The caller from Cincinnati had a disquieting story for Ottawa County health officials.
It was late July, and a group of four adults and six children had recently visited South Bass Island. Two days after their weekend trip, all the youngsters awakened in the middle of the night with nausea, diarrhea, and vomiting.
Within days, sanitarians with the county health department learned that other visitors and some residents had been stricken with the same symptoms. A trickle of calls soon grew into a flood, and the health department found itself overwhelmed, Commissioner Nancy Osborn said yesterday.
Fortunately, a partnership of local, state, and federal health officials helped Ottawa County's department interview potential victims, handle media requests, and pinpoint the likely cause of the gastrointestinal outbreak that sickened 1,450 people.
"We learned that mutual aid is absolutely critical," Ms. Osborn said during an environmental health forum at Toledo Hospital sponsored by the Toledo-Lucas County health department. "It is absolutely essential. We couldn't have done it without all our state and local partners."
As the first reports of nausea, vomiting, and diarrhea began reaching the Ottawa County health department in early August, 2004, local investigators looked at food poisoning as the most likely culprit, Ms. Osborn said.
"Those are very normal symptoms for foodborne illnesses," she said in an interview after her presentation.
By Aug. 16, Ottawa County was receiving 200 calls a day about the outbreak and asked the Wood County and Toledo-Lucas County health departments to help conduct interviews. Eventually, 11 other Ohio city and county health departments also assisted with that task.
Soon, the Ohio Department of Health took over the investigation, and a team of three epidemiologists from the federal Centers for Disease Control and Prevention arrived.
It was about that time that the first signs began pointing toward water contamination.
Eventually, indicators of possible fecal contamination were found in 17 wells at 14 public establishments in Put-in-Bay Township tested by the Ohio Environmental Protection Agency and in dozens of private wells tested by state and local experts.
The state health department recommended Aug. 26 that island visitors and residents use bottled or boiled water, and the number of reported illness cases soon began dropping. EPA has ordered owners of public wells to treat them with chlorination and ultraviolet light or provide bottled water or water from the village of Put-in-Bay's system.
An expansion of the village water and sewage systems is under way, and Ms. Osborn said the entire island eventually needs such service.
"The solution to that is island-wide sewage systems and island-wide water systems," she said.
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