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