Waterborne enteric disease outbreaks in Israel, 1976-1985

Waterborne enteric disease remains a major public health problem in developing countries, as well as in developed countries, such that the World Health Organization declared 1981-90 the International Water Decade. Israeli experience with waterborne disease outbreaks in the decade 1976-85 is reviewed. Community water systems accounted for 52 outbreaks, with 25 occurring between 1976 and 1980 and 27 between 1981 and 1985. Total cases reported in these outbreaks were 7,681 and 10,880 respectively. In the latter period, reported cases resulting from these outbreaks constituted a very high percentage of the total reported cases of diarrheal disease in the country. The waterborne disease outbreaks were mostly due to secondary contamination of water systems due to human error and poor maintenance. In comparison with the United States, Israel experienced 18.7 times as many community waterborne disease outbreaks per capita. The need for routine preventive chlorination, and filtration on a selective basis, of community drinking water systems is strongly indicated, as recommended in current United States and World Health Organization guidelines in order to improve this grossly substandard aspect of Israeli public health.