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Book Details
Abstract
Drinking water provides an efficient source for the spread of gastrointestinal microbial pathogens capable of causing serious human disease. The massive death toll and burden of disease worldwide caused by unsafe drinking water is a compelling reason to value the privilege of having safe drinking water delivered to individual homes. On rare occasions, that privilege has been undermined in affluent nations by waterborne disease outbreaks traced to the water supply. Using the rich and detailed perspectives offered by the evidence and reports from the Canadian public inquiries into the Walkerton (2000) and North Battleford (2001) outbreaks to develop templates for understanding their key dimensions, over 60 waterborne outbreaks from 15 affluent countries over the past 30 years are explored as individual case studies. Recurring themes and patterns are revealed and the critical human dimensions are highlighted suggesting insights for more effective and more individualized preventive strategies, personnel training, management, and regulatory control. Safe Drinking Water aims to raise understanding and awareness of those factors that have most commonly contributed to or caused drinking-water-transmitted disease outbreaks - essentially a case-history analysis within the multi-barrier framework. It contains detailed analysis of the failures underlying drinking-water-transmitted disease epidemics that have been documented in the open literature, by public inquiry, in investigation reports, in surveillance databases and other reliable information sources. The book adopts a theme of 'converting hindsight into foresight', to inform drinking-water and health professionals including operators, managers, engineers, chemists and microbiologists, regulators, as well as undergraduates and graduates at specialty level. Key Features: Contains details and perspectives of major outbreaks not widely known or understood beyond those directly involved in the investigations. Technical and scientific background associated with case studies is offered in an accessible summary form. Does not require specialist training or experience to comprehend the details of the numerous outbreaks reviewed. By providing a broad-spectrum review using a consistent approach, several key recurring themes are revealed that offer insights for developing localized, tailor-made prevention strategies.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Contents | v | ||
| Foreword | xiii | ||
| Preface | xvi | ||
| List of Abbreviations | xxi | ||
| 1.0 Introduction | xxv | ||
| 2.0 Causes of Waterborne Disease Outbreaks | xxx | ||
| 2.1\tHISTORICAL BACKGROUND | xxx | ||
| 2.2\tMAJOR CLASSES OF WATERBORNE PATHOGENS | xliv | ||
| 2.2.1\tViruses | xlv | ||
| 2.2.2\tBacteria | xlvi | ||
| 2.2.3\tProtozoa | xlviii | ||
| 2.3\tSPECIFIC PATHOGENS RELEVANT TO OUTBREAK CASE STUDIES | xlix | ||
| 2.3.1\tHepatitis A Virus | xlix | ||
| 2.3.2\tNorovirus (Norwalk virus) | li | ||
| 2.3.3\tRotavirus | liii | ||
| 2.3.4\tCampylobacter | liv | ||
| 2.3.5\tEscherichia coli (Enterohemorrhagic E. coli, Enterotoxigenic E. coli) | lvi | ||
| 2.3.6\tSalmonella | lviii | ||
| 2.3.7\tShigella | lx | ||
| 2.3.8\tGiardia lamblia (syn. G. intestinalis, G. duodenalis) | lxi | ||
| 2.3.9\tCryptosporidium parvum | lxii | ||
| 2.3.10\t\tToxoplasma gondii | lxv | ||
| 2.4\tINDICATOR AND SURROGATE ORGANISMS | lxvi | ||
| 2.5\tSUMMARY OF PATHOGENS | lxix | ||
| 3.0 Capabilities of Water Safety Barriers | lxxiv | ||
| 3.1\tINTRODUCTION TO WATER QUALITY | lxxiv | ||
| 3.2\tSOURCE WATER PROTECTION | lxxix | ||
| 3.3\tCONVENTIONAL WATER TREATMENT PROCESSES | lxxx | ||
| 3.3.1\tCoagulation, Flocculation and Sedimentation (Clarification) | lxxxi | ||
| 3.3.2\tFiltration | lxxxvi | ||
| 3.3.3\tDisinfection: Chlorination | xci | ||
| 3.4\tADVANCED WATER TREATMENT PROCESSES | xcvii | ||
| 3.4.1\tMembrane Filtration | xcviii | ||
| 3.4.2\tOzonation | xcix | ||
| 3.4.3\tUltraviolet Radiation Disinfection | xcix | ||
| 3.4.4\tOther Processes | c | ||
| 3.5\tWATER DISTRIBUTION AND STORAGE | c | ||
| 3.6\tRISK MANAGEMENT FOR SAFE DRINKING WATER | cii | ||
| 4.0 Waterborne Outbreak Case Studies | cv | ||
| 4.1\tINTRODUCTION | cv | ||
| 4.2\tWALKERTON, ONTARIO, CANADA | cxix | ||
| 4.2.1\tScope of the Outbreak | cxix | ||
| 4.2.2\tThe Walkerton Drinking Water System | cxx | ||
| 4.2.3\tThe Outbreak Experience in May 2000 | cxxi | ||
| 4.2.3.1\tIntroduction | cxxi | ||
| 4.2.3.2\tMay 8, 2000 – Heavy Rainfall and Local Flooding | cxxi | ||
| 4.2.3.3\tMay 17 – Laboratory Report to PUC of E. coli Contamination | cxxiv | ||
| 4.2.3.4\tMay 18 – First Cases of Illness Recognized | cxxiv | ||
| 4.2.3.5\tMay 21 – Boil Water Advisory Issued by Health Unit | cxxvii | ||
| 4.2.3.6\tMay 23 – Health Unit Learns of E. coli Contamination Results | cxxx | ||
| 4.2.4\tDirect Causes of the Walkerton Outbreak | cxxxiv | ||
| 4.2.5\tCommentary | cxlii | ||
| 4.3\tOUTBREAKS IN THE 1970s | cxlvii | ||
| 4.3.1\tOverview | cxlvii | ||
| 4.3.2 Richmond Heights, Florida, U.S.A. | cxlix | ||
| 4.3.2.1\tScope of the Outbreak | cxlix | ||
| 4.3.2.2\tThe Richmond Heights Drinking Water System | cxlix | ||
| 4.3.2.3\tOutbreak Experience January to March 1974 | cxlix | ||
| 4.3.2.4\tDirect Causes of the Outbreak | cl | ||
| 4.3.2.5\tCommentary | cli | ||
| 4.3.3 Rome, New York, U.S.A. | clii | ||
| 4.3.3.1\tScope of the Outbreak | clii | ||
| 4.3.3.2\tThe Rome, New York Drinking Water System | clii | ||
| 4.3.3.3\tOutbreak Experience November 1974–June 1975 | clii | ||
| 4.3.3.4\tDirect Causes of the Outbreak | cliii | ||
| 4.3.3.5\tCommentary | cliii | ||
| 4.3.4 Crater Lake, Oregon, U.S.A. | cliv | ||
| 4.3.4.1\tScope of the Outbreak | cliv | ||
| 4.3.4.2\tThe Crater Lake Drinking Water System | cliv | ||
| 4.3.4.3\tOutbreak Experience June–July 1975 | cliv | ||
| 4.3.4.4\tDirect Causes of the Outbreak | clv | ||
| 4.3.4.5\tCommentary | clv | ||
| 4.3.5 Camas, Washington, U.S.A. | clvi | ||
| 4.3.5.1\tScope of the Outbreak | clvi | ||
| 4.3.5.2\tThe Camas Drinking Water System | clvi | ||
| 4.3.5.3\tOutbreak Experience April–May 1976 | clvi | ||
| 4.3.5.4\tDirect Causes of the Outbreak | clvii | ||
| 4.3.5.5\tCommentary | clvii | ||
| 4.3.6 Berlin, New Hampshire, U.S.A. | clviii | ||
| 4.3.6.1\tScope of the Outbreak | clviii | ||
| 4.3.6.2\tThe Berlin, New Hampshire Drinking Water System | clviii | ||
| 4.3.6.3\tOutbreak Experience March–May 1977 | clix | ||
| 4.3.6.4\tDirect Causes of the Outbreak | clx | ||
| 4.3.6.5\tCommentary | clxi | ||
| 4.3.7 Bennington, Vermont, U.S.A. | clxi | ||
| 4.3.7.1\tScope of the Outbreak | clxi | ||
| 4.3.7.2\tThe Bennington Drinking Water System | clxi | ||
| 4.3.7.3\tOutbreak Experience May–June 1978 | clxii | ||
| 4.3.7.4\tDirect Causes of the Outbreak | clxii | ||
| 4.3.7.5\tCommentary | clxii | ||
| 4.3.8 Bradford, Pennsylvania, U.S.A. | clxiii | ||
| 4.3.8.1\tScope of the Outbreak | clxiii | ||
| 4.3.8.2\tThe Bradford Drinking Water System | clxiv | ||
| 4.3.8.3\tOutbreak Experience July and December 1979 | clxiv | ||
| 4.3.8.4\tDirect Causes of the Outbreak | clxiv | ||
| 4.3.8.5\tCommentary | clxv | ||
| 4.4\tOUTBREAKS IN THE 1980s | clxvi | ||
| 4.4.1\tOverview | clxvi | ||
| 4.4.2 Georgetown, Texas, U.S.A. | clxvi | ||
| 4.4.2.1\tScope of the Outbreak | clxvi | ||
| 4.4.2.2\tThe Georgetown Drinking Water System | clxvii | ||
| 4.4.2.3\tOutbreak Experience June 1980 | clxvii | ||
| 4.4.2.4\tDirect Causes of the Outbreak | clxvii | ||
| 4.4.2.5\tCommentary | clxviii | ||
| 4.4.3 Red Lodge, Montana, U.S.A. | clxviii | ||
| 4.4.3.1\tScope of the Outbreak | clxviii | ||
| 4.4.3.2\tThe Red Lodge Drinking Water System | clxviii | ||
| 4.4.3.3\tOutbreak Experience June–August 1980 | clxix | ||
| 4.4.3.4\tDirect Causes of the Outbreak | clxx | ||
| 4.4.3.5\tCommentary | clxx | ||
| 4.4.4 Bramham, Yorkshire, England | clxxi | ||
| 4.4.4.1\tScope of the Outbreak | clxxi | ||
| 4.4.4.2\tThe Bramham Drinking Water System | clxxi | ||
| 4.4.4.3\tOutbreak Experience July 1980 | clxxi | ||
| 4.4.4.4\tDirect Causes of the Outbreak | clxxii | ||
| 4.4.4.5\tCommentary | clxxiii | ||
| 4.4.5 Rome, Georgia, U.S.A. | clxxiv | ||
| 4.4.5.1\tScope of the Outbreak | clxxiv | ||
| 4.4.5.2\tThe Rome, Georgia Drinking Water System | clxxiv | ||
| 4.4.5.3\tOutbreak Experience August 1980 | clxxv | ||
| 4.4.5.4\tDirect Causes of the Outbreak | clxxv | ||
| 4.4.5.5\tCommentary | clxxvi | ||
| 4.4.6\tGrums and Vålberg, Vårmland, Sweden | clxxvi | ||
| 4.4.6.1\tScope of the Outbreak | clxxvi | ||
| 4.4.6.2\tThe Grums and Vålberg Drinking Water System | clxxvii | ||
| 4.4.6.3\tOutbreak Experience October 1980 | clxxvii | ||
| 4.4.6.4\tDirect Causes of the Outbreak | clxxvii | ||
| 4.4.6.5\tCommentary | clxxix | ||
| 4.4.7 Eagle-Vail, Colorado, U.S.A. | clxxix | ||
| 4.4.7.1\tScope of the Outbreak | clxxix | ||
| 4.4.7.2\tThe Eagle-Vail and Avon Drinking Water System | clxxix | ||
| 4.4.7.3\tOutbreak Experience March 1981 | clxxx | ||
| 4.4.7.4\tDirect Causes of the Outbreak | clxxxi | ||
| 4.4.7.5\tCommentary | clxxxii | ||
| 4.4.8 Mjövik (Karlskrona), Blekinge, Sweden | clxxxii | ||
| 4.4.8.1\tScope of the Outbreak | clxxxii | ||
| 4.4.8.2\tThe Mjövik Drinking Water System | clxxxii | ||
| 4.4.8.3\tOutbreak Experience October 16 to 27, 1982 | clxxxiii | ||
| 4.4.8.4\tDirect Causes of the Outbreak | clxxxiv | ||
| 4.4.8.5\tCommentary | clxxxv | ||
| 4.4.9 Drumheller, Alberta, Canada | clxxxv | ||
| 4.4.9.1\tScope of the Outbreak | clxxxv | ||
| 4.4.9.2\tThe Drumheller Drinking Water System | clxxxvi | ||
| 4.4.9.3\tOutbreak Experience February 17 to 28, 1983 | clxxxvi | ||
| 4.4.9.4\tDirect Causes of the Outbreak | clxxxvii | ||
| 4.4.9.5\tCommentary | clxxxviii | ||
| 4.4.10 Greenville, Florida, U.S.A. | clxxxix | ||
| 4.4.10.1 Scope of the Outbreak | clxxxix | ||
| 4.4.10.2 The Greenville Drinking Water System | clxxxix | ||
| 4.4.10.3 Outbreak Experience May 1983 | clxxxix | ||
| 4.4.10.4 Direct Causes of the Outbreak | cxc | ||
| 4.4.10.5 Commentary | cxci | ||
| 4.4.11 Braun Station, Texas, U.S.A. | cxcii | ||
| 4.4.11.1 Scope of the Outbreak | cxcii | ||
| 4.4.11.2 The Braun Station Drinking Water System | cxcii | ||
| 4.4.11.3 Outbreak Experience May–July 1984 | cxcii | ||
| 4.4.11.4 Direct Causes of the Outbreak | cxciii | ||
| 4.4.11.5 Commentary | cxciv | ||
| 4.4.12 Alsvåg, Norway | cxciv | ||
| 4.4.12.1 Scope of the Outbreak | cxciv | ||
| 4.4.12.2 The Alsvåg Drinking Water System | cxciv | ||
| 4.4.12.3 Outbreak Experience June 10–July 15, 1984 | cxciv | ||
| 4.4.12.4 Direct Causes of the Outbreak | cxcv | ||
| 4.4.12.5 Commentary | cxcv | ||
| 4.4.13 Orangeville, Ontario, Canada | cxcvi | ||
| 4.4.13.1 Scope of the Outbreak | cxcvi | ||
| 4.4.13.2 The Orangeville Drinking Water System | cxcvi | ||
| 4.4.13.3 Outbreak Experience March 29–April 17, 1985 | cxcvi | ||
| 4.4.13.4 Direct Causes of the Outbreak | cxcvii | ||
| 4.4.13.5 Commentary | cxcviii | ||
| 4.4.14 Pittsfield, Massachusetts, U.S.A. | cxcviii | ||
| 4.4.14.1 Scope of the Outbreak | cxcviii | ||
| 4.4.14.2 The Pittsfield Drinking Water System | cxcviii | ||
| 4.4.14.3 Outbreak Experience November 1985–January 1986 | cxcix | ||
| 4.4.14.4 Direct Causes of the Outbreak | cc | ||
| 4.4.14.5 Commentary | cc | ||
| 4.4.15 Penticton, B.C., Canada | cci | ||
| 4.4.15.1 Scope of the Outbreak | cci | ||
| 4.4.15.2 The Penticton Drinking Water System | cci | ||
| 4.4.15.3 Outbreak Experience June–November 1986 | cci | ||
| 4.4.15.4 Direct Causes of the Outbreak | cciv | ||
| 4.4.15.5 Commentary | cciv | ||
| 4.4.16 Sälen, Dalarna, Sweden | ccv | ||
| 4.4.16.1 Scope of the Outbreak | ccv | ||
| 4.4.16.2 The Resort Drinking Water System | ccv | ||
| 4.4.16.3 Outbreak Experience December 20, 1986–January 17, 1987 | ccv | ||
| 4. 4.16.4 Direct Causes of the Outbreak | ccvi | ||
| 4. 4.16.5 Commentary | ccvii | ||
| 4.4.17 Carrollton, Georgia, U.S.A. | ccvii | ||
| 4.4.17.1 Scope of the Outbreak | ccvii | ||
| 4.4.17.2 The Carollton Drinking Water System | ccvii | ||
| 4.4.17.3 Outbreak Experience January 12 to February 7, 1987 | ccviii | ||
| 4.4.17.4 Direct Causes of the Outbreak | ccix | ||
| 4.4.17.5 Commentary | ccix | ||
| 4.4.18 Sunbury, Diggers Rest and Bulla, Victoria, Australia | ccx | ||
| 4.4.18.1 Scope of the Outbreak | ccx | ||
| 4.4.18.2 The Sunbury Region Drinking Water System | ccx | ||
| 4.4.18.3 Outbreak Experience October 1987 | ccxi | ||
| 4.4.18.4 Direct Causes of the Outbreak | ccxi | ||
| 4.4.18.5 Commentary | ccxii | ||
| 4.4.19 Boden, Sweden | ccxiii | ||
| 4.4.19.1 Scope of the Outbreak | ccxiii | ||
| 4.4.19.2 The Boden Drinking Water System | ccxiii | ||
| 4.4.19.3 Outbreak Experience March–April 1988 | ccxiii | ||
| 4.4.19.4 Direct Causes of the Outbreak | ccxiv | ||
| 4.4.19.5 Commentary | ccxv | ||
| 4.4.20 Saltcoats/Stevenston, Ayrshire, Scotland | ccxv | ||
| 4.4.20.1 Scope of the Outbreak | ccxv | ||
| 4.4.20.2 The Saltcoats and Stevenston Drinking Water System | ccxv | ||
| 4.4.20.3 Outbreak Experience March–April 1988 | ccxv | ||
| 4.4.20.4 Direct Causes of the Outbreak | ccxvi | ||
| 4.4.20.5 Commentary | ccxvii | ||
| 4.4.21 Skjervøy, Norway | ccxviii | ||
| 4.4.21.1 Scope of the Outbreak | ccxviii | ||
| 4.4.21.2 The Skjervøy Drinking Water System | ccxviii | ||
| 4.4.21.3 Outbreak Experience July–August 1988 | ccxviii | ||
| 4.4.21.4 Direct Causes of the Outbreak | ccxviii | ||
| 4.4.21.5 Commentary | ccxix | ||
| 4.4.22 Swindon, Oxfordshire and Wiltshire, England | ccxix | ||
| 4.4.22.1 Scope of the Outbreak | ccxix | ||
| 4.4.22.2 The Farmoor Drinking Water Supply | ccxx | ||
| 4.4.22.3 Outbreak Experience December 28, 1988–April 28, 1989 | ccxx | ||
| 4.4.22.4 Direct Causes of the Outbreak | ccxx | ||
| 4.4.22.5 Commentary | ccxxii | ||
| 4.4.23 Oakcreek Canyon, Sedona, Arizona, U.S.A | ccxxiii | ||
| 4.4.23.1 Scope of the Outbreak | ccxxiii | ||
| 4.4.23.2 The Oakcreek Canyon Resort Water System | ccxxiii | ||
| 4.4.23.3 Outbreak Experience April–May 1989 | ccxxiii | ||
| 4.4.23.4 Direct Causes of the Outbreak | ccxxiv | ||
| 4.4.23.5 Commentary | ccxxv | ||
| 4.5\tOUTBREAKS IN THE 1990s | ccxxvi | ||
| 4.5.1\tOverview | ccxxvi | ||
| 4.5.2 Cabool, Missouri, U.S.A. | ccxxvi | ||
| 4.5.2.1 Scope of the Outbreak | ccxxvi | ||
| 4.5.2.2 The Cabool Drinking Water System | ccxxvi | ||
| 4.5.2.3 Outbreak Experience December 15, 1989–January 20, 1990 | ccxxvii | ||
| 4.5.2.4 Direct Causes of the Outbreak | ccxxviii | ||
| 4.5.2.5 Commentary | ccxxx | ||
| 4.5.3 Moama, New South Wales, Australia | ccxxxi | ||
| 4.5.3.1 Scope of the Outbreak | ccxxxi | ||
| 4.5.3.2 The Moama Caravan Park “A” Drinking Water System | ccxxxi | ||
| 4.5.3.3 Outbreak Experience December 25, 1989–January 8, 1990 | ccxxxii | ||
| 4.5.3.4 Direct Causes of the Outbreak | ccxxxiii | ||
| 4.5.3.5 Commentary | ccxxxiv | ||
| 4.5.4 Creston / Erickson, B.C., Canada | ccxxxiv | ||
| 4.5.4.1 Scope of the Outbreak | ccxxxiv | ||
| 4.5.4.2 The Creston and Erickson Drinking Water System | ccxxxiv | ||
| 4.5.4.3 Outbreak Experience January–March 1990 | ccxxxiv | ||
| 4.5.4.4 Direct Causes of the Outbreak | ccxxxvi | ||
| 4.5.4.5 Commentary | ccxxxvi | ||
| 4.5.5 Nursery School / Kindergarten, Saitama, Japan | ccxxxvii | ||
| 4.5.5.1 Scope of the Outbreak | ccxxxvii | ||
| 4.5.5.2 The Nursery School Drinking Water System | ccxxxvii | ||
| 4.5.5.3 Outbreak Experience October 1990 | ccxxxviii | ||
| 4.5.5.4 Direct Causes of the Outbreak | ccxxxviii | ||
| 4.5.5.5 Commentary | ccxxxix | ||
| 4.5.6\tThe Isle of Thanet Region, Kent, England, | ccxxxix | ||
| 4.5.6.1 Scope of the Outbreak | ccxxxix | ||
| 4.5.6.2 The East Kent Drinking Water Supply Region | ccxxxix | ||
| 4.5.6.3 Outbreak Experience December 1990–January 1991 | ccxxxix | ||
| 4.5.6.4 Direct Causes of the Outbreak | ccxl | ||
| 4.5.6.5 Commentary | ccxli | ||
| 4.5.7 Naas, County Kildare, Ireland | ccxli | ||
| 4.5.7.1 Scope of the Outbreak | ccxli | ||
| 4.5.7.2 The Naas Drinking Water System | ccxlii | ||
| 4.5.7.3 Outbreak Experience October 5–25, 1991 | ccxlii | ||
| 4.5.7.4 Direct Causes of the Outbreak | ccxliii | ||
| 4.5.7.5 Commentary | ccxliii | ||
| 4.5.8 Uggelose, Denmark | ccxliv | ||
| 4.5.8.1 Scope of the Outbreak | ccxliv | ||
| 4.5.8.2 The Uggelose Drinking Water System | ccxliv | ||
| 4.5.8.3 Outbreak Experience December 16, 1991–February 2, 1992 | ccxliv | ||
| 4.5.8.4 Direct Causes of the Outbreak | ccxlv | ||
| 4.5.8.5 Commentary | ccxlvi | ||
| 4.5.9 Jackson County, Oregon, U.S.A. | ccxlvi | ||
| 4.5.9.1 Scope of the Outbreak | ccxlvi | ||
| 4.5.9.2 The Talent Bear Creek and Medford Water Commission Drinking Water System | ccxlvii | ||
| 4.5.9.3 Outbreak Experience January–June 1992 | ccxlvii | ||
| 4.5.9.4 Direct Causes of the Outbreak | ccxlix | ||
| 4.5.9.5 Commentary | ccl | ||
| 4.5.10 Bradford, West Yorkshire, England | ccl | ||
| 4.5.10.1 Scope of the Outbreak | ccl | ||
| 4.5.10.2 The Bradford Drinking Water System | ccl | ||
| 4.5.10.3 Outbreak Experience October–December 1992 | ccl | ||
| 4.5.10.4 Direct Causes of the Outbreak | cclii | ||
| 4.5.10.5 Commentary | cclii | ||
| 4.5.11 Warrington, Cheshire, England | cclii | ||
| 4.5.11.1 Scope of the Outbreak | cclii | ||
| 4.5.11.2 The Warrington Drinking Water System | ccliii | ||
| 4.5.11.3 Outbreak Experience November 1992–February 1993 | ccliii | ||
| 4.5.11.4 Direct Causes of the Outbreak | ccliv | ||
| 4.5.11.5 Commentary | cclv | ||
| 4.5.12 Kitchener–Waterloo, Ontario, Canada | cclv | ||
| 4.5.12.1 Scope of the Outbreak | cclv | ||
| 4.5.12.2 The Kitchener–Waterloo Drinking Water System | cclv | ||
| 4.5.12.3 Outbreak Experience March–May 1993 | cclvi | ||
| 4.5.12.4 Direct Causes of the Outbreak | cclvi | ||
| 4.5.12.5 Commentary | cclvii | ||
| 4.5.13 Milwaukee, Wisconsin, U.S.A. | cclviii | ||
| 4.5.13.1 Scope of the Outbreak | cclviii | ||
| 4.5.13.2 The Milwaukee Drinking Water System | cclviii | ||
| 4.5.13.3 Outbreak Experience March–April 1993 | cclix | ||
| 4.5.13.4 Direct Causes of the Outbreak | cclxiv | ||
| 4.5.13.5 Commentary | cclxvi | ||
| 4.5.14 Gideon, Missouri, U.S.A. | cclxxii | ||
| 4.5.14.1 Scope of the Outbreak | cclxxii | ||
| 4.5.14.2 The Gideon Drinking Water System | cclxxii | ||
| 4.5.14.3 Outbreak Experience November 1993–December 1993 | cclxxiii | ||
| 4.5.14.4 Direct Causes of the Outbreak | cclxxiv | ||
| 4.5.14.5 Commentary | cclxxvi | ||
| 4.5.15 Noormarkku, Finland | cclxxvii | ||
| 4.5.15.1 Scope of the Outbreak | cclxxvii | ||
| 4.5.15.2 The Noormarkku Drinking Water System | cclxxvii | ||
| 4.5.15.3 Outbreak Experience April 1994 | cclxxvii | ||
| 4.5.15.4 Direct Causes of the Outbreak | cclxxviii | ||
| 4.5.15.5 Commentary | cclxxix | ||
| 4.5.16 Temagami, Ontario, Canada | cclxxix | ||
| 4.5.16.1 Scope of the Outbreak | cclxxix | ||
| 4.5.16.2 The Temagami Drinking Water System | cclxxx | ||
| 4.5.16.3 Outbreak Experience February–May 1994 | cclxxx | ||
| 4.5.16.4 Direct Causes of the Outbreak | cclxxx | ||
| 4.5.16.5 Commentary | cclxxxi | ||
| 4.5.17 Victoria, B.C., Canada | cclxxxii | ||
| 4.5.17.1 Scope of the Outbreak | cclxxxii | ||
| 4.5.17.2 The Victoria Drinking Water System | cclxxxii | ||
| 4.5.17.3 Outbreak Experience October 1994–May 1995 | cclxxxii | ||
| 4.5.17.4 Direct Causes of the Outbreak | cclxxxiv | ||
| 4.5.17.5 Commentary | cclxxxvi | ||
| 4.5.18 Village in Fife, Scotland | cclxxxvii | ||
| 4.5.18.1 Scope of the Outbreak | cclxxxvii | ||
| 4.5.18.2 The Village Drinking Water System | cclxxxvii | ||
| 4.5.18.3 Outbreak Experience March 6–21, 1995 | cclxxxvii | ||
| 4.5.18.4 Direct Causes of the Outbreak | cclxxxviii | ||
| 4.5.18.5 Commentary | cclxxxix | ||
| 4.5.19 Yukon Territory, Canada | cclxxxix | ||
| 4.5.19.1 Scope of the Outbreak | cclxxxix | ||
| 4.5.19.2 The Restaurant/Motel Drinking Water System | ccxc | ||
| 4.5.19.3 Outbreak Experience June–July 1995 | ccxc | ||
| 4.5.19.4 Direct Causes of the Outbreak | ccxci | ||
| 4.5.19.5 Commentary | ccxci | ||
| 4.5.20 South Devon (Torbay and District), England | ccxcii | ||
| 4.5.20.1 Scope of the Outbreak | ccxcii | ||
| 4.5.20.2 The Littlehempston Drinking Water Treatment Plant | ccxcii | ||
| 4.5.20.3 Outbreak Experience July 27–September 28, 1995 | ccxciii | ||
| 4.5.20.4 Direct Causes of the Outbreak | ccxcv | ||
| 4.5.20.5 Commentary | ccxcvi | ||
| 4.5.21 Klarup, North Jutland, Denmark | ccxcvii | ||
| 4.5.21.1 Scope of the Outbreak | ccxcvii | ||
| 4.5.21.2 The Klarup Drinking Water System | ccxcviii | ||
| 4.5.21.3 Outbreak Experience December 12, 1995–March 3, 1996 | ccxcviii | ||
| 4.5.21.4 Direct Causes of the Outbreak | ccxcix | ||
| 4.5.21.5 Commentary | ccxcix | ||
| 4.5.22 Cranbrook, B.C., Canada | ccc | ||
| 4.5.22.1 Scope of the Outbreak | ccc | ||
| 4.5.22.2 The Cranbrook Drinking Water System | ccc | ||
| 4.5.22.3 Outbreak Experience May–July 1996 | ccc | ||
| 4.5.22.4 Direct Causes of the Outbreak | ccci | ||
| 4.5.22.5 Commentary | cccii | ||
| 4.5.23 Ogose Town, Saitama Prefecture, Japan | ccciii | ||
| 4.5.23.1 Scope of the Outbreak | ccciii | ||
| 4.5.23.2 The Ogose Drinking Water System | ccciii | ||
| 4.5.23.3 Outbreak Experience June 1996 | ccciii | ||
| 4.5.23.4 Direct Causes of the Outbreak | cccv | ||
| 4.5.23.5 Commentary | cccv | ||
| 4.5.24 Strömsund, Jämtland, Sweden | cccvi | ||
| 4.5.24.1 Scope of the Outbreak | cccvi | ||
| 4.5.24.2 The Strömsund Drinking Water System | cccvi | ||
| 4.5.24.3 Outbreak Experience August–September 1996 | cccvi | ||
| 4.5.24.4 Direct Causes of the Outbreak | cccviii | ||
| 4.5.24.5 Commentary | cccviii | ||
| 4.5.25 NW London and W Hertfordshire (North Thames), England | cccix | ||
| 4.5.25.1 Scope of the Outbreak | cccix | ||
| 4.5.25.2 The Clay Lane Drinking Water Treatment System | cccix | ||
| 4.5.25.3 Outbreak Experience February–April 1997 | cccix | ||
| 4.5.25.4 Direct Causes of the Outbreak | cccx | ||
| 4.5.25.5 Commentary | cccxi | ||
| 4.5.26 Resort Hotel, Bermuda | cccxi | ||
| 4.5.26.1 Scope of the Outbreak | cccxi | ||
| 4.5.26.2 The Resort Hotel Drinking Water Treatment System | cccxii | ||
| 4.5.26.3 Outbreak Experience February 1998 | cccxii | ||
| 4.5.26.4 Direct Causes of the Outbreak | cccxiii | ||
| 4.5.26.5 Commentary | cccxiv | ||
| 4.5.27 Heinävesi, Finland | cccxiv | ||
| 4.5.27.1 Scope of the Outbreak | cccxiv | ||
| 4.5.27.2 The Heinävesi Drinking Water System | cccxiv | ||
| 4.5.27.3 Outbreak Experience March–April 1998 | cccxiv | ||
| 4.5.27.4 Direct Causes of the Outbreak | cccxv | ||
| 4.5.27.5 Commentary | cccxvi | ||
| 4.5.28 Alpine, Wyoming, U.S.A. | cccxvi | ||
| 4.5.28.1 Scope of the Outbreak | cccxvi | ||
| 4.5.28.2 The Alpine Drinking Water System | cccxvii | ||
| 4.5.28.3 Outbreak Experience June 26–July 30, 1998 | cccxvii | ||
| 4.5.28.4 Direct Causes of the Outbreak | cccxvii | ||
| 4.5.28.5 Commentary | cccxvii | ||
| 4.5.29 Brushy Creek, Williamson County, U.S.A. | cccxviii | ||
| 4.5.29.1 Scope of the Outbreak | cccxviii | ||
| 4.5.29.2 The Brushy Creek MUD Drinking Water System | cccxix | ||
| 4.5.29.3 Outbreak Experience July 21–August 2, 1998 | cccxix | ||
| 4.5.29.4 Direct Causes of the Outbreak | cccxx | ||
| 4.5.29.5 Commentary | cccxxi | ||
| 4.5.30 La Neuveville, Bern Canton, Switzerland | cccxxi | ||
| 4.5.30.1 Scope of the Outbreak | cccxxi | ||
| 4.5.30.2 The La Neuveville Drinking Water System | cccxxii | ||
| 4.5.30.3 Outbreak Experience August 1998 | cccxxii | ||
| 4.5.30.4 Direct Causes of the Outbreak | cccxxiii | ||
| 4.5.30.5 Commentary | cccxxiv | ||
| 4.5.31 Washington County Fair, New York, U.S.A. | cccxxiv | ||
| 4.5.31.1 Scope of the Outbreak | cccxxiv | ||
| 4.5.31.2 The Washington County Fair Drinking Water System | cccxxv | ||
| 4.5.31.3 Outbreak Experience September 1999 | cccxxvi | ||
| 4.5.31.4 Direct Causes of the Outbreak | cccxxvii | ||
| 4.5.31.5 Commentary | cccxxviii | ||
| 4.6\tOUTBREAKS IN THE 21ST CENTURY | cccxxix | ||
| 4.6.1\tOverview | cccxxix | ||
| 4.6.2 Clitheroe, Lancashire, England | cccxxix | ||
| 4.6.2.1 Scope of the Outbreak | cccxxix | ||
| 4.6.2.2 The Clitheroe Drinking Water System | cccxxix | ||
| 4.6.2.3 Outbreak Experience March 4–20, 2000 | cccxxx | ||
| 4.6.2.4 Direct Causes of the Outbreak | cccxxxi | ||
| 4.6.2.5 Commentary | cccxxxi | ||
| 4.6.3 Belfast, Northern Ireland, UK | cccxxxi | ||
| 4.6.3.1 Scope of the Outbreaks | cccxxxi | ||
| 4.6.3.2 The Belfast Drinking Water Systems | cccxxxii | ||
| 4.6.3.3 Outbreak Experience April–May 2000, August 2000 and February–April 2001 | cccxxxii | ||
| 4.6.3.4 Direct Causes of the Outbreak | cccxxxiv | ||
| 4.6.3.5 Commentary | cccxxxv | ||
| 4.6.4 Resort, Gulf of Taranto, Italy | cccxxxvi | ||
| 4.6.4.1 Scope of the Outbreak | cccxxxvi | ||
| 4.6.4.2 The Resort Drinking Water System | cccxxxvi | ||
| 4.6.4.3 Outbreak Experience July 7–31, 2000 | cccxxxvi | ||
| 4.6.4.4 Direct Causes of the Outbreak | cccxxxvii | ||
| 4.6.4.5 Commentary | cccxxxviii | ||
| 4.6.5 Asikkala, Finland | cccxxxviii | ||
| 4.6.5.1 Scope of the Outbreaks | cccxxxviii | ||
| 4.6.5.2 The Drinking Water Systems | cccxxxviii | ||
| 4.6.5.3 Outbreak Experience August 2000, August 2001 and October–November 2001 | cccxxxix | ||
| 4.6.5.4 Direct Causes of the Outbreaks | cccxxxix | ||
| 4.6.5.5 Commentary | cccxxxix | ||
| 4.6.6 North Battleford, Saskatchewan, Canada | cccxl | ||
| 4.6.6.1 Scope of the Outbreak in April 2001 | cccxl | ||
| 4.6.6.2 The North Battleford Drinking Water System | cccxli | ||
| 4.6.6.3 Outbreak Experience March–April, 2001 | cccxliii | ||
| 4.6.6.4 Direct Causes of the Outbreak | cccl | ||
| 4.6.6.5 Commentary | ccclv | ||
| 4.6.7 Boarding School, Hawke’s Bay, New Zealand | ccclxv | ||
| 4.6.7.1 Scope of the Outbreak | ccclxv | ||
| 4.6.7.2 The Boarding School Drinking Water System | ccclxv | ||
| 4.6.7.3 Outbreak Experience May 2001 | ccclxv | ||
| 4.6.7.4 Direct Causes of the Outbreak | ccclxvi | ||
| 4.6.7.5 Commentary | ccclxviii | ||
| 4.6.8 Camp/Conference Centre, Stockholm County, Sweden | ccclxix | ||
| 4.6.8.1 Scope of the Outbreak | ccclxix | ||
| 4.6.8.2 The Camp/Conference Centre Drinking Water System | ccclxix | ||
| 4.6.8.3 Outbreak Experience May–June 2001 | ccclxx | ||
| 4.6.8.4 Direct Causes of the Outbreak | ccclxx | ||
| 4.6.8.5 Commentary | ccclxxi | ||
| 4.6.9\tTranstrand, County of Dalarna, Sweden, | ccclxxi | ||
| 4.6.9.1\tScope of the Outbreak | ccclxxi | ||
| 4.6.9.2\tThe Transtrand Drinking Water System | ccclxxi | ||
| 4.6.9.3 Outbreak Experience February 18–March 18, 2002 | ccclxxi | ||
| 4.6.9.4 Direct Causes of the Outbreak | ccclxxiii | ||
| 4.6.9.5\tCommentary | ccclxxiv | ||
| 4.7\tA WATERBORNE OUTBREAK OF BAD NEWS — SYDNEY, AUSTRALIA | ccclxxv | ||
| 4.7.1 \tScope of the Sydney Water Crisis, July–September 1998 | ccclxxv | ||
| 4.7.2\tThe Sydney Drinking Water System | ccclxxvi | ||
| 4.7.3\tBad News Experience | ccclxxviii | ||
| 4.7.4\tDirect Causes of the Incident | ccclxxxvi | ||
| 4.7.5\tCommentary | cccxci | ||
| 4.8\tA WATERBORNE OUTBREAK BY ANY OTHER NAME? EDMONTON, ALBERTA, CANADA | cccxciii | ||
| 4.8.1\tScope of the Outbreak, October 1982–June 1983 | cccxciii | ||
| 4.8.2\tThe Edmonton Drinking Water System | cccxciv | ||
| 4.8.3\tThe Outbreak Experience: October 1982–April 1983 | cccxcv | ||
| 4.8.4\tDirect Causes of the Outbreak | cccxcix | ||
| 4.8.5\tCommentary | cdiii | ||
| 5.0 Overview and Recurring Themes | cdv | ||
| 5.1\tSUMMARIES OF OUTBREAKS AVAILABLE IN THE LITERATURE | cdv | ||
| 5.1.1\tIntroduction | cdv | ||
| 5.1.2\tRecent Summaries of Waterborne Outbreaks in the U.S. | cdvi | ||
| 5.1.3\tSummaries of Drinking Waterborne Outbreaks in the U.K. | cdx | ||
| 5.1.4\tSummaries of Drinking Waterborne Outbreaks in Sweden | cdxi | ||
| 5.1.5\tSummaries of Drinking Waterborne Outbreaks in Finland | cdxii | ||
| 5.1.6\tSummaries of Drinking Waterborne Outbreaks in Canada | cdxiii | ||
| 5.1.7\tSummaries of Drinking Waterborne Outbreaks in Japan | cdxv | ||
| 5.1.8\tSummaries of Drinking Waterborne Outbreaks in Switzerland | cdxvi | ||
| 5.1.9\tSummaries of Drinking Waterborne Outbreaks – Multiple Countries | cdxvi | ||
| 5.2\tRECURRING THEMES | cdxviii | ||
| 5.2.1\tConverting Hindsight into Foresight | cdxviii | ||
| 5.2.2\tPathogens Pose the Greatest Risk to Drinking Water Safety | cdxix | ||
| 5.2.3\tRobust Multiple Barriers Are Essential | cdxxii | ||
| 5.2.3.1 Source protection and selection | cdxxv | ||
| 5.2.3.2 Treatment | cdxxv | ||
| 5.2.3.3 Distribution | cdxxvi | ||
| 5.2.3.4 Monitoring | cdxxvii | ||
| 5.2.3.5 Response | cdxxix | ||
| 5.2.4\tTrouble is Preceded by Change | cdxxx | ||
| 5.2.5\tOperators Must be Capable and Responsive | cdxxxi | ||
| 5.2.6 Drinking Water Professionals | cdxxxiv | ||
| 5.2.7 Risk Management | cdxxxvii | ||
| 5.2.8\tOther Recurring Themes | cdxlii | ||
| 5.2.8.1\tResorts | cdxlii | ||
| 5.2.8.2\tConcerns with chlorination | cdxlii | ||
| 5.2.8.3\tGender distribution of cases | cdxliii | ||
| 5.2.8.4\tPublic health context | cdxliv | ||
| 5.3\tROUTINE MICROBIAL SAFETY OF DRINKING WATER | cdxlv | ||
| 6.0 Outbreak Prevention - Safe Water | cdxlviii | ||
| 6.1\tINTRODUCTION | cdxlviii | ||
| 6.2\tCHALLENGES | cdl | ||
| 6.3\tLIMITATIONS | cdli | ||
| 6.4\tELEMENTS OF PREVENTION | cdlii | ||
| 6.5\tPREVENTIVE APPROACHES | cdlii | ||
| 6.5.1\tInsights From Expert Reviews and Inquiries | cdlii | ||
| 6.5.1.1 The Badenoch and Bouchier Expert Group Reports | cdliii | ||
| 6.5.1.2 The Walkerton Inquiry Reports | cdlvii | ||
| 6.5.1.3 The North Battleford Inquiry Report | cdlix | ||
| 6.5.2\tDrinking Water Safety Programs | cdlix | ||
| 6.5.2.1 QualServe, International Water Treatment Alliance, Partnership for Safe Water, U.S. Environmental Protection Agency Composite Correction Program | cdlx | ||
| 6.5.2.2 Hazard Analysis and Critical Control Point (HACCP) | cdlxi | ||
| 6.5.2.3 New Zealand Public Health Risk Management Plans | cdlxii | ||
| 6.5.2.4 Australian Framework for Management of Drinking Water Quality | cdlxiv | ||
| 6.5.2.5 From Source to Tap: Guidance on the Multiple Barrier Approach to Safe Drinking Water | cdlxvi | ||
| 6.5.2.6 World Health Organization Drinking Water Guideline Water Safety Plans | cdlxvi | ||
| 6.5.2.7 The Bonn Charter — A Drinking Water Quality Framework for the 21st Century | cdlxviii | ||
| 6.6\tTHE PUBLIC AND SAFE DRINKING WATER | cdlxix | ||
| 7.0 Conclusions | cdlxxi | ||
| 8.0 References | cdlxxiv | ||
| Index | d |