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We report an outbreak associated with a dinner cruise on Lake Michigan. This took place on the same day as heavy rainfall, which resulted in 42·4 billion liters of rainwater and storm runoff containing highly diluted sewage being released into the lake. Of 72 cruise participants, 41 (57%) reported gastroenteritis. Stool specimens were positive for Shigella sonnei (n=3), Giardia (n=3), and Cryptosporidium (n=2). Ice consumption was associated with illness (risk ratio 2·2, P=0·011). S. sonnei was isolated from a swab obtained from the one of the boat's ice bins. Environmental inspection revealed conditions and equipment that could have contributed to lake water contaminating the hose used to load potable water onto the boat. Knowledge of water holding and distribution systems on boats, and of potential risks associated with flooding and the release of diluted sewage into large bodies of water, is crucial for public health guidance regarding recreational cruises.

Objective: To review the experience of a large children's hospital and two community hospitals in Chicago in which malaria was diagnosed in children during a recent 6-year period., Methods: Retrospective medical record review covering the years 1985 to 1990., Results: Twenty cases of childhood malaria were diagnosed, generally in patients hospitalized for fever unresponsive to oral antibiotics also associated with splenomegaly, with presumptive diagnoses of malignancy, typhoid fever, acute appendicitis, or urinary tract infection. History of recent immigration to the United States or travel to a malaria-endemic area was frequently not elicited until several days into hospitalization, thus delaying diagnosis and therapy., Conclusions: Because malaria in the United States pediatric population has increased as a result of foreign immigration and overseas travel, pediatricians must be alert to the possibility of malaria in febrile children, and the importance of antimalarial prophylaxis should be communicated to parents of children traveling to endemic areas.