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Surveillance for Waterborne Disease Outbreaks and Other Health Events Associated with Recreational Water -United States, 2007-2008
Citation:
Roberts, V. A., M. C. Hlavsa, A. R. Anderson, V. Hill, A. Kahl, E. D. HILBORN, T. J. WADE, M. Beach, J. S. Yoder, M. Orr, L. Garrison, L. A. Hicks, AND A. Newton. Surveillance for Waterborne Disease Outbreaks and Other Health Events Associated with Recreational Water -United States, 2007-2008. Presented at Water and Health, where Science Meets Policy, Chapel Hill, NC, October 03 - 07, 2011.
Impact/Purpose:
CDC summarized data on recreational water-associated outbreaks and select recreational water-associated health events that occurred during January 2007-December 2008 and reported by public health agencies in the states, District of Columbia, territories, and Freely Associated States. Other recreational water-associated health events were reported directly to WBDOSS or to other surveillance programs at CDC, ATSDR, and the U.S. Consumer Product Safety Commission (CPSC). The term "other recreational water-associated health events" includes pool chemical-associated health events, single cases of Vibrio wound infection, and single cases of primary amebic meningoencephalitis (PAM).
Description:
Background: Since 1978, CDC, EPA, and the Council of State and Territorial Epidemiologists have collaborated on the Waterborne Disease and Outbreak Surveillance System (WBDOSS) to capture data on waterborne disease outbreaks associated with recreational water. WBDOSS is the primary source of data concerning the scope and health effects of recreational water-associated outbreaks in the United States. Methods: CDC summarized data on recreational water-associated outbreaks and select recreational water-associated health events that occurred during January 2007-December 2008 and reported by public health agencies in the states, District of Columbia, territories, and Freely Associated States. Other recreational water-associated health events were reported directly to WBDOSS or to other surveillance programs at CDC, ATSDR, and the U.S. Consumer Product Safety Commission (CPSC). The term "other recreational water-associated health events" includes pool chemical-associated health events, single cases of Vibrio wound infection, and single cases of primary amebic meningoencephalitis (PAM). Results: A total of 134 recreational water-associated outbreaks were reported by 38 states and one territory and resulted in at least 13,966 cases. A total of 116 (86.6%) outbreaks were associated with treated recreational water (e.g., pools and interactive fountains) and resulted in 13,480 (96.5%) cases. Of the 134 outbreaks, the majority (81 [60.4%]) were outbreaks of acute gastrointestinal illness and resulted in 12,477 (89.30/0) cases. Ofthe 105 (78.4%) outbreaks with a confirmed etiology, 68 (64.8%) were caused by parasites; 22 (21.0%), by bacteria; five (4.8%), by viruses; 9 (8.6%), chemicals or toxins, and one (1.0%) multiple etiology types. Cryptosporidium was confirmed as the etiologic agent of 60 (44.8%) of 134'outbreaks, resulting in 12,154 (87.0%) cases; 58 (96.7%) of these outbreaks and 12,137 (99.9%) of the cases were associated with treated recreational water. Thirty-two pool chemical-associated health events reported to WBDOSS resulted in 48 cases of illness or injury; 27 (79.4%) could be at least partially attributed to chemical handling errors. ATSDR received 92 reports of hazardous substance events at aquatic facilities. Over half ofthese events (55 [59.8%]) resulted in human injury; the most frequently reported primary contributing factor was human error. Estimates using CSPC's data indicated that 4,574 (95% confidence interval [CI]: 2,703-6,446) emergency department (ED) visits due to pool chemical-associated injuries occurred in 2008; the most frequent diagnosis was poisoning (1,784 ED visits [95% CI: 585-2,984]). A total of 236 Vibrio wound infections reported to CDC were associated with untreated recreational water; V. vulnificus infection was diagnosed in 36 (48.6%) of the 74 hospitalized patients and six (66.7%)ofthe nine cases who died. Eightfatal cases of PAM·occurred after exposure to warm untreated freshwater. Conclusions: The 134 recreational water-associated outbreaks reported to WBDOSS in 2007-2008 was the largest number of outbreaks ever reported in a two-year period. Outbreaks were most frequently associated with treated recreational water; Cryptosporidium was the leading etiologic agent. Injuries associated with pool chemicals are common and preventable. Data on select recreational water-associated health events further elucidated the epidemiology of U.S. recreational water-associated illness and injury by highlighting less frequently implicated venues, settings, etiologies (e.g., chemicals) and illness types (Le., not acute gastrointestinal illness). CDC uses WBDOSS data to 1) characterize the epidemiology of recreational water-associated outbreaks; 2) evaluate the adequacy of regulations and public awareness activities; and 3) establish public health priorities. The views expressed do not necessarily reflect the views and policies of the U.S. Environmental Protection Agency.