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Advisory note on bottled drinking water contaminated with Protozoa
Egypt
Event notification:
Ministry of Health and Population of Egypt has announced that some brands of bottled water should be avoided as they tested positive for intestinal pathogens.
Kindly find below the names of water brands found positive with protozoa, and names of the responsible companies which the Egypt Supreme Water Committee has issued a directive to close these wells that tested positive for the pathogen.
This advisory is to respond to your questions and inquiries on this matter.
S.No.    Brand name    Company    Governorate/site of contaminated Well
1    Alfa    Man factory for natural water    Beheira/Wadi Elnatroun
2    Alhadeer    Misr Oropa for food industry    Beheira/Wadi Elnatroun
3    Sawa       
4    Aqua delta    Aqua delta factory    Menoufia/Sadat city
5    Taiba    Taiba company    Menoufia/Sadat city
6    Aqua Mina    Bergen company for food industry (Image)    Giza (Kilometer 62, desert Cairo/Alexandria road)
7    Aqua sotair       

The following measures have been taken by Egyptian Authority and MOHP:
1.    Communication with responsible authorities to shut down the contaminated wells operated by the above companies.
2.    Communication to responsible authorities to pull contaminated brands
3.    Referral of this accident to general attorney for investigation
4.    Development of the press release to inform the media and community
 
Contamination of bottled drinking water with protozoa
Introduction:
Several species of parasitic protozoa are transmitted through water contaminated by human and animal excreta. Gardia intestinalis and Entamoeba histolytica the most important intestinal parasites that can be transmitted through water world-wide. Many of these incidents have been reported all over the world.
Ground water (source of bottled water in this case) that mix with surface water or leak contaminated by excreta of human or animals that got into the distribution system may contain low level of Cryptosporidium and Gardia can give rise to water-borne illness. Cysts of these organisms are very resistant to disinfectants. Disinfection alone offers no protection against Cryptosporidium and only limited protection against Gardia. Filtration of such waters is essential to the production of drinking water.
I.    How people can avoid infection:
a.    Washing hands with soap, particularly before preparing food and after using toilette. Appropriate hand hygiene practices include not only washing hands but also keeping fingernails trimmed and clean.
b.    If you get sick with diarrhea, please report to the nearest health care facility for testing and treatment. Wash your hands frequently with soap and water, or use alcohol-based product containing at least 60% alcohol to clean hands. Avoid bottled water with brand names mentioned in the table above.
Use other brands as they tested negative for these pathogens. On purchasing bottled water look for the following:
i.    Bar code
ii.    Production and expiry dates.
c.    Individuals who wish to avoid waterborne pathogens can bring their drinking water to a full boil (100 C˚) for one minute. Boiling water is the most effective way to inactivate (kill) pathogens.
d.    As an alternative, a point-of-use (personal use, end-of-tap, and under-sink) filter that removes particles one micrometer or less in diameter provide the greatest assurance of Cry

II.    How people get infection:
o    Consumption of water contaminated with Crypto and/or Gardia cysts or live forms passed through animal or human excreta.
o    Person to person transmission from persons passing the cysts through excreta or live forms of the parasites to their contacts.
III.    Symptoms of the disease:
    Watery diarrhea is the most prominent symptom.
    Some patients suffer nausea, abdominal cramps, vomiting and mild fever.

IV.    Duration of communicability (for how long patients can transmit infection to others): it is generally 7-14 days in immune-competent individuals where patients can pass cysts of Crypto for two weeks in their excreta.

V.    Incubation period (time elapsed between infection and appearance of manifestations): it varies widely but is usually about 7 days for Crypto, and 6-15 for Gardia.
Immune-competent individuals can clear the parasite, in contradiction with immune-deficient patients.