Federal and state regulators require utilities to monitor water supplies continuously. Water is an important potential mode of transmission for many pathogens, including bacteria, viruses, and parasites (Table 9.1).
There are two complementary approaches to monitoring these biological contaminants. Ongoing comprehensive surveillance is intended to signal the occurrence of contaminated water before its distribution to the general public. The underlying intent of this approach is to detect contaminates to prevent illness, in terms of an early warning detection system. A secondary surveillance approach involves analysis of water supplies that is initiated once presence of a biological agent has been confirmed. This second method is a detect-to-treat strategy, intended to uncover the original contamination point and the route(s) of dispersion. A combination of the two approaches facilitates tracking of the contamination to the source, essentially activating the public health response for detection of additional exposures and the development of triage protocols.
The principal roles of water supply biosurveillance are to communicate with utility regulators and governmental public health (as well as law enforcement, as appropriate), organize emergency preparedness, and coordinate crisis management. Surveillance is crucial during situations likely to cause water contamination, such as pipe ruptures (water main ruptures reduce distribution water pressure, increasing vulnerability to contamination), shortages, and threats to the water system, in particular bioterrorism threats. Several organizations are involved in defining surveillance policy, specifically in the areas of protocol development, identification of emerging threats, protection, security, and emergency planning. These include the water utilities, the government regulators overseeing them, and law enforcement and governmental public health organizations.
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