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Previous Volume 331:161-167 July 21, 1994 Number 3 Next

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ABSTRACT

Background Early in the spring of 1993 there was a widespread outbreak of acute watery diarrhea among the residents of Milwaukee.

Methods We investigated the two Milwaukee water-treatment plants, gathered data from clinical laboratories on the results of tests for enteric pathogens, and examined ice made during the time of the outbreak for cryptosporidium oocysts. We surveyed residents with confirmed cryptosporidium infection and a sample of those with acute watery diarrhea consistent with cryptosporidium infection. To estimate the magnitude of the outbreak, we also conducted a survey using randomly selected telephone numbers in Milwaukee and four surrounding counties.

Results There were marked increases in the turbidity of treated water at the city's southern water-treatment plant from March 23 until April 9, when the plant was shut down. Cryptosporidium oocysts were identified in water from ice made in southern Milwaukee during these weeks. The rates of isolation of other enteric pathogens remained stable, but there was more than a 100-fold increase in the rate of isolation of cryptosporidium. The median duration of illness was 9 days (range, 1 to 55). The median maximal number of stools per day was 12 (range, 1 to 90). Among 285 people surveyed who had laboratory-confirmed cryptosporidiosis, the clinical manifestations included watery diarrhea (in 93 percent), abdominal cramps (in 84 percent), fever (in 57 percent), and vomiting (in 48 percent). We estimate that 403,000 people had watery diarrhea attributable to this outbreak.

Conclusions This massive outbreak of watery diarrhea was caused by cryptosporidium oocysts that passed through the filtration system of one of the city's water-treatment plants. Water-quality standards and the testing of patients for cryptosporidium were not adequate to detect this outbreak.

Source Information

From the Bureau of Public Health, Wisconsin Division of Health, Madison (W.R.M., N.J.H., M.E.P., J.J.K., J.P.D.); the Epidemiology Program Office, Division of Field Epidemiology (W.R.M., D.E.P.), Epidemic Intelligence Service (W.R.M.), Division of Parasitic Diseases, National Center for Infectious Diseases (D.G.A.), Centers for Disease Control and Prevention, Atlanta; the City of Milwaukee Department of Health (K.A.B.) and Bureau of Laboratories (M.S.G.), Milwaukee; the U.S. Environmental Protection Agency, Cincinnati (K.R.F.); and the University of South Florida, Tampa (J.B.R.).

Address reprint requests to Dr. Davis at the Wisconsin Division of Health, Bureau of Public Health, 1400 E. Washington Ave., Rm. 241, Madison, WI 53703.

Full Text of this Article

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Cryptosporidium and the Public Water Supply
Kaminski J. C., Mac Kenzie W. R., Addiss D. G., Davis J. P.
Extract | Full Text  
N Engl J Med 1994; 331:1529-1530, Dec 1, 1994. Correspondence

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