From May to June 2012, a waterborne outbreak of 124 cases of cryptosporidiosis occurred in the plumbing systems of an older high-rise apartment complex in Seoul, Republic of Korea. The residents of this apartment complex had symptoms of watery diarrhea and vomiting. Tap water samples in the apartment complex and its adjacent buildings were collected and tested for 57 parameters under the Korean Drinking Water Standards and for additional 11 microbiological parameters. The microbiological parameters included total colony counts, Clostridium perfringens, Enterococcus, fecal streptococcus, Salmonella, Shigella, Pseudomonas aeruginosa, Cryptosporidium oocysts, Giardia cysts, total culturable viruses, and Norovirus. While the tap water samples of the adjacent buildings complied with the Korean Drinking Water Standards for all parameters, fecal bacteria and Cryptosporidium oocysts were detected in the tap water samples of the outbreak apartment complex. It turned out that the agent of the disease was Cryptosporidium parvum. The drinking water was polluted with sewage from a septic tank in the apartment complex. To remove C. parvum oocysts, we conducted physical processes of cleaning the water storage tanks, flushing the indoor pipes, and replacing old pipes with new ones. Finally we restored the clean drinking water to the apartment complex after identification of no oocysts.
Objectives: Cryptosporidium, a protozoan parasite, has been recognized as a frequent cause of waterborne disease due to its extremely strong resistance against chlorine disinfection. Although there has as yet been no report of a Cryptosporidium outbreak through drinking water in Korea, it is important to estimate the health risk of Cryptosporidium in water supply systems because of the various infection cases in human and domestic animals and frequent detection reports on their oocysts in water environments. Methods: This study evaluated the annual infection risk of Cryptosporidium in tap water using the quantitative microbial risk assessment technique. Exposure assessment was performed upon the results of a national survey on Cryptosporidium on the water sources of 97 large-scale water purification plants in Korea, water treatment efficacy, and daily unboiled tap water consumption. The estimates of the US Environmental Protection Agency on the mean likelihood of infection from ingesting one oocyst were applied for effect assessment. Results: Using probabilistic methods, mean annual infection risk of Cryptosporidiosis by the intake of tap water was estimated to fall within the range of 2.3 × 10-4 to 1.0 × 10-3 (median 5.7 × 10-4). The risk in using river sources was predicted to be four times higher than with lake sources. With 0.5-log higher removal efficacy, the risk was estimated to be 1.8 × 10-4 , and could then be lowered by one-third. Conclusions: These estimations can be compared with acceptable risk and then used to determine the adequacy and priority of various drinking water quality strategies such as the establishment of new treatment technology.
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