CSTE Position Statement(s)
BackgroundA waterborne disease outbreak is an incident in which two or more epidemiologically-linked persons experience a similar illness after exposure to the same water source and epidemiologic evidence implicates the water as the likely source of the illness.
Clinical DescriptionSymptoms of illness depend upon etiologic agent.
Laboratory Criteria For DiagnosisDepends upon etiologic agent.
ConfirmedAny outbreak of an infectious disease, chemical poisoning or toxin-mediated illness where water is indicated as the source by an epidemiological investigation
The implicated water in these waterborne disease outbreaks may be drinking water, recreational water, water not intended for drinking (e.g., water used for agricultural purposes or in a cooling tower) or water of unknown intent. The route of exposure may be ingestion, inhalation, intranasal, or contact. The agent associated with the waterborne disease outbreak may be a microbe, chemical, or toxin. Water testing to demonstrate contamination or identify the etiologic agent is preferred, but not required for inclusion. Chemicals (including disinfection byproducts) in drinking water or in recreational water that cause health effects either through water exposure or by volatilization leading to poor air quality are included. Reports of waterborne disease outbreaks received through the National Outbreak Reporting System (NORS) are captured in the Waterborne Disease and Outbreak Surveillance System (WBDOSS).
Although not reported through NORS, the WBDOSS also accepts single cases of chemical exposure, wound infection and other illnesses, (e.g., Naegleria infections) that are epidemiologically linked to water exposure as well as aquatic facility-related health events (e.g., chemical mixing accidents or air quality problems). However, these single cases or aquatic facility-related health events are not reported or analyzed as waterborne disease outbreaks.