Water-related Outbreak Response Toolkits and Resources

The Centers for Disease Control and Prevention (CDC) has created multiple outbreak response toolkits and other resources to assist public health professionals during their outbreak response to save time on creating tools so more time can be spent on the investigation.

Public health professionals must rapidly determine the cause of the outbreak, the number of people infected, when and where the exposure occurred, what prevention measures must be put in place to stop the outbreak, and how to clean and remediate the source of water exposure. Each step requires training, skills, and tools to expedite the investigation.

The pictured magazine covers feature the work of public health professionals in 1976 as they raced to trace the origin of the first documented outbreak of Legionnaire’s disease in Philadelphia, Pennsylvania (1). As with any outbreak, response to water-related events must be conducted in a timely manner.

Overview

These resources are intended to give public health officials support materials and the epidemiologic/laboratory support needed for investigating water-related outbreaks. Waterborne disease outbreaks are a nationally notifiable condition. To report waterborne disease outbreaks to CDC, please enter the report in the electronic National Outbreak Reporting System (NORS). Health jurisdictions that do not have access to NORS can complete the NORS CDC 52.12 reporting form. State health departments that would like to request epidemiologic or technical assistance from CDC for a waterborne disease outbreak investigation may contact the Waterborne Disease Outbreak Coordinator by telephone (770-488-7756) or by emailing parasites@cdc.gov. Laboratory testing support for outbreak investigations is provided under CDC Laboratory Testing Support for Outbreak Investigations.

Toolkits

Recreational Water-associated Outbreak Response Toolkit

This toolkit is intended to help state and local health departments respond to outbreaks associated with recreational water illnesses (RWIs). Materials include helpful tips, questionnaires, environmental investigation forms, investigation needs, pool remediation guidance, communication guidance, data management suggestions, laboratory support, and reporting requirements.

While some downloadable documents within this toolkit are cryptosporidiosis-specific, they can also be used as models when creating similar documents for other pathogens. Likewise, though these materials were primarily created for outbreaks involving parasitic diseases, some of the information can be used or adapted for use in non-parasitic drinking water-related outbreaks. All documents can be downloaded and altered as needed.

Drinking Water-associated Outbreak Response Toolkit

This toolkit is intended to help state and local health departments respond to outbreaks associated with diseases related to drinking water. Materials include helpful tips, questionnaires, data management suggestions, laboratory support, and reporting requirements.

While some downloadable documents within this toolkit are cryptosporidiosis-specific, they can also be used as models when creating similar documents for other pathogens. Likewise, though these materials were primarily created for outbreaks involving parasitic diseases, some of the information can be used or adapted for use in non-parasitic drinking water-related outbreaks. All documents can be downloaded and altered as needed.

Legionellosis Outbreak Response Toolkit and Resource Site

This toolkit and resource site provides public health professionals, clinicians, laboratorians, and other allied health fields with background information, clinical information, investigation guidance, and resources about Legionnaires' disease and Pontiac fever cases or potential outbreaks.

Unexplained Respiratory Disease Outbreaks (URDO)

This resource site provides background, guidance, and resources to state and local health departments, as well as other public health professionals, to assist in the investigation of a cluster or outbreak of respiratory infections of unknown etiology.

Foodborne Outbreak Response Toolkit

This toolkit site focuses on foodborne disease outbreak response. Resources include a guide to confirming foodborne disease, guidelines for specimen collection, standard questionnaires, and reporting forms.

Worker Safety Response Toolkit for Storm and Flood Cleanup

This toolkit and resource site provides recommendations for relief workers and emergency responders during their response to natural disasters. Materials include assessment tools and NIOSH guidelines related to pre-exposure medical screening, immunization recommendations, assessment tools for safety and health in hospitals and shelters, protective equipment and clothing, disaster site management, firefighting, stress, air quality, electrical hazards, tree removal, carbon monoxide, heat stress, falls, and hazardous materials, among other related topics.

Outbreak Response Guides

Cryptosporidiosis Outbreak, Response and Evaluation Guidance (PDF, 577 kb, 16 pages)

This guidance was developed to assist state and local health departments in developing a proactive program to reduce the occurrence and spread of cryptosporidiosis outbreaks. It focuses on reducing the risk of these outbreaks expanding into community-wide outbreaks.

Cryptosporidium and Water: A Public Health Handbook (PDF, 1.2 mb, 151 pages)

This 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).

CDC Laboratory Testing Support for Outbreak Investigations

State health departments can request epidemiologic assistance and laboratory testing from CDC to investigate waterborne disease and outbreak. CDC and the U.S. Environmental Protection Agency (EPA) can be consulted regarding engineering and environmental aspects of recreational water treatment and collection of proper water samples to identify pathogenic viruses, bacteria, and parasites, which require special protocols for their recovery.

Requests for Testing for Bacterial Enteric Organisms

Division of Foodborne, Bacterial, and Mycotic Diseases
National Center for Zoonotic, Vector-borne and Enteric Diseases
Coordinating Center for Infectious Diseases, CDC
Telephone: 404-639-1798

Requests for Information or Testing for Legionella

Division of Bacterial Diseases
National Center for Immunization and Respiratory Diseases
Coordinating Center for Infectious Diseases, CDC
Telephone: 404-639-2215

Requests for Testing for Parasites

Division of Parasitic Diseases
National Center for Zoonotic, Vector-borne and Enteric Diseases
Coordinating Center for Infectious Diseases, CDC
Telephone: 770-488-7756

Also please access Parasitic Diseases laboratory assistance support through DPDx. DPDx is a Web site developed and maintained by CDC that uses the Internet to assist laboratorians and pathologists in the diagnosis of parasitic diseases, both in the United States and abroad. DPDx has a Reference and Training function, in which all users can browse through concise reviews of parasites and parasitic diseases, including an image library and a review of recommended procedures for collecting, shipping, processing, and examining biologic specimens. There is also a Diagnostic Assistance function, in which laboratorians and other health professionals desiring assistance in parasite identification can ask questions and/or send digital images of specimens for expedited review and consultation with DPD staff. Assistance is free of charge.

Requests for Testing for Viruses

Division of Viral Diseases
National Center for Immunization and Respiratory Diseases
Coordinating Center for Infectious Diseases, CDC
Telephone: 404-639-3607

Other Outbreak Control and Prevention Resources

Surveillance/Tracking Data for Waterborne Outbreaks and Contaminants

Data, statistics and surveillance information for waterborne diseases and contaminants.

"Bad Bug Book" (U.S. Food and Drug Administration)

This handbook provides basic facts regarding foodborne pathogenic microorganisms and natural toxins Many of these same pathogens can also be spread through water. It brings together in one place information from the Food and Drug Administration, the Centers for Disease Control and Prevention, the USDA Food Safety Inspection Service, and the National Institutes of Health.

1. Magazine story covers related to the 1976 outbreak of Legionnaire’s disease. From Centers for Disease Control & Prevention (CDC) Public Health Library, #1185. Copyright 1976 by CDC. Reprinted with permission.