Preventing Water-Borne Infections For People with Weakened Immune Systems
Who is at higher risk from water-borne infections?
People with very weak immune systems who are at higher risk of certain water-borne diseases include those with:
- HIV infection who have a CD4+ count of less than 100 cells/mm3;
- lymphoma or leukemia (hematological malignancies) who are being actively treated or have been in remission and off treatment for less than 1 year;
- hematopoietic stem cell transplant recipients; and
- people born with diseases that severely affect their immune systems.
Some people with weakened immune systems, such as those with certain types of cancers or taking certain medications, may not be at higher risk of severe water-borne diseases. These people do not need to take extra precautions with their drinking water.
Ask your doctor or nurse practioner how weak your immune system is, and whether you need to take extra precautions.
How can drinking water become contaminated?
Drinking water can contain different organisms, including bacteria, viruses and parasites, which can cause disease. These organisms can exist in the source water, such as lake water, and survive through treatment, or they can enter the water supply in the distribution system.
Well water can be contaminated if the well is located or constructed in a way that the groundwater it draws from is at risk of containing pathogens (germs) such as a shallow well or a well drilled in fractured rock.
Surface water, such as rivers, lakes and streams, can also contain disease-causing organisms from animal feces.
If you have a weak immune system, you should not drink water from surface sources or groundwater at risk of containing pathogens, unless the water has been treated to remove or inactivate at least 99.9 per cent of parasites (protozoa), 99.99 per cent of viruses and all harmful bacteria.
Most community water systems in B.C. have effective treatment, such as disinfection or chlorination, against bacteria and viruses. However, in many cases, treatment may not provide a 99.9 per cent reduction in infectious parasites. Some water systems and many private supplies have no treatment at all. If the water you drink has not been disinfected, please refer to HealthLinkBC File #49b Disinfecting Drinking Water.
How can I further treat disinfected water?
People with very weak immune systems should consult with their doctor or nurse practitioner and may need to take extra precautions with their drinking water.
Boiling: If your water supply has already been disinfected, bring the water to a full boil to inactivate any Cryptosporidium parasites - a major concern for people with weakened immune systems. For more information, see HealthLinkBC File #48 Cryptosporidium Infection.
If the water has not already been disinfected, bring the water to a full boil for at least 1 minute. This will kill or inactivate bacteria, viruses and parasites. At elevations over 2,000 meters (6,500 feet), boil water for at least 2 minutes to disinfect it.
Do not drink or use tap water to brush your teeth, rinse your mouth, mix drinks or make ice cubes without boiling it first.
Please note that boiling water will get rid of viruses, bacteria and parasites but not chemicals which may be found in the water.
Reverse Osmosis (RO): RO is effective against all disease-causing organisms and many chemical contaminants. Unless it has a high capacity, it will only produce small amounts of water and waste a large volume. Speak to a water treatment specialist to see if this is the best option for you.
Ultraviolet (UV) Treatment: UV light will kill many disease-causing organisms, and is effective against almost all parasites. UV will not kill some bacterial spores and some viruses, so it should not be used unless the water supply is at least disinfected. UV treatment units should meet NSF Standard #55A.
Filters: Filters do not remove bacteria and viruses and should not be used unless the water supply is disinfected first.
If you plan to install a drinking water filter in your home, you will need a system labeled as Absolute 1 micron or smaller, and labeled as meeting ANSI/NSF International Standard #53 for removal of parasites.
Jug-type filters, such as a Brita®, which sit in a jug and allow water to trickle through, and some tap-mounted and built-in devices are not an appropriate solution. The jug filter models are not effective in removing many disease-causing organisms.
Can I drink bottled water?
Bottled water in B.C. may or may not have been treated. If you have a very weak immune system, check with the bottling company to find out what treatment, if any, it has had. Bottled water that has been properly treated using one of the methods listed above can be used for drinking, brushing teeth, making ice cubes and for recipes where water is used but not boiled, such as cold soups.
For More Information
For more information, including the level of treatment in your local water system, contact your drinking water purveyor or supplier, or the local environmental health officer or drinking water officer. To find your health authority’s drinking water contact visit www2.gov.bc.ca/gov/content/environment/air-land-water/water/water-quality/drinking-water-quality/health-authority-contacts.
For more information about water-borne infections and how to safely disinfect your drinking water, see the following HealthLinkBC Files: