A community waterborne outbreak of salmonellosis and the effectiveness of a boil water order

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] 29, 28.4), and the attack rate increased with increased water consumption. S. typhimurium was recovered from samples 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 wide-spread illness unless water supplies are properly operated and maintained. Effective education to improve compliance during boil water orders is needed.