human immunodeciency virus infection. Journal of Infectious
Diseases, 180:20032008.
271
Dowd SE et al. (2003) Conrmed detection of Cyclospora cayetanensis, Encephalito-

zoon intestinalis and Cryptosporidium parvum in water used for drinking. Journal
of Water and Health, 1:117123.
Cyclospora, Isospora and microsporidia. Current Infectious Disease Reports, 5:6673.
Joynson DHM (1999) Emerging parasitic infections in man. The Infectious Disease
Review, 1:131134.
Slifko TR, Smith HV, Rose JB (2000) Emerging parasite zoonoses associated with water
and food. International Journal for Parasitology, 30:13791393.
11.3.9 Naegleria fowleri

General description
Naegleria are free-living amoeboagellates distributed widely in the environment.
There are several species of Naegleria, of which N. fowleri is the primary infectious
species. Naegleria spp. exist as a trophozoite, a agellate and a cyst stage. The tropho-
zoite (1020 mm) moves by eruptive pseudopod formation feeding on bacteria and
reproduces by binary ssion. The trophozoite can transform into a agellate stage with
two anterior agella. The agellate does not divide but reverts to the trophozoite stage.
Under adverse conditions, the trophozoite transforms into a circular cyst (715 mm),
which is resistant to unfavourable conditions.

Naegleria fowleri causes primary amoebic meningoencephalitis (PAM) in healthy indi-
viduals. The amoeba enters the brain by penetrating the olfactory mucosa and cribi-
form plate. The disease is acute, and patients often die within 510 days and before
the infectious agent can be diagnosed. Treatment is difcult. Although the infection
is rare, new cases are reported every year.

Naegleria fowleri is thermophilic and grows well at temperatures up to 45 C. It occurs
naturally in fresh water of suitable temperature, and prevalence is only indirectly
related to human activity, inasmuch as such activity may modify temperature or
promote bacterial (food source) production. The pathogen has been reported from
many countries, usually associated with thermally polluted water environments such
as geothermal water or heated swimming pools. However, the organism has been
detected in drinking-water supplies, particularly where water temperature can exceed
2530 C. Water is the only known source of infection. The rst cases of amoebic
meningitis were diagnosed in 1965 in Australia and Florida. Since that time, about
100 cases of PAM have been reported throughout the world.
272
Routes of exposure
Infection with N. fowleri is almost exclusively contracted by exposure of the nasal
passages to contaminated water. Infection is predominantly associated with recre-
ational use of water, including swimming pools and spas, as well as surface waters nat-
urally heated by the sun, industrial cooling waters and geothermal springs. In a limited
number of cases, a link to recreational water exposure is lacking. The occurrence of
PAM is highest during hot summer months, when many people engage in water recre-
ation and when the temperature of water is conducive to growth of the organism.
Consumption of contaminated water or food and person-to-person spread have not
been reported as routes of transmission.
Naegleria fowleri has been detected in drinking-water supplies. Although unproven, a
direct or indirect role of drinking-water-derived organisms for example, through
use of drinking-water in swimming pools is possible. Any water supply that sea-
sonally exceeds 30 C or that continually exceeds 25 C can potentially support the
growth of N. fowleri. In such cases, a periodic prospective study would be valuable.
Free chlorine or monochloramine residuals in excess of 0.5 mg/litre have been shown
to control N. fowleri, providing the disinfectant persists through the water distribu-
tion system. In addition to maintaining persistent disinfectant residuals, other control
measures aimed at limiting the presence of biolm organisms will reduce food sources
and hence growth of the organism in distribution systems. Owing to the environ-
mental nature of this amoeba, E. coli (or, alternatively, thermotolerant coliforms)
cannot be relied upon as an index for the presence/absence of N. fowleri in drinking-
water supplies.
Behets J et al. (2003) Detection of Naegleria spp. and Naegleria fowleri: a comparison
of agellation tests, ELISA and PCR. Water Science and Technology, 47:117122.
Cabanes P-A et al. (2001) Assessing the risk of primary amoebic meningoencephali-
tis from swimming in the presence of environmental Naegleria fowleri. Applied and
Environmental Microbiology, 67:29272931.
Dorsch MM, Cameron AS, Robinson BS (1983) The epidemiology and control of
primary amoebic meningoencephalitis with particular reference to South Australia.
Transactions of the Royal Society of Tropical Medicine and Hygiene, 77:372377.
Martinez AJ, Visvesvara GS (1997) Free-living amphizoic and opportunistic amebas.
Brain Pathology, 7:583598.
Parija SC, Jayakeerthee SR (1999) Naegleria fowleri: a free living amoeba of emerging
medical importance. Communicable Diseases, 31:153159.
273
11.3.10 Toxoplasma gondii

General description
Many species of Toxoplasma and Toxoplasma-like organisms have been described, but
it would appear that T. gondii is the only human infectious species. Toxoplasma gondii
is a coccidian parasite, and the cat is the denitive host. Only cats harbour the para-
site in the intestinal tract, where sexual reproduction takes place. The actively multi-
plying asexual form in the human host is an obligate, intracellular parasite (diameter
36 mm) called a tachyzoite. A chronic phase of the disease develops as the tachyzoites
transform into slowly replicating bradyzoites, which eventually become cysts in the
host tissue. In the natural cycle, mice and rats containing infective cysts are eaten by
cats, which host the sexual stage of the parasite. The cyst wall is digested, and brady-
zoites penetrate epithelial cells of the small intestine. Several generations of intra-
cellular multiplication lead to the development of micro- and macrogametes.
Fertilization of the latter leads to the development of oocysts that are excreted in faeces
as early as 5 days after a cat has ingested the cysts. Oocysts require 15 days to sporu-
late in the environment. Sporulated oocysts and tissue-borne cysts can both cause
infections in susceptible hosts.

Toxoplasmosis is usually asymptomatic in humans. In a small percentage of cases,
u-like symptoms, lymphadenopathy and hepatosplenomegaly present 523 days
after the ingestion of cysts or oocysts. Dormant cysts, formed in organ tissue after
primary infection, can be reactivated when the immune system becomes suppressed,
producing disseminated disease involving the central nervous system and lungs and
leading to severe neurological disorders or pneumonia. When these infection sites
are involved, the disease can be fatal in immunocompromised patients. Congenital
toxoplasmosis is mostly asymptomatic, but can produce chorioretinitis, cerebral
calcications, hydrocephalus, severe thrombocytopenia and convulsions. Primary
infection during early pregnancy can lead to spontaneous abortion, stillbirth or
fetal abnormality.

Toxoplasmosis is found worldwide. Estimates indicate that in many parts of the world,
1530% of lamb and pork meat is infected with cysts. The prevalence of oocyst-
shedding cats may be 1%. By the third decade of life, about 50% of the European
population is infected, and in France this proportion is close to 80%. Toxoplasma
gondii oocysts may occur in water sources and supplies contaminated with the faeces
of infected cats. Due to a lack of practical methods for the detection of T. gondii
oocysts, there is little information on the prevalence of the oocysts in raw and treated
water supplies. Details on the survival and behaviour of the oocysts in water envi-
ronments are also not available. However, qualitative evidence of the presence of
oocysts in faecally polluted water has been reported, and results suggest that T. gondii
274
oocysts may be as resistant to unfavourable conditions in water environments as the

oocysts of related parasites.
Routes of exposure
Both T. gondii oocysts that sporulate after excretion by cats and tissue-borne cysts are
potentially infectious. Humans can become infected by ingestion of oocysts excreted
by cats by direct contact or through contact with contaminated soil or water. Two out-
breaks of toxoplasmosis have been associated with consumption of contaminated
water. In Panama, creek water contaminated by oocysts from jungle cats was identi-
ed as the most likely source of infection, while in 1995, an outbreak in Canada was
associated with a drinking-water reservoir being contaminated by excreta from
domestic or wild cats. A study in Brazil during 19971999 identied the consump-
tion of unltered drinking-water as a risk factor for T. gondii seropositivity. More com-
monly, humans contract toxoplasmosis through the consumption of undercooked or
raw meat and meat products containing T. gondii cysts. Transplacental infection also
occurs.
Contaminated drinking-water has been identied as a source of toxoplasmosis out-
breaks. Little is known about the response of T. gondii to water treatment processes.
The oocysts are larger than Cryptosporidium oocysts and should be amenable to
removal by ltration. Within a WSP, control measures to manage potential risk from
T. gondii should be focused on prevention of source water contamination by wild and
domesticated cats. If necessary, the organisms can be removed by ltration. Owing to
the lack of information on sensitivity of T. gondii to disinfection, the reliability of
E. coli (or, alternatively, thermotolerant coliforms) as an indicator for the
presence/absence of these organisms in drinking-water supplies is unknown.
Aramini JJ et al. (1999) Potential contamination of drinking water with Toxoplasma
gondii oocysts. Epidemiology and Infection, 122:305315.
Bahia-Oliveira LMG et al. (2003) Highly endemic, waterborne toxoplasmosis in North
Rio de Janeiro State, Brazil. Emerging Infectious Diseases, 9:5562.
Bowie WR et al. (1997) Outbreak of toxoplasmosis associated with municipal drink-
ing water. The BC Toxoplasma Investigation Team. Lancet, 350:173177.
Kourenti C et al. (2003) Development and application of different methods for the
detection of Toxoplasma gondii in water. Applied and Environmental Microbiology,
69:102106.
11.4 Helminth pathogens

The word helminth comes from the Greek word meaning worm and refers to all
types of worms, both free-living and parasitic. The major parasitic worms are classi-
275
ed primarily in the phylum Nematoda (roundworms) and the phylum Platy-

helminthes (atworms including trematodes). Helminth parasites infect a large
number of people and animals worldwide. For most helminths, drinking-water is not
a signicant route of transmission. There are two exceptions: Dracunculus medinen-
sis (guinea worm) and Fasciola spp. (F. hepatica and F. gigantica) (liver ukes).
Dracunculiasis and fascioliasis both require intermediate hosts to complete their life
cycles but are transmitted through drinking-water by different mechanisms. Other
helminthiases can be transmitted through water contact (schistosomiasis) or are asso-
ciated with the use of untreated wastewater in agriculture (ascariasis, trichuriasis,
hookworm infections and strongyloidiasis) but are not usually transmitted through
drinking-water.
11.4.1 Dracunculus medinensis

Dracunculus medinensis, commonly known as guinea worm, belongs to the phylum
Nematoda and is the only nematode associated with signicant transmission by drink-
ing-water.
The eradication of guinea worm infection from the world by 1995 was a target
of the International Drinking Water Supply and Sanitation Decade (19811990),
and the World Health Assembly formally committed itself to this goal in 1991. The
Dracunculus Eradication Programme has achieved a massive reduction in the
number of cases. There were an estimated 3.3 million cases in 1986, 625 000 cases
in 1990 and fewer than 60 000 cases in 2002, with the majority occurring in Sudan.
Dracunculiasis is restricted to a central belt of countries in sub-Saharan Africa.
General description
The D. medinensis worms inhabit the cutaneous and subcutaneous tissues of infected
individuals, the female reaching a length of up to 700 mm, and the male 25 mm. When
the female is ready to discharge larvae (embryos), its anterior end emerges from a
blister or ulcer, usually on the foot or lower limb, and releases large numbers of rhab-
ditiform larvae when the affected part of the body is immersed in water. The larvae
can move about in water for approximately 3 days and during that time can be
ingested by many species of Cyclops (cyclopoid Copepoda, Crustacea). The larvae pen-
etrate into the haemocoelom, moult twice and are infective to a new host in about 2
weeks. If the Cyclops (0.52.0 mm) are swallowed in drinking-water, the larvae are
released in the stomach, penetrate the intestinal and peritoneal walls and inhabit the
subcutaneous tissues.

The onset of symptoms occurs just prior to the local eruption of the worm. The early
manifestations of urticaria, erythema, dyspnoea, vomiting, pruritus and giddiness are
of an allergic nature. In about 50% of cases, the whole worm is extruded in a few
weeks; the lesion then heals rapidly, and disability is of limited duration. In the
276
remaining cases, however, complications ensue, and the track of the worm becomes
secondarily infected, leading to a severe inammatory reaction that may result in
abscess formation with disabling pain that lasts for months. Mortality is extremely
rare, but permanent disability can result from contractures of tendons and chronic
arthritis. The economic impact can be substantial. One study reported an 11% annual
reduction in rice production from an area of eastern Nigeria, at a cost of US$20
million.

Infection with guinea worm is geographically limited to a central belt of countries in
sub-Saharan Africa. Drinking-water containing infected Cyclops is the only source of
infection with Dracunculus. The disease typically occurs in rural areas where piped
water supplies are not available. Transmission tends to be highly seasonal, depending
on changes in water sources. For instance, transmission is highest in the early rainy
season in a dry savannah zone of Mali with under 800 mm annual rainfall but in the
dry season in the humid savannah area of southern Nigeria with over 1300 mm annual
rainfall. The eradication strategy combines a variety of interventions, including inte-
grated surveillance systems, intensied case containment measures, provision of safe
water and health education.
Routes of exposure
The only route of exposure is the consumption of drinking-water containing Cyclops
spp. carrying infectious Dracunculus larvae.
Dracunculus medinensis is the only human parasite that may be eradicated in the near
future by the provision of safe drinking-water. Infection can be prevented by a number
of relatively simple control measures. These include intervention strategies to prevent
the release of D. medinensis larvae from female worms in infected patients into water
and control of Cyclops spp. in water resources by means of sh. Prevention can also
be achieved through the provision of boreholes and safe wells. Wells and springs
should be surrounded by cement curbings, and bathing and washing in these waters
should be avoided. Other control measures include ltration of water carrying infec-
tious Dracunculus larvae through a ne mesh cloth to remove Cyclops spp. or inacti-
vation of Cyclops spp. in drinking-water by treatment with chlorine.
Cairncross S, Muller R, Zagaria N (2002) Dracunculiasis (guinea worm disease) and
the eradication initiative. Clinical Microbiology Reviews, 15:223246.
Hopkins DR, Ruiz-Tiben E (1991) Strategies for dracunculiasis eradication. Bulletin
of the World Health Organization, 69:533540.
277
11.4.2 Fasciola spp.

Fascioliasis is caused by two trematode species of the genus Fasciola: F. hepatica,
present in Europe, Africa, Asia, the Americas and Oceania, and F. gigantica, mainly
distributed in Africa and Asia. Human fascioliasis was considered a secondary
zoonotic disease until the mid-1990s. In most regions, fascioliasis is a foodborne
disease. However, the discovery of oating metacercariae in hyperendemic regions
(including the Andean Altiplano region in South America) indicates that drinking-
water may be a signicant transmission route for fascioliasis in certain locations.
General description
The life cycle of F. hepatica and F. gigantica takes about 1423 weeks and requires two
hosts. The life cycle comprises four phases. In the rst phase, the denitive host ingests
metacercariae. The metacercariae excyst in the intestinal tract and then migrate to the
liver and bile ducts. After 34 months, the ukes attain sexual maturity and produce
eggs, which are excreted into the bile and intestine. Adult ukes can live for 914 years
in the host. In the second phase, the eggs are excreted by the human or animal. Once
in fresh water, a miracidium develops inside. In the third phase, miracidia penetrate
a snail host and develop into cercaria, which are released into the water. In the fourth
and nal phase, cercaria swim for a short period of time until they reach a suitable
attachment site (aquatic plants), where they encyst to form metacercariae, which
become infective within 24 h. Some metacercariae do not attach to plants but remain
oating in the water.

The parasites inhabit the large biliary passages and the gall-bladder. Disease symp-
toms are different for the acute and chronic phases of the infection. The invasive or
acute phase may last from 2 to 4 months and is characterized by symptoms such as
dyspepsia, nausea and vomiting, abdominal pain and a high fever (up to 40 C).
Anaemia and allergic responses (e.g., pruritis, urticaria) may also occur. In children,
the acute infection can be accompanied by severe symptoms and sometimes causes
death. The obstructive or chronic phase (after months to years of infection) may be
characterized by painful liver enlargement and in some cases obstructive jaundice,
chest pains, loss of weight and cholelithiasis. The most important pathogenic seque-
lae are hepatic lesions and brosis and chronic inammation of the bile ducts. Imma-
ture ukes may deviate during migration, enter other organs and cause ectopic
fascioliasis in a range of subcutaneous tissues. Fascioliasis can be treated with
triclabendazole.

Human cases have been increasing in 51 countries on ve continents. Estimates of the
numbers of humans with fascioliasis range from 2.4 to 17 million people or even
higher, depending on unquantied prevalence in many African and Asian countries.
278
Analysis of the geographical distribution of human cases shows that the correla-
tion between animal and human fascioliasis occurs only at a basic level. High preva-
lences in humans are not necessarily related to areas where fascioliasis is a great
veterinary problem. Major health problems associated with fascioliasis occur in
Andean countries (Bolivia, Peru, Chile, Ecuador), the Caribbean (Cuba), northern
Africa (Egypt), Near East (Iran and neighbouring countries) and western Europe
(Portugal, France and Spain).
Routes of exposure
Humans can contract fascioliasis when they ingest infective metacercariae by eating
raw aquatic plants (and, in some cases, terrestrial plants, such as lettuce, irrigated with
contaminated water), drinking contaminated water, using utensils washed in con-
taminated water or eating raw liver infected with immature ukes.
Water is often cited as a human infection source. In the Bolivian Altiplano, 13% of
metacercariae isolates are oating. Untreated drinking-water in hyperendemic regions
often contains oating metacercariae; for example, a small stream crossing in the
Altiplano region of Bolivia contained up to 7 metacercariae per 500 ml. The impor-
tance of fascioliasis transmission through water is supported by indirect evidence.
There are signicant positive associations between liver uke infection and infection
by other waterborne protozoans and helminths in Andean countries and in Egypt. In
many human hyperendemic areas of the Americas, people do not have a history of
eating watercress or other water plants. In the Nile Delta region, people living in
houses with piped water had a higher infection risk. Metacercariae are likely to be
resistant to chlorine disinfection but should be removed by various ltration
processes. For example, in Tiba, Egypt, human prevalence was markedly decreased
after ltered water was supplied to specially constructed washing units.
Mas-Coma S (2004) Human fascioliasis. In: Waterborne zoonoses: Identication, causes,
and controls. IWA Publishing, London, on behalf of the World Health Organiza-
tion, Geneva.
Mas-Coma S, Esteban JG, Bargues MD (1999) Epidemiology of human fascioliasis: a
review and proposed new classication. Bulletin of the World Health Organization,
77(4):340346.
WHO (1995) Control of foodborne trematode infections. Geneva, World Health
Organization (WHO Technical Report Series 849).
11.5 Toxic cyanobacteria

More detailed information on toxic cyanobacteria is available in the supporting
document Toxic Cyanobacteria in Water (see section 1.3).
279
General description
Cyanobacteria are photosynthetic bacteria that share some properties with algae.
Notably, they possess chlorophyll-a and liberate oxygen during photosynthesis. The
rst species to be recognized were blue-green in colour; hence, a common term for
these organisms is blue-green algae. However, owing to the production of different
pigments, there are a large number that are not blue-green, and they can range in
colour from blue-green to yellow-brown and red. Most cyanobacteria are aerobic pho-
totrophs, but some exhibit heterotrophic growth. They may grow as separate cells or
in multicellular laments or colonies. They can be identied by their morphology to
genus level under a microscope. Some species form surface blooms or scums, while
others stay mixed in the water column or are bottom dwelling (benthic). Some
cyanobacteria possess the ability to regulate their buoyancy via intracellular gas
vacuoles, and some species can x elemental nitrogen dissolved in water. The most
notable feature of cyanobacteria in terms of public health impact is that a range of
species can produce toxins.

Many cyanobacteria produce potent toxins, as shown in Table 11.1. Cyanobacterial
toxins are also discussed in section 8.5.6. Each toxin has specic properties, with dis-
tinct concerns including liver damage, neurotoxicity and tumour promotion. Acute
symptoms reported after exposure include gastrointenstinal disorders, fever and
irritations of the skin, ears, eyes, throat and respiratory tract. Cyanobacteria do not
multiply in the human body and hence are not infectious.

Cyanobacteria are widespread and found in a diverse range of environments, includ-
ing soils, seawater and, most notably, freshwater environments. Some environmental
conditions, including sunlight, warm weather, low turbulence and high nutrient levels,
can promote growth. Depending on the species, this may result in greenish discol-
Table 11.1 Cyanotoxins produced by cyanobacteria

Toxic species Cyanotoxin
Potentially Anabaena spp. Anatoxin-a(S), anatoxin-a, microcystins, saxitoxins
Anabaenopsis millenii Microcystins
Aphanizomenon spp. Anatoxin-a, saxitoxins, cylindrospermopsin
Cylindrospermum spp. Cylindrospermopsin, saxitoxins, anatoxin-a
Lyngbya spp. Saxitoxins, lyngbyatoxins
Microcystis spp. Microcystins, anatoxin-a (minor amounts)
Nodularia spp. Nodularins
Nostoc spp. Microcystins
Oscillatoria spp. Anatoxin-a, microcystins
Planktothrix spp. Anatoxin-a, homoanatoxin-a, microcystins
Raphidiopsis curvata Cylindrospermopsin
Umezakia natans Cylindrospermopsin
280
oration of water due to a high density of suspended cells and, in some cases, the
formation of surface scums. Such cell accumulations may lead to high toxin
concentrations.
Routes of exposure
Potential health concerns arise from exposure to the toxins through ingestion of
drinking-water, during recreation, through showering and potentially through con-
sumption of algal food supplement tablets. Repeated or chronic exposure is the
primary concern for many of the cyanotoxins; in some cases, however, acute toxicity
is more important (e.g., lyngbyatoxins and the neurotoxins saxitoxin and anatoxin).
Human fatalities have occurred through use of inadequately treated water containing
high cyanotoxin levels for renal dialysis. Dermal exposure may lead to irritation of the
skin and mucous membranes and to allergic reactions.
Cyanobacteria occur in low cell density in most surface waters. However, in suitable
environmental conditions, high-density blooms can occur. Eutrophication
(increased biological growth associated with increased nutrients) can support the
development of cyanobacterial blooms (see also section 8.5.6).
Backer LC (2002) Cyanobacterial harmful algal blooms (CyanoHABs): Developing a
public health response. Lake and Reservoir Management, 18:2031.
Chorus I, Bartram J, eds. (1999) Toxic cyanobacteria in water: A guide to their public
health consequences, monitoring and management. Published by E & FN Spon,
London, on behalf of the World Health Organization, Geneva.
Lahti K et al. (2001) Occurrence of microcystins in raw water sources and treated
drinking water of Finnish waterworks. Water Science and Technology, 43:225228.
11.6 Indicator and index organisms

Owing to issues relating to complexity, cost and timeliness of obtaining results, testing
for specic pathogens is generally limited to validation, where monitoring is used to
determine whether a treatment or other process is effective in removing target organ-
isms. Very occasionally, pathogen testing may be performed to verify that a specic
treatment or process has been effective. However, microbial testing included as part
of operational and verication (including surveillance) monitoring is usually limited
to that for indicator organisms, either to measure the effectiveness of control meas-
ures or as an index of faecal pollution.
The concept of using indicator organisms as signals of faecal pollution is a well
established practice in the assessment of drinking-water quality. The criteria deter-
mined for such indicators were that they should not be pathogens themselves and
should:
281
be universally present in faeces of humans and animals in large numbers;

not multiply in natural waters;
persist in water in a similar manner to faecal pathogens;
be present in higher numbers than faecal pathogens;
respond to treatment processes in a similar fashion to faecal pathogens; and
be readily detected by simple, inexpensive methods.
These criteria reect an assumption that the same indicator organism could be used
as both an index of faecal pollution and an indicator of treatment/process efcacy.
However, it has become clear that one indicator cannot full these two roles. Increased
attention has focused on shortcomings of traditional indicators, such as E. coli, as sur-
rogates for enteric viruses and protozoa, and alternative indicators of these pathogens,
such as bacteriophages and bacterial spores, have been suggested. In addition, greater
reliance is being placed on parameters that can be used as indicators for the effec-
tiveness of treatments and processes designed to remove faecal pathogens, including
bacteria, viruses, protozoa and helminths.
It is important to distinguish between microbial testing undertaken to signal the
presence of faecal pathogens or alternatively to measure the effectiveness of treat-
ments/processes. As a rst step, the separate terms index and indicator have been
proposed, whereby:
an index organism is one that points to the presence of pathogenic organisms

for example, as an index of faecal pathogens; and
an indicator organism is one that is used to measure the effectiveness of a process
for example, a process indicator or disinfection indicator.
These terms can also be applied to non-microbial parameters; hence, turbidity can be
used a ltration indicator.
Further discussion on index and indicator organisms is contained in the support-
ing document Assessing Microbial Safety of Drinking Water (see section 1.3).
11.6.1 Total coliform bacteria

General description
Total coliform bacteria include a wide range of aerobic and facultatively anaerobic,
Gram-negative, non-spore-forming bacilli capable of growing in the presence of rel-
atively high concentrations of bile salts with the fermentation of lactose and produc-
tion of acid or aldehyde within 24 h at 3537 C. Escherichia coli and thermotolerant
coliforms are a subset of the total coliform group that can ferment lactose at higher
temperatures (see section 11.6.2). As part of lactose fermentation, total coliforms
produce the enzyme b-galactosidase. Traditionally, coliform bacteria were regarded as
belonging to the genera Escherichia, Citrobacter, Klebsiella and Enterobacter, but the
group is more heterogeneous and includes a wider range of genera, such as Serratia
and Hafnia. The total coliform group includes both faecal and environmental species.
282
Indicator value
Total coliforms include organisms that can survive and grow in water. Hence, they are
not useful as an index of faecal pathogens, but they can be used as an indicator of
treatment effectiveness and to assess the cleanliness and integrity of distribution
systems and the potential presence of biolms. However, there are better indicators
for these purposes. As a disinfection indicator, the test for total coliforms is far slower
and less reliable than direct measurement of disinfectant residual. In addition, total
coliforms are far more sensitive to disinfection than are enteric viruses and protozoa.
HPC measurements detect a wider range of microorganisms and are generally
considered a better indicator of distribution system integrity and cleanliness.

Total coliform bacteria (excluding E. coli) occur in both sewage and natural waters.
Some of these bacteria are excreted in the faeces of humans and animals, but many
coliforms are heterotrophic and able to multiply in water and soil environments. Total
coliforms can also survive and grow in water distribution systems, particularly in the
presence of biolms.
Application in practice
Total coliforms are generally measured in 100-ml samples of water. A variety of rela-
tively simple procedures are available based on the production of acid from lactose or
the production of the enzyme b-galactosidase. The procedures include membrane l-
tration followed by incubation of the membranes on selective media at 3537 C and
counting of colonies after 24 h. Alternative methods include most probable number
procedures using tubes or micro-titre plates and P/A tests. Field test kits are available.
Total coliforms should be absent immediately after disinfection, and the presence of
these organisms indicates inadequate treatment. The presence of total coliforms in
distribution systems and stored water supplies can reveal regrowth and possible
biolm formation or contamination through ingress of foreign material, including
soil or plants.
Ashbolt NJ, Grabow WOK, Snozzi M (2001) Indicators of microbial water quality.
In: Fewtrell L, Bartram J, eds. Water quality: Guidelines, standards and health
Assessment of risk and risk management for water-related infectious disease. WHO
Water Series. London, IWA Publishing, pp. 289315.
283
Sueiro RA et al. (2001) Evaluation of Coli-ID and MUG Plus media for recovering
Escherichia coli and other coliform bacteria from groundwater samples. Water
Science and Technology, 43:213216.
11.6.2 Escherichia coli and thermotolerant coliform bacteria

General description
Total coliform bacteria that are able to ferment lactose at 4445 C are known as ther-
motolerant coliforms. In most waters, the predominant genus is Escherichia, but some
types of Citrobacter, Klebsiella and Enterobacter are also thermotolerant. Escherichia
coli can be differentiated from the other thermotolerant coliforms by the ability to
produce indole from tryptophan or by the production of the enzyme b-glucuronidase.
Escherichia coli is present in very high numbers in human and animal faeces and is
rarely found in the absence of faecal pollution, although there is some evidence for
growth in tropical soils. Thermotolerant coliform species other than E. coli can include
environmental organisms.
Indicator value
Escherichia coli is considered the most suitable index of faecal contamination. In most
circumstances, populations of thermotolerant coliforms are composed predominantly
of E. coli; as a result, this group is regarded as a less reliable but acceptable index of
faecal pollution. Escherichia coli (or, alternatively, thermotolerant coliforms) is the rst
organism of choice in monitoring programmes for verication, including surveillance
of drinking-water quality. These organisms are also used as disinfection indicators,
but testing is far slower and less reliable than direct measurement of disinfectant resid-
ual. In addition, E. coli is far more sensitive to disinfection than are enteric viruses
and protozoa.

Escherichia coli occurs in high numbers in human and animal faeces, sewage and water
subject to recent faecal pollution. Water temperatures and nutrient conditions present
in drinking-water distribution systems are highly unlikely to support the growth of
these organisms.
Escherichia coli (or, alternatively, thermotolerant coliforms) are generally measured in
100-ml samples of water. A variety of relatively simple procedures are available based
on the production of acid and gas from lactose or the production of the enzyme b-
glucuronidase. The procedures include membrane ltration followed by incubation
of the membranes on selective media at 4445 C and counting of colonies after 24 h.
Alternative methods include most probable number procedures using tubes or micro-
titre plates and P/A tests, some for volumes of water larger than 100 ml. Field test kits
are available.
284
The presence of E. coli (or, alternatively, thermotolerant coliforms) provides evidence
of recent faecal contamination, and detection should lead to consideration of further
action, which could include further sampling and investigation of potential sources
such as inadequate treatment or breaches in distribution system integrity.
George I et al. (2001) Use of rapid enzymatic assays to study the distribution of faecal
coliforms in the Seine river (France). Water Science and Technology, 43:7780.
Sueiro RA et al. (2001) Evaluation of Coli-ID and MUG Plus media for recovering
Escherichia coli and other coliform bacteria from groundwater samples. Water
Science and Technology, 43:213216.
11.6.3 Heterotrophic plate counts

A substantial review of the use of HPC is available (Bartram et al., 2003).
General description
HPC measurement detects a wide spectrum of heterotrophic microorganisms, includ-
ing bacteria and fungi, based on the ability of the organisms to grow on rich growth
media, without inhibitory or selective agents, over a specied incubation period and
at a dened temperature. The spectrum of organisms detected by HPC testing
includes organisms sensitive to disinfection processes, such as coliform bacteria;
organisms resistant to disinfection, such as spore formers; and organisms that rapidly
proliferate in treated water in the absence of residual disinfectants. The tests detect
only a small proportion of the microorganisms that are present in water. The popu-
lation recovered will differ according to the method and conditions applied. Although
standard methods have been developed, there is no single universal HPC measure-
ment. A range of media is available, incubation temperatures used vary from 20 C to
37 C and incubation periods range from a few hours to 7 days or more.
Indicator value
The test has little value as an index of pathogen presence but can be useful in opera-
tional monitoring as a treatment and disinfectant indicator, where the objective is
to keep numbers as low as possible. In addition, HPC measurement can be used in
assessing the cleanliness and integrity of distribution systems and the presence of
biolms.
285

Heterotrophic microorganisms include both members of the natural (typically non-
hazardous) microbial ora of water environments and organisms present in a range
of pollution sources. They occur in large numbers in raw water sources. The actual
organisms detected by HPC tests vary widely between locations and between consec-
utive samples. Some drinking-water treatment processes, such as coagulation and
sedimentation, reduce the number of HPC organisms in water. However, the organ-
isms proliferate in other treatment processes, such as biologically active carbon and
sand ltration. Numbers of HPC organisms are reduced signicantly by disinfection
practices, such as chlorination, ozonation and UV light irradiation. However, in prac-
tice, none of the disinfection processes sterilizes water; under suitable conditions, such
as the absence of disinfectant residuals, HPC organisms can grow rapidly. HPC organ-
isms can grow in water and on surfaces in contact with water as biolms. The prin-
cipal determinants of growth or regrowth are temperature, availability of nutrients,
including assimilable organic carbon, lack of disinfectant residual and stagnation.
No sophisticated laboratory facilities or highly trained staff are required. Results on
simple aerobically incubated agar plates are available within hours to days, depend-
ing on the characteristics of the procedure used.
After disinfection, numbers would be expected to be low; for most uses of HPC test
results, however, actual numbers are of less value than changes in numbers at partic-
ular locations. In distribution systems, increasing numbers can indicate a deteriora-
tion in cleanliness, possibly stagnation and the potential development of biolms.
HPC can include potentially opportunistic pathogens such as Acinetobacter,
Aeromonas, Flavobacterium, Klebsiella, Moraxella, Serratia, Pseudomonas and Xan-
thomonas. However, there is no evidence of an association of any of these organisms
with gastrointestinal infection through ingestion of drinking-water in the general
population.
286
11.6.4 Intestinal enterococci

General description
Intestinal enterococci are a subgroup of the larger group of organisms dened as
faecal streptococci, comprising species of the genus Streptococcus. These bacteria are
Gram-positive and relatively tolerant of sodium chloride and alkaline pH levels. They
are facultatively anaerobic and occur singly, in pairs or as short chains. Faecal strep-
tococci including intestinal enterococci all give a positive reaction with Lanceelds
Group D antisera and have been isolated from the faeces of warm-blooded animals.
The subgroup intestinal enterococci consists of the species Enterococcus faecalis, E.
faecium, E. durans and E. hirae. This group was separated from the rest of the faecal
streptococci because they are relatively specic for faecal pollution. However, some
intestinal enterococci isolated from water may occasionally also originate from other
habitats, including soil, in the absence of faecal pollution.
Indicator value
The intestinal enterococci group can be used as an index of faecal pollution. Most
species do not multiply in water environments. The numbers of intestinal enterococci
in human faeces are generally about an order of magnitude lower than those of E. coli.
Important advantages of this group are that they tend to survive longer in water envi-
ronments than E. coli (or thermotolerant coliforms), are more resistant to drying and
are more resistant to chlorination. Intestinal enterococci have been used in testing of
raw water as an index of faecal pathogens that survive longer than E. coli and in drink-
ing-water to augment testing for E. coli. In addition, they have been used to test water
quality after repairs to distribution systems or after new mains have been laid.

Intestinal enterococci are typically excreted in the faeces of humans and other warm-
blooded animals. Some members of the group have also been detected in soil in the
absence of faecal contamination. Intestinal enterococci are present in large numbers
in sewage and water environments polluted by sewage or wastes from humans and
animals.
Enterococci are detectable by simple, inexpensive cultural methods that require basic
bacteriology laboratory facilities. Commonly used methods include membrane ltra-
tion with incubation of membranes on selective media and counting of colonies after
incubation at 3537 C for 48 h. Other methods include a most probable number
technique using micro-titre plates where detection is based on the ability of intestinal
enterococci to hydrolyse 4-methyl-umbelliferyl-b-D-glucoside in the presence of
thallium acetate and nalidixic acid within 36 h at 41 C.
287
The presence of intestinal enterococci provides evidence of recent faecal contamina-
tion, and detection should lead to consideration of further action, which could include
further sampling and investigation of potential sources such as inadequate treatment
or breaches in distribution system integrity.
Junco TT et al. (2001) Identication and antibiotic resistance of faecal enterococci
isolated from water samples. International Journal of Hygiene and Environmental
Health, 203:363368.
Pinto B et al. (1999) Characterization of faecal streptococci as indicators of faecal
pollution and distribution in the environment. Letters in Applied Microbiology,
29:258263.
11.6.5 Clostridium perfringens

General description
Clostridium spp. are Gram-positive, anaerobic, sulte-reducing bacilli. They produce
spores that are exceptionally resistant to unfavourable conditions in water environ-
ments, including UV irradiation, temperature and pH extremes, and disinfection
processes, such as chlorination. The characteristic species of the genus, C. perfringens,
is a member of the normal intestinal ora of 1335% of humans and other warm-
blooded animals. Other species are not exclusively of faecal origin. Like E. coli, C.
perfringens does not multiply in most water environments and is a highly specic indi-
cator of faecal pollution.
Indicator value
In view of the exceptional resistance of C. perfringens spores to disinfection processes
and other unfavourable environmental conditions, C. perfringens has been proposed
as an index of enteric viruses and protozoa in treated drinking-water supplies. In addi-
tion, C. perfringens can serve as an index of faecal pollution that took place previously
and hence indicate sources liable to intermittent contamination. Clostridium perfrin-
gens is not recommended for routine monitoring, as the exceptionally long survival
times of its spores are likely to far exceed those of enteric pathogens, including viruses
and protozoa. Clostridium perfringens spores are smaller than protozoan (oo)cysts and
may be useful indicators of the effectiveness of ltration processes. Low numbers in
288
some source waters suggest that use of C. perfringens spores for this purpose may be
limited to validation of processes rather than routine monitoring.

Clostridium perfringens and its spores are virtually always present in sewage. The
organism does not multiply in water environments. Clostridium perfringens is present
more often and in higher numbers in the faeces of some animals, such as dogs, than
in the faeces of humans and less often in the faeces of many other warm-blooded
animals. The numbers excreted in faeces are normally substantially lower than those
of E. coli.
Vegetative cells and spores of C. perfringens are usually detected by membrane ltra-
tion techniques in which membranes are incubated on selective media under strict
anaerobic conditions. These detection techniques are not as simple and inexpensive
as those for other indicators, such as E. coli and intestinal enterococci.
The presence of C. perfringens in drinking-water can be an index of intermittent faecal
contamination. Potential sources of contamination should be investigated. Filtration
processes designed to remove enteric viruses or protozoa should also remove C.
perfringens. Detection in water immediately after treatment should lead to investiga-
tion of ltration plant performance.
Araujo M et al. (2001) Evaluation of uorogenic TSC agar for recovering Clostridium
perfringens in groundwater samples. Water Science and Technology, 43:201204.
Nieminski EC, Bellamy WD, Moss LR (2000) Using surrogates to improve plant
performance. Journal of the American Water Works Association, 92(3):6778.
Payment P, Franco E (1993) Clostridium perfringens and somatic coliphages as indi-
cators of the efciency of drinking-water treatment for viruses and protozoan cysts.
11.6.6 Coliphages
General description
Bacteriophages (phages) are viruses that use only bacteria as hosts for replication.
Coliphages use E. coli and closely related species as hosts and hence can be released
289
by these bacterial hosts into the faeces of humans and other warm-blooded animals.
Coliphages used in water quality assessment are divided into the major groups of
somatic coliphages and F-RNA coliphages. Differences between the two groups
include the route of infection.
Somatic coliphages initiate infection by attaching to receptors permanently located
on the cell wall of hosts. They replicate more frequently in the gastrointestinal tract
of warm-blooded animals but can also replicate in water environments. Somatic
coliphages consist of a wide range of phages (members of the phage families
Myoviridae, Siphoviridae, Podoviridae and Microviridae) with a spectrum of mor-
phological types.
F-RNA coliphages initiate infection by attaching to fertility (F-, sex) mbriae on E.
coli hosts. These F-mbriae are produced only by bacteria carrying the fertility (F-)
plasmid. Since F-mbriae are produced only in the logarithmic growth phase at tem-
peratures above 30 C, F-RNA phages are not likely to replicate in environments other
than the gastrointestinal tract of warm-blooded animals. F-RNA coliphages comprise
a restricted group of closely related phages, which belong to the family Leviviridae,
and consist of a single-stranded RNA genome and an icosahedral capsid that is mor-
phologically similar to that of picornaviruses. F-RNA coliphages have been divided
into serological types IIV, which can be identied as genotypes by molecular tech-
niques such as gene probe hybridization. Members of groups I and IV have to date
been found exclusively in animal faeces, and group III in human faeces. Group II
phages have been detected in human faeces and no animal faeces other than about
28% of porcine faeces. This specicity, which is not fully understood, offers a poten-
tial tool to distinguish between faecal pollution of human and animal origin under
certain conditions and limitations.
Indicator value
Phages share many properties with human viruses, notably composition, morphol-
ogy, structure and mode of replication. As a result, coliphages are useful models or
surrogates to assess the behaviour of enteric viruses in water environments and the
sensitivity to treatment and disinfection processes. In this regard, they are superior to
faecal bacteria. However, there is no direct correlation between numbers of coliphages
and numbers of enteric viruses. In addition, coliphages cannot be absolutely relied
upon as an index for enteric viruses. This has been conrmed by the isolation of
enteric viruses from treated and disinfected drinking-water supplies that yielded
negative results in conventional tests for coliphages.
F-RNA coliphages provide a more specic index of faecal pollution than somatic
phages. In addition, F-RNA coliphages are better indicators of the behaviour of enteric
viruses in water environments and their response to treatment and disinfection
processes than are somatic coliphages. This has been conrmed by studies in which
the behaviour and survival of F-RNA coliphages, somatic phages, faecal bacteria and
enteric viruses have been compared. Available data indicate that the specicity of F-
290
RNA serogroups (genotypes) for human and animal excreta may prove useful in the
distinction between faecal pollution of human and animal origin. However, there are
shortcomings and conicting data that need to be resolved, and the extent to which
this tool can be applied in practice remains to be elucidated. Due to the limitations
of coliphages, they are best used in laboratory investigations, pilot trials and possibly
validation testing. They are not suitable for operational or verication (including
surveillance) monitoring.

Coliphages are excreted by humans and animals in relatively low numbers. As a result
of their respective modes of replication and host specicity, somatic coliphages are
generally excreted by most humans and animals, whereas F-RNA coliphages are
excreted by a variable and generally lower percentage of humans and animals. Avail-
able data indicate that in some communities, F-RNA phages are detectable in 10% of
human, 45% of bovine, 60% of porcine and 70% of poultry faecal specimens. Somatic
coliphages have been found to generally outnumber F-RNA phages in water environ-
ments by a factor of about 5 and cytopathogenic human viruses by a factor of about
500, although these ratios vary considerably. Sewage contains somatic coliphages in
numbers of the order of 106108 per litre; in one study, slaughterhouse wastewater was
found to contain somatic coliphages in numbers up to 1010 per litre. There are indi-
cations that they may multiply in sewage, and somatic coliphages may multiply in
natural water environments using saprophytic hosts. Somatic phages and F-RNA
phages have been detected in numbers up to 105 per litre in lake and river water.
Somatic coliphages are detectable by relatively simple and inexpensive plaque assays,
which yield results within 24 h. Plaque assays for F-RNA coliphages are not quite as
simple, because the culture of host bacteria has to be in the logarithmic growth phase
at a temperature above 30 C to ensure that F-mbriae are present. Plaque assays using
large petri dishes have been designed for the quantitative enumeration of plaques in
100-ml samples, and P/A tests have been developed for volumes of water of 500 ml or
more.
Since coliphages typically replicate in the gastrointestinal tract of humans and
warm-blooded animals, their presence in drinking-water provides an index of faecal
pollution and hence the potential presence of enteric viruses and possibly also other
pathogens. The presence of coliphages in drinking-water also indicates shortcomings
in treatment and disinfection processes designed to remove enteric viruses. F-RNA
coliphages provide a more specic index for faecal pollution. The absence of col-
iphages from treated drinking-water supplies does not conrm the absence of
pathogens such as enteric viruses and protozoan parasites.
291
Grabow WOK (2001) Bacteriophages: Update on application as models for viruses in
water. Water SA, 27:251268.
Mooijman KA et al. (2001) Optimisation of the ISO-method on enumeration of
somatic coliphages (draft ISO 107052). Water Science and Technology, 43:205208.
Schaper M et al. (2002) Distribution of genotypes of F-specic RNA bacteriophages
in human and non-human sources of faecal pollution in South Africa and Spain.
Journal of Applied Microbiology, 92:657667.
Storey MV, Ashbolt NJ (2001) Persistence of two model enteric viruses (B40-8 and
MS-2 bacteriophages) in water distribution pipe biolms. Water Science and
11.6.7 Bacteroides fragilis phages

General description
The bacterial genus Bacteroides inhabits the human gastrointestinal tract in greater
numbers than E. coli. Faeces can contain 1091010 Bacteroides per gram compared with
106108 E. coli per gram. Bacteroides are rapidly inactivated by environmental oxygen
levels, but Bacteroides bacteriophages are resistant to unfavourable conditions. Two
groups of B. fragilis phages are used as indicators in water quality assessment. One is
a restricted group of phages that specically uses B. fragilis strain HSP40 as host. This
group of phages appears unique, because it is found only in human faeces and not in
faeces of other animals. The numbers of these phages in sewage appear to be relatively
low, and they are almost absent in some geographical areas. The B. fragilis HSP40
phages belong to the family Siphoviridae, with exible non-contractile tails, double-
stranded DNA and capsids with a diameter of up to 60 nm. The second group of
Bacteroides phages used as indicators is those that use B. fragilis strain RYC2056 as a
host. This group includes a substantially wider spectrum of phages, occurring in the
faeces of humans and many other animals. The numbers of these phages in sewage
are generally substantially higher than those of B. fragilis HSP40 phages.
Indicator value
Bacteroides bacteriophages have been proposed as a possible index of faecal pollution
due to their specic association with faecal material and exceptional resistance to envi-
ronmental conditions. In particular, B. fragilis HSP40 phages are found only in human
faeces. Bacteroides fragilis phage B40-8, a typical member of the group of B. fragilis
HSP40 phages, has been found to be more resistant to inactivation by chlorine than
poliovirus type 1, simian rotavirus SA11, coliphage f2, E. coli and Streptococcus fae-
calis. Bacteroides fragilis strain RYC2056 phages seem to be likewise relatively resistant
292
to disinfection. Indicator shortcomings of B. fragilis phages include relatively low

numbers in sewage and polluted water environments. This applies in particular to B.
fragilis HSP40 phages. Human enteric viruses have been detected in drinking-water
supplies that yielded negative results in conventional tests for B. fragilis HSP40 phages.
Owing to the limitations of Bacteroides bacteriophages, they are best used in labora-
tory investigations, pilot trials and possibly validation testing. They are not suitable
for operational or verication (including surveillance) monitoring.

Bacteroides fragilis HSP40 phages are excreted by about 1020% of humans in certain
parts of the world; consequently, their numbers in sewage are substantially lower than
those of somatic and even F-RNA coliphages. A mean count of 67 B. fragilis HSP40
phages per litre in a sewage-polluted river has been reported. In some parts of the
world, B. fragilis HSP40 phages would appear not to be detectable in sewage at all.
Phages using B. fragilis RYC2056 as host are excreted in larger numbers and seem to
occur more universally. On average, these phages are excreted by more than 25% of
humans. In a survey of water environments, B. fragilis HSP40 phages have been found
to outnumber cytopathogenic enteric viruses on average by only about 5-fold. Theo-
retically, wastewaters could be expected to contain higher levels of B. fragilis phages
than those detected. The reason for the discrepancy may be due to failure in main-
taining sufciently anaerobic conditions during the performance of plaque assays.
Improvement of detection methods may result in the recording of higher numbers of
B. fragilis phages in sewage and polluted water environments.
Disadvantages of B. fragilis phages are that the detection methods are more complex
and expensive than those for coliphages. Costs are increased by the need to use antibi-
otics for purposes of selection and to incubate cultures and plaque assays under
absolute anaerobic conditions. Results of plaque assays are usually available after
about 24 h compared with about 8 h for coliphages.
The presence of B. fragilis phages in drinking-water is sound evidence of faecal pol-
lution as well as shortcomings in water treatment and disinfection processes. In addi-
tion, the presence of B. fragilis HSP40 phages strongly indicates faecal pollution of
human origin. However, B. fragilis phages occur in relatively low numbers in sewage,
polluted water environments and drinking-water supplies. This implies that the
absence of B. fragilis phages from treated drinking-water supplies does not conrm
the absence of pathogens such as enteric viruses and protozoan parasites.
293
Bradley G et al. (1999) Distribution of the human faecal bacterium Bacteroides frag-
ilis and their relationship to current sewage pollution indicators in bathing waters.
Journal of Applied Microbiology, 85(Suppl.):90S100S.
Grabow WOK (2001) Bacteriophages: Update on application as models for viruses in
water. Water SA, 27:251268.
Puig A et al. (1999) Diversity of Bacteroides fragilis strains in their capacity to recover
phages from human and animal wastes and from fecally polluted wastewater.
Storey MV, Ashbolt NJ (2001) Persistence of two model enteric viruses (B40-8 and
MS-2 bacteriophages) in water distribution pipe biolms. Water Science and
Tartera C, Lucena F, Jofre J (1989) Human origin of Bacteroides fragilis bacteriophages
present in the environment. Applied and Environmental Microbiology,
10:26962701.
11.6.8 Enteric viruses

General description
The viruses referred to here are a combined group of those that infect the human
gastrointestinal tract and are predominantly transmitted by the faecaloral route.
Well known members of this group include the enteroviruses, astroviruses, enteric
adenoviruses, orthoreoviruses, rotaviruses, caliciviruses and hepatitis A and E viruses.
The enteric viruses cover a wide spectrum of viruses, members of which are a major
cause of morbidity and mortality worldwide. Members of the group of enteric viruses
differ with regard to structure, composition, nucleic acid and morphology. There are
also differences in the numbers and frequency of excretion, survival in the environ-
ment and resistance to water treatment processes. Enteric viruses have robust capsids
that enable them to survive unfavourable conditions in the environment as well as
allowing passage through the acidic and proteolytic conditions in the stomach on their
way to the duodenum, where they infect susceptible epithelial cells.
Indicator value
The use of enteric viruses as indicator or index organisms is based on the shortcom-
ings of the existing choices. The survival of faecal bacteria in water environments and
the sensitivity to treatment and disinfection processes differ substantially from those
of enteric viruses. Monitoring based on one or more representatives of the large group
of enteric viruses themselves would, therefore, be more valuable for assessment of the
presence of any of the enteric viruses in water and the response to control measures.

Enteric viruses are excreted by individuals worldwide at a frequency and in numbers
that result in many of these viruses being universally present in substantial numbers
294
in wastewater. However, the prevalence of individual members may vary to a large

extent due to variations in rates of infection and excretion. Much higher numbers
would be present during outbreaks.
Practical methods are not yet available for the routine monitoring of water supplies
for a broad spectrum of enteric viruses. Viruses that are more readily detectable
include members of the enterovirus, adenovirus and orthoreovirus groups. These
viruses occur in polluted environments in relatively high numbers and can be detected
by reasonably practical and moderate-cost techniques based on cytopathogenic effect
in cell culture that yield results within 312 days (depending on the type of virus). In
addition, progress in technology and expertise is decreasing costs. The cost for the
recovery of enteric viruses from large volumes of drinking-water has been reduced
extensively. Some techniques for instance, those based on glass wool
adsorptionelution are inexpensive. The cost of cell culture procedures has also been
reduced. Consequently, the cost of testing drinking-water supplies for cytopathogenic
viruses has become acceptable for certain purposes. Testing could be used to validate
effectiveness of treatment processes and, in certain circumstances, as part of specic
investigations to verify performance of processes. The incubation times, cost and rel-
ative complexity of testing mean that enteric virus testing is not suitable for opera-
tional or verication (including surveillance) monitoring. Orthoreoviruses, and at
least the vaccine strains of polioviruses detected in many water environments, also
have the advantage of not constituting a health risk to laboratory workers.
The presence of any enteric viruses in drinking-water should be regarded as an index
for the potential presence of other enteric viruses, is conclusive evidence of faecal
pollution and also provides evidence of shortcomings in water treatment and disin-
fection processes.
Ashbolt NJ, Grabow WOK, Snozzi M (2001) Indicators of microbial water quality. In:
Fewtrell L, Bartram J, eds. Water quality: Guidelines, standards and health Assess-
ment of risk and risk management for water-related infectious disease. WHO Water
Series. London, IWA Publishing, pp. 289315.
Grabow WOK, Taylor MB, de Villiers JC (2001) New methods for the detection of
viruses: call for review of drinking-water quality guidelines. Water Science and
Technology, 43:18.
295
12
Chemical fact sheets
T he background documents referred to in this chapter may be found on the Water

Sanitation and Health website at http://www.who.int/water_sanitation_health/
dwq/guidelines/en/.
12.1 Acrylamide
Residual acrylamide monomer occurs in polyacrylamide coagulants used in the treat-
ment of drinking-water. In general, the maximum authorized dose of polymer is
1 mg/litre. At a monomer content of 0.05%, this corresponds to a maximum theoret-
ical concentration of 0.5 mg/litre of the monomer in water. Practical concentrations
may be lower by a factor of 23. This applies to the anionic and non-ionic polyacry-
lamides, but residual levels from cationic polyacrylamides may be higher. Polyacry-
lamides are also used as grouting agents in the construction of drinking-water
reservoirs and wells. Additional human exposure might result from food, owing to the
use of polyacrylamide in food processing and the potential formation of acrylamide
in foods cooked at high temperatures.
Guideline value 0.0005 mg/litre (0.5 mg/litre)

Occurrence Concentrations of a few micrograms per litre have been detected in
tap water.
Basis of guideline Combined mammary, thyroid and uterine tumours observed in
derivation female rats in a drinking-water study, and using the linearized
multistage model
Limit of detection 0.032 mg/litre by GC; 0.2 mg/litre by HPLC; 10 mg/litre by HPLC with UV
detection
Treatment achievability Conventional treatment processes do not remove acrylamide.
Acrylamide concentrations in drinking-water are controlled by limiting
either the acrylamide content of polyacrylamide occulants or the
dose used, or both.
Additional comments Although the practical quantication level for acrylamide in most
laboratories is above the guideline value (generally in the order of 1
mg/litre), concentrations in drinking-water can be controlled by
product and dose specication.
296
12
Chemical fact sheets
T he background documents referred to in this chapter may be found on the Water

Sanitation and Health website at http://www.who.int/water_sanitation_health/
dwq/guidelines/en/.
12.1 Acrylamide
Residual acrylamide monomer occurs in polyacrylamide coagulants used in the treat-
ment of drinking-water. In general, the maximum authorized dose of polymer is
1 mg/litre. At a monomer content of 0.05%, this corresponds to a maximum theoret-
ical concentration of 0.5 mg/litre of the monomer in water. Practical concentrations
may be lower by a factor of 23. This applies to the anionic and non-ionic polyacry-
lamides, but residual levels from cationic polyacrylamides may be higher. Polyacry-
lamides are also used as grouting agents in the construction of drinking-water
reservoirs and wells. Additional human exposure might result from food, owing to the
use of polyacrylamide in food processing and the potential formation of acrylamide
in foods cooked at high temperatures.

Occurrence Concentrations of a few micrograms per litre have been detected in
tap water.
Basis of guideline Combined mammary, thyroid and uterine tumours observed in
derivation female rats in a drinking-water study, and using the linearized
multistage model
Limit of detection 0.032 mg/litre by GC; 0.2 mg/litre by HPLC; 10 mg/litre by HPLC with UV
detection
Treatment achievability Conventional treatment processes do not remove acrylamide.
Acrylamide concentrations in drinking-water are controlled by limiting
either the acrylamide content of polyacrylamide occulants or the
dose used, or both.
Additional comments Although the practical quantication level for acrylamide in most
laboratories is above the guideline value (generally in the order of 1
mg/litre), concentrations in drinking-water can be controlled by
296
12. CHEMICAL FACT SHEETS
Toxicological review
Following ingestion, acrylamide is readily absorbed from the gastrointestinal tract and
widely distributed in body uids. Acrylamide can cross the placenta. It is neurotoxic,
affects germ cells and impairs reproductive function. In mutagenicity assays, acry-
lamide was negative in the Ames test but induced gene mutations in mammalian cells
and chromosomal aberrations in vitro and in vivo. In a long-term carcinogenicity
study in rats exposed via drinking-water, acrylamide induced scrotal, thyroid and
adrenal tumours in males and mammary, thyroid and uterine tumours in females.
IARC has placed acrylamide in Group 2A. Recent data have shown that exposure to
acrylamide from cooked food is much higher than previously thought. The signi-
cance of this new information for the risk assessment has not yet been determined.
History of guideline development

The 1958, 1963 and 1971 WHO International Standards for Drinking-water and the
rst edition of the Guidelines for Drinking-water Quality, published in 1984, did
not refer to acrylamide. The 1993 Guidelines established a guideline value of
0.0005 mg/litre associated with an upper-bound excess lifetime cancer risk of 10-5,
noting that although the practical quantication level for acrylamide is generally in
the order of 0.001 mg/litre, concentrations in drinking-water can be controlled by
Assessment date
The risk assessment was conducted in 2003.
Principal reference
WHO (2003) Acrylamide in drinking-water. Background document for preparation of
WHO Guidelines for drinking-water quality. Geneva, World Health Organization
(WHO/SDE/WSH/03.04/71).
12.2 Alachlor
Alachlor (CAS No. 15972-60-8) is a pre- and post-emergence herbicide used to control
annual grasses and many broad-leaved weeds in maize and a number of other crops.
It is lost from soil mainly through volatilization, photodegradation and biodegrada-
tion. Many alachlor degradation products have been identied in soil.
297
Guideline value 0.02 mg/litre

Occurrence Has been detected in groundwater and surface water; has also been
detected in drinking-water at levels below 0.002 mg/litre
Basis of guideline Calculated by applying the linearized multistage model to data on the
derivation incidence of nasal tumours in rats
Limit of detection 0.1 mg/litre by gasliquid chromatography with electrolytic
conductivity detection in the nitrogen mode or by capillary column
GC with a nitrogenphosphorus detector
Treatment achievability 0.001 mg/litre should be achievable using GAC
On the basis of available experimental data, evidence for the genotoxicity of alachlor
is considered to be equivocal. However, a metabolite of alachlor, 2,6-diethylaniline,
has been shown to be mutagenic. Available data from two studies in rats clearly indi-
cate that alachlor is carcinogenic, causing benign and malignant tumours of the nasal
turbinate, malignant stomach tumours and benign thyroid tumours.

The 1958 and 1963 WHO International Standards for Drinking-water did not refer to
alachlor, but the 1971 International Standards suggested that pesticide residues that
may occur in community water supplies make only a minimal contribution to the
total daily intake of pesticides for the population served. Alachlor was not evaluated
in the rst edition of the Guidelines for Drinking-water Quality, published in 1984,
but the 1993 Guidelines calculated a guideline value of 0.02 mg/litre for alachlor in
drinking-water, corresponding to an upper-bound excess lifetime cancer risk of 10-5.
Assessment date
The risk assessment was originally conducted in 1993. The Final Task Force Meeting
in 2003 agreed that this risk assessment be brought forward to this edition of the
Guidelines for Drinking-water Quality.
Principal reference
WHO (2003) Alachlor in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/31).
12.3 Aldicarb
Aldicarb (CAS No. 116-06-3) is a systemic pesticide used to control nematodes in soil
and insects and mites on a variety of crops. It is very soluble in water and highly
mobile in soil. It degrades mainly by biodegradation and hydrolysis, persisting for
weeks to months.
298

Occurrence Frequently found as a contaminant in groundwater, particularly when
associated with sandy soil; concentrations in well water as high as
500 mg/litre have been measured. Aldicarb sulfoxide and aldicarb
sulfone residues are found in an approximately 1 : 1 ratio in
groundwater.
ADI 0.003 mg/kg of body weight based on cholinesterase depression in a
single oral dose study in human volunteers
Limit of detection 0.001 mg/litre by reverse-phase HPLC with uorescence detection
Treatment achievability 0.001 mg/litre should be achievable using GAC or ozonation
Guideline derivation
allocation to water 10% of ADI
weight 60-kg adult
consumption 2 litres/day
Additional comments The guideline value derived from the 1992 JMPR assessment was very
similar to the guideline value derived in the second edition, which was
therefore retained.
Aldicarb is one of the most acutely toxic pesticides in use, although the only consis-
tently observed toxic effect with both long-term and single-dose administration is
acetylcholinesterase inhibition. It is metabolized to the sulfoxide and sulfone. Aldicarb
sulfoxide is a more potent inhibitor of acetylcholinesterase than aldicarb itself, while
aldicarb sulfone is considerably less toxic than either aldicarb or the sulfoxide. The
weight of evidence indicates that aldicarb, aldicarb sulfoxide and aldicarb sulfone are
not genotoxic or carcinogenic. IARC has concluded that aldicarb is not classiable as
to its carcinogenicity (Group 3).

aldicarb, but the 1971 International Standards suggested that pesticide residues that
total daily intake of pesticides for the population served. Aldicarb was not evaluated
in the rst edition of the Guidelines for Drinking-water Quality, published in 1984, but
a health-based guideline value of 0.01 mg/litre was derived for aldicarb in the 1993
Guidelines.
Assessment date
299
Principal references
FAO/WHO (1993) Pesticide residues in food 1992. Rome, Food and Agriculture Orga-
nization of the United Nations, Joint FAO/WHO Meeting on Pesticide Residues
(Report No. 116).
WHO (2003) Aldicarb in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/72).
12.4 Aldrin and dieldrin

Aldrin (CAS No. 309-00-2) and dieldrin (CAS No. 60-57-1) are chlorinated pesticides
that are used against soil-dwelling pests, for wood protection and, in the case of diel-
drin, against insects of public health importance. Since the early 1970s, a number of
countries have either severely restricted or banned the use of both compounds, par-
ticularly in agriculture. The two compounds are closely related with respect to their
toxicology and mode of action. Aldrin is rapidly converted to dieldrin under most
environmental conditions and in the body. Dieldrin is a highly persistent organochlo-
rine compound that has low mobility in soil, can be lost to the atmosphere and bioac-
cumulates. Dietary exposure to aldrin/dieldrin is very low and decreasing.
Guideline value 0.00003 mg/litre (0.03 mg/litre) combined aldrin and dieldrin
Occurrence Concentrations of aldrin and dieldrin in drinking-water normally less
than 0.01 mg/litre; rarely present in groundwater
PTDI 0.1 mg/kg of body weight (combined total for aldrin and dieldrin),
based on NOAELs of 1 mg/kg of diet in the dog and 0.5 mg/kg of diet
in the rat, which are equivalent to 0.025 mg/kg of body weight per day
in both species, and applying an uncertainty factor of 250 based on
concern about carcinogenicity observed in mice
Limit of detection 0.003 mg/litre for aldrin and 0.002 mg/litre for dieldrin by GC with ECD
Treatment achievability 0.02 mg/litre should be achievable using coagulation, GAC or
ozonation
allocation to water 1% of PTDI
weight 60-kg adult
Additional comments Aldrin and dieldrin are listed under the Stockholm Convention on
Persistent Organic Pollutants. Hence, monitoring may occur in addition
to that required by drinking-water guidelines.
Both compounds are highly toxic in experimental animals, and cases of poisoning in
humans have occurred. Aldrin and dieldrin have more than one mechanism of toxi-
city. The target organs are the central nervous system and the liver. In long-term
studies, dieldrin was shown to produce liver tumours in both sexes of two strains of
300
mice. It did not produce an increase in tumours in rats and does not appear to be
genotoxic. IARC has classied aldrin and dieldrin in Group 3. It is considered that all
the available information on aldrin and dieldrin taken together, including studies on
humans, supports the view that, for practical purposes, these chemicals make very
little contribution, if any, to the incidence of cancer in humans.

aldrin and dieldrin, but the 1971 International Standards suggested that pesticide
residues that may occur in community water supplies make only a minimal contri-
bution to the total daily intake of pesticides for the population served. In the rst
edition of the Guidelines for Drinking-water Quality, published in 1984, a health-based
guideline value of 0.03 mg/litre was recommended for aldrin and dieldrin, based on
the ADI recommended by JMPR in 1970 for aldrin and dieldrin residues separately
or together and reafrmed by toxicological data available in 1977. The 1993 Guide-
lines conrmed the health-based guideline value of 0.03 mg/litre for aldrin and diel-
drin, based on the reafrmation of the ADI recommended in 1977 by JMPR.
Assessment date
FAO/WHO (1995) Pesticide residues in food 1994. Report of the Joint Meeting of the
FAO Panel of Experts on Pesticide Residues in Food and the Environment and WHO
Toxicological and Environmental Core Assessment Groups. Rome, Food and Agricul-
ture Organization of the United Nations (FAO Plant Production and Protection
Paper 127).
WHO (2003) Aldrin and dieldrin in drinking-water. Background document for prepa-
ration of WHO Guidelines for drinking-water quality. Geneva, World Health Orga-
nization (WHO/SDE/WSH/03.04/73).
12.5 Aluminium
Aluminium is the most abundant metallic element and constitutes about 8% of the
Earths crust. Aluminium salts are widely used in water treatment as coagulants to
reduce organic matter, colour, turbidity and microorganism levels. Such use may lead
to increased concentrations of aluminium in nished water. Where residual concen-
trations are high, undesirable colour and turbidity may ensue. Concentrations of alu-
minium at which such problems may occur are highly dependent on a number of
water quality parameters and operational factors at the water treatment plant. Alu-
minium intake from foods, particularly those containing aluminium compounds used
as food additives, represents the major route of aluminium exposure for the general
301
public. The contribution of drinking-water to the total oral exposure to aluminium

is usually less than 5% of the total intake.
In humans, aluminium and its compounds appear to be poorly absorbed, although
the rate and extent of absorption have not been adequately studied for all sectors of
the population. The degree of aluminium absorption depends on a number of param-
eters, such as the aluminium salt administered, pH (for aluminium speciation and
solubility), bioavailability and dietary factors. These parameters should be taken into
consideration during tissue dosimetry and response assessment. The use of currently
available animal studies to develop a guideline value for aluminium is not appropri-
ate because of these specic toxicokinetic/toxicodynamic considerations.
There is little indication that orally ingested aluminium is acutely toxic to humans
despite the widespread occurrence of the element in foods, drinking-water and many
antacid preparations. It has been hypothesized that aluminium exposure is a risk
factor for the development or acceleration of onset of Alzheimer disease (AD) in
humans. The 1997 WHO EHC document for aluminium concludes that:
On the whole, the positive relationship between aluminium in drinking-water and AD,
which was demonstrated in several epidemiological studies, cannot be totally dismissed.
However, strong reservations about inferring a causal relationship are warranted in view of
the failure of these studies to account for demonstrated confounding factors and for total
aluminium intake from all sources.
Taken together, the relative risks for AD from exposure to aluminium in drinking-water
above 100 mg/litre, as determined in these studies, are low (less than 2.0). But, because the
risk estimates are imprecise for a variety of methodological reasons, a population-attribut-
able risk cannot be calculated with precision. Such imprecise predictions may, however, be
useful in making decisions about the need to control exposures to aluminium in the general
population.
Owing to the limitations of the animal data as a model for humans and the uncer-
tainty surrounding the human data, a health-based guideline value for aluminium
cannot be derived at this time.
The benecial effects of the use of aluminium as a coagulant in water treatment
are recognized. Taking this into account, and considering the health concerns about
aluminium (i.e., its potential neurotoxicity), a practicable level is derived, based on
optimization of the coagulation process in drinking-water plants using aluminium-
based coagulants, to minimize aluminium levels in nished water.
Several approaches are available for minimizing residual aluminium concentra-
tions in treated water. These include use of optimum pH in the coagulation process,
avoiding excessive aluminium dosage, good mixing at the point of application of the
coagulant, optimum paddle speeds for occulation and efcient ltration of the alu-
minium oc. Under good operating conditions, concentrations of aluminium of
0.1 mg/litre or less are achievable in large water treatment facilities. Small facilities
(e.g., those serving fewer than 10 000 people) might experience some difculties in
attaining this level, because the small size of the plant provides little buffering for uc-
tuation in operation; moreover, such facilities often have limited resources and limited
302
access to the expertise needed to solve specic operational problems. For these small
facilities, 0.2 mg/litre or less is a practicable level for aluminium in nished water.

The 1958, 1963 and 1971 WHO International Standards for Drinking-water did not
refer to aluminium. In the rst edition of the Guidelines for Drinking-water Quality,
published in 1984, a guideline value of 0.2 mg/litre was established for aluminium,
based on aesthetic considerations (as a compromise between the use of aluminium
compounds in water treatment and discoloration that may be observed if levels above
0.1 mg/litre remain in the distributed water). No health-based guideline value was rec-
ommended in the 1993 Guidelines, but the Guidelines conrmed that a concentration
of 0.2 mg/litre in drinking-water provides a compromise between the practical use of
aluminium salts in water treatment and discoloration of distributed water. No health-
based guideline value was derived for aluminium in the addendum to the Guidelines
published in 1998, owing to the limitations of the animal data as a model for humans
and the uncertainty surrounding the human data. However, taking the benecial
effects of the use of aluminium as a coagulant in water treatment into account and
considering the health concerns about aluminium (i.e., its potential neurotoxicity),
a practicable level was derived based on optimization of the coagulation process in
drinking-water plants using aluminium-based coagulants, to minimize aluminium
levels in nished water. Under good operating conditions, concentrations of alu-
minium of 0.1 mg/litre or less are achievable in large water treatment facilities. For
small facilities, 0.2 mg/litre or less is a practicable level for aluminium in nished
water.
Assessment date
Principal reference
WHO (2003) Aluminium in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/53).
12.6 Ammonia
The term ammonia includes the non-ionized (NH3) and ionized (NH4+) species.
Ammonia in the environment originates from metabolic, agricultural and industrial
processes and from disinfection with chloramine. Natural levels in groundwater and
surface water are usually below 0.2 mg/litre. Anaerobic groundwaters may contain up
to 3 mg/litre. Intensive rearing of farm animals can give rise to much higher levels
in surface water. Ammonia contamination can also arise from cement mortar pipe
303
linings. Ammonia in water is an indicator of possible bacterial, sewage and animal

waste pollution.
Ammonia is a major component of the metabolism of mammals. Exposure from
environmental sources is insignicant in comparison with endogenous synthesis of
ammonia. Toxicological effects are observed only at exposures above about 200 mg/kg
of body weight.
Ammonia in drinking-water is not of immediate health relevance, and therefore
no health-based guideline value is proposed. However, ammonia can compromise dis-
infection efciency, result in nitrite formation in distribution systems, cause the failure
of lters for the removal of manganese and cause taste and odour problems (see also
chapter 10).

rst edition of the Guidelines for Drinking-water Quality, published in 1984, did not
refer to ammonia. In the 1993 Guidelines, no health-based guideline value was rec-
ommended, but the Guidelines stated that ammonia could cause taste and odour
problems at concentrations above 35 and 1.5 mg/litre, respectively.
Assessment date
Principal reference
WHO (2003) Ammonia in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/1).
12.7 Antimony
Elemental antimony forms very hard alloys with copper, lead and tin. Antimony com-
pounds have various therapeutic uses. Antimony was considered as a possible replace-
ment for lead in solders, but there is no evidence of any signicant contribution to
drinking-water concentrations from this source. Daily oral uptake of antimony
appears to be signicantly higher than exposure by inhalation, although total expo-
sure from environmental sources, food and drinking-water is very low compared with
occupational exposure.
304

Occurrence Concentrations in groundwater and surface water normally range
from 0.1 to 0.2 mg/litre; concentrations in drinking-water appear to be
less than 5 mg/litre.
TDI 6 mg/kg of body weight, based on a NOAEL of 6.0 mg/kg of body
weight per day for decreased body weight gain and reduced food and
water intake in a 90-day study in which rats were administered
potassium antimony tartrate in drinking-water, using an uncertainty
factor of 1000 (100 for inter- and intraspecies variation, 10 for the
short duration of the study)
Limit of detection 0.01 mg/litre by EAAS; 0.11 mg/litre by ICP/MS; 0.8 mg/litre by graphite
furnace atomic absorption spectrophotometry; 5 mg/litre by hydride
generation AAS
Treatment achievability Conventional treatment processes do not remove antimony. However,
antimony is not normally a raw water contaminant. As the most
common source of antimony in drinking-water appears to be
dissolution from metal plumbing and ttings, control of antimony
from such sources would be by product control.
allocation to water 10% of TDI
weight 60-kg adult
There has been a signicant increase in the toxicity data available since the previous
review, although much of it pertains to the intraperitoneal route of exposure. The
form of antimony in drinking-water is a key determinant of the toxicity, and it would
appear that antimony leached from antimony-containing materials would be in the
form of the antimony(V) oxo-anion, which is the less toxic form. The subchronic tox-
icity of antimony trioxide is lower than that of potassium antimony tartrate, which is
the most soluble form. Antimony trioxide, due to its low bioavailability, is genotoxic
only in some in vitro tests, but not in vivo, whereas soluble antimony(III) salts exert
genotoxic effects in vitro and in vivo. Animal experiments from which the carcino-
genic potential of soluble or insoluble antimony compounds may be quantied are
not available. IARC has concluded that antimony trioxide is possibly carcinogenic to
humans (Group 2B) on the basis of an inhalation study in rats, but that antimony
trisulde was not classiable as to its carcinogenicity to humans (Group 3). However,
chronic oral uptake of potassium antimony tartrate may not be associated with an
additional carcinogenic risk, since antimony after inhalation exposure was carcino-
genic only in the lung but not in other organs and is known to cause direct lung
damage following chronic inhalation as a consequence of overload with insoluble par-
ticulates. Although there is some evidence for the carcinogenicity of certain antimony
compounds by inhalation, there are no data to indicate carcinogenicity by the oral
route.
305

refer to antimony. In the rst edition of the Guidelines for Drinking-water Quality,
published in 1984, it was concluded that no action was required for antimony. A
provisional guideline value for antimony was set at a practical quantication level of
0.005 mg/litre in the 1993 Guidelines, based on available toxicological data.
Assessment date
Principal reference
WHO (2003) Antimony in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/74).
12.8 Arsenic
Arsenic is widely distributed throughout the Earths crust, most often as arsenic sulde
or as metal arsenates and arsenides. Arsenicals are used commercially and industri-
ally, primarily as alloying agents in the manufacture of transistors, lasers and semi-
conductors. Arsenic is introduced into drinking-water sources primarily through the
dissolution of naturally occurring minerals and ores. Except for individuals who are
occupationally exposed to arsenic, the most important route of exposure is through
the oral intake of food and beverages. There are a number of regions where arsenic
may be present in drinking-water sources, particularly groundwater, at elevated
concentrations. Arsenic in drinking-water is a signicant cause of health effects in
some areas, and arsenic is considered to be a high-priority substance for screening in
drinking-water sources. Concentrations are often highly dependent on the depth to
which the well is sunk.
Provisional guideline 0.01 mg/litre

value The guideline value is designated as provisional in view of the
scientic uncertainties.
Occurrence Levels in natural waters generally rangey between 1 and 2 mg/litre,
although concentrations may be elevated (up to 12 mg/litre) in areas
containing natural sources.
Basis of guideline There remains considerable uncertainty over the actual risks at low
derivation concentrations, and available data on mode of action do not provide a
biological basis for using either linear or non-linear extrapolation. In
view of the signicant uncertainties surrounding the risk assessment
for arsenic carcinogenicity, the practical quantication limit in the
region of 110 mg/litre and the practical difculties in removing
arsenic from drinking-water, the guideline value of 10 mg/litre is
retained. In view of the scientic uncertainties, the guideline value is
designated as provisional.
306
Limit of detection 0.1 mg/litre by ICP/MS; 2 mg/litre by hydride generation AAS or FAAS
Treatment achievability It is technically feasible to achieve arsenic concentrations of 5 mg/litre
or lower using any of several possible treatment methods. However,
this requires careful process optimization and control, and a more
reasonable expectation is that 10 mg/litre should be achievable by
conventional treatment, e.g., coagulation.
Additional comments A management guidance document on arsenic is available.
In many countries, this guideline value may not be attainable.
Where this is the case, every effort should be made to keep
concentrations as low as possible.
Arsenic has not been demonstrated to be essential in humans. It is an important
drinking-water contaminant, as it is one of the few substances shown to cause cancer
in humans through consumption of drinking-water. There is overwhelming evidence
from epidemiological studies that consumption of elevated levels of arsenic through
drinking-water is causally related to the development of cancer at several sites, par-
ticularly skin, bladder and lung. In several parts of the world, arsenic-induced disease,
including cancer, is a signicant public health problem. Because trivalent inorganic
arsenic has greater reactivity and toxicity than pentavalent inorganic arsenic, it is gen-
erally believed that the trivalent form is the carcinogen. However, there remain con-
siderable uncertainty and controversy over both the mechanism of carcinogenicity
and the shape of the doseresponse curve at low intakes. Inorganic arsenic compounds
are classied by IARC in Group 1 (carcinogenic to humans) on the basis of sufcient
evidence for carcinogenicity in humans and limited evidence for carcinogenicity in
animals.

The 1958 WHO International Standards for Drinking-water recommended a
maximum allowable concentration of 0.2 mg/litre for arsenic, based on health con-
cerns. In the 1963 International Standards, this value was lowered to 0.05 mg/litre,
which was retained as a tentative upper concentration limit in the 1971 International
Standards. The guideline value of 0.05 mg/litre was also retained in the rst edition
of the Guidelines for Drinking-water Quality, published in 1984. A provisional guide-
line value for arsenic was set at the practical quantication limit of 0.01 mg/litre in
the 1993 Guidelines, based on concern regarding its carcinogenicity in humans.
Assessment date
IPCS (2001) Arsenic and arsenic compounds. Geneva, World Health Organization,
International Programme on Chemical Safety (Environmental Health Criteria 224).
307
WHO (2003) Arsenic in drinking-water. Background document for preparation of

(WHO/SDE/WSH/03.04/75).
12.9 Asbestos
Asbestos is introduced into water by the dissolution of asbestos-containing minerals
and ores as well as from industrial efuents, atmospheric pollution and asbestos-
cement pipes in the distribution system. Exfoliation of asbestos bres from asbestos-
cement pipes is related to the aggressiveness of the water supply. Limited data indicate
that exposure to airborne asbestos released from tap water during showers or humid-
ication is negligible.
Asbestos is a known human carcinogen by the inhalation route. Although well
studied, there has been little convincing evidence of the carcinogenicity of ingested
asbestos in epidemiological studies of populations with drinking-water supplies con-
taining high concentrations of asbestos. Moreover, in extensive studies in animal
species, asbestos has not consistently increased the incidence of tumours of the gas-
trointestinal tract. There is, therefore, no consistent evidence that ingested asbestos is
hazardous to health, and thus it is concluded that there is no need to establish a health-
based guideline value for asbestos in drinking-water.

refer to asbestos. In the rst edition of the Guidelines for Drinking-water Quality, pub-
lished in 1984, it was noted that available data were insufcient to determine whether
a guideline value was needed for asbestos. The 1993 Guidelines concluded that there
was no consistent evidence that ingested asbestos was hazardous to health and that
there was therefore no need to establish a health-based guideline value for asbestos in
drinking-water.
Assessment date
Principal reference
WHO (2003) Asbestos in drinking-water. Background document for preparation of
12.10 Atrazine
Atrazine (CAS No. 1912-24-9) is a selective pre- and early post-emergence herbicide.
It has been found in surface water and groundwater as a result of its mobility in soil.
308
It is relatively stable in soil and aquatic environments, with a half-life measured in

months, but is degraded by photolysis and microbial action in soil.

Occurrence Found in groundwater and drinking-water at levels below 10 mg/litre
TDI 0.5 mg/kg of body weight based on a NOAEL of 0.5 mg/kg of body
weight per day in a carcinogenicity study in the rat and an uncertainty
factor of 1000 (100 for inter- and intraspecies variation and 10 to
reect potential neoplasia)
Limit of detection 0.01 mg/litre by GC/MS
weight 60-kg adult
The weight of evidence from a wide variety of genotoxicity assays indicates that
atrazine is not genotoxic. There is evidence that atrazine can induce mammary
tumours in rats. It is highly probable that the mechanism for this process is non-
genotoxic. No signicant increase in neoplasia has been observed in mice. IARC has
concluded that there is inadequate evidence in humans and limited evidence in exper-
imental animals for the carcinogenicity of atrazine (Group 2B).

atrazine, but the 1971 International Standards suggested that pesticide residues that
total daily intake of pesticides for the population served. Atrazine was not evaluated
the 1993 Guidelines established a health-based guideline value of 0.002 mg/litre for
atrazine in drinking-water.
Assessment date
Principal reference
WHO (2003) Atrazine in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/32).
309
12.11 Barium
Barium is present as a trace element in both igneous and sedimentary rocks, and
barium compounds are used in a variety of industrial applications; however, barium
in water comes primarily from natural sources. Food is the primary source of intake
for the non-occupationally exposed population. However, where barium levels in
water are high, drinking-water may contribute signicantly to total intake.

Occurrence Concentrations in drinking-water are generally below 100 mg/litre,
although concentrations above 1 mg/litre have been measured in
drinking-water derived from groundwater.
NOAEL in humans 7.3 mg/litre in the most sensitive epidemiological study conducted to
date, in which there were no signicant differences in blood pressure
or in the prevalence of cardiovascular disease between a population
drinking water containing a mean barium concentration of
7.3 mg/litre and one whose water contained a barium concentration
of 0.1 mg/litre
Guideline derivation Uncertainty factor of 10 for intraspecies variation applied to NOAEL in
humans
Limit of detection 0.1 mg/litre by ICP/MS; 2 mg/litre by AAS; 3 mg/litre by ICP/optical
emission spectroscopy
Treatment achievability 0.1 mg/litre should be achievable using either ion exchange or
precipitation softening; other conventional processes are ineffective
There is no evidence that barium is carcinogenic or mutagenic. Barium has been
shown to cause nephropathy in laboratory animals, but the toxicological end-point
of greatest concern to humans appears to be its potential to cause hypertension.

The 1958 WHO International Standards for Drinking-water did not refer to barium.
The 1963 International Standards recommended a maximum allowable concentra-
tion of 1.0 mg/litre, based on health concerns. The 1971 International Standards stated
that barium should be controlled in drinking-water, but that insufcient information
was available to enable a tentative limit to be established. In the rst edition of the
Guidelines for Drinking-water Quality, published in 1984, it was concluded that it was
not necessary to establish a guideline value for barium in drinking-water, as there was
no rm evidence of any health effects associated with the normally low levels of
barium in water. A health-based guideline value of 0.7 mg/litre was derived for barium
in the 1993 Guidelines, based on concern regarding the potential of barium to cause
hypertension.
Assessment date
310
IPCS (2001) Barium and barium compounds. Geneva, World Health Organization,
International Programme on Chemical Safety (Concise International Chemical
Assessment Document 33).
WHO (2003) Barium in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/76).
12.12 Bentazone
Bentazone (CAS No. 25057-89-0) is a broad-spectrum herbicide used for a variety of
crops. Photodegradation occurs in soil and water; however, bentazone is very mobile
in soil and moderately persistent in the environment. Bentazone has been reported to
occur in surface water, groundwater and drinking-water at concentrations of a few
micrograms per litre or less. Although it has been found in groundwater and has a
high afnity for the water compartment, it does not seem to accumulate in the
environment. Exposure from food is unlikely to be high.
Long-term studies conducted in rats and mice have not indicated a carcinogenic
potential, and a variety of in vitro and in vivo assays have indicated that bentazone is
not genotoxic. A health-based value of 300 mg/litre can be calculated on the basis of
an ADI of 0.1 mg/kg of body weight established by JMPR, based on haematological
effects observed in a 2-year dietary study in rats. However, because bentazone occurs
at concentrations well below those at which toxic effects are observed, it is not con-
sidered necessary to derive a health-based guideline value.

bentazone, but the 1971 International Standards suggested that pesticide residues that
may occur in community water supplies make only a minimal contribution to the total
daily intake of pesticides for the population served. Bentazone was not evaluated in the
rst edition of the Guidelines for Drinking-water Quality, published in 1984, but the
1993 Guidelines established a health-based guideline value of 0.03 mg/litre for benta-
zone, based on an ADI established by JMPR in 1991. This guideline value was amended
to 0.3 mg/litre in the addendum to the Guidelines, published in 1998, based on new
information on the environmental behaviour of bentazone and exposure from food.
Assessment date
FAO/WHO (1999) Pesticide residues in food 1998. Evaluations 1998. Part II Tox-
icology. Geneva, World Health Organization, Joint FAO/WHO Meeting on Pesti-
cide Residues (WHO/PCS/01.12).
311
WHO (2003) Bentazone in drinking-water. Background document for preparation of

(WHO/SDE/WSH/03.04/77).
12.13 Benzene
Benzene is used principally in the production of other organic chemicals. It is present
in petrol, and vehicular emissions constitute the main source of benzene in the envi-
ronment. Benzene may be introduced into water by industrial efuents and atmos-
pheric pollution.

Occurrence Concentrations in drinking-water generally less than 5 mg/litre
Basis of guideline Robust linear extrapolation model (because of statistical lack of t of
derivation some of the data with the linearized multistage model) applied to
leukaemia and lymphomas in female mice and oral cavity squamous
cell carcinomas in male rats in a 2-year gavage study in rats and mice
Limit of detection 0.2 mg/litre by GC with photoionization detection and conrmation by
MS
Treatment achievability 0.01 mg/litre should be achievable using GAC or air stripping
Additional comments Lower end of estimated range of concentrations in drinking-water
corresponding to an upper-bound excess lifetime cancer risk of 10-5
(1080 mg/litre) corresponds to the estimate derived from data on
leukaemia from epidemiological studies involving inhalation exposure,
which formed the basis for the previous guideline value. The previous
guideline value is therefore retained.
Acute exposure of humans to high concentrations of benzene primarily affects the
central nervous system. At lower concentrations, benzene is toxic to the haematopoi-
etic system, causing a continuum of haematological changes, including leukaemia.
Because benzene is carcinogenic to humans, IARC has classied it in Group 1. Haema-
tological abnormalities similar to those observed in humans have been observed in
animal species exposed to benzene. In animal studies, benzene was shown to be car-
cinogenic following both inhalation and ingestion. It induced several types of tumours
in both rats and mice in a 2-year carcinogenesis bioassay by gavage in corn oil. Benzene
has not been found to be mutagenic in bacterial assays, but it has been shown to cause
chromosomal aberrations in vivo in a number of species, including humans, and to
be positive in the mouse micronucleus test.

refer to benzene. In the rst edition of the Guidelines for Drinking-water Quality, pub-
lished in 1984, a health-based guideline value of 0.01 mg/litre was recommended for
312
benzene based on human leukaemia data from inhalation exposure applied to a linear
multistage extrapolation model. The 1993 Guidelines estimated the range of benzene
concentrations in drinking-water corresponding to an upper-bound excess lifetime
cancer risk of 10-5 to be 0.010.08 mg/litre based on carcinogenicity in female mice
and male rats. As the lower end of this estimate corresponds to the estimate derived
from epidemiological data, which formed the basis for the previous guideline value
of 0.01 mg/litre associated with a 10-5 upper-bound excess lifetime cancer risk, the
guideline value of 0.01 mg/litre was retained.
Assessment date
Principal reference
WHO (2003) Benzene in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/24).
12.14 Boron
Boron compounds are used in the manufacture of glass, soaps and detergents and as
ame retardants. The general population obtains the greatest amount of boron
through food intake, as it is naturally found in many edible plants. Boron is found
naturally in groundwater, but its presence in surface water is frequently a consequence
of the discharge of treated sewage efuent, in which it arises from use in some deter-
gents, to surface waters.
Provisional guideline value 0.5 mg/litre

The guideline is designated as provisional because it will be difcult to
achieve in areas with high natural boron levels with the treatment
technology available.
Occurrence Concentrations vary widely and depend on the surrounding geology
and wastewater discharges. For most of the world, the concentration
range of boron in drinking-water is judged to be between 0.1 and
0.3 mg/litre.
TDI 0.16 mg/kg of body weight, based on a NOAEL of 9.6 mg/kg of body
weight per day for developmental toxicity (decreased fetal body
weight in rats) and an uncertainty factor of 60 (10 for interspecies
variation and 6 for intraspecies variation)
Limit of detection 0.2 mg/litre by ICP/MS; 610 mg/litre by ICP/AES
313
Treatment achievability Conventional water treatment (coagulation, sedimentation, ltration)

does not signicantly remove boron, and special methods need to be
installed in order to remove boron from waters with high boron
concentrations. Ion exchange and reverse osmosis processes may
enable substantial reduction but are likely to be prohibitively
expensive. Blending with low-boron supplies may be the only
economical method to reduce boron concentrations in waters where
these concentrations are high.
weight 60-kg adult
Short- and long-term oral exposures to boric acid or borax in laboratory animals have
demonstrated that the male reproductive tract is a consistent target of toxicity. Tes-
ticular lesions have been observed in rats, mice and dogs given boric acid or borax in
food or drinking-water. Developmental toxicity has been demonstrated experimen-
tally in rats, mice and rabbits. Negative results in a large number of mutagenicity
assays indicate that boric acid and borax are not genotoxic. In long-term studies in
mice and rats, boric acid and borax caused no increase in tumour incidence.

refer to boron. In the rst edition of the Guidelines for Drinking-water Quality, pub-
lished in 1984, it was concluded that no action was required for boron. A health-based
guideline value of 0.3 mg/litre for boron was established in the 1993 Guidelines, while
noting that borons removal by drinking-water treatment appears to be poor. This
guideline value was increased to 0.5 mg/litre in the addendum to the Guidelines pub-
lished in 1998 and was designated as provisional because, with the treatment tech-
nology available, the guideline value will be difcult to achieve in areas with high
natural boron levels.
Assessment date
Principal reference
WHO (2003) Boron in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/54).
314
12.15 Bromate
Sodium and potassium bromate are powerful oxidizers used mainly in permanent
wave neutralizing solutions and the dyeing of textiles using sulfur dyes. Potassium
bromate is also used as an oxidizer to mature our during milling, in treating barley
in beer making and in sh paste products, although JECFA has concluded that the use
of potassium bromate in food processing is not appropriate. Bromate is not normally
found in water, but may be formed during ozonation when the bromide ion is present
in water. Under certain conditions, bromate may also be formed in concentrated
hypochlorite solutions used to disinfect drinking-water.

value The guideline value is provisional because of limitations in available
analytical and treatment methods and uncertainties in the
toxicological data.
Occurrence Has been reported in drinking-water with a variety of source water
characteristics after ozonation at concentrations ranging from <2 to
293 mg/litre, depending on bromide ion concentration, ozone dosage,
pH, alkalinity and dissolved organic carbon
Basis of guideline Upper-bound estimate of cancer potency for bromate is 0.19 per
derivation mg/kg of body weight per day, based on low-dose linear extrapolation
(a one-stage Weibull time-to-tumour model was applied to the
incidence of mesotheliomas, renal tubule tumours and thyroid
follicular tumours in male rats given potassium bromate in drinking-
water, using the 12-, 26-, 52- and 77-week interim kill data). A health-
based value of 2 mg/litre is associated with the upper-bound excess
cancer risk of 10-5. A similar conclusion may be reached through
several other methods of extrapolation, leading to values in the range
26 mg/litre.
Limit of detection 1.5 mg/litre by ion chromatography with suppressed conductivity
detection; 0.2 mg/litre by ion chromatography with UV/visible
absorbance detection; 0.3 mg/litre by ion chromatography with
detection by ICP/MS
Treatment achievability Bromate is difcult to remove once formed. By appropriate control of
disinfection conditions, it is possible to achieve bromate
concentrations below 0.01 mg/litre.
IARC has concluded that although there is inadequate evidence of carcinogenicity in
humans, there is sufcient evidence for the carcinogenicity of potassium bromate in
experimental animals and has classied it in Group 2B (possibly carcinogenic to
humans). Bromate is mutagenic both in vitro and in vivo. At this time, there is not
sufcient evidence to conclude the mode of carcinogenic action for potassium
bromate. Observation of tumours at a relatively early time and the positive response
of bromate in a variety of genotoxicity assays suggest that the predominant mode of
action at low doses is due to DNA reactivity. Although there is limited evidence to
315
suggest that the DNA reactivity in kidney tumours may have a non-linear
doseresponse relationship, there is no evidence to suggest that this same
doseresponse relationship operates in the development of mesotheliomas or thyroid
tumours. Oxidative stress may play a role in the formation of kidney tumours, but
the evidence is insufcient to establish lipid peroxidation and free radical production
as key events responsible for induction of kidney tumours. Also, there are no data cur-
rently available to suggest that any single mechanism, including oxidative stress, is
responsible for the production of thyroid and peritoneal tumours by bromate.

refer to bromate. The 1993 Guidelines calculated the concentration of bromate in
drinking-water associated with an upper-bound excess lifetime cancer risk of 10-5 to
be 0.003 mg/litre. However, because of limitations in available analytical and treat-
ment methods, a provisional guideline value of 0.025 mg/litre, associated with an
upper-bound excess lifetime cancer risk of 7 10-5, was recommended.
Assessment date
Principal reference
WHO (2003) Bromate in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/78).
12.16 Brominated acetic acids

Brominated acetic acids are formed during disinfection of water that contains
bromide ions and organic matter. Bromide ions occur naturally in surface water and
groundwater and exhibit seasonal uctuations in levels. Bromide ion levels can
increase due to saltwater intrusion resulting from drought conditions or due to pol-
lution. Brominated acetates are generally present in surface water and groundwater
distribution systems at mean concentrations below 5 mg/litre.
The database for dibromoacetic acid is considered inadequate for the derivation of
a guideline value. There are no systemic toxicity studies of subchronic duration or
longer. The database also lacks suitable toxicokinetic studies, a carcinogenicity study,
a developmental study in a second species and a multigeneration reproductive toxic-
ity study (one has been conducted but is currently being evaluated by the US EPA).
Available mutagenicity data suggest that dibromoacetate is genotoxic.
Data are also limited on the oral toxicity of monobromoacetic acid and bro-
mochloroacetic acid. Limited mutagenicity and genotoxicity data give mixed results
for monobromoacetic acid and generally positive results for bromochloroacetic acid.
316
Data gaps include subchronic or chronic toxicity studies, multigeneration reproduc-

tive toxicity studies, standard developmental toxicity studies and carcinogenicity
studies. The available data are considered inadequate to establish guideline values for
these chemicals.

refer to brominated acetic acids. Brominated acetic acids were not evaluated in the
rst edition of the Guidelines for Drinking-water Quality, published in 1984, in the
second edition, published in 1993, or in the addendum to the second edition, pub-
lished in 1998.
Assessment date
IPCS (2000) Disinfectants and disinfectant by-products. Geneva, World Health Orga-
nization, International Programme on Chemical Safety (Environmental Health
Criteria 216).
WHO (2003) Brominated acetic acids in drinking-water. Background document for
preparation of WHO Guidelines for drinking-water quality. Geneva, World Health
Organization (WHO/SDE/WSH/03.04/79).
12.17 Cadmium
Cadmium metal is used in the steel industry and in plastics. Cadmium compounds
are widely used in batteries. Cadmium is released to the environment in wastewater,
and diffuse pollution is caused by contamination from fertilizers and local air pollu-
tion. Contamination in drinking-water may also be caused by impurities in the zinc
of galvanized pipes and solders and some metal ttings. Food is the main source of
daily exposure to cadmium. The daily oral intake is 1035 mg. Smoking is a signicant
additional source of cadmium exposure.

Occurrence Levels in drinking-water usually less than 1 mg/litre
PTWI 7 mg/kg of body weight, on the basis that if levels of cadmium in the
renal cortex are not to exceed 50 mg/kg, total intake of cadmium
(assuming an absorption rate for dietary cadmium of 5% and a daily
excretion rate of 0.005% of body burden) should not exceed 1 mg/kg
of body weight per day
Limit of detection 0.01 mg/litre by ICP/MS; 2 mg/litre by FAAS
Treatment achievability 0.002 mg/litre should be achievable using coagulation or precipitation
softening
317
allocation to water 10% of PTWI
weight 60-kg adult
Additional comments Although new information indicates that a proportion of the
general population may be at increased risk for tubular
dysfunction when exposed at the current PTWI, the risk estimates
that can be made at present are imprecise.
It is recognized that the margin between the PTWI and the actual
weekly intake of cadmium by the general population is small, less
than 10-fold, and that this margin may be even smaller in smokers.
Absorption of cadmium compounds is dependent on the solubility of the compounds.
Cadmium accumulates primarily in the kidneys and has a long biological half-life in
humans of 1035 years. There is evidence that cadmium is carcinogenic by the inhala-
tion route, and IARC has classied cadmium and cadmium compounds in Group 2A.
However, there is no evidence of carcinogenicity by the oral route and no clear evi-
dence for the genotoxicity of cadmium. The kidney is the main target organ for
cadmium toxicity. The critical cadmium concentration in the renal cortex that would
produce a 10% prevalence of low-molecular-weight proteinuria in the general popu-
lation is about 200 mg/kg and would be reached after a daily dietary intake of about
175 mg per person for 50 years.

The 1958 WHO International Standards for Drinking-water did not refer to cadmium.
The 1963 International Standards recommended a maximum allowable concentra-
tion of 0.01 mg/litre, based on health concerns. This value was retained in the 1971
International Standards as a tentative upper concentration limit, based on the lowest
concentration that could be conveniently measured. In the rst edition of the Guide-
lines for Drinking-water Quality, published in 1984, a guideline value of 0.005 mg/litre
was recommended for cadmium in drinking-water. This value was lowered to 0.003
mg/litre in the 1993 Guidelines, based on the PTWI set by JECFA.
Assessment date
JECFA (2000) Summary and conclusions of the fty-fth meeting, Geneva, 615 June
2000. Geneva, World Health Organization, Joint FAO/WHO Expert Committee on
Food Additives.
318
WHO (2003) Cadmium in drinking-water. Background document for preparation of

(WHO/SDE/WSH/03.04/80).
12.18 Carbofuran
Carbofuran (CAS No. 1563-66-2) is used worldwide as a pesticide for many crops.
Residues in treated crops are generally very low or not detectable. The physical and
chemical properties of carbofuran and the few data on occurrence indicate that drink-
ing-water from both groundwater and surface water sources is potentially the major
route of exposure.

Occurrence Has been detected in surface water, groundwater and drinking-water,
generally at levels of a few micrograms per litre or lower; highest
concentration (30 mg/litre) measured in groundwater
ADI 0.002 mg/kg of body weight based on a NOAEL of 0.22 mg/kg of body
weight per day for acute (reversible) effects in dogs in a short-term (4-
week) study conducted as an adjunct to a 13-week study in which
inhibition of erythrocyte acetylcholinesterase activity was observed,
and using an uncertainty factor of 100
Limit of detection 0.1 mg/litre by GC with a nitrogenphosphorus detector; 0.9 mg/litre by
reverse-phase HPLC with a uorescence detector
Treatment achievability 1 mg/litre should be achievable using GAC
weight 60-kg adult
Additional comments Use of a 4-week study was considered appropriate because the NOAEL
is based on a reversible acute effect; the NOAEL will also be protective
for chronic effects.
Carbofuran is highly toxic after acute oral administration. The main systemic effect
of carbofuran poisoning in short- and long-term toxicity studies appears to be
cholinesterase inhibition. No evidence of teratogenicity has been found in reproduc-
tive toxicity studies. On the basis of available studies, carbofuran does not appear to
be carcinogenic or genotoxic.

carbofuran, but the 1971 International Standards suggested that pesticide residues that
may occur in community water supplies make only a minimal contribution to the total
daily intake of pesticides for the population served. Carbofuran was not evaluated in
the rst edition of the Guidelines for Drinking-water Quality, published in 1984, but a
319
health-based guideline value of 0.005 mg/litre was established for carbofuran in the
1993 Guidelines, based on human data and supported by observations in laboratory
animals. This value was amended to 0.007 mg/litre in the addendum to the Guidelines
published in 1998, on the basis of the ADI established by JMPR in 1996.
Assessment date
icological. Geneva, World Health Organization, Joint FAO/WHO Meeting on Pes-
ticide Residues (WHO/PCS/97.1).
WHO (2003) Carbofuran in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/81).
12.19 Carbon tetrachloride

Carbon tetrachloride is used mainly in the production of chlorouorocarbon refrig-
erants, foam-blowing agents and solvents. However, since the Montreal Protocol on
Substances that Deplete the Ozone Layer (1987) and its amendments (1990 and 1992)
established a timetable for the phase-out of the production and consumption of
carbon tetrachloride, manufacture and use have dropped and will continue to drop.
Carbon tetrachloride is released mostly into the atmosphere but also into industrial
wastewater. Although it readily migrates from surface water to the atmosphere, levels
in anaerobic groundwater may remain elevated for months or even years. Although
available data on concentrations in food are limited, the intake from air is expected
to be much greater than that from food or drinking-water.

Occurrence Concentrations in drinking-water generally less than 5 mg/litre
TDI 1.4 mg/kg of body weight, based on a NOAEL of 1 mg/kg of body
weight per day for hepatotoxic effects in a 12-week oral gavage study
in rats, incorporating a conversion factor of 5/7 for daily dosing and
applying an uncertainty factor of 500 (100 for inter- and intraspecies
variation, 10 for the duration of the study and a modifying factor of
0.5 because it was a bolus study)
Limit of detection 0.10.3 mg/litre by GC with ECD or MS
Treatment achievability 0.001 mg/litre should be achievable using air stripping
320
weight 60-kg adult
Additional comments The guideline value is lower than the range of values associated with
upper-bound lifetime excess cancer risks of 10-4, 10-5 and 10-6
calculated by linear extrapolation.
The primary targets for carbon tetrachloride toxicity are liver and kidney. In experi-
ments with mice and rats, carbon tetrachloride proved to be capable of inducing
hepatomas and hepatocellular carcinomas. The doses inducing hepatic tumours were
higher than those inducing cell toxicity. It is likely that the carcinogenicity of carbon
tetrachloride is secondary to its hepatotoxic effects. On the basis of available data,
carbon tetrachloride can be considered to be a non-genotoxic compound. Carbon
tetrachloride is classied by IARC as being possibly carcinogenic to humans (Group
2B): there is sufcient evidence that carbon tetrachloride is carcinogenic in labora-
tory animals, but inadequate evidence in humans.

refer to carbon tetrachloride. In the rst edition of the Guidelines for Drinking-water
Quality, published in 1984, a tentative guideline value of 0.003 mg/litre was recom-
mended; the guideline was designated as tentative because reliable evidence on which
to calculate a guideline value based on carcinogenicity was available in only one
animal species, because of the good qualitative supporting data and because of its fre-
quency of occurrence in water. The 1993 Guidelines established a health-based guide-
line value of 0.002 mg/litre for carbon tetrachloride.
Assessment date
IPCS (1999) Carbon tetrachloride. Geneva, World Health Organization, International
Programme on Chemical Safety (Environmental Health Criteria 208).
WHO (2003) Carbon tetrachloride in drinking-water. Background document for prepa-
12.20 Chloral hydrate (trichloroacetaldehyde)

Chloral hydrate is formed as a by-product of chlorination when chlorine reacts with
humic acids. It has been widely used as a sedative or hypnotic drug in humans at oral
doses of up to 14 mg/kg of body weight.
321

value The guideline value is designated as provisional because of limitations
of the available database.
Occurrence Found in drinking-water at concentrations of up to 100 mg/litre
TDI 1.6 mg/kg of body weight, based on a LOAEL of 16 mg/kg of body
weight per day for liver enlargement from a 90-day drinking-water
study in mice, using an uncertainty factor of 10 000 to take into
consideration intra- and intraspecies variation, the short duration of
the study and the use of a LOAEL instead of a NOAEL
Quantication limit 1 mg/litre by GC with ECD; 3 mg/litre by GC/MS
Treatment achievability Chloral hydrate concentrations in drinking-water are generally below
0.05 mg/litre. Chloral hydrate concentrations may be reduced by
removal of precursor compounds, changes to disinfection practice or
GAC treatment.
weight 60-kg adult
The information available on the toxicity of chloral hydrate is limited, but effects on
the liver have been observed in 90-day studies in mice. Chloral hydrate has been shown
to be genotoxic in some short-term tests in vitro, but it does not bind to DNA. It has
been found to disrupt chromosome segregation in cell division.

refer to chloral hydrate. The 1993 Guidelines established a provisional health-based
guideline value of 0.01 mg/litre for chloral hydrate in drinking-water. The guideline
value was designated as provisional because of the limitations of the available data-
base, necessitating the use of an uncertainty factor of 10 000.
Assessment date
Principal reference
WHO (2003) Chloral hydrate (trichloroacetaldehyde) in drinking-water. Background
document for preparation of WHO Guidelines for drinking-water quality. Geneva,
World Health Organization (WHO/SDE/WSH/03.04/49).
322
12.21 Chlordane
Chlordane (CAS No. 57-47-9) is a broad-spectrum insecticide that has been used since
1947. Its use has recently been increasingly restricted in many countries, and it is now
used mainly to destroy termites by subsurface injection into soil. Chlordane may be
a low-level source of contamination of groundwater when applied by subsurface injec-
tion. Technical chlordane is a mixture of compounds, with the cis and trans forms of
chlordane predominating. It is very resistant to degradation, is highly immobile in soil
and it unlikely to migrate to groundwater, where it has only rarely been found. It is
readily lost to the atmosphere. Although levels of chlordane in food have been decreas-
ing, it is highly persistent and has a high bioaccumulation potential.

Occurrence Has been detected in both drinking-water and groundwater, usually at
levels below 0.1 mg/litre
PTDI 0.5 mg/kg of body weight based on a NOAEL of 50 mg/kg of body
weight per day for increased liver weights, serum bilirubin levels and
incidence of hepatocellular swelling, derived from a long-term dietary
study in rats, and using an uncertainty factor of 100
Limit of detection 0.014 mg/litre by GC with an ECD
weight 60-kg adult
Additional comments Chlordane is listed under the Stockholm Convention on Persistent
Organic Pollutants. Hence, monitoring may occur in addition to that
required by drinking-water guidelines.
In experimental animals, prolonged exposure in the diet causes liver damage. Chlor-
dane produces liver tumours in mice, but the weight of evidence indicates that it is
not genotoxic. Chlordane can interfere with cell communication in vitro, a charac-
teristic of many tumour promoters. IARC re-evaluated chlordane in 1991 and con-
cluded that there is inadequate evidence for its carcinogenicity in humans and
sufcient evidence for its carcinogenicity in animals, classifying it in Group 2B.

chlordane, but the 1971 International Standards suggested that pesticide residues that
total daily intake of pesticides for the population served. In the rst edition of the
Guidelines for Drinking-water Quality, published in 1984, a health-based guideline
value of 0.3 mg/litre was recommended for chlordane (total isomers), based on the
323
ADI recommended by JMPR in 1977. The 1993 Guidelines established a health-based

guideline value of 0.2 mg/litre for chlordane in drinking-water, based on an ADI estab-
lished by JMPR in 1986.
Assessment date
Paper 127).
WHO (2003) Chlordane in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/84).
12.22 Chloride
Chloride in drinking-water originates from natural sources, sewage and industrial
efuents, urban runoff containing de-icing salt and saline intrusion.
The main source of human exposure to chloride is the addition of salt to food, and
the intake from this source is usually greatly in excess of that from drinking-water.
Excessive chloride concentrations increase rates of corrosion of metals in the dis-
tribution system, depending on the alkalinity of the water. This can lead to increased
concentrations of metals in the supply.
No health-based guideline value is proposed for chloride in drinking-water.
However, chloride concentrations in excess of about 250 mg/litre can give rise to
detectable taste in water (see chapter 10).

The 1958 WHO International Standards for Drinking-water suggested that concentra-
tions of chloride greater than 600 mg/litre would markedly impair the potability
of the water. The 1963 and 1971 International Standards retained this value as a
maximum allowable or permissible concentration. In the rst edition of the Guide-
lines for Drinking-water Quality, published in 1984, a guideline value of 250 mg/litre
was established for chloride, based on taste considerations. No health-based guideline
value for chloride in drinking-water was proposed in the 1993 Guidelines, although
it was conrmed that chloride concentrations in excess of about 250 mg/litre can give
rise to detectable taste in water.
324
Assessment date
Principal reference
WHO (2003) Chloride in drinking-water. Background document for preparation of
12.23 Chlorine
Chlorine is produced in large amounts and widely used both industrially and domes-
tically as an important disinfectant and bleach. In particular, it is widely used in the
disinfection of swimming pools and is the most commonly used disinfectant and
oxidant in drinking-water treatment. In water, chlorine reacts to form hypochlorous
acid and hypochlorites.
Guideline value 5 mg/litre

Occurrence Present in most disinfected drinking-water at concentrations of
0.21 mg/litre
TDI 150 mg/kg of body weight, derived from a NOAEL for the absence of
toxicity in rodents ingesting chlorine in drinking-water for 2 years
Limit of detection 0.01 mg/litre following pre-column derivatization to
4-bromoacetanilide by HPLC; 10 mg/litre as free chlorine by
colorimetry; 0.2 mg/litre by ion chromatography
Treatment achievability It is possible to reduce the concentration of chlorine effectively to zero
(< 0.1 mg/litre) by reduction. However, it is normal practice to supply
water with a chlorine residual of a few tenths of a milligram per litre to
act as a preservative during distribution.
weight 60-kg adult
Additional comments The guideline value is conservative, as no adverse effect level was
identied in the critical study.
Most individuals are able to taste chlorine at the guideline value.
In humans and animals exposed to chlorine in drinking-water, no specic adverse
treatment-related effects have been observed. IARC has classied hypochlorite in
Group 3.
325

refer to chlorine. The 1993 Guidelines established a guideline value of 5 mg/litre for
free chlorine in drinking-water, but noted that this value is conservative, as no adverse
effect level was identied in the study used. It was also noted that most individuals
are able to taste chlorine at the guideline value.
Assessment date
Principal reference
WHO (2003) Chlorine in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/45).
12.24 Chlorite and chlorate

Chlorite and chlorate are DBPs resulting from the use of chlorine dioxide as a disin-
fectant and for odour/taste control in water. Chlorine dioxide is also used as a bleach-
ing agent for cellulose, paper pulp, our and oils. Sodium chlorite and sodium chlorate
are both used in the production of chlorine dioxide as well as for other commercial
purposes. Chlorine dioxide rapidly decomposes into chlorite, chlorate and chloride
ions in treated water, chlorite being the predominant species; this reaction is favoured
by alkaline conditions. The major route of environmental exposure to chlorine
dioxide, sodium chlorite and sodium chlorate is through drinking-water.
Provisional guideline
values
Chlorite 0.7 mg/litre
Chlorate 0.7 mg/litre The guideline values for chlorite and chlorate are
designated as provisional because use of chlorine dioxide as a
disinfectant may result in the chlorite and chlorate guideline values
being exceeded, and difculties in meeting the guideline value must
never be a reason for compromising adequate disinfection.
Occurrence Levels of chlorite in water reported in one study ranged from 3.2 to
7.0 mg/litre; however, the combined levels will not exceed the dose of
chlorine dioxide applied.
326
TDIs
Chlorite 30 mg/kg of body weight based on a NOAEL of 2.9 mg/kg of body
weight per day identied in a two-generation study in rats, based on
lower startle amplitude, decreased absolute brain weight in the F1 and
F2 generations and altered liver weights in two generations, using an
uncertainty factor of 100 (10 each for inter- and intraspecies variation)
Chlorate 30 mg/kg of body weight based on a NOAEL of 30 mg/kg of body
weight per day in a recent well conducted 90-day study in rats, based
on thyroid gland colloid depletion at the next higher dose, and using
an uncertainty factor of 1000 (10 each for inter- and intraspecies
variation and 10 for the short duration of the study)
Limit of detection 5 mg/litre by ion chromatography with suppressed conductivity
detection for chlorate
Treatment achievability It is possible to reduce the concentration of chlorine dioxide
effectively to zero ( < 0.1 mg/litre) by reduction; however, it is normal
practice to supply water with a chlorine dioxide residual of a few
tenths of a milligram per litre to act as a preservative during
distribution. Chlorate concentrations arising from the use of sodium
hypochlorite are generally around 0.1 mg/litre, although
concentrations above 1 mg/litre have been reported. With chlorine
dioxide disinfection, the concentration of chlorate depends heavily on
process conditions (in both the chlorine dioxide generator and the
water treatment plant) and applied dose of chlorine dioxide. As there
is no viable option for reducing chlorate concentrations, control of
chlorate concentration must rely on preventing its addition (from
sodium hypochlorite) or formation (from chlorine dioxide). Chlorite ion
is an inevitable by-product arising from the use of chlorine dioxide.
When chlorine dioxide is used as the nal disinfectant at typical doses,
the resulting chlorite concentration should be <0.2 mg/litre. If chlorine
dioxide is used as a pre-oxidant, the resulting chlorite concentration
may need to be reduced using ferrous iron or activated carbon.
weight 60-kg adult
Chlorine dioxide
Chlorine dioxide has been shown to impair neurobehavioural and neurological devel-
opment in rats exposed perinatally. Signicant depression of thyroid hormones has
also been observed in rats and monkeys exposed to it in drinking-water studies. A
guideline value has not been established for chlorine dioxide because of its rapid
hydrolysis to chlorite and because the chlorite provisional guideline value is ade-
quately protective for potential toxicity from chlorine dioxide. The taste and odour
threshold for this compound is 0.4 mg/litre.
327
Chlorite
IARC has concluded that chlorite is not classiable as to its carcinogenicity to humans.
The primary and most consistent nding arising from exposure to chlorite is oxida-
tive stress resulting in changes in the red blood cells. This end-point is seen in labo-
ratory animals and, by analogy with chlorate, in humans exposed to high doses in
poisoning incidents. Studies with human volunteers for up to 12 weeks did not iden-
tify any effect on blood parameters at the highest dose tested, 36 mg/kg of body weight
per day.
Chlorate
Like chlorite, the primary concern with chlorate is oxidative damage to red blood cells.
Also like chlorite, a chlorate dose of 36 mg/kg of body weight per day for 12 weeks did
not result in any adverse effects in human volunteers. Although the database for chlo-
rate is less extensive than that for chlorite, a recent well conducted 90-day study in
rats is available. A long-term study is in progress, which should provide more infor-
mation on chronic exposure to chlorate.

refer to chlorine dioxide, chlorate or chlorite. The 1993 Guidelines established a pro-
visional health-based guideline value of 0.2 mg/litre for chlorite in drinking-water.
The guideline value was designated as provisional because use of chlorine dioxide as
a disinfectant may result in the chlorite guideline value being exceeded, and difcul-
ties in meeting the guideline value must never be a reason for compromising disin-
fection. The 1993 Guidelines did not establish a health-based guideline value for
chlorine dioxide in drinking-water because of its rapid breakdown and because the
provisional guideline value for chlorite is adequately protective for potential toxicity
from chlorine dioxide. The 1993 Guidelines concluded that available data on the
effects of chlorate in humans and experimental animals are insufcient to permit
development of a guideline value and recommended that further research was needed
to characterize the non-lethal effects of chlorate. It was noted that the taste and odour
threshold for chlorine dioxide is 0.4 mg/litre.
Assessment date
Criteria 216).
328
WHO (2003) Chlorite and chlorate in drinking-water. Background document for prepa-
12.25 Chloroacetones
1,1-Dichloroacetone is formed from the reaction between chlorine and organic pre-
cursors and has been detected in chlorinated drinking-water. Concentrations are esti-
mated to be less than 10 mg/litre and usually less than 1 mg/litre.
The toxicological data on 1,1-dichloroacetone are very limited, although studies
with single doses indicate that it affects the liver.
There are insufcient data at present to permit the proposal of guideline values for
1,1-dichloroacetone or any of the other chloroacetones.

refer to chloroacetones. The 1993 Guidelines concluded that there were insufcient
data available to permit the proposal of guideline values for any of the chloroacetones.
Assessment date
Principal reference
WHO (2003) Chloroacetones in drinking-water. Background document for preparation
of WHO Guidelines for drinking-water quality. Geneva, World Health Organization
(WHO/SDE/WSH/03.04/50).
12.26 Chlorophenols (2-chlorophenol, 2,4-dichlorophenol,

2,4,6-trichlorophenol)
Chlorophenols are present in drinking-water as a result of the chlorination of phenols,
as by-products of the reaction of hypochlorite with phenolic acids, as biocides or as
degradation products of phenoxy herbicides. Those most likely to occur in drinking-
water as by-products of chlorination are 2-chlorophenol, 2,4-dichlorophenol and
2,4,6-trichlorophenol. The taste thresholds for chlorophenols in drinking-water are
low.
329
Guideline value for 0.2 mg/litre

2,4,6-trichlorophenol
Occurrence Concentrations of chlorophenols in drinking-water are usually less
than 1 mg/litre.
Basis of guideline Applying the linearized multistage model to leukaemias in male rats
derivation observed in a 2-year feeding study (hepatic tumours found in this
study were not used for risk estimation because of the possible role of
contaminants in their induction)
Limit of detection 0.55 mg/litre by formation of pentauorobenzyl ether derivatives;
110 mg/litre (monochlorophenols), 0.5 mg/litre (dichlorophenols) and
0.01 mg/litre (trichlorophenols) using GC with ECD
Treatment achievability 2,4,6-Trichlorophenol concentrations are generally less than 1 mg/litre.
If necessary, 2,4,6-trichlorophenol concentrations can be reduced
using GAC.
Additional comments The guideline value for 2,4,6-trichlorophenol exceeds its lowest
reported taste threshold.
2-Chlorophenol
Data on the toxicity of 2-chlorophenol are limited. Therefore, no health-based guide-
line value has been derived.
2,4-Dichlorophenol
Data on the toxicity of 2,4-dichlorophenol are limited. Therefore, no health-based
guideline value has been derived.
2,4,6-Trichlorophenol
2,4,6-Trichlorophenol has been reported to induce lymphomas and leukaemias in
male rats and hepatic tumours in male and female mice. The compound has not been
shown to be mutagenic in the Ames test but has shown weak mutagenic activity in
other in vitro and in vivo studies. IARC has classied 2,4,6-trichlorophenol in Group
2B.

refer to chlorophenols. In the rst edition of the Guidelines for Drinking-water Quality,
published in 1984, no guideline values for 2-chlorophenol, 4-chlorophenol, 2,4-
dichlorophenol, 2,6-dichlorophenol or 2,4,5-trichlorophenol were recommended
after a detailed evaluation of the compounds, although it was suggested that individ-
ual chlorophenols should not be present in drinking-water at a level above 0.0001
mg/litre for organoleptic reasons (and the total phenol content of water to be chlori-
nated should be kept below 0.001 mg/litre). In the same edition, a health-based guide-
line value of 0.01 mg/litre was recommended for 2,4,6-trichlorophenol, while noting
330
that the linear multistage extrapolation model appropriate for chemical carcinogens
that was used in its derivation involved considerable uncertainty. It was also noted
that 2,4,6-trichlorophenol may be detected by its taste and odour at a concentration
of 0.0001 mg/litre. No health-based guidelines for 2-chlorophenol or 2,4-dichlorophe-
nol were derived in the 1993 Guidelines, as data on their toxicity were limited. A guide-
line value of 0.2 mg/litre, associated with a 10-5 upper-bound excess lifetime cancer
risk, was calculated for 2,4,6-trichlorophenol. This concentration exceeds the lowest
reported taste threshold for the chemical (0.002 mg/litre).
Assessment date
Principal reference
WHO (2003) Chlorophenols in drinking-water. Background document for preparation
(WHO/SDE/WSH/03.04/47).
12.27 Chloropicrin
Chloropicrin, or trichloronitromethane, is formed by the reaction of chlorine with
humic and amino acids and with nitrophenols. Its formation is increased in the pres-
ence of nitrates. Limited data from the USA indicate that concentrations in drinking-
water are usually less than 5 mg/litre.
Decreased survival and body weights have been reported following long-term oral
exposure in laboratory animals. Chloropicrin has been shown to be mutagenic in bac-
terial tests and in in vitro assays in lymphocytes. Because of the high mortality in a
carcinogenesis bioassay and the limited number of end-points examined in the 78-
week toxicity study, the available data were considered inadequate to permit the estab-
lishment of a guideline value for chloropicrin.

The 1958, 1963 and 1971 WHO International Standards for Drinking-water and
the rst edition of the Guidelines for Drinking-water Quality, published in 1984, did
not refer to chloropicrin. The 1993 Guidelines considered the available data to be
inadequate to permit the establishment of a guideline value for chloropicrin in
drinking-water.
Assessment date
331
Principal reference
WHO (2003) Chloropicrin in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/52).
12.28 Chlorotoluron
Chlorotoluron (CAS No. 15545-48-9) is a pre- or early post-emergence herbicide that
is slowly biodegradable and mobile in soil. There is only very limited exposure to this
compound from food.

Occurrence Detected in drinking-water at concentrations of less than 1 mg/litre
TDI 11.3 mg/kg of body weight, derived from a NOAEL of 11.3 mg/kg of
body weight per day for systemic effects in a 2-year feeding study in
mice using an uncertainty factor of 1000 (100 for inter- and
intraspecies variation and 10 for evidence of carcinogenicity)
Limit of detection 0.1 mg/litre by separation by reverse-phase HPLC followed by UV and
electrochemical detection
weight 60-kg adult
Chlorotoluron is of low toxicity in single, short-term and long-term exposures in
animals, but it has been shown to cause an increase in adenomas and carcinomas
of the kidneys of male mice given high doses for 2 years. As no carcinogenic effects
were reported in a 2-year study in rats, it has been suggested that chlorotoluron has
a carcinogenic potential that is both species- and sex-specic. Chlorotoluron and its
metabolites have shown no evidence of genotoxicity.

chlorotoluron, but the 1971 International Standards suggested that pesticide residues
that may occur in community water supplies make only a minimal contribution
to the total daily intake of pesticides for the population served. Chlorotoluron was
not evaluated in the rst edition of the Guidelines for Drinking-water Quality, pub-
lished in 1984, but the 1993 Guidelines established a health-based guideline value
of 0.03 mg/litre for chlorotoluron in drinking-water.
332
Assessment date
Principal reference
WHO (2003) Chlorotoluron in drinking-water. Background document for preparation
(WHO/SDE/WSH/03.04/33).
12.29 Chlorpyrifos
Chlorpyrifos (CAS No. 2921-88-2) is a broad-spectrum organophosphorus insecti-
cide used for the control of mosquitos, ies, various crop pests in soil and on foliage,
household pests and aquatic larvae. Athough it is not recommended for addition
to water for public health purposes by WHOPES, it may be used in some countries
as an aquatic larvicide for the control of mosquito larvae. Chlorpyrifos is strongly
absorbed by soil and does not readily leach from it, degrading slowly by microbial
action. It has a low solubility in water and great tendency to partition from aqueous
into organic phases in the environment.

Occurrence Detected in surface waters in USA, usually at concentrations below 0.1
mg/litre; also detected in groundwater in less than 1% of the wells
tested, usually at concentrations below 0.01 mg/litre
ADI 0.01 mg/kg of body weight on the basis of a NOAEL of 1 mg/kg of
body weight per day for inhibition of brain acetylcholinesterase
activity in studies in mice, rats and dogs, using a 100-fold uncertainty
factor, and on the basis of a NOAEL of 0.1 mg/kg of body weight per
day for inhibition of erythrocyte acetylcholinesterase activity in a
study of human subjects exposed for 9 days, using a 10-fold
uncertainty factor
Limit of detection 1 mg/litre by GC using an ECD or ame photometric detection
Treatment achievability No data available; should be amenable to treatment by coagulation
(1020% removal), activated carbon adsorption and ozonation
weight 60-kg adult
JMPR concluded that chlorpyrifos is unlikely to pose a carcinogenic risk to humans.
Chlorpyrifos was not genotoxic in an adequate range of studies in vitro and in vivo.
In long-term studies, inhibition of cholinesterase activity was the main toxicological
nding in all species.
333

chlorpyrifos, but the 1971 International Standards suggested that pesticide residues
that may occur in community water supplies make only a minimal contribution to
the total daily intake of pesticides for the population served. Chlorpyrifos was not
evaluated in the rst edition of the Guidelines for Drinking-water Quality, published
in 1984, in the second edition, published in 1993, or in the addendum to the second
edition, published in 1998.
Assessment date
FAO/WHO (2000) Pesticide residues in food 1999 evaluations. Part II Toxicological.
Geneva, World Health Organization, Joint FAO/WHO Meeting on Pesticide
Residues (WHO/PCS/00.4).
WHO (2003) Chlorpyrifos in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/87).
12.30 Chromium
Chromium is widely distributed in the Earths crust. It can exist in valences of +2 to
+6. In general, food appears to be the major source of intake.
Provisional guideline 0.05 mg/litre for total chromium

value The guideline value is designated as provisional because of
uncertainties in the toxicological database.
Occurrence Total chromium concentrations in drinking-water are usually less than
2 mg/litre, although concentrations as high as 120 mg/litre have been
reported.
Basis of guideline value There are no adequate toxicity studies available to provide a basis for
derivation a NOAEL. The guideline value was rst proposed in 1958 for
hexavalent chromium, based on health concerns, but was later
changed to a guideline for total chromium because of difculties in
analysing for the hexavalent form only.
Limit of detection 0.050.2 mg/litre for total chromium by AAS
Treatment achievability 0.015 mg/litre should be achievable using coagulation
In a long-term carcinogenicity study in rats given chromium(III) by the oral route,
no increase in tumour incidence was observed. In rats, chromium(VI) is a carcino-
gen via the inhalation route, although the limited data available do not show evidence
334
for carcinogenicity via the oral route. In epidemiological studies, an association has
been found between exposure to chromium(VI) by the inhalation route and lung
cancer. IARC has classied chromium(VI) in Group 1 (human carcinogen) and
chromium(III) in Group 3. Chromium(VI) compounds are active in a wide range of
in vitro and in vivo genotoxicity tests, whereas chromium(III) compounds are not.

maximum allowable concentration of 0.05 mg/litre for chromium (hexavalent), based
on health concerns. This value was retained in the 1963 International Standards.
Chromium was not evaluated in the 1971 International Standards. In the rst edition
of the Guidelines for Drinking-water Quality, published in 1984, the guideline value of
0.05 mg/litre for total chromium was retained; total chromium was specied because
of difculties in analysing for the hexavalent form only. The 1993 Guidelines ques-
tioned the guideline value of 0.05 mg/litre because of the carcinogenicity of hexava-
lent chromium by the inhalation route and its genotoxicity, although the available
toxicological data did not support the derivation of a new value. As a practical
measure, 0.05 mg/litre, which is considered to be unlikely to give rise to signicant
health risks, was retained as the provisional guideline value until additional informa-
tion becomes available and chromium can be re-evaluated.
Assessment date
Principal reference
WHO (2003) Chromium in drinking-water. Background document for preparation of
12.31 Copper
Copper is both an essential nutrient and a drinking-water contaminant. It has many
commercial uses. It is used to make pipes, valves and ttings and is present in alloys
and coatings. Copper sulfate pentahydrate is sometimes added to surface water for
the control of algae. Copper concentrations in drinking-water vary widely, with the
primary source most often being the corrosion of interior copper plumbing. Levels
in running or fully ushed water tend to be low, whereas those in standing or par-
tially ushed water samples are more variable and can be substantially higher (fre-
quently > 1 mg/litre). Copper concentrations in treated water often increase during
distribution, especially in systems with an acid pH or high-carbonate waters with an
alkaline pH. Food and water are the primary sources of copper exposure in developed
335
countries. Consumption of standing or partially ushed water from a distribution

system that includes copper pipes or ttings can considerably increase total daily
copper exposure, especially for infants fed formula reconstituted with tap water.

Occurrence Concentrations in drinking-water range from 0.005 to >30 mg/litre,
primarily as a result of the corrosion of interior copper plumbing.
Basis of guideline To be protective against acute gastrointestinal effects of copper and
derivation provide an adequate margin of safety in populations with normal
copper homeostasis
Limit of detection 0.020.1 mg/litre by ICP/MS; 0.3 mg/litre by ICP/optical emission
spectroscopy; 0.5 mg/litre by FAAS
Treatment achievability Copper is not removed by conventional treatment processes. However,
copper is not normally a raw water contaminant.
Additional comments For adults with normal copper homeostasis, the guideline value
should permit consumption of 2 or 3 litres of water per day, use of
a nutritional supplement and copper from foods without
exceeding the tolerable upper intake level of 10 mg/day or eliciting
an adverse gastrointestinal response.
Staining of laundry and sanitary ware occurs at copper
concentrations above 1 mg/litre. At levels above 2.5 mg/litre,
copper imparts an undesirable bitter taste to water; at higher
levels, the colour of water is also impacted.
In most instances where copper tubing is used as a plumbing
material, concentrations of copper will be below the guideline
value. However, there are some conditions, such as highly acidic or
aggressive waters, that will give rise to much higher copper
concentrations, and the use of copper tubing may not be
appropriate in such circumstances.
IPCS concluded that the upper limit of the acceptable range of oral intake in adults
is uncertain but is most likely in the range of several (more than 2 or 3) but not many
milligrams per day in adults. This evaluation was based solely on studies of gastroin-
testinal effects of copper-contaminated drinking-water. The available data on toxicity
in animals were not considered helpful in establishing the upper limit of the accept-
able range of oral intake due to uncertainty about an appropriate model for humans,
but they help to establish a mode of action for the response. The data on the gas-
trointestinal effects of copper must be used with caution, since the effects observed
are inuenced by the concentration of ingested copper to a greater extent than the
total mass or dose ingested in a 24-h period. Recent studies have delineated the thresh-
old for the effects of copper in drinking-water on the gastrointestinal tract, but there
is still some uncertainty regarding the long-term effects of copper on sensitive popu-
lations, such as carriers of the gene for Wilson disease and other metabolic disorders
of copper homeostasis.
336

tions of copper greater than 1.5 mg/litre would markedly impair the potability of the
water. The 1963 and 1971 International Standards retained this value as a maximum
allowable or permissible concentration. In the rst edition of the Guidelines for Drink-
ing-water Quality, published in 1984, a guideline value of 1.0 mg/litre was established
for copper, based on its laundry and other staining properties. The 1993 Guidelines
derived a provisional health-based guideline value of 2 mg/litre for copper from the
PMTDI proposed by JECFA, based on a rather old study in dogs that did not take into
account differences in copper metabolism between infants and adults. The guideline
value was considered provisional because of the uncertainties regarding copper toxi-
city in humans. This guideline value was retained in the addendum to the Guidelines
published in 1998 and remained provisional as a result of uncertainties in the
doseresponse relationship between copper in drinking-water and acute gastroin-
testinal effects in humans. It was stressed that the outcome of epidemiological studies
in progress in Chile, Sweden and the USA may permit more accurate quantication
of effect levels for copper-induced toxicity in humans, including sensitive subpopu-
lations. Copper can also give rise to taste problems at concentrations above 5 mg/litre
and can stain laundry and sanitary ware at concentrations above 1 mg/litre.
Assessment date
IPCS (1998) Copper. Geneva, World Health Organization, International Programme
on Chemical Safety (Environmental Health Criteria 200).
WHO (2003) Copper in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/88).
12.32 Cyanazine
Cyanazine (CAS No. 21725-46-2) is a member of the triazine family of herbicides. It
is used as a pre- and post-emergence herbicide for the control of annual grasses and
broadleaf weeds. It can be degraded in soil and water by microorganisms and by
hydrolysis.

Occurrence Has been detected in surface water and groundwater, usually at
concentrations of a few micrograms per litre, although levels as high
as 1.3 and 3.5 mg/litre have been measured in surface water and
groundwater, respectively
337
TDI 0.198 mg/kg of body weight based on a NOAEL of 0.198 mg/kg of body
weight for hyperactivity in male rats in a 2-year
toxicity/carcinogenicity study, with an uncertainty factor of 1000 (100
for inter- and intraspecies variation and 10 for limited evidence of
carcinogenicity)
Limit of detection 0.01 mg/litre by GC with MS
weight 60-kg adult
On the basis of the available mutagenicity data on cyanazine, evidence for genotoxi-
city is equivocal. Cyanazine causes mammary gland tumours in Sprague-Dawley rats
but not in mice. The mechanism of mammary gland tumour development in Sprague-
Dawley rats is currently under investigation and may prove to be hormonal (cf.
atrazine). Cyanazine is also teratogenic in Fischer 344 rats at dose levels of 25 mg/kg
of body weight per day and higher.

cyanazine, but the 1971 International Standards suggested that pesticide residues that
Guidelines for Drinking-water Quality, published in 1984, no guideline value for tri-
azine herbicides, which include cyanazine, was recommended after a detailed evalua-
tion of the compounds. Cyanazine was not evaluated in the second edition of the
Guidelines for Drinking-water Quality, published in 1993. In the addendum to the
second edition of these Guidelines, published in 1998, a health-based guideline value
of 0.6 mg/litre was established for cyanazine in drinking-water.
Assessment date
Principal reference
WHO (2003) Cyanazine in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/60).
338
12.33 Cyanide
Cyanides can be found in some foods, particularly in some developing countries, and
they are occasionally found in drinking-water, primarily as a consequence of indus-
trial contamination.

Occurrence Occasionally found in drinking-water
TDI 12 mg/kg of body weight, based on a LOAEL of 1.2 mg/kg of body
weight per day for effects on behavioural patterns and serum
biochemistry in a 6-month study in pigs, using an uncertainty factor of
100 for inter- and intraspecies variation (no additional factor for use of
a LOAEL instead of a NOAEL was considered necessary because of
doubts over the biological signicance of the observed changes)
Limit of detection 2 mg/litre by titrimetric and photometric techniques
Treatment achievability Cyanide is removed from water by high doses of chlorine.
allocation to water 20% of TDI (because exposure to cyanide from other sources is
normally small and because exposure from water is only intermittent)
weight 60-kg adult
Additional The guideline value is considered to be protective for acute and
considerations long-term exposure.
The acute toxicity of cyanides is high. Effects on the thyroid and particularly the
nervous system were observed in some populations as a consequence of the long-term
consumption of inadequately processed cassava containing high levels of cyanide.

maximum allowable concentration of 0.01 mg/litre for cyanide, based on health con-
cerns. This value was raised to 0.2 mg/litre in the 1963 International Standards. The
tentative upper concentration limit was lowered to 0.05 mg/litre in the 1971 Interna-
tional Standards upon consideration of the ADI of hydrogen cyanide residues in some
fumigated foods of 0.05 mg/kg of body weight and to ensure that the water source is
not too highly contaminated by industrial efuents and that water treatment has been
adequate. In the rst edition of the Guidelines for Drinking-water Quality, published
in 1984, it was determined that a guideline value of 0.1 mg/litre would be a rea-
sonable level for the protection of public health. A health-based guideline value of
0.07 mg/litre, which was considered to be protective for both acute and long-term
exposure, was derived in the 1993 Guidelines.
339
Assessment date
Principal reference
WHO (2003) Cyanide in drinking-water. Background document for preparation of
12.34 Cyanogen chloride

Cyanogen chloride is a by-product of chloramination. It is a reaction product of
organic precursors with hypochlorous acid in the presence of ammonium ion. Con-
centrations detected in drinking-water treated with chlorine and chloramine were 0.4
and 1.6 mg/litre, respectively.
Cyanogen chloride is rapidly metabolized to cyanide in the body. There are few
data on the oral toxicity of cyanogen chloride, and the guideline value is based, there-
fore, on cyanide. The guideline value is 70 mg/litre for cyanide as total cyanogenic com-
pounds (see Cyanide in section 12.33).

refer to cyanogen chloride. The 1993 Guidelines derived a health-based guideline
value for cyanogen chloride based on cyanide, as cyanogen chloride is rapidly metab-
olized to cyanide in the body and as there are few data on the oral toxicity of cyanogen
chloride. The guideline value is 0.07 mg/litre for cyanide as total cyanogenic com-
pounds (see Cyanide in section 12.33).
Assessment date
Principal reference
WHO (2003) Cyanogen chloride in drinking-water. Background document for prepara-
tion of WHO Guidelines for drinking-water quality. Geneva, World Health Organi-
zation (WHO/SDE/WSH/03.04/51).
12.35 2,4-D (2,4-dichlorophenoxyacetic acid)

The term 2,4-D is used here to refer to the free acid, 2,4-dichlorophenoxyacetic acid
(CAS No. 94-75-7). Commercial 2,4-D products are marketed as the free acid, alkali
340
and amine salts, and ester formulations. 2,4-D itself is chemically stable, but its esters
are rapidly hydrolysed to the free acid. 2,4-D is a systemic herbicide used for control
of broad-leaved weeds, including aquatic weeds. 2,4-D is rapidly biodegraded in the
environment. Residues of 2,4-D in food rarely exceed a few tens of micrograms per
kilogram.

Occurrence Levels in water usually below 0.5 mg/litre, although concentrations as
high as 30 mg/litre have been measured
ADI 0.01 mg/kg of body weight for the sum of 2,4-D and its salts and
esters, expressed as 2,4-D, on the basis of a NOAEL of 1 mg/kg of body
weight per day in a 1-year study of toxicity in dogs (for a variety of
effects, including histopathological lesions in kidneys and liver) and a
2-year study of toxicity and carcinogenicity in rats (for renal lesions)
Limit of detection 0.1 mg/litre by gasliquid chromatography with electrolytic
conductivity detection
weight 60-kg adult
Additional comments The guideline value applies to 2,4-D, as salts and esters of 2,4-D are
rapidly hydrolysed to the free acid in water
Epidemiological studies have suggested an association between exposure to
chlorophenoxy herbicides, including 2,4-D, and two forms of cancer in humans: soft-
tissue sarcomas and non-Hodgkin lymphoma. The results of these studies, however,
are inconsistent; the associations found are weak, and conicting conclusions have
been reached by the investigators. Most of the studies did not provide information on
exposure specically to 2,4-D, and the risk was related to the general category of
chlorophenoxy herbicides, a group that includes 2,4,5-trichlorophenoxyacetic acid
(2,4,5-T), which was potentially contaminated with dioxins. JMPR concluded that it
was not possible to evaluate the carcinogenic potential of 2,4-D on the basis of the
available epidemiological studies. JMPR has also concluded that 2,4-D and its salts
and esters are not genotoxic. The toxicity of the salts and esters of 2,4-D is compara-
ble to that of the acid.

2,4-D, but the 1971 International Standards suggested that pesticide residues that may
occur in community water supplies make only a minimal contribution to the total
daily intake of pesticides for the population served. In the rst edition of the Guide-
341
lines for Drinking-water Quality, published in 1984, a health-based guideline value of

0.1 mg/litre was recommended for 2,4-D, based on the ADI recommended by WHO
in 1976, but it was noted that some individuals may be able to detect 2,4-D by taste
and odour at levels exceeding 0.05 mg/litre. The 1993 Guidelines established a health-
based guideline value of 0.03 mg/litre for 2,4-D in drinking-water. This guideline value
was retained in the addendum to these Guidelines, published in 1998, but was based
on the more recent (1996) toxicological evaluation conducted by JMPR. This guide-
line value applies to 2,4-D, as salts and esters of 2,4-D are rapidly hydrolysed to the
free acid in water.
Assessment date
FAO/WHO (1997) Pesticide residues in food 1996. Evaluations 1996. Part II Toxi-
cological. Geneva, World Health Organization, Joint FAO/WHO Meeting on
Pesticide Residues (WHO/PCS/97.1).
WHO (2003) 2,4-D in drinking-water. Background document for preparation of WHO
Guidelines for drinking-water quality. Geneva, World Health Organization
(WHO/SDE/WSH/03.04/70).
12.36 2,4-DB
The half-lives for degradation of chlorophenoxy herbicides, including 2,4-DB (CAS
No. 94-82-6), in the environment are in the order of several days. Chlorophenoxy her-
bicides are not often found in food.

Occurrence Chlorophenoxy herbicides not frequently found in drinking- water;
when detected, concentrations are usually no greater than a few
micrograms per litre
TDI 30 mg/kg of body weight, based on a NOAEL of 3 mg/kg of body
weight per day for effects on body and organ weights, blood
chemistry and haematological parameters in a 2-year study in rats,
with an uncertainty factor of 100 (for inter- and intraspecies variation)
Limit of detection 1 mg/litre to 1 mg/litre for various methods commonly used for the
determination of chlorophenoxy herbicides in water, including solvent
extraction, separation by GC, gasliquid chromatography, thin-layer
chromatography or HPLC, with ECD or UV detection
342
weight 60-kg adult
Additional The NOAEL used in the guideline value derivation is similar
considerations to the NOAEL of 2.5 mg/kg of body weight per day obtained in a
short-term study in beagle dogs and the NOAEL for hepatocyte
hypertrophy of 5 mg/kg of body weight per day obtained in a 3-
month study in rats.
Chlorophenoxy herbicides, as a group, have been classied in Group 2B by IARC.
However, the available data from studies in exposed populations and animals do not
permit assessment of the carcinogenic potential to humans of any specic chlorophe-
noxy herbicide. Therefore, drinking-water guidelines for these compounds are based
on a threshold approach for other toxic effects.

chlorophenoxy herbicides, including 2,4-DB, but the 1971 International Standards
suggested that pesticide residues that may occur in community water supplies make
only a minimal contribution to the total daily intake of pesticides for the population
served. 2,4-DB was not evaluated in the rst edition of the Guidelines for Drinking-
water Quality, published in 1984, but the 1993 Guidelines established a health-based
guideline value of 0.09 mg/litre for 2,4-DB.
Assessment date
Principal reference
WHO (2003) Chlorophenoxy herbicides (excluding 2,4-D and MCPA) in drinking-
water. Background document for preparation of WHO Guidelines for drinking-water
quality. Geneva, World Health Organization (WHO/SDE/WSH/03.04/44).
12.37 DDT and metabolites

The structure of DDT (CAS No. 107917-42-0) permits several different isomeric
forms, and commercial products consist predominantly of p,p-DDT. Its use has been
restricted or banned in several countries, although DDT is still used in some coun-
tries for the control of vectors that transmit yellow fever, sleeping sickness, typhus,
malaria and other insect-transmitted diseases. DDT and its metabolites are persistent
343
in the environment and resistant to complete degradation by microorganisms.

Food is the major source of intake of DDT and related compounds for the general
population.

Occurrence Detected in surface water at concentrations below 1 mg/litre; also
detected in drinking-water at 100-fold lower concentrations
PTDI 0.01 mg/kg of body weight based on a NOAEL of 1 mg/kg of body
weight per day for developmental toxicity in rats, applying an
uncertainty factor of 100
Limit of detection 0.011 mg/litre by GC using an ECD
Treatment achievability 0.1 mg/litre should be achievable using coagulation or GAC
weight 10-kg child
consumption 1 litre/day
Additional comments DDT is listed under the Stockholm Convention on Persistent
Organic Pollutants. Hence, monitoring may occur in addition to
that required by drinking-water guidelines.
The guideline value is derived on the basis of a 10-kg child
consuming 1 litre of drinking-water per day, because infants and
children may be exposed to greater amounts of chemicals in
relation to their body weight and because of concern over the
bioaccumulation of DDT.
It should be emphasized that the benets of DDT use in malaria
and other vector control programmes outweigh any health risk
from the presence of DDT in drinking-water.
A working group convened by IARC classied the DDT complex as a non-genotoxic
carcinogen in rodents and a potent promoter of liver tumours. IARC has concluded
that there is insufcient evidence in humans and sufcient evidence in experimental
animals for the carcinogenicity of DDT (Group 2B) based upon liver tumours
observed in rats and mice. The results of epidemiological studies of pancreatic cancer,
multiple myeloma, non-Hodgkin lymphoma and uterine cancer did not support the
hypothesis of an association with environmental exposure to the DDT complex. Con-
icting data were obtained with regard to some genotoxic end-points. In most studies,
DDT did not induce genotoxic effects in rodent or human cell systems, nor was it
mutagenic to fungi or bacteria. The US Agency for Toxic Substances and Disease Reg-
istry concluded that the DDT complex could impair reproduction and/or develop-
ment in several species. Hepatic effects of DDT in rats include increased liver weights,
hypertrophy, hyperplasia, induction of microsomal enzymes, including cytochrome
P450, cell necrosis, increased activity of serum liver enzymes and mitogenic effects,
which might be related to a regenerative liver response to DDT.
344

DDT, but the 1971 International Standards suggested that pesticide residues that may
0.001 mg/litre was recommended for DDT (total isomers), based on the ADI recom-
mended by JMPR in 1969. The 1993 Guidelines established a health-based guideline
value of 0.002 mg/litre for DDT and its metabolites in drinking-water, derived from
the ADI recommended by JMPR in 1984 and taking into consideration the fact that
infants and children may be exposed to greater amounts of chemicals in relation to
their body weight, concern over the bioaccumulation of DDT and the signicant
exposure to DDT by routes other than water. It was noted that the guideline value
exceeds the water solubility of DDT of 0.001 mg/litre, but that some DDT may be
adsorbed onto the small amount of particulate matter present in drinking-water, so
the guideline value could be reached under certain circumstances. It was also empha-
sized that the benets of DDT use in malaria and other vector control programmes
far outweigh any health risk from the presence of DDT in drinking-water.
Assessment date
FAO/WHO (2001) Pesticide residues in food 2000. Evaluations 2000. Part II
Toxicology. Geneva, World Health Organization, Joint FAO/WHO Meeting on
WHO (2003) DDT and its derivatives in drinking-water. Background document for
12.38 Dialkyltins
The group of chemicals known as the organotins is composed of a large number of
compounds with differing properties and applications. The most widely used of the
organotins are the disubstituted compounds, which are employed as stabilizers in
plastics, including polyvinyl chloride (PVC) water pipes, and the trisubstituted com-
pounds, which are widely used as biocides.
The disubstituted compounds that may leach from PVC water pipes at low con-
centrations for a short time after installation are primarily immunotoxins, although
they appear to be of low general toxicity. The data available are insufcient to permit
the proposal of guideline values for individual dialkyltins.
345

refer to dialkyltins. The 1993 Guidelines concluded that the data available were insuf-
cient to permit the proposal of guideline values for individual dialkyltins.
Assessment date
Principal reference
WHO (2003) Dialkyltins in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/109).
12.39 1,2-Dibromo-3-chloropropane (DBCP)

1,2-Dibromo-3-chloropropane (CAS No. 96-12-8) is a soil fumigant that is highly
soluble in water. It has a taste and odour threshold in water of 10 mg/litre. DBCP was
detected in vegetables grown in treated soils, and low levels have been detected in air.

Occurrence Limited survey found levels of up to a few micrograms per litre in
drinking-water
Basis of guideline Linearized multistage model was applied to the data on the incidence
derivation of stomach, kidney and liver tumours in the male rat in a 104-week
dietary study
Limit of detection 0.02 mg/litre by GC with ECD
Treatment achievability 1 mg/litre should be achievable using air stripping followed by GAC
Additional comments The guideline value of 1 mg/litre should be protective for the
reproductive toxicity of DBCP.
On the basis of animal data from different strains of rats and mice, DBCP was deter-
mined to be carcinogenic in both sexes by the oral, inhalation and dermal routes.
DBCP was also determined to be a reproductive toxicant in humans and several
species of laboratory animals. DBCP was found to be genotoxic in a majority of in
vitro and in vivo assays. IARC has classied DBCP in Group 2B based upon sufcient
evidence of carcinogenicity in animals. Recent epidemiological evidence suggests an
increase in cancer mortality in individuals exposed to high levels of DBCP.

DBCP, but the 1971 International Standards suggested that pesticide residues that may
346
daily intake of pesticides for the population served. DBCP was not evaluated in the
rst edition of the Guidelines for Drinking-water Quality, published in 1984, but the
1993 Guidelines calculated a guideline value of 0.001 mg/litre for DBCP in drinking-
water, corresponding to an upper-bound excess lifetime cancer risk of 10-5 and suf-
ciently protective for the reproductive toxicity of the pesticide. It was noted that for
a contaminated water supply, extensive treatment would be required to reduce the
level of DBCP to the guideline value.
Assessment date
Principal reference
WHO (2003) 1,2-Dibromo-3-chloropropane in drinking-water. Background document
for preparation of WHO Guidelines for drinking-water quality. Geneva, World Health
12.40 1,2-Dibromoethane (ethylene dibromide)

1,2-Dibromoethane (CAS No. 106-93-4) is used as a lead scavenger in tetra-alkyl lead
petrol and antiknock preparations and as a fumigant for soils, grains and fruits.
However, with the phasing out of leaded petrol and of the use of 1,2-dibromoethane
in agricultural applications in many countries, use of this substance has declined sig-
nicantly. In addition to its continued use as a petrol additive in some countries, 1,2-
dibromoethane is currently used principally as a solvent and as an intermediate in the
chemical industry.
Provisional guideline 0.0004 mg/litre (0.4 mg/litre)

value The guideline value is provisional due to serious limitations of the
critical studies.
Occurrence Detected in groundwater following its use as a soil fumigant at
concentrations as high as 100 mg/litre
Basis of guideline Lower end of the range (and thus more conservative estimate) of
derivation lifetime low-dose cancer risks calculated by linearized multistage
modelling of the incidences of haemangiosarcomas and tumours in
the stomach, liver, lung and adrenal cortex (adjusted for the observed
high early mortality, where appropriate, and corrected for the
expected rate of increase in tumour formation in rodents in a standard
bioassay of 104 weeks) of rats and/or mice exposed to 1,2-
dibromoethane by gavage
347
Limit of detection 0.01 mg/litre by microextraction GC/MS; 0.03 mg/litre by purge and trap
GC with halogen-specic detector; 0.8 mg/litre by purge-and-trap
capillary column GC with photoionization and electrolytic
conductivity detectors in series
1,2-Dibromoethane has induced an increased incidence of tumours at several sites in
all carcinogenicity bioassays identied in which rats or mice were exposed to the com-
pound by gavage, ingestion in drinking-water, dermal application and inhalation.
However, many of these studies were characterized by high early mortality, limited
histopathological examination, small group sizes or use of only one exposure level.
The substance acted as an initiator of liver foci in an initiation/promotion assay but
did not initiate skin tumour development. 1,2-Dibromoethane was consistently geno-
toxic in in vitro assays, although results of in vivo assays were mixed. Biotransforma-
tion to active metabolites, which have been demonstrated to bind to DNA, is probably
involved in the induction of tumours. Available data do not support the existence of
a non-genotoxic mechanism of tumour induction. The available data thus indicate
that 1,2-dibromoethane is a genotoxic carcinogen in rodents. Data on the potential
carcinogenicity in humans are inadequate; however, it is likely that 1,2-dibromoethane
is metabolized similarly in rodent species and in humans (although there may be
varying potential for the production of active metabolites in humans, owing to genetic
polymorphism). IARC classied 1,2-dibromoethane in Group 2A (the agent is prob-
ably carcinogenic to humans).

1,2-dibromoethane, but the 1971 International Standards suggested that pesticide
residues that may occur in community water supplies make only a minimal con-
tribution to the total daily intake of pesticides for the population served. 1,2-
Dibromoethane was not evaluated in the rst edition of the Guidelines for Drinking-
water Quality, published in 1984, but the 1993 Guidelines noted that 1,2-
dibromoethane appears to be a genotoxic carcinogen. However, as the studies to date
were inadequate for mathematical risk extrapolation, a guideline value for 1,2-
dibromoethane was not derived. The Guidelines recommended that 1,2-dibro-
moethane be re-evaluated as soon as new data became available. In the addendum to
these Guidelines, published in 1998, the guideline value that corresponds to an upper-
bound excess lifetime cancer risk for various tumour types of 10-5 was calculated to
be in the range 0.00040.015 mg/litre. This guideline value was considered to be pro-
visional because of the serious limitations of the critical studies.
348
Assessment date
IPCS (1995) Report of the 1994 meeting of the Core Assessment Group. Geneva, World
Health Organization, International Programme on Chemical Safety, Joint Meeting
on Pesticides (WHO/PCS/95.7).
IPCS (1996) 1,2-Dibromoethane. Geneva, World Health Organization, International
WHO (2003) 1,2-Dibromoethane in drinking-water. Background document for prepa-
12.41 Dichloroacetic acid

Chlorinated acetic acids are formed from organic material during water chlorination.

value The guideline value is designated as provisional because the data are
insufcient to ensure that the value is technically achievable.
Difculties in meeting a guideline value must never be a reason to
compromise adequate disinfection.
Occurrence Found in nished chlorinated water at concentrations up to about 100
mg/litre, but in most cases at concentrations less than 50 mg/litre
TDI 7.6 mg/kg of body weight, based on a study in which no effects were
seen in the livers of mice exposed to dichloroacetate at 7.6 mg/kg of
body weight per day for 75 weeks and incorporating an uncertainty
factor of 1000 (100 for intra- and interspecies variation and 10 for
possible carcinogenicity)
Limit of detection 1 mg/litre by GC with ECD; 2 mg/litre by GC/MS
Treatment achievability Concentrations may be reduced by installing or optimizing
coagulation to remove precursors and/or by controlling the pH during
chlorination.
weight 60-kg adult
In several bioassays, dichloroacetate has been shown to induce hepatic tumours in
mice. However, the evidence for the carcinogenicity of dichloroacetate is insufcient
to derive a guideline value based on carcinogenicity. No adequate data on genotoxic-
ity are available.
349

refer to dichloroacetic acid. In the 1993 Guidelines, a provisional guideline value of
0.05 mg/litre was derived for dichloroacetic acid; the guideline value was designated
as provisional because the data were insufcient to ensure that the value was techni-
cally achievable.
Assessment date
Principal reference
WHO (2003) Dichloroacetic acid in drinking-water. Background document for prepa-
12.42 Dichlorobenzenes (1,2-dichlorobenzene, 1,3-dichlorobenzene,

1,4-dichlorobenzene)
The dichlorobenzenes (DCBs) are widely used in industry and in domestic products
such as odour-masking agents, chemical dyestuffs and pesticides. Sources of human
exposure are predominantly air and food.
Guideline values
1,2-Dichlorobenzene 1 mg/litre
1,4-Dichlorobenzene 0.3 mg/litre
Occurrence Have been found in raw water sources at levels as high as 10 mg/litre
and in drinking-water at concentrations up to 3 mg/litre; much higher
concentrations (up to 7 mg/litre) present in contaminated
groundwater
TDIs
1,2-Dichlorobenzene 429 mg/kg of body weight, based on a NOAEL of 60 mg/kg of body
weight per day for tubular degeneration of the kidney identied in a
2-year mouse gavage study, correcting for 5 days per week dosing and
using an uncertainty factor of 100 (for inter- and intraspecies
variation)
1,4-Dichlorobenzene 107 mg/kg of body weight, based on a LOAEL of 150 mg/kg of body
weight per day for kidney effects identied in a 2-year rat study,
correcting for 5 days per week dosing and using an uncertainty factor
of 1000 (100 for inter- and intraspecies variation and 10 for the use of
a LOAEL instead of a NOAEL and the carcinogenicity end-point)
350
Limit of detection 0.010.25 mg/litre by gasliquid chromatography with ECD; 3.5 mg/litre
by GC using a photoionization detector
weight 60-kg adult
Additional comments Guideline values for both 1,2- and 1,4-DCB far exceed their lowest
reported taste thresholds in water of 1 and 6 mg/litre, respectively.
1,2-Dichlorobenzene
1,2-DCB is of low acute toxicity by the oral route of exposure. Oral exposure to high
doses of 1,2-DCB affects mainly the liver and kidneys. The balance of evidence sug-
gests that 1,2-DCB is not genotoxic, and there is no evidence for its carcinogenicity
in rodents.
1,3-Dichlorobenzene
There are insufcient toxicological data on this compound to permit a guideline value
to be proposed, but it should be noted that it is rarely found in drinking-water.
1,4-Dichlorobenzene
1,4-DCB is of low acute toxicity, but there is evidence that it increases the incidence
of renal tumours in rats and of hepatocellular adenomas and carcinomas in mice after
long-term exposure. IARC has placed 1,4-DCB in Group 2B. 1,4-DCB is not consid-
ered to be genotoxic, and the relevance for humans of the tumours observed in
animals is doubtful.

refer to DCBs. In the rst edition of the Guidelines for Drinking-water Quality, pub-
lished in 1984, no guideline value was recommended for 1,2- or 1,4-DCB after a
detailed evaluation of the compounds. Toxicological limits for drinking-water of
0.0050.05 mg/litre were derived based on an ADI; given that the threshold odour
concentrations are 0.003 mg/litre for 1,2-DCB and 0.001 mg/litre for 1,4-DCB, 10%
of each of these values was recommended as a level unlikely to give rise to taste and
odour problems in drinking-water supplies. The 1993 Guidelines calculated a health-
based guideline value of 1 mg/litre for 1,2-DCB, which far exceeds the lowest reported
taste threshold of 1,2-DCB in water (0.001 mg/litre). There were insufcient toxico-
logical data on 1,3-DCB to permit a guideline value to be proposed, but the 1993
Guidelines noted that it is rarely found in drinking-water. A health-based guideline
value of 0.3 mg/litre was proposed for 1,4-DCB, which far exceeds the lowest reported
odour threshold of 1,4-DCB in water (0.0003 mg/litre).
351
Assessment date
Principal reference
WHO (2003) Dichlorobenzenes in drinking-water. Background document for prepara-
12.43 1,1-Dichloroethane
1,1-Dichloroethane is used as a chemical intermediate and solvent. There are limited
data showing that it can be present at concentrations of up to 10 mg/litre in drinking-
water. However, because of the widespread use and disposal of this chemical, its occur-
rence in groundwater may increase.
1,1-Dichloroethane is rapidly metabolized by mammals to acetic acid and a variety
of chlorinated compounds. It is of relatively low acute toxicity, and limited data are
available on its toxicity from short- and long-term studies. There is limited in vitro
evidence of genotoxicity. One carcinogenicity study by gavage in mice and rats pro-
vided no conclusive evidence of carcinogenicity, although there was some evidence of
an increased incidence of haemangiosarcomas in treated animals.
In view of the very limited database on toxicity and carcinogenicity, it was con-
cluded that no guideline value should be proposed.

The 1958, 1963 and 1971 WHO International Standards for Drinking-water and
the rst edition of the Guidelines for Drinking-water Quality, published in 1984, did
not refer to 1,1-dichloroethane. In view of the very limited database on toxicity and
carcinogenicity, the 1993 Guidelines concluded that no guideline value for 1,1-
dichloroethane should be proposed.
Assessment date
Principal reference
WHO (2003) 1,1-Dichloroethane in drinking-water. Background document for prepa-
352
12.44 1,2-Dichloroethane
1,2-Dichloroethane is used mainly as an intermediate in the production of vinyl chlo-
ride and other chemicals and to a lesser extent as a solvent. It may enter surface waters
via efuents from industries that manufacture or use the substance. It may also enter
groundwater, where it may persist for long periods, following disposal in waste sites.
It is found in urban air.

Occurrence Has been found in drinking-water at levels of up to a few micrograms
per litre
Basis of guideline Applying the linearized multistage model to haemangiosarcomas
derivation observed in male rats in a 78-week gavage study
Limit of detection 0.062.8 mg/litre by GC/MS; 0.030.2 mg/litre by GC with electrolytic
conductivity detector; 5 mg/litre by GC with FID; 0.03 mg/litre by GC
with photoionization detection
Additional The guideline value of 0.030 mg/litre is consistent with the value
considerations derived from IPCS (1998), based on a 10-5 risk level.
IARC has classied 1,2-dichloroethane in Group 2B (possible human carcinogen). It
has been shown to produce statistically signicant increases in a number of tumour
types in laboratory animals, including the relatively rare haemangiosarcoma, and
the balance of evidence indicates that it is potentially genotoxic. Targets of 1,2-
dichloroethane toxicity in orally exposed animals included the immune system,
central nervous system, liver and kidney. Data indicate that 1,2-dichloroethane is less
potent when inhaled.

refer to 1,2-dichloroethane. In the rst edition of the Guidelines for Drinking-water
Quality, published in 1984, a health-based guideline value of 0.01 mg/litre was rec-
ommended for 1,2-dichloroethane, while noting that the mathematical model appro-
priate to chemical carcinogens that was used in its derivation involved considerable
uncertainty. The 1993 Guidelines calculated a guideline value of 0.03 mg/litre for 1,2-
dichloroethane on the basis of haemangiosarcomas observed in male rats, corre-
sponding to an upper-bound excess lifetime cancer risk of 10-5.
Assessment date
353
IPCS (1995) 1,2-Dichloroethane, 2nd ed. Geneva, World Health Organization, Inter-
national Programme on Chemical Safety (Environmental Health Criteria 176).
IPCS (1998) 1,2-Dichloroethane. Geneva, World Health Organization, International
Programme on Chemical Safety (Concise International Chemical Assessment
Document 1).
WHO (2003) 1,2-Dichloroethane in drinking-water. Background document for prepa-
12.45 1,1-Dichloroethene
1,1-Dichloroethene, or vinylidene chloride, is used mainly as a monomer in the pro-
duction of polyvinylidene chloride co-polymers and as an intermediate in the syn-
thesis of other organic chemicals. It is an occasional contaminant of drinking-water,
usually being found together with other chlorinated hydrocarbons. There are no data
on levels in food, but levels in air are generally less than 40 ng/m3 except at some man-
ufacturing sites.

Occurrence Detected in nished drinking-water taken from groundwater sources
at median concentrations of 0.281.2 mg/litre and in public drinking-
water supplies at concentrations ranging from 0.2 to 0.5 mg/litre
TDI 9 mg/kg of body weight, based on a LOAEL (for increased incidence of
hepatic lesions in females) of 9 mg/kg of body weight per day in a 2-
year drinking-water study in rats, using an uncertainty factor of 1000
(100 for intra- and interspecies variation and 10 for the use of a LOAEL
instead of a NOAEL and the potential for carcinogenicity)
Limit of detection 0.025 mg/litre by capillary GC with ECD; 0.07 mg/litre by purge-and-trap
packed column GC with ECD or microcoulometric detector; 4.7 mg/litre
by purge-and-trap packed column GC/MS
weight 60-kg adult
1,1-Dichloroethene is a central nervous system depressant and may cause liver and
kidney toxicity in occupationally exposed humans. It causes liver and kidney damage
in laboratory animals. IARC has placed 1,1-dichloroethene in Group 3. It was found
to be genotoxic in a number of test systems in vitro but was not active in the domi-
nant lethal and micronucleus assays in vivo. It induced kidney tumours in mice in one
inhalation study but was reported not to be carcinogenic in a number of other studies,
including several in which it was given in drinking-water.
354

refer to 1,1-dichloroethene. In the rst edition of the Guidelines for Drinking-water
Quality, published in 1984, a health-based guideline value of 0.0003 mg/litre was rec-
ommended for 1,1-dichloroethene, while noting that the mathematical model appro-
priate to chemical carcinogens that was used in its derivation involved considerable
uncertainty. A health-based guideline value of 0.03 mg/litre for 1,1-dichloroethene
was recommended in the 1993 Guidelines.
Assessment date
Principal reference
WHO (2003) 1,1-Dichloroethene in drinking-water. Background document for prepa-
12.46 1,2-Dichloroethene
1,2-Dichloroethene exists in a cis and a trans form. The cis form is more frequently
found as a water contaminant. The presence of these two isomers, which are metabo-
lites of other unsaturated halogenated hydrocarbons in wastewater and anaerobic
groundwater, may indicate the simultaneous presence of more toxic organochlorine
chemicals, such as vinyl chloride. Accordingly, their presence indicates that more
intensive monitoring should be conducted. There are no data on exposure from
food. Concentrations in air are low, with higher concentrations, in the microgram per
cubic metre range, near production sites. The cis isomer was previously used as an
anaesthetic.

Occurrence Has been found in drinking-water supplies derived from groundwater
at levels up to 120 mg/litre
TDI 17 mg/kg of body weight, based on a NOAEL (for increases in serum
alkaline phosphatase levels and increased thymus weight) of 17
mg/kg of body weight from a 90-day study in mice administered
trans-1,2-dichloroethene in drinking-water, using an uncertainty factor
of 1000 (100 for inter- and intraspecies variation and 10 for the short
duration of the study)
Limit of detection 0.17 mg/litre by GC with MS
355
weight 60-kg adult
Additional comments Data on the trans isomer were used to calculate a joint guideline value
for both isomers because toxicity for the trans isomer occurred at a
lower dose than for the cis isomer and because data suggest that the
mouse is a more sensitive species than the rat.
There is little information on the absorption, distribution and excretion of 1,2-
dichloroethene. However, by analogy with 1,1-dichloroethene, it would be expected
to be readily absorbed, distributed mainly to the liver, kidneys and lungs and rapidly
excreted. The cis isomer is more rapidly metabolized than the trans isomer in in vitro
systems. Both isomers have been reported to cause increased serum alkaline phos-
phatase levels in rodents. In a 3-month study in mice given the trans isomer in drink-
ing-water, there was a reported increase in serum alkaline phosphatase and reduced
thymus and lung weights. Transient immunological effects were also reported, the tox-
icological signicance of which is unclear. Trans-1,2-dichloroethene also caused
reduced kidney weights in rats, but at higher doses. Only one rat toxicity study is avail-
able for the cis isomer, which produced toxic effects in rats similar in magnitude to
those induced by the trans isomer in mice, but at higher doses. There are limited data
to suggest that both isomers may possess some genotoxic activity. There is no infor-
mation on carcinogenicity.

refer to 1,2-dichloroethene. In the rst edition of the Guidelines for Drinking-water
Quality, published in 1984, no guideline value was recommended after a detailed
evaluation of the compound. In the 1993 Guidelines, a joint guideline value of
0.05 mg/litre was calculated for both 1,2-dichloroethene isomers using toxicity data
on the trans isomer.
Assessment date
Principal reference
WHO (2003) 1,2-Dichloroethene in drinking-water. Background document for prepa-
356
12.47 Dichloromethane
Dichloromethane, or methylene chloride, is widely used as a solvent for many pur-
poses, including coffee decaffeination and paint stripping. Exposure from drinking-
water is likely to be insignicant compared with that from other sources.

Occurrence Dichloromethane has been found in surface water samples at
concentrations ranging from 0.1 to 743 mg/litre. Levels are usually
higher in groundwater because volatilization is restricted;
concentrations as high as 3600 mg/litre have been reported. Mean
concentrations in drinking-water were less than 1 mg/litre.
TDI 6 mg/kg of body weight, derived from a NOAEL of 6 mg/kg of body
weight per day for hepatotoxic effects in a 2-year drinking-water study
in rats, using an uncertainty factor of 1000 (100 for inter- and
intraspecies variation and 10 for concern about carcinogenic
potential)
Limit of detection 0.3 mg/litre by purge-and-trap GC with MS detection (note that
dichloromethane vapour readily penetrates tubing during the
procedure)
Treatment achievability 20 mg/litre should be achievable using air stripping
weight 60-kg adult
Dichloromethane is of low acute toxicity. An inhalation study in mice provided con-
clusive evidence of carcinogenicity, whereas drinking-water studies in rats and mice
provided only suggestive evidence. IARC has placed dichloromethane in Group 2B;
however, the balance of evidence suggests that it is not a genotoxic carcinogen and
that genotoxic metabolites are not formed in relevant amounts in vivo.

refer to dichloromethane. In the rst edition of the Guidelines for Drinking-water
Quality, published in 1984, no guideline value was recommended after a detailed eval-
uation of the compound. The 1993 Guidelines established a health-based guideline
value of 0.02 mg/litre for dichloromethane, noting that widespread exposure from
other sources is possible.
Assessment date
357
Principal reference
WHO (2003) Dichloromethane in drinking-water. Background document for prepara-
12.48 1,2-Dichloropropane (1,2-DCP)

1,2-Dichloropropane (CAS No. 78-87-5) is used as an insecticide fumigant on grain
and soil and to control peach tree borers. It is also used as an intermediate in the pro-
duction of perchloroethylene and other chlorinated products and as a solvent. 1,2-
DCP is relatively resistant to hydrolysis, is poorly adsorbed onto soil and can migrate
into groundwater.

value The guideline value is provisional owing to limitations of the
toxicological database.
Occurrence Detected in groundwater and drinking-water, usually at
concentrations below 20 mg/litre, although levels as high as 440
mg/litre have been measured in well water
TDI 14 mg/kg of body weight based on a LOAEL of 71.4 mg/kg of body
weight per day (100 mg/kg of body weight per day corrected for 5
days per week dosing) for changes in haematological parameters in a
13-week study in male rats, with an uncertainty factor of 5000 (100 for
inter- and intraspecies variation, 10 for use of a LOAEL and 5 to reect
limitations of the database, including the limited data on in vivo
genotoxicity and use of a subchronic study)
Limit of detection 0.02 mg/litre by a purge-and-trap GC method with an electrolytic
conductivity detector or GC/MS
weight 60-kg adult
1,2-DCP was evaluated by IARC in 1986 and 1987. The substance was classied in
Group 3 (not classiable as to its carcinogenicity to humans) on the basis of limited
evidence for its carcinogenicity in experimental animals and insufcient data with
which to evaluate its carcinogenicity in humans. Results from in vitro assays for muta-
genicity were mixed. The in vivo studies, which were limited in number and design,
were negative. In accordance with the IARC evaluation, the evidence from the long-
term carcinogenicity studies in mice and rats was considered limited, and it was con-
cluded that the use of a threshold approach for the toxicological evaluation of
1,2-DCP was appropriate.
358

1,2-DCP, but the 1971 International Standards suggested that pesticide residues that
total daily intake of pesticides for the population served. 1,2-DCP was not evaluated
but the 1993 Guidelines proposed a provisional health-based guideline value of
0.02 mg/litre for 1,2-DCP in drinking-water. The value was provisional because an
uncertainty factor of 10 000 was used in its derivation. This guideline value was
amended to 0.04 mg/litre in the addendum to these Guidelines, published in 1998,
using a lower uncertainty factor. This guideline value was considered to be provisional
owing to the magnitude of the uncertainty factor and the fact that the database had
not changed since the previous guideline value had been derived.
Assessment date
Principal reference
WHO (2003) 1,2-Dichloropropane (1,2-DCP) in drinking-water. Background document
for preparation of WHO Guidelines for drinking-water quality. Geneva, World Health
12.49 1,3-Dichloropropane
1,3-Dichloropropane (CAS No. 142-28-9) has several industrial uses and may be
found as a contaminant of soil fumigants containing 1,3-dichloropropene. It is rarely
found in water.
1,3-Dichloropropane is of low acute toxicity. There is some indication that it may
be genotoxic in bacterial systems. No short-term, long-term, reproductive or devel-
opmental toxicity data pertinent to exposure via drinking-water could be located in
the literature. The available data are considered insufcient to permit recommenda-
tion of a guideline value.

1,3-dichloropropane, but the 1971 International Standards suggested that pesticide
bution to the total daily intake of pesticides for the population served. 1,3-Dichloro-
propane was not evaluated in the rst edition of the Guidelines for Drinking-water
Quality, published in 1984, but the 1993 Guidelines concluded that the available data
359
were insufcient to permit recommendation of a guideline value for 1,3-dichloro-

propane in drinking-water.
Assessment date
Principal reference
WHO (2003) 1,3-Dichloropropane in drinking-water. Background document for prepa-
12.50 1,3-Dichloropropene
1,3-Dichloropropene (CAS Nos. 542-75-6 isomer mixture; 10061-01-5 cis isomer;
10061-02-6 trans isomer) is a soil fumigant, the commercial product being a mixture
of cis and trans isomers. It is used to control a wide variety of soil pests, particularly
nematodes in sandy soils. Notwithstanding its high vapour pressure, it is soluble in
water at the gram per litre level and can be considered a potential water contaminant.

Occurrence Has been found in surface water and groundwater at concentrations
of a few micrograms per litre
Basis of guideline Calculated by applying the linearized multistage model to the
derivation observation of lung and bladder tumours in female mice in a 2-year
gavage study
Limit of detection 0.34 and 0.20 mg/litre by purge-and-trap packed column GC using an
electrolytic conductivity detector or microcoulometric detector for cis-
1,3-dichloropropene and trans-1,3- dichloropropene, respectively
Treatment achievability No information found on removal from water
1,3-Dichloropropene is a direct-acting mutagen that has been shown to produce
forestomach tumours following long-term oral gavage exposure in rats and mice.
Tumours have also been found in the bladder and lungs of female mice and the liver
of male rats. Long-term inhalation studies in the rat have proved negative, whereas
some benign lung tumours have been reported in inhalation studies in mice. IARC
has classied 1,3-dichloropropene in Group 2B (possible human carcinogen).

1,3-dichloropropene, but the 1971 International Standards suggested that pesticide
360
bution to the total daily intake of pesticides for the population served. 1,3-Dichloro-
propene was not evaluated in the rst edition of the Guidelines for Drinking-water
Quality, published in 1984, but the 1993 Guidelines calculated a guideline value of
0.02 mg/litre for 1,3-dichloropropene in drinking-water, corresponding to an upper-
bound excess lifetime cancer risk of 10-5.
Assessment date
Principal reference
WHO (2003) 1,3-Dichloropropene in drinking-water. Background document for prepa-
12.51 Dichlorprop (2,4-DP)

The half-lives for degradation of chlorophenoxy herbicides, including dichlorprop
(CAS No. 120-36-5), in the environment are in the order of several days. Chlorophe-
noxy herbicides are not often found in food.

TDI 36.4 mg/kg of body weight, based on a NOAEL for renal toxicity in a
2-year study in rats of 100 mg/kg of diet, equal to 3.64 mg/kg of body
weight per day, applying an uncertainty factor of 100 (for intra- and
interspecies variation)
Limit of detection 1 mg/litre to 1 mg/litre for various methods commonly used for the
determination of chlorophenoxy herbicides in water, including solvent
extraction, separation by GC, gasliquid chromatography, thin-layer
chromatography or HPLC, with ECD or UV detection
Treatment achievability No data available
weight 60-kg adult
361

on a threshold approach for other toxic effects. In dietary studies in rats, slight liver
hypertrophy was observed in a 3-month study, and effects in a 2-year study included
hepatocellular swelling, mild anaemia, increased incidence of brown pigment in the
kidneys (possibly indicative of slight degeneration of the tubular epithelium) and
decreased urinary specic gravity and protein.

chlorophenoxy herbicides, including dichlorprop, but the 1971 International Stan-
dards suggested that pesticide residues that may occur in community water supplies
make only a minimal contribution to the total daily intake of pesticides for the
population served. Dichlorprop was not evaluated in the rst edition of the Guide-
lines for Drinking-water Quality, published in 1984, but the 1993 Guidelines estab-
lished a health-based guideline value of 0.1 mg/litre for dichlorprop.
Assessment date
Principal reference
12.52 Di(2-ethylhexyl)adipate
Di(2-ethylhexyl)adipate (DEHA) is used mainly as a plasticizer for synthetic resins
such as PVC. Reports of the presence of DEHA in surface water and drinking-water
are scarce, but DEHA has occasionally been identied in drinking-water at levels of a
few micrograms per litre. As a consequence of its use in PVC lms, food is the most
important source of human exposure (up to 20 mg/day).
DEHA is of low short-term toxicity; however, dietary levels above 6000 mg/kg of
feed induce peroxisomal proliferation in the liver of rodents. This effect is often asso-
ciated with the development of liver tumours. DEHA induced liver carcinomas in
female mice at very high doses but not in male mice or rats. It is not genotoxic. IARC
has placed DEHA in Group 3.
A health-based value of 80 mg/litre can be calculated for DEHA on the basis of a
TDI of 280 mg/kg of body weight, based on fetotoxicity in rats, and allocating 1% of
the TDI to drinking-water. However, because DEHA occurs at concentrations well
362
below those at which toxic effects are observed, it is not considered necessary to derive
a health-based guideline value.

refer to DEHA. The 1993 Guidelines proposed a health-based guideline value of 0.08
mg/litre for DEHA in drinking-water.
Assessment date
Principal reference
WHO (2003) Di(2-ethylhexyl)adipate in drinking-water. Background document for
12.53 Di(2-ethylhexyl)phthalate
Di(2-ethylhexyl)phthalate (DEHP) is used primarily as a plasticizer. Exposure among
individuals may vary considerably because of the broad nature of products into which
DEHP is incorporated. In general, food will be the main exposure route.

Occurrence Found in surface water, groundwater and drinking-water in
concentrations of a few micrograms per litre; in polluted surface water
and groundwater, concentrations of hundreds of micrograms per litre
have been reported
weight per day for peroxisomal proliferation in the liver in rats, using
an uncertainty factor of 100 for inter- and Intraspecies variation
weight 60-kg adult
Additional comments The reliability of some data on environmental water samples is
questionable because of secondary contamination during sampling
and working-up procedures. Concentrations that exceed the solubility
more than 10-fold have been reported.
In rats, DEHP is readily absorbed from the gastrointestinal tract. In primates (includ-
ing humans), absorption after ingestion is lower. Species differences are also observed
363
in the metabolic prole. Most species excrete primarily the conjugated mono-ester in
urine. Rats, however, predominantly excrete terminal oxidation products. DEHP is
widely distributed in the body, with highest levels in liver and adipose tissue, without
showing signicant accumulation. The acute oral toxicity is low. The most striking
effect in short-term toxicity studies is the proliferation of hepatic peroxisomes, indi-
cated by increased peroxisomal enzyme activity and histopathological changes. The
available information suggests that primates, including humans, are far less sensitive
to this effect than rodents. In long-term oral carcinogenicity studies, hepatocellular
carcinomas were found in rats and mice. IARC has concluded that DEHP is possibly
carcinogenic to humans (Group 2B). In 1988, JECFA evaluated DEHP and recom-
mended that human exposure to this compound in food be reduced to the lowest level
attainable. The Committee considered that this might be achieved by using alterna-
tive plasticizers or alternatives to plastic material containing DEHP. In a variety of in
vitro and in vivo studies, DEHP and its metabolites have shown no evidence of geno-
toxicity, with the exception of induction of aneuploidy and cell transformation.

refer to DEHP. The 1993 Guidelines established a health-based guideline value of
0.008 mg/litre for DEHP in drinking-water.
Assessment date
Principal reference
WHO (2003) Di(2-ethylhexyl)phthalate in drinking-water. Background document for
12.54 Dimethoate
Dimethoate (CAS No. 60-51-5) is an organophosphorus insecticide used to control a
broad range of insects in agriculture, as well as the housey. It has a half-life of 18 h
to 8 weeks and is not expected to persist in water, although it is relatively stable at pH
27. A total daily intake from food of 0.001 mg/kg of body weight has been estimated.
364

Occurrence Detected at trace levels in a private well in Canada, but not detected
in a Canadian survey of surface water or drinking- water supplies
ADI 0.002 mg/kg of body weight based on an apparent NOAEL of
1.2 mg/kg of body weight per day for reproductive performance in a
study of reproductive toxicity in rats, applying an uncertainty factor of
500 to take into consideration concern regarding whether this could
be a LOAEL
Treatment achievability 1 mg/litre should be achievable using GAC and chlorination
weight 60-kg adult
In studies with human volunteers, dimethoate has been shown to be a cholinesterase
inhibitor and a skin irritant. Dimethoate is not carcinogenic to rodents. JMPR con-
cluded that although in vitro studies indicate that dimethoate has mutagenic poten-
tial, this potential does not appear to be expressed in vivo. In a multigeneration study
of reproductive toxicity in rats, the NOAEL appeared to be 1.2 mg/kg of body weight
per day, but there was some indication that reproductive performance may have been
affected at lower doses. No data were available to assess whether the effects on repro-
ductive performance were secondary to inhibition of cholinesterase. JMPR concluded
that it was not appropriate to base the ADI on the results of the studies of volunteers,
since the crucial end-point (reproductive performance) has not been assessed in
humans. It was suggested that there may be a need to re-evaluate the toxicity of
dimethoate after the periodic review of the residue and analytical aspects of
dimethoate has been completed if it is determined that omethoate is a major residue.

dimethoate, but the 1971 International Standards suggested that pesticide residues
the total daily intake of pesticides for the population served. Dimethoate was not eval-
uated in the rst edition of the Guidelines for Drinking-water Quality, published in
1984, in the second edition, published in 1993, or in the addendum to the second
Assessment date
365
WHO (2003) Dimethoate in drinking-water. Background document for preparation of
WHO Guidelines for drinking-water quality. Geneva, 1World Health Organization
(WHO/SDE/WSH/03.04/90).
12.55 Diquat
Diquat (CAS No. 2764-72-9) is a non-selective contact herbicide and crop desiccant.
Diquat may also be used (at or below 1 mg/litre) as an aquatic herbicide for the control
of free-oating and submerged aquatic weeds in ponds, lakes and irrigation ditches.
Because of its rapid degradation in water and strong adsorption onto sediments,
diquat has rarely been found in drinking-water.
Diquat does not appear to be carcinogenic or genotoxic. The main toxicological
nding in experimental animals is cataract formation. A health-based value of
6 mg/litre for diquat ion can be calculated on the basis of an ADI of 0.002 mg of diquat
ion per kg of body weight, based on cataract formation at the next higher dose in a
2-year study in rats. However, because diquat has rarely been found in drinking-water,
it is not considered necessary to derive a guideline value. It should also be noted that
the limit of detection of diquat in water is 0.001 mg/litre, and its practical quantica-
tion limit is about 0.01 mg/litre.

diquat, but the 1971 International Standards suggested that pesticide residues that
total daily intake of pesticides for the population served. Diquat was not evaluated in
the rst two editions of the Guidelines for Drinking-water Quality, published in 1984
and 1993. In the addendum to the second edition of these Guidelines, published in
1998, a health-based value of 0.006 mg/litre was calculated for the diquat ion using
the ADI established by JMPR in 1993. However, the limit of detection of diquat in
water is 0.001 mg/litre, and its practical quantication limit is about 0.01 mg/litre. A
provisional guideline value of 0.01 mg/litre was therefore established for diquation.
Assessment date
366
WHO (2003) Diquat in drinking-water. Background document for preparation of

(WHO/SDE/WSH/03.04/91).
12.56 Edetic acid (EDTA)

Human exposure to EDTA arises directly from its use in food additives, medicines,
and personal care and hygiene products. Exposure to EDTA from drinking-water is
probably very small in comparison with that from other sources. Once EDTA is
present in the aquatic environment, its speciation will depend on the water quality
and the presence of trace metals with which it will combine. The removal of EDTA
from communal wastewater by biodegradation in sewage purication plants is very
limited.
Guideline value 0.6 mg/litre (for EDTA as the free acid)

Occurrence Present in surface waters generally at concentrations below
70 mg/litre, although higher concentrations (900 mg/litre) have been
measured; detected in drinking-water prepared from surface waters at
concentrations of 1030 mg/litre
ADI 1.9 mg/kg of body weight as the free acid (ADI of 2.5 mg/kg of body
weight proposed by JECFA for calcium disodium edetate as a food
additive)
Limit of detection 1 mg/litre by potentiometric stripping analyis
Treatment achievability 0.01 mg/litre using GAC plus ozonation
weight 60-kg adult
Additional comments Concern has been expressed over the ability of EDTA to complex, and
therefore reduce the availability of, zinc. However, this is of signicance
only at elevated doses substantially in excess of those encountered in
the environment.
Calcium disodium edetate is poorly absorbed from the gut. The long-term toxicity of
EDTA is complicated by its ability to chelate essential and toxic metals. Those toxi-
cological studies that are available indicate that the apparent toxicological effects of
EDTA have in fact been due to zinc deciency as a consequence of complexation.
EDTA does not appear to be teratogenic or carcinogenic in animals. The vast clinical
experience of the use of EDTA in the treatment of metal poisoning has demonstrated
its safety in humans.

367
refer to edetic acid. The 1993 Guidelines proposed a provisional health-based guide-
line value of 0.2 mg/litre for edetic acid, based on an ADI for calcium disodium edetate
as a food additive proposed by JECFA in 1973 and assuming that a 10-kg child con-
sumes 1 litre of water per day, in view of the possibility of zinc complexation. The
value was considered provisional to reect the fact that the JECFA ADI had not been
considered since 1973. JECFA further evaluated the toxicological studies available on
EDTA in 1993 and was unable to add any further important information regarding
the toxicity of EDTA and its calcium and sodium salts to the 1973 evaluation. In the
addendum to the second edition of the Guidelines, published in 1998, a guideline
value of 0.6 mg/litre was derived for EDTA (free acid), using different assumptions
from those used in the derivation of the provisional guideline value in the 1993 Guide-
lines. In particular, it was noted that the ability of EDTA to complex, and therefore
reduce the availability of, zinc was of signicance only at elevated doses substantially
in excess of those encountered in the environment.
Assessment date
Principal reference
WHO (2003) Edetic acid (EDTA) in drinking-water. Background document for prepa-
12.57 Endosulfan
Endosulfan (CAS No. 115-29-7) is an insecticide used in countries throughout the
world to control pests on fruit, vegetables and tea and on non-food crops such as
tobacco and cotton. In addition to its agricultural use, it is used in the control of the
tsetse y, as a wood preservative and for the control of home garden pests. Endosul-
fan contamination does not appear to be widespread in the aquatic environment, but
the chemical has been found in agricultural runoff and rivers in industrialized areas
where it is manufactured or formulated, as well as in surface water and groundwater
samples collected from hazardous waste sites in the USA. Surface water samples in the
USA generally contain less than 1 mg/litre. The main source of exposure of the general
population is food, but residues have generally been found to be well below the
FAO/WHO maximum residue limits. Another important route of exposure to endo-
sulfan for the general population is the use of tobacco products.
JMPR concluded that endosulfan is not genotoxic, and no carcinogenic effects were
noted in long-term studies using mice and rats. The kidney is the target organ for tox-
icity. Several recent studies have shown that endosulfan, alone or in combination with
other pesticides, may bind to estrogen receptors and perturb the endocrine system. A
368
health-based value of 20 mg/litre can be calculated for endosulfan on the basis of an

ADI of 0.006 mg/kg of body weight, based on results from a 2-year dietary study of
toxicity in rats, and supported by a 78-week study in mice, a 1-year study in dogs and
a developmental toxicity study in rats. However, because endosulfan occurs at con-
centrations well below those at which toxic effects are observed, it is not considered
necessary to derive a guideline value.

endosulfan, but the 1971 International Standards suggested that pesticide residues that
total daily intake of pesticides for the population served. Endosulfan was not evalu-
ated in the rst edition of the Guidelines for Drinking-water Quality, published in 1984,
in the second edition, published in 1993, or in the addendum to the second edition,
published in 1998.
Assessment date
WHO (2003) Endosulfan in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/92).
12.58 Endrin
Endrin (CAS No. 72-20-8) is a broad-spectrum foliar insecticide that acts against a
wide range of agricultural pests. It is also used as a rodenticide. Small amounts of
endrin are present in food, but the total intake from food appears to be decreasing.

Occurrence Traces of endrin found in the drinking-water supplies of several
countries
PTDI 0.0002 mg/kg of body weight, based on a NOAEL of 0.025 mg/kg of
body weight per day in a 2-year study in dogs and applying an
uncertainty factor of 100
Limit of detection 0.002 mg/litre by GC with ECD
369
weight 60-kg adult
Additional comments Endrin is listed under the Stockholm Convention on Persistent Organic
Pollutants. Hence, monitoring may occur in addition to that required
by drinking-water guidelines.
Toxicological data are insufcient to indicate whether endrin is a carcinogenic hazard
to humans. The primary site of action of endrin is the central nervous system.

endrin, but the 1971 International Standards suggested that pesticide residues that
total daily intake of pesticides for the population served. Endrin was not evaluated in
the rst edition of the Guidelines for Drinking-water Quality, published in 1984, in the
second edition, published in 1993, or in the addendum to the second edition, pub-
lished in 1998.
Assessment date
Paper 127).
IPCS (1992) Endrin. Geneva, World Health Organization, International Programme
WHO (2003) Endrin in drinking-water. Background document for preparation of WHO
(WHO/SDE/WSH/03.04/93).
12.59 Epichlorohydrin
Epichlorohydrin is used for the manufacture of glycerol, unmodied epoxy resins and
water treatment resins. No quantitative data are available on its occurrence in food or
drinking-water. Epichlorohydrin is hydrolysed in aqueous media.
370
Provisional guideline 0.0004 mg/litre (0.4 mg/litre)

value The guideline value is considered to be provisional because of the
uncertainties surrounding the toxicity of epichlorohydrin and the use
of a large uncertainty factor in deriving the guideline value.
Occurrence No quantitative data available
TDI 0.14 mg/kg of body weight, on the basis of a LOAEL of 2 mg/kg of body
weight per day for forestomach hyperplasia observed in a 2-year
gavage study in rats, correcting for 5 days per week dosing and using
an uncertainty factor of 10 000 to take into consideration inter- and
intraspecies variation (100), the use of a LOAEL instead of a NOAEL (10)
and carcinogenicity (10)
Limit of detection 0.01 mg/litre by GC with ECD; 0.1 and 0.5 mg/litre by GC/MS;
0.01 mg/litre by GC with FID
Treatment achievability Conventional treatment processes do not remove epichlorohydrin.
Epichlorohydrin concentrations in drinking- water are controlled by
limiting either the epichlorohydrin content of polyamine occulants or
the dose used, or both.
weight 60-kg adult
Additional comments Although epichlorohydrin is a genotoxic carcinogen, the use of the
linearized multistage model for estimating cancer risk was considered
inappropriate because tumours are seen only at the site of
administration, where epichlorohydrin is highly irritating.
Epichlorohydrin is rapidly and extensively absorbed following oral, inhalation or
dermal exposure. It binds easily to cellular components. Major toxic effects are local
irritation and damage to the central nervous system. It induces squamous cell carci-
nomas in the nasal cavity by inhalation and forestomach tumours by the oral route.
It has been shown to be genotoxic in vitro and in vivo. IARC has placed epichlorohy-
drin in Group 2A (probably carcinogenic to humans).

refer to epichlorohydrin. The 1993 Guidelines proposed a provisional health-based
guideline value of 0.0004 mg/litre for epichlorohydrin. The value was provisional
because it was derived using an uncertainty factor of 10 000. It was noted that a prac-
tical quantication level for epichlorohydrin is of the order of 0.03 mg/litre, but con-
centrations in drinking-water can be controlled by specifying the epichlorohydrin
content of products coming into contact with it.
371
Assessment date
Principal reference
WHO (2003) Epichlorohydrin in drinking-water. Background document for preparation
(WHO/SDE/WSH/03.04/94).
12.60 Ethylbenzene
The primary sources of ethylbenzene in the environment are the petroleum industry
and the use of petroleum products. Because of its physical and chemical properties,
more than 96% of ethylbenzene in the environment can be expected to be present in
air. Values of up to 26 mg/m3 in air have been reported. Ethylbenzene is found in trace
amounts in surface water, groundwater, drinking-water and food.

Occurrence Concentrations in drinking-water are generally below 1 mg/litre; levels
up to 300 mg/litre have been reported in groundwater contaminated
by point emissions.
weight per day for hepatotoxicity and nephrotoxicity observed in a
limited 6-month study in rats, correcting for 5 days per week dosing
and using an uncertainty factor of 1000 (100 for inter- and
intraspecies variation and 10 for the limited database and short
duration of the study)
Limit of detection 0.0020.005 mg/litre by GC with photoionization detector;
0.030.06 mg/litre by GC/MS
weight 60-kg adult
Additional comments The guideline value exceeds the lowest reported odour threshold for
ethylbenzene in drinking-water (0.002 mg/litre).
Ethylbenzene is readily absorbed by oral, inhalation or dermal routes. In humans,
storage in fat has been reported. Ethylbenzene is almost completely converted to
soluble metabolites, which are excreted rapidly in urine. The acute oral toxicity is low.
No denite conclusions can be drawn from limited teratogenicity data. No data on
reproduction, long-term toxicity or carcinogenicity are available. Ethylbenzene has
shown no evidence of genotoxicity in in vitro or in in vivo systems.
372

refer to ethylbenzene. The 1993 Guidelines proposed a health-based guideline value
of 0.3 mg/litre for ethylbenzene, noting that this value exceeds the lowest reported
odour threshold for ethylbenzene in drinking-water (0.002 mg/litre).
Assessment date
Principal reference
WHO (2003) Ethylbenzene in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/26).
12.61 Fenitrothion
Fenitrothion (CAS No. 122-14-5) is mainly used in agriculture for controlling insects
on rice, cereals, fruits, vegetables, stored grains and cotton and in forest areas. It is also
used for the control of ies, mosquitos and cockroaches in public health programmes
and/or indoor use. Fenitrothion is stable in water only in the absence of sunlight or
microbial contamination. In soil, biodegradation is the primary route of degradation,
although photolysis may also play a role. Fenitrothion residues detected in water were
low (maximum 1.30 mg/litre) during the spruce budworm spray programme. Follow-
ing the spraying of forests to control spruce budworm, water samples did not contain
detectable amounts of fenitrothion; post-spray samples contained <0.01 mg/litre.
Levels of fenitrothion residues in fruits, vegetables and cereal grains decline rapidly
after treatment, with a half-life of 12 days. Intake of fenitrothion appears to be pri-
marily (95%) from food.
On the basis of testing in an adequate range of studies in vitro and in vivo, JMPR
concluded that fenitrothion is unlikely to be genotoxic. It also concluded that feni-
trothion is unlikely to pose a carcinogenic risk to humans. In long-term studies of
toxicity, inhibition of cholinesterase activity was the main toxicological nding in all
species. A health-based value of 8 mg/litre can be calculated for fenitrothion on the
basis of an ADI of 0.005 mg/kg of body weight, based on a NOAEL of 0.5 mg/kg of
body weight per day for inhibition of brain and erythrocyte cholinesterase activity in
a 2-year study of toxicity in rats and supported by a NOAEL of 0.57 mg/kg of body
weight per day for inhibition of brain and erythrocyte cholinesterase activity in a 3-
month study of ocular toxicity in rats and a NOAEL of 0.65 mg/kg of body weight per
day for reduced food consumption and body weight gain in a study of reproductive
toxicity in rats, and allocating 5% of the ADI to drinking-water. However, because
373
fenitrothion occurs at concentrations well below those at which toxic effects are
observed, it is not considered necessary to derive a guideline value.

fenitrothion, but the 1971 International Standards suggested that pesticide residues
the total daily intake of pesticides for the population served. Fenitrothion was not
Assessment date
WHO (2003) Fenitrothion in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/95).
12.62 Fenoprop (2,4,5-TP; 2,4,5-trichlorophenoxy propionic acid)

The half-lives for degradation of chlorophenoxy herbicides, including fenoprop (CAS

weight for adverse effects on the liver in a study in which beagle dogs
were administered fenoprop in the diet for 2 years, with an
uncertainty factor of 300 (100 for inter- and intraspecies variation
and 3 for limitations in the database)
Limit of detection 0.2 mg/litre by either packed or capillary column GC with ECD
Treatment achievability No data found; 0.001 mg/litre should be achievable using GAC
weight 60-kg adult
374
on a threshold approach for other toxic effects. Effects observed in long-term studies
with beagle dogs given fenoprop in the diet include mild degeneration and necrosis
of hepatocytes and broblastic proliferation in one study and severe liver pathology
in another study. In rats, increased kidney weight was observed in two long-term
dietary studies.

chlorophenoxy herbicides, including fenoprop, but the 1971 International Standards
served. Fenoprop was not evaluated in the rst edition of the Guidelines for Drinking-
guideline value of 0.009 mg/litre for fenoprop.
Assessment date
Principal reference
12.63 Fluoride
Fluoride accounts for about 0.3 g/kg of the Earths crust and exists in the form of u-
orides in a number of minerals. The most important source of uoride in drinking-
water is naturally occurring. Inorganic uoride-containing minerals are used widely
in industry for a wide range of purposes, including aluminium production. Fluorides
can be released to the environment from the phosphate-containing rock used to
produce phosphate fertilizers; these phosphate deposits contain about 4% uorine.
Fluorosilicic acid, sodium hexauorosilicate and sodium uoride are used in munic-
ipal water uoridation schemes. Daily exposure to uoride depends mainly on the
geographical area. In most circumstances, food seems to be the primary source of u-
oride intake, with lesser contributions from drinking-water and from toothpaste. In
areas with relatively high concentrations, particularly in groundwater, drinking-water
375
becomes increasingly important as a source of uoride. Intakes in areas where high-

uoride coal is used indoors may also be signicant.

Occurrence In groundwater, concentrations vary with the type of rock the water
ows through but do not usually exceed 10 mg/litre; the highest
natural level reported is 2800 mg/litre.
Basis of guideline Epidemiological evidence that concentrations above this value carry
derivation an increasing risk of dental uorosis, and progressively higher
concentrations lead to increasing risks of skeletal uorosis. The value is
higher than that recommended for articial uoridation of water
supplies, which is usually 0.51.0 mg/litre.
Limit of detection 0.01 mg/litre by ion chromatography; 0.1 mg/litre by ion- selective
electrodes or the SPADNS (sulfo phenyl azo dihydroxy naphthalene
disulfonic acid) colorimetric method
Treatment achievability 1 mg/litre should be achievable using activated alumina (not a
conventional treatment process, but relatively simple to install lters)
Additional comments A management guidance document on uoride is available.
In setting national standards for uoride or in evaluating the
possible health consequences of exposure to uoride, it is essential
to consider the intake of water by the population of interest and
the intake of uoride from other sources (e.g., from food, air and
dental preparations). Where the intakes from other sources are
likely to approach, or be greater than, 6 mg/day, it would be
appropriate to consider setting standards at a lower concentration
than the guideline value.
In areas with high natural uoride levels in drinking-water, the
guideline value may be difcult to achieve, in some circumstances,
with the treatment technology available.
Many epidemiological studies of possible adverse effects of the long-term ingestion
of uoride via drinking-water have been carried out. These studies clearly establish
that uoride primarily produces effects on skeletal tissues (bones and teeth). In many
regions with high uoride exposure, uoride is a signicant cause of morbidity. Low
concentrations provide protection against dental caries, especially in children. The
pre- and post-eruptive protective effects of uoride (involving the incorporation of
uoride into the matrix of the tooth during its formation, the development of shal-
lower tooth grooves, which are consequently less prone to decay, and surface contact
with enamel) increase with uoride concentration up to about 2 mg/litre of drinking-
water; the minimum concentration of uoride in drinking-water required to produce
it is approximately 0.5 mg/litre. However, uoride can also have an adverse effect on
tooth enamel and may give rise to mild dental uorosis at drinking-water concentra-
tions between 0.9 and 1.2 mg/litre, depending on intake. Elevated uoride intakes can
also have more serious effects on skeletal tissues. It has been concluded that there is
376
a clear excess risk of adverse skeletal effects for a total intake of 14 mg/day and sug-
gestive evidence of an increased risk of effects on the skeleton at total uoride intakes
above about 6 mg/day.

The 1958 and 1963 WHO International Standards for Drinking-water referred to u-
oride, stating that concentrations in drinking-water in excess of 1.01.5 mg of uo-
rine per litre may give rise to dental uorosis in some children, and much higher
concentrations may eventually result in skeletal damage in both children and adults.
To prevent the development of dental caries in children, a number of communal water
supplies are uoridated to bring the uorine concentration to 1.0 mg/litre. The 1971
International Standards recommended control limits for uorides in drinking-water
for various ranges of the annual average of maximum daily air temperatures; control
limits ranged from 0.60.8 mg/litre for temperatures of 26.332.6 C to 0.91.7
mg/litre for temperatures of 1012 C. In the rst edition of the Guidelines for Drink-
for uoride, as mottling of teeth has been reported very occasionally at higher levels.
It was also noted that local application of the guideline value must take into account
climatic conditions and higher levels of water intake. The 1993 Guidelines concluded
that there was no evidence to suggest that the guideline value of 1.5 mg/litre set in
1984 needed to be revised. It was also recognized that in areas with high natural u-
oride levels, the guideline value may be difcult to achieve in some circumstances with
the treatment technology available. It was also emphasized that in setting national
standards for uoride, it is particularly important to consider climatic conditions,
volume of water intake and intake of uoride from other sources.
Assessment date
IPCS (2002) Fluorides. Geneva, World Health Organization, International Programme
WHO (2003) Fluoride in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/96).
12.64 Formaldehyde
Formaldehyde occurs in industrial efuents and is emitted into air from plastic mate-
rials and resin glues. Formaldehyde in drinking-water results primarily from the oxi-
dation of natural organic matter during ozonation and chlorination. It is also found
in drinking-water as a result of release from polyacetal plastic ttings.
377

Occurrence Concentrations of up to 30 mg/litre have been found in ozonated
drinking-water.
TDI 150 mg/kg of body weight, derived from a NOAEL (for a variety of
effects, including increased relative kidney weights in females and an
increased incidence of renal papillary necrosis in both sexes) of
15 mg/kg of body weight per day in a 2-year study in rats,
incorporating an uncertainty factor of 100 (for intra- and interspecies
variation); no account was taken of potential carcinogenicity from the
inhalation of formaldehyde from various indoor water uses, such as
showering
Limit of detection 6.2 mg/litre by HPLC following derivatization with 2,4-
dinitrophenylhydrazine and liquidsolid extraction
Treatment achievability <0.03 mg/litre by process control/modication
weight 60-kg adult
Rats and mice exposed to formaldehyde by inhalation exhibited an increased inci-
dence of carcinomas of the nasal cavity at doses that caused irritation of the nasal
epithelium. Ingestion of formaldehyde in drinking-water for 2 years caused stomach
irritation in rats. Papillomas of the stomach associated with severe tissue irritation
were observed in one study. IARC has classied formaldehyde in Group 2A. The
weight of evidence indicates that formaldehyde is not carcinogenic by the oral route.

refer to formaldehyde. The 1993 Guidelines established a health-based guideline value
of 0.9 mg/litre for formaldehyde in drinking-water.
Assessment date
Principal reference
WHO (2003) Formaldehyde in drinking-water. Background document for preparation
(WHO/SDE/WSH/03.04/48).
378
12.65 Glyphosate and AMPA

Glyphosate (CAS No. 1071-83-6) is a broad-spectrum herbicide used in both agri-
culture and forestry and for aquatic weed control. Microbial biodegradation of
glyphosate occurs in soil, aquatic sediment and water, the major metabolite being
aminomethylphosphonic acid (AMPA) (CAS No. 1066-51-9). Glyphosate is chemi-
cally stable in water and is not subject to photochemical degradation. The low mobil-
ity of glyphosate in soil indicates minimal potential for the contamination of
groundwater. Glyphosate can, however, enter surface and subsurface waters after
direct use near aquatic environments or by runoff or leaching from terrestrial
applications.
Glyphosate and AMPA have similar toxicological proles, and both are considered
to exhibit low toxicity. A health-based value of 0.9 mg/litre can be derived based on
the group ADI for AMPA alone or in combination with glyphosate of 0.3 mg/kg of
body weight, based upon a NOAEL of 32 mg/kg of body weight per day, the highest
dose tested, identied in a 26-month study of toxicity in rats fed technical-grade
glyphosate and using an uncertainty factor of 100.
Because of their low toxicity, the health-based value derived for AMPA alone or in
combination with glyphosate is orders of magnitude higher than concentrations of
glyphosate or AMPA normally found in drinking-water. Under usual conditions,
therefore, the presence of glyphosate and AMPA in drinking-water does not represent
a hazard to human health. For this reason, the establishment of a guideline value for
glyphosate and AMPA is not deemed necessary.

glyphosate, but the 1971 International Standards suggested that pesticide residues that
total daily intake of pesticides for the population served. Glyphosate was not evalu-
ated in the rst two editions of the Guidelines for Drinking-water Quality, published
in 1984 and 1993. In the addendum to these Guidelines, published in 1998, a health-
based value of 5 mg/litre was derived for glyphosate using the ADI derived in the EHC
monograph for glyphosate published in 1994. However, the health-based value is
orders of magnitude higher than the concentrations normally found in drinking-
water. Under usual conditions, therefore, the presence of glyphosate in drinking-water
does not represent a hazard to human health, and it was not deemed necessary to
establish a guideline value for glyphosate. It was noted that most AMPA, the major
metabolite of glyphosate, found in water comes from sources other than glyphosate
degradation.
Assessment date
379
FAO/WHO (1998) Pesticide residues in food 1997 evaluations. Part II Toxicological
and environmental. Geneva, World Health Organization, Joint FAO/WHO Meeting
on Pesticide Residues (WHO/PCS/98.6).
IPCS (1994) Glyphosate. Geneva, World Health Organization, International Pro-
gramme on Chemical Safety (Environmental Health Criteria 159).
WHO (2003) Glyphosate and AMPA in drinking-water. Background document for
12.66 Halogenated acetonitriles (dichloroacetonitrile,

dibromoacetonitrile, bromochloroacetonitrile,
trichloroacetonitrile)
Halogenated acetonitriles are produced during water chlorination or chloramination
from naturally occurring substances, including algae, fulvic acid and proteinaceous
material. In general, increasing temperature and/or decreasing pH have been associ-
ated with increasing concentrations of halogenated acetonitriles. Ambient bromide
levels appear to inuence, to some degree, the speciation of halogenated acetonitrile
compounds. Dichloroacetonitrile is by far the most predominant halogenated ace-
tonitrile species detected in drinking-water.

value for The guideline value for dichloroacetonitrile is provisional due to
dichloroacetonitrile limitations of the toxicological database.
Guideline value for 0.07 mg/litre
dibromoacetonitrile
Occurrence Halogenated acetonitriles have been found in surface water and
groundwater distribution systems at concentrations generally below
10 mg/litre and usually below 1 mg/litre.
TDIs
Dichloroacetonitrile 2.7 mg/kg of body weight based on a LOAEL of 8 mg/kg of body
weight per day for increased relative liver weight in male and female
rats in a 90-day study, using an uncertainty factor of 3000 (taking into
consideration intra- and interspecies variation, the short duration of
the study, the use of a minimal LOAEL and database deciencies)
Dibromoacetonitrile 11 mg/kg of body weight, based on a NOAEL of 11.3 mg/kg of body
weight per day for decreased body weight in male F344 rats in a
90-day drinking-water study and an uncertainty factor of 1000
(accounting for inter- and intraspecies variation, subchronic to chronic
extrapolation and database insufciencies)
380
Treatment achievability Concentrations of individual halogenated acetonitriles can exceed

0.01 mg/litre, although levels of 0.002 mg/litre or less are more usual.
Trichloroacetonitrile concentrations are likely to be much less than
0.001 mg/litre. Reduction of organic precursors will reduce their
formation.
weight 60-kg adult
IARC has concluded that dichloro-, dibromo-, bromochloro- and trichloroacetoni-
trile are not classiable as to their carcinogenicity in humans. Dichloroacetonitrile and
bromochloroacetonitrile have been shown to be mutagenic in bacterial assays, whereas
results for dibromoacetonitrile and trichloroacetonitrile were negative. All four of
these halogenated acetonitriles induced sister chromatid exchange and DNA strand
breaks and adducts in mammalian cells in vitro but were negative in the mouse
micronucleus test.
The majority of reproductive and developmental toxicity studies of the halogenated
acetonitriles were conducted using tricaprylin as a vehicle for gavage administration
of the compound under study. As tricaprylin was subsequently demonstrated to be a
developmental toxicant that potentiated the effects of trichloroacetonitrile and, pre-
sumably, other halogenated acetonitriles, results reported for developmental studies
using tricaprylin as the gavage vehicle are likely to overestimate the developmental
toxicity of these halogenated acetonitriles.
Dichloroacetonitrile
Dichloroacetonitrile induced decreases in body weight and increases in relative liver
weight in short-term studies. Although developmental toxicity has been demon-
strated, the studies used tricaprylin as the vehicle for gavage administration.
Dibromoacetonitrile
Dibromoacetonitrile is currently under test for chronic toxicity in mice and rats. None
of the available reproductive or developmental studies were adequate to use in the
quantitative doseresponse assessment. The data gap may be particularly relevant
since cyanide, a metabolite of dibromoacetonitrile, induces male reproductive system
toxicity, and due to uncertainty regarding the signicance of the testes effects observed
in the 14-day National Toxicology Program (NTP) rat study.
Bromochloroacetonitrile
Available data are insufcient to serve as a basis for derivation of a guideline value for
bromochloroacetonitrile.
381
Trichloroacetonitrile
Available data are also insufcient to serve as a basis for derivation of a guideline value
for trichloroacetonitrile. The previous provisional guideline value of 1 mg/litre was
based on a developmental toxicity study in which trichloroacetonitrile was adminis-
tered by gavage in tricaprylin vehicle, and a recent re-evaluation judged this study to
be unreliable in light of the nding in a more recent study that tricaprylin potenti-
ates the developmental and teratogenic effects of halogenated acetonitriles and alters
the spectrum of malformations in the fetuses of treated dams.

refer to halogenated acetonitriles. The 1993 Guidelines established provisional health-
based guideline values of 0.09 mg/litre for dichloroacetonitrile, 0.1 mg/litre for dibro-
moacetonitrile and 0.001 mg/litre for trichloroacetonitrile. The guideline values were
designated as provisional because of the limitations of the databases (i.e., lack of long-
term toxicity and carcinogenicity bioassays). Available data were insufcient to serve
as a basis for derivation of a guideline value for bromochloroacetonitrile.
Assessment date
IPCS (2000) Disinfectants and disinfectant by-products. Geneva, World Health
Organization, International Programme on Chemical Safety (Environmental
Health Criteria 216).
WHO (2003) Halogenated acetonitriles in drinking-water. Background document for
12.67 Hardness
Hardness in water is caused by dissolved calcium and, to a lesser extent, magnesium.
It is usually expressed as the equivalent quantity of calcium carbonate.
Depending on pH and alkalinity, hardness above about 200 mg/litre can result
in scale deposition, particularly on heating. Soft waters with a hardness of less than
about 100 mg/litre have a low buffering capacity and may be more corrosive to water
pipes.
A number of ecological and analytical epidemiological studies have shown a sta-
tistically signicant inverse relationship between hardness of drinking-water and car-
diovascular disease. There is some indication that very soft waters may have an adverse
effect on mineral balance, but detailed studies were not available for evaluation.
382
No health-based guideline value is proposed for hardness. However, the degree of

hardness in water may affect its acceptability to the consumer in terms of taste and
scale deposition (see chapter 10).

hardness. The 1971 International Standards stated that the maximum permissible
level of hardness in drinking-water was 10 mEq/litre (500 mg calcium carbonate/litre),
based on the acceptability of water for domestic use. In the rst edition of the Guide-
lines for Drinking-water Quality, published in 1984, it was concluded that there was
no rm evidence that drinking hard water causes any adverse effects on human health
and that no recommendation on the restriction of municipal water softening or on
the maintenance of a minimum residual calcium or magnesium level was warranted.
A guideline value of 500 mg/litre (as calcium carbonate) was established for hardness,
based on taste and household use considerations. No health-based guideline value for
hardness was proposed in the 1993 Guidelines, although hardness above approxi-
mately 200 mg/litre may cause scale deposition in the distribution system. Public
acceptability of the degree of hardness may vary considerably from one community
to another, depending on local conditions, and the taste of water with hardness in
excess of 500 mg/litre is tolerated by consumers in some instances.
Assessment date
Principal reference
WHO (2003) Hardness in drinking-water. Background document for preparation of
12.68 Heptachlor and heptachlor epoxide

Heptachlor (CAS No. 76-44-8) is a broad-spectrum insecticide, the use of which has
been banned or restricted in many countries. At present, the major use of heptachlor
is for termite control by subsurface injection into soil. Heptachlor is quite persistent
in soil, where it is mainly transformed to its epoxide. Heptachlor epoxide (CAS No.
1024-57-3) is very resistant to further degradation. Heptachlor and heptachlor
epoxide bind to soil particles and migrate very slowly. Heptachlor and heptachlor
epoxide have been found in drinking-water at levels of nanograms per litre. Diet is
considered to represent the major source of exposure to heptachlor, although intake
is decreasing.
383
Prolonged exposure to heptachlor has been associated with damage to the liver and
central nervous system toxicity. In 1991, IARC reviewed the data on heptachlor and
concluded that the evidence for carcinogenicity was sufcient in animals and inade-
quate in humans, classifying it in Group 2B. A health-based value of 0.03 mg/litre can
be calculated for heptachlor and heptachlor epoxide on the basis of a PTDI of
0.1 mg/kg of body weight, based on a NOAEL for heptachlor of 0.025 mg/kg of body
weight per day from two studies in the dog, taking into consideration inadequacies of
the database and allocating 1% of the PTDI to drinking-water. However, because hep-
tachlor and heptachlor epoxide occur at concentrations well below those at which
toxic effects are observed, it is not considered necessary to derive a guideline value. It
should also be noted that concentrations below 0.1 mg/litre are generally not achiev-
able using conventional treatment technology.

heptachlor and heptachlor epoxide, but the 1971 International Standards suggested
that pesticide residues that may occur in community water supplies make only a
minimal contribution to the total daily intake of pesticides for the population served.
In the rst edition of the Guidelines for Drinking-water Quality, published in 1984, a
health-based guideline value of 0.1 mg/litre was recommended for heptachlor and hep-
tachlor epoxide, based on the ADI recommended by JMPR. It was noted that this
guideline value was less than the value that would have been calculated by applying
the multistage model at a projected incremental cancer risk of 1 per 100 000 per life-
time. The 1993 Guidelines established a health-based guideline value of 0.03 mg/litre
for heptachlor, based on an ADI established by JMPR in 1991 and taking into con-
sideration the fact that the main source of exposure seems to be food.
Assessment date
FAO/WHO (1992) Pesticide residues in food 1991. Evaluations 1991. Part II.
Toxicology. Geneva, World Health Organization, Joint FAO/WHO Meeting on
Paper 127).
WHO (2003) Heptachlor and heptachlor epoxide in drinking-water. Background docu-
ment for preparation of WHO Guidelines for drinking-water quality. Geneva, World
Health Organization (WHO/SDE/WSH/03.04/99).
384
12.69 Hexachlorobenzene (HCB)

The major agricultural application for HCB (CAS No. 118-74-1) was as a seed dress-
ing for crops to prevent the growth of fungi, but its use is now uncommon. At present,
it appears mainly as a by-product of several chemical processes or an impurity in some
pesticides. HCB is distributed throughout the environment because it is mobile and
resistant to degradation. It bioaccumulates in organisms because of its physico-
chemical properties and its slow elimination. HCB is commonly detected at low levels
in food, and it is generally present at low concentrations in ambient air. It has been
detected only infrequently, and at very low concentrations (below 0.1 mg/litre), in
IARC has evaluated the evidence for the carcinogenicity of HCB in animals and
humans and assigned it to Group 2B. HCB has been shown to induce tumours in
three animal species and at a variety of sites. A health-based value of 1 mg/litre can be
derived for HCB by applying the linearized multistage low-dose extrapolation model
to liver tumours observed in female rats in a 2-year dietary study. Using an alterna-
tive (TD05) approach, a health-based guidance value of 0.16 mg/kg body weight per
day can be calculated, which corresponds to a drinking-water concentration of
approximately 0.05 mg/litre, if one assumes a 1% allocation of the guidance value to
drinking-water.
Because the health-based values derived from both of these approaches are con-
siderably higher than the concentrations at which HCB is detected in drinking-water
(i.e., sub-nanograms per litre), when it is detected, it is not considered necessary to
establish a guideline value for HCB in drinking-water. Hexachlorobenzene is listed
under the Stockholm Convention on Persistent Organic Pollutants.

HCB, but the 1971 International Standards suggested that pesticide residues that may
0.01 mg/litre was recommended for HCB, derived from the linear multistage extrapo-
lation model for a cancer risk of less than 1 in 100 000 for a lifetime of exposure; it
was noted that the mathematical model used involved considerable uncertainty. The
1993 Guidelines calculated a guideline value of 1 mg/litre for HCB in drinking-water,
corresponding to an upper-bound excess lifetime cancer risk of 10-5.
Assessment date
385
IPCS (1997) Hexachlorobenzene. Geneva, World Health Organization, International
WHO (2003) Hexachlorobenzene in drinking-water. Background document for prepa-
ration of WHO Guidelines for drinking-water quality. Geneva, World Health
12.70 Hexachlorobutadiene (HCBD)

HCBD is used as a solvent in chlorine gas production, a pesticide, an intermediate in
the manufacture of rubber compounds and a lubricant. Concentrations of up to
6 mg/litre have been reported in the efuents from chemical manufacturing plants.
It is also found in air and food.

Occurrence Has been detected in surface water at concentrations of a few
micrograms per litre and in drinking-water at concentrations below
0.5 mg/litre
weight per day for renal toxicity in a 2-year feeding study in rats, using
an uncertainty factor of 1000 (100 for inter- and intraspecies variation
and 10 for limited evidence of carcinogenicity and genotoxicity of
some metabolites)
Limit of detection 0.01 mg/litre by GC/MS; 0.18 mg/litre by GC with ECD
weight 60-kg adult
Additional comments The practical quantication level for HCBD is of the order of 2 mg/litre,
but concentrations in drinking-water can be controlled by specifying
the HCBD content of products coming into contact with it.
HCBD is easily absorbed and metabolized via conjugation with glutathione. This con-
jugate can be further metabolized to a nephrotoxic derivative. Kidney tumours were
observed in a long-term oral study in rats. HCBD has not been shown to be carcino-
genic by other routes of exposure. IARC has placed HCBD in Group 3. Positive and
negative results for HCBD have been obtained in bacterial assays for point mutation;
however, several metabolites have given positive results.

386
refer to HCBD. The 1993 Guidelines derived a health-based guideline value of 0.0006
mg/litre for HCBD, noting that although a practical quantication level for HCBD is
of the order of 0.002 mg/litre, concentrations in drinking-water can be controlled by
specifying the HCBD content of products coming into contact with it.
Assessment date
The risk assessment was conducted in in 2003.
IPCS (1994) Hexachlorobutadiene. Geneva, World Health Organization, International
WHO (2003) Hexachlorobutadiene in drinking-water. Background document for prepa-
12.71 Hydrogen sulde

Hydrogen sulde is a gas with an offensive rotten eggs odour that is detectable at
very low concentrations, below 0.8 mg/m3 in air. It is formed when suldes are hydrol-
ysed in water. However, the level of hydrogen sulde found in drinking-water will
usually be low, because suldes are readily oxidized in well aerated water.
The acute toxicity to humans of hydrogen sulde following inhalation of the gas
is high; eye irritation can be observed at concentrations of 1530 mg/m3. Although
oral toxicity data are lacking, it is unlikely that a person could consume a harmful
dose of hydrogen sulde from drinking-water. Consequently, no guideline value is
proposed. However, hydrogen sulde should not be detectable in drinking-water by
taste or odour (see chapter 10).

refer to hydrogen sulde. In the rst edition of the Guidelines for Drinking-water
Quality, published in 1984, it was recommended that hydrogen sulde should not be
detectable by the consumer, based on aesthetic considerations. A guideline value was
not needed, since any contamination can be easily detected by the consumer. The 1993
Guidelines did not propose a health-based guideline value, as oral toxicity data are
lacking; nevertheless, it is unlikely that a person could consume a harmful dose of
hydrogen sulde from drinking-water. The taste and odour thresholds of hydrogen
sulde in water are estimated to be between 0.05 and 0.1 mg/litre.
Assessment date
387
Principal reference
WHO (2003) Hydrogen sulde in drinking-water. Background document for prepara-
12.72 Inorganic tin

Tin is used principally in the production of coatings used in the food industry. Food,
particularly canned food, therefore represents the major route of human exposure to
tin. For the general population, drinking-water is not a signicant source of tin, and
levels in drinking-water greater than 12 mg/litre are exceptional. However, there is
increasing use of tin in solder, which may be used in domestic plumbing, and tin has
been proposed for use as a corrosion inhibitor.
Tin and inorganic tin compounds are poorly absorbed from the gastrointestinal
tract, do not accumulate in tissues and are rapidly excreted, primarily in the faeces.
No increased incidence of tumours was observed in long-term carcinogenicity
studies conducted in mice and rats fed stannous chloride. Tin has not been shown to
be teratogenic or fetotoxic in mice, rats or hamsters. In rats, the NOAEL in a long-
term feeding study was 20 mg/kg of body weight per day.
The main adverse effect on humans of excessive levels of tin in canned beverages
(above 150 mg/kg) or other canned foods (above 250 m/kg) has been acute gastric irri-
tation. There is no evidence of adverse effects in humans associated with chronic expo-
sure to tin.
In 1989, JECFA established a PTWI of 14 mg/kg of body weight from a TDI of
2 mg/kg of body weight on the basis that the problem with tin is associated with acute
gastrointestinal irritancy, the threshold for which is about 200 mg/kg in food. This was
reafrmed by JECFA in 2000. In view of its low toxicity, the presence of tin in drink-
ing-water does not, therefore, represent a hazard to human health. For this reason, the
establishment of a guideline value for inorganic tin is not deemed necessary.

inorganic tin. The 1971 International Standards stated that tin should be controlled
in drinking-water, but that insufcient information was available to enable a tenta-
tive limit to be established. In the rst edition of the Guidelines for Drinking-water
Quality, published in 1984, it was concluded that no action was required for tin. The
establishment of a guideline value for inorganic tin was not deemed necessary in the
1993 Guidelines, as, because of the low toxicity of inorganic tin, a tentative guideline
value could be derived 3 orders of magnitude higher than the normal tin concentra-
tion in drinking-water. Therefore, the presence of tin in drinking-water does not rep-
resent a hazard to human health.
388
Assessment date
Principal reference
WHO (2003) Inorganic tin in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/115).
12.73 Iodine
Iodine occurs naturally in water in the form of iodide. Traces of iodine are produced
by oxidation of iodide during water treatment. Iodine is occasionally used for water
disinfection in the eld or in emergency situations.
Iodine is an essential element for the synthesis of thyroid hormones. Estimates of
the dietary requirement for adult humans range from 80 to 150 mg/day; in many parts
of the world, there are dietary deciencies in iodine. In 1988, JECFA set a PMTDI for
iodine of 1 mg/day (17 mg/kg of body weight per day) from all sources, based prima-
rily on data on the effects of iodide. However, recent data from studies in rats indi-
cate that the effects of iodine in drinking-water on thyroid hormone concentrations
in the blood differ from those of iodide.
Available data therefore suggest that derivation of a guideline value for iodine on
the basis of information on the effects of iodide is inappropriate, and there are few
relevant data on the effects of iodine. Because iodine is not recommended for long-
term disinfection, lifetime exposure to iodine concentrations such as might occur
from water disinfection is unlikely. For these reasons, a guideline value for iodine has
not been established at this time. There is, however, a need for guidance concerning
the use of iodine as a disinfectant in emergency situations and for travellers.

refer to iodine. The 1993 Guidelines did not establish a guideline value for iodine
because available data suggest that derivation of a guideline value for iodine on the
basis of information on the effects of iodide is inappropriate and there are few rele-
vant data on the effects of iodine; also, because iodine is not recommended for long-
term disinfection, lifetime exposure to iodine concentrations such as might occur
from water disinfection is unlikely.
Assessment date
389
Principal reference
WHO (2003) Iodine in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/46).
12.74 Iron
Iron is one of the most abundant metals in the Earths crust. It is found in natural
fresh waters at levels ranging from 0.5 to 50 mg/litre. Iron may also be present in
drinking-water as a result of the use of iron coagulants or the corrosion of steel and
cast iron pipes during water distribution.
Iron is an essential element in human nutrition. Estimates of the minimum daily
requirement for iron depend on age, sex, physiological status and iron bioavailability
and range from about 10 to 50 mg/day.
As a precaution against storage in the body of excessive iron, in 1983 JECFA estab-
lished a PMTDI of 0.8 mg/kg of body weight, which applies to iron from all sources
except for iron oxides used as colouring agents and iron supplements taken during
pregnancy and lactation or for specic clinical requirements. An allocation of 10% of
this PMTDI to drinking-water gives a value of about 2 mg/litre, which does not
present a hazard to health. The taste and appearance of drinking-water will usually
be affected below this level (see chapter 10).
No guideline value for iron in drinking-water is proposed.

tions of iron greater than 1.0 mg/litre would markedly impair the potability of the
allowable or permissible concentration. In the rst edition of the Guidelines for
Drinking-water Quality, published in 1984, a guideline value of 0.3 mg/litre was estab-
lished, as a compromise between irons use in water treatment and aesthetic consid-
erations. No health-based guideline value for iron in drinking-water was proposed in
the 1993 Guidelines, but it was mentioned that a value of about 2 mg/litre can be
derived from the PMTDI established in 1983 by JECFA as a precaution against storage
in the body of excessive iron. Iron stains laundry and plumbing xtures at levels above
0.3 mg/litre; there is usually no noticeable taste at iron concentrations below 0.3
mg/litre, and concentrations of 13 mg/litre can be acceptable for people drinking
anaerobic well water.
Assessment date
390
Principal reference
WHO (2003) Iron in drinking-water. Background document for preparation of WHO
12.75 Isoproturon
Isoproturon (CAS No. 34123-59-6) is a selective, systemic herbicide used in the
control of annual grasses and broad-leaved weeds in cereals. It can be photodegraded,
hydrolysed and biodegraded and persists for periods ranging from days to weeks. It
is mobile in soil. There is evidence that exposure to this compound through food is
low.

Occurrence Has been detected in surface water and groundwater, usually at
concentrations below 0.1 mg/litre; levels above 0.1 mg/litre have
occasionally been detected in drinking-water
TDI 3 mg/kg of body weight based on a NOAEL of approximately 3 mg/kg
of body weight in a 90-day study in dogs and a 2-year Feeding study
in rats, with an uncertainty factor of 1000 (100 for inter- and
intraspecies variation and 10 for evidence of non-genotoxic
carcinogenicity in rats)
Limit of detection 10100 ng/litre by reverse-phase HPLC followed by UV or
electrochemical detection
Treatment achievability 0.1 mg/litre should be achievable using ozonation
weight 60-kg adult
Isoproturon is of low acute toxicity and low to moderate toxicity following short- and
long-term exposures. It does not possess signicant genotoxic activity, but it causes
marked enzyme induction and liver enlargement. Isoproturon caused an increase in
hepatocellular tumours in male and female rats, but this was apparent only at doses
that also caused liver toxicity. Isoproturon appears to be a tumour promoter rather
than a complete carcinogen.

isoproturon, but the 1971 International Standards suggested that pesticide residues
the total daily intake of pesticides for the population served. Isoproturon was not eval-
391
1984, but the 1993 Guidelines calculated a health-based guideline value of

0.009 mg/litre for isoproturon in drinking-water.
Assessment date
Principal reference
WHO (2003) Isoproturon in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/37).
12.76 Lead
Lead is used principally in the production of lead-acid batteries, solder and alloys. The
organolead compounds tetraethyl and tetramethyl lead have also been used exten-
sively as antiknock and lubricating agents in petrol, although their use for these
purposes in many countries is being phased out. Owing to the decreasing use of lead-
containing additives in petrol and of lead-containing solder in the food processing
industry, concentrations in air and food are declining, and intake from drinking-water
constitutes a greater proportion of total intake. Lead is rarely present in tap water as
a result of its dissolution from natural sources; rather, its presence is primarily from
household plumbing systems containing lead in pipes, solder, ttings or the service
connections to homes. The amount of lead dissolved from the plumbing system
depends on several factors, including pH, temperature, water hardness and standing
time of the water, with soft, acidic water being the most plumbosolvent.

although much higher concentrations (above 100 mg/litre) have been
measured where lead ttings are present.
PTWI 25 mg/kg of body weight (equivalent to 3.5 mg/kg of body weight per
day) for infants and children on the basis that lead is a cumulative
poison and that there should be no accumulation of body burden of
lead
Limit of detection 1 mg/litre by AAS
Treatment achievability Not a raw water contaminant; treatment not applicable
weight 5-kg infant
consumption 0.75 litre/day
392
Additional comments As infants are considered to be the most sensitive subgroup of the
population, this guideline value will also be protective for other
age groups.
Lead is exceptional in that most lead in drinking-water arises from
plumbing in buildings and the remedy consists principally of
removing plumbing and ttings containing lead. This requires
much time and money, and it is recognized that not all water will
meet the guideline immediately. Meanwhile, all other practical
measures to reduce total exposure to lead, including corrosion
control, should be implemented.
Placental transfer of lead occurs in humans as early as the 12th week of gestation and
continues throughout development. Young children absorb 45 times as much lead
as adults, and the biological half-life may be considerably longer in children than in
adults. Lead is a general toxicant that accumulates in the skeleton. Infants, children
up to 6 years of age and pregnant women are most susceptible to its adverse health
effects. Inhibition of the activity of d-aminolaevulinic dehydratase (porphobilinogen
synthase; one of the major enzymes involved in the biosynthesis of haem) in children
has been observed at blood lead levels as low as 5 mg/dl, although adverse effects are
not associated with its inhibition at this level. Lead also interferes with calcium metab-
olism, both directly and by interfering with vitamin D metabolism. These effects have
been observed in children at blood lead levels ranging from 12 to 120 mg/dl, with no
evidence of a threshold. Lead is toxic to both the central and peripheral nervous
systems, inducing subencephalopathic neurological and behavioural effects. There is
electrophysiological evidence of effects on the nervous system in children with blood
lead levels well below 30 mg/dl. The balance of evidence from cross-sectional epi-
demiological studies indicates that there are statistically signicant associations
between blood lead levels of 30 mg/dl and more and intelligence quotient decits of
about four points in children. Results from prospective (longitudinal) epidemiologi-
cal studies suggest that prenatal exposure to lead may have early effects on mental
development that do not persist to the age of 4 years. Research on primates has sup-
ported the results of the epidemiological studies, in that signicant behavioural and
cognitive effects have been observed following postnatal exposure resulting in blood
lead levels ranging from 11 to 33 mg/dl. Renal tumours have been induced in experi-
mental animals exposed to high concentrations of lead compounds in the diet, and
IARC has classied lead and inorganic lead compounds in Group 2B (possible human
carcinogen). However, there is evidence from studies in humans that adverse neuro-
toxic effects other than cancer may occur at very low concentrations of lead and that
a guideline value derived on this basis would also be protective for carcinogenic effects.

maximum allowable concentration of 0.1 mg/litre for lead, based on health concerns.
393
This value was lowered to 0.05 mg/litre in the 1963 International Standards. The ten-
tative upper concentration limit was increased to 0.1 mg/litre in the 1971 International
Standards, because this level was accepted in many countries and the water had been
consumed for many years without apparent ill effects, and it was difcult to reach a
lower level in countries where lead pipes were used. In the rst edition of the Guide-
0.05 mg/litre was recommended. The 1993 Guidelines proposed a health-based guide-
line value of 0.01 mg/litre, using the PTWI established by JECFA for infants and chil-
dren, on the basis that lead is a cumulative poison and that there should be no
accumulation of body burden of lead. As infants are considered to be the most sen-
sitive subgroup of the population, this guideline value would also be protective for
other age groups. The Guidelines also recognized that lead is exceptional, in that most
lead in drinking-water arises from plumbing, and the remedy consists principally of
removing plumbing and ttings containing lead. As this requires much time and
money, it is recognized that not all water will meet the guideline immediately. Mean-
while, all other practical measures to reduce total exposure to lead, including corro-
sion control, should be implemented. JECFA has reassessed lead and conrmed the
previously derived PTWI.
Assessment date
Principal reference
WHO (2003) Lead in drinking-water. Background document for preparation of WHO
12.77 Lindane
Lindane (g-hexachlorocyclohexane, g-HCH) (CAS No. 58-89-9) is used as an insecti-
cide on fruit and vegetable crops, for seed treatment and in forestry. It is also used as
a therapeutic pesticide in humans and animals. Several countries have restricted the
use of lindane. Lindane can be degraded in soil and rarely leaches to groundwater. In
surface waters, it can be removed by evaporation. Exposure of humans occurs mainly
via food, but this is decreasing. There may also be exposure from its use in public
health and as a wood preservative.
394

Occurrence Has been detected in both surface water and groundwater, usually at
concentrations below 0.1 mg/litre, although concentrations as high as
12 mg/litre have been measured in wastewater-contaminated rivers
ADI 0.005 mg/kg of body weight on the basis of a NOAEL of 0.47 mg/kg of
body weight per day in a 2-year toxicity/carcinogenicity study in rats
in which an increased incidence of periacinar hepatocellular
hypertrophy, increased liver and spleen weights and increased
mortality occurred at higher doses, using an uncertainty factor of 100
Limit of detection 0.01 mg/litre using GC
weight 60-kg adult
Lindane was toxic to the kidney and liver after administration orally, dermally or by
inhalation in short-term and long-term studies of toxicity and reproductive toxicity
in rats. The renal toxicity of lindane was specic to male rats and was considered not
to be relevant to human risk assessment, since it is a consequence of accumulation of
a2u-globulin, a protein that is not found in humans. Hepatocellular hypertrophy was
observed in a number of studies in mice, rats and rabbits and was reversed only par-
tially after recovery periods of up to 6 weeks. Lindane did not induce a carcinogenic
response in rats or dogs, but it caused an increased incidence of adenomas and car-
cinomas of the liver in agouti and pseudoagouti mice, but not in black or any other
strains of mice, in a study of the role of genetic background in the latency and inci-
dence of tumorigenesis. JMPR has concluded that there was no evidence of genotox-
icity. In the absence of genotoxicity and on the basis of the weight of the evidence
from the studies of carcinogenicity, JMPR has concluded that lindane is not likely to
pose a carcinogenic risk to humans. Further, in an epidemiological study designed to
assess the potential association between breast cancer and exposure to chlorinated
pesticides, no correlation with lindane was found.

lindane, but the 1971 International Standards suggested that pesticide residues that
value of 3 mg/litre was recommended for lindane, based on the ADI recommended by
JMPR. The 1993 Guidelines established a health-based guideline value of 2 mg/litre for
lindane in drinking-water, on the basis of a study used to establish an ADI by JMPR
395
in 1989 but using a compound intake estimate considered to be more appropriate in

light of additional data and recognizing that there may be substantial exposure to
lindane from its use in public health and as a wood preservative.
Assessment date
FAO/WHO (2002) Pesticide residues in food 2002. Rome, Food and Agriculture Orga-
nization of the United Nations, Joint FAO/WHO Meeting on Pesticide Residues
(FAO Plant Production and Protection Paper 172).
WHO (2003) Lindane in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/102).
12.78 Malathion
Malathion (CAS No. 121-75-5) is commonly used to control mosquitos and a variety
of insects that attack fruits, vegetables, landscaping plants and shrubs. It can also be
found in other pesticide products used indoors, on pets to control ticks and insects
and to control human head and body lice. Under least favourable conditions (i.e.,
low pH and little organic content), malathion may persist in water with a half-life of
months or even years. However, under most conditions, the half-life appears to be
roughly 714 days. Malathion has been detected in surface water and drinking-water
at concentrations below 2 mg/litre.
Malathion inhibits cholinesterase activity in mice, rats and human volunteers. It
increased the incidence of liver adenomas in mice when administered in the diet. Most
of the evidence indicates that malathion is not genotoxic, although some studies indi-
cate that it can produce chromosomal aberrations and sister chromatid exchange in
vitro. JMPR has concluded that malathion is not genotoxic.
A health-based value of 0.9 mg/litre can be calculated for malathion based on an
allocation of 10% of the JMPR ADI based on a NOAEL of 29 mg/kg of body weight
per day in a 2-year study of toxicity and carcinogenicity in rats, using an uncertainty
factor of 100 and supported by a NOAEL of 25 mg/kg of body weight per day in a
developmental toxicity study in rabbits to drinking-water. However, intake of
malathion from all sources is generally low and well below the ADI. As the chemical
occurs in drinking-water at concentrations much lower than the health-based value,
the presence of malathion in drinking-water under usual conditions is unlikely to rep-
resent a hazard to human health. For this reason, it is considered unnecessary to derive
a guideline value for malathion in drinking-water.
396

malathion, but the 1971 International Standards suggested that pesticide residues that
total daily intake of pesticides for the population served. Malathion was not evaluated
in the rst edition of the Guidelines for Drinking-water Quality, published in 1984, in
the second edition, published in 1993, or in the addendum to the second edition, pub-
lished in 1998.
Assessment date
WHO (2003) Malathion in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/103).
12.79 Manganese
Manganese is one of the most abundant metals in the Earths crust, usually occurring
with iron. It is used principally in the manufacture of iron and steel alloys, as an
oxidant for cleaning, bleaching and disinfection as potassium permanganate and as
an ingredient in various products. More recently, it has been used in an organic com-
pound, MMT, as an octane enhancer in petrol in North America. Manganese green-
sands are used in some locations for potable water treatment. Manganese is an
essential element for humans and other animals and occurs naturally in many food
sources. The most important oxidative states for the environment and biology are
Mn2+, Mn4+ and Mn7+. Manganese is naturally occurring in many surface water and
groundwater sources, particularly in anaerobic or low oxidation conditions, and this
is the most important source for drinking-water. The greatest exposure to manganese
is usually from food.
397

Occurrence Levels in fresh water typically range from 1 to 200 mg/litre, although
levels as high as 10 mg/litre in acidic groundwater have been
reported; higher levels in aerobic waters usually associated with
industrial pollution
TDI 0.06 mg/kg of body weight, based on the upper range value of
manganese intake of 11 mg/day, identied using dietary surveys, at
which there are no observed adverse effects (i.e., considered a
NOAEL), using an uncertainty factor of 3 to take into consideration the
possible increased bioavailability of manganese from water
Limit of detection 0.01 mg/litre by AAS; 0.05 mg/litre by ICP/MS; 0.5 mg/litre by ICP/optical
emission spectroscopy; 1 mg/litre by EAAS; 10 mg/litre by FAAS
Treatment achievability 0.05 mg/litre should be achievable using oxidation and ltration
allocation to water 20% of TDI (because manganese is essential trace element)
weight 60-kg adult
Additional comments The presence of manganese in drinking-water will be objectionable to
consumers if it is deposited in water mains and causes water
discoloration. Concentrations below 0.050.1 mg/litre are usually
acceptable to consumers but may sometimes still give rise to the
deposition of black deposits in water mains over an extended period;
this may vary with local circumstances.
Manganese is an essential element for humans and other animals. Adverse effects can
result from both deciency and overexposure. Manganese is known to cause neuro-
logical effects following inhalation exposure, particularly in occupational settings, and
there have been epidemiological studies that report adverse neurological effects fol-
lowing extended exposure to very high levels in drinking-water. However, there are a
number of signicant potential confounding factors in these studies, and a number
of other studies have failed to observe adverse effects following exposure through
drinking-water. Animal data, especially rodent data, are not desirable for human risk
assessment because the physiological requirements for manganese vary among dif-
ferent species. Further, rodents are of limited value in assessing the neurobehavioural
effects, because the neurological effects (e.g., tremor, gait disorders) seen in primates
are often preceded or accompanied by psychological symptoms (e.g., irritability, emo-
tional lability), which are not apparent in rodents. The only primate study is of limited
use in a quantitative risk assessment because only one dose group was studied in a
small number of animals and the manganese content in the basal diet was not
provided.

tions of manganese greater than 0.5 mg/litre would markedly impair the potability of
398
the water. The 1963 and 1971 International Standards retained this value as a
lines for Drinking-water Quality, published in 1984, a guideline value of 0.1 mg/litre
was established for manganese, based on its staining properties. The 1993 Guidelines
concluded that although no single study is suitable for use in calculating a guideline
value, the weight of evidence from actual daily intake and toxicity studies in labora-
tory animals given manganese in drinking-water supports the view that a provisional
health-based guideline value of 0.5 mg/litre should be adequate to protect public
health. It was also noted that concentrations below 0.1 mg/litre are usually acceptable
to consumers, although this may vary with local circumstances.
Assessment date
IPCS (1999) Manganese and its compounds. Geneva, World Health Organization,
International Programme on Chemical Safety (Concise International Chemical
Assessment Document 12).
WHO (2003) Manganese in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/104).
12.80 MCPA [4-(2-methyl-4-chlorophenoxy)acetic acid]

MCPA (CAS No. 94-74-6) is a chlorophenoxy post-emergence herbicide that is very
soluble, is highly mobile and can leach from the soil. It is metabolized by bacteria and
can be photochemically degraded. MCPA has only limited persistence in water.

Occurrence Not frequently detected in drinking-water; has been measured in
surface water and groundwater at concentrations below 0.54 and
5.5 mg/litre, respectively
weight for renal and liver toxicity observed at higher dose levels in a
1-year feeding study in dogs, with an uncertainty factor of 300 (100 for
inter- and intraspecies variation and 3 for inadequacies in the
database)
Limit of detection 0.01 mg/litre by GC/MS and by GC with ECD
weight 60-kg adult
399
There are only limited and inconclusive data on the genotoxicity of MCPA. IARC eval-
uated MCPA in 1983 and concluded that the available data on humans and experi-
mental animals were inadequate for an evaluation of carcinogenicity. Further
evaluations by IARC on chlorophenoxy herbicides in 1986 and 1987 concluded that
evidence for their carcinogenicity was limited in humans and inadequate in animals
(Group 2B). Recent carcinogenicity studies on rats and mice did not indicate that
MCPA was carcinogenic. No adequate epidemiological data on exposure to MCPA
alone are available.

MCPA, but the 1971 International Standards suggested that pesticide residues that
total daily intake of pesticides for the population served. MCPA was not evaluated in
the rst edition of the Guidelines for Drinking-water Quality, published in 1984, but
MCPA in drinking-water.
Assessment date
Principal reference
WHO (2003) MCPA in drinking-water. Background document for preparation of WHO
(WHO/SDE/WSH/03.04/38).
12.81 Mecoprop (MCPP; [2(2-methyl-chlorophenoxy) propionic

acid])
The half-lives for degradation of chlorophenoxy herbicides, including mecoprop (CAS
No. 93-65-2; 7085-19-0 racemic mixture), in the environment are in the order of
several days. Chlorophenoxy herbicides are not often found in food.
400

weight for effects on kidney weight in 1- and 2-year studies in rats,
with an uncertainty factor of 300 (100 for inter- and intraspecies
variation and 3 for limitations in the database)
Limit of detection 0.01 mg/litre by GC/MS; 0.010.02 mg/litre by GC with ECD
weight 60-kg adult
on a threshold approach for other toxic effects. Effects of dietary administration of
mecoprop in short- and long-term studies include decreased relative kidney weight
(rats and beagle dogs), increased relative liver weight (rats), effects on blood param-
eters (rats and beagle dogs) and depressed body weight gain (beagle dogs).

chlorophenoxy herbicides, including mecoprop, but the 1971 International Standards
served. Mecoprop was not evaluated in the rst edition of the Guidelines for Drink-
ing-water Quality, published in 1984, but the 1993 Guidelines established a health-
based guideline value of 0.01 mg/litre for mecoprop.
Assessment date
Principal reference
401
12.82 Mercury
Mercury is used in the electrolytic production of chlorine, in electrical appliances, in
dental amalgams and as a raw material for various mercury compounds. Methylation
of inorganic mercury has been shown to occur in fresh water and in seawater, although
almost all mercury in uncontaminated drinking-water is thought to be in the form of
Hg2+. Thus, it is unlikely that there is any direct risk of the intake of organic mercury
compounds, especially of alkylmercurials, as a result of the ingestion of drinking-
water. However, there is a real possibility that methylmercury will be converted into
inorganic mercury. Food is the main source of mercury in non-occupationally
exposed populations; the mean dietary intake of mercury in various countries ranges
from 2 to 20 mg/day per person.
Guideline value 0.001 mg/litre for total mercury

Occurrence Mercury is present in the inorganic form in surface water and
groundwater at concentrations usually below 0.5 mg/litre, although
local mineral deposits may produce higher levels in groundwater.
PTWI 5 mg/kg of body weight for total mercury for the general population,
of which no more than 3.3 mg/kg of body weight should be present as
methylmercury
Limit of detection 0.001 mg/litre by atomic uorescence spectrometry; 0.05 mg/litre by
cold vapour AAS; 0.6 mg/litre by ICP; 5 mg/litre by FAAS
weight 60-kg adult
Additional Pregnant women and nursing mothers are likely to be at greater risk
considerations than the general population from the adverse effects of
methylmercury.
The toxic effects of inorganic mercury compounds are seen mainly in the kidney.
Methylmercury affects mainly the central nervous system.

The 1958 and 1963 WHO International Standards for Drinking-water did not mention
mercury. Mercury was rst mentioned in the 1971 International Standards, which
gave the tentative upper concentration limit for mercury as 0.001 mg/litre (total
mercury), based on health concerns. It was noted that this gure was related to levels
found in natural water. In the rst edition of the Guidelines for Drinking-water Quality,
published in 1984, the guideline value of 0.001 mg/litre, which applied to all chemi-
cal forms of mercury, was retained. The 1993 Guidelines also retained the guideline
402
value for total mercury of 0.001 mg/litre, based on the PTWI for methylmercury estab-
lished by JECFA in 1972 and reafrmed by JECFA in 1988.
Assessment date
Principal reference
WHO (2003) Mercury in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/10).
12.83 Methoxychlor
Methoxychlor (CAS No. 72-43-5) is an insecticide used on vegetables, fruit, trees,
fodder and farm animals. It is poorly soluble in water and highly immobile in most
agricultural soils. Under normal conditions of use, methoxychlor does not seem to be
of environmental concern. Daily intake from food and air is expected to be below
1 mg per person. Environmental metabolites are formed preferentially under anaero-
bic rather than aerobic conditions and include mainly the dechlorinated and demethy-
lated products. There is some potential for the accumulation of the parent compound
and its metabolites in surface water sediments.

Occurrence Detected occasionally in drinking-water, at concentrations as high as
300 mg/litre in rural areas
TDI 5 mg/kg of body weight, based on a systemic NOAEL of 5 mg/kg of
body weight in a teratology study in rabbits, with an uncertainty
factor of 1000 (100 for inter- and intraspecies variation and 10
reecting concern for threshold carcinogenicity and the limited
database)
Limit of detection 0.0010.01 mg/litre by GC
weight 60-kg adult
The genotoxic potential of methoxychlor appears to be negligible. In 1979, IARC
assigned methoxychlor to Group 3. Subsequent data suggest a carcinogenic potential
of methoxychlor for liver and testes in mice. This may be due to the hormonal activ-
ity of proestrogenic mammalian metabolites of methoxychlor and may therefore have
403
a threshold. The study, however, was inadequate because only one dose was used and
because this dose may have been above the maximum tolerated dose. The database
for studies on long-term, short-term and reproductive toxicity is inadequate. A tera-
tology study in rabbits reported a systemic NOAEL of 5 mg/kg of body weight per day,
which is lower than the LOAELs and NOAELs from other studies. This NOAEL was
therefore selected for use in the derivation of a TDI.

methoxychlor, but the 1971 International Standards suggested that pesticide residues
the total daily intake of pesticides for the population served. In the rst edition of the
value of 0.03 mg/litre was recommended for methoxychlor, based on the ADI recom-
mended by JMPR in 1965 and reafrmed in 1977. The 1993 Guidelines established a
health-based guideline value of 0.02 mg/litre for methoxychlor in drinking-water.
Assessment date
Principal reference
WHO (2003) Methoxychlor in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/105).
12.84 Methyl parathion

Methyl parathion (CAS No. 298-00-0) is a non-systemic insecticide and acaricide that
is produced throughout the world and has been registered for use on many crops, in
particular cotton. It partitions mainly to air and soil in the environment. There is vir-
tually no movement through soil, and neither the parent compound nor its break-
down products will reach groundwater. By far the most important route for the
environmental degradation of methyl parathion is microbial degradation. Half-lives
of methyl parathion in water are in the order of weeks to months. Concentrations of
methyl parathion in natural waters of agricultural areas in the USA ranged up to
0.46 mg/litre, with highest levels in summer. The general population can come into
contact with methyl parathion via air, water or food.
A NOAEL of 0.3 mg/kg of body weight per day was derived from the combined
results of several studies conducted in humans, based on the depression of erythro-
cyte and plasma cholinesterase activities. Methyl parathion decreased cholinesterase
activities in long-term studies in mice and rats, but did not induce carcinogenic
404
effects. Methyl parathion was mutagenic in bacteria, but there was no evidence of
genotoxicity in a limited range of studies in mammalian systems.
A health-based value of 9 mg/litre can be calculated for methyl parathion on the
basis of an ADI of 0.003 mg/kg of body weight, based on a NOAEL of 0.25 mg/kg
of body weight per day in a 2-year study in rats for retinal degeneration, sciatic
nerve demyelination, reduced body weight, anaemia and decreased brain acetyl-
cholinesterase activity, using an uncertainty factor of 100. Since the toxicological
end-points seen in animals were other than acetylcholinesterase inhibition, it was con-
sidered more appropriate to use these data rather than the NOAEL derived for
cholinesterase inhibition in humans.
Intake of methyl parathion from all sources is generally low and well below the
ADI. As the health-based value is much higher than methyl parathion concentrations
likely to be found in drinking-water, the presence of methyl parathion in drinking-
water under usual conditions is unlikely to represent a hazard to human health. For
this reason, the establishment of a guideline value for methyl parathion is not deemed
necessary.

methyl parathion, but the 1971 International Standards suggested that pesticide
bution to the total daily intake of pesticides for the population served. Methyl
parathion was not evaluated in the rst edition of the Guidelines for Drinking-water
Quality, published in 1984, in the second edition, published in 1993, or in the adden-
dum to the second edition, published in 1998.
Assessment date
IPCS (1992) Methyl parathion. Geneva, World Health Organization, International
WHO (2003) Methyl parathion in drinking-water. Background document for prepara-
12.85 Metolachlor
Metolachlor (CAS No. 51218-45-2) is a selective pre-emergence herbicide used on a
number of crops. It can be lost from the soil through biodegradation, photodegrada-
405
tion and volatilization. It is fairly mobile and under certain conditions can contami-
nate groundwater, but it is mostly found in surface water.

Occurrence Detected in surface water and groundwater at concentrations that can
exceed 10 mg/litre
weight for an apparent decrease in kidney weight at the two highest
dose levels in a 1-year dog study, with an uncertainty factor of 1000
(100 for inter- and intraspecies variation and 10 reecting some
concern regarding carcinogenicity)
Limit of detection 0.750.01 mg/litre by GC with nitrogenphosphorus detection
weight 60-kg adult
In a 1-year study in beagle dogs, administration of metolachlor resulted in decreased
kidney weight at the two highest dose levels. In 2-year studies with rodents fed meto-
lachlor in the diet, the only toxicological effects observed in albino mice were
decreased body weight gain and decreased survival in females at the highest dose level,
whereas rats showed decreased body weight gain and food consumption at the highest
dose level. There is no evidence from available studies that metolachlor is carcino-
genic in mice. In rats, an increase in liver tumours in females as well as a few nasal
tumours in males have been observed. Metolachlor is not genotoxic.

metolachlor, but the 1971 International Standards suggested that pesticide residues
the total daily intake of pesticides for the population served. Metolachlor was not
in 1984, but the 1993 Guidelines established a health-based guideline value of
0.01 mg/litre for metolachlor in drinking-water.
Assessment date
406
Principal reference
WHO (2003) Metolachlor in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/39).
12.86 Microcystin-LR
Among the more than 80 microcystins identied to date, only a few occur frequently
and in high concentrations. Microcystin-LR is among the most frequent and most
toxic microcystin congeners. Frequently occurring cyanobacterial genera that contain
these toxins are Microcystis, Planktothrix and Anabaena. Microcystins usually occur
within the cells; substantial amounts are released to the surrounding water only in sit-
uations of cell rupture (i.e., lysis).
Provisional guideline 0.001 mg/litre (for total microcystin-LR, free plus cell-bound)
value The guideline value is provisional, as it covers only microcystin-LR, the
database is limited and new data for the toxicity of cyanobacterial
toxins are being generated.
TDI 0.04 mg/kg of body weight, based on liver pathology observed in a 13-
week study in mice and applying an uncertainty factor of 1000, taking
into consideration limitations in the database, in particular lack of data
on chronic toxicity and carcinogenicity
Limit of detection 0.11 mg/litre by HPLC following extraction of cells with 75% aqueous
methanol or following concentration of microcystins from liquid
samples on C-18; will allow differentiation between variants where
standards are available.
0.10.5 mg/litre by commercially available immunoassay kits (ELISA) for
microcystins dissolved in water or in aqueous extracts of cells; will
detect most microcystins. These are less precise in quantication than
HPLC, but useful for screening.
0.51.5 mg/litre by protein phosphatase assay for microcystins
dissolved in water or in aqueous extracts of cells; will detect all
microcystins. This assay is less precise in quantication and
identication than HPLC, but useful for screening.
Monitoring The preferred approach is visual monitoring (including microscopy for
potentially microcystin-containing genera) of source water for
evidence of increasing cyanobacterial cell density (blooms) or bloom-
forming potential, and increased vigilance where such events occur.
Chemical monitoring of microcystins is not the preferred focus.
Prevention and Actions to decrease the probability of bloom occurrence include
treatment catchment and source water management, such as reducing nutrient
loading or changing reservoir stratication and mixing. Treatment
effective for the removal of cyanobacteria includes ltration to remove
intact cells. Treatment effective against free microcystins in water (as
well as most other free cyanotoxins) includes oxidation through ozone
or chlorine at sufcient concentrations and contact times, as well as
GAC and some PAC applications.
407
weight 60-kg adult
Additional comments While guideline values are derived where sufcient data exist, they are
intended to inform the interpretation of monitoring data and not to
indicate that there is a requirement for routine monitoring by
chemical analysis.
Microcystin-LR is a potent inhibitor of eukaryotic protein serine/threonine phos-
phatases 1 and 2A. The primary target for microcystin toxicity is the liver, as micro-
cystins cross cell membranes chiey through the bile acid transporter. Guideline
derivation was based on an oral 13-week study with mice, supported by an oral 44-
day study with pigs. A large number of poisonings of livestock and wildlife have been
recorded. Evidence of tumour promotion has been published.

Cyanobacterial toxins were not evaluated in the 1958, 1963 and 1971 WHO Interna-
tional Standards for Drinking-water or in the rst two editions of the Guidelines for
Drinking-water Quality, published in 1984 and 1993. In the addendum to the second
edition of the Guidelines, published in 1998, it was concluded that there were insuf-
cient data to allow a guideline value to be derived for any cyanobacterial toxins other
than microcystin-LR. A health-based guideline value for total microcystin-LR (free
plus cell-bound) of 0.001 mg/litre was derived, assuming signicant exposure from
drinking-water. The guideline value was designated as provisional, as it covers only
microcystin-LR, the database is limited and new data for the toxicity of cyanobacte-
rial toxins are being generated.
Assessment date
WHO (2003) Cyanobacterial toxins: Microcystin-LR in drinking-water. Background
document for preparation of WHO Guidelines for drinking-water quality. Geneva,
World Health Organization (WHO/SDE/WSH/03.04/57).
12.87 Molinate
Molinate (CAS No. 2212-67-1) is a herbicide used to control broad-leaved and grassy
weeds in rice. The available data suggest that groundwater pollution by molinate is
408
restricted to some rice-growing regions. Data on the occurrence of molinate in the

environment are limited. Molinate is of low persistence in water and soil, with a half-
life of about 5 days.

Occurrence Concentrations in water rarely exceed 1 mg/litre.
TDI 2 mg/kg of body weight, based on a NOAEL for reproductive toxicity in
the rat of 0.2 mg/kg of body weight, with an uncertainty factor of 100
(for inter- and intraspecies variation)
weight 60-kg adult
On the basis of the limited information available, molinate does not seem to be car-
cinogenic or mutagenic in animals. Evidence suggests that impairment of the repro-
ductive performance of the male rat represents the most sensitive indicator of
molinate exposure. However, epidemiological data based on the examination of
workers involved in molinate production do not indicate any effect on human
fertility.

molinate, but the 1971 International Standards suggested that pesticide residues that
total daily intake of pesticides for the population served. Molinate was not evaluated
molinate in drinking-water.
Assessment date
Principal reference
WHO (2003) Molinate in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/40).
409
12.88 Molybdenum
Molybdenum is found naturally in soil and is used in the manufacture of special steels
and in the production of tungsten and pigments, and molybdenum compounds are
used as lubricant additives and in agriculture to prevent molybdenum deciency in
crops.

Occurrence Concentrations in drinking-water are usually less than 0.01 mg/litre,
although concentrations as high as 200 mg/litre have been reported in
areas near mining sites.
NOAEL 0.2 mg/litre in a 2-year study of humans exposed through their
drinking-water, using an uncertainty factor of 3 for intraspecies
variation (because molybdenum is an essential element)
Limit of detection 0.25 mg/litre by graphite furnace AAS; 2 mg/litre by ICP/AES
Treatment achievability Molybdenum is not removed from drinking-water.
Additional comments The guideline value is within the range of that derived on the basis of
results of toxicological studies in animal species and is consistent with
the essential daily requirement.
Molybdenum is considered to be an essential element, with an estimated daily require-
ment of 0.10.3 mg for adults. No data are available on the carcinogenicity of molyb-
denum by the oral route. Additional toxicological information is needed on the impact
of molybdenum on bottle-fed infants.

molybdenum. The 1971 International Standards stated that molybdenum should be
controlled in drinking-water, but that insufcient information was available to enable
a tentative limit to be established. In the rst edition of the Guidelines for Drinking-
water Quality, published in 1984, it was concluded that no action was required
for molybdenum. The 1993 Guidelines proposed a health-based guideline value of
0.07 mg/litre for molybdenum based on a 2-year study of humans exposed through
their drinking-water. This value is within the range of that derived on the basis of
results of toxicological studies in animal species and is consistent with the essential
daily requirement.
Assessment date
410
Principal reference
WHO (2003) Molybdenum in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/11).
12.89 Monochloramine
Mono-, di- and trichloramines are considered by-products of drinking-water chlori-
nation, being formed when ammonia is added to chlorinated water. Monochloramine
may also be added to maintain residual disinfection activity in potable water distri-
bution systems. The use of chloramines for disinfection instead of chlorine reduces
the formation of THMs in drinking-water supplies. However, formation of other by-
products, such as haloketones, chloropicrin, cyanogen chloride, haloacetic acids,
haloacetonitriles, aldehydes and chlorophenols, has been reported. Monochloramine
is recognized as a less effective disinfectant than chlorine. Only monochloramine, the
most abundant chloramine, is considered here, as it has been the most extensively
studied.

Occurrence Typical chloramine concentrations of 0.52 mg/litre are found in
drinking-water supplies where chloramine is used as a primary
disinfectant or to provide a chlorine residual in the distribution
system.
weight per day, the highest dose administered to male rats in a 2-year
NTP drinking-water study (although mean body weights of rats given
the highest dose were lower than those of their respective control
groups, it is probable that the lower body weights were caused by the
unpalatability of the drinking-water)
Limit of detection 10 mg/litre by colorimetric methods
Treatment achievability It is possible to reduce the concentration of chloramine effectively to
zero (<0.1 mg/litre) by reduction; however, it is normal practice to
supply water with a chloramine residual of a few tenths of a milligram
per litre to act as a preservative during distribution.
weight 60-kg adult
Additional comments An additional uncertainty factor for possible carcinogenicity was
not applied because equivocal cancer effects reported in the NTP
study in only one species and in only one sex were within the
range observed in historical controls.
Most individuals are able to taste chloramines at concentrations
below 5 mg/litre, and some at levels as low as 0.3 mg/litre.
411
Although monochloramine has been shown to be mutagenic in some in vitro studies,
it has not been found to be genotoxic in vivo. IARC has classied chloramine in Group
3, and the US EPA has classied monochloramine in group D (not classiable as to
human carcinogenicity, as there is inadequate human and animal evidence). In the
NTP bioassay in two species, the incidence of mononuclear cell leukaemias in female
F344/N rats was increased, but no other increases in tumour incidence were observed.
IPCS (2000) did not consider that the increase in mononuclear cell leukaemia was
treatment-related.

refer to chloramines. The 1993 Guidelines established a health-based guideline value
of 3 mg/litre for monochloramine in drinking-water. Available data were insufcient
for the establishment of guideline values for dichloramine and trichloramine. It was
noted that the odour thresholds for dichloramine and trichloramine are much lower
than that for monochloramine.
Assessment date
Criteria 216).
WHO (2003) Monochloramine in drinking-water. Background document for prepara-
12.90 Monochloroacetic acid

412

Occurrence Present in surface water-derived drinking-water at <282 mg/litre
(mean 2.1 mg/litre)
TDI 3.5 mg/kg of body weight, based on a LOAEL of 3.5 mg/kg of body
weight per day from a study in which increased absolute and relative
spleen weights were observed in male rats exposed to
monochloroacetic acid in drinking-water for 2 years, and using an
and 10 for use of a minimal LOAEL instead of a NOAEL and database
deciencies, including the lack of a multigeneration reproductive
toxicity study)
Treatment achievability No information available
weight 60-kg adult
No evidence of carcinogenicity of monochloroacetate was found in 2-year gavage
bioassays with rats and mice. Monochloroacetate has given mixed results in a limited
number of mutagenicity assays and has been negative for clastogenicity in genotoxi-
city studies. IARC has not classied the carcinogenicity of monochloroacetic acid.

refer to monochloroacetic acid. The 1993 Guidelines did not establish a guideline
value for monochloroacetic acid, as available toxicity data were considered insuf-
cient.
Assessment date
Principal reference
WHO (2003) Monochloroacetic acid in drinking-water. Background document for
12.91 Monochlorobenzene
Releases of monochlorobenzene (MCB) to the environment are thought to be mainly
due to volatilization losses associated with its use as a solvent in pesticide formula-
tions, as a degreasing agent and from other industrial applications. MCB has been
413
detected in surface water, groundwater and drinking-water; mean concentrations were

less than 1 mg/litre in some potable water sources (maximum 5 mg/litre) in Canada.
The major source of human exposure is probably air.
MCB is of low acute toxicity. Oral exposure to high doses of MCB affects mainly
the liver, kidneys and haematopoietic system. There is limited evidence of carcino-
genicity in male rats, with high doses increasing the occurrence of neoplastic nodules
in the liver. The majority of evidence suggests that MCB is not mutagenic; although
it binds to DNA in vivo, the level of binding is low.
A health-based value of 300 mg/litre can be calculated for MCB on the basis of a
TDI of 85.7 mg/kg of body weight, based on neoplastic nodules identied in a 2-year
rat study with dosing by gavage, and taking into consideration the limited evidence
of carcinogenicity. However, because MCB occurs at concentrations well below those
at which toxic effects are observed, it is not considered necessary to derive a guideline
value. It should also be noted that the health-based value far exceeds the lowest
reported taste and odour threshold for MCB in water.

refer to MCB. In the rst edition of the Guidelines for Drinking-water Quality, pub-
lished in 1984, no guideline value for chlorobenzene was recommended after a
detailed evaluation of the compound. Following consideration of the calculated tox-
icological limit for drinking-water of 0.0050.05 mg/litre based on a tentative ADI and
the fact that the threshold odour concentration of MCB in water is 0.03 mg/litre, no
guideline value was recommended, and 0.003 mg/litre was recommended to avoid
taste and odour problems in drinking-water. The 1993 Guidelines proposed a health-
based guideline value of 0.3 mg/litre for MCB, noting that this value far exceeds the
lowest reported taste and odour threshold for MCB in water (0.01 mg/litre).
Assessment date
Principal reference
WHO (2003) Monochlorobenzene in drinking-water. Background document for prepa-
12.92 MX
MX, which is the common name for 3-chloro-4-dichloromethyl-5-hydroxy-2(5H)-
furanone, is formed by the reaction of chlorine with complex organic matter in
drinking-water. It has been identied in chlorinated humic acid solutions and
drinking-water in Finland, the United Kingdom and the USA and was found to be
414
present in 37 water sources at levels of 267 ng/litre. Five drinking-water samples from
different Japanese cities contained MX at concentrations ranging from <3 to 9 ng/litre.
MX is a potent mutagen in bacteria and in cells in vitro and has undergone a life-
time study in rats in which some tumorigenic responses were observed. These data
indicate that MX induces thyroid and bile duct tumours. IARC has classied MX in
Group 2B on the basis of rat tumorigenicity and its strong mutagenicity.
A health-based value of 1.8 mg/litre can be calculated for MX on the basis of the
increase in cholangiomas and cholangiocarcinomas in female rats using the linearized
multistage model (without a body surface area correction). However, this is signi-
cantly above the concentrations that would be found in drinking-water, and, in
view of the analytical difculties in measuring this compound at such low concen-
trations, it is considered unnecessary to propose a formal guideline value for MX in
drinking-water.

refer to MX. The 1993 Guidelines concluded that available data were inadequate to
permit a guideline value for MX to be established.
Assessment date
Criteria 216).
WHO (2003) MX in drinking-water. Background document for preparation of WHO
(WHO/SDE/WSH/03.04/108).
12.93 Nickel
Nickel is used mainly in the production of stainless steel and nickel alloys. Food is the
dominant source of nickel exposure in the non-smoking, non-occupationally exposed
population; water is generally a minor contributor to the total daily oral intake.
However, where there is heavy pollution or use of certain types of kettles, of non-
resistant material in wells or of water that has come into contact with nickel- or
chromium-plated taps, the nickel contribution from water may be signicant.
415

value The guideline value is considered provisional owing to uncertainties
about the effect level for perinatal mortality.
Occurrence The concentration of nickel in drinking-water is normally less than
0.02 mg/litre, although nickel released from taps and ttings may
contribute up to 1 mg/litre. In special cases of release from natural or
industrial nickel deposits in the ground, the nickel concentrations in
drinking-water may be even higher.
TDI 5 mg/kg of body weight, derived from a NOAEL of 5 mg/kg of body
weight per day from a dietary study in rats in which altered organ to
body weight ratios were observed, using an uncertainty factor of 1000
(100 for inter- and intraspecies variation and an extra factor of 10 to
compensate for the lack of adequate studies on long-term exposure
and reproductive effects, a lack of data on carcinogenicity by the oral
route and a much higher intestinal absorption when taken on an
empty stomach in drinking-water than when taken together with
food)
Limit of detection 0.1 mg/litre by ICP/MS; 1 mg/litre by EAAS or ICP/optical emission
spectroscopy; 15 mg/litre by ICP; 20 mg/litre by FAAS
Treatment achievability 20 mg/litre should be achievable by conventional treatment, e.g.,
coagulation. However, nickel is not usually a raw water contaminant.
weight 60-kg adult
IARC concluded that inhaled nickel compounds are carcinogenic to humans (Group
1) and metallic nickel is possibly carcinogenic (Group 2B). However, there is a lack of
evidence of a carcinogenic risk from oral exposure to nickel. Dose-related increases
in perinatal mortality were observed in a carefully conducted two-generation study
in rats, but variations in response between successive litters make it difcult to draw
rm conclusions from this study.

refer to nickel. In the rst edition of the Guidelines for Drinking-water Quality, pub-
lished in 1984, it was concluded that the toxicological data available indicate that a
guideline value for nickel in drinking-water was not required. A health-based guide-
line value of 0.02 mg/litre was derived in the 1993 Guidelines, which should provide
sufcient protection for individuals who are sensitive to nickel. This guideline value
was maintained in the addendum to the Guidelines published in 1998 because, on the
basis of the available data, it was considered to provide sufcient protection for indi-
viduals who are sensitive to nickel. However, the guideline value was designated as
provisional owing to uncertainties about the effect level for perinatal mortality.
416
Assessment date
Principal reference
WHO (2003) Nickel in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/55).
12.94 Nitrate and nitrite

Nitrate and nitrite are naturally occurring ions that are part of the nitrogen cycle.
Nitrate is used mainly in inorganic fertilizers, and sodium nitrite is used as a food
preservative, especially in cured meats. The nitrate concentration in groundwater and
surface water is normally low but can reach high levels as a result of leaching or runoff
from agricultural land or contamination from human or animal wastes as a conse-
quence of the oxidation of ammonia and similar sources. Anaerobic conditions may
result in the formation and persistence of nitrite. Chloramination may give rise to the
formation of nitrite within the distribution system if the formation of chloramine is
not sufciently controlled. The formation of nitrite is as a consequence of microbial
activity and may be intermittent. Nitrication in distribution systems can increase
nitrite levels, usually by 0.21.5 mg/litre.
Guideline value for 50 mg/litre to protect against methaemoglobinaemia in bottle-fed

nitrate infants (short-term exposure)
Guideline value /
Provisional guideline
3exposure)
mg/litre for methaemoglobinaemia in infants (short-term
value for nitrite The0.2guideline

mg/litre (provisional) (long-term exposure)
value for chronic effects of nitrite is considered
provisional owing to uncertainty surrounding the relevance of the
observed adverse health effects for humans and the susceptibility of
humans compared with animals. The occurrence of nitrite in
distribution as a consequence of chloramine use will be intermittent,
and average exposures over time should not exceed the provisional
guideline value.
Guideline value for The sum of the ratios of the concentrations of each to its guideline
combined nitrate value should not exceed 1.
plus nitrite
Occurrence In most countries, nitrate levels in drinking-water derived from surface
water do not exceed 10 mg/litre, although nitrate levels in well water
often exceed 50 mg/litre; nitrite levels are normally lower, less than a
few milligrams per litre.
417
Basis of guideline
derivation
nitrate (bottle-fed infants): in epidemiological studies,
methaemoglobinaemia was not reported in infants in areas where
drinking-water consistently contained less than 50 mg of nitrate
per litre
nitrite (bottle-fed infants): nitrite is 10 times more potent than
nitrate on a molar basis with respect to methaemoglobin
formation
nitrite (long-term exposure): based on allocation to drinking- water
of 10% of JECFA ADI of 0.06 mg/kg of body weight per day, based
on nitrite-induced morphological changes in the adrenals, heart
and lungs in laboratory animal studies
Limit of detection 0.1 mg/litre (nitrate) and 0.05 mg/litre (nitrite) by liquid
chromatography; 0.011 mg/litre (nitrate) by spectrometric
techniques; 0.0050.01 mg/litre (nitrite) by a molecular absorption
spectrometric method; 22 mg/litre (nitrate) and 35 mg/litre (nitrite) by
ion chromatography
Treatment
achievability
nitrate: 5 mg/litre or lower should be achievable using biological
denitrication (surface waters) or ion exchange (groundwaters)
nitrite: 0.1 mg/litre should be achievable using chlorination
(to form nitrate)
Additional comments Nitrite can occur in distribution at higher concentrations when
chloramination is used, but the occurrence is almost invariably
sporadic. Methaemoglobinaemia is therefore the most important
consideration, and the guideline derived for protection against
methaemoglobinaemia would be the most appropriate under
these circumstances, allowing for any nitrate that may also be
present.
All water systems that practise chloramination should closely and
regularly monitor their systems to verify disinfectant levels,
microbiological quality and nitrite levels. If nitrication is detected
(e.g., reduced disinfectant residuals and increased nitrite levels),
steps should be taken to modify the treatment train or water
chemistry in order to maintain a safe water quality. Efcient
disinfection must never be compromised.
Methaemoglobinaemia in infants also appears to be associated
with simultaneous exposure to microbial contaminants.
The primary health concern regarding nitrate and nitrite is the formation of
methaemoglobinaemia, so-called blue-baby syndrome. Nitrate is reduced to nitrite
in the stomach of infants, and nitrite is able to oxidize haemoglobin (Hb) to
methaemoglobin (metHb), which is unable to transport oxygen around the body. The
reduced oxygen transport becomes clinically manifest when metHb concentrations
reach 10% or more of normal Hb concentrations; the condition, called methaemo-
globinaemia, causes cyanosis and, at higher concentrations, asphyxia. The normal
metHb level in infants under 3 months of age is less than 3%.
The Hb of young infants is more susceptible to metHb formation than that of older
children and adults; this is believed to be the result of the large proportion of fetal
418
Hb, which is more easily oxidized to metHb, still present in the blood of infants. In
addition, there is a deciency in infants of metHb reductase, the enzyme responsible
for the reduction of metHb to Hb. The reduction of nitrate to nitrite by gastric bac-
teria is also higher in infants because of low gastric acidity. The level of nitrate in
breast milk is relatively low; when bottle-fed, however, these young infants are at risk
because of the potential for exposure to nitrate/nitrite in drinking-water and the rel-
atively high intake of water in relation to body weight. The higher reduction of nitrate
to nitrite in young infants is not very well quantied, but it appears that gastroin-
testinal infections exacerbate the conversion from nitrate to nitrite.
The weight of evidence is strongly against there being an association between nitrite
and nitrate exposure in humans and the risk of cancer.
Studies with nitrite in laboratory rats have reported hypertrophy of the adrenal
zona glomerulosa. The mechanism of induction of this effect and whether it occurs
in other species is unclear. JECFA developed an ADI of 5 mg of potassium nitrite per
kg of body weight based on the NOAEL in these studies.

The 1958 WHO International Standards for Drinking-water referred to nitrates, stating
that the ingestion of water containing nitrates in excess of 50100 mg/litre (as nitrate)
may give rise to methaemoglobinaemia in infants under 1 year of age. In the 1963
International Standards, this value was lowered to 45 mg/litre (as nitrate), which was
retained in the 1971 International Standards. The 1971 International Standards rst
mentioned concern over the possibility of nitrosamine formation in vivo; as
nitrosamines are a possible hazard to human health, the 1971 Standards stated that it
may eventually become necessary to reduce the level of nitrates in water if it is found
that this source makes a signicant contribution to the hazard to human health arising
from nitrosamines. In the rst edition of the Guidelines for Drinking-water Quality,
published in 1984, a guideline value of 10 mg/litre for nitrate-nitrogen was recom-
mended. It was also recommended that the guideline value for nitrite must be corre-
spondingly lower than that for nitrate, and it was noted that the nitrite-nitrogen level
should be considerably lower than 1 mg/litre where drinking-water is correctly treated.
The 1993 Guidelines concluded that extensive epidemiological data support the
current guideline value for nitrate-nitrogen of 10 mg/litre, but stated that this value
should be expressed not on the basis of nitrate-nitrogen but on the basis of nitrate
itself, which is the chemical entity of concern to health. The guideline value for nitrate
is therefore 50 mg/litre. This guideline value for methaemoglobinaemia in infants, an
acute effect, was conrmed in the addendum to the Guidelines, published in 1998. It
was also concluded in the 1993 Guidelines that a guideline value for nitrite should be
proposed, although no suitable animal studies of methaemoglobinaemia were avail-
able. A provisional guideline value for nitrite of 3 mg/litre was therefore proposed by
accepting a relative potency for nitrite and nitrate with respect to methaemoglobin
formation of 10 : 1 (on a molar basis). In the addendum to the Guidelines, published
419
in 1998, it was concluded that human data on nitrite reviewed by JECFA supported
the current provisional guideline value of 3 mg/litre, based on induction of
methaemoglobinaemia in infants. In addition, a guideline value of 0.2 mg/litre for
nitrate ion associated with long-term exposure was derived in the addendum to the
Guidelines, based on JECFAs ADI derived in 1995. However, because of the uncer-
tainty surrounding the relevance of the observed adverse health effects for humans
and the susceptibility of humans compared with animals, this guideline value was con-
sidered provisional. Because of the possibility of simultaneous occurrence of nitrite
and nitrate in drinking-water, it was recommended in the 1993 and 1998 Guidelines
that the sum of the ratios of the concentration of each to its guideline value should
not exceed 1.
Assessment date
Principal reference
WHO (2003) Nitrate and nitrite in drinking-water. Background document for prepara-
12.95 Nitrilotriacetic acid (NTA)

Nitrilotriacetic acid (NTA) is used primarily in laundry detergents as a replacement
for phosphates and in the treatment of boiler water to prevent accumulation of
mineral scale.

Occurrence Concentrations in drinking-water usually do not exceed a few
micrograms per litre, although concentrations as high as 35 mg/litre
have been measured.
TDI 10 mg/kg of body weight, based on nephritis and nephrosis in a 2-year
study in rats and using an uncertainty factor of 1000 (100 for inter-
and intraspecies variation and 10 for carcinogenic potential at high
doses)
Limit of detection 0.2 mg/litre using GC with a nitrogen-specic detector
weight 60-kg adult
420
NTA is not metabolized in animals and is rapidly eliminated, although some may be
briey retained in bone. It is of low acute toxicity to animals, but it has been shown
to produce kidney tumours in rodents following long-term exposure to doses higher
than those required to produce nephrotoxicity. IARC has placed NTA in Group 2B. It
is not genotoxic, and the reported induction of tumours is believed to be due to cyto-
toxicity resulting from the chelation of divalent cations such as zinc and calcium in
the urinary tract, leading to the development of hyperplasia and subsequently
neoplasia.

NTA. The 1971 International Standards stated that NTA should be controlled in
drinking-water, but that insufcient information was available to enable a tentative
limit to be established. In the rst edition of the Guidelines for Drinking-water Quality,
published in 1984, it was determined that no further action on NTA was required.
A health-based guideline value of 0.2 mg/litre was established for NTA in the 1993
Guidelines.
Assessment date
Principal reference
WHO (2003) Nitrilotriacetic acid in drinking-water. Background document for prepa-
12.96 Parathion
Parathion (CAS No. 56-38-2) is a non-systemic insecticide that is used in many coun-
tries throughout the world. It is used as a fumigant and acaricide and as a pre-harvest
soil and foliage treatment on a wide variety of crops, both outdoors and in green-
houses. Parathion released to the environment will adsorb strongly to the top layer of
soil and is not likely to leach signicantly. Parathion disappears from surface waters
in about a week. The general population is not usually exposed to parathion from air
or water. Parathion residues in food are the main source of exposure.
Parathion inhibits cholinesterase activity in all species tested. There has been no
evidence of carcinogenicity in 2-year rat studies. JMPR concluded that parathion is
not genotoxic.
A health-based value of 10 mg/litre can be calculated for parathion on the basis of
an ADI of 0.004 mg/kg of body weight based on a NOAEL of 0.4 mg/kg body weight
421
per day in a 2-year study in rats for retinal atrophy and inhibition of brain acetyl-
cholinesterase at the higher dose, and using an uncertainty factor of 100. Lower
NOAELs in animals, based only on inhibition of erythrocyte or brain acetyl-
cholinesterase, were not considered relevant because of the availability of a NOAEL
for erythrocyte acetylcholinesterase inhibition in humans, which was 0.1 mg/kg of
body weight per day.
Intake of parathion from all sources is generally low and well below the ADI. As
the health-based value is much higher than parathion concentrations likely to be
found in drinking-water, the presence of parathion in drinking-water under usual
conditions is unlikely to represent a hazard to human health. For this reason, the estab-
lishment of a guideline value for parathion is not deemed necessary.

parathion, but the 1971 International Standards suggested that pesticide residues that
total daily intake of pesticides for the population served. Parathion was not evaluated
in the second edition, published in 1993, or in the addendum to the second edition,
published in 1998.
Assessment date
WHO (2003) Parathion in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/110).
12.97 Pendimethalin
Pendimethalin (CAS No. 40487-42-1) is a pre-emergence herbicide that is fairly
immobile and persistent in soil. It is used in large amounts in Japan (5000 tonnes per
year). It is lost through photodegradation, biodegradation and volatilization. The
leaching potential of pendimethalin appears to be very low, but little is known about
its more polar degradation products.
422

Occurrence Rarely been found in drinking-water in the limited studies available
(detection limit 0.01 mg/litre)
TDI 5 mg/kg of body weight, based on evidence of slight liver toxicity even
at the lowest dose tested (5 mg/kg of body weight) in a long-term rat
feeding study, with an uncertainty factor of 1000 (100 for inter- and
intraspecies variation and 10 for a combination of the use of a LOAEL
instead of a NOAEL and limitations of the database)
weight 60-kg adult
In a short-term dietary study in rats, a variety of indications of hepatotoxicity as well
as increased kidney weights in males were observed at the highest dose level. In a long-
term dietary study, some toxic effects (hyperglycaemia in the mouse and hepatotoxi-
city in the rat) were present even at the lowest dose level. On the basis of available
data, pendimethalin does not appear to have signicant mutagenic activity. Long-term
studies in mice and rats have not provided evidence of carcinogenicity; however, these
studies have some important methodological limitations.

pendimethalin, but the 1971 International Standards suggested that pesticide residues
the total daily intake of pesticides for the population served. Pendimethalin was not
in 1984, but the 1993 Guidelines established a health-based guideline value of
0.02 mg/litre for pendimethalin in drinking-water.
Assessment date
Principal reference
WHO (2003) Pendimethalin in drinking-water. Background document for preparation
(WHO/SDE/WSH/03.04/41).
423
12.98 Pentachlorophenol (PCP)

PCP (CAS No. 87-86-5) and other chlorophenols are used primarily for protecting
wood from fungal growth. Food is usually the major source of exposure to PCP unless
there is a specic local chlorophenol contamination of drinking-water or exposure
from log homes treated with PCP.

value The guideline value is considered provisional because of the variations
in metabolism between experimental animals and humans.
Occurrence Concentrations in water samples are usually below 10 mg/litre,
although much higher concentrations in groundwater may be
measured under certain conditions.
Basis of guideline Multistage modelling of tumour incidence in a US NTP bioassay
derivation without incorporation of a body surface area correction, recognizing
that there are interspecies differences in metabolism between animals
and humans, with an important metabolite formed in rats being only
a minor metabolite in humans
Limit of detection 0.0050.01 mg/litre by GC with ECD
Additional comments The concentration of PCP associated with a 10-5 upper-bound excess
lifetime cancer risk is similar to the guideline value established in the
second edition, so that guideline value is retained.
IARC classied PCP in Group 2B (the agent is possibly carcinogenic to humans) on
the basis of inadequate evidence of carcinogenicity in humans but sufcient evidence
in experimental animals. There is suggestive, although inconclusive, evidence of the
carcinogenicity of PCP from epidemiological studies of populations exposed to mix-
tures that include PCP. Conclusive evidence of carcinogenicity has been obtained in
one animal species (mice). Although there are notable variations in metabolism
between experimental animals and humans, it was considered prudent to treat PCP
as a potential carcinogen.

PCP, but the 1971 International Standards suggested that pesticide residues that may
0.01 mg/litre was recommended for PCP. The 1993 Guidelines established a health-
based guideline value of 0.009 mg/litre for PCP in drinking-water. This value was con-
sidered provisional because PCP was evaluated only at the Final Task Group Meeting
on the basis of an EHC monograph (No. 71). The concentration of PCP associated
424
with a 10-5 upper-bound excess lifetime cancer risk was found to be similar to the
provisional guideline value established in 1993, and so that provisional guideline value
was retained in the addendum to the Guidelines, published in 1998.
Assessment date
Principal reference
WHO (2003) Pentachlorophenol in drinking-water. Background document for pre-
paration of WHO Guidelines for drinking-water quality. Geneva, World Health
12.99 Permethrin
Permethrin (CAS No. 52645-53-1) is a contact insecticide effective against a
broad range of pests in agriculture, forestry and public health. It is also a WHOPES-
recommended larvicide used to control aquatic invertebrates in water mains. Perme-
thrin is photodegraded both in water and on soil surfaces. Concentrations as high as
0.8 mg/litre have been recorded in surface water; levels in drinking-water have not
been reported. In soil, permethrin is rapidly degraded by hydrolysis and microbial
action under aerobic conditions. Exposure of the general population to permethrin
is mainly via the diet.
Technical-grade permethrin is of low acute toxicity. The cis isomer is considerably
more toxic than the trans isomer. IARC has classied permethrin in Group 3, as there
are no human data and only limited data from animal studies. Permethrin is not
genotoxic.
An ADI of 0.05 mg/kg of body weight for 2 : 3 and 1 : 3 cis : trans-permethrin has
been derived by applying an uncertainty factor of 100 to a NOAEL of 100 mg/kg,
equivalent to 5 mg/kg of body weight per day, from a 2-year dietary study in rats, based
on clinical signs and changes in body and organ weights and blood chemistry, and a
NOAEL of 5 mg/kg of body weight per day from a 1-year study in dogs, based on
reduced body weight at 100 mg/kg of body weight per day. A health-based value of
20 mg/litre can be calculated for permethrin by allocating 1% of this ADI to drinking-
water (because there is signicant exposure to permethrin from the environment).
However, because permethrin occurs at concentrations well below those at which toxic
effects are observed, it is not considered necessary to derive a guideline value.

permethrin, but the 1971 International Standards suggested that pesticide residues
425
the total daily intake of pesticides for the population served. Permethrin was not eval-
1984, but the 1993 Guidelines established a health-based guideline value of 0.02
mg/litre for permethrin in drinking-water, based on an ADI established by JMPR in
1987 for 2 : 3 and 1 : 3 cis : trans-permethrin and recognizing the signicant exposure
to permethrin from the environment. It was noted that if permethrin is to be used as
a larvicide for the control of mosquitos and other insects of health signicance in
drinking-water sources, the share of the ADI allocated to drinking-water may be
increased.
Assessment date
WHO (2003) Permethrin in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/111).
12.100 pH
No health-based guideline value is proposed for pH. Although pH usually has no
direct impact on consumers, it is one of the most important operational water quality
parameters (see chapter 10).

The 1958 WHO International Standards for Drinking-water suggested that pH less
than 6.5 or greater than 9.2 would markedly impair the potability of the water. The
1963 and 1971 International Standards retained the pH range 6.59.2 as the allow-
able or permissible range. In the rst edition of the Guidelines for Drinking-water
Quality, published in 1984, a guideline value pH range of 6.58.5 was established for
pH, based on aesthetic considerations. It was noted that the acceptable range of pH
may be broader in the absence of a distribution system. No health-based guideline
value was proposed for pH in the 1993 Guidelines. Although pH usually has no direct
impact on consumers, it is one of the most important operational water quality
parameters, the optimum pH required often being in the range 6.59.5.
Assessment date
426
Principal reference
WHO (2003) pH in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/12).
12.101 2-Phenylphenol and its sodium salt

2-Phenylphenol (CAS No. 90-43-7) is used as a disinfectant, bactericide and virucide.
In agriculture, it is used in disinfecting fruits, vegetables and eggs. It is also used as a
general surface disinfectant in hospitals, nursing homes, veterinary hospitals, poultry
farms, dairy farms, commercial laundries, barbershops and food processing plants.
2-Phenylphenol is readily degraded in surface waters, with a half-life of about 1 week
in river water.
2-Phenylphenol has been determined to be of low toxicity. Both 2-phenylphenol
and its sodium salt are carcinogenic in male rats, and 2-phenylphenol is carcinogenic
in male mice. However, urinary bladder tumours observed in male rats and liver
tumours observed in male mice exposed to 2-phenylphenol appear to be threshold
phenomena that are species- and sex-specic. JMPR has concluded that 2-phenylphe-
nol is unlikely to represent a carcinogenic risk to humans. Although a working group
convened by IARC has classied 2-phenylphenol, sodium salt, in Group 2B (possibly
carcinogenic to humans) and 2-phenylphenol in Group 3 (not classiable as to its
carcinogenicity to humans), JMPR noted that the IARC classication is based on
hazard identication, not risk assessment, and is furthermore limited to published lit-
erature, excluding unpublished studies on toxicity and carcinogenicity. JMPR also
concluded that there are unresolved questions about the genotoxic potential of
2-phenylphenol.
A health-based value of 1 mg/litre can be calculated for 2-phenylphenol on the basis
of an ADI of 0.4 mg/kg of body weight, based on a NOAEL of 39 mg/kg of body weight
per day in a 2-year toxicity study for decreased body weight gain and hyperplasia of
the urinary bladder and carcinogenicity of the urinary bladder in male rats, using an
uncertainty factor of 100. Because of its low toxicity, however, the health-based value
derived for 2-phenylphenol is much higher than 2-phenylphenol concentrations likely
to be found in drinking-water. Under usual conditions, therefore, the presence of 2-
phenylphenol in drinking-water is unlikely to represent a hazard to human health.
For this reason, the establishment of a guideline value for 2-phenylphenol is not
deemed necessary.

2-phenylphenol, but the 1971 International Standards suggested that pesticide
bution to the total daily intake of pesticides for the population served. 2-Phenylphe-
nol was not evaluated in the rst edition of the Guidelines for Drinking-water Quality,
427
published in 1984, in the second edition, published in 1993, or in the addendum to

the second edition, published in 1998.
Assessment date
WHO (2003) 2-Phenylphenol and its sodium salt in drinking-water. Background docu-
12.102 Polynuclear aromatic hydrocarbons (PAHs)

PAHs form a class of diverse organic compounds each containing two or more fused
aromatic rings of carbon and hydrogen atoms. Most PAHs enter the environment via
the atmosphere from a variety of combustion processes and pyrolysis sources. Owing
to their low solubility and high afnity for particulate matter, they are not usually
found in water in notable concentrations. The main source of PAH contamination in
drinking-water is usually the coal-tar coating of drinking-water distribution pipes,
used to protect the pipes from corrosion. Fluoranthene is the most commonly
detected PAH in drinking-water and is associated primarily with coal-tar linings of
cast iron or ductile iron distribution pipes. PAHs have been detected in a variety of
foods as a result of the deposition of airborne PAHs and in sh from contaminated
waters. PAHs are also formed during some methods of food preparation, such as char-
broiling, grilling, roasting, frying or baking. For the general population, the major
routes of exposure to PAHs are from food and ambient and indoor air. The use of
open res for heating and cooking may increase PAH exposure, especially in devel-
oping countries. Where there are elevated levels of contamination by coal-tar coat-
ings of water pipes, PAH intake from drinking-water could equal or even exceed that
from food.
Guideline value for 0.0007 mg/litre (0.7 mg/litre)

benzo[a]pyrene (BaP)
Occurrence PAH levels in uncontaminated groundwater usually in range
05 ng/litre; concentrations in contaminated groundwater may exceed
10 mg/litre; typical concentration range for sum of selected PAHs in
drinking-water is from about 1 ng/litre to 11 mg/litre
428
Basis of guideline Based on an oral carcinogenicity study in mice and calculated using
derivation a two-stage birthdeath mutation model, which incorporates variable
dosing patterns and time of killing; quantication of doseresponse
for tumours, on the basis of new studies in which the carcinogenicity
of BaP was examined following oral administration in mice, but for
which the number of dose groups was smaller, conrms this value
Limit of detection 0.01 mg/litre by GC/MS and reverse-phase HPLC with a uorescence
detector
Additional comments The presence of signicant concentrations of BaP in drinking-water
in the absence of very high concentrations of uoranthene
indicates the presence of coal-tar particles, which may arise from
seriously deteriorating coal-tar pipe linings.
It is recommended that the use of coal-tar-based and similar
materials for pipe linings and coatings on storage tanks be
discontinued.
Evidence that mixtures of PAHs are carcinogenic to humans comes primarily from
occupational studies of workers following inhalation and dermal exposure. No data
are available for humans for the oral route of exposure. There are few data on the oral
toxicity of PAHs other than BaP, particularly in drinking-water. Relative potencies of
carcinogenic PAHs have been determined by comparison of data from dermal and
other studies. The order of potencies is consistent, and this scheme therefore provides
a useful indicator of PAH potency relative to BaP.
A health-based value of 4 mg/litre can be calculated for uoranthene on the
basis of a NOAEL of 125 mg/kg of body weight per day for increased serum gluta-
matepyruvate transaminase levels, kidney and liver pathology, and clinical and
haematological changes in a 13-week oral gavage study in mice, using an uncertainty
factor of 10 000 (100 for inter- and intraspecies variation, 10 for the use of a sub-
chronic study and inadequate database and 10 because of clear evidence of co-
carcinogenicity with BaP in mouse skin painting studies). However, this health-based
value is signicantly above the concentrations normally found in drinking-water.
Under usual conditions, therefore, the presence of uoranthene in drinking-water
does not represent a hazard to human health. For this reason, the establishment of a
guideline value for uoranthene is not deemed necessary.

PAHs. The 1971 International Standards stated that some PAHs are known to be
carcinogenic and that the concentrations of six representative PAH compounds
(uoranthene, 3,4-benzuoranthene, 11,12-benzuoranthene, 3,4-benzpyrene, 1,12-
benzpyrene and indeno [1,2,3-cd] pyrene) should therefore not, in general, exceed
0.0002 mg/litre. In the rst edition of the Guidelines for Drinking-water Quality,
429
published in 1984, the only PAH for which there was sufcient substantiated toxico-
logical evidence to set a guideline value was BaP. A health-based guideline value of
0.00001 mg/litre was recommended for BaP, while noting that the mathematical
model appropriate to chemical carcinogens that was used in its derivation involved
considerable uncertainty. It was also recommended that the control of PAHs in
drinking-water should be based on the concept that the levels found in unpolluted
groundwater should not be exceeded. The 1993 Guidelines concluded that there were
insufcient data available to derive drinking-water guidelines for PAHs other than
BaP. The guideline value for BaP, corresponding to an upper-bound excess lifetime
cancer risk of 10-5, was calculated to be 0.0007 mg/litre. This guideline value was
retained in the addendum to the second edition of the Guidelines, published in 1998,
as it was conrmed by new studies on the carcinogenicity of the compound. It was
also recommended that the use of coal-tar-based and similar materials for pipe linings
and coatings on storage tanks be discontinued. Although a health-based value for u-
oranthene was calculated in the addendum, it was signicantly above the concentra-
tions found in drinking-water, and it was concluded that, under usual conditions, the
presence of uoranthene in drinking-water does not represent a hazard to human
health; thus, the establishment of a guideline value for uoranthene was not deemed
necessary. As there are few data on the oral toxicity of other PAHs, particularly in
drinking-water, relative potencies of carcinogenic PAHs were determined by compar-
ison of data from dermal and other studies, which provides a useful indicator of PAH
potency relative to BaP.
Assessment date
Principal reference
WHO (2003) Polynuclear aromatic hydrocarbons in drinking-water. Background docu-
12.103 Propanil
Propanil (CAS No. 709-98-8) is a contact post-emergence herbicide used to control
broad-leaved and grassy weeds, mainly in rice. It is a mobile compound with afnity
for the water compartment. Propanil is not, however, persistent, being easily trans-
formed under natural conditions to several metabolites. Two of these metabolites,
3,4-dichloroaniline and 3,3,4,4-tetrachloroazobenzene, are more toxic and more per-
sistent than the parent compound. Although used in a number of countries, propanil
has only occasionally been detected in groundwater.
430
Although a health-based value for propanil can be derived, this has not been done,
because propanil is readily transformed into metabolites that are more toxic. There-
fore, a guideline value for the parent compound is considered inappropriate, and there
are inadequate data on the metabolites to allow the derivation of a guideline value for
them. Authorities should consider the possible presence in water of more toxic envi-
ronmental metabolites.

propanil, but the 1971 International Standards suggested that pesticide residues that
total daily intake of pesticides for the population served. Propanil was not evaluated
propanil in drinking-water, noting that in applying this guideline, authorities should
consider the possible presence of more toxic metabolites in water.
Assessment date
Principal reference
WHO (2003) Propanil in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/112).
12.104 Pyriproxyfen
Pyriproxyfen (CAS No. 95737-68-1) is a broad-spectrum insect growth regulator with
insecticidal activity against public health insect pests. It is a WHOPES-recommended
insecticide for the control of mosquito larvae. In agriculture and horticulture,
pyriproxyfen has registered uses for the control of scale, whitey, bollworm, jassids,
aphids and cutworms. Pyriproxyfen degrades rapidly in soil under aerobic conditions,
with a half-life of 6.436 days. It disappeared from aerobic lake watersediment
systems with half-lives of 16 and 21 days. Pyriproxyfen appeared to be degraded much
more slowly in anaerobic lake watersediment systems. As pyriproxyfen is a new pes-
ticide, few environmental data have been collected. Intake of pyriproxyfen from all
sources is generally low and below the ADI.
431

Occurrence No detectable concentrations found in surface water in the USA
ADI 0.1 mg/kg of body weight based on an overall NOAEL of 10 mg/kg of
body weight per day for increased relative liver weight and increased
total plasma cholesterol concentration in male dogs in two 1-year
toxicity studies, using an uncertainty factor of 100
Limit of detection No information found
Treatment achievability No data available; 1 mg/litre should be achievable using GAC
weight 60-kg adult
JMPR concluded that pyriproxyfen was not carcinogenic or genotoxic. In short- and
long-term studies of the effects of pyriproxyfen in mice, rats and dogs, the liver
(increases in liver weight and changes in plasma lipid concentrations, particularly cho-
lesterol) was the main toxicological target.

pyriproxyfen, but the 1971 International Standards suggested that pesticide residues
the total daily intake of pesticides for the population served. Pyriproxyfen was not
Assessment date
WHO (2003) Pyriproxyfen in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/113).
12.105 Selenium
Selenium is present in the Earths crust, often in association with sulfur-containing
minerals. Selenium is an essential trace element, and foodstuffs such as cereals, meat
432
and sh are the principal source of selenium in the general population. Levels in food
also vary greatly according to geographical area of production.

Occurrence Levels in drinking-water vary greatly in different geographical areas
but are usually much less than 0.01 mg/litre.
NOAEL in humans Estimated to be about 4 mg/kg of body weight per day, based on data
in which a group of 142 persons with a mean daily intake of 4 mg/kg
body weight showed no clinical or biochemical signs of selenium
toxicity
Limit of detection 0.5 mg/litre by AAS with hydride generation
Treatment achievability 0.01 mg/litre should be achievable using coagulation for selenium(IV)
removal; selenium(VI) is not removed by conventional treatment
processes
allocation to wate 10% of NOAEL
weight 60-kg adult
Selenium is an essential element for humans, with a recommended daily intake of
about 1 mg/kg of body weight for adults. Selenium compounds have been shown to
be genotoxic in in vitro systems with metabolic activation, but not in humans. There
was no evidence of teratogenic effects in monkeys. Long-term toxicity in rats is char-
acterized by depression of growth and liver pathology. In humans, the toxic effects of
long-term selenium exposure are manifested in nails, hair and liver. Data from China
indicate that clinical and biochemical signs occur at a daily intake above 0.8 mg. Daily
intakes of Venezuelan children with clinical signs were estimated to be about 0.7 mg
on the basis of their blood levels and the Chinese data on the relationship between
blood level and intake. Effects on synthesis of a liver protein were also seen in a small
group of patients with rheumatoid arthritis given selenium at a rate of 0.25 mg/day
in addition to selenium from food. No clinical or biochemical signs of selenium tox-
icity were reported in a group of 142 persons with a mean daily intake of 0.24 mg
(maximum 0.72 mg) from food.

The 1958 WHO International Standards for Drinking-water recommended a maxi-
mum allowable concentration of 0.05 mg/litre for selenium, based on health concerns.
In the 1963 International Standards, this value was lowered to 0.01 mg/litre, which was
retained in the 1971 International Standards as a tentative upper concentration limit,
while recognizing that selenium is an essential trace element for some species. In the
rst edition of the Guidelines for Drinking-water Quality, published in 1984, the guide-
line value of 0.01 mg/litre was again retained, although it was noted that in areas of
433
relatively higher or lower selenium dietary intake, the guideline value may have to be
modied accordingly. The 1993 Guidelines proposed a health-based guideline value
of 0.01 mg/litre on the basis of human studies.
Assessment date
Principal reference
WHO (2003) Selenium in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/13).
12.106 Silver
Silver occurs naturally mainly in the form of its very insoluble and immobile oxides,
suldes and some salts. It has occasionally been found in groundwater, surface water
and drinking-water at concentrations above 5 mg/litre. Levels in drinking-water
treated with silver for disinfection may be above 50 mg/litre. Recent estimates of daily
intake are about 7 mg per person.
Only a small percentage of silver is absorbed. Retention rates in humans and lab-
oratory animals range between 0 and 10%.
The only obvious sign of silver overload is argyria, a condition in which skin and
hair are heavily discoloured by silver in the tissues. An oral NOAEL for argyria in
humans for a total lifetime intake of 10 g of silver was estimated on the basis of human
case reports and long-term animal experiments.
The low levels of silver in drinking-water, generally below 5 mg/litre, are not rele-
vant to human health with respect to argyria. On the other hand, special situations
exist where silver salts may be used to maintain the bacteriological quality of
drinking-water. Higher levels of silver, up to 0.1 mg/litre (this concentration gives a
total dose over 70 years of half the human NOAEL of 10 g), could be tolerated in such
cases without risk to health.
There are no adequate data with which to derive a health-based guideline value for
silver in drinking-water.

refer to silver. In the rst edition of the Guidelines for Drinking-water Quality, pub-
lished in 1984, it was not considered necessary to establish a guideline value for silver
in drinking-water. No health-based guideline value for silver was proposed in the 1993
Guidelines. Where silver salts are used to maintain the bacteriological quality of
434
drinking-water, levels of silver up to 0.1 mg/litre can be tolerated without risk to

health.
Assessment date
Principal reference
WHO (2003) Silver in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/14).
12.107 Simazine
Simazine (CAS No. 122-34-9) is a pre-emergence herbicide used on a number of crops
as well as in non-crop areas. It is fairly resistant to physical and chemical dissipation
processes in the soil. It is persistent and mobile in the environment.

Occurrence Frequently detected in groundwater and surface water at
concentrations of up to a few micrograms per litre
weight from a long-term study in the rat (based on weight changes,
effects on haematological parameters and an increase in mammary
tumours) and an uncertainty factor of 1000 (100 for inter- and
intraspecies variation and 10 for possible non-genotoxic
carcinogenicity)
Limit of detection 0.01 mg/litre by GC/MS; 0.10.2 mg/litre by GC with ame thermionic
detection
weight 60-kg adult
Simazine does not appear to be genotoxic in mammalian systems. Recent studies have
shown an increase in mammary tumours in the female rat but no effects in the mouse.
IARC has classied simazine in Group 3.

simazine, but the 1971 International Standards suggested that pesticide residues that
435
total daily intake of pesticides for the population served. Simazine was not evaluated
simazine in drinking-water.
Assessment date
Principal reference
WHO (2003) Simazine in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/42).
12.108 Sodium
Sodium salts (e.g., sodium chloride) are found in virtually all food (the main source
of daily exposure) and drinking-water. Although concentrations of sodium in potable
water are typically less than 20 mg/litre, they can greatly exceed this in some coun-
tries. The levels of sodium salts in air are normally low in relation to those in food or
water. It should be noted that some water softeners can add signicantly to the sodium
content of drinking-water.
No rm conclusions can be drawn concerning the possible association between
sodium in drinking-water and the occurrence of hypertension. Therefore, no health-
based guideline value is proposed. However, concentrations in excess of 200 mg/litre
may give rise to unacceptable taste (see chapter 10).

refer to sodium. In the rst edition of the Guidelines for Drinking-water Quality, pub-
lished in 1984, it was concluded that there was insufcient evidence to justify a guide-
line value for sodium in water based on health risk considerations, but it was noted
that intake of sodium from drinking-water may be of greater signicance in persons
who require a sodium-restricted diet and bottle-fed infants. A guideline value of
200 mg/litre was established for sodium based on taste considerations. No health-
based guideline value was proposed for sodium in the 1993 Guidelines, as no rm
conclusions could be drawn concerning the possible association between sodium in
drinking-water and the occurrence of hypertension. However, concentrations in
excess of 200 mg/litre may give rise to unacceptable taste.
436
Assessment date
Principal reference
WHO (2003) Sodium in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/15).
12.109 Styrene
Styrene, which is used primarily for the production of plastics and resins, is found in
trace amounts in surface water, drinking-water and food. In industrial areas, expo-
sure via air can result in intake of a few hundred micrograms per day. Smoking may
increase daily exposure by up to 10-fold.

Occurrence Has been detected in drinking-water and surface water at
concentrations below 1 mg/litre
weight per day for decreased body weight observed in a 2- year
drinking-water study in rats, and using an uncertainty factor of 1000
(100 for inter- and intraspecies variation and 10 for the
carcinogenicity and genotoxicity of the reactive intermediate styrene-
7,8-oxide)
Limit of detection 0.3 mg/litre by GC with photoionization detection and conrmation by
MS
Treatment achievability 0.02 mg/litre may be achievable using GAC
weight 60-kg adult
Additional comments Styrene may affect the acceptability of drinking-water at the
guideline value.
Following oral or inhalation exposure, styrene is rapidly absorbed and widely dis-
tributed in the body, with a preference for lipid depots. It is metabolized to the active
intermediate styrene-7,8-oxide, which is conjugated with glutathione or further
metabolized. Metabolites are rapidly and almost completely excreted in urine. Styrene
has a low acute toxicity. In short-term toxicity studies in rats, impairment of glu-
tathione transferase activity and reduced glutathione concentrations were observed.
In in vitro tests, styrene has been shown to be mutagenic in the presence of metabolic
437
activation only. In in vitro as well as in in vivo studies, chromosomal aberrations have

been observed, mostly at high doses of styrene. The reactive intermediate styrene-7,8-
oxide is a direct-acting mutagen. In long-term studies, orally administered styrene
increased the incidence of lung tumours in mice at high dose levels but had no
carcinogenic effect in rats. Styrene-7,8-oxide was carcinogenic in rats after oral
administration. IARC has classied styrene in Group 2B. The available data suggest
that the carcinogenicity of styrene is due to overloading of the detoxication mecha-
nism for styrene-7,8-oxide (e.g., glutathione depletion).

refer to styrene. The 1993 Guidelines established a health-based guideline value of
0.02 mg/litre for styrene, noting that styrene may affect the acceptability of drinking-
water at this concentration.
Assessment date
Principal reference
WHO (2003) Styrene in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/27).
12.110 Sulfate
Sulfates occur naturally in numerous minerals and are used commercially, principally
in the chemical industry. They are discharged into water in industrial wastes and
through atmospheric deposition; however, the highest levels usually occur in ground-
water and are from natural sources. In general, the average daily intake of sulfate from
drinking-water, air and food is approximately 500 mg, food being the major source.
However, in areas with drinking-water supplies containing high levels of sulfate,
drinking-water may constitute the principal source of intake.
The existing data do not identify a level of sulfate in drinking-water that is likely
to cause adverse human health effects. The data from a liquid diet piglet study and
from tap water studies with human volunteers indicate a laxative effect at concentra-
tions of 10001200 mg/litre but no increase in diarrhoea, dehydration or weight loss.
No health-based guideline is proposed for sulfate. However, because of the gas-
trointestinal effects resulting from ingestion of drinking-water containing high sulfate
levels, it is recommended that health authorities be notied of sources of drinking-
water that contain sulfate concentrations in excess of 500 mg/litre. The presence of
438
sulfate in drinking-water may also cause noticeable taste (see chapter 10) and may
contribute to the corrosion of distribution systems.

tions of sulfate greater than 400 mg/litre would markedly impair the potability of the
allowable or permissible concentration. The rst two editions of the International Stan-
dards also suggested that concentrations of magnesium plus sodium sulfate in excess
of 1000 mg/litre would markedly impair drinking-water potability. In the rst edition
of the Guidelines for Drinking-water Quality, published in 1984, a guideline value of 400
mg/litre for sulfate was established, based on taste considerations. No health-based
guideline value for sulfate was proposed in the 1993 Guidelines. However, because of
the gastrointestinal effects resulting from ingestion of drinking-water containing high
sulfate levels, it was recommended that health authorities be notied of sources of
drinking-water that contain sulfate concentrations in excess of 500 mg/litre. The pres-
ence of sulfate in drinking-water may also cause noticeable taste at concentrations
above 250 mg/litre and may contribute to the corrosion of distribution systems.
Assessment date
Principal reference
WHO (2003) Sulfate in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/114).
12.111 2,4,5-T (2,4,5-Trichlorophenoxyacetic acid)

The half-lives for degradation of chlorophenoxy herbicides, including 2,4,5-T (CAS

TDI 3 mg/kg of body weight, based on a NOAEL of 3 mg/kg of body weight
for reduced body weight gain, increased liver and kidney weights and
renal toxicity in a 2-year study in rats, with an uncertainty factor of
1000 (100 for inter- and intraspecies variation and 10 to take into
consideration the suggested association between 2,4,5-T and soft
tissue sarcoma and non- Hodgkin lymphoma in epidemiological
studies)
439

weight 60-kg adult
on a threshold approach for other toxic effects. The NOAEL for reproductive effects
(reduced neonatal survival, decreased fertility, reduced relative liver weights and
thymus weights in litters) of dioxin-free (<0.03 mg/kg) 2,4,5-T in a three-generation
reproduction study in rats is the same as the NOAEL for reduced body weight gain,
increased liver and kidney weights and renal toxicity in a toxicity study in which rats
were fed 2,4,5-T (practically free from dioxin contamination) in the diet for 2 years.

chlorophenoxy herbicides, including 2,4,5-T, but the 1971 International Standards
served. 2,4,5-T was not evaluated in the rst edition of the Guidelines for Drinking-
guideline value of 0.009 mg/litre for 2,4,5-T.
Assessment date
Principal reference
12.112 Terbuthylazine (TBA)

TBA (CAS No. 5915-41-3), a herbicide that belongs to the chlorotriazine family, is
used in both pre- and post-emergence treatment of a variety of agricultural crops and
440
in forestry. Degradation of TBA in natural water depends on the presence of sedi-

ments and biological activity.

Occurrence Concentrations in water seldom exceed 0.2 mg/litre, although higher
concentrations have been observed.
weight for decreased body weight gain at the next higher dose in a 2-
year toxicity/carcinogenicity study in rats, with an uncertainty factor of
100 (for inter- and intraspecies variation)
Limit of detection 0.1 mg/litre by HPLC with UV detection
weight 60-kg adult
There is no evidence that TBA is carcinogenic or mutagenic. In long-term dietary
studies in rats, effects on red blood cell parameters in females, an increased incidence
of non-neoplastic lesions in the liver, lung, thyroid and testis and a slight decrease in
body weight gain were observed.

TBA, but the 1971 International Standards suggested that pesticide residues that may
lines for Drinking-water Quality, published in 1984, no guideline value for triazine her-
bicides, which include TBA, was recommended after a detailed evaluation of the
compounds. TBA was not evaluated in the second edition of the Guidelines for Drink-
ing-water Quality, published in 1993. In the addendum to the second edition of the
Guidelines, published in 1998, a health-based guideline value of 0.007 mg/litre was
derived for TBA in drinking-water.
Assessment date
441
Principal reference
WHO (2003) Terbuthylazine in drinking-water. Background document for preparation
(WHO/SDE/WSH/03.04/63).
12.113 Tetrachloroethene
Tetrachloroethene has been used primarily as a solvent in dry cleaning industries and
to a lesser extent as a degreasing solvent. It is widespread in the environment and is
found in trace amounts in water, aquatic organisms, air, foodstuffs and human tissue.
The highest environmental levels of tetrachloroethene are found in the commercial
dry cleaning and metal degreasing industries. Emissions can sometimes lead to high
concentrations in groundwater. Tetrachloroethene in anaerobic groundwater may
degrade to more toxic compounds, including vinyl chloride.

although much higher concentrations have been detected in well
water (23 mg/litre) and in contaminated groundwater (1 mg/litre).
TDI 14 mg/kg of body weight, based on hepatotoxic effects observed in a
6-week gavage study in male mice and a 90-day drinking-water study
in male and female rats, and taking into consideration carcinogenic
potential (but not the short length of the study, in view of the
database and considerations regarding the application of the dose via
drinking-water in one of the two critical studies)
Limit of detection 0.2 mg/litre by GC with ECD; 4.1 mg/litre by GC/MS
weight 60-kg adult
At high concentrations, tetrachloroethene causes central nervous system depression.
Lower concentrations of tetrachloroethene have been reported to damage the
liver and the kidneys. IARC has classied tetrachloroethene in Group 2A. Tetra-
chloroethene has been reported to produce liver tumours in male and female mice,
with some evidence of mononuclear cell leukaemia in male and female rats and kidney
tumours in male rats. The overall evidence from studies conducted to assess the geno-
toxicity of tetrachloroethene, including induction of single-strand DNA breaks, muta-
tion in germ cells and chromosomal aberrations in vitro and in vivo, indicates that
tetrachloroethene is not genotoxic.
442

refer to tetrachloroethene. In the rst edition of the Guidelines for Drinking-water
mended; the guideline was designated as tentative because, although the carcino-
genicity data did not justify a full guideline value, the compound was considered to
have important health implications when present in drinking-water. The 1993 Guide-
lines established a health-based guideline value of 0.04 mg/litre for tetrachloroethene.
Assessment date
Principal reference
WHO (2003) Tetrachloroethene in drinking-water. Background document for prepara-
12.114 Toluene
Most toluene (in the form of benzenetoluenexylene mixtures) is used in the blend-
ing of petrol. It is also used as a solvent and as a raw material in chemical production.
The main exposure is via air. Exposure is increased by smoking and in trafc.

Occurrence Concentrations of a few micrograms per litre have been found in
surface water, groundwater and drinking-water; point emissions can
lead to higher concentrations in groundwater (up to 1 mg/litre). It may
also penetrate plastic pipes from contaminated soil.
TDI 223 mg/kg of body weight, based on a LOAEL of 312 mg/kg of body
weight per day for marginal hepatotoxic effects observed in a 13-
week gavage study in mice, correcting for 5 days per week dosing and
using an uncertainty factor of 1000 (100 for inter- and intraspecies
variation and 10 for the short duration of the study and use of a
LOAEL instead of a NOAEL)
Limit of detection 0.13 mg/litre by GC with FID; 6 mg/litre by GC/MS
weight 60-kg adult
toluene in water.
443
Toluene is absorbed completely from the gastrointestinal tract and rapidly distributed
in the body, with a preference for adipose tissue. Toluene is rapidly metabolized and,
following conjugation, excreted predominantly in urine. With occupational exposure
to toluene by inhalation, impairment of the central nervous system and irritation of
mucous membranes are observed. The acute oral toxicity is low. Toluene exerts embry-
otoxic and fetotoxic effects, but there is no clear evidence of teratogenic activity in
laboratory animals and humans. In long-term inhalation studies in rats and mice,
there is no evidence for carcinogenicity of toluene. Genotoxicity tests in vitro were
negative, whereas in vivo assays showed conicting results with respect to chromoso-
mal aberrations. IARC has concluded that there is inadequate evidence for the car-
cinogenicity of toluene in both experimental animals and humans and classied it as
Group 3 (not classiable as to its carcinogenicity to humans).

refer to toluene. In the rst edition of the Guidelines for Drinking-water Quality, pub-
lished in 1984, no guideline value was recommended after a detailed evaluation of
the compound. The 1993 Guidelines established a health-based guideline value of
0.7 mg/litre for toluene, but noted that this value exceeds the lowest reported odour
threshold for toluene in water (0.024 mg/litre).
Assessment date
Principal reference
WHO (2003) Toluene in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/116).
12.115 Total dissolved solids (TDS)

TDS comprise inorganic salts (principally calcium, magnesium, potassium, sodium,
bicarbonates, chlorides and sulfates) and small amounts of organic matter that are
dissolved in water. TDS in drinking-water originate from natural sources, sewage,
urban runoff and industrial wastewater. Salts used for road de-icing in some coun-
tries may also contribute to the TDS content of drinking-water. Concentrations of
TDS in water vary considerably in different geological regions owing to differences in
the solubilities of minerals.
Reliable data on possible health effects associated with the ingestion of TDS in
drinking-water are not available, and no health-based guideline value is proposed.
However, the presence of high levels of TDS in drinking-water may be objectionable
to consumers (see chapter 10).
444

tions of total solids greater than 1500 mg/litre would markedly impair the potability
of the water. The 1963 and 1971 International Standards retained this value as a
lines for Drinking-water Quality, published in 1984, a guideline value of 1000 mg/litre
was established for TDS, based on taste considerations. No health-based guideline
value for TDS was proposed in the 1993 Guidelines, as reliable data on possible health
effects associated with the ingestion of TDS in drinking-water were not available.
However, the presence of high levels of TDS in drinking-water (greater than
1200 mg/litre) may be objectionable to consumers. Water with extremely low con-
centrations of TDS may also be unacceptable because of its at, insipid taste.
Assessment date
Principal reference
WHO (2003) Total dissolved solids in drinking-water. Background document for prepa-
12.116 Trichloroacetic acid


Occurrence Detected in US groundwater and surface water distribution systems at
mean concentrations of 5.3 mg/litre (range <1.080 mg/litre) and
16 mg/litre (range <1.0174 mg/litre), respectively; maximum
concentration (200 mg/litre) measured in chlorinated water in Australia
weight per day from a study in which decreased body weight,
increased liver serum enzyme activity and liver histopathology were
seen in rats exposed to trichloroacetate in drinking-water for 2 years,
incorporating an uncertainty factor of 1000 (100 for inter- and
intraspecies variation and 10 for database deciencies, including the
absence of a multigeneration reproductive study, the lack of a
developmental study in a second species and the absence of full
histopathological data in a second species)
445
Treatment achievability Trichloroacetic acid concentrations in drinking-water are generally

below 0.1 mg/litre. Concentrations may be reduced by installing or
optimizing coagulation to remove precursors and/or by controlling
the pH during chlorination.
weight 60-kg adult
Additional comments A similar TDI for trichloroacetate was established by IPCS based on a
NOAEL for hepatic toxicity in a long-term study in mice.
Trichloroacetic acid has been shown to induce tumours in the liver of mice. It has
given mixed results in in vitro assays for mutations and chromosomal aberrations and
has been reported to cause chromosomal aberrations in in vivo studies. IARC has clas-
sied trichloroacetic acid in Group 3, not classiable as to its carcinogenicity to
humans. The weight of evidence indicates that trichloroacetic acid is not a genotoxic
carcinogen.

refer to trichloroacetic acid. In the 1993 Guidelines, a provisional guideline value of
0.1 mg/litre was derived for trichloroacetic acid, with the provisional designation
because of the limitations of the available toxicological database and because there
were inadequate data to judge whether the guideline value was technically achievable.
It was emphasized that difculties in meeting the guideline value must never be a
reason for compromising adequate disinfection.
Assessment date
Principal reference
WHO (2003) Trichloroacetic acid in drinking-water. Background document for prepa-
12.117 Trichlorobenzenes (total)

Releases of trichlorobenzenes (TCBs) into the environment occur through their man-
ufacture and use as industrial chemicals, chemical intermediates and solvents. TCBs
are found in drinking-water, but rarely at levels above 1 mg/litre. General population
exposure will primarily result from air and food.
446
The TCBs are of moderate acute toxicity. After short-term oral exposure, all three
isomers show similar toxic effects, predominantly on the liver. Long-term toxicity and
carcinogenicity studies via the oral route have not been carried out, but the data avail-
able suggest that all three isomers are non-genotoxic.
A health-based value of 20 mg/litre can be calculated for total TCBs on the basis of
a TDI of 7.7 mg/kg of body weight, based on liver toxicity identied in a 13-week rat
study, taking into consideration the short duration of the study. However, because
TCBs occur at concentrations well below those at which toxic effects are observed, it
is not considered necessary to derive a health-based guideline value. It should be noted
that the health-based value exceeds the lowest reported odour threshold in water.

refer to TCBs. In the rst edition of the Guidelines for Drinking-water Quality, pub-
lished in 1984, it was concluded that insufcient health data were available from which
to derive a guideline value for 1,2,4-TCB. The 1993 Guidelines proposed a health-
based guideline value of 0.02 mg/litre for total TCBs, because of the similarity in the
toxicity of the three isomers, but noted that this value exceeds the lowest reported
odour threshold in water (0.005 mg/litre for 1,2,4-TCB).
Assessment date
Principal reference
WHO (2003) Trichlorobenzenes in drinking-water. Background document for prepara-
12.118 1,1,1-Trichloroethane
1,1,1-Trichloroethane is widely used as a cleaning solvent for electrical equipment, as
a solvent for adhesives, coatings and textile dyes and as a coolant and lubricant. It is
found mainly in the atmosphere, although it is mobile in soils and readily migrates
to groundwaters. 1,1,1-Trichloroethane has been found in only a small proportion of
surface waters and groundwaters, usually at concentrations of less than 20 mg/litre;
higher concentrations (up to 150 mg/litre) have been observed in a few instances. There
appears to be increasing exposure to 1,1,1-trichloroethane from other sources.
1,1,1-Trichloroethane is rapidly absorbed from the lungs and gastrointestinal tract,
but only small amounts about 6% in humans and 3% in experimental animals
are metabolized. Exposure to high concentrations can lead to hepatic steatosis (fatty
liver) in both humans and laboratory animals. In a well conducted oral study in mice
and rats, effects included reduced liver weight and changes in the kidney consistent
447
with hyaline droplet neuropathy. IARC has placed 1,1,1-trichloroethane in Group 3.

1,1,1-Trichloroethane does not appear to be mutagenic.
A health-based value of 2 mg/litre can be calculated for 1,1,1-trichloroethane on
the basis of a TDI of 0.6 mg/kg of body weight, based on changes in the kidney that
were consistent with hyaline droplet nephropathy observed in a 13-week oral study
in male rats, and taking into account the short duration of the study. However, because
1,1,1-trichloroethane occurs at concentrations well below those at which toxic effects
are observed, it is not considered necessary to derive a guideline value.

refer to 1,1,1-trichloroethane. In the rst edition of the Guidelines for Drinking-water
Quality, published in 1984, no guideline value was recommended after a detailed eval-
uation of the compound. The 1993 Guidelines proposed a provisional guideline value
of 2 mg/litre for 1,1,1-trichloroethane. The value was provisional because it was based
on an inhalation study rather than an oral study. It was strongly recommended that
an adequate oral toxicity study be conducted to provide more acceptable data for the
derivation of a guideline value.
Assessment date
Principal reference
WHO (2003) 1,1,1-Trichloroethane in drinking-water. Background document for prepa-
12.119 Trichloroethene
Trichloroethene is used mainly in dry cleaning and metal degreasing operations. Its
use in industrialized countries has declined sharply since 1970. It is released mainly
to the atmosphere but may be introduced into surface water and groundwater in
industrial efuents. It is expected that exposure to trichloroethene from air will be
greater than that from food or drinking-water. Trichloroethene in anaerobic ground-
water may degrade to more toxic compounds, including vinyl chloride.

deciencies in the toxicological database.
Occurrence Found mostly in groundwater from which it is not lost to air; mean
concentration of 2.1 mg/litre in a survey of drinking- water; also
present in 24% of 158 non-random samples collected in a
groundwater supply survey at a median level of 1 mg/litre and a
maximum of 130 mg/litre
448
TDI 23.8 mg/kg of body weight (including allowance for 5 days per week
dosing), based on a LOAEL of 100 mg/kg of body weight per day for
minor effects on relative liver weight in a 6-week study in mice, using
an uncertainty factor of 3000 (100 for intra- and interspecies variation,
10 for limited evidence of carcinogenicity and 3 in view of the short
duration of the study and the use of a LOAEL rather than a NOAEL)
Limit of detection 0.037 mg/litre by capillary GC with ECD; 0.12 mg/litre by purge-and-trap
packed column GC with ECD or microcoulometric detector; 0.2 mg/litre
by purge-and-trap packed column GC/MS
weight 60-kg adult
The reactive epoxide trichloroethene oxide is an essential feature of the metabolic
pathway. Trichloroethene has been classied by IARC in Group 3. It has been shown
to induce lung and liver tumours in various strains of mice at toxic doses. However,
there are no conclusive data to suggest that this chemical causes cancer in other
species. Trichloroethene is a weakly active mutagen in bacteria and yeast.

refer to trichloroethene. In the rst edition of the Guidelines for Drinking-water
mended; the guideline was designated as tentative because, although carcinogenicity
was observed in one species only, the compound occurs relatively frequently in
drinking-water. The 1993 Guidelines established a provisional health-based guideline
value of 0.07 mg/litre for trichloroethene. The value was provisional because an uncer-
tainty factor of 3000 was used in its derivation.
Assessment date
Principal reference
WHO (2003) Trichloroethene in drinking-water. Background document for preparation
(WHO/SDE/WSH/03.04/22).
449
12.120 Triuralin
Triuralin (CAS No. 1582-09-8) is a pre-emergence herbicide used in a number of
crops. It has low water solubility and a high afnity for soil. However, biodegradation
and photodegradation processes may give rise to polar metabolites that may contam-
inate drinking-water sources. Although this compound is used in many countries, rel-
atively few data are available concerning contamination of drinking-water.

Occurrence Not detected in the small number of drinking-water samples analysed;
has been detected in surface water at concentrations above
0.5 mg/litre and rarely in groundwater
weight for mild hepatic effects in a 1-year feeding study in dogs, with
an uncertainty factor of 100 (for inter- and intraspecies variation)
Limit of detection 0.05 mg/litre by GC with nitrogenphosphorus detection
weight 60-kg adult
Additional comments Authorities should note that some impure technical grades of
triuralin could contain potent carcinogenic compounds and
therefore should not be used.
Triuralin of high purity does not possess mutagenic properties. Technical triuralin
of low purity may contain nitroso contaminants and has been found to be mutagenic.
No evidence of carcinogenicity was demonstrated in a number of long-term toxic-
ity/carcinogenicity studies with pure (99%) test material. IARC recently evaluated
technical-grade triuralin and assigned it to Group 3.

triuralin, but the 1971 International Standards suggested that pesticide residues that
total daily intake of pesticides for the population served. Triuralin was not evaluated
the 1993 Guidelines established a health-based guideline value of 0.02 mg/litre for tri-
uralin in drinking-water, noting that authorities should be aware that some impure
technical grades of triuralin could contain potent carcinogenic compounds and
therefore should not be used.
450
Assessment date
Principal reference
WHO (2003) Triuralin in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/43).
12.121 Trihalomethanes (bromoform, bromodichloromethane,

dibromochloromethane, chloroform)
Trihalomethanes (THMs) are generated principally as by-products of the chlorina-
tion of drinking-water, being formed from naturally occurring organic compounds.
Hypochlorous acid oxidizes bromide ion to form hypobromous acid, which reacts
with endogenous organic materials (e.g., humic or fulvic acids) to form brominated
THMs. The amount of each THM formed depends on the temperature, pH and chlo-
rine and bromide ion concentrations. It is assumed that most THMs present in water
are ultimately transferred to air as a result of their volatility. For chloroform, for
example, individuals may be exposed during showering to elevated concentrations
from chlorinated tap water. Based on estimates of mean exposure from various media,
the general population is exposed to chloroform principally in food, drinking-water
and indoor air, in approximately equivalent amounts.
Guideline values
Chloroform 0.2 mg/litre
Bromoform 0.1 mg/litre
Dibromochloromethane 0.1 mg/litre
(DBCM)
Bromodichloromethane 0.06 mg/litre
(BDCM)
Occurrence THMs are rarely found in raw water but are often present in nished
water; concentrations are generally below 100 mg/litre. In most
circumstances, chloroform is the dominant compound.
TDIs
Chloroform 13 mg/kg of body weight, based on slight hepatotoxicity (increases in
hepatic serum enzymes and fatty cysts) observed in beagle dogs
ingesting 15 mg of chloroform per kg of body weight per day in
toothpaste for 7.5 years, incorporating an uncertainty factor of 1000
(100 for inter- and intraspecies variation and 10 for use of a LOAEL
rather than a NOAEL and a subchronic study) and correcting for 6 days
per week dosing
451
Bromoform 17.9 mg/kg of body weight, based on the absence of histopathological

lesions in the liver in a well conducted and well documented 90-day
study in rats, using an uncertainty factor of 1000 (100 for intra- and
interspecies variation and 10 for possible carcinogenicity and short
duration of exposure)
DBCM 21.4 mg/kg of body weight, based on absence of histopathological
effects in the liver in a well conducted and well documented 90-day
study in rats, using an uncertainty factor of 1000 (100 for intra- and
interspecies variation and 10 for the short duration of the study); an
additional uncertainty factor for potential carcinogenicity was not
applied because of the questions regarding mouse liver tumours from
corn oil vehicles and inconclusive evidence of genotoxicity
Basis of guideline Application of the linearized multistage model for the
derivation for BDCM observed increases in incidence of kidney tumours in male mice
observed in an NTP bioassay, as these tumours yield the most
protective value (guideline value is supported by a recently published
feeding study in rats that was not available for full evaluation)
Limit of detection 0.1 mg/litre by GC with ECD; 2.2 mg/litre by GC/MS
Treatment achievability Concentrations of chloroform, bromoform, BDCM and DBCM in
drinking-water are generally <0.05 mg/litre. Concentrations can be
reduced by changes to disinfection practice (reducing organic THM
precursors) or using air stripping.
allocation to water 20% of TDI for bromoform and DBCM
50% of TDI for chloroform (based on estimates indicating that the
general population is exposed to chloroform principally in food,
drinking-water and indoor air in approximately equivalent amounts
and that most of the chloroform in indoor air is present as a result of
volatilization from drinking-water)
weight 60-kg adult
Additional comments For authorities wishing to establish a total THM standard to account
for additive toxicity, the following fractionation approach could be
taken:
Cbromoform C C C
+ DBCM + BDCM + chloroform 1
GVbromoform GVDBCM GVBDCM GVchloroform
where C = concentration and GV = guideline value.
It is emphasized that adequate disinfection should never be
compromised in attempting to meet guidelines for THMs.
Chloroform
The weight of evidence for genotoxicity of chloroform is considered negative. The
weight of evidence for liver tumours in mice is consistent with a threshold mecha-
nism of induction. Although it is plausible that kidney tumours in rats may similarly
be associated with a threshold mechanism, there are some limitations of the database
452
in this regard. The most universally observed toxic effect of chloroform is damage
to the centrilobular region of the liver. The severity of these effects per unit dose
administered depends on the species, vehicle and method by which the chloroform is
administered.
Bromoform
In an NTP bioassay, bromoform induced a small increase in relatively rare tumours
of the large intestine in rats of both sexes but did not induce tumours in mice. Data
from a variety of assays on the genotoxicity of bromoform are equivocal. IARC has
classied bromoform in Group 3 (not classiable as to its carcinogenicity to humans).
Dibromochloromethane
In an NTP bioassay, DBCM induced hepatic tumours in female and possibly in male
mice but not in rats. The genotoxicity of DBCM has been studied in a number of
assays, but the available data are considered inconclusive. IARC has classied DBCM
in Group 3 (not classiable as to its carcinogenicity to humans).
Bromodichloromethane
IARC has classied BDCM in Group 2B (possibly carcinogenic to humans). BDCM
gave both positive and negative results in a variety of in vitro and in vivo genotoxic-
ity assays. In an NTP bioassay, BDCM induced renal adenomas and adenocarcinomas
in both sexes of rats and male mice, rare tumours of the large intestine (adenoma-
tous polyps and adenocarcinomas) in both sexes of rats and hepatocellular adenomas
and adenocarcinomas in female mice.

refer to THMs. In the rst edition of the Guidelines for Drinking-water Quality, pub-
lished in 1984, no guideline values for THMs other than chloroform were recom-
mended after a detailed evaluation of the compounds. A health-based guideline value
of 0.03 mg/litre was established for chloroform only, as few data existed for the
remaining THMs and, for most water supplies, chloroform was the most commonly
encountered member of the group. It was noted that the guideline value for chloro-
form was obtained using a linear multistage extrapolation of data obtained from male
rats, a mathematical model appropriate to chemical carcinogens that involves con-
siderable uncertainty. It was also mentioned that although the available toxicological
data were useful in establishing a guideline value for chloroform only, the concentra-
tions of the other THMs should also be minimized. Limits ranging from 0.025 to 0.25
mg/litre, which represent a balance between the levels that can be achieved given
certain circumstances and those that are desirable, have been set in several countries
for the sum of bromoform, DBCM, BDCM and chloroform. In the 1993 Guidelines,
no guideline value was set for total THMs, but guideline values were established sep-
453
arately for all four THMs. Authorities wishing to establish a total THM standard to
account for additive toxicity could use a fractionation approach in which the sum of
the ratios of each of the four THMs to their respective guideline values is less than 1.
The 1993 Guidelines established health-based guideline values of 0.1 mg/litre for both
bromoform and DBCM. Guideline values of 0.06 mg/litre for BDCM and 0.2 mg/litre
for chloroform, associated with an upper-bound excess lifetime cancer risk of 10-5,
were also recommended. The guideline value of 0.2 mg/litre for chloroform was
retained in the addendum to the second edition of the Guidelines, published in 1998,
but was developed on the basis of a TDI for threshold effects.
Assessment date
The risk assessments were originally conducted in 1993 and 1998 (for chloroform).
The Final Task Force Meeting in 2003 agreed that these risk assessments be brought
forward to this edition of the Guidelines for Drinking-water Quality.
Principal reference
WHO (2003) Trihalomethanes in drinking-water. Background document for prepara-
12.122 Uranium
Uranium is widespread in nature, occurring in granites and various other mineral
deposits. Uranium is used mainly as fuel in nuclear power stations. Uranium is present
in the environment as a result of leaching from natural deposits, release in mill tail-
ings, emissions from the nuclear industry, the combustion of coal and other fuels and
the use of phosphate fertilizers that contain uranium. Intake of uranium through air
is low, and it appears that intake through food is between 1 and 4 mg/day. Intake
through drinking-water is normally extremely low; however, in circumstances in
which uranium is present in a drinking-water source, the majority of intake can be
through drinking-water.

outstanding uncertainties regarding the toxicology and epidemiology
of uranium as well as difculties concerning its technical achievability
in smaller supplies.
Occurrence Levels in drinking-water are generally less than 1 mg/litre, although
concentrations as high as 700 mg/litre have been measured in private
supplies.
454
TDI 0.6 mg/kg of body weight per day, based on the application of an
uncertainty factor of 100 (for inter- and intraspecies variation) to a
LOAEL (equivalent to 60 mg of uranium per kg of body weight per day)
for degenerative lesions in the proximal convoluted tubule of the
kidney in male rats in a 91-day study in which uranyl nitrate
hexahydrate was administered in drinking-water. It was considered
unnecessary to apply an additional uncertainty factor for the use of a
LOAEL instead of a NOAEL and the short length of the study because
of the minimal degree of severity of the lesions and the short half-life
of uranium in the kidney, with no indication that the severity of the
renal lesions will be exacerbated following continued exposure. This is
supported by data from epidemiological studies.
Limit of detection 0.01 mg/litre by ICP/MS; 0.1 mg/litre by solid uorimetry with either
laser excitation or UV light; 0.2 mg/litre by ICP using adsorption with
chelating resin
Treatment 1 mg/litre should be achievable using conventional treatment, e.g.,
achievability coagulation or ion exchange
allocation to water 80% of TDI (because intake from other sources is low in most areas)
weight 60-kg adult
Additional comments The data on intake from food in most areas suggest that intake
from food is low and support the higher allocation to drinking-
water. In some regions, exposure from sources such as soil may be
higher and should be taken into account in setting national or
local standards.
The concentration of uranium in drinking-water associated with
the onset of measurable tubular dysfunction remains uncertain, as
does the clinical signicance of the observed changes at low
exposure levels. A guideline value of up to 30 mg/litre may be
protective of kidney toxicity because of uncertainty regarding the
clinical signicance of changes observed in epidemiological
studies.
Only chemical, not radiological, aspects of uranium toxicity have
been addressed here.
A document on depleted uranium, which is a by-product of natural
uranium, is available.
There are insufcient data regarding the carcinogenicity of uranium in humans and
experimental animals. Nephritis is the primary chemically induced effect of uranium
in humans. Little information is available on the chronic health effects of exposure to
environmental uranium in humans. A number of epidemiological studies of popula-
tions exposed to uranium in drinking-water have shown a correlation with alkaline
phosphatase and b-microglobulin in urine along with modest alterations in proximal
tubular function. However, the actual measurements were still within the normal
physiological range.
455

uranium. The 1971 International Standards stated that uranium should be controlled
in drinking-water, but that insufcient information was available to enable a tenta-
tive limit to be established. In the rst edition of the Guidelines for Drinking-water
Quality, published in 1984, it was concluded that no action was required for uranium.
A health-based guideline value for uranium was not derived in the 1993 Guidelines,
as adequate short- and long-term studies on the chemical toxicity of uranium were
not available. Until such information became available, it was recommended that the
limits for radiological characteristics of uranium be used. The equivalent for natural
uranium, based on these limits, is approximately 0.14 mg/litre. In the addendum to
the Guidelines, published in 1998, a health-based guideline value of 0.002 mg/litre was
established. This guideline value was designated as provisional, because it may be dif-
cult to achieve in areas with high natural uranium levels with the treatment tech-
nology available and because of limitations in the key study. It was noted that several
human studies are under way that may provide helpful additional data.
Assessment date
Principal reference
WHO (2003) Uranium in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/118).
12.123 Vinyl chloride

Vinyl chloride is used primarily for the production of PVC. Owing to its high volatil-
ity, vinyl chloride has rarely been detected in surface waters, except in contaminated
areas. Unplasticized PVC is increasingly being used in some countries for water mains
supplies. Migration of vinyl chloride monomer from unplasticized PVC is a possible
source of vinyl chloride in drinking-water. It appears that inhalation is the most
important route of vinyl chloride intake, although drinking-water may contribute
a substantial portion of daily intake where PVC piping with a high residual content
of vinyl chloride monomer is used in the distribution network. Vinyl chloride has
been reported in groundwater as a degradation product of the chlorinated solvents
trichloroethene and tetrachloroethene.
456

Occurrence Rarely detected in surface waters, the concentrations measured
generally not exceeding 10 mg/litre; much higher concentrations
found in groundwater and well water in contaminated areas;
concentrations up to 10 mg/litre detected in drinking-water
Basis for guideline Application of a linear extrapolation by drawing a straight line
derivation between the dose, determined using a pharmocokinetic model,
resulting in tumours in 10% of animals in rat bioassays involving oral
exposure and the origin (zero dose), determining the value associated
with the upper-bound risk of 10-5 and assuming a doubling of the risk
for exposure from birth
Limit of detection 0.01 mg/litre by GC with ECD or FID with MS for conrmation
Additional comments The results of the linear extrapolation are nearly identical to those
derived using the linearized multistage model.
As vinyl chloride is a known human carcinogen, exposure to this
compound should be avoided as far as practicable, and levels
should be kept as low as technically feasible.
Vinyl chloride is primarily of concern as a potential contaminant
from some grades of PVC pipe and is best controlled by
specication of material quality.
There is sufcient evidence of the carcinogenicity of vinyl chloride in humans from
industrial populations exposed to high concentrations via the inhalation route, and
IARC has classied vinyl chloride in Group 1. Studies of workers employed in the
vinyl chloride industry have shown a marked exposureresponse for all liver cancers,
angiosarcomas and hepatocellular carcinoma, but no strong relationship between
cumulative vinyl chloride exposure and other cancers. Animal data show vinyl chlo-
ride to be a multisite carcinogen. When administered orally or by inhalation to mice,
rats and hamsters, it produced tumours in the mammary gland, lungs, Zymbal gland
and skin, as well as angiosarcomas of the liver and other sites. Evidence indicates that
vinyl chloride metabolites are genotoxic, interacting directly with DNA. DNA adducts
formed by the reaction of DNA with a vinyl chloride metabolite have also been iden-
tied. Occupational exposure has resulted in chromosomal aberrations, micronuclei
and sister chromatid exchanges; response levels were correlated with exposure levels.

refer to vinyl chloride. In the rst edition of the Guidelines for Drinking-water Quality,
published in 1984, no guideline value was recommended, because the occurrence of
vinyl chloride in water seemed to be associated primarily with the use of poorly
polymerized PVC water pipes, a problem that was more appropriately controlled
by product specication. The 1993 Guidelines calculated a guideline value of
457
0.005 mg/litre for vinyl chloride based on an upper-bound excess lifetime cancer risk
of 10-5.
Assessment date
IPCS (1999) Vinyl chloride. Geneva, World Health Organization, International Pro-
gramme on Chemical Safety (Environmental Health Criteria 215).
WHO (2003) Vinyl chloride in drinking-water. Background document for preparation
(WHO/SDE/WSH/03.04/119).
12.124 Xylenes
Xylenes are used in blending petrol, as a solvent and as a chemical intermediate. They
are released to the environment largely via air. Exposure to xylenes is mainly from air,
and exposure is increased by smoking.

Occurrence Concentrations of up to 8 mg/litre have been reported in surface water,
groundwater and drinking-water; levels of a few milligrams per litre
were found in groundwater polluted by point emissions. Xylenes can
also penetrate plastic pipe from contaminated soil.
TDI 179 mg/kg of body weight, based on a NOAEL of 250 mg/kg of body
weight per day for decreased body weight in a 103- week gavage
study in rats, correcting for 5 days per week dosing and using an
and 10 for the limited toxicological end-points)
Limit of detection 0.1 mg/litre by GC/MS; 1 mg/litre by GC with FID
weight 60-kg adult
xylenes in drinking-water.
Xylenes are rapidly absorbed by inhalation. Data on oral exposure are lacking. Xylenes
are rapidly distributed in the body, predominantly in adipose tissue. They are almost
completely metabolized and excreted in urine. The acute oral toxicity of xylenes is
low. No convincing evidence for teratogenicity has been found. Long-term carcino-
458
genicity studies have shown no evidence for carcinogenicity. In vitro as well as in vivo
mutagenicity tests have proved negative.

refer to xylenes. The 1993 Guidelines proposed a health-based guideline value of 0.5
mg/litre for xylenes, noting that this value exceeds the lowest reported odour thresh-
old for xylenes in drinking-water (0.02 mg/litre).
Assessment date
Principal reference
WHO (2003) Xylenes in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/25).
12.125 Zinc
Zinc is an essential trace element found in virtually all food and potable water in the
form of salts or organic complexes. The diet is normally the principal source of zinc.
Although levels of zinc in surface water and groundwater normally do not exceed 0.01
and 0.05 mg/litre, respectively, concentrations in tap water can be much higher as a
result of dissolution of zinc from pipes.
In 1982, JECFA proposed a PMTDI for zinc of 1 mg/kg of body weight. The daily
requirement for adult men is 1520 mg/day. It was considered that, taking into account
recent studies on humans, the derivation of a guideline value is not required at this
time. However, drinking-water containing zinc at levels above 3 mg/litre may not be
acceptable to consumers (see chapter 10).

tions of zinc greater than 15 mg/litre would markedly impair the potability of the
allowable or permissible concentration. In the rst edition of the Guidelines for Drink-
for zinc, based on taste considerations. The 1993 Guidelines concluded that, taking
into account recent studies on humans, the derivation of a guideline value was not
required at this time. However, drinking-water containing zinc at levels above
3 mg/litre may not be acceptable to consumers.
459
Assessment date
Principal reference
WHO (2003) Zinc in drinking-water. Background document for preparation of
(WHO/SDE/WSH/03.04/17).
460
ANNEX 1
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466
ANNEX 2
Contributors to the development of the

third edition of the Guidelines on
drinking-water quality
Mr M. Abbaszadegan, (21: iv), American Water Works Services Inc., Belleville, IL, USA
Dr M. Abdulraheem, (9), United Nations Environment Programme, Manama,
Bahrain
Dr H. Abouzaid, (1, 7, 9, 15, 23, 25, 27), WHO, Regional Ofce for the Eastern Mediter-
ranean, Cairo, Egypt
Mr R. Abrams, (19), WHO, Regional Ofce for the Western Pacic, Manila,
Philippines
Mr J. Adams, (5), (formerly of Oxfam, Oxford, UK)
Dr Z. Adeel, (15), The United Nations University, Tokyo, Japan
Mr M. Adriaanse, (5), United Nations Environment Programme, The Hague,
Netherlands
Mr R. Aertgeerts, (7, 15, 23, 25, 27), European Centre for Environment and Health,
Rome, Italy
Dr R. Ainsworth, (12, 20, 23, 25), Water Science and Technology, Bucklebury, UK
Dr A. Aitio, (26), WHO, Geneva, Switzerland
Ms M. Al Alili, (9), Abu Dhabi Water and Electricity Authority, Abu Dhabi, United
Arab Emirates
Dr F. Al Awadhi, (9), United Nations Environment Programme, Bahrain, and Regional
Organization for the Protection of the Marine Environment, Kuwait
Dr M.M.Z. Al-Ghali, (21), Ministry of Health, Damascus, Syria
Dr B. Ali, (27), Kwame Nkrumah University of Science and Technology, Kumasi,
Ghana
Dr M. Ali, (27), Water, Engineering and Development Centre, Loughborough Uni-
versity, Loughborough, UK
Dr A. Ali Alawadhi, (9), Ministry of Electricity and Water, Manama, Bahrain
Mr M. Al Jabri, (9), Ministry of Regional Municipalities, Environment and Water
Resources, Muscat, Oman
Dr A. Allen, (27), University of York, Ireland
Dr M. Allen, (14), American Water Works Association, Denver, CO, USA
Mr H. Al Motairy, (9), Ministry of Defence and Aviation, Jeddah, Saudi Arabia
467
Ms E. Al Nakhi, (9), Abu Dhabi Water and Electricity Authority, Abu Dhabi, United
Arab Emirates
Dr M. Al Rashed, (9), Kuwait Institute for Scientic Research, Safat, Kuwait
Mr M. Al So, (9), House of Soa, Al Khobar, Saudi Arabia
Dr M. Al Sulaiti, (9), Qatar Electricity and Water Corporation, Doha, Qatar
Dr S. Ambu, (11), Ministry of Health, Kuala Lumpur, Malaysia
American Chemistry Council, (19), Washington, DC, USA
Ms Y. Andersson, (6), Swedish Institute for Infectious Disease Control, Solna, Sweden
Dr M. Ando, (15), Ministry of Health, Labour and Welfare, Tokyo, Japan
Dr M. Asami, (11, 15), National Institute of Public Health, Tokyo, Japan
Dr N. Ashbolt, (6, 8, 13, 14, 23, 28), University of New South Wales, Sydney, Australia
Ms K. Asora, (10), Samoa Water Supply, Apia, Samoa
Dr K.-K. Au, (24), Greeley and Hansen, Limited Liability Company, Chicago, USA
Dr S. Azevedo, (29), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
Dr L. Backer, (19), National Center for Environmental Health, Atlanta, USA
Mr D. Bahadur Shrestha, (15), Department of Water Supply and Sewerage, Kath-
mandu, Nepal
Dr K. Bailey, (5), WRc-NSF Ltd, Marlow, UK (now retired)
Dr H. Bakir, (9), Centre for Environmental Health Activities, Amman, Jordan
Dr G. Ball, (3), NSF International, Ann Arbor, MI, USA
Dr M. Balonov, (20), International Atomic Energy Agency, Vienna, Austria
Mr R. Bannerman, (27), Water Resources Consultancy Service, Accra, Ghana
Dr J. Bartram, (1, 2, 3, 4, 5, 6, 7, 8, 9, 12, 13, 14, 15, 16, 18, 19: xiiilii, livlxviii, 21:
iv, 22, 23, 24, 25, 29), WHO, Geneva, Switzerland
Dr A. Basaran, (10, 11, 12, 15, 25), WHO, Regional Ofce for the Western Pacic,
Manila, Philippines
Dr A. Bathija, (19: xxvi), US Environmental Protection Agency, Washington, DC, USA
Mr U. Bayar, (11), State Inspectorate for Health, Ulaanbaatar, Mongolia
Mr G. Bellen, (2), NSF International, Ann Arbor, MI, USA
Dr R. Belmar, (15), Ministry of Health of Chile, Santiago, Chile
Dr R. Bentham, (16), Department of Environmental Health, Adelaide, Australia
Dr K. Bentley, (4), Centre for Environmental Health, Woden, Australia
Mrs U. Bera, (10), Ministry of Health, Suva, Fiji
Dr P. Berger, (21: iv, 27), US Environmental Protection Agency, Washington, DC, USA
Dr U. Blumenthal, (6, 28), London School of Hygiene and Tropical Medicine, London,
UK
Dr A. Boehncke, (19: vii), Fraunhofer Institute of Toxicology and Experimental Med-
icine, Hanover, Germany
Ms E. Bolt, (27), International Research Centre on Water and Sanitation, Delft,
Netherlands
Dr L. Bonadonna, (14, 21: i), Istituto Superiore di Sanit, Rome, Italy
468
ANNEX 2. CONTRIBUTORS TO THE DEVELOPMENT OF THE THIRD EDITION
Dr X. Bonnefoy, (19: xii, liii, lxix), WHO European Center for Environment and
Health, Bonn, Germany (formerly of WHO Regional Ofce for Europe, Copen-
hagen, Denmark)
Mr L. Bontoux, (6), European Commission, Brussels, Belgium
Ms T. Boonyakarnkul, (8, 12, 15, 22, 25), Ministry of Public Health, Nonthaburi,
Thailand
Professor K. Botzenhart, (5, 16, 21: iii), Tuebingen University, Tuebingen, Germany
Dr L. Bowling, (29), Department of Land and Water Conservation, Parramatta,
Australia
Dr E. Briand, (16), Centre Scientique et Technique du Btiment, Marne-la Valle,
France
Dr S. Bumaa, (11), Health Inspection Services, Ulaanbaatar, Mongolia
Mr M. Burch, (8, 29), Australian Water Quality Centre, Salisbury, Australia
Dr T. Burns, (19), The Vinyl Institute, Inc., Arlington, VA, USA
Professor D. Bursill, (8), Australian Water Quality Centre, Salisbury, Australia
Dr J. Butler, (21: iii), Centers for Disease Control and Prevention, Atlanta, GA, USA
Dr P. Byleveld, (10), New South Wales Department of Health, Gladesville, Australia
Mr P. Callan, (7, 8, 13, 15, 17, 19: xiiilii, livlxviii, 22, 25), National Health and
Medical Research Council, Canberra, Australia
Professor G. Cangelosi, (18), Seattle Biomedical Research Institute, Seattle, USA
Professor W. Carmichael, (29), Wright State University, Ohio, USA
Mr R. Carr, (23), WHO, Geneva, Switzerland
Dr R. Carter, (27), Craneld University, Silsoe, UK
Dr C. Castell-Exner, (27), The German Technical and Scientic Association for Gas
and Water, Bonn, Germany
Dr M. Cavalieri, (29), Local Agency for Electricity and Water Supply, Rome, Italy
Dr R. Chalmers, (26), Public Health Laboratory Service, Swansea, UK
Dr K. Chambers, (23), WRc-NSF Ltd, Swindon, UK
Professor P. Chambon, (1, 4, 19: ixii), University of Lyon, Lyon, France,
Mr C.K.R. Chan, (11), Shatin Treatment Works, Shatin, Hong Kong, Special Admin-
istrative Region of China
Mr S. Chantaphone, (11), Ministry of Health, Ventiane, Lao Peoples Democratic
Republic
Dr D. Chapman, (29), Cork, Ireland
Mr G.P.R. Chaney, (7), International Association of Plumbing and Mechanical Of-
cials, Ontario, CA, USA
Ms L. Channan, (10), South Pacic Applied Geoscience Commission, Suva, Fiji
Professor W. Chee Woon, (11), University of Malaya, Kuala Lumpur, Malaysia
Dr T. Chi Ho, (11), Health Department, Macao, Macao, Peoples Republic of China
Dr N. Chiu, (15, 19: xlvi), US Environmental Protection Agency, Washington, DC,
USA
Dr Y.-G. Cho, (11), Waterworks Gwangju, Gwangju City, Republic of Korea
469
Dr I. Chorus, (2, 5, 7, 8, 15, 20, 22, 25, 27, 29), Umweltbundesamt, Berlin, Germany
Dr W.T. Chung, (11), Department of Health, Wan Chai, Hong Kong, Special Admin-
istrative Region of China
Dr J. Clancy, (23), Clancy Environmental Consultants, St. Albans, VT, USA
Dr J. Clark-Curtiss, (18), Washington University, St. Louis, MO, USA
Dr E. Clayton, (21: ii), US Armed Forces Research Institute of Medical Sciences,
Bangkok, Thailand
Professor G. Codd, (29), University of Dundee, Dundee, UK
Dr O. Conerly, (19), US Environmental Protection Agency, Washington, DC, USA
Dr M. Cooper, (19), Envirorad Services Pty Ltd, Victoria, Australia
Dr C. Corvalan, (26), WHO, Geneva, Switzerland
Dr A.L. Corwin, (21: ii), US Armed Forces Research Institute of Medical Sciences,
Jakarta, Indonesia
Dr J. Cotruvo, (3, 5, 7, 9, 14, 18, 22, 23, 25), Joseph Cotruvo & Associates, Limited Lia-
bility Company, and NSF International, Washington, DC, USA
Professor D.Crawford-Brown,(26),University of North Carolina,Chapel Hill,NC,USA
Dr J. Creasy, (23), WRc-NSF Ltd, Swindon, UK
Dr S. Crespi, (16), Policlinica Miramar, Palma, Spain
Dr G. Cronberg, (29), Lund University, Lund, Sweden
Dr D. Cunliffe, (8, 13, 19, 20, 21: iv, 22, 23, 25, 27), Environmental Health Service,
Adelaide, Australia
Dr F. Dagendorf, (16), Institute for Hygiene and Public Health, Bonn, Germany
Dr J.L. Daroussin, (20), European Commission, Luxembourg
Dr H. Darpito, (19, 20, 22), Ministry of Health, Jakarta Pusat, Indonesia
Dr A. Davison, (13, 25), Water Futures, Dundas Valley, NSW, Australia (formerly of
the Ministry of Energy and Utilities, Parramatta, NSW, Australia)
Dr F. de Buttet, (19, 20), Gisenec-Unesen, Paris, France
Dr M.-A. DeGroote, (18), University of Colorado, Denver, CO, USA
Dr G. de Hollander, (26), National Institute for Public Health and the Environment
(RIVM), Bilthoven, Netherlands
Dr D. Deere, (6, 8, 12, 13, 23, 25, 27), Water Futures, Dundas Valley, Australia (for-
merly of South East Water Ltd, Moorabbin, Australia)
Mr W. Delai, (10), Ministry of Health, Suva, Fiji
Dr J.M. Delattre, (14, 21: i), Institut Pasteur de Lille, Lille, France
Dr S. Dethoudom, (11), Water Supply Authority, Ventiane, Lao Peoples Democratic
Republic
Professor B. De Villiers, (27), Potchefstroom University for CHE, Potchefstroom,
South Africa
Mr I. Deyab, (9), Environment Public Authority, Safat, Kuwait
Professor H. Dieter, (19: xxii), Federal Environment Agency, Berlin, Germany
Dr P. Dillon, (27), Commonwealth Scientic and Industrial Research Organisation,
Land and Water, Glen Osmond, Australia
470
Dr J. Donohue, (7, 19: xxxvi), US Environmental Protection Agency, Washington, DC,

USA
Dr J. Doss, (19, 20), International Bottled Water Association, Alexandria, USA
Dr V. Drasar, (16), OHS-National Legionella Reference Laboratory, Vyskov, Czech
Republic
Dr M. Drikas, (19, 29), Australian Water Quality Center, Salisbury, Australia
Dr J. Du, (19: lii), US Environmental Protection Agency, Washington, DC, USA
Dr A. Dufour, (6, 8, 14, 16, 27), US Environmental Protection Agency, Cincinnati, OH,
USA
Dr S. Edberg, (14), Yale University, New Haven, CT, USA
Dr N. Edmonds, (19: xxxi), Health Canada, Ottawa, Canada
Dr J. Eisenberg, (6, 28), University of California, Berkeley, CA, USA
Dr M. El Desouky, (9), Kuwait Institute for Scientic Research, Safat, Kuwait
Dr H. El Habr, (9), United Nations Environment Programme, Managa, Bahrain
Professor F. El Zaatari, (18), Baylor College of Medicine, Houston, TX, USA
Dr M. Ema, (19: xlii, xlix), National Institute of Health Sciences, Tokyo, Japan
Mr P. Emile, (10), Ministry of Health, Rarotonga, Cook Islands
Dr R. Enderlein, (29), United Nations Economic Commission for Europe, Geneva,
Switzerland
Dr T. Endo, (5, 7, 14, 15, 19, 22), Ministry of Health, Labor and Welfare, Tokyo, Japan
Mr H. Enevoldsen, (9), Intergovernmental Oceanographic Commission of UNESCO,
IOC Science and Communication Centre on Harmful Algae, Copenhagen,
Denmark
Dr S. Enkhsetseg, (15), Ministry of Health, Ulaanbaatar, Mongolia
Dr O. Espinoza, (19: xii, liii, lxix), WHO Regional Ofce for Europe, Copenhagen,
Denmark
Mr S. Esrey, (6), deceased (formerly of UNICEF, New York, USA)
Mr G. Ethier, (4), International Council of Metals and the Environment, Ottawa,
Canada
Dr C. Evins, (23), Drinking Water Inspectorate, London, UK
Dr M. Exner, (14, 16, 22), Universitt Bonn, Bonn, Germany
Professor I. Falconer, (29), University of Adelaide, Adelaide, Australia
Dr J. Falkinham, (18), Fralin Biotechnology Center, Blacksburg, VA, USA
Dr M. Farrimond, (23), UK Water Industry Research, London, UK
Dr J. Fastner, (15, 29), Federal Environmental Agency, Berlin, Germany
Professor B. Fattal, (6), Hebrew University of Jerusalem, Jerusalem, Israel
Mr J. Fawell, (4, 5, 7, 15, 17, 19: vi, xiilxix, 20, 22, 29), independent consultant, High
Wycombe, UK
Ms F. Feagai, (10), Princess Margaret Hospital, Funafuti, Tuvalu
Dr T. Fengthong, (15), Ministry of Health, Ventiane, Lao Peoples Democratic
Republic
Dr I. Feuerpfeil, (21: iv), Umweltbundesamt, Bad Elster, Germany
471
Dr L. Fewtrell, (6, 12), Center for Research into Environment & Health, University of
Wales, Aberystwyth, UK
Mr B. Fields, (16), Centers for Disease Control and Prevention, Atlanta, GA, USA
Mr J. Filiomea, (10), Ministry of Health and Medical Service, Honiara, Solomon
Islands
Dr J. Fitch, (20), South Australian Health Commission, Adelaide, Australia
Dr J. Fitzgerald, (29), South Australian Health Commission, Adelaide, Australia
Dr J. Fleisher, (6), State University of New York, Downstate Medical Center, New York,
NY, USA
Dr L. Forbes, (23), Leith Forbes & Associates Pty Ltd, Victoria, Australia
Dr T. Ford, (18), Montana State University, Bozeman, MT, USA
Dr R. Franceys, (27), Craneld University, Silsoe, UK
Ms P. Franz, (10), Paulau Environment Quality Protection Agency, Koror, Republic of
Palau
Dr I. Fraser, (19, 20), Department of Health, London, UK
Dr C. Fricker, (14, 21: iv), CRF Consulting, Reading, UK
Dr A. Friday, (22), Ministry of Health, Kampala, Uganda
Dr E. Funari, (7), Istituto Superiore di Sanit, Rome, Italy
Dr H. Galal-Gorchev, (1, 2, 4, 5, 19: ixii, liii, lxix), US Environmental Protection
Agency, Washington, DC (formerly of WHO, Geneva, Switzerland)
Dr P. Gale, (8), WRc-NSF Ltd, Marlow, UK
Dr Y. Ganou, (22), Ministry of Health, Ougadougo, Burkino Faso
Dr M. Gardner, (19), WRc-NSF Ltd, Marlow, UK
Dr A.E.H. Gassim, (22), Ministry of Health, Makkah, Saudi Arabia
Dr R. Gaunt, (4), International Council of Metals and the Environment, Ottawa,
Canada
Dr A.-M. Gebhart, (3), NSF International, Ann Arbor, MI, USA
Dr B. Genthe, (27), Division Environment, Pretoria, South Africa
Dr C. Gerba, (14, 28), Arizona University, Tucson, AZ, USA
Dr T. Gerschel, (19), European Copper Institute, Brussels, Belgium
Dr H. Gezairy, (9), WHO, Regional Ofce for the Eastern Mediterranean, Cairo, Egypt
Ms M. Giddings, (15, 19: xiiilii, livlxviii, 20, 22, 29), Health Canada, Ottawa, Canada
Professor W. Giger, (27), Swiss Federal Institute for Environmental Science and Tech-
nology, Dbendorf, Switzerland
Dr N. Gjolme, (29), National Institute for Public Health, Oslo, Norway
Dr A. Glasmacher, (14), Universitt Bonn, Bonn, Germany
Dr A. Godfree, (23, 25, 27), United Utilities Water, Warrington, UK
Mr S. Godfrey, (10, 12), Water, Engineering and Development Centre, Loughborough
University, Loughborough, UK
Dr M.I. Gonzalez, (19, 20, 22), National Institute of Hygiene, Epidemiology and
Microbiology, Havana, Cuba
Ms F. Gore, (22), WHO, Geneva, Switzerland
472
Dr P. Gosling, (21: i), Department of Health, London, UK

Dr P. Gowin, (9), International Atomic Energy Agency, Vienna, Austria
Professor W. Grabow, (5, 6, 8, 13, 19, 20, 21: ii, 22, 25), retired (formerly of Univer-
sity of Pretoria, Pretoria, South Africa)
Mr W. Graham, (4), CropLife International, Brussels, Belgium
Dr P. Grandjean, (19, 20), Institute of Public Health, Odense, Denmark
Dr S. Grant-Trusdale, (19: xxxiv), Health Canada, Ottawa, Canada
Dr R. Gregory, (29), WRc-NSF Ltd, Swindon, UK
Professor A. Grohmann, (19, 27), independent, Berlin, Germany
Dr S. Gupta, (19: v), Health Canada, Ottawa, Canada
Professor C. Haas, (6, 28), Drexel University, Philadelphia, PA, USA
Dr W. Haas, (18), Robert Koch Institute, Berlin, Germany
Ms L. Haller, (12), WHO, Geneva, Switzerland
Mr F. Hannecart, (10), Noumea City Hygiene Service, Noumea, New Caledonia
Dr K.-I. Harada, (29), Meijo University, Nagoya, Japan
Dr M. Hardiman, (20), WHO, Geneva, Switzerland
Mr H. Hashizume, (5, 9, 15, 17, 19: xiiilii, livlxviii, 22), Ministry of the Environ-
ment, Tokyo, Japan (formerly of WHO, Geneva, Switzerland)
Dr A. Havelaar, (1, 2, 5, 6, 7, 8, 20, 21: iv, 22, 25, 26, 28), National Institute for Public
Health and the Environment (RIVM), Bilthoven, Netherlands
Mr T. Hayakawa, (1, 5), Ministry of Health & Welfare, Tokyo, Japan
Mr J. Hayes, (16), Institute for Healthcare Management, High Wycombe, UK
Mr P. Hecq, (22), European Commission, Brussels, Belgium
Mr P. Heinsbroek, (10, 11, 15), WHO, Regional Ofce for the South Pacic, Manila,
Philippines
Dr R. Heinze, (29), Umweltbundesamt, Bad Elster, Germany
Mr E. Hellan, (10), Pohnpei Environment Protection Agency, Kolonia, Federated
States of Micronesia
Dr R. Helmer, (1, 4, 19: xii, liii, lxix, 22), retired (formerly of WHO, Geneva, Switzer-
land)
Dr P. Henriksen, (29), National Environmental Research Institute, Roskilde, Denmark
Dr N. Hepworth, (27), Lancaster, UK
Professor J. Hermon-Taylor, (18), St Georges Hospital Medical School, London, UK
Mr A. Hicking, (10), Marshall Islands Environment Protection Agency, Majuro, Mar-
shall Islands
Dr G. Hoetzel, (29), La Trobe University, Victoria, Australia
Dr A. Hogue, (6), US Department of Agriculture, Washington, DC, USA (formerly of
WHO, Geneva, Switzerland)
Dr D. Holt, (23), Thames Water Utilities Ltd, Reading, UK
Mr M. Hori, (7), Ministry of Health and Welfare, Tokyo, Japan
Professor H. Hring, (2), Umweltbundesamt, Bad Elster, Germany
Ms M. Hoshino, (15), UNICEF, Tokyo, Japan
473
Dr G. Howard, (2, 5, 7, 8, 12, 13, 15, 19, 20, 22, 23, 25), DFID Bangladesh, Dhaka,
Bangladesh (formerly of Water Engineering and Development Centre, Loughbor-
ough University, Loughborough, UK)
Dr P. Howsam, (27), Craneld University, Silsoe, UK
Professor S. Hrudey, (8, 29), University of Alberta, Edmonton, Canada
Mr J. Hueb, (20, 21: v, 23), WHO, Geneva, Switzerland
Dr J. Hulka, (19, 20), National Radiation Protection Institute, Prague, Czech
Republic
Dr N. Hung Long, (15), Ministry of Health, Han Noi, Viet Nam
Dr P. Hunter, (14, 23), University of East Anglia, Norwich, UK
Dr K. Hussain, (9), Ministry of Health, Manama, Bahrain
Mr O.D. Hydes, (4, 5, 7), independent consultant, West Sussex, UK (formerly of Drink-
ing Water Inspectorate, London, UK)
Dr A. Iannucci, (3), NSF International, Ann Arbor, MI, USA
Mr S. Iddings, (11, 15), WHO, Phnom Penh, Cambodia
Dr M. Ince, (12, 25), independent consultant, Loughborough, UK (formerly of Water,
Engineering and Development Centre, Loughborough University, Loughborough,
UK)
International Bottled Water Association, (19), Alexandria, VA, USA
Mr K. Ishii, (15), Japan Water Works Association, Tokyo, Japan
Mr J. Ishiwata, (11), Ministry of Health, Labour and Welfare, Tokyo, Japan
Mr P. Jackson, (2, 5, 7, 15, 19: xiiilii, livlxviii, 22, 25), WRc-NSF Ltd, Marlow, UK
Dr J. Jacob, (21: v), (formerly of Umweltbundesamt, Bad Elster, Germany)
Dr M. Janda, (21: i), Health and Welfare Agency, Berkeley, CA, USA
Mr A. Jensen, (1, 2), DHI Water and Environment, Horsholm, Denmark
Dr R. Johnson, (19), Rohm and Haas Company, USA
Dr D. Jonas, (7), Industry Council for Development, Ramsgate, UK
Dr G. Jones, (29), Commonwealth Scientic and Industrial Research Organisation,
Brisbane, Australia
Mr C. Jrgensen, (5), DHI Water and Environment, Horsholm, Denmark
Dr C. Joseph, (16), Communicable Disease Surveillance Control, London, UK
Mr H. Kai-Chye, (10), Canberra, Australia
Ms R. Kalmet, (10), Mines and Water Resources, Port Vila, Vanuatu
Mr I. Karnjanareka, (15), Ministry of Public Health, Nonthaburi, Thailand
Dr D. Kay, (6), University of Wales, Abeystwyth, UK
Dr H. Kerndorff, (27), Umweltbundesamt, Berlin, Germany
Dr S. Khamdan, (9), Ministry of State for Municipalities and Environment Affairs,
Manama, Bahrain
Mr P. Khanna, (21: ii), National Environmental Engineering Institute, Nagpur, India
Mr M. Kidanu, (22), WHO, Regional Ofce for Africa, Harare, Zimbabwe
Dr J. Kielhorn, (4, 19: vii, xv, lxvii), Fraunhofer Institute of Toxicology and Experi-
mental Medicine, Hanover, Germany
474
Dr R. Kirby, (8, 25), Industry Council for Development, Ramsgate, UK

Dr G. Klein, (1), WHO, Bonn, Germany (formerly of Umweltbundesamt, Bad Elster,
Germany)
Dr J. Komarkova, (29), Hydrobiological Institute of the Czech Academy of Sciences,
Cesk Budejovice, Czech Republic
Dr H. Komulainen, (22), National Public Health Institute, Kuopio, Finland
Dr F. Kondo, (29), Aichi Prefectural Institute of Public Health, Nagoya, Japan
Dr M. Koopmans, (26), National Institute for Public Health and the Environment
Dr F. Kozisek, (19), National Institute of Public Health, Prague, Czech Republic
Dr A. Kozma-Trkne, (29), National Institute for Public Health, Budapest, Hungary
Dr T. Kuiper-Goodman, (29), Health Canada, Ottawa, Canada
Dr S. Kunikane, (7, 15, 17, 22), Ministry of Health, Labour and Welfare, Tokyo, Japan
Dr T. Kwader, (27), URS Corporation, Tallahassee, FL, USA
Miss K. Kwee-Chu, (11), Ministry of Health, Kuala Lumpur, Malaysia
Mr P. Lataga, (10), Department of Health, Pago-pago, American Samoa
Dr B. Lang, (4), Novartis Crop Protection AG, Basel, Switzerland
Dr J. Langford, (8), Water Services Association, Melbourne, Australia
Dr J. Latorre, (25), Universidad del Valle, Cali, Colombia
Dr L. Lawton, (29), Robert Gordon University of Aberdeen, Aberdeen, UK
Dr M. LeChevallier, (7, 8, 14, 18, 23, 24), American Water Works Service Company,
Inc., Voorhees, NJ, USA
Dr H. Leclerc, (14, 19, 20), University of Lille, Lille, France
Dr J. Lee, (5, 16, 21: iii), Queens Medical Centre, Nottingham, UK
Mr F. Leitz, (9), Water Treatment Engineering and Research Group, Denver, CO, USA
Professor Le The Thu, (11), Institute of Hygiene and Public Health, Ho Chi Minh
City, Viet Nam
Dr Y. Levi, (23), Laboratoire Sant Publique Environnement, Universit Paris XI,
Chatenay-Malabry, France
Dr D. Levy, (19, 20), Centers for Disease Control and Prevention, Atlanta, GA, USA
Dr N. Lightfoot, (14), UK Public Health Laboratory Service, Newcastle-upon-Tyne,
UK
Dr P. Literathy, (2, 5, 29), Kuwait Institute for Scientic Research, Safat, Kuwait (for-
merly of Water Resource Research Centre VITUKI, Budapest, Hungary)
Mr S. Loau, (15), Preventive Health Services, Apia, Samoa
Dr J.F. Luna, (26), Secretariat of Health, Mexico City, Mexico
Dr U. Lund, (4, 7, 19: ixii, liii, lxix), DHI Water and Environment, Horsholm,
Denmark
Dr Y. Magara, (1, 4, 5, 7, 14, 15, 19: xiiilii, livlxviii, 21: iv, 22), Hokkaido University,
Sapporo, Japan
Mr T. Magno, (10), WHO Representatives Ofce in Papua New Guinea, Port Moresby,
Papua New Guinea
475
Dr B. Magtibay, (11, 22), Bureau of International Health Cooperation, Manila, Philip-

pines
Dr I. Mkelinen, (20), Radiation and Nuclear Safety Authority, Helsinki, Finland
Dr D. Mangino, (3), NSF International, Ann Arbor, MI, USA
Dr A. Marandi, (19), University of Tartu, Tartu, Estonia
Dr T. Mariee, (21: iii), Queen Elizabeth II Health Science Centre, Halifax, Canada
Mr A. Marquez, (10),Guam Environmental Protection Agency, Barrigada, Guam
Dr B. Marsalek, (29), Institute of Botany, Brno, Czech Republic
Professor M. Martin, (27), Bangladesh University of Engineering and Technology,
Dhaka, Bangladesh
Dr R. Mascarenhas, (19: xxiii, xxiv, xxx, lvi, lxii, lxiii), Metcalf and Eddy, Devizes, UK
Dr D. McFadden, (3), NSF International, Ann Arbor, MI, USA
Dr M. McLaughlin, (27), Commonwealth Scientic and Industrial Research Organi-
sation, Land and Water, Glen Osmond, Australia
Dr B. McRae, (8), Australian Water Association, Artarmon, Australia
Dr D. Medeiros, (26), Health Canada, Ottawa, Canada
Dr G. Medema, (5, 7, 8, 21: iv), KIWA N.V, Nieuwegein, Netherlands
Ms M.E. Meek, (4), Health Canada, Ottawa, Canada
Dr J. Meheus, (4), International Water Supply Association, Antwerpen, Belgium
Ms G. Melix, (10), Papeete, French Polynesia
Dr J.M. Melse, (26), National Institute for Public Health and the Environment
(RIVM), Utrecht, Netherlands
Dr T. Meredith, (22), WHO, Geneva, Switzerland
Mr T. Metutera, (10), Public Utilities Board, Tarawa, Kiribati
Dr E. Meyer, (3), Umweltbundesamt, Berlin, Germany
Dr S. Miller, (27), US Department of Agriculture Agricultural Research Service
(USDA-ARS), Tucson, AZ, USA
Dr B. Mintz, (19: xii, liii, lxix), Centers for Disease Control and Prevention (CDC),
Atlanta, GA, USA
Mr M.Z. bin Mohd Talha, (11), Ministry of Health, Kuala Lumpur, Malaysia
Ms M.N. Mons, (7), KIWA Research and Consultancy, Nieuwegein, Netherlands
Professor M.R. Moore, (19), National Research Centre for Environmental Toxicology,
Queensland, University of Queensland, Queensland, Australia
Dr G. Morace, (21: ii), Istituto Superiore di Sanit, Rome, Italy
Dr A. Moreau, (14, 19, 20), Danone Water Technology Centre, Evian, France
Dr R. Morris, (5, 7, 23), IWA, London, UK
Dr D. Mossel, (14), Eijkman Foundation, Utrecht, Netherlands
Ms G. Motturi, (2, 5), WHO, Regional Ofce for Europe, Copenhagen, Denmark
Dr G. Moy, (4, 29), WHO, Geneva, Switzerland
Dr L. Mur, (29), University of Amsterdam, Amsterdam, Netherlands
Ms S. Murcott, (19, 20), Massachusetts Institute of Technology, Massachusetts, USA
Dr P. Murphy, (26), US Environmental Protection Agency, Edison, NJ, USA
476
Dr S. Murphy, (3), NSF International, Ann Arbor, MI, USA

Dr F.J. Murray, (4), International Life Sciences Institute, San Jos, CA, USA
Mr M.W. Muru, (10), Health Protection, Waigani, Papua New Guinea
Mr C. Mwesigye, (7), WHO, Kampala, Uganda
Dr D. Nabarro, (22), WHO, Geneva, Switzerland
Dr G.B. Nair, (21: v), National Institute of Cholera and Enteric Diseases, Calcutta,
India
Pr. K. Nath, (19), Institution of Public Health Engineering, Calcutta, India
Mr P. Navuth, (11), Ministry of Industry, Mines and Energy, Phnom Penh,
Cambodia
Mr M. Neal, (19), Invista, Teesside, UK
Dr A. Neller, (8), University of Sunshine Coast, Maroochydore, Australia
Mr J. Newbold, (16), Health and Safety Executive, Bootle, UK
Dr E. Ngoni Mudege, (27), Institute of Water and Sanitation Development, Harare,
Zimbabwe
Dr C. Nhachi, (15), WHO, Regional Ofce for Africa, Harare, Zimbabwe
Dr G. Nichols, (18), Health Protection Agency, London, UK
Dr T. Nishimura, (15, 19: xix, xlii, xlix, lvii), Ministry of Health, Labour and Welfare,
Tokyo, Japan
Ms S. Nofal, (9), WHO, Cairo, Egypt
Dr C. Nokes, (25), Environmental Science and Research Ltd, Christchurch, New
Zealand
Dr L. Ofanoa, (10), Ministry of Health, Nukuolofa, Tonga
Dr H. Ogawa, (23), WHO, Regional Ofce for the Western Pacic, Manila, Philippines
Dr E. Ohanian, (4, 7, 19: ilii; livlxviii, 22), US Environmental Protection Agency,
Washington, DC, USA
Dr Y. Okumura, (20), Nagasaki University, Japan
Ms J. Orme-Zavaleta, (1), US Environmental Protection Agency, Washington, DC,
USA
Dr Y. Ortega, (21: iv), University of Arizona, Tucson, AZ, USA
Dr J. Padisk, (29), University of Veszprm, Veszprm, Hungary
Dr F. Pamminger, (23), Yarra Valley Water, Melbourne, Australia
Mr I. Papadopoulos, (5, 7), European Commission, Athens, Greece (formerly of Euro-
pean Commission, Brussels, Belgium)
Dr C.N. Paramasivan, (18), Indian Council of Medical Research, Chennai, India
Mr R. Paramasivan, (21: ii), National Environmental Engineering Research Institute,
Nagpur, India
Mr D. Parish, (10), Pacic Water Association, Suva, Fiji
Dr C. Pastoris, (21: iii), Istituto Superiore di Sanit, Rome, Italy
Dr E. Pawlitzky, (29), Umweltbundesamt, Berlin, Germany
Dr P. Payment, (6, 14, 23), National Institute of Scientic Research, University of
Quebec, Montreal, Canada
477
Dr S. Pedley, (5, 21: ii, 29), Robens Centre, University of Surrey, Guildford, UK
Dr H.K. bin Pengiran Haji Ismail, (11), Ministry of Health, Bandar Seri Begawan
Negara 1210, Brunei Darussalam
Dr G. Peralta, (10, 11, 15), University of the Philippines, Quezon City, Philippines
Mr A. Percival, (8), Consumer Health Forum, Cobargo, Australia
Dr K. Petersson Graw, (4, 19: iii), National Food Administration, Uppsala, Sweden
Dr M.S. Pillay, (11, 15, 27), Ministry of Health, Kuala Lumpur, Malaysia
Mr S. Pita Helu, (15), Tonga Water Board, Nukualofa, Tonga
Dr J. Plouffe, (21: iii), University Hospitals, Columbus, OH, USA
Dr A. Pozniak, (18), Chelsea & Westminster Hospital, London, UK
Dr E. Pozio, (21: iv), Istituto Superiore di Sanit, Rome, Italy
Dr A. Pozniak, (18), Chelsea & Westminster Hospital, London, UK
Mr M. Pretrick, (10), National Government, Palikir, Federated States of Micronesia
Dr C. Price, (19, 20), American Chemical Council, Arlington, VA, USA
Mr F. Properzi, (22), WHO, Geneva, Switzerland
Dr V. Puklova, (19), National Institute of Public Health, Prague, Czech Republic
Mr T. Pule, (23, 25, 27), WHO, Regional Ofce for Africa, Harare, Zimbabwe
Dr D. Purkiss, (3), NSF International, Ann Arbor, MI, USA
Dr A. Pruess-Ustun, (6, 26), WHO, Geneva, Switzerland
Dr L. Quiggle, (3), NSF International, Ann Arbor, MI, USA
Dr P.P. Raingsey, (11), Ministry of Health, Phnom Penh, Cambodia
Dr C. Ramsay, (22), Scottish Centre for Infection and Environmental Health, Glasgow,
UK
Dr P. Ravest-Weber, (3), NSF International, Ann Arbor, MI, USA
Dr D. Reasoner, (14, 23), National Risk Management Research Laboratory, US Envi-
ronmental Protection Agency, Cincinnati, OH, USA
Dr G. Rees, (7, 18), Askham Bryan College, York, UK (formerly University of Surrey,
Guildford, UK)
Dr S. Regli, (21: iv, 23), US Environmental Protection Agency, Washington, DC, USA
Dr R. Reilly, (26), Scottish Centre for Infection and Environmental Health, Glasgow,
UK
Dr M. Repacholi, (20, 22), WHO, Geneva, Switzerland
Mrs M. Richold, (4), European Centre for Ecotoxicology and Toxicology, Sharnbrook,
UK
Dr J. Ridgway, (3, 5), WRc-NSF Ltd, Marlow, UK
Ms J. Riego de Dios, (11, 15), National Center for Disease Prevention and Control,
Manila, Philippines
Mrs U. Ringelband, (5), Umweltbundesamt, Berlin, Germany
Dr M. Rivett, (27), University of Birmingham, Birmingham, UK
Mr W. Robertson, (3, 7, 8, 14, 23, 26), Health Canada, Ottawa, Canada
Dr C. Robinson, (20), International Atomic Energy Agency, Vienna, Austria
Dr J. Rocourt, (28), WHO, Geneva, Switzerland
478
Ms R. Rooney, (12, 16), WHO, Geneva, Switzerland

Dr J. Rose, (14, 21: iv, 28), University of South Florida, St. Petersburg, FL, USA
Dr K. Rotert, (19, 20), US Environmental Protection Agency, Washington, DC, USA
Dr J. Rothel, (18), Cellestis Limited, Victoria, Australia
Mr H. Salas, (2), WHO, Regional Ofce for the Americas, Washington, DC, USA
Mr A. Salem, (9), Abu Dhabi Water and Electricity Authority, Abu Dhabi, United Arab
Emirates
Dr P. Samnang, (15), Ministry of Health, Phnom Penh, Cambodia
Dr M. Santamaria, (16), WHO, Geneva, Switzerland
Mr M. Saray, (11), Ministry of Rural Development, Phnom Penh, Cambodia
Mr D. Sartory, (5, 21: i), Severn Trent Water Ltd, Shelton, UK
Dr M. Savkin, (20), Institut Biophysics, Moscow, Russian Federation
Dr S. Schaub, (6, 16, 21: iv, 28), US Environmental Protection Agency, Washington,
DC, USA
Professor R. Schertenleib, (27), Swiss Federal Institute for Environmental Science and
Technology, Dbendorf, Switzerland
Dr J. Schijven, (27), National Institute for Public Health and the Environment
Mrs G. Schlag, (5), Umweltbundesamt, Berlin, Germany
Mr O. Schmoll, (8, 15, 27), Umweltbundesamt, Berlin, Germany
Professor L. Schwartzbrod, (19, 20), WHO Collaborating Center for Microorganisms
in Wastewater, Nancy, France
Mr P. Scott, (8), Melbourne Water, Melbourne, Australia
Professor K.-P. Seiler, (27), National Research Center for Environment and Health,
Institut fr Hydrologie, Neuherberg, Germany
Dr Y.-C. Seo, (11), Sangji University, Wonju, Republic of Korea
Dr I. Shalaru, (19, 20, 22), Ministry of Health, Chisinau, Republic of Moldova
Dr D. Sharp, (10, 15), WHO Representative Ofce in South Pacic, Suva, Fiji
Ms S. Shaw, (7, 21: iv), US Environmental Protection Agency, Washington, DC, USA
Ms F. Shoaie, (9), Department of the Environment, Tehran, Islamic Republic of Iran
Dr Y. Shun-Zhang, (29), Institute of Public Health, Shanghai, Peoples Republic of
China
Dr E. Sievers, (19, 20), Kiel, Germany
Dr D. Simazaki, (15), National Institute of Public Health, Tokyo, Japan
Professor I. Simmers, (27), Vrije University, Amsterdam, Netherlands
Mr T. Simons, (1, 4), European Commission, Brussels, Belgium
Dr M. Sinclair, (8), Monash University Medical School, Prahran, Australia
Dr K. Sivonen, (29), University of Helsinki, Helsinki, Finland
Dr B. Skinner, (12), Water, Engineering and Development Centre, Loughborough Uni-
Dr O. Skulberg, (29), Norwegian Institute for Public Health, Oslo, Norway
479
Professor H.V. Smith, (5, 21: iv), Scottish Parasite Diagnostic Laboratory, Stobhill Hos-
pital, Glasgow, UK
Dr M. Smith, (23), Water, Engineering and Development Centre, Loughborough Uni-
Dr M. Snozzi, (7), Swiss Federal Institute for Environmental Science and Technology,
Dbendorf, Switzerland
Professor M. Sobsey, (7, 8, 12, 13, 19, 20, 22, 25, 28), University of North Carolina,
Chapel Hill, USA
Professor J.A. Sokal, (19, 20, 22), Institute of Occupational Medicine and Environ-
mental Health, Sosnowiec, Poland
Dr F. Solsona, (15, 23, 25, 27), retired (formerly of WHO, Regional Ofce for the
Americas/Centro Panamericano de Ingeneria Sanitaria Ciencias del Ambiente
[CEPIS], Lima, Peru)
Dr G.J.A. Speijers, (4, 19: iv), National Institute for Public Health and the Environ-
ment (RIVM), Bilthoven, Netherlands
Dr D. Srinivasan, (10), University of the South Pacic, Suva, Fiji
Dr G. Staneld, (5, 7, 21: ii, 25), WRc-NSF Ltd, Marlow, UK
Dr T.A. Stenstrom, (6, 16, 22), Swedish Institute for Infectious Disease Control, Solna,
Sweden
Dr M. Stevens, (8, 12, 13, 14, 15, 19, 20, 23, 25), Melbourne Water Corporation, Mel-
bourne, Australia
Dr T. Stinear, (18), Institut Pasteur, Paris, France
Dr M. Storey, (23), University of New South Wales, Sydney, Australia
Mr M. Strauss, (6), Swiss Federal Institute for Environmental Science and Technol-
ogy, Dbendorf, Switzerland
Dr K. Subramanian, (7), Health Canada, Ottawa, Canada
Dr S. Surman, (16), Health Protection Agency, London, UK
Mr T. Taeuea, (10), Ministry of Health, Tarawa, Kiribati
Mr P. Talota, (10), Ministry of Health and Medical Service, Honiara, Solomon Islands
Mr C. Tan, (11), Ministry of Environment, Singapore
Mr B. Tanner, (2), NSF International, Brussels, Belgium
Mr H. Tano, (4), Ministry of Health and Welfare, Tokyo, Japan
Professor I. Tartakovsky, (16), Gamaleya Research Institute for Epidemiology and
Microbiology, Moscow, Russian Federation
Dr A. Tayeh, (20), WHO, Geneva, Switzerland
Dr M. Taylor, (8, 19, 20, 22, 27), Ministry of Health, Wellington, New Zealand
Dr R. Taylor, (8, 10, 15), Health Surveillance and Disease Control, Rockhampton,
Australia
Mr J. Teio, (10), Department of Health, Waigani, Papua New Guinea
Dr P.F.M. Teunis, (7, 8, 28), National Institute for Public Health and the Environment
480
Dr B.H. Thomas, (4), independent consultant (formerly Health Canada, Ottawa,

Canada)
Mr T. Thompson, (7, 12, 15, 17, 22, 23, 25, 27), WHO, Regional Ofce for South-East
Asia, New Delhi, India
Dr F. Tiefenbrunner, (21: iii), Institute of Hygiene and Social Medicine, Innsbruck,
Austria
Mr Tiew King Nyau, (11), Public Utilities Board, Singapore
Dr D. Till, (8, 28), Consultant Public Health Microbiologist, Wellington, New Zealand
Mr T. Tipi, (10), Health Department, Apia, Samoa
Mr T.Q. Toan, (11), National Institute of Occupational and Environmental Health,
Hanoi, Viet Nam
Dr P. Toft, (1, 4, 7, 15, 19: xiiilii, livlxviii, 22), independent consultant, Qualicum
Beach, Canada
Mr V. Tovu, (10), Ministry of Health, Port Vila, Vanuatu
Mr L. Tuitupou, (10), Ministry of Health, Nukuolafo, Tonga
Professor J. Tuomisto, (4, 19: x), National Public Health Institute, Kuopio, Finland
Dr I. Turai, (20, 22), WHO, Geneva, Switzerland
Dr R. Uauy, (4, 15, 19, 20), Instituto de Nutricin y Technologia de los Alimentos,
Santiago, Chile
Mr S. Unisuga, (2), Ministry of Health and Welfare, Tokyo, Japan
Dr H. Utkilen, (29), National Institute for Public Health, Oslo, Norway
Dr J. van Den Berg, (3), KIWA N.V., Nieuwegein, Netherlands
Dr D. van der Kooij, (14, 21: i, 23), KIWA N.V., Nieuwegein, Netherlands
Ms K. VandeVelde, (19), International Antimony Oxide Industry Association,
Campine, Beerse, Belgium
Dr A.M. van Dijk-Looijaard, (4), KIWA N.V, Nieuwegein, Netherlands
Dr F.X.R. van Leeuwen, (4), National Institute of Public Health and the Environment
(RIVM), Bilthoven, Netherlands (formerly of WHO European Centre for Envi-
ronment and Health, Netherlands)
Dr J. Vapnek, (29), Food and Agriculture Organization of the United Nations, Rome,
Italy
Mr A. Versteegh, (16), National Institute for Public Health and the Environment
Ms C. Vickers, (15, 19: xiiilii, livlxviii),WHO, Geneva, Switzerland
Dr V. Vincent, (18), Institut Pasteur, Paris, France
The Vinyl Institute, (19), Arlington, VA, USA
Dr D. Vitanage, (23), Sydney Water, Sydney, Australia
Dr U. von Gunten, (19), Swiss Federal Institute for Environmental Science and Tech-
nology Dbendorf, Switzerland
Professor F. Von Reyn, (18), Dartmouth Hitchcock Medical Centre, Hanover, NH,
USA
481
Professor M. Von Sperling, (6), Federal University of Minas Gerais, Belo Horizonte,
Brazil
Dr T. Vourtsanis, (23), Sydney Water, Sydney, Australia
Dr P. Waggit, (27), Environment Australia, Darwin, Australia
Dr I. Wagner, (3), Technologie Zentrum Wasser, Karlsruhe, Germany
Mr M. Waite, (6), Drinking Water Inspectorate, London, UK
Mr M. Waring, (19, 20), Department of Health, London, UK
Ms M. Whittaker, (3), NSF International, Ann Arbor, MI, USA
Dr B. Wilkins, (20), National Radiological Protection Board, UK
Dr J. Wilson, (3), NSF International, Ann Arbor, MI, USA
Dr R. Wolter, (27), Umweltbundesamt, Berlin, Germany
Dr D. Wong, (19: xxvii, xxxiii, lxviii), US Environmental Protection Agency, Wash-
ington, DC, USA
Dr A. Wrixon, (20), International Atomic Energy Agency, Vienna, Austria
Professor Y. Xu, (27), University of the Western Cape, Bellville, South Africa
Mr T. Yamamura, (7), (formerly of WHO, Geneva, Switzerland)
Dr S. Yamashita, (20), Nagasaki University, Japan
Dr C. Yayan, (15), Institute of Environmental Health Monitoring, Beijing, Peoples
Republic of China
Dr B. Yessekin, (27), The Regional Environmental Centre for Central Asia, Almaty,
Kazakhstan
Dr Z. Yinfa, (11), Ministry of Health, Beijing, Peoples Republic of China
Mr N. Yoshiguti, (1), Ministry of Health and Welfare, Tokyo, Japan
Dr M. Younes, (1, 7, 20), WHO, Geneva, Switzerland
Mr J. Youngson, (10), Crown Public Health, Christchurch, New Zealand
Dr V. Yu, (21: iii), Pittsburgh University, Pittsburgh, PA, USA
Professor Q. Yuhui, (11), Institute of Environmental Health Monitoring, Beijing,
Peoples Republic of China
Mrs N. Zainuddin, (11), Ministry of Health, Kuala Lumpur, Malaysia
1. Expert Consultation on Rolling Revision of WHO Guidelines for Drinking-water

Quality, Geneva, 1315 December 1995
2. Expert Consultation on Protection and Control of Water Quality for the Updating
of the WHO Guidelines for Drinking-water Quality, Bad Elster, Germany, 1719
June 1996
3. Expert Consultation on Safety of Materials and Chemicals Used in Production and
Distribution of Drinking-water, Ann Arbor, Michigan, USA, 2324 January 1997
4. Expert Consultation on Rolling Revision of the Guidelines for Drinking-water
Quality: Report of Working Group Meeting on Chemical Substances for the Updat-
ing of WHO Guidelines for Drinking-water Quality, Geneva, Switzerland, 2226
April 1997
482
5. Expert Consultation on Rolling Revision of the Guidelines for Drinking-water

Quality: Aspects of Protection and Control and of Microbiological Quality, Med-
menham, UK, 1721 March 1998
6. Expert Consultation on Harmonized Risk Assessment for Water-related Microbio-
logical Hazards, Stockholm, Sweden, 1216 September 1999
7. Drinking-water Quality Committee Meeting, Berlin, Germany, 59 June 2000
8. Expert Consultation on Effective Approaches to Regulating Microbial Drinking-
water Quality, Adelaide, Australia, 1418 May 2001
9. Consultation on Planning of Water Quality Guidelines for Desalination, Bahrain,
2831 May 2001
10. Workshop on Drinking-water Quality Surveillance and Safety, Nadi, Fiji, 29
October1 November 2001
11. Workshop on Drinking-water Quality Surveillance and Safety, Kuala Lumpur,
Malaysia, 1215 November 2001
12. Expert Consultation on Preparation of Supporting Documents for the Updating of
Microbial Aspects of WHO Guidelines for Drinking-water Quality, Loughborough,
UK, 1823 November 2001
13. WHO Meeting: Guidelines on Drinking-water Quality, Micro Working Group, Mel-
bourne, Australia, 1314 April 2002
14. Meeting on HPC Bacteria in Drinking-water, Geneva, Switzerland, 2526 April
2002
15. Global Meeting on the Revision of WHO Guidelines for Drinking-water Quality,
Tokyo, Japan, 2329 May 2002
16. Meeting on Prevention and Control of Legionnaires Disease, London, 1820 June
2002
17. Chemical Safety of Drinking-water: Assessing Priorities for Risk Management, Nyon,
Switzerland, 2630 August 2002
18. Expert Consultation on Mycobacterium Avium Complex, Guildford, UK, 1820
September 2002
19. Contributors to the chemical substantiation document on:
i. Aluminium
ii. Boron
iii. Nickel
iv. Nitrate and Nitrite
v. Cyanobacterial Toxins: Microcystin-LR
vi. Edetic Acid (EDTA)
vii. Polynuclear aromatic hydrocarbons
viii. Cyanazine
ix. 1,2-Dichloropropane (1,2-DCP)
x. Pentachlorophenol
xi. Terbuthylazine (TBA)
xii. Trihalomethanes
483
xiii. 1,1,1-Trichloroethane
xiv. 1,2-Dibromoethane
xv. 1,2-Dichloroethane
xvi. Di(2-ethylhexyl)adipate
xvii. 2-Phenylphenol
xviii. 2,4-Dichlorophenoxyacetic acid
xix. Acrylamide
xx. Aldicarb
xxi. Aldrin and Dieldrin
xxii. Antimony
xxiii. Arsenic
xxiv. Barium
xxv. Bentazone
xxvi. Bromate
xxvii. Brominated Acetic Acids
xxviii. Cadmium
xxix. Carbofuran
xxx. Carbon Tetrachloride
xxxi. Monochloramine
xxxii. Chlordane
xxxiii. Monochloroacetic acid
xxxiv. Chlorite and Chlorate
xxxv. Chlorpyrifos
xxxvi. Copper
xxxvii. DDT and its Derivatives
xxxviii. Dimethoate
xxxix. Diquat
xl. Endosulfan
xli. Endrin
xlii. Epichlorohydrin
xliii. Fenitrothion
xliv. Fluoride
xlv. Glyphosate and AMPA
xlvi. Halogenated Acetonitriles
xlvii. Heptachlor and Heptachlor Epoxide
xlviii. Hexachlorobenzene
xlix. Hexachlorobutadiene
l. Lindane
li. Malathion
lii. Manganese
liii. Methoxychlor
liv. Methyl Parathion
484
lv. Monochlorobenzene
lvi. MX
lvii. Dialkyltins
lviii. Parathion
lix. Permethrin
lx. Propanil
lxi. Pyriproxyfen
lxii. Sulfate
lxiii. Inorganic Tin
lxiv. Toluene
lxv. Trichlorobenzenes
lxvi. Uranium
lxvii. Vinyl Chloride
lxviii. Trichloroacetic Acid
lxix. Dichloroacetic Acid
20. Provision of comments on drafts of the Guidelines for Drinking-water Quality (3rd
edition)
21. Contributor to Guidelines for Drinking-water Quality (2nd edition), Addendum,
Microbiological Agents in Drinking-water
i. Aeromonas
ii. Enteric Hepatitis Viruses
iii. Legionella
iv. Protozoan Parasites (Cryptosporidium, Giardia, Cyclospora)
v. Vibrio cholerae
22. Participant in Final Task Force Meeting for 3rd Edition of Guidelines on Drinking-
water Quality, Geneva, Switzerland, 31 March 4 April 2003
23. Contributor to the background document Safe, Piped Water: Managing Microbial
Water Quality in Piped Distribution Systems.
24. Contributor to the background document Water Treatment and Pathogen Control:
Process Efciency in Achieving Safe Drinking-water.
25. Contributor to the background document Water Safety Plans.
26. Contributor to the background document Quantifying Public Health Risk in the
WHO Guidelines for Drinking-Water Quality: A Burden of Disease Approach.
27. Contributor to the background document Protecting Groundwaters for Health
Managing the Quality of Drinking-water Sources.
28. Contributor to the background document Hazard Characterization for Pathogens
in Food and Water: Guidelines.
29. Contributor to the background document Toxic Cyanobacteria in Water.
485
ANNEX 3
Default assumptions
A3.1 Drinking-water consumption and body weight
G lobal data on the consumption of drinking-water are limited. In studies carried

out in Canada, the Netherlands, the United Kingdom and the USA, the average
daily per capita consumption was usually found to be less than 2 litres, but there was
considerable variation between individuals. As water intake will vary with climate,
physical activity and culture, the above studies, which were conducted in temperate
zones, can give only a limited view of consumption patterns throughout the world.
At temperatures above 25 C, for example, there is a sharp rise in uid intake, largely
to meet the demands of an increased sweat rate (ICRP, 1992; see also Howard &
Bartram, 2003).
In developing guidelines for microbial hazard, per capita daily consumption of 1
litre of unboiled water was assumed.
In developing the guideline values for potentially hazardous chemicals, a daily per
capita consumption of 2 litres by a person weighing 60 kg was generally assumed. The
guideline values set for drinking-water using this assumption do, on average, err on
the side of caution. However, such an assumption may underestimate the consump-
tion of water per unit weight, and thus exposure, for those living in hot climates, as
well as for infants and children, who consume more uid per unit weight than adults.
The higher intakes, and hence exposure, for infants and children apply for only a
limited time, but this period may coincide with greater sensitivity to some toxic agents
and less for others. Irreversible effects that occur at a young age will have more social
and public health signicance than those that are delayed. Where it was judged that
this segment of the population was at a particularly high risk from exposure to certain
chemicals, the guideline value was derived on the basis of a 10-kg child consuming 1
litre per day or a 5-kg bottle-fed infant consuming 0.75 litre per day. The correspon-
ding daily uid intakes are higher than for adults on a body weight basis.
A3.2 Inhalation and dermal absorption

The contribution of drinking-water to daily exposure includes some indirect routes
such as inhalation of particles and droplets containing microbes and volatile
486
ANNEX 2. CONTRIBUTORS TO THE DEVELOPMENT
substances, and dermal contact during bathing or showering as well as direct

ingestion.
In most cases, available data are insufcient to permit reliable estimates of expo-
sure by inhalation and dermal absorption of contaminants present in drinking-water.
It was not always possible, therefore, to address intake from these routes specically
in the derivation of the guideline values. However, that portion of the total tolerable
daily intake (TDI) allocated to drinking-water is generally sufcient to allow for these
additional routes of intake (see section 8.2.2). Should there be reason to believe that
potential inhalation of volatile compounds and dermal exposure from various indoor
water uses (such as showering) are not adequately addressed, authorities could con-
sider taking this into account in setting national standards or guidelines.
487
ANNEX 4
Chemical summary tables
Table A4.1 Chemicals excluded from guideline value derivation

Amitraz Degrades rapidly in the environment and is not expected to occur at
measurable concentrations in drinking-water supplies
Beryllium Unlikely to occur in drinking-water
Chlorobenzilate Unlikely to occur in drinking-water
Chlorothalonil Unlikely to occur in drinking-water
Cypermethrin Unlikely to occur in drinking-water
Diazinon Unlikely to occur in drinking-water
Dinoseb Unlikely to occur in drinking-water
Ethylene thiourea Unlikely to occur in drinking-water
Fenamiphos Unlikely to occur in drinking-water
Formothion Unlikely to occur in drinking-water
Hexachlorocyclohexanes Unlikely to occur in drinking-water
(mixed isomers)
MCPB Unlikely to occur in drinking-water
Methamidophos Unlikely to occur in drinking-water
Methomyl Unlikely to occur in drinking-water
Mirex Unlikely to occur in drinking-water
Monocrotophos Has been withdrawn from use in many countries and is unlikely to
occur in drinking-water
Oxamyl Unlikely to occur in drinking-water
Phorate Unlikely to occur in drinking-water
Propoxur Unlikely to occur in drinking-water
Pyridate Not persistent and only rarely found in drinking-water
Quintozene Unlikely to occur in drinking-water
Toxaphene Unlikely to occur in drinking-water
Triazophos Unlikely to occur in drinking-water
Tributyltin oxide Unlikely to occur in drinking-water
Trichlorfon Unlikely to occur in drinking-water
488
ANNEX 4. CHEMICAL SUMMARY TABLES
Table A4.2 Chemicals for which guideline values have not been established
Aluminium Owing to limitations in the animal data as a model for humans and the
uncertainty surrounding the human data, a health-based guideline
value cannot be derived; however, practicable levels based on
optimization of the coagulation process in drinking-water plants using
aluminium-based coagulants are derived: 0.1 mg/litre or less in large
water treatment facilities, and 0.2 mg/litre or less in small facilities
Ammonia Occurs in drinking-water at concentrations well below those at which
Asbestos No consistent evidence that ingested asbestos is hazardous to health
Bentazone Occurs in drinking-water at concentrations well below those at which
Bromochloroacetate Available data inadequate to permit derivation of health-based
guideline value
Bromochloroacetonitrile Available data inadequate to permit derivation of health-based
guideline value
Chloride Not of health concern at levels found in drinking-watera
Chlorine dioxide Guideline value not established because of the rapid breakdown of
chlorine dioxide and because the chlorite provisional guideline value is
adequately protective for potential toxicity from chlorine dioxide
Chloroacetones Available data inadequate to permit derivation of health-based
guideline values for any of the chloroacetones
Chlorophenol, 2- Available data inadequate to permit derivation of health-based
guideline value
Chloropicrin Available data inadequate to permit derivation of health-based
guideline value
Dialkyltins Available data inadequate to permit derivation of health-based
guideline values for any of the dialkyltins
Dibromoacetate Available data inadequate to permit derivation of health-based
guideline value
Dichloramine Available data inadequate to permit derivation of health-based
guideline value
Dichlorobenzene, 1,3- Toxicological data are insufcient to permit derivation of health-based
guideline value
Dichloroethane, 1,1- Very limited database on toxicity and carcinogenicity
Dichlorophenol, 2,4- Available data inadequate to permit derivation of health-based
guideline value
Dichloropropane, 1,3- Data insufcient to permit derivation of health-based guideline value
Di(2-ethylhexyl)adipate Occurs in drinking-water at concentrations well below those at which
Diquat Rarely found in drinking-water, but may be used as an aquatic
herbicide for the control of free-oating and submerged aquatic
weeds in ponds, lakes and irrigation ditches
Endosulfan Occurs in drinking-water at concentrations well below those at which
Fenitrothion Occurs in drinking-water at concentrations well below those at which
Fluoranthene Occurs in drinking-water at concentrations well below those at which
Glyphosate and AMPA Occurs in drinking-water at concentrations well below those at which
Hardness Not of health concern at levels found in drinking-watera
Heptachlor and Occurs in drinking-water at concentrations well below those at which
heptachlor epoxide toxic effects may occur
continued
489
Table A4.2 Continued

Hexachlorobenzene Occurs in drinking-water at concentrations well below those at which
Hydrogen sulde Not of health concern at levels found in drinking-watera
Inorganic tin Occurs in drinking-water at concentrations well below those at which
Iodine Available data inadequate to permit derivation of health-based
guideline value, and lifetime exposure to iodine through water
disinfection is unlikely
Iron Not of health concern at concentrations normally observed in
drinking-water, and taste and appearance of water are affected below
the health-based value
Malathion Occurs in drinking-water at concentrations well below those at which
Methyl parathion Occurs in drinking-water at concentrations well below those at which
Monobromoacetate Available data inadequate to permit derivation of health-based
guideline value
Monochlorobenzene Occurs in drinking-water at concentrations well below those at which
toxic effects may occur, and health-based value would far exceed
lowest reported taste and odour threshold
MX Occurs in drinking-water at concentrations well below those at which
Parathion Occurs in drinking-water at concentrations well below those at which
Permethrin Occurs in drinking-water at concentrations well below those at which
pH Not of health concern at levels found in drinking-waterb
Phenylphenol, 2- and its Occurs in drinking-water at concentrations well below those at which
sodium salt toxic effects may occur
Propanil Readily transformed into metabolites that are more toxic; a guideline
value for the parent compound is considered inappropriate, and there
are inadequate data to enable the derivation of guideline values for
the metabolites
Silver Available data inadequate to permit derivation of health-based
guideline value
Sodium Not of health concern at levels found in drinking-watera
Sulfate Not of health concern at levels found in drinking-watera
Total dissolved solids Not of health concern at levels found in drinking-watera
(TDS)
Trichloramine Available data inadequate to permit derivation of health-based
guideline value
Trichloroacetonitrile Available data inadequate to permit derivation of health-based
guideline value
Trichlorobenzenes (total) Occurs in drinking-water at concentrations well below those at which
toxic effects may occur, and health-based value would exceed lowest
reported odour threshold
Trichloroethane, 1,1,1- Occurs in drinking-water at concentrations well below those at which
Zinc Not of health concern at concentrations normally observed in
drinking-watera
a
May affect acceptability of drinking-water (see chapter 10).
b
An important operational water quality parameter.
490
Table A4.3 Guideline values for chemicals that are of health signicance in drinking-water
Guideline valuea
Acrylamide 0.0005b
Alachlor 0.02b
Aldicarb 0.01 Applies to aldicarb sulfoxide and
aldicarb sulfone
Aldrin and dieldrin 0.00003 For combined aldrin plus dieldrin
Antimony 0.02
Arsenic 0.01 (P)
Atrazine 0.002
Barium 0.7
Benzene 0.01b
Benzo[a]pyrene 0.0007b
Boron 0.5 (T)
Bromate 0.01b (A, T)
Bromodichloromethane 0.06b
Bromoform 0.1
Cadmium 0.003
Carbofuran 0.007
Carbon tetrachloride 0.004
Chloral hydrate 0.01 (P)
Chlorate 0.7 (D)
Chlordane 0.0002
Chlorine 5 (C) For effective disinfection, there should
be a residual concentration of free
chlorine of 0.5 mg/litre after at least
30 min contact time at pH <8.0
Chlorite 0.7 (D)
Chloroform 0.2
Chlorotoluron 0.03
Chlorpyrifos 0.03
Chromium 0.05 (P) For total chromium
Copper 2 Staining of laundry and sanitary ware
may occur below guideline value
Cyanazine 0.0006
Cyanide 0.07
Cyanogen chloride 0.07 For cyanide as total cyanogenic
compounds
2,4-D (2,4-dichlorophenoxyacetic 0.03 Applies to free acid
acid)
2,4-DB 0.09
DDT and metabolites 0.001
Di(2-ethylhexyl)phthalate 0.008
Dibromoacetonitrile 0.07
Dibromochloromethane 0.1
1,2-Dibromo-3-chloropropane 0.001b
1,2-Dibromoethane 0.0004b (P)
Dichloroacetate 0.05 (T, D)
Dichloroacetonitrile 0.02 (P)
continued
491

Guideline value
Dichlorobenzene, 1,4- 0.3 (C)
Dichloroethane, 1,2- 0.03b
Dichloroethene, 1,1- 0.03
Dichloroethene, 1,2- 0.05
Dichloromethane 0.02
1,2-Dichloropropane (1,2-DCP) 0.04 (P)
1,3-Dichloropropene 0.02b
Dichlorprop 0.1
Dimethoate 0.006
Edetic acid (EDTA) 0.6 Applies to the free acid
Endrin 0.0006
Epichlorohydrin 0.0004 (P)
Ethylbenzene 0.3 (C)
Fenoprop 0.009
Fluoride 1.5 Volume of water consumed and intake
from other sources should be considered
when setting national standards
Formaldehyde 0.9
Hexachlorobutadiene 0.0006
Isoproturon 0.009
Lead 0.01
Lindane 0.002
Manganese 0.4 (C)
MCPA 0.002
Mecoprop 0.01
Mercury 0.001 For total mercury (inorganic plus
organic)
Methoxychlor 0.02
Metolachlor 0.01
Microcystin-LR 0.001 (P) For total microcystin-LR (free plus cell-
bound)
Molinate 0.006
Molybdenum 0.07
Monochloramine 3
Monochloroacetate 0.02
Nickel 0.02 (P)
Nitrate (as NO3-) 50 Short-term exposure
Nitrilotriacetic acid (NTA) 0.2
Nitrite (as NO2-) 3 Short-term exposure
0.2 (P) Long-term exposure
Pendimethalin 0.02
Pentachlorophenol 0.009b (P)
Pyriproxyfen 0.3
Selenium 0.01
Simazine 0.002
Styrene 0.02 (C)
2,4,5-T 0.009
Terbuthylazine 0.007
Tetrachloroethene 0.04
Toluene 0.7 (C)
492

Guideline value
Trichloroacetate 0.2
Trichloroethene 0.07 (P)
Trichlorophenol, 2,4,6- 0.2b (C)
Triuralin 0.02
Trihalomethanes The sum of the ratio of the
concentration of each to its respective
guideline value should not exceed 1
Uranium 0.015 (P, T) Only chemical aspects of uranium
addressed
Vinyl chloride 0.0003b
Xylenes 0.5 (C)
a
limited; T = provisional guideline value because calculated guideline value is below the level that can be achieved
through practical treatment methods, source protection, etc.; A = provisional guideline value because calculated
guideline value is below the achievable quantication level; D = provisional guideline value because disinfection is
likely to result in the guideline value being exceeded; C = concentrations of the substance at or below the health-
based guideline value may affect the appearance, taste or odour of the water, leading to consumer complaints.
b
associated with an upper-bound excess lifetime cancer risk of 10-5 (one additional cancer per 100 000 of the pop-
ulation ingesting drinking-water containing the substance at the guideline value for 70 years). Concentrations asso-
ciated with upper-bound estimated excess lifetime cancer risks of 10-4 and 10-6 can be calculated by multiplying
and dividing, respectively, the guideline value by 10.
493
Index
Page numbers in bold indicate main discussions.
Acanthamoeba 122, 123, 125, 259261 Agricultural activities, chemicals from 147
Acceptability 7, 23, 210220 analysis 159, 161
biologically derived contaminants guideline values 187188, 189, 190, 191
211213 treatment achievabilities 169170
chemical contaminants 146, 156, AIDS 124, 270
213219 Air
desalinated water 112113 chemical intake 152
in emergency and disaster situations radon intake 206207
106 Air stripping 175
Acceptable daily intake (ADI) 150 Aircraft 116117
derivation of guideline values 152 Airports 116117
uncertainty factors 150151 Alachlor 297298
Access to water (accessibility) 90, 9192 analysis 161
denition of reasonable 91 guideline value 191, 298, 491
equitability 105 treatment achievability 169, 298
Acinetobacter 102, 124, 222224, 286 Aldicarb 298300
Acrylamide 296297 analysis 161
analysis 162 guideline value 191, 299, 491
guideline value 194, 296, 491 treatment achievability 169, 299
Actinomycetes 212 Aldrin 300301
Activated alumina 179 analysis 161
Activated carbon guideline value 191, 300, 491
adsorption 176177 treatment achievability 169, 300
granular (GAC) 176, 177 Algae 213
powdered (PAC) 176 blue-green see Cyanobacteria
Additives 30 harmful events 111, 213
Adenoviruses 122, 248250, 295 toxins 111
Adequacy of supply, surveillance 9093 Alkalinity 217
ADI see Acceptable daily intake corrosion and 181, 184
Advanced oxidation processes 173 see also pH
Aeration processes 175 Alkylbenzenes 217
Aeromonas 102, 124, 224225, 286 Alpha radiation activity
Aerosols 123 measurement 207208
Affordability 90, 92 screening levels 204, 205, 206
Aggressivity, desalinated water 112 Alumina, activated 179
Aggressivity index 183 Aluminium 193, 213, 301303, 489
494
INDEX
Alzheimer disease (AD) 302 Atrazine 308309

Americium-241 202 analysis 161
Aminomethylphosphonic acid (AMPA) guideline value 191, 309, 491
190, 379380, 489 treatment achievability 169, 309
Amitraz 189, 488 Audit 8687, 94
Ammonia 190, 303304, 489 Avoidance, water 79
taste and odour 213
treatment to remove 220 Bacillus 221, 225226
Amoebae 63 Bacillus cereus 221, 225, 226
Legionella ingestion 234 Bacillus thuringiensis israelensis 190
persistence in water 125 Backow 62, 63
see also Acanthamoeba; Entamoeba large buildings 101
histolytica; Naegleria fowleri Bacteria 221
Amoebiasis 266 indicator and index 282289
Amoebic meningoencephalitis, primary pathogenic 122, 222247
(PAM) 123, 272, 273 persistence in water 125
AMPA 190, 379380, 489 treatment effects 138141
Analytical methods Bacteriophages 142, 289294
chemicals 157166 Bacteroides fragilis 292294
radionuclides 207208 coliphages 289292
Ancylostoma 124 Bacteroides fragilis phages 292294
Animals Balantidium coli (balantidiasis) 124,
in drinking-water 212213 261262
toxicity studies 148 Barium 310311
uncertainty factors 151 analysis 159
Anion exchange 177 guideline value 186, 310, 491
Anthrax 225 BDCM see Bromodichloromethane
Antimony 304306 Becquerel (Bq) 201
analysis 159 Benchmark dose (BMD) 152, 153
guideline value 194, 305, 491 Bentazone 190, 311312, 489
Appearance 7, 210, 211220 Benzene 312313
biologically derived contaminants analysis 160
211213 guideline value 188, 312, 491
chemical contaminants 213219 treatment achievability 168, 312
treatments for improving 219220 3,4-Benzuoranthene 429
Argyria 434 11,12-Benzuoranthene 429
Arsenic 6, 306308 Benzo[a]pyrene 428429, 430
analysis 159 analysis 162
in drinking-water sources 146, 306 guideline value 194, 428, 491
guideline value 186, 306, 491 1,12-Benzpyrene 429
priority 3536 3,4-Benzpyrene 429
treatment achievability 167, 307 Beryllium 187, 488
Asbestos 193, 308, 489 Beta-Poisson doseresponse relation 129
Asbestoscement pipes 183 Beta radiation activity 205
Ascariasis (Ascaris) 124, 276 measurement 207208
Asellus aquaticus 212 screening levels 204, 205, 206
Aspergillus 102 Bilharziasis 123
Assessing Microbial Safety of Drinking Water: Biolms 45, 63
Improving Approaches and Methods atypical mycobacteria 235, 236
18, 59 coliform bacteria 283
Astroviruses 250251 desalinated water 113
Atomic absorption spectrometry (AAS) Klebsiella 233
159164 Legionella 234, 235
Atomic emission spectrometry (AES) 164 Biological denitrication 179
495
Biological nitrication 179 scale 183184, 215216

Biologically derived contaminants 211213 see also Hardness
Bleach, household 107 Calcium hypochlorite 107, 171
Blooms, cyanobacterial 195, 213, 281 Calcium sulfate 218
Blue-baby syndrome Caliciviruses 251253
(methaemoglobinaemia) 6, 418420 Campylobacter 228229
Blue-green algae see Cyanobacteria performance target setting 132
Body weight 150 risk characterization 129, 130
assumptions 486 in source waters 137
Boil water orders 79 Campylobacter coli 122, 228
Boiling of water Campylobacter jejuni 122, 228
bottle-fed infants 114 Campylobacter pylori see Helicobacter pylori
emergencies and disasters 79, 107 Cancer
travellers 110 radiation-induced 200
Borehole water supplies 6566 radon-related risk 207
Boron 313314 tolerable risk 4647
analysis 159 see also Carcinogens
guideline value 186, 313, 491 Carbofuran 161, 319320
Bottle-fed infants 114, 418, 419 guideline value 191, 319, 491
Bottled water 113115 treatment achievability 169, 319
international standards 114115 Carbon, activated see Activated carbon
potential health benets 114 Carbon-14 (14C), 202
travellers 110, 111 Carbon tetrachloride 320321
Brackish water 111 analysis 160
Brass corrosion 182183 guideline value 188, 320, 491
Bromate 179, 315316 treatment achievability 168, 320
analysis 162 Carcinogens
guideline value 194, 315, 491 derivation of guideline values 149
strategies for reducing 180 genotoxic 148149, 154
Brominated acetic acids 316317 guideline values 154
Bromochloroacetate 193, 316317, 489 IARC classication 149
Bromochloroacetonitrile 193, 380382, 489 non-genotoxic 149
Bromodichloromethane (BDCM) 451454 tolerable risk 4647
analysis 162, 452 uncertainty factors 151
guideline value 194, 451, 491 Cascade aeration 175
Bromoform 451454 Catchments 53, 54, 5659
analysis 162 control measures 5859
guideline value 194, 451, 491 hazard identication 5658
Buildings mapping, emergency and disaster
large 99104, 235 situations 108
plumbing systems 1718 new systems 5253
Burkholderia pseudomallei 122, 221, roles and responsibilities 11, 1213, 14
226227 see also Source waters
Burns injuries 103 Categorical regression 152, 153154
Cation exchange 177
Cadmium 317319 Cement, corrosion 183
analysis 159 Cercariae 123
guideline value 188, 317, 491 Certication 1617, 42
treatment achievability 168, 317 agencies 1617
Caesium-134 (134Cs), 202 chemicals in water 43
Caesium-137 (137Cs), 202 desalination systems 112
Calcium, taste threshold 215 Chemical Safety of Drinking-water: Assessing
Calcium carbonate Priorities for Risk Management 18,
corrosion control 181, 182, 183, 184 36
496
INDEX
Chemical-specic adjustment factors targets 4243

(CSAF) 152, 154 verication 3031, 72, 73
Chemicals 67, 145196 Children
acceptability aspects 146, 156, 213219 consumption assumptions 486
agricultural activities see Agricultural hygiene education 103104
activities, chemicals from radionuclide guidance levels 204
allocation of intake 151152 see also Infants
alternative routes of exposure 4344, 146 Chironomus larvae 212
analytical methods 157166 Chloral hydrate (trichloroacetaldehyde)
achievabilities 157158, 159, 160163 321322
ranking of complexity 158 analysis 162
categorization by source 147 guideline value 194, 322, 491
desalination systems 111112 Chloramination 6364, 172
emergencies involving 79, 108109 by-products 179, 180, 192
guideline values see Guideline values nitrite formation 417, 418
health-based targets 41, 4243 Chloramines 172
health hazards 67, 145147 dialysis water 103
IARC classication 149 see also Monochloramine
industrial sources and human dwellings Chlorate 179, 326329
see Industrial sources and human analysis 162
dwellings, chemicals from guideline value 194, 326, 491
information sources 36, 148, 156 Chlordane 323324
inorganic analysis 161
analytical methods 158, 159 guideline value 191, 323, 491
guideline values 185, 186 treatment achievability 169, 323
mixtures 156 Chloride 185, 324325, 489
naturally occurring see Naturally acceptability 213214, 324
occurring chemicals corrosion and 181, 182, 184
non-guideline 156 Chlorinated acetic acids 145, 179, 349350,
non-threshold 148149 412413, 445446
derivation of guideline values 154 Chlorinated anisoles 214
provisional guideline values 155156 Chlorinated ketones 179
organic, analytical methods 158, Chlorination 61, 171172
160161 breakpoint 171
priority setting 3536 by-products 145, 179180, 192, 451
on ships 118 in emergencies 79
short-listing 36 marginal 171
summary tables 488493 microbial reduction 140
threshold 148, 149154 for travellers 110
alternative approaches 152154 Chlorine 5, 171, 325326
derivation of guideline values 149152 acceptable levels 214
treatment 166184 analysis 162
achievabilities 166171 gas, liqueed 171
for corrosion control 180184 guideline value 194, 325, 491
process control measures 179180 residual
processes 171179 emergency and disaster situations 107,
used in treatment/materials in contact 108
with water 147 monitoring 69, 82
analysis 159, 162 treatment see Chlorination
guideline values 188190, 193194 Chlorine dioxide 326
see also Disinfection by-products by-products 179, 180, 192, 326
water quality see also Chlorate; Chlorite
emergency and disaster situations guideline value 193, 328, 489
108109 microbial reduction 140
497
toxicity 327 Coliform bacteria

water treatment 173 detection methods 144
Chlorite 179, 326329 thermotolerant 142, 143, 282, 284285
analysis 162 total 282284
guideline value 194, 326, 491 Coliphages 289292
3-Chloro-4-dichloromethyl-5-hydroxy- F-RNA 290291
2(5H)-furanone (MX) 193, somatic 290, 291
414415, 490 Colitis, amoebic 266
Chloroacetones 193, 329, 489 Collection, water
Chlorobenzilate 189, 488 emergency and disaster situations
Chloroform 145, 451454 106
analysis 162, 452 household use 71
guideline value 194, 451, 491 Colorimetric methods 158
2-Chlorophenol 193, 214, 329331, Colour 211, 214
489 Communication 2728
Chlorophenols 214, 329331 emergency and disaster situations
Chlorophenoxy herbicides 341, 342343, 106
361362, 374375, 439440 surveillance information 9597
Chloropicrin 193, 331332, 489 water safety plans 8283
Chlorothalonil 189, 488 Community
Chlorotoluron 332333 communication 28, 96
analysis 161 involvement in setting standards 34
guideline value 191, 332, 491 organizations 12, 96
treatment achievability 169, 332 Community drinking-water systems
Chlorpyrifos 190, 333334 6467
analysis 163 control measures 6567
guideline value 195, 333, 491 development of water safety plans
Cholera 244245 (WSPs) 85
Chromatography 164165 ensuring operation and maintenance
Chromium 334335 94
analysis 159 grading schemes 97, 98
guideline value 186, 334, 491 hazard identication 6465
Chydorus sphaericus 212 management 8182
Citrobacter 282, 284 operational monitoring 71, 82
Clarication 138139 roles and responsibilities 1112, 1415
drinking-water for travellers 110 surveillance 87, 8889
emergency and disaster situations 105, verication testing 7475
107 Concise International Chemical Assessment
Clostridium perfringens 142, 288289 Documents (CICADs) 36
Closure, drinking-water supply 79 Concrete, dissolution 183
Cloudiness 211 Condence intervals 153
Co-precipitation method, radionuclide Conjunctivitis, adenovirus 248, 249
analysis 208 Consumers
Coagulation (chemical) 60, 175176 acceptability to see Acceptability
before disinfection 179180 interaction with 96
microbial reduction 138139 right of access to information 83, 96
Coal-tar linings, pipes 428, 430 roles and responsibilities 1516
Coastal water 111 Consumption, drinking-water, daily per
Code of good practice 3334 capita 90
Code of Practice for Collecting, Processing and assumptions 486
Marketing of Natural Mineral Waters performance target setting and 128,
115 133134
Codex Alimentarius Commission (CAC) Contact, transmission via 221
114115 Contact lenses 238, 260261
498
INDEX
Continuity of supply 90, 9293 Cyanogen chloride 162, 194, 340, 491
Control measures 26, 49, 68 Cyanotoxins 4, 280, 281
assessment and planning 5556 classication 192
dened 55 guideline values 192196
monitoring performance see Operational treatment 171, 195
monitoring see also Microcystin-LR
operational and critical limits 70 Cyclops 212, 276, 277
prioritizing hazards 5355 Cyclospora cayetanensis 122, 259,
validation see Validation 264265
Cooling towers 100, 234 Cyclosporiasis 264
Copper 335337 Cylindrospermopsin 192, 280
acceptability 214215 Cypermethrin 189, 488
analysis 159 Cystic brosis 238
corrosion 182
guideline value 194, 336, 491 2,4-D (2,4-dichlorophenoxyacetic acid)
impingement attack 182 340342
pitting 182 analysis 161
Corrosion 180184, 217 guideline value 191, 341, 491
control strategies 184 treatment achievability 169, 341
galvanic 182 DALYs see Disability-adjusted life years
indices 183184 Data
inhibitors 181, 184 tness for purpose 75
pitting 182 regional use 9697, 98
Costs system assessment and design 5356
treatment 166167 Day care centres 103104
water supply 92 2,4-DB 161, 191, 342343, 491
Coxsackieviruses 253254 DBCP see 1,2-Dibromo-3-chloropropane
Crangonyx pseudogracilis 212 DBPs see Disinfection by-products
Critical limits 70 DCBs see Dichlorobenzenes
Crustaceans 212 DDT and metabolites 190, 343345
Cryptosporidiosis 259, 262263 analysis 163
Cryptosporidium (parvum) 122, guideline value 195, 344, 491
262264 treatment achievability 170, 344
disinfection 140141 Dealkalization 177
oocysts 110, 262, 263 Dechlorination 171
performance target setting 131132, DEHA see Di(2-ethylhexyl)adipate
133134 DEHP see Di(2-ethylhexyl)phthalate
risk characterization 130 Demineralized water 114
in source waters 137 Denitrication, biological 179
Ct concept 61 Dermal absorption
Culex larvae 212 assumptions 486487
Cyanazine 337338 chemicals 152
analysis 161 Desalination systems 111113, 178
guideline value 191, 337, 491 Detergents, synthetic 218
treatment achievability 169 Developing countries, urban areas 88
Cyanide 339340 Deviations 77
analysis 159 Devices
guideline value 188, 339, 491 certication see Certication
Cyanobacteria 147, 192, 221, 279281 medical, washing 103
acceptability 213 Dezincication of brass 182
blooms 195, 213, 281 Di(2-ethylhexyl)adipate (DEHA) 187,
health concerns 4 362363, 489
toxins see Cyanotoxins Dialkyltins 193, 345346, 489
treatment 171, 195 Dialysis, renal 103
499
Diarrhoea 1,2-Dichloropropane (1,2-DCP) 358359

cryptosporidiosis 262263 analysis 161
Escherichia coli 230 guideline value 191, 358, 492
Giardia 267 treatment achievability 169, 358
rotavirus 258 1,3-Dichloropropane 190, 359360, 489
travellers 109 1,3-Dichloropropene 161, 191, 360361,
Diatomaceous earth 139 492
Diazinon 189, 488 Dichlorprop (2,4-DP) 161, 191, 361362,
1,2-Dibromo-3-chloropropane (DBCP) 492
346347 Dieldrin 300301
analysis 161 analysis 161
guideline value 191, 346, 491 guideline value 191, 300, 491
treatment achievability 169, 346 treatment achievability 169, 300
Dibromoacetate 193, 316, 489 Dimethoate 364366
Dibromoacetonitrile 162, 194, 380382, analysis 161
491 guideline value 191, 365, 492
Dibromochloromethane (DCBM) 451454 treatment achievability 169, 365
analysis 162 Dinoseb 189, 488
guideline value 194, 451, 491 1,4-Dioxane 168
1,2-Dibromoethane (ethylene dibromide) Di(2-ethylhexyl)phthalate (DEHP) 160,
347349 188, 363364, 491
analysis 161 Diquat 190, 366367, 489
guideline value 191, 347, 491 Disability-adjusted life years (DALYs)
treatment achievability 169, 348 4547
Dichloramine 193, 411, 489 microbial hazards 129130
Dichloroacetate 162, 194, 349350, 491 reference level of risk and 45
1,1-Dichloroacetone 329 Disasters 63, 104109
Dichloroacetonitrile 162, 194, 380382, 491 chemical and radiological guidelines
3,4-Dichloroaniline 430 108109
1,2-Dichlorobenzene 350352 microbial guidelines 107108
acceptable levels 215 monitoring 106107
analysis 160 practical considerations 105106
guideline value 188, 350, 491 sanitary inspections and catchment
treatment achievability 168, 351 mapping 108
1,3-Dichlorobenzene 187, 350352, 489 testing kits and laboratories 109
1,4-Dichlorobenzene 350352 see also Emergencies
acceptable levels 215 Disease burden
analysis 160 health outcome targets and 134135
guideline value 188, 350, 492 waterborne infections 129130
treatment achievability 168, 351 Disinfectants 188189
Dichlorobenzenes (DCBs) 215, 350352 analysis 162
1,1-Dichloroethane 187, 352, 489 DBP formation and 180
1,2-Dichloroethane 353354 guideline values 193, 194
analysis 160 residual, piped distribution systems 63
guideline value 188, 353, 492 see also specic disinfectants
treatment achievability 168, 353 Disinfection 56, 61
1,1-Dichloroethene 160, 188, 354355, 492 in emergency and disaster situations
1,2-Dichloroethene 355356 105106, 107
analysis 160 indicator organisms 283, 284, 286
guideline value 188, 355, 492 limitations 5
treatment achievability 168, 355 methods 171173
Dichloromethane 160, 188, 357358, 492 microbial reduction 140141
2,4-Dichlorophenol 193, 214, 329331, 489 non-chemical 180
2,4-Dichlorophenoxyacetic acid see 2,4-D resistant organisms 142
500
INDEX
on ships 120 documentation and reporting 28, 77

for travellers 110 follow-up investigation 77
vendor supplies 15 microbial guidelines 107108
Disinfection by-products (DBPs) 5, 145, monitoring 106107
179180, 189, 192 practical considerations 105106
analysis 162 radionuclide releases 198
desalinated water 111112 response plans 7677, 7879
guideline values 193, 194 sanitary inspections and catchment
strategies for reducing 179180 mapping 108
see also specic chemicals testing kits and laboratories 109
Displaced populations 104 see also Disasters; Incidents
Distilled water 114 Emerging diseases 259
Documentation 2728 Empty bed contact time (EBCT) 177
incidents and emergencies 28, 77 Encephalitis, granulomatous amoebic
supporting 1821 (GAE) 260, 261
water safety plans 8283 Encephalitozoon 270, 271
Domestic supplies see Household drinking- Endosulfan 190, 368369, 489
water supplies Endrin 369370
Domestic Water Quantity, Service Level and analysis 161
Health 18 guideline value 191, 369, 492
Dose, infectious 129 treatment achievability 169, 369
Doseresponse assessment, microbial Entamoeba histolytica 122, 265267
pathogens 127, 128129 Enteric fever 239
Dracunculus Eradication Programme 276 Enteric pathogens, in source waters
Dracunculus medinensis (guinea worm) 136137
123, 124, 221, 276277 Enteric viruses 247248, 294295
intermediate host 212 coliphages as indicator 290291
signicance in drinking-water 122, 277 indicator value 294
Dreissena polymorpha 212 in source waters 137
Droughts 104 Enterobacter 282, 284
Dysentery Enterococci, intestinal 287288
amoebic 266 Enterococcus spp. 287
bacillary 240241 Enterocolitis, Staphylococcus aureus 242
Enterocytozoon 270
Earthquakes 104 Enteroviruses 122, 142, 253254, 295
Echinococcus 124 Environmental Health Criteria monographs
Echoviruses 253 (EHCs) 36
Edetic acid (EDTA) 367368 Environmental Protection Agency, US (US
analysis 160 EPA) 36
guideline value 188, 367, 492 Enzyme-linked immunosorbent assay
treatment achievability 168, 367 (ELISA) 165166
EDTA see Edetic acid Epichlorohydrin (ECH) 162, 194, 370372,
Education programmes 12, 71, 89 492
establishing 94 Equitability, access to water 105
schools and day care centres 103104 Escherichia coli 282
Electrode, ion-selective 158 detection methods 144
Electron capture detection (ECD) 165 emergency and disaster situations
Electrothermal atomic absorption 108
spectrometry (EAAS) 164 enterohaemorrhagic (EHEC) 122,
ELISA (enzyme-linked immunosorbent 229230
assay) 165166 enteroinvasive (EIEC) 229, 230
Emergencies 76, 104109 enteropathogenic (EPEC) 229, 230
chemical and radiological guidelines enterotoxigenic (ETEC) 229, 230
108109 guideline values 143
501
as indicator of faecal pollution 29, 142, direct 173

284285 drinking-water for travellers 110
pathogenic 122, 229231 dual-media or multimedia 174
phages (coliphages) 289292 granular high-rate 139
piped distribution systems 63 horizontal 173, 174
in source waters 137 membrane 139
see also Coliform bacteria microbial reduction 139140
Ethylbenzene 372373 precoat 139
analysis 160 pressure 173, 174
guideline value 188, 372, 492 rapid gravity 173174
odour and taste thresholds 215 roughing 138, 174
treatment achievability 168, 372 slow sand 139, 173, 174175
Ethylene dibromide see 1,2-Dibromoethane First-ush diverters 66
Ethylene thiourea 189, 488 Fit for purpose 75
Evaluation of the H2S Method for Detection Flame atomic absorption spectrometry
of Fecal Contamination of Drinking (FAAS) 159
Water 19 Flame ionization detection (FID) 165
Evaporation method, radionuclide analysis Flavobacterium 124, 286
207208 Flocculation 60, 138139, 175176
Exposure assessment, microbial pathogens Floods 104
127, 128 Flotation, dissolved air 138, 176
Eye infections Flow diagrams 52
Acanthamoeba 260 Fluoranthene 193, 428, 489
adenovirus 248, 249 health-based values 429, 430
Fluoride 375377
Faecaloral route of transmission 122, 221 analysis 159
Faecal contamination 34 desalinated water 113
control measures 5, 59 guideline value 186, 376, 492
in emergencies 79, 107 health concerns 6, 376377
indicator organisms see Faecal indicator priority 3536
organisms treatment achievability 167, 376
large buildings 100 Fluorosis 376377
on ships 117 Food
Faecal indicator organisms 29, 281295 acceptable daily intakes (ADIs) 150
community supplies 82 intake of chemicals 152
criteria 281282 production and processing 115116
desalinated water 112 safety, travellers 109110
emergency and disaster situations 107, Food and Agriculture Organization (FAO)
108 114
guideline values 143 Food poisoning
methods of detection 143144 Bacillus cereus 225, 226
operational monitoring 69 Campylobacter 228
presence/absence (P/A) testing 72 Salmonella 239, 240
in source waters 136137 Staphylococcus aureus 242
verication testing 72, 74, 142 Formaldehyde 162, 194, 377378, 492
Fasciola 124, 276, 278279 Formothion 189, 488
Fascioliasis 278279 Framework for safe drinking water 23,
Fasciolopsis 124 2236
Fenamiphos 189, 488 health-based targets 2425
Fenitrothion 190, 373374, 489 key components 22
Fenoprop 161, 191, 374375, 492 management plans, documentation and
Field test kits 109, 158 communication 2728
Filtration 6061, 173175 operational monitoring 2627
after coagulation 176 requirements 2229
502
INDEX
risk assessment 44 derivation 47, 147156

supporting information 2223 approaches 148149
surveillance of drinking-water quality data quality 154155
2829 non-threshold chemicals (non-TDI-
system assessment and design 2526 based) 154155
Fulvic acids 214 signicant gures 152
Fungi 212 threshold chemicals (TDI-based)
149154
b-Galactosidase 282, 283 see also Tolerable daily intake
Galvanized iron 183 in emergencies 108109
Gammarus pulex 212 health-based targets based on 41
Gas chromatography (GC) 165 mixtures of chemicals and 156
Gas chromatography/mass spectrometry provisional 31, 148, 155156
(GC/MS) 165 high uncertainty and 151
Gastroenteritis use and designation 155
adenovirus 248249 radionuclides 202204
astrovirus 250 radon 207
calicivirus 252 summary tables 488493
Campylobacter 228 treatment achievability 166171
rotavirus 258 verication of microbial quality 143
Salmonella 239 GuillainBarr syndrome 228
Yersinia 246 Guinea worm see Dracunculus medinensis
Genotoxic carcinogens 148149
Geosmin 212, 213 Haemolytic uraemic syndrome (HUS)
Geothermal waters 272, 273 229230
Giardia (intestinalis) 122, 267268 Hafnia 282
disinfection 140141 Halogenated acetonitriles 380382
in source waters 137 Hardness 185, 382383, 489
Giardiasis 267 acceptability 215216
b-Glucuronidase 284 corrosion and 182, 184
Glyphosate 190, 379380, 489 treatment to reduce 220
Gnat larvae 212 Hazard 52
Grading schemes, safety of drinking-water identication 127
29, 5355, 97, 98 prioritization, for control 5355
Granular activated carbon (GAC) 176, 177 Hazard Characterization for Pathogens in
Granulomatous amoebic encephalitis (GAE) Food and Water: Guidelines 19
260, 261 Hazardous events 52, 127
Gray (Gy) 201 Health-based targets 2425, 3747
Groundwaters benets 38
Acinetobacter 222223 establishing 4347
arsenic contamination 146 microbial hazards 126135
control measures 58, 59, 6566 role and purpose 3739
hazard identication 56, 57 types 3943
pathogen occurrence 136137 Health care facilities
radon 206 drinking-water quality 102103
system assessment and design 53, 54 health risk assessment 100
Guide to Ship Sanitation 118 Health education 89, 103104
Guideline values (GVs) 12, 67, 25, 30 see also Education programmes
acceptability and 156 Health outcome targets 2425, 40, 43
applying 3031 waterborne infections 134135
chemicals by source category 184196 Health promotion 89
chemicals excluded 488 Health risks 37
chemicals of health signicance 491493 aircraft and airports 116
chemicals without established 489490 chemicals 67, 145147
503
large buildings 100 Human dwellings, chemicals originating

microbial see Microbial hazards from see Industrial sources and
radiological 7, 198, 200201 human dwellings, chemicals
ships 117118 from
travellers 109 Humic acids 214
Helicobacter pylori 221, 231232 Hydrocarbons, low molecular weight 217
Helminths 4, 221, 275279 Hydrogen peroxide 173, 180
signicance in drinking-water 122, 124 Hydrogen sulde 185, 387388, 490
Hepatitis A virus (HAV) 122, 125, acceptable levels 216
254256 treatment to remove 220
Hepatitis E virus (HEV) 122, 256257 Hydroquinone 118
Heptachlor 190, 383384, 489 Hydroxyl radicals 173
Heptachlor epoxide 190, 383384, 489 Hygiene
Heterotrophic micro-organisms 69, 286 education programmes see Education
Heterotrophic plate counts (HPC) 5, programmes
285286 service level and 90, 91
Heterotrophic Plate Counts and Drinking- Hypertension 436
water Safety 19 Hypochlorite 107, 171
Hexachlorobenzene (HCB) 187, 385386, Hypochlorous acid 171
490
Hexachlorobutadiene (HCBD) 386387 Ice 110, 113
analysis 160 Immunity
guideline value 188, 386, 492 acquired 125, 130131
treatment achievability 168, 386 variations in 121, 125
Hexachlorocyclohexanes 189, 488 Immunocompromised persons 102, 124
High-income countries, rotavirus Aeromonas infections 224
performance targets 131132 atypical mycobacteria infections 236
High-performance liquid chromatography disease burden estimates 130
(HPLC) 165 isosporiasis 269
Holistic approach 3 Klebsiella infections 232
Hookworm infections 276 Pseudomonas aeruginosa 238
Hospital-acquired (nosocomial) infections toxoplasmosis 274
Acinetobacter 222, 223 travellers 111
Klebsiella 232, 233 Tsukamurella infections 243
Pseudomonas aeruginosa 238 Impingement attack 182, 183
Hospitals Improvement, drinking-water systems
drinking-water quality 102103 6768
health risk assessment 100 Incidents 76
Hot water systems 100, 234235 audit 8687
Hotels 100 documentation and reporting 28, 77
Household drinking-water supplies follow-up investigation 77
collection, transportation and storage of predictable 77
water 71 response plans 7677, 78
control measures 6567 unplanned events 7778
hazard identication 6465 see also Emergencies
management 8182 Indeno [1,2,3-cd] pyrene 429
operational monitoring 71 Index organisms 281295
quantity of water collected and used Indicator organisms 29, 281295
9091 Inductively coupled plasma/atomic
roles and responsibilities 1112, 1516 emission spectrometry (ICP/AES)
surveillance 89 164
system assessment 6467 Inductively coupled plasma/mass
treatment 141 spectrometry (ICP/MS) 164
water safety plans (WSPs) 4849, 85 Industrial efuents 214
504
INDEX
Industrial sources and human dwellings, Intestinal enterococci 287288

chemicals from Invertebrate animals 212213
analysis 159, 160 Iodine 389390
guideline values 185187, 188 guideline value 193, 389, 490
treatment achievability 168 treatment, for travellers 110, 111
Infants Iodine-131 202
bottle-fed 114, 418, 419 Ion chromatography 164165
consumption assumptions 486 Ion exchange 139, 177
see also Children Ion-selective electrode 158
Infections, waterborne 4, 121124, Iron 193, 390391, 490
221 acceptable levels 216, 390
asymptomatic 125126 corrosion 181
emergency and disaster situations 79, galvanized 183
104, 106 priority 3536
health-based targets 39, 43 Iron bacteria 213, 216
health outcome targets 134135 Isoproturon 391392
public health aspects 1011, 125126 analysis 161
risk characterization 127, 129131 guideline value 191, 391, 492
routes of transmission 221 treatment achievability 169, 391
ships 117 Isospora belli 221, 268270
see also Pathogens Isosporiasis 269
Inltration
bankside 138 Jar tests 176
contamination via 62, 63 Joint FAO/WHO Expert Committee
Information channels, establishing 94 on Food Additives (JECFA) 36,
Ingress 150
non-piped distribution systems 65 Joint FAO/WHO Meetings on Pesticide
piped distribution systems 62, 63 Residues (JMPR) 36, 150
Inhalation
assumptions 486487 Keratitis, Acanthamoeba 260261
chemicals 152 Keratoconjunctivitis, epidemic (shipyard
micro-organisms 123, 221 eye) 248, 249
radionuclides 197 Kits, testing 109, 158
radon 206207 Klebsiella 232233
Inorganic tin 193, 388389 as indicator organism 282, 284, 286
Insecticides, aquatic 190 pathogenicity 124, 232
Intakes
control measures 59 Laboratories, in emergencies and disasters
hazard identication 5758 109
Intermittent water supply 63, 9293, Lactose fermentation 282, 283, 284
101 Lakes 137
International Agency for Research on Land use 1213
Cancer (IARC) 149 Langelier index (LI) 184
International Atomic Energy Agency (IAEA) Large buildings 99104, 235
201202 drinking-water quality 102104
International Commission on Radiological health risk assessment 100
Protection (ICRP) 197, 198, independent surveillance and supporting
201202 programmes 102
International Health Regulations 116 management 101
International Organization for monitoring 101102
Standardization (ISO) standards 75, system assessment 100101
76, 144, 208 Larson ratio 184
International standards 2 Larvae 212
Interspecies variation 151 Larvicides, aquatic 190
505
Latrines, contamination from 186 MCPA (4-(2-methyl-4-

Laws, national drinking-water 3132 chlorophenoxy)acetic acid) 399400
Lead 6, 392394 analysis 161
corrosion 181182 treatment achievability 169, 399
guideline value 194, 392, 492 MCPB 189, 488
priority 3536 MCPP see Mecoprop
sampling locations 73 Mean, arithmetic vs geometric 131
Lead-210 202 Mecoprop 400401
Legionella spp. 4, 123, 221, 233235 analysis 161
control measures 64. 234235 guideline value 191, 401, 492
health care facilities 103 treatment achievability 169, 401
large building systems 100, 235 Medical devices, cleaning 103
persistence 125 Melioidosis 226227
signicance in drinking-water 122, Membrane processes, water treatment 178,
234235 180
Legionellosis 100, 123, 233234 Meningoencephalitis, primary amoebic
Legionnaires disease 123, 233234 (PAM) 123, 272, 273
Likelihood categories 5455 Mercury 402403
Lime softening 139, 179 analysis 159
Lindane 394396 guideline value 188, 402, 492
analysis 161, 395 treatment achievability 168, 402
guideline value 191, 395, 492 Meringue dezincication 182183
treatment achievability 169, 395 Methaemoglobinaemia 6, 418420
Liver ukes see Fasciola Methamidophos 189, 488
LOAEL see Lowest-observed-adverse-effect Methomyl 189, 488
level Methoprene 190
Local authorities 1112 Methoxychlor 403404
Low-income countries, rotavirus analysis 161
performance targets 131132 guideline value 191, 403, 492
Lowest-observed-adverse-effect level treatment achievability 169, 403
(LOAEL) 149, 150 4-(2-Methyl-4-chlorophenoxy)acetic acid
uncertainty factors 151 see MCPA
Lung cancer, radon-related risk 207 2-(2-Methyl-chlorophenoxy) propionic acid
see Mecoprop
Magnesium 215 2-Methyl isoborneol 212, 213
Malathion 190, 396397, 490 Methyl parathion 190, 404405, 490
Management Methylene chloride see Dichloromethane
aircraft and airports 117 Methylmercury 402
community and household supplies Metolachlor 405407
8182 analysis 161
large buildings 101 guideline value 191, 406, 492
piped distribution systems 7681 treatment achievability 169, 406
plans 2728, 49 Micro-organisms, indicator and index
roles and responsibilities 818 281295
ships 119120 Microbial aspects 35, 121144
Managing Water in the Home 19, 6667 Microbial growth
Manganese 397399 bottled water 114
acceptability 216, 398 desalinated water 113
analysis 159 Microbial hazards 34, 121126
guideline value 186, 398, 492 health-based target setting 126135
priority 36 identication 127
treatment to remove 167, 220 water quality targets 43, 126
Mass spectrometry (MS) 164, 165 Microbial pathogens see Pathogens
506
INDEX
Microbial quality Naegleria fowleri 123, 125, 221, 272273

assessing priorities 35 control measures 64, 273
emergency and disaster situations 79, signicance in drinking-water 122, 273
107108 Nais worms 212
grading schemes based on 97, 98 Nanoltration 140, 178
health care facilities 102103 National Academy of Sciences (NAS) (USA)
verication 2930, 72, 142143 207
Microcystin-LR 195196, 407408, 492 National drinking-water policy 3134
Microcystins 103, 192, 196, 280 National performance targets 133134
Microltration 139, 178 National priorities, supply improvement
Microsporidia 221, 259, 270272 93
Microstraining 138 National standards and regulations 3132
Millennium Development Goals 33 chemical contaminants 146
Mineral waters, natural 114115 developing 2, 3234
see also Bottled water Natural disasters 63, 104
Mining activities 186 Naturally occurring chemicals 147
Minister of health 33 analysis 159
Ministries, government 33, 34 guideline values 184185, 186
Mirex 189, 488 treatment achievability 167
Molinate 161, 191, 408409, 492 see also Chemicals
Molluscs 212 Necator 124
Molybdenum 159, 186, 410411, 492 Nematodes 212, 276
Monitoring New drinking-water supply systems
dissolved radionuclides 204205 assessment and design 5253
emergency and disaster situations source verication 74
106107 Nickel 415417
operational see Operational monitoring analysis 159, 416
plans, preparing 80 guideline value 194, 416, 492
see also Sanitary inspection; Surveillance leaching 183
Monobromoacetate 193, 316317, 490 Nitrate 6, 417420
Monochloramine 411412 agricultural sources 187
acceptability 216217 analysis 159, 418
by-products 179, 180 treatment achievability 169, 418
disinfection activity 140, 172 Nitrication, biological 179
guideline value 194, 411, 492 Nitrilotriacetic acid (NTA) 420421
Monochloroacetate 162, 194, 412413, analysis 160, 420
Monochlorobenzene (MCB) 187, 217, treatment achievability 168
413414, 490 Nitrite 6, 417420
Monocrotophos 189, 488 analysis 159, 418
Moraxella 286 desalinated water 113
Mudslides 104 guideline value 191, 417, 492
Multiagency approach, collaborative 8 treatment achievability 169, 418
Multiple-barrier concept 3, 5, 56 Nitrosamines 419
MX (3-chloro-4-dichloromethyl-5- No-observed-adverse-effect level (NOAEL)
hydroxy-2(5H)-furanone) 193, 149, 150
414415, 490 uncertainty factors 151
Mycobacterium (mycobacteria) 235237 vs benchmark dose 153
atypical (non-tuberculous) 122, 124, NOAEL see No-observed-adverse-effect
221 level
health care facilities 102 Non-piped water systems 6467
Mycobacterium avium complex 235, 236 control measures 6567
Mycobacterium kansasii 235, 236 hazard identication 6465
507
operational monitoring 71 Particulate matter 211, 219

roles and responsibilities 16 Pathogenic Mycobacteria in Water 19
treatment 141 Pathogens 121124
Norms, drinking-water 10 alternative routes of transmission 5,
Noroviruses (Norwalk-like viruses) 122, 4344, 122
251 bacterial 222247
Nosema 270 doseresponse assessment 127, 128129
Nosocomial infections see Hospital-acquired exposure assessment 127, 128
infections fact sheets 221279
Nuisance organisms 45 health-based targets 39
Nursing care homes 100 helminth 275279
occurrence 135, 136137
Octanol/water partition coefcient 177 performance targets 4142, 131134
Odour 7, 210, 211220 persistence and growth in water 124125
biologically derived contaminants protozoan 259275
211213 special properties 142
chemical contaminants 213219 transmission pathways 123
treatments for removing 219220 treatment 137141
Oils, petroleum 186, 217 viral 247259
Operational limits 70 see also Infections, waterborne
Operational monitoring 2627, 49, 6871 Pendimethalin 422423
aircraft and airports 116117 analysis 161
community supplies 71, 82 guideline value 191, 423, 492
dened 68 Pentachlorophenol (PCP) 424425
large buildings 101102 analysis 160, 424
parameters 6870 guideline value 188, 424, 492
ships 119 treatment achievability 168, 424
Organic matter 214 Performance targets 25, 40, 4142, 126
Organisms, visible 211, 212213 national/local adaptation 133134
Organotins 345346 pathogens in raw water 131132, 133
Orthophosphate 181, 182 risk-based development 131134
Orthoreoviruses 257259, 295 Perlite 139
Osmosis 178 Permethrin 190, 425426, 490
reverse 140, 178 Pesticides 187
Oxamyl 189, 488 used in water for public health 147
Oxidation processes, advanced 173 analysis 161, 163
Oxygen guideline values 190192, 195
dissolved 215 treatment achievability 170
transfer 175 see also Agricultural activities, chemicals
Ozonation 172 from; specic compounds
by-products 179, 180, 192 Petroleum oils 186, 217
microbial reduction 141 pH 185, 426427, 490
Ozone 172, 173 chemical coagulation 175176
community supplies 82
Packaged drinking-water 113115 corrosion and 181, 182, 184
international standards 114115 DBP formation and 179180
safety 113114 emergency and disaster situations 108
see also Bottled water optimum range 217, 426
Parasites 420 saturation 184
persistence in water 125 Phages see Bacteriophages
secondary hosts 212 Pharyngoconjunctival fever 248
waterborne 122, 124 2-Phenylphenol (and its sodium salt) 190,
see also Helminths; Protozoa 427428, 490
Parathion 190, 421422, 490 Phorate 189, 488
508
INDEX
Piped distribution systems 6164 Priorities

assessment and design 54 assessing chemical 3536
control measures 6364 assessing microbial 35
hazard identication 6263 identifying 3436
intermittent supply 63 setting 34
large buildings 100, 101 Problem formulation, microbial hazards 127
management procedures 7681 Propanil 190, 430431, 490
microbial hazards 123 Propoxur 189, 488
operational monitoring parameters 69 Protozoa 221
on ships 118, 119 cysts and oocysts, removal 61
verication testing 74 pathogenic 122, 259275
Pipes 1718 resistance to treatment 142
bursts 62 treatment effects 138141
cement lining 183 Pseudomonas 286
coal-tar linings 428, 430 Pseudomonas aeruginosa 102, 122, 124,
contaminants 193, 194 237239
corrosion 181, 182, 183 Public awareness, establishing 94
lead 181 Public health
Pitting corrosion 182 authorities, roles and responsibilities
Platyhelminthes 276 1011, 13
Pleistophora 270 policy context 44
Plumatella 212 surveillance 1011
Plumbing 1718 waterborne infections and 125126
household 16 Purge-and-trap packed-column GC method
on ships 118 165
Plumbosolvency 181182 Purge-and-trap packed-column GC/MS
Plutonium-239 (239Pu) 202 method 165
Pneumonia, Burkholderia pseudomallei 226 Pylon technique 208
Poisson distribution 129 Pyridate 189, 488
Policy Pyriproxyfen 190, 431432
development, wider 10 analysis 163
national drinking-water 3134 guideline value 195, 432, 492
Poliovirus 253, 295 treatment achievability 170, 432
Polonium-210 (210Po) 202
Polyacrylamides 296 QMRA see Quantitative microbial risk
Polynuclear aromatic hydrocarbons (PAHs) assessment
428430 Quality assurance 7576
Polyphosphates 181 Quality control 89, 7576
Polyvinylchloride (PVC) 456 Quantifying Public Health Risk in the WHO
Pontiac fever 233, 234 Guidelines for Drinking-water
Pools, stagnant 101 Quality 19, 47
Port authority 118, 119 Quantitative microbial risk assessment
Potassium-40 (40K) 205 (QMRA) 43, 126131
measurement 208 doseresponse assessment 128129
Potassium bromate 315 exposure assessment 128
Powdered activated carbon (PAC) 176 problem formulation and hazard
Presence/absence (P/A) testing 72 identication 127
Pressure, water 62, 63 risk characterization 129131
large buildings 101 Quantitative risk assessment 43
measurement, operational monitoring 69 Quantitative service indicators 7475
Pretreatment 60, 138 Quantity of supply
Prevention, disease 6 assessment of adequacy 9091
Preventive integrated management emergency and disaster situations 105
approach 8 Quintozene 189, 488
509
Radiation Regulations, national see National standards

absorbed dose 201 and regulations
background exposures 198 Reoviridae 257
committed effective dose 201, 205 Reporting
dose 201202 incidents and emergencies 28, 77
effective dose 201 radioactivity analysis 209
equivalent dose 201 surveillance information 9597
exposure through drinking-water 200 Reservoirs 54
health risks 7, 198, 200201 control measures 5859, 64
reference dose level (RDL) 198, 202 hazard identication 5758
sources 198201 occurrence of pathogens 137
Radioactivity Resource protection 5659, 81
measurement 207208 control measures 5859
screening 204 hazard identication 5658
units 201202 Respiratory infections, adenoviral 248
Radiological aspects 7, 197209 Reverse osmosis 140, 178
Radionuclides 7, 197209 Risk
activity concentration 201, 202 dened 52
analytical methods 207208 judgement of tolerable 2, 37
dose coefcients 201202 reference level 4445, 47, 132133
emergency and disaster situations scoring 5355
108109 Riskbenet approach 2, 45
guidance levels 202204 Risk assessment 5355
monitoring and assessment for dissolved in framework for safe drinking water 44
204205 quantitative 43
remedial measures 205 quantitative microbial see Quantitative
reporting of results 209 microbial risk assessment
sampling 209 Risk characterization, waterborne infection
screening for 204, 206 127, 129131
sources 200 Rivers, occurrence of pathogens 136, 137
strategy for assessing drinking-water 205, Roles and responsibilities, management
206 818
Radium-226 (226Ra) 202 Rotaviruses (HRVs) 122, 257259
Radium-228 (228Ra) 202 performance target setting 131132, 133,
Radon (222Rn) 197, 206207 134, 135
in air and water 206 risk characterization 129, 130131
guidance levels 207 Roughing lters 138, 174
measurement 208 Routes of transmission 123
risk 207
sampling 209 Safe, Piped Water: Managing Microbial
Rainfall 2930 Water Quality in Piped Distribution
Rainwater Systems 1920
collection systems 65, 66, 141 Salmonella (salmonellae) 122, 137, 239240
consumption 114 Salmonella Enteritidis 239
Records see Documentation Salmonella Paratyphi 239
Red water 181, 216 Salmonella typhi 122, 239
Reference dose level (RDL) 198, 202 Salmonella Typhimurium 239, 240
Reference level of risk 4445, 47, 132133 Sample numbers, minimum 74
Regional level Sampling
performance target setting 133134 community-managed supplies 89
supply improvement 93 frequencies 72, 73, 75
use of data for priority setting 9697, ISO standards 75
98 locations 73
Regrowth 5 radioactive contaminants 209
510
INDEX
Sanitary code 3334 Sodium hypochlorite 107, 171

Sanitary inspection 86 Sodium sulfate 218
community-managed supplies 71, 74, 75, Softening 177
89 lime 139, 179
emergency and disaster situations 108 precipitation 179
use of data 97, 98 Solids, total dissolved (TDS) 185, 218,
Sapovirus (Sapporo-like viruses) 122, 251 444445, 490
Scale, calcium carbonate 183184, 215216 Solubility, water 177
Schistosoma spp. 122, 221 Source protection 5659, 66
Schistosomiasis 123, 276 Source waters
Schmutzdecke 174 chemical contaminants 147
Schools 100, 103104 community and household systems 71,
Screening, radionuclides in drinking-water 82
204, 206 control measures 5859
Scum 215 desalination systems 111
Seasonal discontinuity of supply 93 emergency and disaster situations 105
Seawater 111, 112 hazard identication 5658
Sedimentation 60, 138139, 176 microbial hazards 123
Selenium 6, 432434 naturally occurring chemicals 185
analysis 159, 433 new systems 5253
guideline value 186, 433, 492 operational monitoring 69, 71
priority setting and 3536 pathogen occurrence 135, 136137
treatment achievability 167, 433 seasonal uctuation 93
Septata 270 verication 7374
Septic tanks 186 see also Catchments
Serratia 124, 282, 286 Spas 234, 273
Service indicators, quantitative 7475 Specied technology targets 25, 40, 41
Service levels 9091 Spirometra 124
Severity categories 5455 Springs 65, 141
Shigella 122, 240241 Stagnant pools 101
Shigellosis 240241 Standard for Bottled/Packaged Waters 115
Ships 117120 Standard for Natural Mineral Waters
health risks 117118 114115
management 119120 Standard operating procedures (SOPs) 81
operational monitoring 119 incident responses 77, 78
surveillance 120 Standards
system risk assessment 118 bottled drinking-water 114115
Shipyard eye 248, 249 certication 17
Sievert (Sv) 201 drinking-water 10
Signicant gures 152 national see National standards and
Silicates 181 regulations
Silver 434435 Staphylococcus aureus 242243
guideline value 193, 490 Stomach cancer, radon-related risk 207
treatment, for travellers 110 Storage
Simazine 435436 after disinfection 61
analysis 161 emergency and disaster situations 106
guideline value 191, 435, 492 home 71
treatment achievability 170, 435 large buildings 101
Single-hit principle 128129 off-stream/bankside 138
Skin absorption see Dermal absorption on ships 119
Snails 123, 212 systems
Sodium 185, 436437, 490 control measures 5859, 64, 66
taste threshold 217218, 436 surveillance 89
Sodium bromate 315 Streams, occurrence of pathogens 136, 137
511
Streptococci, faecal 142, 287 public health 1011

Strongyloidiasis (Strongyloides) 124, 276 reporting and communicating 9597
Strontium-90 (90Sr) 202 ships 120
Styrene 437438 stages of development 9495
analysis 160, 437 urban areas in developing countries 88
guideline value 188, 437, 492 see also Monitoring
odour threshold 218 Swimming pools 249, 272, 273
treatment achievability 168, 437 System assessment and design 2526, 49,
Styrene-7,8-oxide 437, 438 5168
Sulfate 185, 438439, 490 aircraft and airports 116
acceptable level 218 collecting and evaluating available data
corrosion control 181, 184 5356
notiable level 438439 large buildings 100101
Superchlorination/dechlorination 171 ships 118
Suppliers, drinking-water treatment 5961
audit-based surveillance 87 Systems, drinking-water
independence of surveillance 89 large buildings 99, 100
legal functions and responsibilities 3132 maintaining control 6871
management plans see Water safety plans new 5253, 74
roles and responsibilities 9, 1314 non-piped see Non-piped water systems
Supply, drinking-water operational monitoring see Operational
adequacy 9093 monitoring
emergency and disaster situations piped see Piped distribution systems
105106 resource and source protection 5659
improved technologies 92 on ships 118
intermittent 63, 9293, 101 upgrade and improvement 6768, 94
planning and implementing validation see Validation
improvement 9394 verication see Verication
unimproved technologies 92
Supporting programmes 8081 2,4,5-T (2,4,5-trichlorophenoxy acetic acid)
aircraft and airports 117 439440
large buildings 102 analysis 161
ships 120 guideline value 191, 439, 492
Surface waters treatment achievability 170, 440
control measures 58, 66 Taenia solium 124
emergency and disaster situations 105 Tankers, water 15
hazard identication 5657 Tanks, storage 64
Helicobacter pylori 231 Taps 101
pathogen occurrence 136137 Targets
system assessment and design 53, 54 health-based see Health-based targets
verication 73 health outcome 2425, 40, 43
Surveillance 89, 2829, 8498 incremental improvements towards 2
adapted to specic circumstances 8889 performance see Performance targets
adequacy of supply 9093 specied technology 25, 40, 41
agencies 9, 32, 85 water quality see Water quality targets
aircraft and airports 117 Taste 7, 210, 211220
approaches 8587 biologically derived contaminants
audit-based 8687 211213
direct assessment 87 chemical contaminants 213219
community drinking-water supplies 87, treatments for removing 219220
8889 TBA see Terbuthylazine
denition 9, 84 TDI see Tolerable daily intake
large buildings 102 Team, water safety planning 51
planning and implementation 9395 Temephos 190
512
INDEX
Temperature, water emergency and disaster situations 105,

acceptable levels 220 107
Legionella growth/survival 100, 234235 hazard identication 5960
Naegleria survival 272, 273 household 71, 89, 141
Terbuthylazine (TBA) 440442 indicator organisms 282, 286
analysis 161 membrane processes 178, 180
guideline value 191, 441, 492 operational monitoring parameters
treatment achievability 170, 441 69
Testing kits 109, 158 pathogen removal 137141
3,3,4,4-Tetrachloroazobenzene 430 performance target setting and 131132,
Tetrachloroethene 442443 133134
analysis 160, 442 processes 138141, 171179
guideline value 188, 442, 492 control measures 179180
treatment achievability 168, 442 ranking of complexity/costs 166167
Thermotolerant coliform bacteria 142, 143, validation 67
282, 284285 see also specic treatments
THMs see Trihalomethanes for ships 119
Thorium-228 202 system assessment and design 53, 54
Thorium-230 202 taste, odour and appearance problems
Thorium-232 202 219220
Tin, inorganic 193, 388389, 490 for travellers 110
Titration, volumetric 158 water quality targets 42
Tolerable daily intake (TDI) 149, 150 see also Disinfection
allocation to drinking-water 151152 Triazophos 189, 488
alternative approaches 152154 Tributyltin oxide (TBTO) 189, 488
calculation of guideline values 149150, Trichloramine 193, 411, 490
152 Trichlorfon 189, 488
uncertainty factors 150151 Trichloroacetaldehyde see Chloral
Toluene 443444 hydrate
acceptability 218 Trichloroacetic acid 145, 445446
analysis 160, 443 analysis 162, 445
guideline value 188, 443, 492 guideline value 194, 445, 493
treatment achievability 168, 443 Trichloroacetonitrile 193, 380382, 490
Total coliform bacteria 282284 Trichlorobenzenes (TCBs) 187, 218219,
Total dissolved solids (TDS) 185, 218, 446447, 490
444445, 490 1,1,1-Trichloroethane 187, 447448, 490
Toxaphene 189, 488 Trichloroethene 448449
Toxic Cyanobacteria in Water 20 analysis 160, 449
Toxic shock syndrome 242 guideline value 188, 448, 493
Toxicity studies, animal 148 treatment achievability 168, 449
Toxocara 124 Trichloronitromethane see Chloropicrin
Toxoplasma gondii 122, 274275 2,4,6-Trichlorophenol 329331
Toxoplasmosis 274, 275 acceptable levels 214
2,4,5-TP see Fenoprop analysis 162
Trachipleistophora 270 guideline value 194, 330, 493
Transportation, household water 71 2,4,5-Trichlorophenoxy acetic acid see
Travellers 109111 2,4,5-T
Treatment 5961, 166184 2,4,5-Trichlorophenoxy propionic acid see
achievability 166171 Fenoprop
chemicals used in see under Chemicals Trichuriasis (Trichuris) 124, 276
community sources 71 Triuralin 450451
control measures 6061 analysis 161
for corrosion control 180184 guideline value 191, 450, 493
desalinated water 112 treatment achievability 170, 450
513
Trihalomethanes (THMs) 145, 179, 451454 Vibrio 244246

analysis 162 Vibrio cholerae 122, 125, 244246
guideline values 194, 451, 493 Vinyl chloride 456458
strategies for reducing 179180 analysis 162
Trimethylbenzene 217 guideline value 194, 457, 493
Tritium (3H) 202 Vinylidene chloride see 1,1-Dichloroethene
True colour units (TCU) 214 Viruses 221
Tsukamurella 221, 243244 enteric see Enteric viruses
Tubewells 65 indicator and index 289295
Turbidity 5, 219 pathogenic 122, 247259
community supplies 82 persistence in water 125
emergency and disaster situations 108 treatment effects 138141
operational monitoring 69 Visible organisms 211, 212213
Turner diagram 184 Vittaforma 270
Typhoid fever 239, 240 Volumetric titration 158
Ultraltration 139, 178 Warm water systems 100

Ultraviolet (UV) absorption 159 Wastewater, domestic, chemicals in 186
Ultraviolet (UV) irradiation 141, 173, 180 Water avoidance orders 79
Uncertainty factors (UF) 149, 150151 Water extraction systems, control measures
data-derived 154 5859
United Nations Scientic Committee on the Water quality 90
Effects of Atomic Radiation health care facilities 102103
(UNSCEAR) 198199, 207 monitoring see Monitoring
Unplanned events 7778 sources, in disaster situations 105
Upgrading, drinking-water systems 6768, see also Guideline values
94 Water Quality Monitoring (Bartram &
Upgrading Water Treatment Plants 20 Ballance) 7576
Uranium 6, 454456 Water quality targets (WQTs) 25, 40, 4243,
analysis 159, 455 126
guideline value 186, 454, 493 Water resource management 1213
priority setting and 3536 see also Resource protection
treatment achievability 167, 455 Water Safety Plans 20, 48, 66
Uranium-234 (234U) 202 Water safety plans (WSPs) 4, 24, 26, 4883
Uranium-238 (238U) 202 aircraft and airports 116
Urban areas approval and review 85
in developing countries 88 audit 86, 94
zoning 88 community and household supplies 85
Uveitis, Acanthamoeba 260 documentation and communication
8283
Validation 26, 5051, 67, 136 health care facilities 103
Vendors, water 15 key components 49
Verication 2931, 51, 7176 large buildings 99, 102
chemical quality 3031, 72, 73 management 7682
community-managed supplies 7475 model 66
microbial safety and quality 2930, 72, operational monitoring and maintaining
142143, 284 control 6871
piped distribution systems 74 ships 120
quality assurance and quality control stages in development 50
7576 supporting programmes 8081
water sources 7374 surveillance see Surveillance
Vessels system assessment and design 5168
emergency and disaster situations 106 verication see Verication
packaged drinking-water 113 Water sources see Source waters
514
INDEX
Water suppliers see Suppliers, drinking- Xanthomonas 286

water Xylenes 458459
Water treatment see Treatment acceptable level 219
Water Treatment and Pathogen Control 20, analysis 160, 458
Water vendors 15 treatment achievability 168, 458
Waterborne infections see Infections,
waterborne Yersinia 246247
Weight, body see Body weight Yersinia enterocolitica 122, 246, 247
Wells 59, 65, 141 Yersinia pseudotuberculosis 246, 247
WHO Pesticide Evaluation Scheme
(WHOPES) programme 148, 190 Zinc 193, 459460, 490
Winter vomiting disease 252 acceptable level 219, 459
Wound infections, Aeromonas 224 corrosion 183
WQTs see Water quality targets dissolution from brass 182183
WSPs see Water safety plans Zoning, urban areas 88
515

Guidelines For Drinking Water Quality V3

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Guidelines for

WORLD HEALTH ORGANIZATION

World Health Organization 2004

2.2 Guidelines for verication 29

4.3.5 Verication for community-managed supplies 74

6.2.4 Sanitary inspections and catchment mapping 108

8. Chemical aspects 145

9.2 Units of radioactivity and radiation dose 201

10. Acceptability aspects 210

11. Microbial fact sheets 221

11.1.16 Vibrio 244

12. Chemical fact sheets 296

12.7 Antimony 304

12.47 Dichloromethane 357

12.86 Microcystin-LR 407

Annex 1 Bibliography 461

signicantly expanded guidance on ensuring microbial safety of drinking-water,

T he preparation of the current edition of the Guidelines for Drinking-water Quality

Microbial aspects working group

Chemical aspects working group

Protection and control working group

The WHO coordinators were:

AAS atomic absorption spectrometry

CAC Codex Alimentarius Commission

DAEC diffusely adherent E. coli

EAAS electrothermal atomic absorption spectrometry

FAAS ame atomic absorption spectrometry

GAC granular activated carbon

HACCP hazard analysis and critical control points

IAEA International Atomic Energy Agency

JECFA Joint FAO/WHO Expert Committee on Food Additives

Kow octanol/water partition coefcient

NAS National Academy of Sciences (USA)

PTWI provisional tolerable weekly intake

QMRA quantitative microbial risk assessment

RDL reference dose level

SI Systme international dunits (International System of Units)

WHO World Health Organization

1.1 General considerations and principles

T he primary purpose of the Guidelines for Drinking-water Quality is the protection

a competent health authority; adequate and properly managed systems (adequate

1.1.1 Microbial aspects

ment is often referred to as regrowth. It is typically reected in measurement of

to control such by-products.

Disinfection of drinking-water is considered in more detail in chapter 8, with fact

1.1.3 Chemical aspects

1.1.4 Radiological aspects

1.1.5 Acceptability aspects

1.2 Roles and responsibilities in drinking-water

1.2.1 Surveillance and quality control

national agencies provide a framework of targets, standards and legislation to

Clear lines of accountability and com-

1.2.2 Public health authorities

ongoing monitoring of reportable diseases, many of which can be caused by

geographic and demographic analysis; and

1.2.3 Local authorities

community and household drinking-water systems and correcting deciencies, and

1.2.4 Water resource management