Epidemiology and Infection

Outbreaks of waterborne infectious intestinal disease in England and Wales, 1992–5

C. FURTADO a1a2, G. K. ADAK a1c1, J. M. STUART a3, P. G. WALL a1, H. S. EVANS a1 and D. P. CASEMORE a4
a1 PHLS Communicable Disease Surveillance Centre, London
a2 European Programme for Intervention Epidemiology Training
a3 PHLS Communicable Disease Surveillance Centre (South and West), Gloucester
a4 Cryptosporidium Reference Unit, Public Health Laboratory, Rhyl


Following the introduction of an improved surveillance system for infectious intestinal disease outbreaks in England and Wales, the Public Health Laboratory Service Communicable Disease Surveillance Centre received reports of 26 outbreaks between 1 January 1992 and 31 December 1995 in which there was evidence for waterborne transmission of infection. In these 26 outbreaks, 1756 laboratory confirmed cases were identified of whom 69 (4%) were admitted to hospital. In 19 outbreaks, illness was associated with the consumption of drinking water from public supplies (10 outbreaks) or private supplies (9 outbreaks). The largest outbreak consisted of 575 cases. In 4 of the remaining 7 outbreaks, illness was associated with exposure to swimming pool water. Cryptosporidium was identified as the probable causative organism in all 14 outbreaks associated with public water supplies and swimming pools. Campylobacter was responsible for most outbreaks associated with private water supplies. This review confirms a continuing risk of cryptosporidiosis from chlorinated water supplies in England and Wales, and reinforces governmental advice to water utilities that water treatment processes should be rigorously applied to ensure effective particle removal. High standards of surveillance are important for prompt recognition of outbreaks and institution of control measures. As microbiological evidence of water contamination may be absent or insufficient to implicate a particular water supply, a high standard of epidemiological investigation is recommended in all outbreaks of suspected waterborne disease.

(Accepted February 23 1998)

c1 Author for correspondence: G. K. Adak, PHLS Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ, UK.