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Cryptosporidium and Water: a Public Health Handbook Cdc-Pdf This document is provided by the U.S. Centers for Disease Control and Prevention (CDC) ONLY as an historical reference for the public health community. It is no longer being maintained and the data it contains may no longer be current and/or accurate. The CDC Healthy Water website is the most current source of information on safe water, waterborne diseases, best practices and all other water-related information. It should be consulted first at: http://www.cdc.gov/healthywater/ Persons with disabilities experiencing problems accessing this document should contact CDC-INFO at [email protected], 800-232-4636 or the TTY number at (888) 232-6348 and ask for a 508 Accommodation PR#9342. If emailing please type "508 Accommodation PR#9342" without quotes in the subject line of the email. Cryptosporidium and Water: A Public Health Handbook 1997 WG WCWorking Group on Waterborne Cryptosporidiosis Suggested Citation Cryptosporidium and Water: A Public Health Handbook. Atlanta, Georgia: Working Group on Waterborne Cryptosporidiosis. CDCENTERS FOR DISEASEC CONTROL AND PREVENTION For additional copies of this handbook, write to: Centers for Disease Control and Prevention National Center for Infectious Diseases Division of Parasitic Diseases Mailstop F-22 4770 Buford Highway N.E. Atlanta, GA 30341-3724 CONTENTS Executive Summary Introduction 1- Coordination and Preparation 2- Epidemiologic Surveillance 3- Clinical Laboratory Testing 4- Evaluating Water Test Results Drinking Water Sources, Treatment, and Testing Environmental Sampling Methods Issuing and Rescinding a Boil Water Advisory 5- Outbreak Management Outbreak Assessment News Release Information Frequently Asked Questions Protocols for Special Audiences and Contingencies 6- Educational Information Preventing Cryptosporidiosis: A Guide for Persons With HIV and AIDS Preventing Cryptosporidiosis: A Guide for the Public Preventing Cryptosporidiosis: A Guide to Water Filters and Bottled Water 7- Recreational Water Appendix Selected Articles Key Words and Phrases Figures A-F Index Working Group on Waterborne Cryptosporidiosis (WGWC) Daniel G. Colley and Dennis D. Juranek, Coordinators, WGWC Division of Parasitic Diseases (DPD) National Center for Infectious Diseases Centers for Disease Control and Prevention Scott A. Damon, Publications Coordinator, WGWC, Centers for Disease Control and Prevention Margaret Hurd, Communications Coordinator, WGWC, Centers for Disease Control and Prevention Mary E. Bartlett, DPD Editor, Centers for Disease Control and Prevention Leslie S. Parker, Visual Information Specialist, Centers for Disease Control and Prevention Task Forces and Other Contributors: The draft materials for this handbook were developed through the work of multiple task forces and individuals whose names appear at the beginning of each chapter/section. The draft documents were then reviewed and revised based on comments from representatives* of the entire “Working Group on Waterborne Cryptosporidiosis”. The task force for development of information for state and local health officers** designed the handbook, assembled additional published and unpublished informational materials, and prepared the introductory and transitional chapters needed to produce a cohesive reference document for health departments and the drinking water industry. *WGWC Review Committee Chair: Dennis D. Juranek, Centers for Disease Control and Prevention Chet Anderson, Metropolitan Water District of Southern California Arthur Ashendorff, New York City Department of Environmental Protection Paul S. Berger, U.S. Environmental Protection Agency Kathleen Blair, City of Milwaukee Health Department Scott A. Damon, Centers for Disease Control and Prevention Iris L. Long, AIDS Coalition to Unleash Power Alexis M. Milea, California Department of Health Services James R. Miller, New York City Departments of Health and Environmental Protection Michael T. Osterholm, Minnesota Department of Health Thomas Outlaw, Association of State Drinking Water Administrators Alan Roberson, American Water Works Association Peggy A. Ryker, Kentucky Department of Environmental Protection Faye E. Sorhage, New Jersey Department of Health and Senior Services **WGWC Task Force on Information for State and Local Public Health Officers Chair: Faye E. Sorhage, New Jersey Department of Health and Senior Services David G. Addiss, Centers for Disease Control and Prevention Kathleen Blair, City of Milwaukee Health Department Lynn M. Bradley, Association of State and Territorial Public Health Laboratory Directors Scott A. Damon, Centers for Disease Control and Prevention Anita K. Highsmith, Centers for Disease Control and Prevention Dennis D. Juranek, Centers for Disease Control and Prevention Iris L. Long, AIDS Coalition to Unleash Power James R. Miller, New York City Departments of Health and Environmental Protection Michael T. Osterholm, Minnesota Department of Health Agencies represented on the Working Group on Waterborne Cryptosporidiosis include but are not limited to: Centers for Disease Control and Prevention, U.S. Environmental Protection Agency, Food and Drug Administration, U.S. Depart- ment of Agriculture, Council of State and Territorial Epidemiologists, American Water Works Association, American Water Works Research Foundation, Association of State Drinking Water Administrators, Association of Metropolitan Water Agencies, AIDS Coalition to Unleash Power, National Association of People With AIDS, American Public Health Association, Association of State and Territorial Public Health Laboratory Directors, National Association of City and County Health Officials, Milwaukee Health Department, New York City Department of Health, New York City Depart- ment of Environmental Protection, St. Louis County Health Department, Seattle-King County Department of Health, California Public Health Department, Kentucky Department of Environmental Protection, Maryland Department of the Environment, Minnesota Department of Health, New Jersey Department of Health, New York Department of Environ- mental Protection, Massachusetts Water Resources Authority, Metropolitan Water District of Southern California, New York Hospital-Cornell Medical Center, International Bottled Water Association, NSF International. EXECUTIVE SUMMARY This public health handbook, Cryptosporidium and Water, was developed by the Working Group on Waterborne Cryptosporidiosis (WGWC) -- a multi-disciplinary group composed of representatives from the national Centers for Disease Control and Prevention (CDC), U.S. Environmental Protection Agency (EPA), Food and Drug Administration (FDA), U. S. Department of Agriculture (USDA), state and local health departments, the drinking water industry, and organizations representing the concerns of immunocompromised persons. The handbook was developed to assist local health departments and water utilities in preparing for and responding to reports of Cryptosporidium oocysts in tap water or in a community’s source of drinking water (river, lake, well). A new, federally mandated water monitoring regulation goes into effect in 1997 that requires water utilities to test drinking water sources once a month for Cryptosporidium. Cryptosporidium will likely be found in the water supplies of many communities; such findings may result in many unnecessary boil water advisories if test results are not carefully interpreted. The WGWC encourages health departments and water utilities to work as a team to develop appropriate health risk assessment protocols and public responses to findings of Cryptosporidium in drinking water supplies. The common occurrence of Cryptosporidium in sources of drinking water throughout the nation, and the lack of reliable water testing meth- ods for determining if a sufficient number of viable oocysts are present in water to cause an outbreak, combine to make this a challenging task. Because cryptosporidia are resistant to the chlorine disinfectants commonly used in water treatment, the WGWC encourages water utilities to optimize their filtration methods to reduce the risk of tap water contamination. It should be recognized, however that Cryptosporidium oocysts may occasionally get through even well operated filters. Although the handbook focuses primarily on Cryptosporidium in drinking water and, to a lesser extent, recreational water, most of the principles outlined in the handbook can be applied equally well to the prevention and investigation of other water- borne pathogens. The WGWC recommends the formation of a local Cryptosporidium Response Task Force that includes, at a minimum, representatives from the health department, water regulatory authority, and water utility. Guidance is provided in the handbook for organizing such a task force, evaluating the water system’s vulnerability to Cryptosporidium (e.g., source water protection and water treatment methods) before there is public concern about the risk of waterborne cryptosporidiosis. The handbook also provides guidelines on assessing and developing health department capabilities for detecting a Cryptosporidium outbreak, and developing a coordinated emergency response plan. Also reviewed are some of the complex issues that should be addressed before issuing or rescinding a boil water advisory. If Cryptosporidium is detected in your drinking water, a significant portion of health depart- ment and water utility staff time will be consumed by media and public inquiries. The WGWC encourages you to prepare for such inquiries well in advance of a crisis. One effec- tive approach is to develop
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