GLEC worked cooperatively with the EPA Office of Science and Technology (OST) to provide a list of waterborne microbials that can potentially lead to chronic sequelae, the chronic diseases caused by these microbes, sequelae of the diseases, and the risk of the sequelae as a result of exposure to the microbes. A large number of pathogens, including protozoans, viruses, and bacteria are capable of being transmitted via the water cycle. Since 1850, when it was established that the human bacterial pathogen Vibrio cholerae could be transmitted via contaminated water, a long list of other waterborne pathogens, including viruses and protozoans have been found to be transmissible via this route. However, the question of long term chronic problems that can be sequelae to microbial infections (such as ulcers from Helicobacter pylori and Guillian Barr syndrome from Campylobacter) have not been addressed. Moreover, the risk of having chronic sequelae following disease has not been quantified. The acute diseases attributable to these pathogens and their epidemiology have been well described, but the long term chronic conditions that can result from these diseases have not. GLEC worked directly with EPA to help understand which waterborne pathogens can cause chronic sequelae, what those conditions are, and the risks of acquiring chronic conditions as a consequence of acute or chronic exposure to the pathogens. GLEC developed a database search strategy to discover relevant articles published since 1966. The strategy involved first obtaining a list of protozoa, bacteria, and viruses that can be transmitted in water and can cause chronic disease conditions. The databases were also searched to obtain information on the chronic sequelae of these conditions, and various risk and incidence factors. GLEC developed a list of key words to be used for database searching, and identified the databases to be searched. Following this strategy, GLEC obtained the articles, reviewed the articles to identify other articles or publications to retrieve, and obtained the additional articles. The objective was to obtain complete information on every relevant pathogen, so that all pathogens that have chronic sequelae were identified.
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