Disease surveillance and waterborne outbreaks

Outbreaks are both a demonstration of a breakdown or failure in the system and, by acting as a ‘natural experiment’, present an opportunity to provide new insights into disease transmission and, perhaps, improvements to the system. This chapter outlines in detail the surveillance systems in Sweden and the US that are designed to detect waterborne disease outbreaks, and examines the actions taken upon suspecting an outbreak. It also examines some of the outbreaks that have occurred, principally from drinking water, details lessons that can be learnt from well-conducted investigations, and briefly looks at the worldwide situation.