Sludge Watch ==> Milwaukee 13 years ago - cryptosporidium in the drinking water caused outbreak

[maureen.reilly at sympatico.ca]

Original URL: http://www.jsonline.com/news/metro/apr03/131542.asp


10 years ago, crypto gripped the city
Water contamination lessons lead to safer system 10 years later
By MARILYNN MARCHIONE
mmarchione at journalsentinel.com
Last Updated: April 5, 2003
Most Milwaukeeans can't remember exactly where they were 10 years ago today, 
but it was probably in the bathroom.

Cryptosporidium


Photo/Joe Koshollek
Michael Ryszkiewicz, recovering now from a fractured back, was among the 
Cryptosporidium victims.



Photo/File
After the Cryptosporidium outbreak 10 years ago, the Pryor Ave. well in the 
Bay View neighborhood was a popular place in early April 1993 to get 
untainted water. Years later, many still mistrust water from the tap, though 
experts say Milwaukee's is now extremely safe.


By the Numbers

44,000
Doctor visits.

4,400
Hospitalized.

725,000
Lost work or school days.

$96 million
Lost wages and medical expenses.

$90 million
New water purification system.

Quotable

It was a real tragedy for the community, but even more for the individuals 
affected by it.

- John O. Norquist,
Milwaukee mayor


A tiny parasite with a big name, Cryptosporidium, had gotten into city water 
and thousands of people's guts, causing severe diarrhea and a weeklong order 
to boil water before drinking it.

It happened even though the water met all federal and state standards. It 
happened without health officials being aware of it for many days.

It made history as the largest waterborne disease outbreak in the 
industrialized world.

The official toll: 403,000 sickened, 44,000 doctor visits, 4,400 
hospitalized, more than 100 deaths, 725,000 lost work or school days, $96 
million in lost wages and medical expenses and $90 million for a new water 
purification system.

"It was a real tragedy for the community, but even more for the individuals 
affected by it," Milwaukee Mayor John O. Norquist said.

The epidemic led to fundamental changes around the nation in public health, 
disease surveillance, water treatment and testing . . . even the way people 
view drinking water. Years later, many still mistrust water from the tap, 
though experts say Milwaukee's is now extremely safe.

Life-threatening germ
Most people who got the germ had a week of misery and no long-term 
consequences. But it cost some their lives, primarily AIDS patients whose 
weak immune systems couldn't fight it off without the modern AIDS drugs 
available today.

"It was just a terrible experience. I had several requests for assisted 
suicide, for euthanasia. People were just suffering so much," said Ian 
Gilson, a Milwaukee physician.

Some cancer patients also died, unable to survive a grave medical condition 
and a parasitic infection. Other people didn't lose their lives, but had to 
fight for them.

One woman ran up $35,000 in medical bills and lost a spleen. Some transplant 
patients battled organ rejection all over again. Several people developed a 
rare blood disorder that doctors said may have been triggered by an 
overstimulated immune system trying to defeat the parasite.

Michael Ryszkiewicz lost kidney function and had a transplant the following 
year.

"I went from living a normal life to being on dialysis," said Ryszkiewicz, 
who now lives in Oconomowoc. "It cost me a lot of anguish, a lot of pain. I 
didn't know if I was going to live."

People worried about things big and small: pets getting it, rinsing contact 
lenses, washing dishes, whether hot chocolate and ice at County Stadium 
would be safe for the Brewers' home opener. Women feared babies could get 
the germ through breast-feeding. Some wondered if it caused miscarriages 
they suffered.

Tentacles of the outbreak reached around the nation. One East Coast man got 
sick because he drank from a drinking fountain at the Milwaukee airport 
during a brief layover on a cross-country flight.

The source of the germ that sickened them still isn't known and probably 
never will be.

Following the trail
Cryptosporidium is a protozoan, a one-celled organism that stays dormant in 
water inside an egg-like shell, which splits open and lets the germ multiply 
in the intestines.

It's common in standing water and is a well-known cause of illness in 
cattle, especially calves, so investigation initially focused on farm runoff 
as a potential source. But the picture blurred when genetic analysis by the 
Centers for Disease Control and Prevention revealed that stool samples from 
infected Milwaukeeans contained a human strain of Cryptosporidium, not a 
bovine one.

Although the source remains a mystery, how the germ got in city water is 
well known.

Chlorination doesn't kill Cryptosporidium; it must be filtered out. At the 
time, that depended greatly on chemicals to precipitate impurities out of 
raw water. City officials had been experimenting with a new chemical that 
apparently did this quite poorly, especially at the Howard Avenue 
Purification Plant on the south side.

For weeks, residents called the water department, complaining of cloudy, 
foul-smelling water, and officials kept using more of the chemical to try to 
fix the problem, not realizing it was ineffective.

There were unusual weather conditions - a snowy, wet spring with lots of 
runoff into streams, and wind patterns that affected currents and how water 
flowed around the intake pipe in Lake Michigan, the source of the city's 
water.

City officials also discovered an illegal sewer connection that had been 
allowing waste from a slaughterhouse to enter sanitary sewers.

"It was an unbelievable confluence of events. There were so many things 
going on at the same time," said state epidemiologist Jeff Davis.

By April 5, a Monday, calls were flooding the Milwaukee Health Department 
from the public, the media and pharmacies saying that people were sick, and 
diarrhea medications were flying off shelves.

Water under microscope
For several days, officials tested for bacteria and viruses and came up 
blank. The protozoan didn't come to light until the afternoon of April 7, 
when community doctor Thomas Taft called the Health Department to say that 
another doctor, Anthony Ziebert, had an older patient who tested positive 
for Cryptosporidium.

City health officials had started to test for protozoans and immediately 
sent faxes to hospitals, asking them to do the same. By sunset, eight cases 
were confirmed.

In a meeting to discuss what to do, the mayor set a glass of water in front 
of Davis, the state's chief medical officer, and asked whether he'd drink 
it. Davis said no. Norquist called a 9 p.m. news conference and ordered 
residents in Milwaukee and 10 suburbs that use city water to boil it until 
further notice.

The Milwaukee Journal and the Milwaukee Sentinel abandoned competitive 
publishing and jointly put out a special edition in Spanish and English, 
warning people not to drink the water.

The Howard Ave. plant was closed, and the water treatment problems became 
public knowledge. But by then, thousands were sick. The former Milwaukee 
County Medical Complex was seeing 75 cryptosporidiosis patients a day and 
getting calls from hundreds of others.

Until the cause of the illness was known, "they were giving people water, 
which just made it worse," Taft said.

Hospitals had their own problems, as at West Allis Memorial, where many 
nurses were sick.

"The diarrhea was so severe they could not make it to the regular restrooms 
and would have to use patient restrooms," Taft said.

Flurry of lawsuits
Many people wanted justice. More than 4,000 people filed notices of injury 
with the city, and 1,400 filed claims seeking damages of $25 million. The 
cases were consolidated into a class-action lawsuit, and rulings eventually 
narrowed the number to about 540.

The city ultimately settled for $100,000, and General Chemical Corp., which 
made the water treatment chemical, settled for $1.5 million. About 50 cases, 
all involving people who died, got the largest amounts - $13,500 after 
attorneys' fees.

Meanwhile, Norquist said he tried to focus on preventing future outbreaks by 
overhauling water treatment. An ozone purification system started operating 
in October 1998. The water intake pipe was extended 4,200 feet farther into 
Lake Michigan to draw in a purer supply. Better filters and monitors were 
installed. Security was improved; the city's two water plants now are 
fenced, lighted, policed and video-monitored.

Health officials boosted efforts to detect and track illness in the 
community - the very kind of surveillance being done now in communities 
across the country as part of bioterrorism preparedness.

"It started very small and simple - weekly calls to nursing homes and 
pharmacies just to find out what they're seeing. But today, we're tracking 
about 20 different indicators of illness on an ongoing basis across the 
city," said Health Commissioner Seth Foldy, who came to Milwaukee in 1996.

If there had been such a system including pharmacies, nursing homes and labs 
in 1993, "that outbreak would have been detected much earlier than it was," 
said Jim Hughes, director of the CDC's National Center for Infectious 
Diseases.

"I wished it would have never happened in Milwaukee," said Paul Nannis, an 
Aurora Health Care executive who was health commissioner at the time. But he 
said he was proud of the Health Department's response, and the knowledge the 
epidemic produced about water and its links to public health.

Could it happen again?

"I would never say that," Davis said. "But the likelihood in Milwaukee is 
pretty low because of all the safeguards that have been taken."




A version of this story appeared in the Milwaukee Journal Sentinel on April 
7, 2003.