Volume 29, Number 7—July 2023
Research
Estimating Waterborne Infectious Disease Burden by Exposure Route, United States, 2014
Table 4
Disease or syndrome | Water exposure route, no. deaths (95% CrI) |
||
---|---|---|---|
Recreational water† | Drinking water‡ | NRND water§ | |
Acute otitis externa | 208 (98–352) | 6 (0–41) | 5 (0–24) |
Campylobacteriosis | 9 (0–65) | 12 (0–81) | 6 (0–49) |
Cryptosporidiosis | 16 (0–96) | 6 (0–46) | 3 (0–22) |
Giardiasis | 0 (0–3) | 0 (0–2) | 0 (0–2) |
Legionnaires’ disease | 91 (15–347) | 520 (180–858) | 384 (122–727) |
NTM infection | 476 (0–1,650) | 2,560 (950–4,370) | 763 (0–2,110) |
Norovirus infection | 25 (0–116) | 25 (0–114) | 4 (0–32) |
Pseudomonas pneumonia | 349 (44–795) | 43 (3–213) | 339 (58–779) |
Pseudomonas septicemia | 50 (3–236) | 112 (3–449) | 532 (58–1,390) |
Salmonellosis, nontyphoidal |
4 (0–24) |
18 (0–79) |
2 (0–11) |
STEC infections | |||
O157 serotype | 1 (0–12) | 0 (0–5) | 0 (0–0) |
Non-O157 serotype |
0 (0–6) |
0 (0–1) |
0 (0–4) |
Shigellosis |
0 (0–7) |
0 (0–0) |
0 (0–2) |
Vibrio spp. infections | 58 (0–53) | 0 (0–0) | 1 (0–0) |
V. alginolyticus | 1 (0–4) | 0 (0–0) | 0 (0–0) |
V. parahaemolyticus | 4 (0–9) | 0 (0–0) | 0 (0–0) |
V. vulnificus | 53 (21–84) | 0 (0–5) | 0 (0–13) |
Other Vibrio spp. |
0 (0–2) |
0 (0–0) |
0 (0–0) |
Total deaths | 1,290 (591–2,520) | 3,300 (1,630–5,180) | 2,040 (909–3,690) |
*Estimates are rounded to 3 significant figures. CrI, credible interval; NRND, nonrecreational nondrinking; NTM, nontuberculous mycobacteria; STEC, Shiga toxin–producing Escherichia coli.†Recreational water is used for recreational activities (e.g., swimming) in treated (e.g., pools, hot tubs, and splash pads) or untreated (e.g., lakes, rivers, and oceans) venues (19). ‡Drinking water is used primarily for drinking but can also be used for hygiene activities, like washing or showering, and can come from a public water system, a private well, or commercially bottled sources (19). §NRND water is used for purposes other than recreation or drinking (e.g., for agriculture, industry, medical treatment, backcountry streams, or flood waters) (19).
References
- 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;27:140–9. DOIPubMedGoogle Scholar
- 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;66:1216–21. DOIPubMedGoogle Scholar
- 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;23:507–28. DOIPubMedGoogle Scholar
- Cutler D, Miller G. The role of public health improvements in health advances: the twentieth-century United States. Demography. 2005;42:1–22. DOIPubMedGoogle Scholar
- US Global Change Research Program. The impacts of climate change on human health in the United States. A scientific assessment, 2016. Chapter 6. Climate impacts on water-related illness [cited 2023 Feb 7]. https://health2016.globalchange.gov/high/ClimateHealth2016_FullReport.pdf
- US Geological Survey. Estimated use of water in the United States in 2015. Circular 1441, 2018 [cited 2023 Jan 15]. https://pubs.er.usgs.gov/publication/cir1441
- Wallender EK, Ailes EC, Yoder JS, Roberts VA, Brunkard JM. Contributing factors to disease outbreaks associated with untreated groundwater. Ground Water. 2014;52:886–97. DOIPubMedGoogle Scholar
- Environmental Protection Agency. Community water system survey 2000. Volume 1: overview [cited 2022 Dec 11]. https://nepis.epa.gov/Exe/ZyPDF.cgi?Dockey=20001ZK5.txt
- National Research Council. Drinking water distribution systems: assessing and reducing risks. Washington: National Academies Press; 2006.
- 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;123:749–58. DOIPubMedGoogle Scholar
- Graciaa DS, Cope JR, Roberts VA, Cikesh BL, Kahler AM, Vigar M, et al. Outbreaks associated with untreated recreational water—United States, 2000–2014. MMWR Morb Mortal Wkly Rep. 2018;67:701–6. DOIPubMedGoogle Scholar
- Vanden Esschert KL, Mattioli MC, Hilborn ED, Roberts VA, Yu AT, Lamba K, et al. Outbreaks associated with untreated recreational water—California, Maine, and Minnesota, 2018–2019. MMWR Morb Mortal Wkly Rep. 2020;69:781–3. DOIPubMedGoogle Scholar
- 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):201–40. DOIPubMedGoogle Scholar
- Reynolds KA, Mena KD, Gerba CP. Risk of waterborne illness via drinking water in the United States. Rev Environ Contam Toxicol. 2008;192:117–58.PubMedGoogle Scholar
- Verhougstraete M, Reynolds KA, Pearce-Walker J, Gerba C. Cost-benefit analysis of point-of-use devices for health risks reduction from pathogens in drinking water. J Water Health. 2020;18:968–82. DOIPubMedGoogle Scholar
- 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):71–88. DOIPubMedGoogle Scholar
- 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. DOIPubMedGoogle Scholar
- Dorevitch S, Pratap P, Wroblewski M, Hryhorczuk DO, Li H, Liu LC, et al. Health risks of limited-contact water recreation. Environ Health Perspect. 2012;120:192–7. DOIPubMedGoogle Scholar
- 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;27:182–95. DOIPubMedGoogle Scholar
- van Asperen IA, de Rover CM, Schijven JF, Oetomo SB, Schellekens JF, van Leeuwen NJ, et al. Risk of otitis externa after swimming in recreational fresh water lakes containing Pseudomonas aeruginosa. BMJ. 1995;311:1407–10. DOIPubMedGoogle Scholar
- Hajjartabar M. Poor-quality water in swimming pools associated with a substantial risk of otitis externa due to Pseudomonas aeruginosa. Water Sci Technol. 2004;50:63–7 . DOIPubMedGoogle Scholar
- Wade TJ, Sams EA, Beach MJ, Collier SA, Dufour AP. The incidence and health burden of earaches attributable to recreational swimming in natural waters: a prospective cohort study. Environ Health. 2013;12:67. DOIPubMedGoogle Scholar
- Calderon R, Mood EW. A epidemiological assessment of water quality and “swimmer’s ear”. Arch Environ Health. 1982;37:300–5 . DOIPubMedGoogle Scholar
- Centers for Disease Control and Prevention. Model Aquatic Health Code, 3rd edition. 2018 [cited 2022 Dec 20]. https://www.cdc.gov/mahc/editions/previous.html
- Hlavsa MC, Aluko SK, Miller AD, Person J, Gerdes ME, Lee S, et al. Outbreaks associated with treated recreational water—United States, 2015–2019. MMWR Morb Mortal Wkly Rep. 2021;70:733–8. DOIPubMedGoogle Scholar
- Centers for Disease Control and Prevention. Healthy swimming. April 28, 2022 [cited 2022 May 16]. https://www.cdc.gov/healthywater/swimming/index.html
- 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;67:547–51. DOIPubMedGoogle Scholar
- Centers for Disease Control and Prevention (CDC). Estimated burden of acute otitis externa—United States, 2003-2007. MMWR Morb Mortal Wkly Rep. 2011;60:605–9.PubMedGoogle Scholar
- Centers for Disease Control and Prevention. Healthcare-associated infections (HAIs). August 12, 2019 [cited 2022 Jun 16]. https://www.cdc.gov/hai/organisms/ntm/health-departments.html
- Shih DC, Cassidy PM, Perkins KM, Crist MB, Cieslak PR, Leman RL. Extrapulmonary nontuberculous mycobacterial disease surveillance—Oregon, 2014–2016. MMWR Morb Mortal Wkly Rep. 2018;67:854–7. DOIPubMedGoogle Scholar
- Grigg C, Jackson KA, Barter D, Czaja CA, Johnston H, Lynfield R, et al. Epidemiology of pulmonary and extrapulmonary nontuberculous mycobacteria infections at 4 US emerging infections program sites: a six-month pilot. Clin Infect Dis. 2023 Apr 21 [Epub ahead of print]. PubMedGoogle Scholar
- American Society of Heating, Refrigerating and Air-Conditioning Engineers. ANSI/ASHRAE standard 188–2018, legionellosis: risk management for building water systems. Peachtree Corners (Georgia, USA). Society. 2018.
- Centers for Disease Control and Prevention. Healthcare-associated infections. Reduce risk from water. September 11, 2019 [cited 2022 Nov 29]. https://www.cdc.gov/hai/prevent/environment/water.html
- Clopper BR, Kunz JM, Salandy SW, Smith JC, Hubbard BC, Sarisky JP. A methodology for classifying root causes of outbreaks of Legionnaires’ disease: deficiencies in environmental control and water management. Microorganisms. 2021;9:89. DOIPubMedGoogle Scholar
- Centers for Disease Control and Prevention. Safe water program. 2022 [cited 2022 Sep 13]. https://www.cdc.gov/nceh/ehs/water/index.html
- Centers for Disease Control and Prevention. Developing a water management program to reduce Legionella growth and spread in buildings. A practical guide to implementing industry standards. June 24, 2021 [cited 2022 May 19]. https://www.cdc.gov/legionella/downloads/toolkit.pdf
- Centers for Disease Control and Prevention. Toolkit for controlling Legionella in common sources of exposure. 2021 [cited 2022 Dec 3]. https://www.cdc.gov/legionella/wmp/control-toolkit/index.html
- Centers for Disease Control and Prevention. Reduce risk from water, from plumbing to patients [cited 2023 Mar 16]. https://www.cdc.gov/hai/prevent/environment/water.html
- Kanamori H, Weber DJ, Rutala WA. Healthcare outbreaks associated with a water reservoir and infection prevention strategies. Clin Infect Dis. 2016;62:1423–35. DOIPubMedGoogle Scholar
- Gamage SD, Ambrose M, Kralovic SM, Roselle GA. Water safety and health care: preventing infections caused by opportunistic premise plumbing pathogens. Infect Dis Clin North Am. 2021;35:667–95. DOIPubMedGoogle Scholar
- Decker BK, Palmore TN. The role of water in healthcare-associated infections. Curr Opin Infect Dis. 2013;26:345–51. DOIPubMedGoogle Scholar
- Williams MM, Armbruster CR, Arduino MJ. Plumbing of hospital premises is a reservoir for opportunistically pathogenic microorganisms: a review. Biofouling. 2013;29:147–62. DOIPubMedGoogle Scholar
- Donohue MJ, Vesper S, Mistry J, Donohue JM. Impact of chlorine and chloramine on the detection and quantification of Legionella pneumophila and Mycobacterium species. Appl Environ Microbiol. 2019;85:e01942–19. DOIPubMedGoogle Scholar
- Loret JF, Dumoutier N. Non-tuberculous mycobacteria in drinking water systems: A review of prevalence data and control means. Int J Hyg Environ Health. 2019;222:628–34. DOIPubMedGoogle Scholar
- Centers for Disease Control and Prevention. Preventing waterborne germs at home. February 11, 2022 [cited 2022 May 19]. https://www.cdc.gov/healthywater/drinking/preventing-waterborne-germs-at-home.html
- 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;125:215–22. DOIPubMedGoogle Scholar
- Greco SL, Drudge C, Fernandes R, Kim J, Copes R. Estimates of healthcare utilisation and deaths from waterborne pathogen exposure in Ontario, Canada. Epidemiol Infect. 2020;148:
e70 . DOIPubMedGoogle Scholar
1These first authors contributed equally to this article.