Epidemic/Pandemic Emergency Planning for Water Utilities.

Epidemics and pandemics are natural disasters that water utilities must prepare for and respond to. There are mitigation measures that utilities can employ during an epidemic or pandemic to reduce the impact of these disasters on their operations and the communities that they serve. The guidance and resources in this article should help drinking water utilities deal with present and future COVID-19 concerns, as well as other public health emergencies that will undoubtedly occur in the future.

The importance of clinical surveillance in detecting legionnaires' disease outbreaks: a large outbreak in a hospital with a Legionella disinfection system-Pennsylvania, 2011-2012.

BACKGROUND: Healthcare-associated Legionnaires' disease (LD) is a preventable pneumonia with a 30% case fatality rate. The Centers for Disease Control and Prevention guidelines recommend a high index of suspicion for the diagnosis of healthcare-associated LD. We characterized an outbreak and evaluated contributing factors in a hospital using copper-silver ionization for prevention of Legionella growth in water. METHODS: Through medical records review at a large, urban tertiary care hospital in November 2012, we identified patients diagnosed with LD during 2011-2012. Laboratory-confirmed cases were categorized as definite, probable, and not healthcare associated based on time spent in the hospital during the incubation period. We performed an environmental assessment of the hospital, including collection of samples for Legionella culture. Clinical and environmental isolates were compared by genotyping. Copper and silver ion concentrations were measured in 11 water samples. RESULTS: We identified 5 definite and 17 probable healthcare-associated LD cases; 6 case patients died. Of 25 locations (mostly potable water) where environmental samples were obtained for Legionella-specific culture, all but 2 showed Legionella growth; 11 isolates were identical to 3 clinical isolates by sequence-based typing. Mean copper and silver concentrations were at or above the manufacturer's recommended target for Legionella control. Despite this, all samples where copper and silver concentrations were tested showed Legionella growth. CONCLUSIONS: This outbreak was linked to the hospital's potable water system and highlights the importance of maintaining a high index of suspicion for healthcare-associated LD, even in the setting of a long-term disinfection program.

Nitrate, coliforms, and Cryptosporidium spp. as indicators of stream water quality in western Pennsylvania.

Surface-water treatment plants provide water to approximately 67 percent of the residents of Pennsylvania. Industrial activities and agricultural practices significantly contribute to the chemical and microbiological load of surface-water systems. For the study reported here, surface water from three sites along Two Lick Creek in Indiana County in Pennsylvania were sampled and analyzed for nitrate, iron, total and fecal coliforms, and Cryptosporidium oocysts. Mean nitrate concentrations were 2.88, 3.15, and 3.83 mg/L for Site 1, Site 2, and Site 3, respectively, while mean total-coliform counts ranged from 6.89 x 10(2) to 22.40 x 10(2) CFUs per 100 mL, and fecal coliform counts ranged from 0.30 x 10(2) to 11.1 x 10(2) CFUs per 100 mL. Cryptosporidium oocysts ranged from a low of <46 to a high of 91 per 100 L depending on sample turbidity. The recovery rates of oocysts from spiked samples ranged from 22 percent (low-turbidity samples) to a low of 0.76 percent (high-turbidity samples). This paper discusses the impact of environmental factors on nitrate concentration, coliforms, and Cryptosporidium, as well as the health significance of these water quality indicators.