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ISDS 2012 Conference Abstracts

Public Health Surveillance in Pilot Drinking Water
Contamination Warning Systems
Chrissy Dangel*1, Steven C. Allgeier1, Darcy Gibbons2 and Adam Haas2

1US EPA, Cincinnati, OH, USA; 2CSC Science & Engineering, Alexandria, VA, USA

Objective
This paper describes the lessons learned from operation and main-

tenance of the public health surveillance (PHS) component of five pilot
city drinking water contamination warning systems (CWS) including:
Cincinnati, New York, San Francisco, Philadelphia, and Dallas.

Introduction
The U.S. Environmental Protection Agency (EPA) designed a pro-

gram to pilot multi-component contamination warning systems
(CWSs), known as the “Water Security initiative (WSi).” The Cincin-
nati pilot has been fully operational since January 2008, and an ad-
ditional four pilot utilities will have their own, custom CWSs by the
end of 2012. A workshop amongst the pilot cities was conducted in
May 2012 to discuss lessons learned from the design, implementa-
tion, operation, maintenance, and evaluation of each city’s PHS com-
ponent.

Methods
When evaluating potential surveillance tools to integrate into a

drinking water contamination warning system, it is important to con-
sider design decisions, dual use applications/considerations, and the
unique capabilities of each tool. The pilot cities integrated unique
surveillance tools, which included a combination of automated event
detection tools and communication and coordination procedures into
their respective PHS components. The five pilots performed a thor-
ough, technical evaluation of each component of their CWS, includ-
ing PHS.

Results
Four key lessons learned were identified from implementation of

the PHS component in the five pilot cities. First, improved commu-
nication and coordination between public health and water utilities
was emphasized as an essential goal even if it were not feasible to
implement automated surveillance systems. The WSi pilot project
has helped to strengthen this communication pathway through the
process of collaborating to develop the component, and through the
need to investigate PHS alerts. 

Second, the approximate location of specific cases associated with
PHS alerts was found to be an essential feature that allowed a cross-
comparison to water pressure zones when attempting to locate the
source of possible contamination. More specific location data (e.g.,
latitude and longitude) leads to a more efficient investigation, how-
ever, just narrowing the case location down to a specific hydraulic
region within the water distribution system is extremely useful. 

Third, the ability to quickly visualize spatial distribution of cases
via a visual interface was reported to be valuable to investigators dur-
ing alert investigations. Most pilots implemented a CWS dashboard,
in the form of a central graphical display, which presents the alerts
and was used by the water utility and public health to obtain an un-
derstanding of geospatial relationships between cases, alerts and
water pressure zones. 

Finally, public health and water utility representatives from several
of the WSi pilots acknowledged that their automated surveillance
tools currently have limited capabilities for detection of chemical con-
taminants (which may result in a sudden onset of symptoms), with the
main deficiency being the timeliness of the alerts relative to the win-
dow of opportunity to respond in a meaningful and effective manner.
While they currently focus on detection of traditional waterborne dis-
eases, these tools could potentially be adapted to also detect chemi-
cal contaminants.

Conclusions
The results of the pilots have demonstrated that it is important to

construct and formalize standard operating procedures, so that pub-
lic health personnel and water utilities have a standard communica-
tion protocol. As a basic step to a PHS component, it is important to
establish a relationship between utilities and public health. In addition
to the efforts of the WSi pilots, research is currently being conducted
by the U.S. EPA to analyze health seeking behavior of symptomatic
individuals, because all PHS tools rely on data generated from be-
havior pursued by the affected population during a public health in-
cident. Results from analysis of both emergency department data and
poison control center follow-up phone data are currently underway.

Keywords
Evaluation; Public Health Surveillance; Lessons Learned; Contami-
nation Warning System; Drinking Water

References

[1] US EPA. 2008. Water Security Initiative: Cincinnati Pilot Post-Im-
plementation System Status Report. EPA 817-R-08-004.

*Chrissy Dangel
E-mail: dangel.chrissy@epa.gov

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 5(1):e93, 2013