Information Collection Rule: Optional Public Notice Language For Cryptosporidium

United States Environmental Protection Agency
Office of Water 4603
EPA 811-F-96-007
May 1996

Information Collection Rule Optional Public Notice Language for Cryptosporidium The final Information Collection Rule (ICR) was published in the Federal Register on May 14, 1996. This FR notice finalizes requirements for monitoring microbial contaminants and disinfection byproducts by large public water systems (PWSs). It also requires large PWSs to provide operating data and a description of their treatment plant design. Finally, it requires large PWSs to conduct either bench- or pilot-scale testing of advanced treatment techniques.

Introduction - Cryptosporidium

Cryptosporidium has been found in nearly all surface waters that have been tested nationwide. As water systems monitor for Cryptosporidium, the likelihood exists that it will be detected occasionally at low levels in finished water derived from surface water sources. Cryptosporidium oocysts are very resistant to disinfection, and even a well-operated water system cannot ensure that drinking water will be completely free of this parasite. Because all monitoring data required by the U.S. Environmental Protection Agency's (EPA) Information Collection Rule (ICR) will be available to the public, systems may wish to notify the public that Cryptosporidium may be (or has been) detected in the finished water. Systems are encouraged to work with health department officials in developing a public health response plan for releasing information to the public and the media before testing begins. Systems in which a specific plan has not been developed before detecting oocysts in the finished water are encouraged to consult with their local public health officials and prepare a joint statement. EPA does not require a public notice for Cryptosporidium occurrence.

The optional public notice may be circulated in monthly bills, newspapers, radio or a number of other ways. Elements of the message may include items in the list below. Other information about Cryptosporidium and cryptosporidiosis is available from EPA, the Centers for Disease Control and Prevention (CDC), the American Water Works Association (AWWA), and State and local public health agencies. One example of such information is a joint EPA/CDC statement entitled, "Guidance for People with Severely Weakened Immune Systems," available from the Safe Drinking Water Hotline (1-800-426-4791). An example of optional public notice/education language is attached.

If a system wishes to prepare a public health advisory different from the example attached, it might consider incorporating some or all of the informational elements below.

List of Informational Elements

Cryptosporidium

a microscopic parasite that can cause disease, mainly diarrhea, if swallowed.

• System has been (or will be) testing for Cryptosporidium in water leaving the treatment plant.
• Test results (or notice that customers will be receiving quarterly reports on test results, if applicable).
• Cryptosporidium is common in the environment, including surface waters, and the finding of an occasional oocyst in finished water is not unusual.
• A number of waterborne disease outbreaks caused by Cryptosporidium have recently occurred in the U.S. and other countries.
• Symptoms may include diarrhea, nausea, and/or stomach cramps. (Note that diarrhea may be caused by pathogens and conditions other than Cryptosporidium).
• Cryptosporidium can be spread in a number of ways, including contaminated drinking water and recreational water, unwashed hands, surfaces or food contaminated with feces, and sexual behavior involving contact with feces.
• Interpretation of Cryptosporidium-positive test results is difficult. (According to a CDC workshop report, detecting this parasite at low levels in finished water should not be used as the sole criterion for issuing a boil-water advisory. Other criteria should include data such as turbidity levels, number of large particles, conditions at the treatment plant, or evidence of disease in the community that suggests water quality is unacceptable. [D. Juranek et al., Cryptosporidiosis and public health: Workshop Report, J. Amer. Water Works Assoc. 87:69-80, 1995.].)
  1. Cryptosporidium may be dead.
  2. Cryptosporidium may not be infective to humans, if alive. [A number of species of Cryptosporidium exist, and only one is known to infect humans]
  3. Cryptosporidium recoveries are low using the current method
  4. A rapid analysis is not possible with current method; analysis may take up to two weeks.
  5. Thus, health significance is unknown.
• Local public health department officials are aware of the test results (if public notice is not a joint statement, health department officials should be notified in advance about release of statement).
• Control
  1. System is taking steps to improve Cryptosporidium control.
  2. If system has joined EPA/State/water system Partnership for Safe Water, tell the customers about this and what this partnership involves.
  3. System has been and will be in consultation with local health department during entire monitoring period (If applicable).
  4. Local health department has a surveillance system in place for cryptosporidiosis and/or for an unusually high incidence of diarrhea in the community (if applicable).
  5. Local health department believes that no precautions are currently necessary (if true). Individuals with a severely weakened immune system should consult with their health care providers.
• EPA/CDC guidance/pronouncements.
• System is in full compliance with all EPA/State standards and requirements (if true).
• System will continue to keep you informed.

Contact the Safe Drinking Water Hotline at 1-800-426-4791

Optional Public Notice Language

One of the contaminants we are testing for as part of the ICR is Cryptosporidium. This parasite has caused a number of recent outbreaks of waterborne disease in the U.S. and other countries. The testing we are doing is vital to future control of Cryptosporidium. The following information from EPA, the Centers for Disease Control and Prevention (CDC), and others, tells more about our current knowledge of this parasite.

Cryptosporidium is a protozoan parasite, a one-celled animal too small to be seen without a microscope. It is common in surface waters (e.g., lakes and rivers), especially when these waters contain a high amount of sewage contamination or animal waste. Cryptosporidium is very hard to kill with disinfection, and even a well-run water treatment system cannot ensure that drinking water will contain no live parasites. Current EPA drinking water safety standards were not explicitly designed to assure the removal or killing of Cryptosporidium. EPA is now working to resolve a number of scientific questions that will assist it in setting specific safety standards for Cryptosporidium in the future.

Cryptosporidium can cause symptoms that include diarrhea, nausea, and/or stomach cramps. Because many other organisms and conditions can produce these same symptoms, a special laboratory test is needed to find out whether Cryptosporidium is the cause. The parasite is found in the feces of infected humans or animals. To cause illness, the parasite must first be swallowed. Cryptosporidium can be spread by a very small amount of feces found in a number of places, including unwashed hands, contaminated surfaces inside and outside the home, and contaminated food, drinking water, and recreational water, as well as sexual behavior involving contact with feces.

No precaution about our drinking water is currently needed for the general public. People with severely weakened immune systems are likely to have more severe and longer lasting symptoms than healthy individuals, and should speak with their health care providers about how to protect themselves against Cryptosporidium from all sources.

According to EPA and CDC, there are problems with the current water testing method for Cryptosporidium. The method now in use cannot determine with certainty whether Cryptosporidium found in drinking waters is alive or dead. Also, the method cannot distinguish among several different types of Cryptosporidium, only one of which is known to cause disease in humans. Also, the current method may capture only a small portion of the Cryptosporidium in the water sample, and the time needed between taking a sample and getting back test results from the laboratory may be as long as one or two weeks.

Thus the health significance of any Cryptosporidium that we detect in the water system is hard to know, especially if only very low levels of Cryptosporidium are found. Throughout the entire testing period, we will consult with NAME OF STATE OR LOCAL PUBLIC HEALTH AGENCY. If Cryptosporidium is found in SYSTEM'S NAME's drinking water, we will examine a number of measures of water quality and system operation and, if appropriate, let the public know of any precautions they might need to take.

[If Applicable] In addition to the required testing, the system is also taking part in the new voluntary EPA/STATE/WATER INDUSTRY Partnership for Safe Water. This program is part of our continuing effort to improve water treatment for the control of Cryptosporidium and other disease-causing organisms.

We will make all of our data available to the public. To learn more about Cryptosporidium and SYSTEM NAME's water, please contact IDENTIFY CONTACT.

For More Information

Contact the Safe Drinking Water Hotline at 1-800-426-4791

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