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Recreational Water Illness Outbreak Response Toolkit

The following information is intended to help state and local health departments respond to outbreaks of recreational water illnesses (RWIs). While some downloadable documents below are cryptosporidiosis-specific, they can also be used as models when creating similar documents for other pathogens. Likewise, though these documents focus on parasitic diseases, some of the information can be used or adapted for use in non-parasitic RWI outbreaks. All documents can be downloaded and altered as needed.

General Information

  •  Establish key contacts with partners at other local or state health departments and community partners such as laboratories, media, and child care centers.
  • Check resources and contingency plans. If your health department is low on resources, think ahead to what types of equipment or other resources may be needed in the outbreak response. Other state health department or local health departments may be able to share resources.
  • Share information with other health departments and community partners. This can speed up the investigation process and help fill knowledge gaps.
  •  At the beginning of an outbreak it’s important to identify as many confirmed cases as possible to help find the source of the outbreak. This can be done through mass mailings, press conferences, the Internet, and other types of public outreach.
  • If possible, establish a hotline for outbreak-related calls.
  • To reduce the likelihood of community-wide spread of cryptosporidiosis, consult the Cryptosporidium Outbreak and Response and Evaluation (CORE) Guidelines [PDF - 12 pages].

Laboratory Testing

  • At the beginning of the investigation, get a realistic idea of the turnaround time on lab tests.
  • If the labs are backlogged, consider using private labs/hospitals.
  • CDC’s DPDx offers technical assistance for state and local health department laboratorians, including reference, training, and diagnostic assistance. The goal of DPDx is to use the internet to strengthen diagnosis of parasitic diseases, both in the United States and abroad. Users can browse through concise reviews of parasites and parasitic diseases, including an image library and a review of recommended procedures for collecting, shipping, processing, and examining biologic specimens.

Epidemiologic Investigation Questionnaires

Adult and Pediatric Case and Control Questionnaires

The questionnaires below were used for a specific outbreak. Because their design and content reflect the circumstances involved in that particular outbreak, they are meant to be used only as examples. Depending on the circumstances of your outbreak, you may need to delete, add, or adapt questions to create your outbreak-specific questionnaire.

Environmental Health Investigation Questionnaires

Data Entry and Analysis


  • Keep a log of phone calls regarding the outbreak.
  • Document the number of hours spent on the outbreak for future budgetary/resource reference.

Pool Remediation

Communication with the Public

These are sample letters that may be downloaded, adapted to meet your health department's needs, and sent to different groups in the community to educate them in the event of an outbreak. The listing of letters is not exhaustive, but will help you begin to address the needs of your community as you respond to the outbreak. All letters mention that a Crypto Fact Sheet has been enclosed; a link to this fact sheet is also provided below, along with a link to general information on cryptosporidiosis.

Communications with other Health Departments or Agencies

  • Make periodic, regularly scheduled conference calls with established key contacts. Keep everyone informed, plan next steps, and share information.
  • Decide what information is to be shared and how to share it.
  • Decide on a mechanism to use in sharing information, such as e-mail or fax. Make sure all channels of communication are in working order.

Media Relations

  • Establish contact points with media sources.
  • Form a working group (if possible) to establish good relationships with the media.
  • Provide the media with fact sheets on the pathogen.
  • Send out frequent updates to keep the media correctly informed.

Press Releases

  • When putting together a press release on the pathogen, include any information from existing pathogen-specific fact sheets. You can download any information needed from the links below or your health department’s own site so that the press and any concerned citizens may access the information easily.
  • Most press releases should include appropriate information regarding the who, what, where, when, and why of the outbreak.
  • Consider being somewhat vague when reporting the number of cases to give room for decreasing or increasing case counts as tests are verified or case definitions change. For example, you can say "greater than" or "less than (x) cases," rather than giving exact numbers.

Reporting Waterborne Disease Outbreaks