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Volume 27, Number 8—August 2021
Letter

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

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To the Editors: We read with interest an article by S.A. Collier et al. (1) estimating the economic burden of waterborne illnesses in the United States. Although we found the study noteworthy, the burden estimates differ greatly from those in our 2018 study (2) of the economic burden from recreational waterborne illness in the United States. The studies estimated very different numbers of cases: Collier et al. estimated ≈7.1 million total waterborne illnesses, but we estimated ≈90 million recreational waterborne illnesses in untreated water. Collier et al. estimated $3.3 billion in total direct costs from all waterborne illness caused by 17 pathogens, but we estimated $2.9 billion from recreational waterborne illness alone. Both studies used similar methods to address underreporting and underdiagnosis of illness. Key differences between studies include that Collier et al. summarized healthcare costs associated with infections caused by 17 pathogens that might be waterborne, then relied heavily on expert judgment (3) to estimate the proportion attributable to water exposure. In contrast, our study used data from large cohort studies of water recreation to estimate the burden from mild and moderate illnesses and outbreak data to estimate the burden from severe illnesses from water recreation. Collier et al. estimated the direct costs of illness, whereas our study estimated both direct and indirect costs (e.g., workplace absence). Enteric pathogens responsible for gastrointestinal symptoms after water recreation are generally not identified in clinical testing (4); because Collier et al. used economic burden estimates from waterborne illness based only on 17 pathogens, the study substantially underestimates the overall number of cases and associated economic burden. Future research should consider cohort and outbreak data for treated and untreated recreational water and drinking water to estimate the total economic burden from waterborne illness.

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Stephanie DeFlorio-BarkerComments to Author , Abhilasha Shrestha, and Samuel Dorevitch
Author affiliations: US Environmental Protection Agency, Research Triangle Park, North Carolina, USA (S. DeFlorio-Barker); University of Illinois–Chicago School of Public Health, Chicago, Illinois, USA (A. Shrestha, S. Dorevitch)

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References

  1. Collier  SA, Deng  L, Adam  EA, Benedict  KM, Beshearse  EM, Blackstock  AJ, et al. Estimate of burden and direct healthcare cost of infectious waterborne disease in the United States. Emerg Infect Dis. 2021;27:1409. DOIPubMed
  2. DeFlorio-Barker  S, Wing  C, Jones  RM, Dorevitch  S. Estimate of incidence and cost of recreational waterborne illness on United States surface waters. Environ Health. 2018;17:3. DOIPubMed
  3. Beshearse  E, Bruce  BB, Nane  GF, Cooke  RM, Aspinall  W, Hald  T, et al. Attribution of illnesses transmitted by food and water to comprehensive transmission pathways using structured expert judgment, United States. Emerg Infect Dis. 2021;27:18295. DOIPubMed
  4. Dorevitch  S, Dworkin  MS, Deflorio  SA, Janda  WM, Wuellner  J, Hershow  RC. Enteric pathogens in stool samples of Chicago-area water recreators with new-onset gastrointestinal symptoms. Water Res. 2012;46:496172. DOIPubMed

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Cite This Article

DOI: 10.3201/eid2708.210242

Original Publication Date: July 15, 2021

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Table of Contents – Volume 27, Number 8—August 2021

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Stephanie DeFlorio-Barker, US Environmental Protection Agency, 109 TW Alexander Dr M/D B243-01, Research Triangle Park, NC 27709, USA

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Page created: July 15, 2021
Page updated: July 19, 2021
Page reviewed: July 19, 2021
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.
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