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. 1997 Apr;87(4):580-4.
doi: 10.2105/ajph.87.4.580.

A community waterborne outbreak of salmonellosis and the effectiveness of a boil water order

F J Angulo  1 , S Tippen, D J Sharp, B J Payne, C Collier, J E Hill, T J Barrett, R M Clark, E E Geldreich, H D Donnell Jr, D L Swerdlow
Affiliations

A community waterborne outbreak of salmonellosis and the effectiveness of a boil water order

F J Angulo et al. Am J Public Health. 1997 Apr.

Abstract

Objectives: A 1993 large water-borne outbreak of Salmonella typhimurium infections in Gideon, Mo, a city of 1100 with an unchlorinated community water supply, was investigated to determine the source of contamination and the effectiveness of an order to boil water.

Methods: A survey of household members in Gideon and the surrounding township produced information on diarrheal illness, water consumption, and compliance with the boil water order.

Results: More than 650 persons were ill; 15 were hospitalized, and 7 died. Persons consuming city water were more likely to be ill (relative risk [RR] = 9.1, 95% confidence interval [CI] = 2.9, 28.4), and the attack rate increased with increased water consumption. S. typhimurium was recovered from samples taken from a city fire hydrant and a water storage tower. Persons in 31% (30/ 98) of city households had drunk unboiled water after being informed about the boil water order, including 14 individuals who subsequently became ill. Reasons for noncompliance included "not remembering" (44%) and "disbelieving" (25%) the order.

Conclusions: Communities with deteriorating water systems risk widespread illness unless water supplies are properly operated and maintained. Effective education to improve compliance during boil water orders is needed.

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