Simultaneously MHDL was also identifying the first few Cryptosporidium cases collected internally. On day three, a local infectious disease physician and colleague called the laboratory with a single case of Cryptosporidium that fit the profile of ill patients. The lab also started a rapid fax-back survey of city clinical microbiology labs the following day that confirmed a dramatic increase in testing for GI pathogens citywide yet no agents were identified that would reflect such widespread illness. I then contacted both the North and South water treatment plants (WTP) to obtain daily water quality data from the previous 30 days, which indicated the only changing trend was the increasing turbidity readings from the south water treatment plant, yet were within federal limits. Other staff in the department were also seeing similar indicators throughout the city. After the Health Commissioner inquired about any information our Public Health Laboratory (MHDL) might have regarding GI illness in the community, we proceeded to call local hospital microbiology laboratories and ultimately emergency rooms and determined there was extreme GI illness throughout the city based on the much higher ER patient numbers and increased workload for enteric disease tests. Unknown to the health department at that time, the Milwaukee Water Works had received some complaints regarding the aesthetic quality of tap water. The Director of Nursing had anecdotal information that some pharmacies were selling out of anti-diarrheal medications. On Monday morning, April 5, 1993, the laboratory’s Chief Virologist and the Commissioner of Health received calls inquiring about the nature of apparent gastrointestinal (GI) illness reports in the City. What was the first sign of trouble in Milwaukee in 1993, and how did the health department respond? Microphotograph of Cryptosporidium parvum oocysts Image courtesy of the US Centers for Disease Control and Prevention. Stephen Gradus, Director of the City of Milwaukee Health Department Public Health Laboratories Division since 1990, for a look back at the event, including lessons learned, and improvements implemented. Caused by the chlorine-resistant parasite Cryptosporidium parvum,the outbreak affected over 400,000 people-25 percent of Milwaukee’s population in 1993-and resulted in over $96 million in combined healthcare costs and productivity losses, according to a study by the US Centers for Disease Control and Prevention. Waterborne disease outbreaks are relatively rare events in our time, but just over two decades ago, Milwaukee experienced the largest documented drinking water outbreak in US history. Stephen Gradus, Ph.D., MT(ASCP), D(ABMM), City of Milwaukee Health Department.
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