Improving Waterborne Disease Surveillance

Abstract Public health surveillance has played a key role in controlling the spread of communicable disease and identifying the need for specific public health practices, such as the filtration and chlorination of drinking water supplies. However, the characteristics of waterborne outbreaks since the early 1990s have raised questions about whether current water treatment practices can prevent transmission of some enteric pathogens. It is increasingly accepted that additional information is needed about the occurrence and causes of waterborne disease, both epidemic and endemic. The Centers for Disease Control (CDC) funded “emerging pathogen” surveillance projects in selected state health departments, in part to improve surveillance for several important waterborne agents. In New York City (NYC), the Department of the Environment (DEP), responsible for drinking water treatment and delivery, convened a panel of public health experts in 1994 to evaluate current health department disease surveillance programs. The panel recommended specific waterborne disease surveillance activities and epidemiologic studies to determine endemic waterborne disease risks associated with use of unfiltered surface water sources.