128:. It is suspected that The Howard Avenue Water Purification Plant, one of two water treatment plants in Milwaukee at the time, was contaminated. It is believed that the contamination was due to an ineffective filtration process. Approximately 403,000 residents were affected resulting in illness and hospitalization. Immediate repairs were made to the treatment facilities along with continued infrastructure upgrades during the 25 years since the outbreak. The total cost of the outbreak, in productivity loss and medical expenses, was $ 96 million. At least 69 people died as a result of the outbreak. The city of Milwaukee has spent upwards to $ 510 million in repairs, upgrades, and outreach to citizens.
1614:
343:
toward
Milwaukee Water Works. Carrie Lewis, superintendent of Milwaukee water works in 2015, explained that "people had been hurt, they felt let down by their drinking water and it took a long time for them to believe that we knew what we were doing again," It took ten years for Milwaukee citizens to begin to trust the public water supply again with the help of frequent community outreach by the utility.
342:
Reports of gastrointestinal illness began in April 1993; however, studies occurring after the outbreak confirmed that there were echoes of the epidemic beyond initial contamination as the population contracted the illness through secondary transmission. This resulted in negative public sentiment
304:
that passed through the filtration system of one of the city's water-treatment plants, arising from a sewage treatment plant's outlet two miles upstream in Lake
Michigan. This abnormal condition at the water purification plant lasted from March 23 through April 8, after which, the plant was shut
255:
On April 4, 1993, pharmacist Jeff Langer contacted a local television station after the
Milwaukee Health Department did not respond to his calls regarding substantial increase in gastrointestinal complaints. Sunday evening, April 4, the station came out to interview Jeff Langer regarding the
285:
was never officially identified; however, it was most likely the result of human error at the Howard Avenue Water
Treatment Plant. Initially it was suspected to be caused by runoff from upstream cattle pastures. It was also thought that melting ice and snowmelt carrying
351:
Currently, Milwaukee consistently scores as one of the highest drinking water qualities in the state. This is due to $ 508 million invested in water treatment and monitoring improvements since the outbreak. Improvements in treatment include:
325:
caused by the pathogen. After the outbreak, cryptosporidiosis antibody rates among
Milwaukee children reached 80%, compared to only 10% prior to the outbreak. Deaths have been attributed to this outbreak, mostly among the elderly and
260:
at their local hospitals and calls of complaints related to reduced water-quality aesthetic. Water aesthetics include taste, color, odor, hardness/softness, and turbidity. They are considered a secondary standard under the EPA
685:
Mac Kenzie, William R.; Hoxie, Neil J.; Proctor, Mary E.; Gradus, M. Stephen; Blair, Kathleen A.; Peterson, Dan E.; Kazmierczak, James J.; Addiss, David G.; Fox, Kim R.; Rose, Joan B.; Davis, Jeffrey P. (July 21, 1994).
610:
McDonald, Alicia C.; Mac Kenzie, William R.; Addiss, David G.; Gradus, M. Stephen; Linke, George; Zembrowski, Elizabeth; Hurd, Margaret R.; Arrowood, Michael J.; Lammie, Patrick J.; Priest, Jeffrey W. (1 May 2001).
1119:
942:
157:. Other symptoms include stomach cramps, dehydration, nausea, vomiting, fever, or weight loss. Symptoms can be more severe for people who are immunocompromised, for whom diarrhea can lead to death.
540:
MORGAN-RYAN, UNA M.; FALL, ABBIE; WARD, LUCY A.; HIJJAWI, NAWAL; SULAIMAN, IRSHAD; PAYER, RONALD; THOMPSON, R. C. ANDREW; OLSON, M.; LAL, ALTAF; LIHUA, XIAO (November–December 2002).
256:
substantial increase in requests for anti-diarrhea medications. Following that television interview, April 5, 1993, Milwaukee Health
Department received additional reports of
1031:
1127:
1673:
1668:
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934:
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was the main complaint. This was corroborated by
Milwaukee Water Works records of Maximal Turbidity for both water treatment plants from March through April 1993.
1476:
382:
1643:
794:"Molecular Surveillance of Cryptosporidium spp. in Raw Wastewater in Milwaukee: Implications for Understanding Outbreak Occurrence and Transmission Dynamics"
359:
Monitoring on each stream of flow (8 streams) – previously, streams were only monitored before and after branching off (no way to monitor individual streams)
262:
1344:
585:
1512:
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NPDWR, they are not federally enforced but are standard regulations that states may choose to adopt and enforce themselves. In the spring of 1993,
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866:
1214:
1309:
656:
508:
480:
1658:
1584:
1507:
1423:
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1028:
1155:
613:"Cryptosporidium parvum–Specific Antibody Responses among Children Residing in Milwaukee during the 1993 Waterborne Outbreak"
986:
232:, but a 2018 paper from Sumeeta Khurana and Preeti Chaudhary indicate that antigen tests are not species-specific and that
1517:
1233:
Corso, Phaedra S.; Kramer, Michael H.; Blair, Kathleen A.; Addiss, David G.; Davis, Jeffrey P.; Haddix, Anne C. (2003).
1193:
1653:
1543:
1433:
1365:
1339:
1054:
306:
966:
Lewis, C. (2015, January 9). Superintendent of
Milwaukee Water Works. (M. Gonzalez, & B. Gonzalez, Interviewers)
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1334:
1349:
257:
541:
1471:
1443:
1326:
1302:
194:
1453:
688:"A Massive Outbreak in Milwaukee of Cryptosporidium Infection Transmitted through the Public Water Supply"
387:
188:
198:. However adding to the confusion, these two species were only split from each other in 2002. In 2003,
17:
1589:
1413:
887:"Cryptosporidiosis-associated mortality following a massive waterborne outbreak in Milwaukee, Wisconsin"
210:
125:
305:
down. Over the span of approximately two weeks, 403,000 of an estimated 1.61 million residents in the
199:
158:
1574:
1569:
1438:
1370:
121:
71:
1205:
1502:
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involved in the outbreak. Several species cause cryptosporidiosis in humans, with most caused by
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1403:
1375:
1295:
309:(of which 880,000 were served by the malfunctioning treatment plant) became ill with the stomach
237:
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707:
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Activated charcoal filtration (Actiflo Carb) removes certain drugs, disinfectants, antibiotics
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150:
41:
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906:
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829:
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specifically addresses these issues and clearly identifies the pathogen in this outbreak as
1029:
https://city.milwaukee.gov/water/customer/FAQs/qualityandhealth/Water-treatment-process.htm
161:
are microorganisms that humans ingest, typically through contaminated food or water. Since
1481:
1466:
1058:
1035:
990:
687:
512:
484:
175:
166:
137:
113:
52:
612:
504:. Retrieved from DPDx – Laboratory Identification of Parasites of Public Health Concern:
1234:
505:
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Collection pipe for water was moved further out in the lake to draw higher quality water
1271:
1101:
1076:
911:
886:
769:
726:
557:
447:
423:"Cost of illness in the 1993 waterborne Cryptosporidium outbreak, Milwaukee, Wisconsin"
422:
146:
834:
793:
1632:
1461:
809:
477:
291:
1077:"Cryptosporidiosis in Wisconsin: a case-control study of post-outbreak transmission"
523:
Division of
Foodborne, Waterborne, and Environmental Diseases (DFWED) Home. (2023).
220:
is the cause, but the 1994 source they cite does not specify the species. McDonald
1527:
1120:"Milwaukee, 1993: The Largest Documented Waterborne Disease Outbreak in US History"
542:"Cryptosporidium hominis n. sp. (Apicomplexa: Cryptosporidiidae) from Homo sapiens"
392:
1151:
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Ozone treatment (Effective at treating chlorine-resistant microorganisms, such as
1170:
983:
703:
322:
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825:
760:
573:
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1075:
Osewe P, Addiss DG, Blair KA, Hightower A, Kamb ML, Davis JP (October 1996).
817:
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902:
421:
Corso PS, Kramer MH, Blair KA, Addiss DG, Davis JP, Haddix AC (April 2003).
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117:
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1051:
843:
778:
652:
581:
456:
438:
1215:"Cryptosporidium and public health (Drinking Water and Health Newsletter)"
1110:
920:
711:
792:
Zhou, Ling; Singh, Ajaib; Jiang, Jianlin; Xiao, Lihua (1 November 2003).
318:
282:
154:
142:
885:
Hoxie NJ, Davis JP, Vergeront JM, Nashold RD, Blair KA (December 1997).
743:
935:"Cryptosporidium in Milwaukee's water supply caused widespread illness"
301:
225:
173:
is a period in the life cycle of a coccidian parasite. The oocysts in
310:
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MacKenzie et al. and the CDC showed that this outbreak was caused by
170:
1287:
628:
314:
1249:(4). Centers for Disease Control and Prevention (CDC): 426–431.
1025:
FAQs – Water
Quality and Public Health – Water Treatment Process
1003:
20 years after fatal outbreak, Milwaukee leads on water testing.
331:
1291:
27:
1993 cryptosporidium protozoan outbreak in Milwaukee, Wisconsin
266:
527:
Washington, D.C.: Centers for Disease Control and Prevention.
236:
are needed to differentiate other species. A 2003 study by
124:, and the largest waterborne disease outbreak in documented
265:(NPDWR). Although these drinking aesthetics are under the
1194:"Interim Enhanced Surface Water Treatment Rule Documents"
725:
Khurana, Sumeeta; Chaudhary, Preeti (January–June 2018).
1048:
Wastewater Technology Fact Sheet – Ozone Disinfection.
506:
https://www.cdc.gov/dpdx/cryptosporidiosis/index.html
500:
Centers for Disease Control and Prevention. (2023).
472:
Centers for Disease Control and Prevention. (2023).
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may have entered the water treatment plants through
224:
do find positive results testing blood samples with
1562:
1536:
1495:
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1325:
941:. No. September 2007. Healio. September 2007.
179:are the transmissible stage for cryptosporidiosis.
95:
85:
77:
67:
59:
47:
37:
32:
478:https://www.cdc.gov/parasites/glossary.html#oocyst
1050:Retrieved from Wastewater Technology Fact Sheet:
859:Environmental Science: Earth as a Living Planet
383:1987 Carroll County Cryptosporidiosis outbreak
1303:
984:https://city.milwaukee.gov/water/WaterQuality
535:
533:
8:
727:"Laboratory diagnosis of cryptosporidiosis"
263:National Primary Drinking Water Regulations
182:Most reports do not specify the species of
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109:1993 Milwaukee cryptosporidiosis outbreak
33:1993 Milwaukee cryptosporidiosis outbreak
18:1993 Milwaukee Cryptosporidiosis outbreak
1513:Milwaukee Mitchell International Airport
1235:"Costs of Illness in the 1993 Waterborne
1052:https://www3.epa.gov/npdes/pubs/ozon.pdf
982:. Retrieved from Milwaukee Water Works:
880:
878:
416:
414:
412:
410:
408:
404:
1674:Disease outbreaks in the United States
1669:April 1993 events in the United States
1664:March 1993 events in the United States
1023:Milwaukee Public Water Works. (2023).
111:was a significant distribution of the
29:
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1017:
1015:
1013:
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974:
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960:
945:from the original on 21 February 2021
525:Enteric Diseases Epidemiology Branch.
149:that cause gastrointestinal illness (
7:
1027:. Retrieved from City of Milwaukee:
861:(5th ed.). Wiley. p. 441.
680:
678:
676:
674:
659:from the original on 20 January 2022
496:
494:
492:
468:
466:
1644:1993 disasters in the United States
205:imply without evidence that it was
63:Contaminated water filtration plant
617:The Journal of Infectious Diseases
558:10.1111/j.1550-7408.2002.tb00224.x
546:Journal of Eukaryotic Microbiology
25:
891:American Journal of Public Health
588:from the original on 25 June 2024
1613:
1612:
1175:Milwaukee Water Quality Website]
1124:Water Quality and Health Council
810:10.1128/jcm.41.11.5254-5257.2003
798:Journal of Clinical Microbiology
1508:Milwaukee County Transit System
1239:Outbreak, Milwaukee, Wisconsin"
1210:Milwaukee Health Department Lab
1192:US EPA, OW (October 15, 2015).
1181:"Surface Water Treatment Rules"
1179:US EPA, OW (October 13, 2015).
1158:from the original on 2022-09-01
692:New England Journal of Medicine
347:Current treatment in Milwaukee
1:
857:Botkin DB, Keller EA (2005).
1518:Milwaukee Intermodal Station
1243:Emerging Infectious Diseases
1118:Gradus S (10 January 2014).
476:. Retrieved from Parasites:
427:Emerging Infectious Diseases
372:Online monitoring/automation
330:people, such as people with
978:City of Milwaukee. (2022).
704:10.1056/NEJM199407213310304
1690:
1081:Epidemiology and Infection
1046:USEPA. (1999, September).
1608:
1554:Colleges and universities
1093:10.1017/s0950268800001473
258:gastrointestinal illness
153:) with symptoms such as
939:Infectious Disease News
903:10.2105/ajph.87.12.2032
195:Cryptosporidium hominis
1659:1993 disease outbreaks
1255:10.3201/eid0904.020417
1005:Wisconsin Water Watch.
439:10.3201/eid0904.020417
388:Pryor Avenue Iron Well
281:The root cause of the
189:Cryptosporidium parvum
1152:"CDC Cryptosporidium"
731:Tropical Parasitology
714:– via CrossRef.
169:, it has oocysts. An
126:United States history
122:Milwaukee, Wisconsin
72:Milwaukee, Wisconsin
1424:Historic Third Ward
1130:on 11 November 2022
1001:Ceraso, M. (2013).
744:10.4103/tp.TP_34_17
216:clearly state that
1654:1990s in Milwaukee
1477:Kinnickinnic River
1057:2024-01-25 at the
1034:2023-04-13 at the
989:2023-12-04 at the
511:2019-11-07 at the
483:2023-10-05 at the
474:Parasites Glossary
211:Alicia C. McDonald
1649:1993 in Wisconsin
1639:Cryptosporidiosis
1626:
1625:
1600:Seal of Milwaukee
1523:Port of Milwaukee
1434:Metropolitan area
1319:City of Milwaukee
897:(12): 2032–2035.
868:978-0-471-48816-3
804:(11): 5254–5257.
502:Cryptosporidiosis
328:immunocompromised
234:molecular methods
159:Enteric pathogens
151:cryptosporidiosis
147:enteric pathogens
105:
104:
42:Cryptosporidiosis
16:(Redirected from
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1487:Menomonee Valley
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1217:. Archived from
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1126:. Archived from
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623:(9): 1373–1379.
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1171:"Water Quality"
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367:Cryptosporidium
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299:Cryptosporidium
288:Cryptosporidium
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184:Cryptosporidium
176:Cryptosporidium
165:is a coccidian
163:Cryptosporidium
138:Cryptosporidium
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114:Cryptosporidium
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87:Confirmed cases
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53:Cryptosporidium
48:Parasite strain
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1206:"Laboratory"
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1549:Skyscrapers
1198:www.epa.gov
1185:www.epa.gov
949:22 February
323:dehydration
145:-resistant
1633:Categories
1381:Public art
1327:Government
1225:2006-04-10
1162:2020-12-03
1134:3 December
826:9173124979
761:7704802362
737:(1): 2–7.
574:4630522305
399:References
245:C. hominis
230:C. parvum
218:C. parvum
1544:Landmarks
1454:Geography
1439:Granville
1414:Riverwest
1371:Lake Park
1263:1080-6040
818:0095-1137
753:2229-5070
645:118846463
637:1537-6613
566:1550-7408
271:turbidity
238:Ling Zhou
207:C. parvum
118:protozoan
1618:Category
1419:Bay View
1404:Downtown
1281:12702221
1156:Archived
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377:See also
319:diarrhea
283:epidemic
226:antigens
167:parasite
155:diarrhea
143:chlorine
68:Location
1575:History
1570:Climate
1503:The Hop
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1111:8870627
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912:1381251
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663:25 June
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302:oocysts
251:History
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171:oocyst
141:are a
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1563:Other
1537:Lists
1376:Parks
315:fever
1595:Flag
1580:Beer
1335:Fire
1277:PMID
1259:ISSN
1136:2020
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332:AIDS
321:and
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