Diarrhoea, Diarrhea, Dehydration and Oral Rehydration - Rehydration Project home
Diarrhoea Kills a Child Every 26 Seconds

Home > Resources > CDC - Centers for Disease Control and Prevention

Centers for Disease Control and Prevention
CDC - Centers for Disease Control and Prevention

The Centers for Disease Control and Prevention (CDC) serves as the national focus for developing and applying disease prevention and control, environmental health, and health promotion and education activities designed to improve the health of the people of the United States. CDC is recognized as the lead federal agency for protecting the health and safety of people - at home and abroad, providing credible information to enhance health decisions, and promoting health through strong partnerships.

CDC Safe Water System
The Safe Water System is a water quality intervention that employs simple, inexpensive and robust technologies appropriate for the developing world. The objective is to make water safe through disinfection and safe storage at the point of use.

  • What is the Safe Water System (SWS)?
  • Why was the SWS developed?
  • Who is the SWS for?
  • Where has the Safe Water System (SWS) been used?
  • How is a SWS started?

url: http://www.cdc.gov/safewater/

Safe Water System Manual
Safe Water Systems for the Developing World:
A Handbook for Implementing Household-Based Water Treatment and Safe Storage Projects
url: http://www.cdc.gov/safewater/

First do no harm: making oral rehydration solution (ORS) safer in a cholera epidemic
Oral rehydration solution (ORS) is lifesaving therapy for cholera and pediatric diarrhea. During a cholera epidemic in Guinea-Bissau, we evaluated the microbiologic quality of ORS prepared at a hospital and tested a simple intervention using special vessels for disinfecting tap water with bleach and for preparing, storing, and dispensing ORS. Few coliform bacteria and Escherichia coli were recovered from tap water; however, pre-intervention ORS contained numerous bacteria including E. coli and toxigenic Vibrio cholerae O1. In contrast, ORS samples from intervention vessels had few or no coliform bacteria, no E. coli, and no V. cholerae. Mean pre-intervention counts of coliform bacteria (3.4 X 107 colony-forming units [cfu]/100 ml) and E. coli (6.2 X 103 cfu) decreased significantly during the intervention period to 3.6 X 102 cfu and 0 cfu, respectively (P < 0.001). This simple system using bleach disinfectant and special storage vessels prevents bacterial contamination of ORS and reduces the risk of nosocomial transmission of cholera and other enteric pathogens.

American Journal of Tropical Medicine and Hygiene 1999; 60: 1051-5.
Daniels N, Simons L, Rodrigues A, Gunnlaugsson G, Forester T, Wells J, Hutwagner L, Tauxe R, Mintz E.
pdf version

Evaluation of a novel water treatment and storage intenvention in Nicaragua
The cholera epidemic in Latin America has spotlighted inadequate water quality and sanitation in the Region. The long-term solution to this problem would be for every community to have piped, disinfected water as well as sewage treatment facilities, but sufficient resources to provide such services do not exist. An alternative strategy for improving water quality shows promise.
Pan American Journal of Public Health 1998; 3:135-6.
Macy J, Quick R.

Safe water treatment and storage in the home: A practical new strategy to prevent waterborne disease
In many parts of the developing world, drinking water is collected from unsafe surface sources outside the home and is then held in household storage vessels. Drinking water may be contaminated at the source or during storage; strategies to reduce waterborne disease transmission must safeguard against both events. We describe a two-component prevention strategy, which allows an individual to disinfect drinking water immediately after collection (point-of-use disinfection) and then to store the water in narrow-mouthed, closed vessels designed to prevent recontamination (safe storage).
Journal of the American Medical Association 1995; 273: 948-953.
Mintz E, Reiff F, Tauxe R.

Narrow-mouthed water storage vessels and in situ chlorination in a Bolivian community: a simple method to improve drinking water quality
Epidemiologic investigations of the Latin America cholera epidemic have repeatedly implicated untreated drinking water and water touched by hands during storage as important vehicles for disease transmission. To prevent such transmission, we provided a new narrow-mouthed, plastic, water storage vessel and 5% calcium hypochlorite solution for home disinfection of stored water to a Bolivian Aymara Indian community at risk for cholera. We evaluated acceptance of this intervention and its effect on water quality. Each of 42 families in the study obtained water from a household well; fecal coliform bacteria were found in water from 39 (93%) of 42 wells and 33 (79%) of 42 usual water storage vessels.
American Journal of Tropical Medicine and Hygiene 1996; 54: 511-516.
Quick R, Venczel L, Gonzalez O, Mintz E, Highsmith A, Espada A, Damiani E, Bean N, De Hannover R, Tauxe R.

Diarrhea prevention in Bolivia through point-of-use disinfection and safe storage: a promising new strategy
A novel water quality intervention that consists of point-of-use water disinfection, safe storage and community education was field tested in Bolivia. A total of 127 households in two periurban communities were randomized into intervention and control groups, surveyed and the intervention was distributed.
Epi Infect 1999; 122: 83-90.
Quick R, Venczel L, Mintz E, Soleto L, Aparicio J, Gironaz M, Hutwagner L, Greene K, Bopp C, Maloney K, Chavez D, Sobsey M, Tauxe R.

Low cost safe water for the world: a practical interim solution
A very large segment of the world's population is without a microbiologically safe water supply. It is estimated that in Latin America more than 40% of the population is utilizing water of dubious quality for human consumption. This figure is probably even higher in Africa and areas of southeast Asia. Water used for drinking and food preparation can be an important route of transmission for many of the most widespread and debilitating of the diseases that afflict humans.
Health Policy 1996; 17: 389-408.
Reiff F, Roses M, Venczel L, Quick R, Will V.

Chlorinating well water with liquid bleach was not an effective water disinfection strategy in Guinea-Bissau

In late 1994. a cholera epidemic due to toxigenic Vibrio cholerae serogroup O1. serotype Ogawa, biotype E1 Tor caused 15,296 cases and 285 deaths in Guinea-Bissau. West Africa; three-quarters of the cases occurred in the city of Bissau (WHO 1995. Rodrigues et al. 1997).
International Journal of Envirnomental Health Research 1998; 8: 339-40.
Rowe A, Angulo F, Roberts L, Tauxe R.

Water distribution system and diarrheal disease transmission: a case study in Uzbekistan
Deteriorating water treatment facilities and distribution systems pose a significant public health threat. particularly in republics of the former Soviet Union. Interventions to decrease the disease burden associated with these water systems range from upgrading distribution networks to installing reverse osmosis technology. To provide insight into this decision process, we conducted a randomized intervention study to provide epidemiologic data for water policy decisions in Nukus, Uzbekistan, where drinking water quality is suboptimal. We interviewed residents of 240 households, 120 with and 120 without access to municipal piped water.
American Journal of Tropical Medicine and Hygiene 1998; 59: 941-6.
Semenza J, Roberts L, Henderson A, Bogan J, Rubin C.

Reduction of fecal contamination of street-vended beverages in Guatemala by a simple system for water purification and storage, handwashing, and beverage storage
Street-vended foods and beverages, an integral part of urban economics in the developing world, have been implicated in cholera transmission in Latin America. To improve the microbiologic quality of market-vended beverages in Guatemala, we tested a simple system consisting of dilute bleach (4.95% free available chlorine) for water purification, narrow-mouth plastic vessels with spigots for disinfecting and storing water and for preparing and storing beverages, handwashing soap, and education in using the system. We conducted a randomized controlled intervention trial among 41 vendors who received the intervention and 42 control vendors, comparing total and fecal coliform bacteria and Escherichia coli contamination of market-vended beverages, stored water, and vendors' hands. Samples were obtained at baseline and at each of six weekly follow-up visits.
American Journal of Tropical Medicine and Hygiene 1998; 59: 380-387.
Sobel J, Mahon B, Mendoza C, Passaro D, Cano F, Baier K, Racioppi F, Hutwagner L, Mintz E.

Epidemic Cholera in the New World: Translating Field Epidemiology into New Prevention Strategies
Cholera, a devastating diarrheal disease, has swept through the world in recurrent pandemics since 1817. The seventh and ongoing pandemic began in 1961 when the El Tor biotype of Vibrio cholerae O1 emerged in Indonesia. This pandemic spread through Asia and Africa and finally reached Latin America early in 1991
Emerging Infectious Diseases; 1:141-146.
Tauxe R, Mintz E and Quick R.

Motivational interviewing enhances the adoption of water disinfection practices in Zambia
These studies represent the first adaptation of the Motivational Interviewing (MI) behavior change approach in the developing world, using health workers directly from the community. The objective was to compare the effectiveness of the standard practice of health education (comparison group) to MI (experimental group) in initiating and sustaining safe water treatment and storage behavior.
Health Promotion International 2000: 15:207-214.
Thevos A, Quick R and Yanduli V.

Links to foodborne diseases and food safety web sites

CDC's list of Bacterial and Mycotic Diseases

Bacterial foodborne diseases and pathogens

Brainerd Diarrhea
E.coli 0157:H7
Salmonella enteritidis


Typhoid Fever
Vibrio vulnificus

Parasitic foodborne diseases and pathogens

Alphabetical listing

Ascaris, Roundworms
Cyclospora infection
Guinea worm disease

Environmental foodborne diseases and pathogens

Hepatitis A

General Information

Disease Listings (CDC)
US Government Food Safety Information Gateway
Fight BAC!TM Education Campaign
Foodborne Illness Education Information Center
Public Health Partners - Networks and Resources
Bad Bug Book (FDA)
Traveler's Health Information (CDC)
USFDA: Food Safety
Meat and poultry recalls

updated: 24 April, 2014

Feedback Form