In November 1982, Meade County, Kentucky health officials noted a sudden increase in the incidence of hepatitis A. Using a standardized interview of 73 cases (68 serologically confirmed), and 85 controls (all negative for antibody to hepatitis A virus), the most important risk factor identified was household use of untreated water from a single spring. A dose-response relationship was found for consumption of unboiled spring water. Water samples taken from the spring during the outbreak were contaminated with fecal coliforms.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1645986PMC
http://dx.doi.org/10.2105/ajph.75.2.161DOI Listing

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