Abstract

In 2008, a large Salmonella outbreak caused by contamination of the municipal drinking water supply occurred in Alamosa, Colorado. The objectives of this assessment were to determine the full economic costs associated with the outbreak and the long-term health impacts on the community of Alamosa. We conducted a postal survey of City of Alamosa (2008 population: 8,746) households and businesses, and conducted in-depth interviews with local, state, and nongovernmental agencies, and City of Alamosa healthcare facilities and schools to assess the economic and long-term health impacts of the outbreak. Twenty-one percent of household survey respondents (n = 369/1,732) reported diarrheal illness during the outbreak. Of those, 29% (n = 108) reported experiencing potential long-term health consequences. Most households (n = 699/771, 91%) reported municipal water as their main drinking water source at home before the outbreak; afterwards, only 30% (n = 233) drank unfiltered municipal tap water. The outbreak’s estimated total cost to residents and businesses of Alamosa using a Monte Carlo simulation model (10,000 iterations) was approximately $1.5 million dollars (range: $196,677–$6,002,879), and rose to $2.6 million dollars (range: $1,123,471–$7,792,973) with the inclusion of outbreak response costs to local, state and nongovernmental agencies and City of Alamosa healthcare facilities and schools. This investigation documents the significant economic and health impacts associated with waterborne disease outbreaks and highlights the potential for loss of trust in public water systems following such outbreaks.

Highlights

  • Community-wide outbreaks associated with public drinking water systems are rare in the United States since drinking water regulations were implemented by the Environmental Protection Agency (EPA), beginning in 1974 with the Safe Drinking Water Act (SDWA) [1,2,3]

  • In 2008 a large community-wide outbreak occurred in Alamosa, Colorado caused by contamination of the town’s unchlorinated municipal drinking water supply with Salmonella serotype Typhimurium

  • Household Survey The community survey was distributed to all households that received municipal drinking water (N = 2,692)

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Summary

Introduction

Community-wide outbreaks associated with public drinking water systems are rare in the United States since drinking water regulations were implemented by the Environmental Protection Agency (EPA), beginning in 1974 with the Safe Drinking Water Act (SDWA) [1,2,3]. In 2008 a large community-wide outbreak occurred in Alamosa, Colorado caused by contamination of the town’s unchlorinated municipal drinking water supply with Salmonella serotype Typhimurium. The City’s municipal water was supplied by seven artesian wells and was not chlorinated [5]. On March 14, 2008, the Alamosa County Nursing Service was notified of three culture-confirmed cases of S. Typhimurium among residents of Alamosa, including two cases in infants. An epidemiologic investigation conducted by local and state public health authorities identified the city’s municipal drinking water as the source of the outbreak [5]. From March 192April 11, 2008, Alamosa water was deemed unsafe to drink and residents were under various water advisories. After April 11th, all areas of the water system had been hyperchlorinated and all drinking water restrictions lifted

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