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Appendix B
Documented Waterborne Disease from Bottled Water

The bottled water industry (through IBWA) flatly denies that bottled water has ever caused a disease outbreak--going so far as to assert that the Centers for Disease Control and Prevention (CDC) has found that there has never been an outbreak of waterborne disease from bottled water.1 However, such outbreaks from contaminated bottled water have indeed occurred and are well documented by CDC and others in the scientific literature.

For example, in a published 1996 study of waterborne disease in the United States, the CDC reported a 1994 outbreak of cholera associated with bottled water that occurred in Saipan, U.S. territory in the Marianas Islands in the Pacific.2 FDA bottled water standards apply to this U.S. territory to the same extent that they would in any U.S. state.3 While there was not a full epidemiological study of all those who drank the water, CDC reported that at least 11 were known to have become ill, and 4 were hospitalized with serious cases of cholera.4 The brand of water involved was not named.5 According to an unpublished Waterborne Disease Outbreak report on this outbreak filed with CDC by local public-health officials, approximately one third of the island residents drink water from the company involved, and "thousands" of people may have been exposed.6 The total number of people who became ill is unknown.

The bottled water plants producing the water involved in this outbreak reportedly obtain their water from municipal water (some of the wells used tested positive for fecal coliform bacteria), but they supposedly then treat the water with state-of-the-art treatment using reverse osmosis.7 While the bottles used were supposed to have been cleaned by machine or manually with hot water and a chlorine solution, the bottling plants had, according to CDC, "occasionally been cited for the cursory handling of returned bottles (e.g., for only rinsing them with treated water.")8 The CDC reported that during the outbreak, bottled water tested positive for fecal coliform, but the actual source of the bacterial contamination in the bottled water was not determined.9

Another well-documented cholera outbreak, which occurred in Portugal, was due to the use of bottled water from a contaminated source.10 The outbreak occurred in the mid-1970s, but demonstrates the continuing potential for contaminated bottled water to spread waterborne disease. According to a study of the affected population, there were 2,467 bacteriologically confirmed hospitalized cases of cholera, of whom 48 died.11 While apparently bottled water was not the only cause of the outbreak, at least 82 patients had a history of drinking bottled water from the contaminated source.12 In addition, 36 cholera victims had visited the spa that was fed with the same source as used for bottled water.13 It was believed that the limestone aquifer was contaminated by broken sewers from a nearby village.14

Historically, other cases of illness from bottled water have been documented in the scientific literature. For example, there are published reports showing that bottled water was the causative agent not only in the outbreaks of cholera just noted, but also illnesses from typhoid15 and "traveler's disease."16



Notes

1. See, e.g., International Bottled Water Association, "Frequently Asked Questions," (1997).

2. M.H. Kramer, et al., "Surveillance for Waterborne-Disease Outbreaks -- United States, 1993-1994," Centers for Disease Control & Prevention Surveillance Summaries, Morbidity and Mortality Weekly Report, vol. 45, no. SS-1, pp. 1-31 (April 12, 1996).

3. See, 21 U.S.C. § 321(a).

4. Ibid.

5. Ibid.

6. Waterborne Disease Outbreak Report Form, filed with CDC by Division of Public Health, Commonwealth of the Northern Marianas Islands, dated January 3, 1995.

7. M.H. Kramer, et al., "Surveillance for Waterborne-Disease Outbreaks -- United States, 1993-1994," Centers for Disease Control & Prevention Surveillance Summaries, Morbidity and Mortality Weekly Report, vol. 45, no. SS-1, pp. 1-31 (April 12, 1996).

8. Ibid.

9. Ibid.

10. P.A. Blake, et al., "Cholera in Portugal, 1974. II. Transmission by Bottled Water," American J. Epidemiology, vol. 105, pp. 344-48 (1977).

11. P.A. Blake, et al., "Cholera in Portugal, 1974. I. Modes of Transmission." American J. Epidemiology, vol. 105, pp. 337-43 (1977).

12. Ibid.

13. Ibid.

14. .Ibid.

15. D.W. Warburton, "A Review of the Microbiological Quality of Bottled Water Sold in Canada. Part 2. The Need for More Stringent Regulations," Canadian J. Microbiology, vol. 39, pp. 158-168 (1993), citing R. Buttiaux, "La Surveillance Bacteriologique Des Eaux Minerales en Bouteilles et en Boites," Ann. Instit. Pasteur Lille, vol. 11, pp. 23-28 (1960).

16. D.W. Warburton, "A Review of the Microbiological Quality of Bottled Water Sold in Canada. Part 2. The Need for More Stringent Regulations," Canadian J. Microbiology, vol. 39, pp. 158-168 (1993).

last revised 7/15/2013

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