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Volume 27, Number 1—January 2021

Estimate of Burden and Direct Healthcare Cost of Infectious Waterborne Disease in the United States

Sarah A. CollierComments to Author , Li Deng, Elizabeth A. Adam, Katharine M. Benedict, Elizabeth M. Beshearse, Anna J. Blackstock, Beau B. Bruce, Gordana Derado, Chris Edens, Kathleen E. Fullerton, Julia W. Gargano, Aimee L. Geissler, Aron J. Hall, Arie H. Havelaar, Vincent R. Hill, Robert M. Hoekstra, Sujan C. Reddy, Elaine Scallan, Erin K. Stokes, Jonathan S. Yoder, and Michael J. Beach
Author affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Main Article

Table 1

Data sources used to estimate the total number of illnesses for selected infectious diseases, United States*

Active surveillance data (name of surveillance system) Passive surveillance data Administrative data
Campylobacteriosis (FoodNet) Giardiasis (NNDSS) NTM infection (HCUP NEDS/NIS)
Cryptosporidiosis (FoodNet) Legionnaires’ disease (NNDSS) Otitis externa (NAMCS, HCUP NEDS/NIS)
Norovirus (20,21) Vibrio spp. infection (COVIS) Pseudomonas pneumonia (HCUP NEDS/NIS)
Salmonellosis, nontyphoidal (FoodNet) Vibrio alginolyticus infection (COVIS) Pseudomonas septicemia (HCUP NEDS/NIS)
STEC infection, O157 (FoodNet) Vibrio parahaemolyticus infection (COVIS)
STEC infection, non-O157 (FoodNet) Vibrio vulnificus infection (COVIS)
Shigellosis (FoodNet) Other Vibrio infection (COVIS)

*COVIS, Cholera and Other Vibrio Illness Surveillance; FoodNet, Foodborne Diseases Active Surveillance Network; HCUP NEDS/NIS, Healthcare Cost and Utilization Project’s National Emergency Department Sample and National Inpatient Sample; NAMCS, National Ambulatory Medical Care Survey; NNDSS, National Notifiable Diseases Surveillance System; NTM, nontuberculous mycobacterial; STEC, Shiga toxin–producing Escherichia coli.

Main Article

  1. Armstrong  GL, Conn  LA, Pinner  RW. Trends in infectious disease mortality in the United States during the 20th century. JAMA. 1999;281:616. DOIPubMedGoogle Scholar
  2. Centers for Disease Control and Prevention. Achievements in public health, 1900–1999: control of infectious diseases. MMWR Morb Mortal Wkly Rep. 1999;48:6219.
  3. Benedict  KM, Reses  H, Vigar  M, Roth  DM, Roberts  VA, Mattioli  M, et al. Surveillance for waterborne disease outbreaks associated with drinking water—United States, 2013–2014. MMWR Morb Mortal Wkly Rep. 2017;66:121621. DOIPubMedGoogle Scholar
  4. McClung  RP, Roth  DM, Vigar  M, Roberts  VA, Kahler  AM, Cooley  LA, et al. Waterborne disease outbreaks associated with environmental and undetermined exposures to water—United States, 2013–2014. MMWR Morb Mortal Wkly Rep. 2017;66:12225. DOIPubMedGoogle Scholar
  5. Hlavsa  MC, Cikesh  BL, Roberts  VA, Kahler  AM, Vigar  M, Hilborn  ED, et al. Outbreaks associated with treated recreational water—United States, 2000–2014. MMWR Morb Mortal Wkly Rep. 2018;67:54751. DOIPubMedGoogle Scholar
  6. Craun  GF, Brunkard  JM, Yoder  JS, Roberts  VA, Carpenter  J, Wade  T, et al. Causes of outbreaks associated with drinking water in the United States from 1971 to 2006. Clin Microbiol Rev. 2010;23:50728. DOIPubMedGoogle Scholar
  7. Dieter  CA, Maupin  MA, Caldwell  RR, Harris  MA, Ivahnenko  TI. Estimated use of water in the United States in 2015. US Geological Survey; 2018 [cited 2020 Sep 24].
  8. US Environmental Protection Agency. Community water system survey 2000. Volume 1: overview. 2002 [cited 2020 Sep 24].
  9. US National Research Council. Committee on Public Water Supply Distribution Systems: Water Science and Technology Board. Drinking water distribution systems: assessing and reducing risks. Washington (DC): National Academies Press; 2006.
  10. Falkinham  JO III, Hilborn  ED, Arduino  MJ, Pruden  A, Edwards  MA. Epidemiology and ecology of opportunistic premise plumbing pathogens: Legionella pneumophila, Mycobacterium avium, and Pseudomonas aeruginosa. Environ Health Perspect. 2015;123:74958. DOIPubMedGoogle Scholar
  11. Shields  JM, Hill  VR, Arrowood  MJ, Beach  MJ. Inactivation of Cryptosporidium parvum under chlorinated recreational water conditions. J Water Health. 2008;6:51320. DOIPubMedGoogle Scholar
  12. Chappell  CL, Okhuysen  PC, Langer-Curry  R, Widmer  G, Akiyoshi  DE, Tanriverdi  S, et al. Cryptosporidium hominis: experimental challenge of healthy adults. Am J Trop Med Hyg. 2006;75:8517. DOIPubMedGoogle Scholar
  13. Paranjpye  RN, Nilsson  WB, Liermann  M, Hilborn  ED, George  BJ, Li  Q, et al. Environmental influences on the seasonal distribution of Vibrio parahaemolyticus in the Pacific Northwest of the USA. FEMS Microbiol Ecol. 2015;91:fiv121. DOIPubMedGoogle Scholar
  14. Scallan  E, Hoekstra  RM, Angulo  FJ, Tauxe  RV, Widdowson  MA, Roy  SL, et al. Foodborne illness acquired in the United States—major pathogens. Emerg Infect Dis. 2011;17:715. DOIPubMedGoogle Scholar
  15. Scallan  E, Griffin  PM, Angulo  FJ, Tauxe  RV, Hoekstra  RM. Foodborne illness acquired in the United States—unspecified agents. Emerg Infect Dis. 2011;17:1622. DOIPubMedGoogle Scholar
  16. Colford  JM Jr, Roy  S, Beach  MJ, Hightower  A, Shaw  SE, Wade  TJ. A review of household drinking water intervention trials and an approach to the estimation of endemic waterborne gastroenteritis in the United States. J Water Health. 2006;4(Suppl 2):7188. DOIPubMedGoogle Scholar
  17. Messner  M, Shaw  S, Regli  S, Rotert  K, Blank  V, Soller  J. An approach for developing a national estimate of waterborne disease due to drinking water and a national estimate model application. J Water Health. 2006;4(Suppl 2):20140. DOIPubMedGoogle Scholar
  18. Reynolds  KA, Mena  KD, Gerba  CP. Risk of waterborne illness via drinking water in the United States. Rev Environ Contam Toxicol. 2008;192:11758. DOIPubMedGoogle Scholar
  19. DeFlorio-Barker  S, Wade  TJ, Jones  RM, Friedman  LS, Wing  C, Dorevitch  S. Estimated costs of sporadic gastrointestinal illness associated with surface water recreation: a combined analysis of data from NEEAR and CHEERS studies. Environ Health Perspect. 2017;125:21522. DOIPubMedGoogle Scholar
  20. Grytdal  SP, DeBess  E, Lee  LE, Blythe  D, Ryan  P, Biggs  C, et al. Incidence of norovirus and other viral pathogens that cause acute gastroenteritis (AGE) among Kaiser Permanente member populations in the United States, 2012–2013. PLoS One. 2016;11:e0148395. DOIPubMedGoogle Scholar
  21. Hall  AJ, Rosenthal  M, Gregoricus  N, Greene  SA, Ferguson  J, Henao  OL, et al. Incidence of acute gastroenteritis and role of norovirus, Georgia, USA, 2004-2005. Emerg Infect Dis. 2011;17:13818. DOIPubMedGoogle Scholar
  22. Mead  PS, Slutsker  L, Dietz  V, McCaig  LF, Bresee  JS, Shapiro  C, et al. Food-related illness and death in the United States. Emerg Infect Dis. 1999;5:60725. DOIPubMedGoogle Scholar
  23. Scallan  E, Griffin  PM, McLean  HQ, Mahon  BE. Hospitalisations due to bacterial gastroenteritis: A comparison of surveillance and hospital discharge data. Epidemiol Infect. 2018;146:95460. DOIPubMedGoogle Scholar
  24. Gargano  JW, Adam  EA, Collier  SA, Fullerton  KE, Feinman  SJ, Beach  MJ. Mortality from selected diseases that can be transmitted by water - United States, 2003-2009. J Water Health. 2017;15:43850. DOIPubMedGoogle Scholar
  25. Beshearse E, Bruce BB, Nane GF, Cooke RM, Aspinall W, Hald T, et al. Using structured expert judgment for attribution of foodborne and waterborne illnesses to comprehensive transmission pathways, United States. Emerg Infect Dis. 2021 Jan [in press].
  26. Aspinall  WP, Cooke  RM, Havelaar  AH, Hoffmann  S, Hald  T. Evaluation of a performance-based expert elicitation: WHO global attribution of foodborne diseases. PLoS One. 2016;11:e0149817. DOIPubMedGoogle Scholar
  27. Cooke  RM, Goossens  LHJ; European Commission Directorate-General for Research and Innovation. Procedures guide for structured expert judgement. Brussels: Directorate-General for Research; 2000.
  28. Vose  D. Risk analysis: a quantitative guide. 3rd ed. Hoboken (NJ): Wiley; 2008.
  29. R Core Team. R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2018.
  30. Adam  EA, Collier  SA, Fullerton  KE, Gargano  JW, Beach  MJ. Prevalence and direct costs of emergency department visits and hospitalizations for selected diseases that can be transmitted by water, United States. J Water Health. 2017;15:67383. DOIPubMedGoogle Scholar
  31. Collier  SA, Stockman  LJ, Hicks  LA, Garrison  LE, Zhou  FJ, Beach  MJ. Direct healthcare costs of selected diseases primarily or partially transmitted by water. Epidemiol Infect. 2012;140:200313. DOIPubMedGoogle Scholar
  32. Prüss-Ustün  A, Bos  R, Gore  F, Bartram  J; World Health Organization. Safer water, better health: costs, benefits and sustainability of interventions to protect and promote health. Geneva: The Organization; 2008.
  33. Gibney  KB, O’Toole  J, Sinclair  M, Leder  K. Burden of disease attributed to waterborne transmission of selected enteric pathogens, Australia, 2010. Am J Trop Med Hyg. 2017;96:14003. DOIPubMedGoogle Scholar
  34. Murphy  HM, Thomas  MK, Medeiros  DT, McFADYEN  S, Pintar  KD. Estimating the number of cases of acute gastrointestinal illness (AGI) associated with Canadian municipal drinking water systems. Epidemiol Infect. 2016;144:137185. DOIPubMedGoogle Scholar
  35. Murphy  HM, Thomas  MK, Schmidt  PJ, Medeiros  DT, McFADYEN  S, Pintar  KD. Estimating the burden of acute gastrointestinal illness due to Giardia, Cryptosporidium, Campylobacter, E. coli O157 and norovirus associated with private wells and small water systems in Canada. Epidemiol Infect. 2016;144:135570. DOIPubMedGoogle Scholar
  36. Cassini  A, Colzani  E, Kramarz  P, Kretzschmar  ME, Takkinen  J. Impact of food and water-borne diseases on European population health. Curr Opin Food Sci. 2016;12:219. DOIGoogle Scholar
  37. Collier  SA, Wade  TJ, Sams  EA, Hlavsa  MC, Dufour  AP, Beach  MJ. Swimming in the USA: beachgoer characteristics and health outcomes at US marine and freshwater beaches. J Water Health. 2015;13:53143. DOIPubMedGoogle Scholar
  38. Centers for Disease Control and Prevention. Cryptosporidiosis summary report—National Notifiable Diseases Surveillance System, United States, 2017; 2019 [cited 2020 Sep 24].
  39. Scallan  E, Scallan  E. Activities, achievements, and lessons learned during the first 10 years of the Foodborne Diseases Active Surveillance Network: 1996-2005. Clin Infect Dis. 2007;44:71825. DOIPubMedGoogle Scholar

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Page created: September 21, 2020
Page updated: December 21, 2020
Page reviewed: December 21, 2020
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