BC physicians should be aware of the risk of waterborne infection in the province, particularly for immune-compromised individuals in communities with inadequately treated water supplies.
Cryptosporidium infection is of particular concern since it can cause severe disease in immune-compromised individuals and is not inactivated with chlorine. Conditions that increase the risk of severe Cryptosporidium infection include:
• HIV infection with a CD4+ count of < 100 cells/mm3.
• Hematological malignancies (lymphoma or leukemia) under active treatment or in remission and off treatment for less than 1 year.
• Hematopoietic stem cell transplants.
• Primary immunodeficiencies that affect the number or function of CD4 cells, IFN-gamma and CD40 ligand such as severe combined immunodeficiency (SCID), selective IgA and Saccharomyces opsonin deficiencies, hyper-IgM syndrome and gamma-IFN deficiency
Individuals with the conditions listed above should consider the following additional drinking water treatments:
• Boiling. If the water supply is disinfected with chorine, simply bring water to a full boil. If the water supply is not disinfected with chlorine, filtered, or UV treated, boil for at least 1 minute (2 minutes at elevations >2000m).
• Filters. Filters used should be labeled as “Absolute” (1 micron or smaller), meeting ANSI/NSF International Standard #53. Jug-type filters and some built-in devices are not effective.
• Reverse osmosis.
• Ultraviolet treatment. Treatment must meet NSF Standard #55A.
• Bottled water. Check with company that water has been adequately treated.
Patients can be referred to HealthLink BC File #56, “Drinking Water and Those with Weakened Immune Systems” at www.healthlinkbc.ca/healthfiles/hfile56.stm. For more information on the treatment of the local water system, contact your drinking water supplier or the drinking water officer in your health authority.
—Perry Kendall, MBBS
Provincial Health Officer
Above is the information needed to cite this article in your paper or presentation. The International Committee
of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally
accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.
An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.
BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:
- Only the first three authors are listed, followed by "et al."
- There is no period after the journal name.
- Page numbers are not abbreviated.
For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org