Estimating the Burden of Disease Associated with Outbreaks Reported to the U.S. Waterborne Disease Outbreak Surveillance System: Identifying Limitations and Improvements (Final Report)


EPA announces the release of the final report, Approaches to Estimating the Waterborne Disease Outbreak Burden in the United States: Uses and Limitations of the Waterborne Disease Outbreak Surveillance System.


This report demonstrates how data from the Waterborne Disease Outbreak Surveillance System (WBDOSS) can be used to estimate disease burden and presents results using 30 years of data. This systematic analysis does not attempt to provide an estimate of the actual incidence and burden of outbreak-related waterborne illnesses in the U.S. Rather, the purpose of this report is to explore methods for estimating outbreak disease burden measures from available outbreak surveillance data and to clearly lay out the limitations of the data. Because the report makes recommendations for improvements in the WBDOSS that could result in more useful data in the future, it represents an important step toward making WBDOSS a more useful source of information for Agency policy makers.

This document uses information from the WBDOSS database that has been jointly maintained by the Centers for Disease Control and Prevention and the U.S. EPA since 1971 to analyze the disease burden of waterborne outbreaks.

The term disease burden refers to the magnitude of health impacts, such as decrements in a population’s health or the associated economic burden. The document summarizes the number of cases of waterborne disease associated with reported waterborne outbreaks and estimates their severity. It also presents the monetary burden associated with these reported waterborne outbreaks and quantifies some of the uncertainties inherent in such an estimate.

The burden of waterborne disease is an important measure of the efficacy of the Agency’s efforts to develop, promote and regulate drinking water treatment. Currently, the Agency lacks reliable epidemiological and economic estimates of the fraction of the U.S. waterborne disease burden that is attributable to drinking water outbreaks. Reports of disease outbreaks captured in the WBDOSS are potentially important data sources for estimating this component of the waterborne disease burden, but the utility and limitations of these data for estimating disease burden have not been demonstrated.


This is the final report.


U.S. EPA. Estimating the Burden of Disease Associated with Outbreaks Reported to the U.S. Waterborne Disease Outbreak Surveillance System: Identifying Limitations and Improvements (Final Report). U.S. Environmental Protection Agency, Washington, DC, EPA/600/R-06/069, 2007.


Sep 2006On September 15, 2006 (71 FR 54481), EPA announced a 30-day public comment period for the draft document. The public comment period ended October 16, 2006. In their deliberations, the peer-review panel considered all comments submitted to the docket and oral comments provided during the peer-review meeting by a registered observer.
Oct 2006EPA hosted an independent external peer review on October 26-27, 2006, to review the document. This document was not formally disseminated by EPA, though the draft document was posted on the EPA Web site solely for the purpose of pre-dissemination peer review under applicable information quality guidelines.
Jan 2008EPA released the Final Report.

This document has been reviewed in accordance with U.S. Environmental Protection Agency policy and approved for publication. Mention of trade names or commercial products does not constitute endorsement or recommendation for use.