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The objective of this study was to validate QMRA predictions against epidemiological measurements from outbreaks of waterborne gastrointestinal disease. I screened 2,000 papers and identified 12 outbreaks with the necessary data: disease rates measured using epidemiological methods and pathogen concentrations measured in the source water. Eight of the 12 outbreaks were caused by <jats:italic>Cryptosporidium<\/jats:italic>, three by <jats:italic>Giardia<\/jats:italic>, and one by norovirus. Disease rates varied from 5.5 \u00d7 10<jats:sup>\u22126<\/jats:sup> to 1.1 \u00d7 10<jats:sup>\u22122<\/jats:sup> cases\/person\u2010day, and reported pathogen concentrations varied from 1.2 \u00d7 10<jats:sup>\u22124<\/jats:sup> to 8.6 \u00d7 10<jats:sup>2<\/jats:sup> per liter. I used these concentrations with single\u2010hit dose\u2013response models for all three pathogens to conduct QMRA, producing both point and interval predictions of disease rates for each outbreak. Comparison of QMRA predictions to epidemiological measurements showed good agreement; interval predictions contained measured disease rates for 9 of 12 outbreaks, with point predictions off by factors of 1.0\u2013120 (median = 4.8). Furthermore, 11 outbreaks occurred at mean doses of less than 1 pathogen per exposure. Measured disease rates for these outbreaks were clearly consistent with a single\u2010hit model, and not with a \u201ctwo\u2010hit\u201d threshold model. These results demonstrate the validity of QMRA for predicting disease rates due to <jats:italic>Cryptosporidium<\/jats:italic> and <jats:italic>Giardia<\/jats:italic>.<\/jats:p>","DOI":"10.1111\/risa.13189","type":"journal-article","created":{"date-parts":[[2018,10,6]],"date-time":"2018-10-06T02:42:24Z","timestamp":1538793744000},"page":"599-615","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Validation of Quantitative Microbial Risk Assessment Using Epidemiological Data from Outbreaks of Waterborne Gastrointestinal Disease"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5756-514X","authenticated-orcid":false,"given":"Tucker","family":"Burch","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,10,4]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268800058180"},{"key":"e_1_2_7_3_1","volume-title":"Quantitative microbial risk assessment (QMRA) wiki","author":"Center for Advancing Microbial Risk Assessment","year":"2015"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.2006.75.851"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.2166\/wh.2006.018"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.2166\/wst.1997.0700"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00077-09"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.2166\/wh.2006.015"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.2166\/wh.2006.016"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199503303321304"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-92-2-165"},{"key":"e_1_2_7_12_1","volume-title":"Assessment of water supply and associated matters in relation to the incidence of cryptosporidiosis in West Herts and North London in February and March 1997","author":"Gray M. 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