AWWA WQTC64192

Limited information is available on the health risks associated with water quality in the distribution system. Data from the waterborne disease outbreak surveillance system indicates that distribution system deficiencies are a major cause of waterborne disease outbreaks - due primarily to cross-connections, main breaks, and contaminated storage tanks. Premise plumbing contamination also appears to be an important cause of outbreaks but is likely underestimated and needs further investigation. Epidemiologic studies can be used to examine risks of endemic waterborne disease associated with distribution system deficiencies and intermittent contamination. Previous intervention studies, a case-control study and time-series studies in Canada, the United Kingdom, and the United States are reviewed and preliminary results from a current study in Atlanta are discussed. Includes 22 references, figure.