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In the spring of 1993,
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an unexplained illness struck the
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residents of Milwaukee, Wisconsin.
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400,000 people developed serious
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gastrointestinal
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illness. 4,000 were hospitalized and by
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the time it was under control, more than
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100 people died. Health officials
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suspected it was influenza,
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but it was something more serious and
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much more difficult for medical
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detectives to uncover.
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[Music]
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[Music]
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[Music]
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Milwaukee, Wisconsin, the 17th largest
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city in the United States with a
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population of almost 1 million people.
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It's a city known for its German
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culture, summer festivals,
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and long, cold winters with plenty of
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snow.
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Milwaukee is the home of several large
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breweries producing 11 million barrels
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of beer annually. But in the spring of
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1993,
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Milwaukee became famous for something
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else.
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An unexplained outbreak of
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gastrointestinal
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illness which spread rapidly throughout
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the community. 4,000 people rushed to
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area hospitals all with the same
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symptoms. severe cramps, diarrhea,
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nausea, and fever.
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>> I've had the diarrhea off and on all
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week. I missed two days of work, and I
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thought it was gone, and it came back
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again.
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>> Hardest hit were individuals with
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weakened immune systems, infants, the
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elderly, cancer, and AIDS patients, and
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those who had organ bone marrow
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transplants.
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Four-year-old Becky Ferman suffered from
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a particularly bad case. She was just a
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vibrant child. She was highly
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intelligent, very vivaceious, very
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talkative, very friendly. Um, just a
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normal kid. Becky Ferman was born HIV
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positive, which made her particularly
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susceptible to the mysterious outbreak.
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>> This got to be absolute water turning
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from brown to yellow to green.
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Terrible odor. and she would have
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8 9 10 11 12 bow movements a day.
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>> 40-year-old Antonio Clauddio was also
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affected. Like Becky, he too is HIV
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positive, but the severity of the cramps
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and diarrhea he developed during the
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outbreak was alarming.
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>> Yeah, I freaked out.
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I was like is
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is this
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what's happening to me a nature of
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course of the virus itself of the HIV
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AIDS or is this something else
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>> the primary suspects were chagela
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giardia campalobacttor
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or salmonella but stool samples from the
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infected individuals were all negative
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>> we knew this was big I I mean, we knew a
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lot of people were sick. We knew a lot
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of kids were sick. We were beginning to
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get reports from hospitals that
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patients, particularly with immune
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compromising conditions, particularly
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HIV AIDS, were having very difficult
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times shaking loose of this outbreak.
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And so, we were uh beginning to
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understand that this was in fact an
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epidemic.
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>> And health officials had no idea what
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was causing it.
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[Music]
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Within 24 hours of the outbreak, the
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mayor of Milwaukee knew he faced a
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serious dilemma. No American city had
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ever faced this type of crisis before.
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>> The concern in the health department was
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the beginning of, you know, a real
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concern. What is this? You know, how can
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so many people get sick all at one time?
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>> If the outbreak was caused by a
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contaminated food source, stool samples
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would contain the bacteria which caused
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it. And health officials could find no
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common food source that all of the sick
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individuals used. Food illnesses usually
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center around a common food distribution
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center, processing plant, restaurant,
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or grocery store.
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But one common element among all of the
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infected individuals was water.
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Officials analyzed the water quality
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records at the city's municipal water
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supply, but all of the water quality
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levels were within guidelines
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established by the Environmental
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Protection Agency for safe drinking
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water.
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>> We went back and indicated that to the
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health department and they continued on
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with their investigation into other
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areas. But when scientists looked at the
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distribution pattern of the outbreak,
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they noticed that most of the cases were
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clustered in the south side of the city.
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>> We believed we would have witnessed a
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more normal uniform distribution of
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illness had it been an airborne virus
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because it would have started at a point
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and moved outward. Since the outbreak
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seemed to be centered in Milwaukee
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southside, this narrowed the focus of
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the investigation.
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Becky Ferman lived on Milwaukee
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Southside. Her doctors had no idea what
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caused her illness and soon discovered
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they couldn't cure it in individuals
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like Becky who had HIV.
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One of the things was that she was
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limited in what she could do as far as
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where we could go and what we could do
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with her as far as playing because she
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would have these accidents. Another
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thing was a general weakness
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uh because of the constant diarrhea.
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>> Gastrointestinal illness is usually
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caused by something that is ingested
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once again pointing to food or water.
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The water plant which supplied Milwaukee
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Southside reported that the only unusual
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readout was a peak in turbidity one week
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before the outbreak. Turbidity measures
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the amount of foreign particles in the
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water.
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After a rainstorm or when snow melts,
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turbidity levels will temporarily rise.
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Storms churn river and creek bottoms,
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and melting snow will often gather
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particles as it runs into streams.
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Health officials wondered if the
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increase in turbidity levels was cause
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for concern. The municipal water supply
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was disinfected with chlorine. Was it
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possible that the city's water supply
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was contaminated with something that
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didn't show up in water tests and that
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chlorine would not kill? If so, the
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entire city would be at risk and one of
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the city's largest industries could also
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be affected, the brewing industry.
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The breweries were among the largest
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users of municipal water. If there was
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an unknown organism in the water, was it
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being shipped all across the country by
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the tens of thousands of gallons a day?
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[Music]
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Health officials suspected that
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something in Milwaukeee's water supply
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was causing the outbreak of thousands of
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cases of gastrointestinal illness.
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The water department insisted that the
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water quality levels were all within
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standards set by the Environmental
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Protection Agency and that the water was
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safe to drink. Hospitals and
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laboratories throughout Milwaukee
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continued to analyze stool samples from
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the thousands of individuals affected.
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>> Everything pretty much was a dead end.
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Everywhere we looked was everything was
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negative.
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Sandy Shraderis was doing some of those
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tests at a local hospital. As a
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microbiologist, she was performing the
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routine tests on patients hospitalized
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with the mysterious illness. The
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standard test was an iodine stain. When
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added to the stool samples, the iodine
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would show if parasites were present.
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But all of the iodine tests were
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negative. On her own, Sandy Shraderus
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decided to go one step further. She
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remembered something she learned earlier
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in her training that microbiologist
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should be on the lookout for parasites
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which do not show up on standard tests.
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With that in mind, she noticed a number
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of unusual structures in the samples.
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Structures which didn't react with the
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iodine stain. At that point, I don't
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know exactly what it is yet, but it
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means something. That's your first clue.
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>> So, she performed an acid fast stain.
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She flooded the stool sample with a red
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stain, then washed the sample with
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alcohol and sulfuric acid. During the
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final step, an additional green stain is
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added under the microscope.
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She thought she saw a highly infectious,
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potentially deadly parasite.
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>> First acidf stain wasn't real
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definitive. This is probably our first
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line. It's easiest, it's quickest, it's
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done in about 10 minutes. And I didn't
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feel comfortable calling it on that. So,
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we went on and did a fluorescent stain.
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>> The fluorescent stain introduces the
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parasites antibbody to the sample along
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with a fluorescent agent. Under the
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microscope, Sandy Shraderus noticed a
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bright green glow. It was the
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fluorescent agent attached to the
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antibbody. Proof that a parasite was
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present. It was cryptosperidium.
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Little is known about cryptosperidium
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since it first infected humans just over
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20 years ago. It's a one-sellled
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organism, a protoonean parasite which is
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found in feces from young farm animals,
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particularly calves. Cryptosperidium is
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an 80% of surface water, largely due to
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animal feces washed from farms into
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nearby streams by heavy rains and
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melting snow. Here you can see the tiny
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cryptosperidia escaping from their
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shells. Once they do, they multiply by
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the millions. When they spread
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throughout the gastrointestinal system,
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they absorb nourishment, preventing the
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body from retaining fluids, and causing
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severe cramps, explosive diarrhea and
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other flu-l like symptoms. A healthy
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individual with a healthy immune system
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can usually get rid of the parasite
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within a week with no lasting effects.
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But it can be deadly for those with
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weakened immune systems like the
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elderly, AIDS and cancer patients, and
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individuals with organ and bone marrow
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transplants. When lab technicians
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retested other stool samples, they
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confirmed what Sandy Shraiderus first
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discovered. Cryptosporidium was found in
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seven more stool samples.
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>> Once you knew what you're looking for,
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it was everywhere. I mean, we knew then.
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Now we had the agent. Now, where was it
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coming from? That was the next step.
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>> Since cryptoperidium is a waterborn
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parasite, it renewed fears that the
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city's water supply was contaminated.
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>> The mayor called an emergency meeting of
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both city and state health officials.
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During that meeting, the mayor noticed
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one of the participants, Dr. Jeffrey
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Davis, the state's epidemiologist, was
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drinking diet soda and not water. When
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the mayor turned to Dr. Davis and asked
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if he would drink the city's water. Dr.
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Davis said no.
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>> It wasn't difficult once I asked Dr.
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Davis if he'd drink the water. I mean,
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if he suspected, he's a scientist. He's
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an expert and and a very honest person.
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Uh, you know, if he suspected that there
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could be problems with the water, that's
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pretty good test right there. Since
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boiling was the only way to get rid of
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cryptosperidium,
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the mayor immediately issued a boil
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water advisory recommending that all
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water be boiled for at least 5 minutes
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before use. It was a bold recommendation
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with wide-ranging implications since
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tests for cryptoperidium in the city's
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water supply had not yet been completed.
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Dental offices were closed since their
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drills were water cooled. Restaurants
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were also affected since they use water
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for ice and washing dishes. Three days
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later, tests on Milwaukeee's water done
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by an independent laboratory confirmed
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that cryptosperidium was present in the
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purified water from the Howard Avenue
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water plant. The news of cryptosperidium
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contamination was especially terrifying
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to one segment of the population, people
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with HIV infections or AIDS.
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>> For these patients, it was
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life-threatening immediately. They knew
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what crypto was. This was not a new
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illness to them.
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>> Cryptospidiosis for someone with a
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severely compromised immune system is a
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death sentence. Doug Nelson and the
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organization he directs, the AIDS
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Resource Center of Wisconsin, went into
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crisis mode. He knew that individuals
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with HIV AIDS would never get rid of the
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parasite, but his goal was to make sure
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no one else became infected. The Howard
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Avenue water plant was immediately
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closed. The water flushed out and the
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entire plant disinfected from top to
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bottom to remove any traces of
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cryptosperidium.
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A few days after the boil water
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advisory, the number of
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cryptosperidiosis cases dropped
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significantly, but the levels discovered
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in Milwaukeee's water supply had been
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potent.
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One businessman traveling through
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Milwaukeee's airport reported getting
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sick after drinking just enough water to
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swallow a few aspirin.
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Antonio Claudio was living in Houston
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when he tested positive for
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cryptosperidiosis.
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He believes he was infected while
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visiting his mother who lived on the
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south side of Milwaukee. Since there is
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no cure for cryptosporidiosis
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besides a healthy immune system, Antonio
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lives each day with constant chronic
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diarrhea.
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>> Once you discover you have this this
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disease, your life changes and there's
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just no way to get around it. Prayer
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helps a lot.
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But um
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you just can't erase it. It's reality,
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no matter what portion of it,
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and just waiting to die.
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Little Becky Ferman lost her fight with
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cryptosperidiosis.
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She died after battling its effects for
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many months. Becky was in a coma, eyes
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closed, but she raised her hands to us
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and grabbed held with our hands, took
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three breaths, and and a spirit and
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energy left.
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ripped the heart.
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Um,
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but a gratefulness because she wasn't in
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pain anymore.
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She looked peaceful for the first time.
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Investigators soon had a theory for how
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cryptosperidium
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contaminated Milwaukee's water supply.
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[Music]
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After an intensive investigation, health
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officials developed a theory as to how
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cryptosperidium contaminated
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Milwaukeee's water supply. In early
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April of 1993,
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heavy rains and the spring snow melt
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caused water runoff. The ground was
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still frozen and unable to absorb the
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water. Manure from the farms and fields
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might have washed into nearby streams.
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Manure which contained cryptosperidium.
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The cryptosperidia then made their way
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from the streams into Lake Michigan, the
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source of Milwaukeee's drinking water in
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1993.
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There were no filters or mass
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disinfectants used anywhere in the
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United States which could eliminate the
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cryptosperidium in water plants.
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Chlorine was ineffective against it.
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Over 400,000 people who ingested water
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from the Howard Avenue plant became ill.
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4,000 were hospitalized.
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104 died. That theory held for 4 years.
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During that time, the Centers for
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Disease Control in Atlanta, Georgia,
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continued to investigate Milwaukeekey's
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cryptosperidium outbreak since it was
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the largest waterborne outbreak in
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United States history. In 1997,
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scientists retested four stool samples
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from individuals infected during that
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outbreak.
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They conducted DNA testing on the
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cryptos paridium. And when they did,
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there was a shocking discovery. The type
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of cryptosperidium found in the four
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stool samples from the Milwaukee
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outbreak did not come from farm animals.
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It was a new strain, one which came from
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human waste.
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>> Our results suggest on the basis of the
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limited number of samples that we looked
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at that the Milwaukee outbreak um was
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was not from pasture runoff but was from
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sewage contamination. When investigators
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looked more closely at Milwaukeee's
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water supply, they found that the Howard
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Avenue water plant's intake was less
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than 2 mi down current from a sewage
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treatment plant overflow valve in Lake
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Michigan. The CDC's discovery suggested
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that human waste containing
00:19:12
cryptosperidium was released from the
00:19:15
sewage treatment plant traveled the 2 mi
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downstream where it entered the water
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intake of the Howard Avenue water plant.
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Today, sewage from that plant is no
00:19:27
longer released into Lake Michigan. And
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the Howard Avenue water plant moved
00:19:32
their intake further out into the lake
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away from possible pollutants.
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And Milwaukee is building an ozenization
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facility. Ozone is a form of oxygen
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which kills more microorganisms than
00:19:47
chlorine. It's the only mass
00:19:49
disinfectant process known to kill
00:19:52
cryptosperidium in water. When the
00:19:54
facility is completed, Milwaukee will be
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the only major city in the United States
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to ozenate its water. Every city around
00:20:03
the country that relies on surface water
00:20:05
for its drinking water must study the
00:20:08
Milwaukee example and must follow our
00:20:12
lead in making those extraordinary
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commitments to assure to their public
00:20:17
that in fact the water that they consume
00:20:20
is safe and that they will not get ill
00:20:21
from it and and that they will not die
00:20:23
from it.
00:20:24
>> I mean, I I felt terrible about that.
00:20:26
I'm not an expert on water, but I'm the
00:20:28
mayor and uh you know, you kind of rely
00:20:32
on your city to provide you with water.
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It turns out that cryptosperidium has
00:20:38
gotten in water supplies in other parts
00:20:39
of the country. It's not that uncommon.
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[Music]
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We went through a lot a lot of anger.
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not only anger at the loss of our
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daughter but the anger of loss of so
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many friends.
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As time passed, we came to realize that
00:21:06
yes, I we believe that public officials
00:21:09
were at fault for not knowing more about
00:21:11
it, for not teaching us, but ultimately
00:21:13
we all are corporately responsible, you
00:21:16
and I, and and the world for not caring
00:21:18
about water until someone dies.
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[Music]
00:21:30
Why?
00:21:33
[Music]
00:21:45
Heat.
00:21:49
Everybody.
00:21:50
[Music]
