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    Dijkstra, Arnold F. and de Roda Husman, Ana Maria 2014. Food Safety Management.

    Meltzer, Eyal Lachish, Tamar and Schwartz, Eli 2014. Treatment of Giardiasis after Nonresponse to Nitroimidazole. Emerging Infectious Diseases, Vol. 20, Issue. 10, p. 1738.

    Luna-Gierke, R. E. Wymore, K. Sadlowski, J. Clogher, P. Gierke, R. W. Tobin-D'Angelo, M. Palmer, A. Medus, C. Nicholson, C. McGuire, S. Martin, H. Garman, K. Griffin, P. M. and Mody, R. K. 2014. Multiple-Aetiology Enteric Infections Involving Non-O157 Shiga Toxin-ProducingEscherichia coli- FoodNet, 2001-2010. Zoonoses and Public Health, Vol. 61, Issue. 7, p. 492.


Multi-pathogen waterborne disease outbreak associated with a dinner cruise on Lake Michigan

  • F. SERDAREVIC (a1) (a2), R. C. JONES (a1), K. N. WEAVER (a1), S. R. BLACK (a1), K. A. RITGER (a1), F. GUICHARD (a3), P. DOMBROSKI (a4), B. P. EMANUEL (a5), L. MILLER (a1) and S. I. GERBER (a6)
  • DOI:
  • Published online: 19 May 2011

We report an outbreak associated with a dinner cruise on Lake Michigan. This took place on the same day as heavy rainfall, which resulted in 42·4 billion liters of rainwater and storm runoff containing highly diluted sewage being released into the lake. Of 72 cruise participants, 41 (57%) reported gastroenteritis. Stool specimens were positive for Shigella sonnei (n=3), Giardia (n=3), and Cryptosporidium (n=2). Ice consumption was associated with illness (risk ratio 2·2, P=0·011). S. sonnei was isolated from a swab obtained from the one of the boat's ice bins. Environmental inspection revealed conditions and equipment that could have contributed to lake water contaminating the hose used to load potable water onto the boat. Knowledge of water holding and distribution systems on boats, and of potential risks associated with flooding and the release of diluted sewage into large bodies of water, is crucial for public health guidance regarding recreational cruises.

Corresponding author
*Author for correspondence: S. I. Gerber, M.D., Cook County Department of Public Health, 15900 S. Cicero Avenue, Bldg. E-3rd Fl., Oak Forest, IL 60452, USA. (Email:
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1.RM Rooney , A review of outbreaks of waterborne disease associated with ships: evidence for risk management. Public Health Reports 2004; 119: 435442.

2.DN Lawrence . Outbreaks of gastrointestinal diseases on cruise ships: lessons from three decades of progress. Current Infectious Disease Reports 2004; 6: 115123.

3.P Grenfell , CL Little , S Surman-Lee . The microbiological quality of potable water on board ships docking in the UK and the Channel Islands: an association of Port Health Authorities and Health Protection Agency Study. Journal of Water Health 2008; 6: 215224.

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Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
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