Characteristics of potentially waterborne disease agents
| Agent | Incubation period50 mean (range) | Disease identifying feature?50 | Included on routine test? | Prodrome50 |
|---|---|---|---|---|
| *May be good candidates for detection by syndromic surveillance. Criteria include: (1) narrow incubation period; (2) steep epidemic curve, long prodromal phase; (3) no clinical disease specific identifying feature; (4) disease not included in routine diagnostic tests. | ||||
| Parasitic | ||||
| Cryptosporidium* | 7 days (1–12 days) | No symptoms often include watery diarrhoea and abdominal pain, and may include general malaise, fever anorexia and vomiting | No. Not included on routine O and P stool examination. | None in adults; children may experience a prodrome of vomiting and anorexia. |
| Cyclospora* | 1 week | No. Symptoms include watery diarrhoea, and abdominal pain, nausea, anorexia, fatigue weight loss. | No. Not included on routine O and P stool examination | None. |
| Giardia | 7–10 days (3–25 days) | No. Symptoms include watery diarrhoea, and abdominal pain, bloating, flatulence, fatigue weight loss, fatty bad smelling stool. | Yes. Included on standard O and P stool examination. | None. |
| Entamoeba | 2–4 weeks (few days-years) | Sometimes. Symptoms range from mild diarrhoea to dysentery. Amebic granulomata, colitis, and liver lung, or brain abscess may occur. | Yes. Included on standard O and P stool examination. | None |
| Bacterial | ||||
| Campylobacter | 2–5 days (1–10 days) | No. Symptoms include diarrhoea, abdominal pain, general malaise, fever,and vomiting. | Yes. Included on standard stool culture. | None |
| Enterohemorrhagic E coli* | 3–4 days (2–10 days) | Sometimes. Symptoms range from mild diarrhoea to dysentery. Fever is rare. Haemolytic uraemic syndrome and thrombotic thrombocytopenic purpura can develop. | No. Enterohemorrhagic strains require specific stool culture. | None |
| Enteropathogenic E coli* | 9–12 hours | Usually affects infants. Symptoms include watery diarrhoea and fever. | No. Requires specific stool culture. | None |
| Legionella* 51, 52 | Legionnaires’ disease: 5–6 days (2–10 days);Pontiac fever: 24–48 hours (5–66 hours) | No. Initial clinical presentation does not differ from other pneumonias.Symptoms include anorexia, malaise, myalgia, headache, fever, cough, abdominal pain, diarrhoea. In Legionnaires’ disease these can proceed to respiratory failure and death. | No. | None. |
| Shigella | 1–3 days (12 hours–1 week) | No. Symptoms depend on strain and range from mild to watery diarrhoea to dysentery and can include fever, nausea, and sometimes vomiting, and cramps. | Yes. Included on standard stool culture. | None. |
| Vibrio cholerae | 2–3 days (Few hours-5 days) | Yes. Symptoms include sudden and profuse watery diarrhoea, nausea,vomiting, and rapid dehydration in some cases. | No. Special media required. | None. |
| Vibrio parahaemolyticus* | 12–24 hours (4–30 hours) | No. Symptoms include watery diarrhoea, abdominal pain, nausea, fever, and vomiting. Dysentery sometimes develops. | No. Special media required. | None. |
| Vibrio vulnificus* | 12–72 hours | Yes. Septicaemia, shock, hypotension, bullous skin lesions. | No. Special media required. | None. |
| Viral | ||||
| Hepatitis A* | 28–30 days (15–50 days) | Yes. Symptoms include fever, anorexia, nausea, abdominal pain, jaundice. | Routine once hepatitis is suspected. | Yes. Prodrome before onset of jaundice usually lasts a few days. |
| Norovirus (Norwalk and Norwalk-like viruses)* | 24–48 hours (10–50 hours) | No. Symptoms include nausea, vomiting, fever, diarrhoea, abdominal pain, fever. | No. | None. |
| Rotavirus* | 24–72 hours | No. Symptoms include vomiting fever and watery diarrhoea, and most often affect children under 5 years old. | No. | None. |