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One option for obtaining information about the occurrence and causes of epidemic and endemic waterborne disease is to improve disease surveillance systems now in place in most state and local health departments. The authors recommend additional ways of improving disease surveillance and investigating endemic waterborne disease. Health care reform may reduce the effectiveness of the current system of laboratory-based disease reporting, but opportunities for enhanced disease surveillance may also emerge from these reforms. In addition, new laboratory technologies may make routine surveillance of enteric pathogen infections, rather than disease from these pathogens, increasingly feasible. The interests and information needs of the drinking water industry and its customers can best be assured by its informed participation in the debate over the design and goals of new disease surveillance programs. Includes 35 references, table, figure.