Concern has been growing over the state and safety of municipal water supplies. Government organizations and the water industry seem to have a good working relationship, but both federal standards and industry-wide procedures within the water supplier network are lacking. The more stringent among the existing guidelines are voluntary, and they require both greater standardization and more comprehensive development of rapid (real-time) analysis and data sharing. Currently, to determine the source of a problem, a reactive, trace-back method is the principal tool used by health authorities, which can result in major delays in the public health response. Continuous detection and monitoring strategies are becoming available and could reduce the delays in reporting, but the water supply surveillance infrastructure is currently lagging in its efforts to adopt real-time bioanalytical methods. A report by the Government Accountability Office in 2004 cites physical and technological upgrades, particularly development of real-time monitoring technologies for treated water (in the distribution system) as the area most deserving of federal support. These advances, incorporating molecular biology techniques and epidemiological investigations of water-borne illness, will continue to aid in the direction in which biological surveillance needs to follow. As suggested by the case studies and technologies described herein, methods currently in development can dramatically improve the current state of water supply surveillance. Although the current incident reporting process does not offer the kind of real-time reporting necessary for early reliable detection of bioagent exposure, a more proactive stance toward water sampling, surveillance, and reporting can be developed.

The adoption of pathogen surveillance methods is not the complete answer, as the list of potential biological contaminants is long and new pathogens continue to emerge. Development of comprehensive analysis requires continual assay development and modernization of an aging infrastructure, both of which entail substantial cost. Large numbers of vulnerable access locations exist, often in the distribution system downstream of the locations where biological agent testing is performed. Any attack introduced near the tap (i.e., toward the consumer end of the distribution system) has a greater likelihood of success because such sites are after treatment and, generally, after surveillance. An essential aspect of water surveillance is more intelligent use of the current distribution infrastructure, particularly in terms of water conservation. Water utility organizations should adopt innovative strategies, such a division of municipal water. Much of the water that is delivered through the municipal system is not directly consumed; that is, water treated for consumption is used for industrial or agricultural use, such as irrigation, and may not require the same level of treatment and surveillance. As public education, recycling, and waste reduction efforts expand, and as new detection technologies continue to be developed, the demand and burden on the existing infrastructure may be lessened. A more comprehensive approach to water regulation, management, and surveillance is slowly becoming a reality, but substantial modernization of the water supply infrastructure and policy still remains as a major problem in water supply biosurveillance.

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