scholarly journals Causes of Outbreaks Associated with Drinking Water in the United States from 1971 to 2006

2010 ◽  
Vol 23 (3) ◽  
pp. 507-528 ◽  
Author(s):  
Gunther F. Craun ◽  
Joan M. Brunkard ◽  
Jonathan S. Yoder ◽  
Virginia A. Roberts ◽  
Joe Carpenter ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
Distribution System ◽  
Water System ◽  
The United States ◽  
Water Systems ◽  
Outbreak Detection ◽  
Waterborne Disease ◽  
Public Water Systems ◽  
Annual Proportion

SUMMARY Since 1971, the CDC, EPA, and Council of State and Territorial Epidemiologists (CSTE) have maintained the collaborative national Waterborne Disease and Outbreak Surveillance System (WBDOSS) to document waterborne disease outbreaks (WBDOs) reported by local, state, and territorial health departments. WBDOs were recently reclassified to better characterize water system deficiencies and risk factors; data were analyzed for trends in outbreak occurrence, etiologies, and deficiencies during 1971 to 2006. A total of 833 WBDOs, 577,991 cases of illness, and 106 deaths were reported during 1971 to 2006. Trends of public health significance include (i) a decrease in the number of reported outbreaks over time and in the annual proportion of outbreaks reported in public water systems, (ii) an increase in the annual proportion of outbreaks reported in individual water systems and in the proportion of outbreaks associated with premise plumbing deficiencies in public water systems, (iii) no change in the annual proportion of outbreaks associated with distribution system deficiencies or the use of untreated and improperly treated groundwater in public water systems, and (iv) the increasing importance of Legionella since its inclusion in WBDOSS in 2001. Data from WBDOSS have helped inform public health and regulatory responses. Additional resources for waterborne disease surveillance and outbreak detection are essential to improve our ability to monitor, detect, and prevent waterborne disease in the United States.

scholarly journals An approach for developing a national estimate of waterborne disease due to drinking water and a national estimate model application

2006 ◽  
Vol 4 (S2) ◽  
pp. 201-240 ◽  
Author(s):  
Michael Messner ◽  
Susan Shaw ◽  
Stig Regli ◽  
Ken Rotert ◽  
Valerie Blank ◽  
...  
Keyword(s):  
Drinking Water ◽  
Environmental Protection Agency ◽  
Water System ◽  
Credible Interval ◽  
The United States ◽  
Water Systems ◽  
Epidemiologic Studies ◽  
Incidence Rates ◽  
Waterborne Disease ◽  
Public Water Systems

In this paper, the US Environmental Protection Agency (EPA) presents an approach and a national estimate of drinking water related endemic acute gastrointestinal illness (AGI) that uses information from epidemiologic studies. There have been a limited number of epidemiologic studies that have measured waterborne disease occurrence in the United States. For this analysis, we assume that certain unknown incidence of AGI in each public drinking water system is due to drinking water and that a statistical distribution of the different incidence rates for the population served by each system can be estimated to inform a mean national estimate of AGI illness due to drinking water. Data from public water systems suggest that the incidence rate of AGI due to drinking water may vary by several orders of magnitude. In addition, data from epidemiologic studies show AGI incidence due to drinking water ranging from essentially none (or less than the study detection level) to a rate of 0.26 cases per person-year. Considering these two perspectives collectively, and associated uncertainties, EPA has developed an analytical approach and model for generating a national estimate of annual AGI illness due to drinking water. EPA developed a national estimate of waterborne disease to address, in part, the 1996 Safe Drinking Water Act Amendments. The national estimate uses best available science, but also recognizes gaps in the data to support some of the model assumptions and uncertainties in the estimate. Based on the model presented, EPA estimates a mean incidence of AGI attributable to drinking water of 0.06 cases per year (with a 95% credible interval of 0.02–0.12). The mean estimate represents approximately 8.5% of cases of AGI illness due to all causes among the population served by community water systems. The estimated incidence translates to 16.4 million cases/year among the same population. The estimate illustrates the potential usefulness and challenges of the approach, and provides a focus for discussions of data needs and future study designs. Areas of major uncertainty that currently limit the usefulness of the approach are discussed in the context of the estimate analysis.

scholarly journals Co-Occurrence of Metal Contaminants in United States Public Water Systems in 2013–2015

2021 ◽  
Vol 18 (15) ◽  
pp. 7884
Author(s):  
Alesha K. Thompson ◽  
Michele M. Monti ◽  
Matthew O. Gribble
Keyword(s):  
United States ◽  
Drinking Water ◽  
Water System ◽  
The United States ◽  
Water Systems ◽  
System Level ◽  
Metal Contaminants ◽  
Total Chromium ◽  
Geometric Means ◽  
Public Water Systems

The United States Environmental Protection Agency monitors contaminants in drinking water and consolidates these results in the National Contaminant Occurrence Database. Our objective was to assess the co-occurrence of metal contaminants (total chromium, hexavalent chromium, molybdenum, vanadium, cobalt, and strontium) over the years 2013–2015. We used multilevel Tobit regression models with state and water system-level random intercepts to predict the geometric mean of each contaminant occurring in each public water system, and estimated the pairwise correlations of predicted water system-specific geometric means across contaminants. We found that the geometric means of vanadium and total chromium were positively correlated both in large public water systems (r = 0.45, p < 0.01) and in small public water systems (r = 0.47, p < 0.01). Further research may address the cumulative human health impacts of ingesting more than one contaminant in drinking water.

Calling all Campy – how routine investigation and molecular characterization impacts the understanding of campylobacteriosis epidemiology – Alaska, United States, 2004–2013

2015 ◽  
Vol 144 (2) ◽  
pp. 265-267 ◽  
Author(s):  
L. J. CASTRODALE ◽  
G. M. PROVO ◽  
C. M. XAVIER ◽  
J. B. McLAUGHLIN
Keyword(s):  
Public Health ◽  
United States ◽  
Molecular Characterization ◽  
Case Reports ◽  
Health Impact ◽  
The United States ◽  
Outbreak Detection ◽  
Incident Case ◽  
The Public

SUMMARYUnlike most jurisdictions in the United States, Alaska performs pulsed-field gel electrophoresis (PFGE) characterization of all Campylobacter sp. isolates at the state public health laboratory – a practice that started in 2002. Moreover, in order to ensure early detection and response to campylobacteriosis outbreaks, the Alaska Section of Epidemiology has investigated all incident Campylobacter sp. case reports since 2004. This report summarizes the public health impact of routine incident case investigations and molecular characterization of all Campylobacter sp. isolates. In sum, we found that these efforts have contributed to better characterization of the epidemiology of campylobacteriosis in Alaska, and facilitated more rapid outbreak detection, more public health investigations, and earlier public health interventions.

scholarly journals 1887. Estimating the Burden of Waterborne Disease in the United States

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S53-S54 ◽  
Author(s):  
Sarah Collier ◽  
Katharine Benedict ◽  
Kathleen Fullerton ◽  
Li Deng ◽  
Jennifer R Cope ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
Healthcare Costs ◽  
Burden Of Illness ◽  
The United States ◽  
Waterborne Diseases ◽  
Waterborne Disease ◽  
Waterborne Illnesses ◽  
Credible Intervals ◽  
Ed Visits

Abstract Background Treatment of drinking water is one of the greatest US public health achievements of the twentieth century and provides a safe, reliable water supply. However, waterborne disease and outbreaks continue to occur, and are associated with a variety of water sources and exposure routes. New estimates of the burden of waterborne disease in the United States will direct prevention activities and set public health goals. Methods We chose 17 waterborne diseases for which domestic waterborne transmission was plausible, substantial burden of illness or death was likely, and data were available. Diseases included were campylobacteriosis, cryptosporidiosis, giardiasis, Legionnaires’ disease, norovirus infection, nontuberculous mycobacteria [NTM] infection, otitis externa, Pseudomonas pneumonia and septicemia, salmonellosis, Shiga toxin-producing E. coli infection, shigellosis, and vibriosis. Adapting previously used methods, disease-specific multipliers were used to adjust the reported/documented number of cases of each disease for under-reporting, under-diagnosis, proportion domestically acquired, and proportion transmitted via water, to generate point estimates with 95% credible intervals (CrI). Data sources included surveillance data, population studies, and expert judgment if no other data were available. We estimated the number of illnesses, ED visits, hospitalizations, and deaths, and costs of ED visits and hospitalizations due to waterborne disease in the United States in 2014. Results 7.2 million waterborne illnesses (CrI 3.9–12.0 million) from the selected diseases occur annually, including 600,000 (CrI 365,000–865,000) ED visits, 120,000 (CrI 85,000–150,000) hospitalizations, and 6,500 deaths (CrI 4,300–8,900) deaths, incurring US$3.2 billion (2014 dollars) in direct healthcare costs. Hospitalizations and deaths were predominantly caused by environmental pathogens commonly associated with biofilm in plumbing systems (NTM, Pseudomonas, Legionella) costing US$2 billion annually. Conclusion Millions of domestically acquired waterborne illnesses from these 17 infections occur in the United States each year, and incur billions of dollars in healthcare costs. Disclosures All Authors: No reported Disclosures.

scholarly journals A Systematic Review of Waterborne Disease Outbreaks Associated with Small Non-Community Drinking Water Systems in Canada and the United States

PLoS ONE ◽  
2015 ◽  
Vol 10 (10) ◽  
pp. e0141646 ◽  
Author(s):  
Wendy Pons ◽  
Ian Young ◽  
Jenifer Truong ◽  
Andria Jones-Bitton ◽  
Scott McEwen ◽  
...  
Keyword(s):  
United States ◽  
Systematic Review ◽  
Drinking Water ◽  
Disease Outbreaks ◽  
The United States ◽  
Water Systems ◽  
Waterborne Disease ◽  
Drinking Water Systems

Salmonellosis Outbreaks by Food Vehicle, Serotype, Season, and Geographical Location, United States, 1998 to 2015

2019 ◽  
Vol 82 (7) ◽  
pp. 1191-1199 ◽  
Author(s):  
TEAH R. SNYDER ◽  
SAMEH W. BOKTOR ◽  
NKUCHIA M. M'IKANATHA
Keyword(s):  
Public Health ◽  
United States ◽  
Geographical Location ◽  
The United States ◽  
Outbreak Detection ◽  
Washington Dc ◽  
Infection Rates ◽  
Geographic Variations ◽  
Yearly Average ◽  
Food Commodities

ABSTRACT Salmonella is a major cause of foodborne illness in the United States. Although salmonellosis outbreaks are relatively common, food vehicles and other characteristics are not well understood. We obtained data for salmonellosis outbreaks from 1998 to 2015 that were submitted by public health jurisdictions to the Centers for Disease Control and Prevention's Foodborne Disease Outbreak Surveillance System. In total, 2,447 outbreaks (yearly average, 136) with a confirmed or suspected etiology of nontyphoidal Salmonella were identified. The outbreaks included 65,916 individual cases (mean, 27 cases per outbreak). Food vehicles were identified in 49% of the outbreaks. Frequently implicated foods included eggs (12.5%), chicken (12.4%), and pork (6.5%). Fifty-five (2.2%) outbreaks had fatalities; 87 (0.1%) individuals died. Of those outbreaks with a reported serotype, the most commonly identified were Enteritidis (29.1%), Typhimurium (12.6%), and Newport (7.6%). Serotypes with a statistically significant increase over time included Braenderup and I 4,[5],12:i:−. Some serotypes were commonly associated with outbreaks due to certain food vehicles; 81% of outbreaks due to eggs were associated with serotype Enteritidis. Food commodities that were most commonly associated with multistate outbreaks were nuts and seeds, sprouts, and fruits. Outbreaks occurred most frequently in summer. States with the highest number of salmonellosis outbreaks per 100,000 population were Alaska (0.137) and Minnesota (0.121); states with the lowest were Delaware (&lt;0.001) and Wyoming (&lt;0.001). The highest number of salmonellosis cases per 100,000 population were in Washington, DC (4.786) and Arkansas (3.857). Geographic variations in outbreaks may reflect differences in outbreak detection, investigation, reporting, or risk. In addition to collaboration, data-driven public health interventions are needed to decrease infection rates and to prevent complications related to salmonellosis. HIGHLIGHTS

scholarly journals Waterborne outbreaks reported in the United States

2006 ◽  
Vol 4 (S2) ◽  
pp. 19-30 ◽  
Author(s):  
Michael F. Craun ◽  
Gunther F. Craun ◽  
Rebecca L. Calderon ◽  
Michael J. Beach
Keyword(s):  
United States ◽  
Distribution System ◽  
Distribution Systems ◽  
Water Distribution ◽  
Water System ◽  
Recent Decade ◽  
The United States ◽  
Water Disinfection ◽  
True Incidence ◽  
Additional Information

Epidemic waterborne risks are discussed in this paper. Although the true incidence of waterborne illness is not reflected in the currently reported outbreak statistics, outbreak surveillance has provided information about the important waterborne pathogens, relative degrees of risk associated with water sources and treatment processes, and adequacy of regulations. Pathogens and water system deficiencies that are identified in outbreaks may also be important causes of endemic waterborne illness. In recent years, investigators have identified a large number of pathogens responsible for outbreaks, and research has focused on their sources, resistance to water disinfection, and removal from drinking water. Outbreaks in surface water systems have decreased in the recent decade, most likely due to recent regulations and improved treatment efficacy. Of increased importance, however, are outbreaks caused by the microbial contamination of water distribution systems. In order to better estimate waterborne risks in the United States, additional information is needed about the contribution of distribution system contaminants to endemic waterborne risks and undetected waterborne outbreaks, especially those associated with distribution system contaminants.

scholarly journals Community water fluoridation perceptions and practice in the United States: challenges in governance and implementation

Water Policy ◽  
2020 ◽  
Vol 22 (3) ◽  
pp. 365-375 ◽  
Author(s):  
Thomas Walker ◽  
Lori Dickes ◽  
Elizabeth Crouch
Keyword(s):  
United States ◽  
Water System ◽  
The United States ◽  
Water Systems ◽  
Primary Objective ◽  
Water Fluoridation ◽  
Sample Mean ◽  
Community Water ◽  
Large Water ◽  
Community Water Fluoridation

Abstract The primary objective of this research is to reveal potential challenges in achieving the finalized water fluoridation recommendation made by the Federal Water Fluoridation Panel in the United States (U.S.) with data extracted from consumer confidence reports. A secondary objective is to understand community water system manager's perceptions of and ability to meet this new standard using a survey instrument. Mean fluoridation levels are above the recommended level. The confidence interval does not capture the nationally recommended 0.7 mg/L. The t-test revealed two statistically significant results: that the sample mean is not equal to 0.7 mg/L and that the sample mean is higher than 0.7 mg/L. Respondents felt engaged in the policy process, but preferred state over federal policymaking. There is evidence that the optimal fluoridation level may not have been reached by water systems and that some water systems are under-fluoridating, while others are over-fluoridating. Several large water systems and pockets across the U.S. are not practicing artificial water fluoridation which reduces the effectiveness of this policy. Regular engagement by states with water system managers and feedback from water management professionals could be encouraged to better understand local constraints in meeting the federal recommendation.

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