Abstract
BackgroundDrinking water contamination, with the capability to affect large populations, poses a significant risk to public health. In recent water contamination events, the impact of contamination on public health appeared in data streams monitoring health-seeking behavior. While public health surveillance has traditionally focused on the detection of pathogens, developing methods for detection of illness from fast-acting chemicals has not been an emphasis.MethodsAn automated surveillance system was implemented for Cincinnati's drinking water contamination warning system to monitor health-related 911 calls in the city of Cincinnati. Incident codes indicative of possible water contamination were filtered from all 911 calls for analysis. The 911 surveillance system uses a space-time scan statistic to detect potential water contamination incidents. The frequency and characteristics of the 911 alarms over a 2.5 year period were studied.ResultsDuring the evaluation, 85 alarms occurred, although most occurred prior to the implementation of an additional alerting constraint in May 2009. Data were available for analysis approximately 48 minutes after calls indicating alarms may be generated 1-2 hours after a rapid increase in call volume. Most alerts occurred in areas of high population density. The average alarm area was 9.22 square kilometers. The average number of cases in an alarm was nine calls.ConclusionsThe 911 surveillance system provides timely notification of possible public health events, but did have limitations. While the alarms contained incident codes and location of the caller, additional information such as medical status was not available to assist validating the cause of the alarm. Furthermore, users indicated that a better understanding of 911 system functionality is necessary to understand how it would behave in an actual water contamination event.
Highlights
Drinking water contamination, with the capability to affect large populations, poses a significant risk to public health
In general, the public health partners indicated that the 911 surveillance system provided timely alerts and the use of a standardized software system by 911 call operators to enter 911 call data allowed for consistent coding
The speed of information from 911 surveillance may be valuable for detection of fast-acting contaminants, but participants suggested that a better understanding of the functionality of the 911 surveillance system would be necessary to assess how the system may perform during an actual contamination incident
Summary
With the capability to affect large populations, poses a significant risk to public health. Drinking water contamination incidents can pose a significant public health risk when they are not detected in time to enact measures to reduce exposures and mitigate the spread of contaminated water in a utility’s distribution system [1,2]. Several documented cases of water contamination incidents have concluded that the monitoring of health-seeking actions pursued by the general public may have allowed for earlier detection of contaminated water. On March 19, 2008, drinking water samples were tested for total coliform bacteria through the use of a quick screening test; the results were positive. Though this test was not confirmatory, city officials decided to issue a bottledwater order at this stage of the incident.
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