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JEH Quiz #2 (October 2008)

Featured Article:
“Outbreak of Giardiasis and Cryptosporidiosis Associated with a Neighborhood Interactive Water Fountain¾Florida, 2006”

Questions compiled by co-author
Leah Eisenstein, M.P.H.

Available to NEHA members only, the JEH Quiz, offered six times per calendar year through the Journal of Environmental Health, is a convenient tool for self-assessment and an easily accessible means to accumulate continuing-education (CE) credits toward maintaining your NEHA credentials.

It's a simple process...

Read the featured article in the Journal.
Select the correct answer to each JEH Quiz question and click on the Submit button at the bottom of the page.
One CE credit will be applied to your account with an effective date of October 1, 2008 (first day of issue).
Check your continuing education account online.

Quiz deadline: January 1, 2009

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1.	How many illnesses and deaths were caused by recreational water between 1995 and 2004 in the United States?
	a.	8,000 illnesses and 12 deaths.
	b.	11,500 illnesses and 16 deaths.
	c.	15,000 illnesses and 20 deaths.
	d.	18,500 illnesses and 24 deaths.
2.	How many waterborne disease outbreaks were associated with interactive water fountains between 1995 and 2004 in the United States?
	a.	Three.
	b.	Six.
	c.	Nine.
	d.	12.
3.	Which environmental aspects of Splash Park A were evaluated during the investigation of this outbreak?
	a.	Facility appearance.
	b.	Filtration, disinfection, and water chemistry.
	c.	Record keeping.
	d.	All of the above.
4.	*What was the most significant environmental finding noted during the assessment of Splash Park A with respect to transmission of Giardia* and Cryptosporidium?**
	a.	Piles of trash in equipment room.
	b.	Algae growing on the surface of the fountain area.
	c.	Chlorine level below 0.5 parts per million.
	d.	Improperly maintained maintenance logs.
5.	How many cases of giardiasis and cryptosporidiosis associated with Splash Park A were identified in the course of investigation for this outbreak?
	a.	39 primary cases and eight secondary cases.
	b.	49 primary cases and eight secondary cases.
	c.	39 primary cases and 10 secondary cases.
	d.	49 primary cases and 10 secondary cases.
6.	The median ages of primary Splash Park A cases and secondary Splash Park A cases were consistent with children being infected when playing in the fountain and transmitting infections to their caregivers.
	a.	True.
	b.	False.
7.	This outbreak was most likely caused by a single point-source contamination event.
	a.	True.
	b.	False.
8.	*How long can Giardia* cysts and Cryptosporidium oocysts survive in water with a chlorine level of 1.0 parts per million?**
	a.	30 minutes and 7.9 days, respectively.
	b.	35 minutes and 8.3 days, respectively.
	c.	40 minutes and 9.4 days, respectively.
	d.	45 minutes and 10.6 days, respectively.
9.	Which of the following factors, in general, contributes to the increased risk of disease transmission in interactive water fountain settings?
	a.	Interactive fountains are popular with diaper-aged children due to minimal drowning risk, which increases the risk of fecal contamination.
	b.	The misconception that potable fresh water is used instead of recycled chlorinated nonpotable water encourages children to swallow water intentionally.
	c.	Fecal accidents may go unnoticed due to lack of supervision.
	d.	All of the above.
10.	A barrier to this investigation was the very low rate of symptomatic carriers of giardiasis and cryptosporidiosis.
	a.	True.
	b.	False.
11.	Supplemental disinfection methods, such as ultraviolet light irradiation, ozonation, or chlorine dioxide that quickly kill Giardia and Cryptosporidium, should be considered for interactive water fountains due to the increased risk of fecal contamination.
	a.	True.
	b.	False.
12.	What is the significance of the findings of this outbreak investigation?
	a.	It is the first published example of an outbreak associated with an interactive fountain.
	b.	It is the first published example of an outbreak of giardiasis associated with an interactive water fountain.
	c.	It is the first published example of an outbreak of giardiasis and cryptosporidiosis associated with a recreational water venue.
	d.	None of the above.