Abstract
Waterborne disease outbreaks attributed to various pathogens and drinking water system characteristics have adversely affected public health worldwide throughout recorded history. Data from drinking water disease outbreak (DWDO) reports of widely varying breadth and depth were synthesized to investigate associations between outbreak attributes and human health impacts. Among 1519 outbreaks described in 475 sources identified during review of the primarily peer-reviewed, English language literature, most occurred in the U.S., the U.K. and Canada (in descending order). The outbreaks are most frequently associated with pathogens of unknown etiology, groundwater and untreated systems, and catchment realm-associated deficiencies (i.e., contamination events). Relative frequencies of outbreaks by various attributes are comparable with those within other DWDO reviews, with water system size and treatment type likely driving most of the (often statistically-significant at p < 0.05) differences in outbreak frequency, case count and attack rate. Temporal analysis suggests that while implementation of surface (drinking) water management policies is associated with decreased disease burden, further strengthening of related policies is needed to address the remaining burden attributed to catchment and distribution realm-associated deficiencies and to groundwater viral and disinfection-only system outbreaks.
Highlights
Drinking water disease outbreaks (DWDOs) occur when bacterial, protozoan or viral pathogens or toxic chemicals contaminate drinking water ingested by humans
The contribution of 25 U.S and Canada national waterborne disease outbreak surveillance (NWDOS)-type review sources of over two-thirds of all identified outbreaks explains those sources’ strong influence on temporal and geographic outbreak frequencies
Population-weighted outbreak frequency and total case count data suggest that DWDO reporting systems in Northern
Summary
Drinking water disease outbreaks (DWDOs) occur when bacterial, protozoan or viral pathogens or toxic chemicals contaminate drinking water ingested by humans. A waterborne (or foodborne) outbreak is defined by the World Health Organization (WHO) as when at least two people contract similar illnesses after consuming the same water (or food) and epidemiological analysis identifies the water (or food) as the origin of the illness [2]. Such outbreaks can be large, especially where urban populations receive water through a single water supply system. They are frequently associated with diarrheal illness (e.g., 403,000 estimated cases of cryptosporidiosis in the 1993 Milwaukee, U.S outbreak [3]) and occasionally high levels of mortality (e.g., 8500 estimated deaths in the 1892 cholera outbreak in Hamburg, Germany [4]).
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