MILWAUKEE

DISEASE
OUTBREAK, 1993

BY : JANHAVI KIRAN PATIL

INTRODUCTION
The 1993 Milwaukee
Cryptosporidiosis outbreak' was a
significant distribution of the
Cryptosporidium protozoan in
Milwaukee, Wisconsin, and the
largest waterborne disease outbreak
in documented United States
history.
CAUSES OF OUTBREAK
● The Howard Avenue Water Purification Plant was
contaminated ,and treated water showed turbidity levels well
above normal.
● The root cause of epidemic was never officially identified .
● Initial it was suspected to be caused by Cattle genotype due to
runoff from pastures
● It was also thought that melting ice and snowmelt carrying
CRYPTOSPORIDIUM may have entered the water treatment
plant .
EFFECTS

● There was more than a 100-fold increase in the rate of

isolation of cryptosporidium.
● Watery diarrhea (in 93 percent),
● Abdominal cramps (in 84 percent),
● Fever (in 57 percent)
● Vomiting (in 48 percent)
SEVERITY

● Over the span of approximately two weeks, 403000 of an

estimated 1.61 million residents in the Milwaukee area
became ill.
● Atleast 104 deaths have been attributed to this outbreak,
mostly among the elderly and immune compromised
people, such as AIDS patients.
MITIGATION MEASURES TAKEN

● Application of technical advances to monitor water safety and

minimize the amount of inadequately filtered water to the
public.
● Consistent application of stringent water quality standards.
● Testing of source and finished water for Cryptosporidium.
PRESENT SCENARIO
● Today , the turbidity of filtered plant is measured constantly inside
the plants.
● Tests have not detected a single Cryptosporidium oocyst in filtered
water from the water treatment plant since 1999.
● They also put alarms on the filters to enable automatic shutdown if
turbidity reached a threshold level, and they set and achieved the goal
of maintaining turbidity at a very low level
● These efforts resulted in continuous production by the MWW of
high-quality treated water with mean turbidities of 0.01 NTU .
CONCLUSION
● The 1993 Milwaukee cryptosporidiosis outbreak was the largest
documented waterborne disease outbreak in the United States.
● Cryptosporidium oocysts in untreated water from Lake Michigan
that entered the plant were inadequately removed by the
coagulation and filtration process at the Milwaukee southern
water treatment plant.
● Water quality standards were inadequate to prevent this outbreak.
There was a lack of laboratory testing for Cryptosporidium,
which delayed recognition of the microbial etiology of the
outbreak.