Drinking Water-associated Outbreak Response Toolkit

• Establish key contacts with partners at other local or state health departments and community partners such as laboratories, media, and child care centers.
• Check resources and contingency plans. If your health department is low on resources, think ahead to what types of equipment or other resources may be needed in the outbreak response. Other state health department or local health departments may be able to share resources.
• Share information with other health departments and community partners. This can speed up the investigation process and help fill knowledge gaps.
• At the beginning of an outbreak it’s important to identify as many confirmed cases as possible to help find the source of the outbreak. This can be done through mass mailings, press conferences, the Internet, and other types of public outreach.
• If possible, establish a hotline for outbreak-related calls.
• Go to Chapter 5 "Outbreak Management" in the Cryptosporidium and Water: A Public Health Handbook [PDF - 152 pages] for more detailed outbreak management tips; it is specific to Cryptosporidium outbreaks but parts can be applied to outbreaks caused by other pathogens. This is an old historical document but much of the chapter is still applicable to new investigations.
• To reduce the likelihood of community-wide spread of cryptosporidiosis, consult the Cryptosporidium Outbreak and Response and Evaluation (CORE) Guidelines. [PDF - 12 pages]

• At the beginning of the investigation, get a realistic idea of the turnaround time on lab tests.
• If the labs are backlogged, consider using private labs/hospitals.
• CDC’s DPDx offers technical assistance for state and local health department laboratorians, including reference, training, and diagnostic assistance. The goal of DPDx is to use the internet to strengthen diagnosis of parasitic diseases, both in the United States and abroad. Users can browse through concise reviews of parasites and parasitic diseases, including an image library and a review of recommended procedures for collecting, shipping, processing, and examining biologic specimens.

• Generic Cryptosporidiosis Outbreak Case and Control Questionnaires. [PDF - 13 pages] (this is an excerpt from Cryptosporidium and Water: A Public Health Handbook. [PDF - 152 pages])

• FREE Epi Info™ software. With Epi Info™ and a personal computer, epidemiologists and other public health and medical professionals can rapidly develop a questionnaire or form, customize the data entry process, and enter and analyze data.
• Sample line list to keep track of drinking water-related disease outbreak cases. Please use legal (8.5" x 14") size paper for printing.
  • Sample Outbreak Case Tracking Line List [DOC - 1 page]
  • Sample Outbreak Case Tracking Line List [XLS - 1 page]

• Keep a log of phone calls regarding the outbreak.
• Document the number of hours spent on the outbreak for future budgetary/resource reference.

• Make periodic, regularly scheduled conference calls with established key contacts. Keep everyone informed, plan next steps, and share information.
• Decide what information is to be shared and how to share it.
• Decide on a mechanism to use in sharing information, such as e-mail or fax. Make sure all channels of communication are in working order.

• Establish contact points with media sources.
• Form a working group (if possible) to establish good relationships with the media.
• Provide the media with fact sheets on the pathogen.
• Send out frequent updates to keep the media correctly informed.

• When putting together a press release on the pathogen, include any information from existing pathogen-specific fact sheets. You can download any information needed from the links below or your health department’s own site so that the press and any concerned citizens may access the information easily.
  • General information on cryptosporidiosis
  • Information on all other pathogens related to water
• Most press releases should include appropriate information regarding the who, what, where, when, and why of the outbreak.
• Consider being somewhat vague when reporting the number of cases to give room for decreasing or increasing case counts as tests are verified or case definitions change. For example, you can say "greater than" or "less than (x) cases," rather than giving exact numbers.

Submit waterborne disease outbreak reports to CDC via the electronic National Outbreak Reporting System (NORS).

• NORS reporting forms for health jurisdictions that do not have access to NORS
• NORS training materials for the electronic system and the reporting form