title: A community waterborne outbreak of salmonellosis and the effectiveness of a boil water order.
abstract: OBJECTIVE
  A 1993 large water-borne outbreak of Salmonella typhimurium infections in Gideon, Mo, a city of 1100 with an unchlorinated community water supply, was investigated to determine the source of contamination and the effectiveness of an order to boil water.
  
  
  METHODS
  A survey of household members in Gideon and the surrounding township produced information on diarrheal illness, water consumption, and compliance with the boil water order.
  
  
  RESULTS
  More than 650 persons were ill; 15 were hospitalized, and 7 died. Persons consuming city water were more likely to be ill (relative risk [RR] = 9.1, 95% confidence interval [CI] = 2.9, 28.4), and the attack rate increased with increased water consumption. S. typhimurium was recovered from samples taken from a city fire hydrant and a water storage tower. Persons in 31% (30/ 98) of city households had drunk unboiled water after being informed about the boil water order, including 14 individuals who subsequently became ill. Reasons for noncompliance included "not remembering" (44%) and "disbelieving" (25%) the order.
  
  
  CONCLUSIONS
  Communities with deteriorating water systems risk widespread illness unless water supplies are properly operated and maintained. Effective education to improve compliance during boil water orders is needed.
authors.affiliation: National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga., USA.
authors.forename: F J
authors.initials: FJ
authors.lastname: Angulo
authors.forename: S
authors.initials: S
authors.lastname: Tippen
authors.forename: D J
authors.initials: DJ
authors.lastname: Sharp
authors.forename: B J
authors.initials: BJ
authors.lastname: Payne
authors.forename: C
authors.initials: C
authors.lastname: Collier
authors.forename: J E
authors.initials: JE
authors.lastname: Hill
authors.forename: T J
authors.initials: TJ
authors.lastname: Barrett
authors.forename: R M
authors.initials: RM
authors.lastname: Clark
authors.forename: E E
authors.initials: EE
authors.lastname: Geldreich
authors.forename: H D
authors.initials: HD
authors.lastname: Donnell
authors.forename: D L
authors.initials: DL
authors.lastname: Swerdlow
mesh_terms: D003625:Data Collection; D005759:Gastroenteritis / Q000382:microbiology / Q000517:prevention & control; D006266:Health Education; D006801:Humans; D008923:Missouri; D012480:Salmonella Infections / Q000517:prevention & control* / Q000635:transmission*; D012486:Salmonella typhimurium / Q000302:isolation & purification; D014871:Water Microbiology; D014881:Water Supply / Q000592:standards