Volume 27, Number 1—January 2021
Research
Estimate of Burden and Direct Healthcare Cost of Infectious Waterborne Disease in the United States
Sarah A. Collier
, 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
, 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
Table 2
Estimated number of total cases of domestically acquired waterborne illness in 2014 for selected infectious diseases, United States*
| Disease or syndrome | Estimated confirmed cases | Multipliers |
Estimated total cases (95% CrI) | International travel, % | Waterborne, % (95% CrI) | Domestically acquired waterborne, no. (95% CrI) | |
|---|---|---|---|---|---|---|---|
| Under-reporting | Under-diagnosis | ||||||
| Campylobacteriosis | 54,000 | 1.0 | 28.3 | 1,540,000 (597,000–3,250,000) | 14.4 | 13 (1–31) | 171,000 (13,900–586,000) |
| Cryptosporidiosis | 8,450 | 1.0 | 97.3 | 823,000 (243,000–2,160,000) | 9.9 | 43 (17–73) | 322,000 (61,700–993,000) |
| Giardiasis | 17,900 | 1.30 | 45.9 | 1,070,000 (727,000–1,560,000) | 12.3 | 44 (16–78) | 415,000 (140,000–816,000) |
| Legionnaires’ disease | 5,030 | 1.0 | 2.3 | 11,400 (8,920–13,600) | 1.0 | 97 (67–100) | 11,000 (7,430–13,300) |
| NTM infection | 25,700 | 1.0 | 3.8 | 97,000 (75,700–122,000) | 1.0 | 72 (39–94) | 68,900 (35,800–100,000) |
| Norovirus | NA | 1.0 | NA | 21,800,000 (12,100,000–36,000,000) | 1.1 | 6 (0–25) | 1,330,000 (5,310–5,510,000) |
| Otitis externa† | 1,720,000 | 1.0 | 3.4 | 5,980,000 (3,200,000–8,880,000) | 1.3 | 79 (67–95)† | 4,670,000 (2,350,000–7,290,000) |
| Pseudomonas pneumonia | 15,800 | 1.0 | 2.0 | 31,700 (19,300–46,000) | 1.0 | 51 (14–80) | 15,900 (4,240–29,000) |
| Pseudomonas septicemia | 13,000 | 1.0 | 2.0 | 26,100 (16,700–35,900) | 1.0 | 22 (3–53) | 5,760 (743–14,400) |
| Salmonellosis, nontyphoidal | 46,400 | 1.0 | 29.1 | 1,350,000 (733,000–2,450,000) | 9.7 | 6 (0–22) | 77,000 (5,640–277,000) |
| STEC infection, serotype O157 | 3,530 | 1.0 | 18.2 | 64,200 (13,000–188,000) | 4.0 | 5 (1–13) | 3,360 (336–12,900) |
| STEC infection, serotype non-O157 | 4,550 | 1.0 | 48.1 | 219,000 (80,000–493,000) | 15.3 | 6 (0–17) | 11,400 (0–43,900) |
| Shigellosis |
13,600 |
1.0 |
33.1 |
449,000
(97,800–1,350,000) |
7.8 |
4
(1–21) |
17,300
(1,080–77,500) |
| Vibrio spp. infection | 1,230 | NA | NA | 172,000 (126,000–231,000) | NA | NA | 34,600 (17,600–56,900) |
| V. alginolyticus | 234 | 1.1 | 142.8 | 36,700 (23,600–54,800) | 6.5 | 37 (13–71) | 12,700 (4,100–25,400) |
| V. parahaemolyticus | 593 | 1.1 | 141.6 | 92,400 (55,000–144,000) | 6.7 | 24 (7–38) | 20,800 (6,000–39,000) |
| V. vulnificus | 133 | 1.1 | 1.7 | 249 (178–340) | 1.5 | 77 (40–91) | 188 (93–277) |
| Other Vibrio |
271 |
1.1 |
142.8 |
42,600
(25,500–66,500) |
14.4 |
2
(0–23) |
879
(3–8,490) |
| Total illness | NA | NA | NA | 33,600,000 (23,500,000–48,000,000) | NA | NA | 7,150,000 (3,880,000–12,000,000) |
*Estimates rounded to 3 significant figures. CrI, credible interval; NA, not applicable; NTM, nontuberculous mycobacteria; STEC, Shiga toxin–producing Escherichia coli. †Combines the waterborne source attribution (25) for Pseudomonas spp. otitis externa (81%) and Staphylococcus aureus (75%) in a ratio of 2:1. More details provided in Appendix 1 (https://wwwnc.cdc.gov/EID/article/27/1/19-0676-App1.pdf).
Page created: September 21, 2020
Page updated: December 21, 2020
Page reviewed: December 21, 2020
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.