Chapter
2.3.5 Escherichia coli (Enterohemorrhagic E. coli, Enterotoxigenic E. coli)
2.3.8 Giardia lamblia (syn. G. intestinalis, G. duodenalis)
2.3.9 Cryptosporidium parvum
2.4 INDICATOR AND SURROGATE ORGANISMS
3.0 Capabilities of Water Safety Barriers
3.1 INTRODUCTION TO WATER QUALITY
3.2 SOURCE WATER PROTECTION
3.3 CONVENTIONAL WATER TREATMENT PROCESSES
3.3.1 Coagulation, Flocculation and Sedimentation (Clarification)
3.3.3 Disinfection: Chlorination
3.4 ADVANCED WATER TREATMENT PROCESSES
3.4.1 Membrane Filtration
3.4.3 Ultraviolet Radiation Disinfection
3.5 WATER DISTRIBUTION AND STORAGE
3.6 RISK MANAGEMENT FOR SAFE DRINKING WATER
4.0 Waterborne Outbreak Case Studies
4.2 WALKERTON, ONTARIO, CANADA
4.2.1 Scope of the Outbreak
4.2.2 The Walkerton Drinking Water System
4.2.3 The Outbreak Experience in May 2000
4.2.3.2 May 8, 2000 – Heavy Rainfall and Local Flooding
4.2.3.3 May 17 – Laboratory Report to PUC of E. coli Contamination
4.2.3.4 May 18 – First Cases of Illness Recognized
4.2.3.5 May 21 – Boil Water Advisory Issued by Health Unit
4.2.3.6 May 23 – Health Unit Learns of E. coli Contamination Results
4.2.4 Direct Causes of the Walkerton Outbreak
4.3 OUTBREAKS IN THE 1970s
4.3.2 Richmond Heights, Florida, U.S.A.
4.3.2.1 Scope of the Outbreak
4.3.2.2 The Richmond Heights Drinking Water System
4.3.2.3 Outbreak Experience January to March 1974
4.3.2.4 Direct Causes of the Outbreak
4.3.3 Rome, New York, U.S.A.
4.3.3.1 Scope of the Outbreak
4.3.3.2 The Rome, New York Drinking Water System
4.3.3.3 Outbreak Experience November 1974–June 1975
4.3.3.4 Direct Causes of the Outbreak
4.3.4 Crater Lake, Oregon, U.S.A.
4.3.4.1 Scope of the Outbreak
4.3.4.2 The Crater Lake Drinking Water System
4.3.4.3 Outbreak Experience June–July 1975
4.3.4.4 Direct Causes of the Outbreak
4.3.5 Camas, Washington, U.S.A.
4.3.5.1 Scope of the Outbreak
4.3.5.2 The Camas Drinking Water System
4.3.5.3 Outbreak Experience April–May 1976
4.3.5.4 Direct Causes of the Outbreak
4.3.6 Berlin, New Hampshire, U.S.A.
4.3.6.1 Scope of the Outbreak
4.3.6.2 The Berlin, New Hampshire Drinking Water System
4.3.6.3 Outbreak Experience March–May 1977
4.3.6.4 Direct Causes of the Outbreak
4.3.7 Bennington, Vermont, U.S.A.
4.3.7.1 Scope of the Outbreak
4.3.7.2 The Bennington Drinking Water System
4.3.7.3 Outbreak Experience May–June 1978
4.3.7.4 Direct Causes of the Outbreak
4.3.8 Bradford, Pennsylvania, U.S.A.
4.3.8.1 Scope of the Outbreak
4.3.8.2 The Bradford Drinking Water System
4.3.8.3 Outbreak Experience July and December 1979
4.3.8.4 Direct Causes of the Outbreak
4.4 OUTBREAKS IN THE 1980s
4.4.2 Georgetown, Texas, U.S.A.
4.4.2.1 Scope of the Outbreak
4.4.2.2 The Georgetown Drinking Water System
4.4.2.3 Outbreak Experience June 1980
4.4.2.4 Direct Causes of the Outbreak
4.4.3 Red Lodge, Montana, U.S.A.
4.4.3.1 Scope of the Outbreak
4.4.3.2 The Red Lodge Drinking Water System
4.4.3.3 Outbreak Experience June–August 1980
4.4.3.4 Direct Causes of the Outbreak
4.4.4 Bramham, Yorkshire, England
4.4.4.1 Scope of the Outbreak
4.4.4.2 The Bramham Drinking Water System
4.4.4.3 Outbreak Experience July 1980
4.4.4.4 Direct Causes of the Outbreak
4.4.5 Rome, Georgia, U.S.A.
4.4.5.1 Scope of the Outbreak
4.4.5.2 The Rome, Georgia Drinking Water System
4.4.5.3 Outbreak Experience August 1980
4.4.5.4 Direct Causes of the Outbreak
4.4.6 Grums and Vålberg, Vårmland, Sweden
4.4.6.1 Scope of the Outbreak
4.4.6.2 The Grums and Vålberg Drinking Water System
4.4.6.3 Outbreak Experience October 1980
4.4.6.4 Direct Causes of the Outbreak
4.4.7 Eagle-Vail, Colorado, U.S.A.
4.4.7.1 Scope of the Outbreak
4.4.7.2 The Eagle-Vail and Avon Drinking Water System
4.4.7.3 Outbreak Experience March 1981
4.4.7.4 Direct Causes of the Outbreak
4.4.8 Mjövik (Karlskrona), Blekinge, Sweden
4.4.8.1 Scope of the Outbreak
4.4.8.2 The Mjövik Drinking Water System
4.4.8.3 Outbreak Experience October 16 to 27, 1982
4.4.8.4 Direct Causes of the Outbreak
4.4.9 Drumheller, Alberta, Canada
4.4.9.1 Scope of the Outbreak
4.4.9.2 The Drumheller Drinking Water System
4.4.9.3 Outbreak Experience February 17 to 28, 1983
4.4.9.4 Direct Causes of the Outbreak
4.4.10 Greenville, Florida, U.S.A.
4.4.10.1 Scope of the Outbreak
4.4.10.2 The Greenville Drinking Water System
4.4.10.3 Outbreak Experience May 1983
4.4.10.4 Direct Causes of the Outbreak
4.4.11 Braun Station, Texas, U.S.A.
4.4.11.1 Scope of the Outbreak
4.4.11.2 The Braun Station Drinking Water System
4.4.11.3 Outbreak Experience May–July 1984
4.4.11.4 Direct Causes of the Outbreak
4.4.12.1 Scope of the Outbreak
4.4.12.2 The Alsvåg Drinking Water System
4.4.12.3 Outbreak Experience June 10–July 15, 1984
4.4.12.4 Direct Causes of the Outbreak
4.4.13 Orangeville, Ontario, Canada
4.4.13.1 Scope of the Outbreak
4.4.13.2 The Orangeville Drinking Water System
4.4.13.3 Outbreak Experience March 29–April 17, 1985
4.4.13.4 Direct Causes of the Outbreak
4.4.14 Pittsfield, Massachusetts, U.S.A.
4.4.14.1 Scope of the Outbreak
4.4.14.2 The Pittsfield Drinking Water System
4.4.14.3 Outbreak Experience November 1985–January 1986
4.4.14.4 Direct Causes of the Outbreak
4.4.15 Penticton, B.C., Canada
4.4.15.1 Scope of the Outbreak
4.4.15.2 The Penticton Drinking Water System
4.4.15.3 Outbreak Experience June–November 1986
4.4.15.4 Direct Causes of the Outbreak
4.4.16 Sälen, Dalarna, Sweden
4.4.16.1 Scope of the Outbreak
4.4.16.2 The Resort Drinking Water System
4.4.16.3 Outbreak Experience December 20, 1986–January 17, 1987
4. 4.16.4 Direct Causes of the Outbreak
4.4.17 Carrollton, Georgia, U.S.A.
4.4.17.1 Scope of the Outbreak
4.4.17.2 The Carollton Drinking Water System
4.4.17.3 Outbreak Experience January 12 to February 7, 1987
4.4.17.4 Direct Causes of the Outbreak
4.4.18 Sunbury, Diggers Rest and Bulla, Victoria, Australia
4.4.18.1 Scope of the Outbreak
4.4.18.2 The Sunbury Region Drinking Water System
4.4.18.3 Outbreak Experience October 1987
4.4.18.4 Direct Causes of the Outbreak
4.4.19.1 Scope of the Outbreak
4.4.19.2 The Boden Drinking Water System
4.4.19.3 Outbreak Experience March–April 1988
4.4.19.4 Direct Causes of the Outbreak
4.4.20 Saltcoats/Stevenston, Ayrshire, Scotland
4.4.20.1 Scope of the Outbreak
4.4.20.2 The Saltcoats and Stevenston Drinking Water System
4.4.20.3 Outbreak Experience March–April 1988
4.4.20.4 Direct Causes of the Outbreak
4.4.21.1 Scope of the Outbreak
4.4.21.2 The Skjervøy Drinking Water System
4.4.21.3 Outbreak Experience July–August 1988
4.4.21.4 Direct Causes of the Outbreak
4.4.22 Swindon, Oxfordshire and Wiltshire, England
4.4.22.1 Scope of the Outbreak
4.4.22.2 The Farmoor Drinking Water Supply
4.4.22.3 Outbreak Experience December 28, 1988–April 28, 1989
4.4.22.4 Direct Causes of the Outbreak
4.4.23 Oakcreek Canyon, Sedona, Arizona, U.S.A
4.4.23.1 Scope of the Outbreak
4.4.23.2 The Oakcreek Canyon Resort Water System
4.4.23.3 Outbreak Experience April–May 1989
4.4.23.4 Direct Causes of the Outbreak
4.5 OUTBREAKS IN THE 1990s
4.5.2 Cabool, Missouri, U.S.A.
4.5.2.1 Scope of the Outbreak
4.5.2.2 The Cabool Drinking Water System
4.5.2.3 Outbreak Experience December 15, 1989–January 20, 1990
4.5.2.4 Direct Causes of the Outbreak
4.5.3 Moama, New South Wales, Australia
4.5.3.1 Scope of the Outbreak
4.5.3.2 The Moama Caravan Park “A” Drinking Water System
4.5.3.3 Outbreak Experience December 25, 1989–January 8, 1990
4.5.3.4 Direct Causes of the Outbreak
4.5.4 Creston / Erickson, B.C., Canada
4.5.4.1 Scope of the Outbreak
4.5.4.2 The Creston and Erickson Drinking Water System
4.5.4.3 Outbreak Experience January–March 1990
4.5.4.4 Direct Causes of the Outbreak
4.5.5 Nursery School / Kindergarten, Saitama, Japan
4.5.5.1 Scope of the Outbreak
4.5.5.2 The Nursery School Drinking Water System
4.5.5.3 Outbreak Experience October 1990
4.5.5.4 Direct Causes of the Outbreak
4.5.6 The Isle of Thanet Region, Kent, England,
4.5.6.1 Scope of the Outbreak
4.5.6.2 The East Kent Drinking Water Supply Region
4.5.6.3 Outbreak Experience December 1990–January 1991
4.5.6.4 Direct Causes of the Outbreak
4.5.7 Naas, County Kildare, Ireland
4.5.7.1 Scope of the Outbreak
4.5.7.2 The Naas Drinking Water System
4.5.7.3 Outbreak Experience October 5–25, 1991
4.5.7.4 Direct Causes of the Outbreak
4.5.8.1 Scope of the Outbreak
4.5.8.2 The Uggelose Drinking Water System
4.5.8.3 Outbreak Experience December 16, 1991–February 2, 1992
4.5.8.4 Direct Causes of the Outbreak
4.5.9 Jackson County, Oregon, U.S.A.
4.5.9.1 Scope of the Outbreak
4.5.9.2 The Talent Bear Creek and Medford Water Commission Drinking Water System
4.5.9.3 Outbreak Experience January–June 1992
4.5.9.4 Direct Causes of the Outbreak
4.5.10 Bradford, West Yorkshire, England
4.5.10.1 Scope of the Outbreak
4.5.10.2 The Bradford Drinking Water System
4.5.10.3 Outbreak Experience October–December 1992
4.5.10.4 Direct Causes of the Outbreak
4.5.11 Warrington, Cheshire, England
4.5.11.1 Scope of the Outbreak
4.5.11.2 The Warrington Drinking Water System
4.5.11.3 Outbreak Experience November 1992–February 1993
4.5.11.4 Direct Causes of the Outbreak
4.5.12 Kitchener–Waterloo, Ontario, Canada
4.5.12.1 Scope of the Outbreak
4.5.12.2 The Kitchener–Waterloo Drinking Water System
4.5.12.3 Outbreak Experience March–May 1993
4.5.12.4 Direct Causes of the Outbreak
4.5.13 Milwaukee, Wisconsin, U.S.A.
4.5.13.1 Scope of the Outbreak
4.5.13.2 The Milwaukee Drinking Water System
4.5.13.3 Outbreak Experience March–April 1993
4.5.13.4 Direct Causes of the Outbreak
4.5.14 Gideon, Missouri, U.S.A.
4.5.14.1 Scope of the Outbreak
4.5.14.2 The Gideon Drinking Water System
4.5.14.3 Outbreak Experience November 1993–December 1993
4.5.14.4 Direct Causes of the Outbreak
4.5.15 Noormarkku, Finland
4.5.15.1 Scope of the Outbreak
4.5.15.2 The Noormarkku Drinking Water System
4.5.15.3 Outbreak Experience April 1994
4.5.15.4 Direct Causes of the Outbreak
4.5.16 Temagami, Ontario, Canada
4.5.16.1 Scope of the Outbreak
4.5.16.2 The Temagami Drinking Water System
4.5.16.3 Outbreak Experience February–May 1994
4.5.16.4 Direct Causes of the Outbreak
4.5.17 Victoria, B.C., Canada
4.5.17.1 Scope of the Outbreak
4.5.17.2 The Victoria Drinking Water System
4.5.17.3 Outbreak Experience October 1994–May 1995
4.5.17.4 Direct Causes of the Outbreak
4.5.18 Village in Fife, Scotland
4.5.18.1 Scope of the Outbreak
4.5.18.2 The Village Drinking Water System
4.5.18.3 Outbreak Experience March 6–21, 1995
4.5.18.4 Direct Causes of the Outbreak
4.5.19 Yukon Territory, Canada
4.5.19.1 Scope of the Outbreak
4.5.19.2 The Restaurant/Motel Drinking Water System
4.5.19.3 Outbreak Experience June–July 1995
4.5.19.4 Direct Causes of the Outbreak
4.5.20 South Devon (Torbay and District), England
4.5.20.1 Scope of the Outbreak
4.5.20.2 The Littlehempston Drinking Water Treatment Plant
4.5.20.3 Outbreak Experience July 27–September 28, 1995
4.5.20.4 Direct Causes of the Outbreak
4.5.21 Klarup, North Jutland, Denmark
4.5.21.1 Scope of the Outbreak
4.5.21.2 The Klarup Drinking Water System
4.5.21.3 Outbreak Experience December 12, 1995–March 3, 1996
4.5.21.4 Direct Causes of the Outbreak
4.5.22 Cranbrook, B.C., Canada
4.5.22.1 Scope of the Outbreak
4.5.22.2 The Cranbrook Drinking Water System
4.5.22.3 Outbreak Experience May–July 1996
4.5.22.4 Direct Causes of the Outbreak
4.5.23 Ogose Town, Saitama Prefecture, Japan
4.5.23.1 Scope of the Outbreak
4.5.23.2 The Ogose Drinking Water System
4.5.23.3 Outbreak Experience June 1996
4.5.23.4 Direct Causes of the Outbreak
4.5.24 Strömsund, Jämtland, Sweden
4.5.24.1 Scope of the Outbreak
4.5.24.2 The Strömsund Drinking Water System
4.5.24.3 Outbreak Experience August–September 1996
4.5.24.4 Direct Causes of the Outbreak
4.5.25 NW London and W Hertfordshire (North Thames), England
4.5.25.1 Scope of the Outbreak
4.5.25.2 The Clay Lane Drinking Water Treatment System
4.5.25.3 Outbreak Experience February–April 1997
4.5.25.4 Direct Causes of the Outbreak
4.5.26 Resort Hotel, Bermuda
4.5.26.1 Scope of the Outbreak
4.5.26.2 The Resort Hotel Drinking Water Treatment System
4.5.26.3 Outbreak Experience February 1998
4.5.26.4 Direct Causes of the Outbreak
4.5.27 Heinävesi, Finland
4.5.27.1 Scope of the Outbreak
4.5.27.2 The Heinävesi Drinking Water System
4.5.27.3 Outbreak Experience March–April 1998
4.5.27.4 Direct Causes of the Outbreak
4.5.28 Alpine, Wyoming, U.S.A.
4.5.28.1 Scope of the Outbreak
4.5.28.2 The Alpine Drinking Water System
4.5.28.3 Outbreak Experience June 26–July 30, 1998
4.5.28.4 Direct Causes of the Outbreak
4.5.29 Brushy Creek, Williamson County, U.S.A.
4.5.29.1 Scope of the Outbreak
4.5.29.2 The Brushy Creek MUD Drinking Water System
4.5.29.3 Outbreak Experience July 21–August 2, 1998
4.5.29.4 Direct Causes of the Outbreak
4.5.30 La Neuveville, Bern Canton, Switzerland
4.5.30.1 Scope of the Outbreak
4.5.30.2 The La Neuveville Drinking Water System
4.5.30.3 Outbreak Experience August 1998
4.5.30.4 Direct Causes of the Outbreak
4.5.31 Washington County Fair, New York, U.S.A.
4.5.31.1 Scope of the Outbreak
4.5.31.2 The Washington County Fair Drinking Water System
4.5.31.3 Outbreak Experience September 1999
4.5.31.4 Direct Causes of the Outbreak
4.6 OUTBREAKS IN THE 21ST CENTURY
4.6.2 Clitheroe, Lancashire, England
4.6.2.1 Scope of the Outbreak
4.6.2.2 The Clitheroe Drinking Water System
4.6.2.3 Outbreak Experience March 4–20, 2000
4.6.2.4 Direct Causes of the Outbreak
4.6.3 Belfast, Northern Ireland, UK
4.6.3.1 Scope of the Outbreaks
4.6.3.2 The Belfast Drinking Water Systems
4.6.3.3 Outbreak Experience April–May 2000, August 2000 and February–April 2001
4.6.3.4 Direct Causes of the Outbreak
4.6.4 Resort, Gulf of Taranto, Italy
4.6.4.1 Scope of the Outbreak
4.6.4.2 The Resort Drinking Water System
4.6.4.3 Outbreak Experience July 7–31, 2000
4.6.4.4 Direct Causes of the Outbreak
4.6.5.1 Scope of the Outbreaks
4.6.5.2 The Drinking Water Systems
4.6.5.3 Outbreak Experience August 2000, August 2001 and October–November 2001
4.6.5.4 Direct Causes of the Outbreaks
4.6.6 North Battleford, Saskatchewan, Canada
4.6.6.1 Scope of the Outbreak in April 2001
4.6.6.2 The North Battleford Drinking Water System
4.6.6.3 Outbreak Experience March–April, 2001
4.6.6.4 Direct Causes of the Outbreak
4.6.7 Boarding School, Hawke’s Bay, New Zealand
4.6.7.1 Scope of the Outbreak
4.6.7.2 The Boarding School Drinking Water System
4.6.7.3 Outbreak Experience May 2001
4.6.7.4 Direct Causes of the Outbreak
4.6.8 Camp/Conference Centre, Stockholm County, Sweden
4.6.8.1 Scope of the Outbreak
4.6.8.2 The Camp/Conference Centre Drinking Water System
4.6.8.3 Outbreak Experience May–June 2001
4.6.8.4 Direct Causes of the Outbreak
4.6.9 Transtrand, County of Dalarna, Sweden,
4.6.9.1 Scope of the Outbreak
4.6.9.2 The Transtrand Drinking Water System
4.6.9.3 Outbreak Experience February 18–March 18, 2002
4.6.9.4 Direct Causes of the Outbreak
4.7 A WATERBORNE OUTBREAK OF BAD NEWS — SYDNEY, AUSTRALIA
4.7.1 Scope of the Sydney Water Crisis, July–September 1998
4.7.2 The Sydney Drinking Water System
4.7.3 Bad News Experience
4.7.4 Direct Causes of the Incident
4.8 A WATERBORNE OUTBREAK BY ANY OTHER NAME? EDMONTON, ALBERTA, CANADA
4.8.1 Scope of the Outbreak, October 1982–June 1983
4.8.2 The Edmonton Drinking Water System
4.8.3 The Outbreak Experience: October 1982–April 1983
4.8.4 Direct Causes of the Outbreak
5.0 Overview and Recurring Themes
5.1 SUMMARIES OF OUTBREAKS AVAILABLE IN THE LITERATURE
5.1.2 Recent Summaries of Waterborne Outbreaks in the U.S.
5.1.3 Summaries of Drinking Waterborne Outbreaks in the U.K.
5.1.4 Summaries of Drinking Waterborne Outbreaks in Sweden
5.1.5 Summaries of Drinking Waterborne Outbreaks in Finland
5.1.6 Summaries of Drinking Waterborne Outbreaks in Canada
5.1.7 Summaries of Drinking Waterborne Outbreaks in Japan
5.1.8 Summaries of Drinking Waterborne Outbreaks in Switzerland
5.1.9 Summaries of Drinking Waterborne Outbreaks – Multiple Countries
5.2.1 Converting Hindsight into Foresight
5.2.2 Pathogens Pose the Greatest Risk to Drinking Water Safety
5.2.3 Robust Multiple Barriers Are Essential
5.2.3.1 Source protection and selection
5.2.4 Trouble is Preceded by Change
5.2.5 Operators Must be Capable and Responsive
5.2.6 Drinking Water Professionals
5.2.8 Other Recurring Themes
5.2.8.2 Concerns with chlorination
5.2.8.3 Gender distribution of cases
5.2.8.4 Public health context
5.3 ROUTINE MICROBIAL SAFETY OF DRINKING WATER
6.0 Outbreak Prevention - Safe Water
6.4 ELEMENTS OF PREVENTION
6.5 PREVENTIVE APPROACHES
6.5.1 Insights From Expert Reviews and Inquiries
6.5.1.1 The Badenoch and Bouchier Expert Group Reports
6.5.1.2 The Walkerton Inquiry Reports
6.5.1.3 The North Battleford Inquiry Report
6.5.2 Drinking Water Safety Programs
6.5.2.1 QualServe, International Water Treatment Alliance, Partnership for Safe Water, U.S. Environmental Protection Agency Composite Correction Program
6.5.2.2 Hazard Analysis and Critical Control Point (HACCP)
6.5.2.3 New Zealand Public Health Risk Management Plans
6.5.2.4 Australian Framework for Management of Drinking Water Quality
6.5.2.5 From Source to Tap: Guidance on the Multiple Barrier Approach to Safe Drinking Water
6.5.2.6 World Health Organization Drinking Water Guideline Water Safety Plans
6.5.2.7 The Bonn Charter — A Drinking Water Quality Framework for the 21st Century
6.6 THE PUBLIC AND SAFE DRINKING WATER
Safe Drinking Water
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