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6. Control Outbreak Through Remediation and Outreach

Public health officials may decide on control measures on the basis of strong epidemiological evidence about the disease’s origin, spread, and development. They do not always need to wait for definitive proof of contamination from the laboratory. This practice can result in earlier action to protect the public’s health. As officials learn more during the investigation, they may change, focus, or expand control measures and advice to the public.

All control strategies require risk communication to inform the public about the outbreak, how investigators are working to understand it, and what they can do to reduce risk. Risk communication should be initiated early, even before the outbreak is solved.

While there are many ways to control waterborne disease outbreaks, there are three practical strategies for public health recommendations—health promotion, processes and policies, and water treatment to reduce risk.

Table – Three primary public health strategies to control waterborne disease outbreaks

Table – Three primary public health strategies to control waterborne disease outbreaks
Measure Strategy Examples
Health Promotion Protect the person
Processes and Policies Change the way people interact with water systems
  • Bathroom breaks at pools
  • Diarrhea exclusion policies
  • Point-of-use water filters
Water Treatment to Reduce Risk Isolate people from the hazard
  • Remediation
  • Hyperchlorination
  • Temporary closure of building wing
  • Temporary closure of a beach

As many water systems are often connected to other community systems, control measures such as elimination and substitution are often not practical or effective unless there are extreme circumstances. Considerations for using these approaches:

  • Elimination—physically remove the hazard
    • Examples: shutting off tap water supplies and closing springs
    • Challenges: people need tap water for multiple household uses, ill swimmers will go to other facilities, people may continue to use unsafe water sources
  • Substitution—replace the hazard
    • Examples: providing an alternative source of water
    • Challenges: providing supplemental water from a different source is challenging for extended periods of time
Pie Chart showing Health Promotion, Process and Policies, and Water Treatment to Reduce Risk as the three equally important pieces.
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