SEARCHING FOR A WATER-SUPPLY CONNECTION IN THE CABOOL, MISSOURI DISEASE OUTBREAK OF ESCHERICHIA-COLI O157-H7

A recent disease outbreak resulting in 4 deaths, 32 hospitalizations and a total of 243 documented cases of diarrhea was linked epidemiologically and by on-site data gathering supported by the use of a distribution system model to the public water supply. The pathogenic agent, Escherichia coli serotype O157:H7, was isolated from patients' feces in tests conducted by the Centers for Disease Control. Illness was restricted to people using public water supply. Untreated groundwater quality was not a factor but some disturbances in the distribution system, possibly 43 water meter replacements and 2 line breaks, may have allowed contaminants to enter the water supply. This is the first time a distribution system model has been used to show that the pattern of illness occurrences in a waterborne outbreak study could be related to water movement patterns in the distribution network.