220093 Drinking water security in the 21st century: Revisiting the lessons from Milwaukee's cryptosporiduim outbreak

Tuesday, November 9, 2010 : 5:15 PM - 5:35 PM

Paul A. Biedrzycki, MPH, MBA , Health Department, City of Milwaukee, Milwaukee, WI
Kristina D. Mena, PhD , Division of Environmental Health, El Paso Campus, UT HSC at Houston School of Public Health, El Paso, VA
Geoffrey R. Swain, MD, MPH , University of Wisconsin School of Medicine and Public Health, City of Milwaukee Health Department, Milwaukee, WI
Drinking water security remains a high priority for the U.S. Environmental Protection Agency (USEPA) and U.S. Department of Homeland Security. Early warning and detection of a drinking water contamination event by public health or water utility authorities is a fundamental goal of the USEPA Water Security Initiative (WSI). The WSI encompasses a multifaceted approach that is focused on design, implementation and evaluation of methodologies and systems that are protective and responsive to the intentional introduction of biologic or chemical agents within drinking water distribution systems. The 1993 cryptosporidiosis outbreak in Milwaukee, WI, remains one of the largest waterborne disease outbreaks in modern U.S. history. Over 400,000 persons became ill and 100, primarily immune-suppressed individuals, died as a result of ingesting contaminated drinking water, yet the outbreak was initially undetected by local public health agencies (LPHAs) and the regional water utility. Lessons learned by MHD in the aftermath of the outbreak response can inform the development of response algorithms for the public health surveillance module of the WSI, and provide valuable insight into challenges faced by LPHAs and water utilities that may be common to intentional breaches of water treatment and distribution systems. Further, Milwaukee's quantitative risk-assessment model provides a valuable approach to assessing overall and continued risk of naturally occurring waterborne outbreaks in a community. Data and strategies gleaned from review of experiences like the 1993 outbreak are invaluable in crafting future collaborative and strategic planning by local, regional, and national officials interested in addressing drinking water security.

Learning Areas:
Communication and informatics
Environmental health sciences
Other professions or practice related to public health
Protection of the public in relation to communicable diseases including prevention or control
Public health or related research

Learning Objectives:
Describe the USEPA Water Security Initiative and its role in developing contamination early warning and detection models for drinking water systems. Explain how study of naturally occurring waterborne disease outbreaks can inform the development of viable contaminant early warning and detection in drinking water systems for use by both public health agencies and water utilities. Discuss a risk assessment model developed for the City of Milwaukee related to population risk of Cryptosporidiosis infection associated with drinking water. List components of a public health surveillance module contained within the USEPA Water Security Initiative.

Keywords: Surveillance, Water Quality

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I oversee public health programs pertaining to recreational and drinking water quality within the City of Milwaukee and served as Manager of Environmental Health during the 1993 Milwaukee Cryptosporidium Outbreak
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
Intellitech Systems Inc. Peer Reviewer Consultant

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.