The cryptosporidium outbreak was an enormous water outbreak which happened in 1993 in Milwaukee, Wisconsin. The outbreak was the largest waterborne disease in American history. The waterborne disease outbreak is suspected to have emanated from Howard Avenue Water Purification Plant. The outbreak is estimated to have affected approximately four hundred thousand causing illness and hospitalization. The outbreak was characterised by watery diarrhea and death mainly for AIDS patients which accounted for approximately 93% (Waterandhealth, 2018).
The cryptosporidium outbreak prompted the establishment of water treatment standards able to monitor pathogens and contaminants causing illness. The experiences from the outbreak provide a template which the world can refer to ensure high water treatment standards and quality water. Through vigorous monitoring and evaluating methods that ensure there is high quality and safe water for public use. Additionally, the methods of detecting and identifying cryptosporidium and Giardia in water was developed as a result of the cryptosporidium outbreak. The techniques and methods developed due to the Milwaukee outbreak have gained worldwide application and have been adopted as a standard for testing water borne pathogens (Waterandhealth, 2018).
The cryptosporidium had huge financial implication on costing approximately thirty one million dollars for direct medical cost and approximately sixty four million from lost productivity. See table 1 for the presentation of medical cost representation. The cost implication based of monetary value lost during the outbreak gives a clear sign and illustration of the cost similar waterborne diseases have to the health of an economy.
Table 1: Total cost of illness during the 1993 cryptosporidiosis outbreak
| Illness severity | Medical costs ($) | Productivity losses ($) | Total ($) |
| Mild | 790,760 | 40,212,000 | 41,002,000 |
| Moderate | 2,710,800 | 18,176,000 | 20,887,000 |
| Severe | 28,153,000 | 6,201,400 | 34,355,000 |
| Total cost of illness | 31,655,000 | 64,589,000 | 96,244,000 |
Source: (CDC, 2010)
The cryptosporidium outbreak opened a new frontier in research on the biological and molecular characteristics of the cryptosporidium as a way to prevent future outbreaks. Research reveals that cryptosporidium is similar to cyclospora, toxoplasma and isospora species all which are members of phylum Apicomplexa. Research has helped improve the categorization of cryptosporidium from previous classification based on size, host specificity and region of infection in animals. Molecular advancements has enabled cryptosporidium to be classified into corresponding genus easy to study and identify respectively.
Cryptosporidium enter a human system after the ingestion of the sporulated oocyst which is a biological state which ensure that it is protected from the elements of the environment. Additionally, cryptosporidium has a short life cycle and an auto infective cycle ensures that there is huge colonization of the intestinal tracks within day of ingestion of the oocyst. The biological construct of the parasite which involves a multiple fusion to create merozoites in the meront ensure a rapid reproduction rate (12-14 hours) after the formation of merozites which penetrate cells and the process is repeated numerously. The surface proteins of cryptosporidium composed of proteins, glycoproteins and phospholopids are very immunogenic which helps the parasite resist the host’s immune response.
Further, the cryptosporidium has evolved within an acidic environment which provides the parasite resilience when exposed to acid environments. The parasite has a distinctive critical state as an oocyst which keeps the parasite in a dormant state until it is ingested to activate the preceding stages.
Cryptosporidium has a unique defense for its zygote which protects the parasite’s zygote from environmental elements which would otherwise kill the parasite. The evolution adaption is a critical public health as it increases the occurrence of a disease outbreak. As an oocyst the parasite is resistible to disinfectants, UV lights exposure when these methods are used at practical levels. A break through in killing the oocyst achieved only after employing unpractical measures such as pulse light or exposure to ethylene dioxide gas for a whole day. Public health dictates that a population is protected from an impeding medical issue, though employing prevention measure, researching, identifying, and responding to a possible medical emergency. The biological construct of the oocyst limits option that can be employed to kill the parasite at its zygote state due to the high cost implications.
The high reproduction rate once in the human beings illuminates another frontier of public health concern. The high reproduction reduces the response time needed for medical personnel to response through preventive measures, and responsive measures that can effectively contain a possible outbreaks.
Often, public health in distribution of public water is ensured by adding chlorine into water kill bacteria and virus through a process called chlorination. Chlorination which is a preventive and responsive measure is rendered ineffective since cryptosporidium is resistant to chlorine. The fact mean that there is little prevention measures to protect a population against the parasite.
The biological and molecular component of the parasite demonstrates that outbreaks such as Milwaukie is not isolate situation. The fact being practical methods of killing the parasite inside the oocyst is expensive. Therefore, creating a scenario where public health cannot be maintained through enhancing prevention through treating of public water through impracticable treatment methods.
Biological research on pathogens assist in the identification of components such as cytoskeletones, membranes, organelles and signals pathways that specific pathogens use in their day to day applications. Studying these characteristics of a pathogen assists research to create appropriate destructive remedies that are practical to fight infections. The practicability of biological research in public health helps creates a sensible approach which is implementable to prevent and respond to community level threats. Additionally, the details of the molecular structure of a pathogen is used in water treatment, hotel industry, medical industry and public transportation sector which has a high community mobility. Biological research is not limited on to pathogens but also extends to human physiology where immune resilience and response is analyzed to comprehend various reaction that are expected. Information derived from this research is used to create practical therapies which are effective, acceptable rejection rate and those with cellular and molecular efficiency. In public health such effective therapies are easily applied to respond to a disease outbreak similar to Milwaukie with a high degree of effectiveness.
Milwaukee, 1993: The largest documented Waterborne disease outbreak in US history. (2018, August 21). Water Quality and Health Council. https://waterandhealth.org/safe-drinking-water/drinking-water/milwaukee-1993-largest-documented-waterborne-disease-outbreak-history/
CDC. (2010, December 8). Costs of illness in the 1993 Waterborne Cryptosporidium outbreak, Milwaukee, Wisconsin. Retrieved from https://wwwnc.cdc.gov/eid/article/9/4/02-0417_article
Waterandhealth. (2018, August 21). Milwaukee, 1993: The largest documented Waterborne disease outbreak in US history. Retrieved from https://waterandhealth.org/safe-drinking-water/drinking-water/milwaukee-1993-largest-documented-waterborne-disease-outbreak-history
