Community health impact of extended loss of water service--Alabama, January 2010.

Access to clean water is fundamental to good health. During January 2010, approximately 18,000 residents of two predominantly rural counties in Alabama lost access to municipal water for up to 12 days after below-freezing temperatures led to breaks in water mains and residential water pipes and caused widespread systemic mechanical failures. To assess potential health impacts, use of alternative water sources, and effectiveness of the emergency response, the Alabama Department of Public Health (ADPH) invited CDC to assist in an investigation that included a survey of 470 households representing 1,283 residents and a qualitative investigation (i.e., focus group discussions and interviews with key informants). This report summarizes the results of that investigation, which found a significantly higher prevalence of acute gastrointestinal illness (AGI) among residents of households that lost both water service and water pressure (adjusted odds ratio [AOR] = 2.6), that lost water service for ≥7 days (AOR = 2.4), and that lost water pressure for ≥7 days (AOR = 3.5). Significant dose-response relationships were observed between increased duration of lost water service or pressure and AGI. The survey and qualitative investigation revealed that households, communities, water utilities, and institutions were not adequately prepared for water emergencies in areas of communication and notification, planning for alternative water sources, and interagency coordination. Health effects from loss of water supply or water pressure might be mitigated by public health involvement in fostering household, community, and interagency preparedness, and developing communication strategies that will reach the majority of citizens in a timely manner.