Water Safety

Water Safety

ASTHO supports state efforts to ensure safe drinking water, protect against recreational water hazards, strengthen wastewater programs, and support policies aimed at improving public health protection by enhancing our nation’s water infrastructure.

Legionnaires' Disease

Digging Deeper Into Legionnaires’ Disease Guidance Needs for State and Territorial Health Agencies
As a follow-up to the 2019 report, Legionnaires’ Disease Outbreak Response Gap Analysis, ASTHO conducted key informant interviews with five state health agencies to better understand key topics. Targeted areas of discussion were the overall structure of Legionnaires’ disease programs, diagnosis and clinical testing protocols, surveillance and reporting, outbreak and response, water management programs and prevention, and risk communication. This report shares results and key takeaways from these interviews, including notable challenges.

Understanding Legionnaires' Disease Outbreak Response Gaps and Resource Needs: Results from a Survey of State and Territorial Health Agencies
In spring 2019, ASTHO fielded a survey to improve our understanding of the Legionnaires’ Disease (LD) guidance available to state and territorial health agencies, to learn about state and territorial health agency response to suspected or confirmed LD outbreaks, and to identify resource needs and gaps in existing guidance. The survey focused on how LD is identified; the basic structure and processes of LD surveillance programs, including states’ clinical protocols, outbreak response, prevention, and risk communication; and gaps in existing guidance, protocols, and tools. This report shares findings from the survey, including links to relevant state and federal resources in the appendices.

Using Water Quality Monitoring Data for your Building Water Management Program
This factsheet was jointly developed with the Association of State Drinking Water Administrator and outlines how to monitor water quality in facilities to prevent the growth of Legionella and other opportunistic pathogens. It discusses important basic water quality monitoring parameters, including temperature, pH, turbidity, and disinfectant residual.

Legionella Communications Factsheet: A Guide for Health Agency Staff
Legionella is the leading cause of waterborne disease outbreaks associated with drinking water in the United States. Control of Legionella and other plumbing pathogens is complicated and is a shared responsibility between water utilities, high-risk individuals, and commercial, industrial, institutional, and residential customers. ASTHO partnered with ASDWA to develop this communications factsheet to provide information that state health agency staff can use when talking to building and facility personnel about Legionella and other opportunistic biofilm pathogens, provide information to increase building owner awareness of the potential for pathogens to grow in building water systems, including resources that can help them reduce or minimize pathogen growth in their plumbing, and outline proactive Legionella-related communications methods for state agencies to consider.

Water Preparedness

State and Territorial Preparedness for Drinking Water Emergencies
Managing an effective response to public drinking water emergencies is essential to maintaining critical operations of community infrastructure and protecting public health. ASTHO has worked with state and territorial health agencies and partners to facilitate dialogue and collect data on current gaps and resource needs in drinking water emergency preparedness. This report summarizes recent findings and recommendations for enhancing state and territorial water preparedness and collaborative emergency response efforts.

State of Water Preparedness: A 2018 Scan of Water Preparedness and Response Infrastructure in State and Territorial Health Agencies
ASTHO conducted a survey of state and territorial directors of public health preparedness and environmental health to learn more about the protocols, tools, resources, infrastructure, and gaps related to drinking water emergency preparedness and response infrastructure. The data provided in this report is one effort to identify strengths and understand the complexities of water preparedness, but also to examine opportunities for improvement in the future.

Access and Availability

Water Scarcity Issue Brief (2015)
This brief provides background information on water scarcity and contains examples of the environmental, health, and economic consequences of water scarcity on the U.S. economy.

Drinking Water

Everyone in the United States should have access to safe and reliable drinking water regardless of their geographic location, income, education, racial, or ethnic background.

Safe Drinking Water Resources for States and Territories
A set of resources as reference for states and territories in light of the water safety emergency in Flint, MI. 

Source Water Collaborative
ASTHO works with this nationwide coalition to protect the lakes, rivers, and aquifers supplying America’s drinking water.

Recreational Water Safety

Harmful Algal Blooms
Resources on blue-green algae and harmful algal blooms from states, federal agencies, and international organizations.

Risk Communication of Waterborne Contaminants

In 2018, ASTHO and the Environmental Council of the States (ECOS) interviewed health and environmental agency staff from 13 states regarding their risk communication strategies and lessons learned for two priority waterborne contaminants, per- and polyfluoroalkyl substances (PFAS) (6 states) and harmful algal blooms (HABs) (7 states). We compiled the results into case studies that outline the background of contamination in the state, development of guidance values and health advisories, rollout of advisories and relevant resources, key messages for the public, and challenges and gaps.

In 2019, ASTHO and ECOS built upon these efforts to develop a clearinghouse of PFAS risk communication resources. This clearinghouse is intended to share existing best practices and support states with risk communication strategies for chemicals of emerging concern.

PFAS Case Studies:HAB Case Studies:









ASTHO and ECOS hosted webinars to showcase states' case studies on PFAS and HABs, along with risk communication strategies and lessons learned for these waterborne contaminants.

For more information on this project, please visit the EPA-States Collaborative Pilot Status Reports webpage.

Waste Water Treatment and Biosolids

WERF Protocol for the Surveillance and Investigation of the Concerns Reported by Neighbors of Land Application
This project helps to lay the groundwork and framework for a surveillance and timely response investigation system implemented by multiple jurisdictions throughout the U.S. using a standardized investigation protocol which will benefit future stakeholders. The final protocol includes questionnaires administered to neighbors of land application, biosolids generators, and appliers.