Massive Outbreak of Waterborne Cryptosporidium Infection in Milwaukee, Wisconsin: Recurrence of Illness and Risk of Secondary Transmission

MacKenzie, William R.; Schell, W; Blair, Kathleen; Addiss, David G.; Peterson, Dan; Hoxie, N J; Kazmierczak, James J.; Davis, Jeffrey P.

doi:10.1093/clinids/21.1.57

Cited by 301 publications

(175 citation statements)

References 16 publications

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“…Person-person transmission was not previously believed to have been a major contributor to the Milwaukee outbreak (17). Our analysis supported this view.…”

Section: Application To the Outbreak Conditionsupporting

confidence: 80%

Disease transmission models for public health decision making: analysis of epidemic and endemic conditions caused by waterborne pathogens.

Eisenberg

Brookhart

Rice

et al. 2002

Environ Health Perspect

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Developing effective policy for environmental health issues requires integrating large collections of information that are diverse, highly variable, and uncertain. Despite these uncertainties in the science, decisions must be made. These decisions often have been based on risk assessment. We argue that two important features of risk assessment are to identify research needs and to provide information for decision making. One type of information that a model can provide is the sensitivity of making one decision over another on factors that drive public health risk. To achieve this goal, a risk assessment framework must be based on a description of the exposure and disease processes. Regarding exposure to waterborne pathogens, the appropriate framework is one that explicitly models the disease transmission pathways of pathogens. This approach provides a crucial link between science and policy. Two studies--a Giardia risk assessment case study and an analysis of the 1993 Milwaukee, Wisconsin, Cryptosporidium outbreak--illustrate the role that models can play in policy making.

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“…Person-person transmission was not previously believed to have been a major contributor to the Milwaukee outbreak (17). Our analysis supported this view.…”

Section: Application To the Outbreak Conditionsupporting

confidence: 80%

Disease transmission models for public health decision making: analysis of epidemic and endemic conditions caused by waterborne pathogens.

Eisenberg

Brookhart

Rice

et al. 2002

Environ Health Perspect

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“…Despite wealthy economies and access to proven drinking water-treatment technologies, significant outbreaks of waterborne intestinal disease still occur in the occidental world [2][3][4]. Waterborne disease outbreaks often involve acute gastroenteritis [5].…”

Section: Introductionmentioning

confidence: 99%

Massive outbreak of viral gastroenteritis associated with consumption of municipal drinking water in a European capital city

Werber

Laušević²,

Mugoša³

et al. 2009

Epidemiol. Infect.

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SUMMARYOn 24 August 2008, an outbreak alert regarding cases of acute gastroenteritis in Podgorica triggered investigations to guide control measures. From 23 August to 7 September, 1699 cases were reported in Podgorica (population 136 000) and we estimated the total size of the outbreak to be 10 000-15 000 corresponding to an attack rate of y10 %. We conducted an age-and neighbourhood-matched case-control study, microbiologically analysed faecal and municipal water samples and assessed the water distribution system. All cases (83/83) and 90 % (89/90) of controls drank unboiled chlorinated municipal water [matched odds ratio (mOR) 11 . 2, 95 % confidence interval (CI), 1 . 6-O]. Consumption of bottled water was inversely associated with illness (mOR 0 . 3, 95 % CI 0 . 1-0 . 8). Analyses of faecal samples identified six norovirus genotypes (21/38 samples) and occasionally other viruses. Multiple defects in the water distribution system were noted. These results suggest that the outbreak was caused by faecally contaminated municipal water. It is unusual to have such a large outbreak in a European city especially when the municipal water supply is chlorinated. Therefore, it is important to establish effective multiple-barrier water-treatment systems whenever possible, but even with an established chlorinated supply, sustained vigilance is central to public health.

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“…A major outbreak of human cryptosporidiosis occurred in 1993 in Milwaukee, Wisconsin (US), attracting worldwide interest to the disease, mainly because it was transmitted by water, which demonstrated the parasite's ability to resist existing water treatment methods (MACKENZIE et al, 1995;. The outbreak affected 403.000 people who developed symptoms of gastroenteritis within 2 months of ingesting water from the supply network (CORSO et al, 2003).…”

Section: Cryptosporidium and Giardia: Waterborne Organisms And Their mentioning

confidence: 99%

Waterborne Giardia and Cryptosporidium: contamination of human drinking water by sewage and cattle feces

Toledo

Martins

Freire

2017

SCA

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Water is an important vehicle for pathogens such as Cryptosporidium spp. and Giardia duodenalis. In fact, these organisms are responsible for almost 58% and 38% of the waterborne outbreaks reported in ~60 years. Characteristics related to the environmental phase of these protozoa and the different types of hosts are important factors related to environmental contamination. In cryptosporidiosis and giardiasis, outbreaks caused by waterborne pathogens are identified as major risk factors for contamination of water resources by untreated sewage and the entrainment of cattle feces in rainwater. Further, this review covers taxonomic, biologic, and epidemiologic aspects such as prevalence, risk factors, and molecular characterization of these protozoa observed in humans and cattle in order to elucidate the role of these hosts in environmental pollution, and consequently, as a source of infection for susceptible humans, especially in rural areas. Alternative water resources such as wells and springs are used without water treatment and potability monitoring. Epidemiological data are useful, but insufficient to characterize the source of infection, thereby requiring the use of appropriate molecular methods for subtyping the protozoa detected in environmental and feces samples as well as for assessing public health risk. Key words: Sanitation. Giardia duodenalis. Cryptosporidium parvum. Zoonosis. Rural areas. Molecular characterization. ResumoA água é um importante veículo de transmissão de patógenos, entre eles Cryptosporidium spp e Giardia duodenalis, respectivamente responsáveis por 58% e 38% dos surtos de veiculação hídrica registrados em cerca de 60 anos. Características relacionadas às fases ambientais destes protozoários e a grande quantidade de hospedeiros são importantes fatores relacionados à contaminação ambiental. Em surtos de criptosporidiose e giardíase por veiculação hídrica são apontados como principais fatores de risco a contaminação dos mananciais, utilizados para a dessedentação humana, por esgoto não tratado e o desague de fezes de animais devido ao carreamento por água da chuva. Além destes fatores, esta revisão aborda aspectos taxonômicos, biológicos e epidemiológicos, como prevalência, fatores de risco e caracterização molecular destes protozoários em humanos e bovinos como forma de elucidar a importância destes hospedeiros na contaminação ambiental e, consequentemente, como fonte de infecção para humanos suscetíveis, especialmente em áreas rurais. Nestas áreas são frequentemente utilizadas fontes alternativas de abastecimento de água, como poços e nascentes, sem tratamento e monitoramento de potabilidade. Dados epidemiológicos auxiliam, porém não são suficientes para caracterizar fontes de infecção, sendo necessário o uso de adequadas ferramentas de caracterização molecular para subtipagem de protozoários identificados em fezes e amostras ambientais e avaliação do risco de saúde pública.

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Massive Outbreak of Waterborne Cryptosporidium Infection in Milwaukee, Wisconsin: Recurrence of Illness and Risk of Secondary Transmission

Cited by 301 publications

References 16 publications

Disease transmission models for public health decision making: analysis of epidemic and endemic conditions caused by waterborne pathogens.

Disease transmission models for public health decision making: analysis of epidemic and endemic conditions caused by waterborne pathogens.

Massive outbreak of viral gastroenteritis associated with consumption of municipal drinking water in a European capital city

Waterborne Giardia and Cryptosporidium: contamination of human drinking water by sewage and cattle feces

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