In 1993, two years after cholera struck Peru, an epidemic of cryptosporidiosis in Miluwaukee, Wisconsin, sickened hundreds of thousands of people and caused at least 50 deaths, demonstrating that even “modern” water treatment and distribution facilities are vulnerable to contamination by infectious pathogens. In their contribution to this chapter, workshop presenter Jeffrey Davis and coauthors recount their investigation of this outbreak, which resulted from the confluence of multiple and diverse environmental and human factors. Based on lessons learned from their discoveries, the authors made—and authorities undertook—recommendations to prevent further outbreaks in the Milwaukee water system, resulting in significant improvements in water quality. Their findings have proven applicable to other water treatment facilities that share Lake Michigan and have received attention from water authorities worldwide.

The final paper in this chapter, by workshop presenter Steve Hrudey and Elizabeth Hrudey of the University of Alberta, Canada, discusses an episode of bacteria contamination of the water in Walkerton, Ontario, in 2000. The outbreak sickened nearly half of the town’s 5,000 residents and caused 7 deaths, as well as 27 cases of hemolytic uremic syndrome, a severe kidney disease. Several incidents of human error and duplicity figure prominently among the causes of this entirely preventable outbreak, the authors explain. “Because outbreaks of disease caused by drinking water remain comparatively rare in North America,” they conclude, “complacency about the dangers of waterborne pathogens can easily occur.” Based on their findings, they present a framework for water system oversight intended to save other communities from Walkerton’s fate.

THE CHOLERA EPIDEMIC IN PERU AND LATIN AMERICA IN 1991: THE ROLE OF WATER IN THE ORIGIN AND SPREAD OF THE EPIDEMIC

Carlos Seas, M.D.1

Universidad Peruana Cayetano Heredia


Eduardo Gotuzzo, M.D., FACP1,2

Universidad Peruana Cayetano Heredia

At Athens a man was seized with cholera. He vomited, and was purged and was in pain, and neither the vomiting nor the purging could be stopped; and his voice failed him, and he could not be moved from his

1

Insitituto de Medicina Tropical Alexander von Humboldt. Universidad Peruana Cayetano Heredia, Lima, Peru, and Departamento de Enfermedades Infecciosas, Tropicales y Dermatológicas. Hospital Nacional Cayetano Heredia. Lima, Peru.

2

Corresponding author. Av. Honorio Delgado 430, Lima 31, Peru. Phone: 51-1-4823910, Fax: 51-1-4823404, E-mail: egh@upch.edu.pe.



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