Feeding behaviour related to different feeding devices.

Slow feeding devices (SFDs) are useful tools in order to improve the horse well-being and to reduce wastage, but their use may result in unnatural posture during feeding and frustration behaviours. Moreover, it may be important to evaluate the laterality during feeding. The aim of the study was to investigate ponies' feeding behaviour (i.e., lateralisation, frustration, postural eating style) with different hay feeding methods: on the ground (G), a fully filled hay net (HF), a partially filled hay net (HL), and a slow feeder hay box (HB). Nine ponies of two different breed types (Shetland and Welsh/Cob) were evaluated. Video recordings were obtained and then behavioural analysis was conducted. Data were analysed statistically using k-means cluster analysis, repeated measurement mixed model procedure, principal component analysis (PCA) and Pearson's correlation coefficient. Head tilting was more often performed during feeding from HF and HL compared to G and HB. Forelimb forward, referring to the position that ponies assumed during feeding, was performed less frequently with the hay nets. Ponies, in particular Welsh/Cobs, tended to be more left-lateralized and performed more backward ears when feeding from the hay nets. Blink rate was observed to be greater when ponies were fed from G. No head pushing, striking with forelimb and pawing while feeding was seen. Animals fed from HF tended to eat from the top of the hay net and consequently showed an arched neck; while HL and HB showed for elongated neck an intermediate pattern between G and HF. From our results, HB seemed to be a useful compromise between natural feeding on the ground and the use of hay nets.

Effect of pony morphology and hay feeding methods on back and neck postures.

The application of hay feeding devices, such as the use of hay nets or slow feeders, can help with the management of weight in ponies; however, there is still a lack of knowledge regarding their effect on equine posture. Therefore, the aim of the study was to assess the effect of different feeding devices on the posture of ponies using morphometric analysis. Two different breed types, Shetland type (SH, n = 5) versus Welsh Cob type (WC, n = 4), were fed the same forage in four different ways: on the ground (G), using a fully filled haynet (HF), using a partially filled haynet (HL) and using a slow-feeder hay box (HB). Video recordings were obtained and then geometric morphometric analysis was applied. Breed morphology was confirmed by body morphometric measurements. Data were analysed statistically using one-way ANOVA, canonical variate analysis (CVA), principal component analysis (PCA), partial least-squares (PLS) analysis and multivariate analysis of variance (MANOVA). Moreover, a mixed model was performed to study differences in mandibular angle. SH and WC ponies were shown to have significantly different body morphometric measurements. The geometric morphometric analysis results showed that ponies arch their back and modify their neck shape differently according to the feeding method and their morphological group. For the neck, the SH and WC ponies adapted similarly to the use of small-holed hay nets, but their posture varied when feeding from the ground or hay box. The back postures consistently differed according to the breed type and feeding method. The mandibular angle for both breed types was reduced with all the feeding devices compared to feeding from the ground. Further studies are needed to evaluate the long-term effects of slow-feeding devices on posture and mandibular angle, taking into consideration animals with different morphologies.

Multi-Province Listeriosis Outbreak Linked to Contaminated Deli Meat Consumed Primarily in Institutional Settings, Canada, 2008.

A multi-province outbreak of listeriosis occurred in Canada from June to November 2008. Fifty-seven persons were infected with 1 of 3 similar outbreak strains defined by pulsed-field gel electrophoresis, and 24 (42%) individuals died. Forty-one (72%) of 57 individuals were residents of long-term care facilities or hospital inpatients during their exposure period. Descriptive epidemiology, product traceback, and detection of the outbreak strains of Listeria monocytogenes in food samples and the plant environment confirmed delicatessen meat manufactured by one establishment and purchased primarily by institutions was the source of the outbreak. The food safety investigation identified a plant environment conducive to the introduction and proliferation of L. monocytogenes and persistently contaminated with Listeria spp. This outbreak demonstrated the need for improved listeriosis surveillance, strict control of L. monocytogenes in establishments producing ready-to-eat foods, and advice to vulnerable populations and institutions serving these populations regarding which high-risk foods to avoid.

A retinoscopic survey of 333 horses and ponies in the UK.

INTRODUCTION: Ophthalmic examination in the horse is generally limited to crude assessment of vision and screening for ocular lesions. The refractive state of equine eyes and the potential impact on vision and performance requires further investigation. OBJECTIVE: To assess the refractive state of a large, mixed-breed sample of horses and ponies in the United Kingdom (UK). PROCEDURE: The refractive state of both eyes of 333 horses and ponies was determined by streak retinoscopy, and the effect of age, height, gender, breed and management regime on the refractive state assessed. RESULTS: Emmetropia was found in 557 of 666 (83.63%) of eyes; 228/333 (68.5%) of the horses/ponies were emmetropic in both eyes. Refractive errors of greater than 1.50 D (in either direction) were found in 2.7% of the eyes tested. Ametropic eyes included hyperopia (54%) and myopia (46%). Anisometropia was found in 30.3% of horses and ponies. Breed of horse/pony was the only factor that affected refractive state (in the left eye only, P < 0.05) with Thoroughbred crosses having a tendency toward myopia and Warmbloods/Shires toward hyperopia. DISCUSSION AND CONCLUSION: The retinoscopic survey found emmetropia to be the predominant refractive state of the equine eye with no evidence of an overall trend toward myopia or hyperopia. However, individual and breed-related differences were found. Such factors should be considered in the selection of horses for sport and leisure, and when evaluating their performance potential. More comprehensive visual testing would be valuable in identifying underlying causes of behavioral problems.

Pony feeding management: the role of morphology and hay feeding methods on intake rate, ingestive behaviors and mouth shaping.

In the last decade, haynets and slow feeders have been promoted as sustainable tools to improve the feeding management of horses and reduce forage waste, but little is known about their effects on ponies. Therefore, the aim of this study was to analyze the effects of different hay feeding methods on the ingestive behaviors, intake rate and mouth shaping of ponies belonging to two breed types, which are characterized by different head morphologies. Shetland type (SH, n = 5) and Welsh/Cob type (WC, n = 4) ponies were fed hay using four feeding methods: on the ground (G), a fully filled haynet (HF), a partially filled haynet (HL), and a slow-feeder hay box (HB). Head morphology was measured for each pony. Video recordings were then made to apply geometric morphometrics and to perform behavioral analysis. The intake rate was measured for each pony and each feeding method. Data obtained with geometric morphometrics were analyzed using principal component analysis (PCA) and canonical variate analysis (CVA). Behavioral data and intake rate measurements were analyzed using a mixed model, a post-hoc Tukey's test, a Pearson's correlation test, and a stepwise regression model. The geometric morphometrics results demonstrated that feeding method influenced mouth shaping (36% for G, 78% for HB, 77% for HF, 83% for HL, considering the total variance of shape) and affected the intake rate. Differences in mouth shaping and ingestive behaviors in SH and WC ponies also confirmed the role of morphology in feeding management. The HL proved to be the most effective tool to increase feeding consumption time when needed (5 h/kg for SH ponies and 3 h/kg for WC ponies, considering the intake time), although the HB may be the optimal choice to reduce the intake rate while maintaining a more natural posture. Future studies are suggested to fully understand how body size and morphology influence feeding in equine species.

Foodborne botulism in Canada, 1985-2005.

During 1985-2005, a total of 91 laboratory-confirmed outbreaks of foodborne botulism occurred in Canada; these outbreaks involved 205 cases and 11 deaths. Of the outbreaks, 75 (86.2%) were caused by Clostridium botulinum type E, followed by types A (7, 8.1%) and B (5, 5.7%). Approximately 85% of the outbreaks occurred in Alaska Native communities, particularly the Inuit of Nunavik in northern Quebec and the First Nations population of the Pacific coast of British Columbia. These populations were predominantly exposed to type E botulinum toxin through the consumption of traditionally prepared marine mammal and fish products. Two botulism outbreaks were attributed to commercial ready-to-eat meat products and 3 to foods served in restaurants; several cases were attributed to non-Native home-prepared foods. Three affected pregnant women delivered healthy infants. Improvements in botulism case identification and early treatment have resulted in a reduction in the case-fatality rate in Canada.

Application of a Child Sex Trafficking Screening Tool in Patients with Abuse: A Retrospective Chart Review in the Pediatric Emergency Department.

INTRODUCTION: Human trafficking (HT) is a global problem that may affect children's health. In the United States, victims and children are at risk in most communities. History of abuse is a risk factor for HT. This study explored associations between pediatric patients with positive universal abuse screens and indicators from the commercial sexual exploitation of children/child sex trafficking (CSEC/CST) screening tool. METHOD: A retrospective chart review was conducted on random patients, aged 11-17 years, with positive universal abuse screens at emergency/urgent care departments in a large Midwest pediatric medical center in 2018. Documentation identifying at least two CSEC/CST screening tool indicators was abstracted from these records. Data analysis included descriptive statistics, univariate analyses, and correlations. RESULTS: Two or more indicators from the CSEC/CST screening tool were identified in 43% (n = 121). Age and history of running away were significant predictors for a patient having two or more CSEC/CST positive indicators. DISCUSSION: Targeted screening and interventions are needed to identify and help these vulnerable youth.

Posture and Pull Pressure by Horses When Eating Hay or Haylage from a Hay Net Hung at Various Positions.

These studies assessed the pressure forces exerted by horses to extract forage from haynets. Study 1 measured horse posture and pressure in Newtons (10 N = 1 kg Force) exerted on haynets when feeding from either a single (SH) or double layered (DH) haynet (3 kg Hay), hung low or high. Mean and maximum pull forces were higher for the DH vs. SH (DH: 81 ± 2 N, max 156 N; SH: 74 ± 2.9 N, max 121 N; p < 0.01). Horses pulled harder on low (max pull 144 ± 8 N) compared to high (109 ± 8 N; p < 0.05) hung haynets. Mean maximum angles (nose-poll-withers) recorded were 90° ± 9 for SH and 127° ± 10 for DH (p < 0.01). Study 2 was a latin square design measuring forces exerted by 10 horses when eating from haynets (6 kg fill) with hay or haylage and attached to the wall at single or double points. Pull pressures were significantly higher when eating haylage compared to hay (mean: 7.5 kg vs. 2 kg and max: 32 kg versus 12 kg, respectively, (p < 0.001). Forage type and fracture properties had the greatest effect on apprehension rates of hay from haynets. In this study, the majority of force exerted when eating from haynets was below 70 N for hay and for haylage 50% of pulls were higher than 50 N with 8% of pulls above 200 N.

Rac and Arp2/3-Nucleated Actin Networks Antagonize Rho During Mitotic and Meiotic Cleavages.

In motile cells, the activities of the different Rho family GTPases are spatially segregated within the cell, and during cytokinesis there is evidence that this may also be the case. But while Rho's role as the central organizer for contractile ring assembly is well established, the role of Rac and the branched actin networks it promotes is less well understood. To characterize the contributions of these proteins during cytokinesis, we manipulated Rac and Arp2/3 activity during mitosis and meiosis in sea urchin embryos and sea star oocytes. While neither Rac nor Arp2/3 were essential for early embryonic divisions, loss of either Rac or Arp2/3 activity resulted in polar body defects. Expression of activated Rac resulted in cytokinesis failure as early as the first division, and in oocytes, activated Rac suppressed both the Rho wave that traverses the oocyte prior to polar body extrusion as well as polar body formation itself. However, the inhibitory effect of Rac on cytokinesis, polar body formation and the Rho wave could be suppressed by effector-binding mutations or direct inhibition of Arp2/3. Together, these results suggest that Rac- and Arp2/3 mediated actin networks may directly antagonize Rho signaling, thus providing a potential mechanism to explain why Arp2/3-nucleated branched actin networks must be suppressed at the cell equator for successful cytokinesis.

Challenges of investigating community outbreaks of cyclosporiasis, British Columbia, Canada.

Investigations of community outbreaks of cyclosporiasis are challenged by case-patients' poor recall of exposure resulting from lags in detection and the stealthy nature of food vehicles. We combined multiple techniques, including early consultation with food regulators, traceback of suspected items, and grocery store loyalty card records, to identify a single vehicle for a cyclosporiasis outbreak in British Columbia, Canada, in 2007.

A comparison of sympathetic and conventional training methods on responses to initial horse training.

In 'sympathetic horsemanship' the importance of the natural behaviour of the horse and the use of body language in communication is emphasised. However, it is unclear what effect sympathetic horsemanship has on the welfare of horses. During a 5-week starting period the effect of a sympathetic (ST) versus a conventional (CT) training method was studied using 28 young Warmblood horses. Behavioural observations during the starting period as well as during a standardised final riding test were performed by trained observers. A Wilcoxon matched-pair test was used to detect differences within groups, Mann-Whitney-U to test differences between groups, and principal component analysis (PCA) to evaluate the effect on multiple variables simultaneously. A human-approach test showed that ST horses snorted significantly less compared to CT horses (P=0.006) after the training period. Furthermore, CT horses showed more fear and stress-related behaviours during training such as 'body tension' (P<0.001), 'high head carriage' (P<0.001), 'lip movements' (P=0.008) and 'teeth grinding' (P=0.03). Principal component analysis demonstrated that horses showed consistent differences in a range of behavioural and heart-rate parameters between groups. Behavioural parameters and technical performance during the standardised final riding test did not differ significantly between groups, but mean heart rate was higher for CT horses (P<0.001). The results suggest that applying a sympathetic training method when starting young horses did not compromise technical performance, but seemed to reduce stress during training compared to a conventional training method.

Estimated burden of human Salmonella, Shigella, and Brucella infections in Jordan, 2003-2004.

BACKGROUND: There is limited information on the disease burden due to foodborne pathogens in the eastern Mediterranean region. This study estimates the burden of disease in Jordan for Salmonella, Shigella, and Brucella during 1 year. METHODS: Nationwide population and laboratory surveys were conducted during September 2003 and May 2004, and burden of disease estimates were calculated. A validation study was conducted prospectively from August to September 2003 to provide an estimate of the internal validity of burden estimates. RESULTS: Each year in Jordan there are about 4.4 million episodes of diarrhea among persons >1 year of age and about 1.3 million persons seek medical care for diarrhea. For each person with laboratory-confirmed Shigella or Salmonella infection there are about 273 infected persons in the community. There are approximately 1.1 million episodes of fever and 0.7 million persons >1 year of age seeking medical care for fever each year. For each person with serological confirmed Brucella infection there are about 31 infected persons in the community. There are at least 16,260 Shigella, 6612 Salmonella, and 6912 Brucella cases yearly. CONCLUSION: This study provides baseline information of the burden of selected foodborne pathogens for 1 year in Jordan and indicates significant underreporting and under-diagnosis of Shigella and Salmonella infections.

Associations of processing level variables with Salmonella prevalence and concentration on broiler chicken carcasses and parts in Canada.

A national baseline study was conducted between December 2012 and December 2013 to determine the pre-packaging prevalence and concentration of foodborne pathogens on broiler chicken carcasses and parts at processing; a survey was implemented simultaneously to collect data on the processing practices used to control these pathogens. Thirty federally-registered Canadian poultry processing establishments completed the questionnaire. A total of 2,732 samples of carcasses and parts (breast and thigh pieces) were collected over the study period from these establishments. For Salmonella, the overall proportion positive was 0.22 (95% CI 0.20, 0.23), and the mean concentration was 0.67 (95% CI 0.51, 0.83) MPN/mL of rinse fluid. Multivariable regression models with random intercepts for the establishment and the date of sampling were used to identify associations between Salmonella prevalence and concentration and processing practices. In the final logistic regression model for the prevalence outcome (positive or negative sample), there were three statistically significant variables: product type (carcass or part); chilling method (water or air); and chlorine use in the establishment (chlorine, cetylpyridinium chloride, or neither). The likelihood of testing positive for Salmonella was higher on parts than carcasses (OR 3.03, 95% CI 2.38, 3.86), and higher when cetylpyridinium chloride was used (OR 2.00, 95% CI 1.36, 2.95), or when other processing aids were used (OR 1.99, 95% CI 1.26, 3.15), than when chlorine was used. Water chilling was negatively associated with testing positive for Salmonella when compared with air chilling (OR 0.68, 95% CI 0.48, 0.96). In the final linear regression model for the concentration outcome (log10 MPN/mL), there was one statistically significant variable chilling method, where water chilling was associated with a decrease in concentration (ß -0.23, 95% CI -0.38, -0.08 log10 MPN/mL). The intraclass correlation coefficients for establishment and date sampling were 0.02 and 0.23 in the linear regression model, and 0.01 and 0.34 in the logistic regression model, respectively. Further studies to explore the methods to reduce microbial contamination during the air chilling and cut-up and boning processes in broiler chicken establishments in Canada are recommended.

Live-cell fluorescence imaging of echinoderm embryos.

The rapid development, simplicity and optical clarity of the sea urchin embryo make it an excellent model system for studying the dynamic events of early development. An ever-growing palette of fluorescent proteins and biosensors can now be applied to studying sea urchin development, and there are now a wide variety of imaging modes that can be employed to image sea urchin embryogenesis. However, when performing live-cell imaging, one must take into consideration the sensitivity of embryos (and fluorescent probes) to the intense light associated with confocal microscopes. Here, we discuss general considerations for keeping embryos viable on the microscope stage, as well as probes for imaging cellular membranes and the cytoskeleton. We compare the relative merits of different confocal microscopes for live imaging of embryos and describe the potential for live-cell super-resolution microscopy.

International outbreak of severe botulism with prolonged toxemia caused by commercial carrot juice.

BACKGROUND: On 8 September 2006, 3 Georgia residents presented with symptoms of food-borne botulism, a potentially fatal illness caused by Clostridium botulinum neurotoxins. METHODS: Investigators reviewed medical records and interviewed patients and family members. Foods from patients' homes and samples of the implicated commercial beverage were tested for botulinum toxin and C. botulinum by standard methods. RESULTS: The patients presented with cranial neuropathies and flaccid paralysis; all patients required mechanical ventilation. The 3 Georgia patients had consumed carrot juice from the same bottle before illness onset. An additional case in Florida and 2 in Ontario, Canada, were subsequently identified in patients who had consumed carrot juice. Serum samples obtained from 5 patients tested positive for botulinum toxin type A-in one patient, 12 days after illness onset, and in another patient, 25 days after illness onset. Carrot juice produced by 1 manufacturer, recovered from patients' homes in Georgia, Florida, and Ontario, yielded type A toxin. The juice contained no added sugar, salt, or preservative; inappropriate refrigeration likely resulted in botulinum toxin production. CONCLUSION: This outbreak was caused by commercially produced, internationally distributed carrot juice that was contaminated with botulinum toxin. When toxemia persists, treatment for botulism should be considered even if diagnosed weeks after illness onset. The implicated pasteurized carrot juice had no barriers to growth of C. botulinum other than refrigeration; additional protective measures for carrot juice are needed to prevent future outbreaks. The US Food and Drug Administration has since issued industry guidance to reduce the risk of C. botulinum intoxication from low-acid refrigerated juices.

Gatekeepers of health: a qualitative assessment of child care centre staff's perspectives, practices and challenges to enteric illness prevention and management in child care centres.

BACKGROUND: Enteric outbreaks associated with child care centres (CCC) have been well documented internationally and in Canada. The current literature focuses on identifying potential risk factors for introduction and transmission of enteric disease, but does not examine why these risk factors happen, how the risk is understood and managed by the staff of CCCs, or what challenges they experience responding to enteric illness. The purpose of this study was to explore the understanding, knowledge and actions of CCC staff regarding enteric illness and outbreaks, and to identify challenges that staff encounter while managing them. METHODS: Focus groups were conducted with staff of regulated CCCs in Southern Ontario. Five focus groups were held with 40 participants. An open ended style of interviewing was used. Data were analyzed using content analysis. RESULTS: CCC staff play an important role in preventing and managing enteric illness. Staff used in-depth knowledge of the children, the centre and their personal experiences to assist in making decisions related to enteric illness. The decisions and actions may differ from guidance provided by public health officials, particularly when faced with challenges related to time, money, staffing and parents. CONCLUSION: CCC staff relied on experience and judgment in coordination with public health information to assist decision-making in the management of enteric illness and outbreaks. Advice and guidance from public health officials to CCC staff needs to be consistent yet flexible so that it may be adapted in a variety of situations and meet regulatory and public health requirements.

Outbreak of Escherichia coli 0157:H7 infections associated with consumption of beef donair.

The Calgary Health Region identified an outbreak of Escherichia coli 0157:H7 infection in September 2004 following a fourfold increase in laboratory reports. Clinical isolates were indistinguishable by pulsed-field gel electrophoresis (PFGE), and the PFGE pattern was unique in North America. Most affected individuals reported beef donair consumption in 10-day food histories. We conducted a matched case-control study, inspected the implicated food premises, and conducted a traceback investigation of suspect ground beef to determine the source of the outbreak and implement prevention and control measures. A total of 43 laboratory-confirmed cases were identified, with symptom onsets between 8 September and 1 October 2004. Among 26 matched case-control pairs, consumption of beef donair from one of two locations of a local restaurant chain was the only statistically significant risk factor for infection (matched odds ratio undefined; P < 0.01). No samples of the implicated ground beef were available for microbiological testing. We identified several opportunities for time-temperature abuse and other factors that may have contributed to the serving of unsafe donair meat at the implicated restaurants. This outbreak highlighted gaps in food safety policy related to beef donair and similar products in Canada. Immediately following the outbreak, the Region implemented new safe food handling requirements and a Federal/Provincial/Territorial Working Group was established to make recommendations for national food safety policies specific to these products.

Estimating the burden of acute gastroenteritis, foodborne disease, and pathogens commonly transmitted by food: an international review.

The burden of foodborne disease is not well defined in many countries or regions or on a global level. The World Health Organization (WHO), in conjunction with other national public health agencies, is coordinating a number of international activities designed to assist countries in the strengthening of disease surveillance and to determine the burden of acute gastroenteritis. These data can then be used to estimate the following situations: (1) the burden associated with acute gastroenteritis of foodborne origin, (2) the burden caused by specific pathogens commonly transmitted by food, and (3) the burden caused by specific foods or food groups. Many of the scientists collaborating with the WHO on these activities have been involved in quantifying the burden of acute gastroenteritis on a national basis. This article reviews these key national studies and the international efforts that are providing the necessary information and technical resources to derive national, regional, and global burden of disease estimates.

International outbreak of Salmonella Oranienburg due to German chocolate.

BACKGROUND: This report describes a large international chocolate-associated Salmonella outbreak originating from Germany. METHODS: We conducted epidemiologic investigations including a case-control study, and food safety investigations. Salmonella (S.) Oranienburg isolates were subtyped by the use of pulsed-field gel electrophoresis (PFGE). RESULTS: From 1 October 2001 through 24 March 2002, an estimated excess of 439 S. Oranienburg notifications was registered in Germany. Simultaneously, an increase in S. Oranienburg infections was noted in other European countries in the Enter-net surveillance network. In a multistate matched case-control study in Germany, daily consumption of chocolate (matched odds ratio [MOR]: 4.8; 95% confidence interval [CI]: 1.3-26.5), having shopped at a large chain of discount grocery stores (MOR: 4.2; CI: 1.2-23.0), and consumption of chocolate purchased there (MOR: 5.0; CI: 1.1-47.0) were associated with illness. Subsequently, two brands from the same company, one exclusively produced for that chain, tested positive for S. Oranienburg. In two other European countries and in Canada chocolate from company A was ascertained that also contained S. Oranienburg. Isolates from humans and from chocolates had indistinguishable PFGE profiles. No source or point of contamination was identified. Epidemiological identification of chocolate as a vehicle of infections required two months, and was facilitated by proxy measures. CONCLUSIONS: Despite the use of improved production technologies, the chocolate industry continues to carry a small risk of manufacturing Salmonella-containing products. Particularly in diffuse outbreak-settings, clear associations with surrogates of exposure should suffice to trigger public health action. Networks such as Enter-net have become invaluable for facilitating rapid and appropriate management of international outbreaks.

Infectious disease outbreaks related to drinking water in Canada, 1974-2001.

BACKGROUND: Recent public attention on drinking water supplies in the aftermath of waterborne infection outbreaks in Walkerton and North Battleford raises questions about safety. We analyzed information on waterborne outbreaks occurring between 1974 and 2001 in order to identify apparent trends, review the current status of monitoring and reporting, and gain a better understanding of the impact of drinking water quality on public health and disease burden. METHODS: Data from outbreak investigations, published and unpublished, were categorized by the type of drinking water provider and were assessed to be definitely, probably or possibly waterborne in nature. RESULTS: The final data set consisted of 288 outbreaks of disease linked to a drinking water source. There were 99 outbreaks in public water systems, 138 outbreaks in semi-public systems and 51 outbreaks in private systems. The main known causative agents of waterborne disease outbreaks were (in descending frequency of occurrence) Giardia, Campylobacter, Cryptosporidium, Norwalk-like viruses, Salmonella and hepatitis A virus. SUMMARY: We found that severe weather, close proximity to animal populations, treatment system malfunctions, poor maintenance and treatment practices were associated with the reported disease outbreaks resulting from drinking water supplies. However, issues related to the accuracy, co-ordination, compatibility and detail of data exist. A systematic and coordinated national surveillance system for comparison purposes, trend identification and policy development is needed so that future waterborne disease outbreaks can be avoided.