Surveillance for waterborne disease outbreak, Puerto Rico, 2007-2011

Methods: Waterborne outbreaks are reportable to the Puerto Rico Department of Health (PRDOH) according to the existing Administrative Order. Once an outbreak is confirmed, the response involves a team composed of diverse specialists: epidemiologists, nurses, environmental health specialists and medical technologists among others. Epidemiological, laboratory and environmental information is collected during the investigation. Waterborne outbreaks are reported to the national surveillance system. Results: The PRDOH has investigated three waterborne outbreaks, two of them associated with recreational water and the other to drinking water. 268 cases were related to these outbreaks. Gastrointestinal symptoms were reported by the cases: diarrhea, vomits and abdominal pain. The etiological agent was confirmed in two outbreaks: Cryptosporidium and Cyclospora. The suspected agent was Norovirus on the third event. Some of the risk factors associated with the transmission of the pathogens were the inadequate management of the water in the recreational parks, water service interruption and a decrease in the water pressure in the drinking water system. Conclusion: Waterborne outbreak surveillance allows the detection and knowledge of the factors related with the management of recreational and drinking water that represents a hazard to the public health. Also, allows defining the adequate measures to control and prevent future outbreaks.