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Potential for Disease from Bottled Water

As is discussed in the accompanying Technical Report (print report only), there is no active surveillance for waterborne disease from tap water in the United States, nor is there active surveillance of potential disease from bottled water. There are certain "reportable" diseases, such as measles, which are reportable to CDC and state health departments, and for which there is active surveillance. Most diseases caused by organisms that have been found in bottled water, however, are not reportable, and in any event may come from a variety of sources, so the amount of disease from microbiologically contaminated bottled water (or tap water) is unknown. Thus, since no one is conducting active surveillance to determine if waterborne illnesses are occurring, even if waterborne illness from bottled water were relatively common, it would be unlikely that it would be noticed by health officials unless it reached the point of a major outbreak or epidemic.

There are cases of known and scientifically well-documented waterborne infectious disease from bottled water, but most have occurred outside of the United States . However, there clearly is a widespread potential, according to independent experts, for waterborne disease to be spread via bottled water.

Bottled Water and Vulnerable Populations

Many people who are especially vulnerable to infection (such as the infirm elderly, young infants, people living with HIV/AIDS, people on immunosuppressive chemotherapy, transplant patients, etc.) use bottled water as an alternative to tap water out of concern for their safety. Some leading public-health experts, therefore, argue that bottled water should be of higher microbiological quality than most foods. In fact, health-care providers and other professionals often recommend that people who suffer from chronic health problems drink bottled water. Indeed, FDA's guidance for immunocompromised people (posted on the FDA Web site) recommends that people with lowered immunity should "drink only boiled or bottled water. . . ."

Immunocompromised people often are not aware of the need to ensure that they are drinking microbiologically safe water or are vaguely aware of this issue but simply switch to bottled water on the assumption that it is safer than tap water. As discussed previously and in detail in the accompanying Technical Report (print report only), this may not be a safe assumption.

Bottled Water Storage and Growth of Microorganisms

Bottled water often is stored at relatively warm (room) temperatures for extended periods of time, generally with no residual disinfectant contained in it. As noted in the Technical Report (print report only) and shown in Figure 8, several studies have documented that there can be substantial growth of certain bacteria in bottled mineral water during storage, with substantial increases in some cases in the levels of types such as heterotrophic-plate-count-bacteria and Pseudomonas. Studies also have shown that even when there are relatively low levels of bacteria in water when it is bottled, after one week of storage, total bacteria counts can jump by 1,000-fold or more in mineral water.

Submitted by:

Patricia Stuart General Manager
THINK HEALTHY SYSTEMS - A Division of J.D. Young Company
5321 S. Sheridan, Suite 10 – Tulsa, OK. 74145 – (918) 384-0555