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Abstract

Although there are many ways to sterilize drinking water such as chemical and physical methods, many countries still use chlorine to sterilize drinking water. Several researches have shown a strong correlation between chlorine used in water sterilization and the emergence of a large number of diseases when it reacts naturally with organic matter found in water such as decaying tree residues and animal material, producing substances known as chlorinated hydrocarbons which has adverse effects on health, so this article review aimed to investigate the influences of chlorine on health in general.
Pak. J. Biotechnol. Vol. 16 (3) 163-167 (2019) pISSN: 1812-1837 eISSN 2312-7791 www.pjbt.org
http://doi.org/10.34016/pjbt.2019.16.3.24
REVIEW ARTICLE
HEALTH EFFECTS OF CHLORINATED WATER: A REVIEW ARTICLE
Israa Harjan Mohsen1, Athraa Harjan Mohsen2 and Haider Kamil Zaidan3
1Collage of Nursing, University of Babylon, 2Collage of sciences, University of Kufa, Iraq, 3Iraqi cultural
attaché in Jordan. E. mail: Israa.h.Mohsem@gmail.com
Article received 29.6.2019, Revised 28.8.2019, Accepted 14.9.2019
ABSTRACT
Although there are many ways to sterilize drinking water such as chemical and physical methods, many countries still
use chlorine to sterilize drinking water. Several researches have shown a strong correlation between chlorine used in
water sterilization and the emergence of a large number of diseases when it reacts naturally with organic matter found
in water such as decaying tree residues and animal material, producing substances known as chlorinated hydrocarbons
which has adverse effects on health, so this article review aimed to investigate the influences of chlorine on health in
general.
KeywordsChlorine, by-products, disinfection, water, carcinogenic, health effects
INTRODUCTION
The problem of water contamination is an unend-
ing difficult. Thousands of people were dying
because of many disease cholera, typhoid fever and
amebic dysentery, during the 20s and 30s which are
transmitted through polluted drinking water. When
chlorine was used to sterilize drinking water, this
was reflecting one of the most crucial progresses in
water management in the 20th century. Water chlo-
rination started in 1890 to eliminate the causes of
these diseases. Thanks to this discovery, these dise-
ases have been eradicated and humanity has reac-
hed remarkable expansions in the value of drinking
water and the preservation of the environment. In
the current time about 98% of drinking water is ste-
rile by chlorine around the world. Despite the
importance of chlorine in the sterilization of drin-
king water, sewage and industrial waste, drinking
chlorinated water and direct exposure to chlorine
gas has significant adverse effects. Several studies
have confirmed that chlorine is directly related to
liver, bladder, intestinal cancers, Arteriosclerosis,
high blood pressure and allergies.
Structure of chlorine and its properties: Chlo-
rine word means the pale green, it is chemical
element has the Atomic number 17 and the symbol
(Cl). Chlorine represents a member of halogens
where it presents in the group 17 of the periodic
table of the elements. It is yellow-green gas in the
room temperature, its melting point at -101°C while
the Degree of assimilation is -34.6°C. It smells irri-
tating and pungent like the smell of bleached
detergents. The density of chlorine gas is more than
the density of the air as it is dense (3.21*10-3g\cm3),
for this reason chlorine accumulates at points at low
levels on the surface of the earth slowly rising into
the air, causing an increased exposure time (Sander
1999).Chlorine is characterized by its weak degra-
dation in water. Liquid chlorides, as well as organic
solvents, increase chlorine solubility due to chlor-
ine, whether wet or liquid, of high ability to destroy
and destroy most of the known metals no matter
how different its resistance, such as gold, silver,
platinum and tantalum, For wet and dry chlorine
(Keil and Shepson, 2006). Chlorine is non-flamm-
able but is associated with other substances invol-
ved in the manufacture of explosives. It also lacks
power and interacts strongly with many organic
compounds (Kercher et al., 2009). The chlorine
evaporates rapidly if it is exposed and its viscosity
equals one-third of the viscosity of water and its
volume in its gaseous state is greater than its liquid
state by 450 times. This means that a cubic meter
of liquid chlorine can produce about 450 of gas.
Chlorine is used in its liquid state (sodium hypo-
chlorite) or solid in powdered form in water steri-
lization and the chlorine solubility in the water and
its interaction lead to the formation of derivative
causing biological damage (Baker et al., 2016).
These reactions are including:
1- CL2+H2O= HCL+HOCL (Hypochlorus acid).
2- CL2+H2O= 2HCL+ [ O-]
3- HOCL= HCL+[ O-]
History of chlorine: The chlorine was discovered
by Carl Wilhelm Scheele in 1774 AD, which he
thought contained oxygen but was corrected by Sir
Humphry Davy, who insisted that he was a chemi-
cal element, which he named chlorine in 1810 AD.
In 1810 AD chlorine was first used in water steri-
lization in limited areas and after obtaining amaz-
ing results in eliminating the pathogens of many
diseases, it was widely used for sterilizing drinking
water in Chicago, USA in 1908 AD (Wisniak,
2002). Chlorine is one of the first toxic gases used
as a weapon in wars during the First World War.
Mohsin I.H. et al., Pakistan J. Biotechnol.
264
On April 22, 1915, in a battle near the Belgian city
of Ibery, the German army fired large quantities of
this gas into cylinders stored in trenches which led
to the retreat of French troops (Fitzgerald, 2008).
Chlorine sources and its using: Chlorine is natu-
rally associated with other elements, especially
sodium as NaCl, as well as carnallite and sylvite.
Chlorine forms many soluble salts in ocean waters.
Chloride ions represent 1.9% of the sea water mass.
The amount of chlorine in the soil varies depending
on the distance from the sea. The chlorine rate in
the upper layers of the soil is about 10 ppm. The
plants also contain different levels of chlorine, as it
is one of the main nutrients of the upper plants. It
is concentrated in green plastids (Chen et al.,
2010). The human body contains chlorine in the
form of chloride and rarely cause deficiency in this
element in humans except in cases of vomiting and
diarrhea, severe and persistent sweating and waste,
where the chlorine enters the synthesis of intestinal
acids and participate in the process of digestion of
food and share with potassium and sodium in redu-
cing the balance of water and fluids and helps to
secure Function of muscles and nervous system
(Rolfes et al., 2012).
Chlorine has multiple uses as it is used in the
purification of drinking water as a disinfectant and
is also used as bleach .chlorine enters the industry
directly or indirectly, which is used in the paper,
paints, pesticides, paint, plastics production petro-
latum and tissue industry and solvent industry
(Sioris and Shuller, 2007). Chlorine is used in the
pulp of wood pulp used in the manufacture of paper
and helps to remove ink from recycled paper in
addition to it is used as an alternative to hydrogen
in the industrial rubber industry. It also enters into
the manufacture of organic materials such as chlor-
ite, chloroform and carbon tetrachloride, as well as
contributes to the extraction of bromine (Perez and
Mckay, 2007).
Methods of exposure to chlorine: There are many
faces for the use of chlorine in the industrial and
commercial fields, so exposure to it is accidental
by freeing or draining it from storage containers or
dealing directly with it in factories and water puri-
fication plants. The most harmful methods of
exposure are inhalation of chlorine gas or by direct
contact with the skin and the eye or through inges-
tion of food and chlorine-containing water.
Health damage of chlorine: The benefits of chlor-
ine use in the sterilization areas are very clear, but
despite its usefulness, it has adverse effects. While
it was thought to prevent the spread of epidemics,
it has been helpful in the development of other dis-
eases. When chlorine is added to sterilize drinking
water, it reacts naturally with organic matter found
in water such as decaying tree residues and animal
material, producing substances known as chlorine-
ted hydrocarbons, Trihalomethanes which are chl-
oroform, benzene, bromoform, dibromo-chlorome-
thane, bromo-dichloromethane ( CIS ,2014). These
substances are found in the most common water
supply. The EPA in 2014 has classified these com-
pounds as the main causes of cancer, especially
liver, kidney and colon cancer, where the concen-
tration of chloroform in drinking water has increa-
sed over time as the normal proportions of its pre-
sence in water are 2-68ppb.
The exposure to chlorine increases when swimm-
ing with chlorinated water as the temperature of the
water to 300C increase the proportion of chloro-
form to 0.2mg, but if it rose to 400C, the concen-
tration of up to 7mg, resulting in a lack of blood
flow in the capillaries near the skin, To spread acr-
oss large distances through which it reaches the
bloodstream (Michaud et al., 2007). The inhalation
of chlorine vapor during bathing increases the pro-
blems of asthma, allergies and sinuses. Short-term
exposure to these conditions can cause eyes, cough,
sputum, chest and nose pain.
Exposure to it further causes fluid accumulation
in the lung, pneumonia, bronchitis and dyspnea. It
was found that exposure to fumes during shower
use was 100 times more frequent than drinking the
same water. The body was found to absorb the vol-
atile chemicals during bathing. The effects can be
summarized in the body's organs as follows:
Respiratory system: It is the occurrence of irritat-
ion and inflammation of the nose and throat memb-
ranes and inflammation of the respiratory tract,
where exposure to a high concentration of chlorine
can lead to the accumulation of fluid in the lung and
swelling, and lead to bronchitis and can lead to
death due to suffocation, Chronic symptoms due to
exposure to low levels of chlorine are continuous,
especially by workers who work in institutions pro-
ducing chlorine-containing bleach, drinking water
purification and sewage, and they may have symp-
toms of bronchitis and asthma. They may become
more susceptible to Tuberculosis (Patil et al., 2002).
Though, chlorine-based sterilizers, which include
chlorine, hypochlorite, yet chloroisocyanurates are
the nearly frequent water sterilizers because of the
obstruction concerning lotus borne illnesses. When
disinfectants arouse together with natural amino
complexes, sterilization byproducts (DBP’s), regu-
larly denoted according to like trihalomethanes, are
wrought. Organic compounds, for instance, hypo-
chlorous acid yet chloramines, cause oxidation for
muscles, which damage epithelial tissue junctions
16(3) 2019 Health Effect of chlorinated….
265
and cause rise the permeability of lung epithelium.
Frequent exposure over it marketers triggers the
improvement about bronchial asthma or potentially
permits the passage on allergens. Exposure of chlo-
rination then natural count or decreased ventilation
beyond indoor swimming pools may hold hazar-
dous acid and persistent consequences concerning
the respiratory law (Nemery et al., 2002; Bernard
et al., 2006). Kids, lifesavers, tank attendants, and
the best bathers are at an amplified jeopardy beca-
use of arising top or decrease respiratory issues
(Lourencetti et al., 2008).
Epithelial or mucosal destruction triggered by
way of incur in conformity with chlorine products
into kids under the age five years, pond followers
then competitive swimmers motives a before long
onset concerning allergies (Bernard et al., 2006).
Kids yet youth are nearly prone according to thri-
ving health consequences due to the fact on the
expanding usage in childhood for bodily undertak-
ing (Bougault et al., 2009) or it is tending to stand
swimming among water as is hotter and have grea-
ter ranks about sterilizer (Weisel et al., 2009). Chl-
orine tiers are commonly in 1.0 3.0ppm among
unrestricted swimming pools, each indoors yet out-
doors, then is extended upon water than surface
pollution. The encouraged chlorine ranges are dire-
cted via governance groups in accordance with
avoiding recurrent of illnesses because of water
(Centers for Disease Control and Prevention, 2010).
The study of (Bougault et al., 2012) found that the
swimming for a long time in chlorinated swimming
pools leads to changes in airways like that happe-
ned in asthma with the more expression of mucin.
Eyes: The chlorine reaction with the mucous mem-
brane of the cornea is highly acidic, but the proteins
present in the tears work to reduce the damage of
these acids, which cause burns in the membranes
of the corneal epithelium, that can heal with time.
Burns that occur in the center of the cornea may
lead to an ulcer and then leave a scar inside
(Bernard, 2007).
Skin and hair: Bathing and ablution with chlorina-
ted water which is cause scalp and skin redness,
mainly in people who are most susceptible to aller-
gies. Chlorine is found to be associated with hair
proteins, destroying it, causing it dryness and frag-
ile, losing color, it also increases the problems of
dandruff. Studies have shown that swimming in the
swimming pool with chlorinated water lead to
absorption of chlorine by the skin within 10 minu-
tes, which go over eight cups of water of chlorine,
making the skin dry and itchy (Cmest, 2002). Swi-
mming in a chlorinated pool can dry out the skin
and make it tight and irritated on the grounds that
the chlorine strips the skin of its normal oils. Indi-
viduals with delicate skin may even get aggrava-
tion or a rash from the pool's drying impacts. Chlo-
rine likewise can worsen skin conditions like
dermatitis.
Chlorine really advances the age of free radicals
inside the body, and particularly the skin. Free radi-
cals have been appeared to cause malignancy, as
has chlorine. Drinking faucet water most has been
connected to bladder, breast and bowel cancer and
long-term impacts of drinking, washing and swim-
ming in chlorinated water has been appeared to
cause dangerous melanoma, also called skin can-
cer. Chlorinated water to advance the process of
aging, like the impacts of stretched out presentation
to the sun.
Teeth: The continued contact to chlorinated water,
whether by drinking water or swimming, can cause
tooth decay and weakness. It has been found that
workers who work in institutions and factories that
use chlorine appear on their teeth to corrode due to
hydrochloric acid formed as a result of the chlorine
reaction with the moisture in their mouth besides
inflammation of the lining of the mouth (Pereira et
al., 2006).
In a case report depicts the relatively total loss of
enamel by corrosive disintegration, especially from
the front teeth, in a lady who swam day by day for
about fourteen days in an inappropriately chlorina-
ted swimming pool in Cuba. It accentuates the
requirement for the two swimmers and swimming
pool team to guarantee that water has been appro-
priately chlorinated and that the pH has been chan-
ged in accordance with 7.5 (Dawes and Boroditsky,
2008).
Digestive system: Exposure to chlorine by swallo-
wing and dealing with chlorine-containing deterge-
nts at home leads to vomiting and chest pain. Pro-
longed exposure leads to irritation of the pharynx,
esophagus, and liver and intestinal tissue. Several
studies found that the drinking of water contain
chlorine derivatives (trichloromethanes) such as
chloroform is a carcinogenic agent for rats and
mice. Inhalation of chlorine can lead to cancer risk
(IARC, 2006). There is an increase of 15-35% in
cancer among people who use chlorinated water
compared with other non-chlorinated water where
noticed the presence of correlation between bladder
and rectum cancer with consumption of chlorinated
water. Several studies indicated the presence of
positive correlation between colon, stomach, pan-
creas, liver, bladder and anal cancer and the expo-
sure to chlorinated byproducts in drinking water
(Weiderpass et al., 2003; Slattery et al., 2006;
Villanueva et al., 2007).
Mohsin I.H. et al., Pakistan J. Biotechnol.
266
Heart: Chlorine is one of the oxidizing substances
that reduce the level of oxygen in the cells, increas-
ing the risk of heart disease. It has been shown that
chlorinated water has an effect on the heart and cir-
culation device, which leads to poor circulation and
low growth in birds treated with chlorinated water
compared to the group that took chlorine free water
(Price, 1987).
Abortion: Chlorine reacts with a naturally occur-
ing organic matter, during the production of drink-
ing water and lead to the formation of Disinfection
by-products (DBPs) which is causes adverse repro-
ductive effect, such as, intrauterine growth retarda-
tion, low birth weight and spontaneous abortion
(Richardson et al.,2002). In a cross-sectional study
carried out by (Nieuwenhuijsen, et al., 2008) indi-
cate an increase in the birth defect such as cleft
palate anencephalus and ventricular septal defects
risk, from prenatal exposure to disinfection by-
products in drinking water(Mohsen et al., 2016).
It is found that women who drink chlorinated water
increase their miscarriages and birth of dead fetu-
ses and also increase the number of birth defects
that suffer from heart problems, cleft palate and
brain abnormalities, where chlorine is one of the
important factors that contribute to the increase of
breast cancer across the world (Jaakkola, 2007;
Barrie, 2009).
Conclusions
In spite of chlorine importance in the water disin-
fection and decrease the pathogens in the water,
chlorine gas is fatal even if it is at concentrations as
low and has important role in the occurrence of
several diseases through its participant in the defi-
ciency of immunity, cancer and Abnormalities.
The presence of alternatives become important to
decrease these effects that has become so wide-
spread, As some countries still use this substance
in water sterilization, it is necessary to look for less
hazardous and less harmful substances.
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In contemporary research, funding is generally targeted toward assured and high business returns. In this business approach, studies for possible negative or side effects, especially the long-term use effects of the technologies and products are neglected or overlooked. Ample evidence related to the development of serious detrimental outcomes of many such improperly studied technologies before their widespread use is available in different aspects of the life of animals and plants, and on the overall environment of our planet. A few such examples of serious impacts on human health and the environment are cited in the article along with a brief discussion of the potentially risky application of such one-eyed research-derived technologies.
... Health problems due to eating foods containing chlorine (Cl2) make the stomach prone to ulcer disease. In the long run, it will cause kidney disease and cancer (14). This is not in line with Yunica's (2014) research with a p-value of 0.001, which means a relationship between knowledge and participation in immunizing tetanus toxoid in pregnant women (15). ...
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... Although most of the reagents used in water disinfection are effective and have residual effect benefit; there are health challenges with usage of the reagents for water disinfection including forming of carcinogenic disinfection by-products (DBPs). Various research works had established the link between human consumption of chlorinated water and diseases such as cancer, birth defects, arteriosclerosis, immunity deficiency, among others [7][8][9][10][11][12][13][14][15][16]. Chemical disinfection of water using sodium hypochlorite (NaOCl) has some challenges with the formation of harmful disinfection by-products from its reaction with organic materials in water. ...
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... Health problems that can be caused by consuming chlorine-containing drinks in the long term can cause lung diseases such as pneumonitis, shortness of breath, emphysema, and bronchitis [11]. Furthermore, it can be caused directly to liver, bladder, intestinal cancers, arteriosclerosis, high blood pressure, bronchitis, dyspnea, and allergies [12]. ...
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