You are here:
Waterborne Disease Outbreaks Associated With Environmental and Undetermined Exposures to Water – United States, 2013-2014
Citation:
McClung, R., D. Roth, M. Vigar, V. Roberts, A. Kahler, L. Cooley, E Hilborn, Tim Wade, K. Fullerton, J. Yoder, AND V. Hill. Waterborne Disease Outbreaks Associated With Environmental and Undetermined Exposures to Water – United States, 2013-2014. Transplantation. Lippincott Williams & Wilkins, Philadelphia, PA, 18(1):262-267, (2018). https://doi.org/10.1111/ajt.14607
Impact/Purpose:
This report partially fulfills product for SSWR 3.02a. It describes outbreaks of illness associated with exposure to environmental water sources, or those that are 'undetermined' meaning that they are sources of water that are not intended for drinking or recreation, or are of unknown source.
Description:
Waterborne disease outbreaks can be associated with a wide variety of exposures to water. Many outbreaks arise from exposure to water from drinking water systems (1) or recreational water venues (2), while others are caused by environmental exposures to water or due to an undetermined exposure to water. This report summarizes two groups of waterborne disease outbreaks. Outbreaks with an “environmental” exposure to water are linked to water not associated with a recreational water venue or drinking water system, including water used in cooling towers, industrial processes, agricultural processes, occupational settings, decorative or display settings (e.g., decorative fountains), and water consumed from sources such as back–country streams (3). Outbreaks involving an “undetermined” exposure to water could not be definitively linked to a single type of water exposure due to association with multiple suspected or confirmed water types (e.g. both spa and drinking water systems were implicated) or due to insufficient epidemiologic, laboratory, or environmental evidence to identify the exposure. All outbreaks with first illness onset during 2013-2014 reported to the National Outbreak Reporting System (NORS, http://www.cdc.gov/nors/about.html) by December 31, 2015 are summarized. Outbreaks with first illness onset during 2009-2012 not reported in previous NORS data reports (4, 5) are listed in Table 1 but are not included in the summary and analysis. A waterborne disease outbreak is defined as two or more persons affected by a similar illness who are linked by time and location to a common water exposure. For each outbreak, data were collected regarding the number of ill persons, hospitalizations, and deaths. Results of epidemiologic and laboratory investigations are also reported, including the suspected or confirmed etiologic agent, the type of water to which cases were exposed, and the setting of the water exposure. During the analysis of these data, predominant illness type was determined and water type was further categorized as a human-made or natural water system. Human-made systems include infrastructure intended for water storage or recirculation, while natural water systems include raw water that may or may not be treated at the point of exposure. Waterborne disease outbreaks associated with environmental and undetermined exposures to water from prior years have been reported previously and can be found here: https://www.cdc.gov/healthywater/surveillance/environmental/environ-water-surveillance-reports.html This article describe outbreaks of infections, including legionella and giardia, linked to environmental exposure to water, such as aerosol spread from cooling towers, industrial or agricultural processes, decorative displays, and consumption of water from natural sources
URLs/Downloads:
DOI: Waterborne Disease Outbreaks Associated With Environmental and Undetermined Exposures to Water – United States, 2013-2014