配送系统污染导致美国大量水传播疾病暴发。对过去30年中报告的113起与分布有关的疫情进行回顾，发现498例住院，9例死亡。自1996年以来，在社区供水系统报告的所有疫情中，45%是由于配水系统缺陷造成的。大多数与分布相关的疫情可归因于交叉连接和反虹吸的化学和微生物污染。防止配电系统受到污染是降低水传播疾病暴发风险的关键。重要的预防措施包括在整个系统中保持足够的水压；识别并更换旧的漏水水管；保持余氯并定期监测余氯；收养十字架- 连接控制程序；定期检查储存设施；系统维修后充分消毒；以及加大腐蚀控制力度。老化的供水系统基础设施使美国更容易受到水传播疾病暴发的风险。除非供水商采取行动减少配水系统污染，并为系统维护、维修和更换分配足够的资金，否则可能需要更多的法规来防止这些疫情。包括22个参考文献和表格。

Distribution system contamination has resulted in a significant number of waterborne disease outbreaks in the United States. A review of the 113 distribution-associated outbreaks reported over the past 30 years finds 498 hospitalizations and nine deaths. Since 1996, distribution system deficiencies have caused 45% of all outbreaks reported in community water systems. Most distribution-associated outbreaks were attributable to chemical and microbial contamination from cross-connections and backsiphonage. Preventing contamination of the distribution system is key to reducing the risk of waterborne disease outbreaks. Important preventive steps include maintaining adequate water pressure throughout the system; identifying and replacing older, leaking water mains; maintaining a chlorine residual and routinely monitoring the residual; adopting cross-connection control programs; inspecting storage facilities on a routine basis; adequately disinfecting after system repairs; and increasing corrosion control efforts. An aging water system infrastructure renders the United States even more vulnerable to the risk of waterborne disease outbreaks. More regulations may be required to prevent these outbreaks unless water suppliers take action to reduce distribution system contamination and sufficient funds are allocated for system maintenance, repair, and replacement. Includes 22 references, tables.