Evaluation of Residual Disinfectant Levels in Public Drinking Water Distribution Systems in Relation to an Acanthamoeba Keratitis Outbreak - Illinois, 2002-2009

Acanthamoeba keratitis (AK) is a painful, potentially blinding eye disease associated with contact lens use and corneal injury. AK, caused by the free-living amoeba Acanthamoeba, is ubiquitous in the environment and has been isolated from municipal water supplies. It can be tolerant of normal chlorine levels in drinking water. An AK outbreak investigated in 2003-2005 in five Illinois counties showed a lower AK age-standardized rate ratio in Cook County than in surrounding counties and was hypothesized to be due in part to reductions in residual disinfectant levels (RDLs) in drinking water. We evaluated RDLs in public water systems in the same five Illinois counties over eight years (2002-2009) using a multivariable model of water system RDL measurements. Fitted RDLs for each county were in the acceptable range by United States Environmental Protection Agency standards for the entire study period. After correcting for multiple testing, two of the surrounding counties had fitted RDLs that differed from Cook County for one year--this pattern differed from the epidemiologic pattern of cases observed in the AK outbreak. Our findings do not support the hypothesis that the development of AK was associated with changes in RDLs in the five Illinois counties.