The importance of waterborne disease outbreak surveillance in the United States Gunther Franz Craun

INTRODUCTION Statistics on disease outbreaks associated with contaminated drinking water in the United States have been collected and analyzed for various time periods since 1920 [1-6]. These analyses have informed research, regulatory, and industry actions to improve drinking water quality and reduce waterborne disease risks. For example, the causes of outbreaks reported during 1961-1970 [4] was deliberated during Congressional committee hearings [7], contributing to the passage of the Safe Drinking Water Act [8, 9]. This [4] also led to a partnership between the US Environmental Protection Agency (EPA) and Centers for Disease Control and Prevention (CDC) to improve the detection, investigation, and reporting of waterborne outbreaks. The partnership has continued since 1971 with the periodic publication of outbreak statistics associated with drinking and recreational water, the most recent of which are for 2007-2008 [10, 11]. In this article, the Author focuses on the changing causes of outbreaks in public water systems during the past 38 years to illustrate the importance of waterborne disease surveillance.