Water environment
Humans Animals
Microbial pathogens
Waterborne disease
Figure 10J.169 Waterborne disease interactions in the water environment, (From Cotruvo, J.A., et al., 2004,Waterborne Zoonoses, Identification, Causes, and Control, Published on Behalf of the World Health Organization by IWA Publishing, www.who.int.)
60 50 40 30 20
Number of outbreaks
10 0
1971 1974 1977 1980 1983 1986
Year
1989 1992 1995
Legionella species*
AGI Chemical Viral Parasitic Bacterial
1998 2001
Beginning in 2001, Legionnaires disease was added to the surveillance system, and Legionella species were classified separately.
Acute gastrointestinal illness of unknown etiology.
*
Figure 10J.170 Number of waterborne-disease outbreaks (nZ764) associated with drinking water, by year and etiologic agent in the United States, 1971–2002. (From Blackburn, B.G. et al., 2004, Surveillance of waterborne-disease outbreaks associated with drinking water — United States, 2001–2002,MMWR Surveillance Summaries, vol. 53, no. SS-08, pp. 23–45, www.cdc.gov.)
* Excludes outbreaks of Legionnaires disease 1971
Number of outbreaks
1974 1977 1980 1983 1986 Year 60
50 40 30 20 10 0
1989 1992 1995 1998 2001 Individual Noncommunity Community
Figure 10J.171 Number of waterborne disease outbreaks (nZ758)*associated with drinking water, by year and type of water system — United States, 1971–2002. (From Cotruvo, J.A. et al., (ed.), 2004, Waterborne Zoonoses, Identification, Causes, and Control, Published on Behalf of the World Health Organization by IWA Publishing, Copyright q World Health Organization 2004, wlio.int.)
100 90 80 70 60 50
Outbreaks
Januar y
Febr uar
y
March Apr il
Ma y
June July August
September October
November December 40
30 20 10 0
Figure 10J.172 Outbreaks of waterborne disease by month, 1973–1998. (From Gleick, P.H. et al., 2004, The World’s Water 2004–2005, The Biennial Report on Freshwater Resources, Island Press, Washington,www.worldwater.org.)
Giardiasis Undefined AGI Shigellosis Campylobacterosis Viral AGI
Hepatitis A Salmonellosis
60 50
40
Percent of Waterborne Outbreaks in Surface Water Systems (n = 123) 30
20 10
52%
38%
2%
2%
2%
2%
2%
Figure 10J.173 Etiology of waterborne disease outbreaks in untreated, disinfected-only, and filtered surface water systems in the United States, 1971–1985. (From Craun, G.F., 1988, Surface water supplies and health,J. American Water Works Association, vol. 80, no. 2. Copyright AWWA. Reproduced with permission.)
3500 3000 2500 2000
Cases
1500 1000 500 0
Outbreaks
Year
Outbreaks
7 6 5 4 3 2 1 0
198019811982198319841985198619871988198919901991199219931994199519961997199819992000
Cases
Figure 10J.174 Outbreaks of Waterborne Disease by Month, 1973–1998 (FromWorld’s Water 2004–2005, by Peter H. Gleick. Copyright q2004 Island Press. Reproduced by permission of Island Press, Washington, DC.)
1991 1992 1993 1994 1995 1996 Year
1997 1998 1999 2000
Outbreaks
Outbreaks
100 4
3 2 1 0
90 80 70 60 50 40 30 20 10 0
Cases Cases
Figure 10J.175 Outbreaks of waterborne disease associated with private water supplies in England and Wales from 1980–2000. (From Stanwell-Smith, R., Anderson, Y., and Levy, D., 2003, National surveillance systems in Hunter, P.R., Waite, M., and Ronchi, El., (eds.),Drinking Water and Infectious Disease Establishing the Links, CRC Press LLC, Boca Raton, Florida.
Reproduced with permission.)
Jan 10
8 6 4 2 0
Feb
Number of outbreaks
Mar Apr May Jun Jul Month
Aug Sep Oct Nov Dec
Figure 10J.176 Seasonal distribution of outbreaks associated with both private and public drinking water supplies in England and Wales from 1991 to 2000. (From Stanwell-Smith, R., Anderson Y., and Levy, D., 2006, National Surveillance Systems in Hunter, P.R., Waite, M., and Ronchi, El. (eds.), Drinking Water and Infectious Disease Establishing the Links, CRC Press LLC, Boca Raton, Florida.)
14 12 10 8 6 4 2 0
Cases
Year
Outbreaks
No of outbreaks Cases
19801981198219831984198519861987198819891990199119921993199419951996199719981999 16000 14000 12000 10000 8000 6000 4000
0 2000
Figure 10J.177 Outbreaks and cases of waterborne disease in Sweden, 1980–1999. (From Stanwell-Smith, R., Anderson Y., and Levy, D., 2006, National Surveillance Systems in Hunter, P.R., Waite, M., and Ronchi, El. (eds.), Drinking Water and Infectious Disease Establishing the Links, CRC Press LLC, Boca Raton, Florida.)
0 Salmonella
Shigella Campylobacter Tox. prod. E. coli Giardia Entamoeba Cryptospordium Calicivirus Unknown
20 40 60 80 100
Figure 10J.178 Microbial agents associated with waterborne outbreaks in Sweden, 1980–1999. (From Stanwell-Smith, R., Anderson, Y., and Levy, D., 2003, National surveillance systems in Hunter, P.R., Waite, M., and Ronchi, El., (eds.),Drinking Water and Infectious Disease Establishing the Links, CRC Press LLC, Boca Raton, Florida. Reproduced with permission.)
40 35 30 25 20 15 10 5 0
1978 1980
Number of outbreaks
1982 1984 1986 1988 1990 Year
* Includes keratitis, conjunctivitis, otitis, bronchitis, meningitis, hepatitis, leptospirosis, Pontiac fever, and acute respiratory illness.
† Also includes data from report of ameba infections.
1992 1994 1996 1998 2000 2002 Other*
Dermatitis
Meningoencephalitis† Gastroenteritis
Figure 10J.179 Number of waterborne-disease related outbreaks (nZ445) associated with recreational water by year and illness in the United States, 1978–2002. (From Yoder, J.S. et al., 2004. Surveillance for waterborne-disease outbreaks associated with recreation water — United States, 2001–2002,MMWR Surveillance Summary, vol. 53, no. SS08, pp 1–22, October 22, 2004,www.cdc.gov.)
18 16 14 12 10
Number of outbreaks
8 6 4 2 0
Jan Feb Mar Apr May Jun Jul 2001–2002
* Acute respiratory illness, Pontiac fever, or chemical exposure.
Aug Sep Oct Nov Dec Other*
Meningoencephalitis Dermatitis Gastroenteritis
Figure 10J.180 Number of waterborne-disease related outbreaks (nZ65) associated with recreational water by illness and month in the United States, 2001–2002. (From Yoder, J.S. et al., 2004, Surveillance for waterborne-disease outbreaks associated with recreation water — United States, 2001–2002,MMWR Surveillance Summary, vol. 53, no. SS08, pp 1–22, October 22, 2004,www.cdc.gov.)
Suitability of climate conditions for the transmission of malaria 2004
Africa bears the overwhelming burden of malaria. It is home to the deadliest form of the malaria parasite and to climatic conditions where mosquitoes fluorish. Local environmental conditions, such as wetlands and drainage patterns, also influence the abundance of mosquitoes Consequently, dams and irrigation schemes must be carefully planned and managed in order to reduce opportunities for mosquitoes to breed
Annual deaths from malaria of children under five years 2002 by WHO region Child deaths from malaria
Other vector-borne diseases
Flat worms, whose life cycle partly takes place in freshwater snails, burrow through the skin. 200 million people, many of them children, are currently infected with schistomiasis
This is a virus transmitted by mosquitoes in Asia. 90% of the cases occur in children under 5 yrs
Transmitted by sand flies, this parasite causes skin lesions and damage to internal organs. It killed 59,000 people in 2001 Mosquitoes transmit the virus, which kills more than 10,000 children every yr
Worms lodging in the lymphatic system can cause deformations in children as young as 12 yrs
Japanese encephalities Leishmaniasis
Dengue fever
Lymphatic filariasis
978 661
Africa South-East Asia
Eastern Mediterranean
Western Pacific
The Americas
Europe 1266 44 9443 51 059 57 877
climate suitable, malaria endemic Malaria around the world
Malaria in Africa
Malaria transmission occurs Limited risk
No malaria 2004
climate unsuitable, malaria absent
Schistosomiasis
1 2
2
2
3
1 1
1 3
6
6
3 4
1
1 2
3
2 5
5
5
4
4 3 2
2 6 4
3 5
2 3
1
1
Figure 10J.181 Malaria. (From Gordon, B., Mackay, R., and Rehfuess, E., 2004,Inheriting the world: The Atlas of Children’s Health and the Environment, World Health Organization, www.who.int.)
ENTALPROBLEMS10-321
1,000,000 900,000 800,000 700,000 600,000
Comprehensive monitoring begins
500,000 400,000
Number of cases
300,000 200,000 100,000 0
19721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000
Figure 10J.182 Dracunculiasis (guinea worm) cases worldwide, 1972–2000. (From Gleick. et al., 2002. The world’s water,The Biennial Report on Freshwater Resources, 2002–2003, Island Press, Washington, www.worldwater.org. Reproduced with permission.)
700,000 600,000 500,000 400,000 300,000 200,000 100,000
Number of casees Case fatality rate
0
1950 1952 1954 1956 1958 1960 1962 1964 1966 1968 1970 1972 1974 1976 19781980 1982 1984 1986 19881990 1992 1994 1996 1998 100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Africa Sixth pandemic Seventh pandemic
Case fatality rate (Ploynomial trend)
The Americas Asia
Figure 10J.183 Cholera, reported number of cases and case fatality rates, 1950–1998. (From World Health Organization, WHO Report on Global Surveillance of Epidemic-Prone Infectious Diseases-Cholera,www.who.int.)
DALYs per 1,000 (log scale) African (child: high; adult: very high) African (child: high; adult: high) Southeast Asian (child: high; adult: high) Eastern Mediterranean (child: high; adult: high) Eastern Mediterranean (child: low; adult: low) Southeast Asian (child: low; adult: low) American (child: high; adult: high) American (child: low; adult: low) Western Pacific (child: low; adult: low) Western Pacific (child: very low; adult: very low)
European (child: low; adult: low) European (child: low; adult: high) European (child: very low; adult: high) American (child: very low; adult: very low) 1,000
100
10
1
0 237
234 164163
146116 76 71
22 11
11 11 11 10
Region (mortality strata)
Figure 10J.184 Diarrheal disease from water, sanitation, and hygiene: DALYs per 1,000 children (under 5 years old) by region. (From Pru¨ss, A., Kay, D., Fewtrell, L., and Bartram, J., 2002, Estimating the burden of disease from water, sanitation, and hygiene at a global level,Environmental Health Prerspectives, vol. 110, no. 5, May 2002,www.ehponline.org.)
- 20,000,000 40,000,000 60,000,000 80,000,000 100,000,000 120,000,000 140,000,000
2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020
Total deaths
No millennium goal: Low No millennium goal: High Millennium goal: Low Millennium goal: High
Figure 10J.185 Total water-related deaths between 2000 and 2020. (From Gleick, P. H., 2002, Dirty water: estimated deaths from water- related diseases 2000–2020,Pacific Institute Research Report,q2002 Pacific Institute for Studies in Development, Environment, and Security, on-line atwww.pacinst.org.)
Table 10J.210 Magnitude of Waterborne Disease Outbreaks in the United States, 1920–1980 Frequency of Occurrence (Number of Outbreaks) Size of Outbreak (Cases
of Illness)
Community Systems
Noncommunity Systems
Individual
Systems All Systems
!2 3 0 3 6
2–5 26 35 95 156
6–10 71 50 81 202
11–25 145 119 63 327
26–50 94 124 34 252
51–100 68 82 16 166
101–200 63 50 6 119
201–300 28 14 2 44
301–500 29 14 1 44
501–1,000 29 9 1 39
1,001–3,000 28 3 0 31
3,001–5,000 9 0 0 9
5,001–10,000 5 0 0 5
O10,000 5 0 0 5
Total 603 500 302 1,405
Source: From Craun, G.F., 1986,Waterborne Diseases in the United States. Copyright CRC Press, Inc., Boca Raton, FL. Reprinted with permission.
90th percentile (10 percent of children have this blood lead level or greater)
Median value (50 percent of children have this blood lead level or greater)
Blood lead concentrations, micrograms per deciliter (mg/dL)
30
25
20
15
5
0 101,2
1976−
1980
1988−
1991
1992−
1994
1999−
2000
Figure 10J.186 Concentration of lead in blood of children age 5 and under, 1976–1980, 1988–1991, 1992–1994, 1999–2000. (From United States Environmental Protection Agency, 2003, EPA’s Draft Report on the Environment, 2003, EPA 600-R-03- 050. U.S. Environmental Protection Agency.America’s Children and the Environment Measures of Contaminants, Body Burdens, and Illnesses, Second Edition, February 2003. Data from CDC National Center for Health Statistics, National Health and Nutrition Examination Survey, 1976–2000,www.epa.gov.
110mg/dL of blood lead has been identified by CDC as elevated, which indicates the need for interventions. (CDC Preventing Lead Poisoning in Young Children, 1991.)
2Recent research suggests that blood levels less than 10mg/dL may still produce subtle, subclinical health effects in children. (Schmidt, C.W.Poisoning Young Minds, 1999.)
Table 10J.211 Etiology of Waterborne Disease Outbreaks in the United States, 1920–1984
Time Period Disease Outbreaks Cases Deaths Time Period Disease Outbreaks Cases Deaths
1920–1925 Typhoid fever 127 7,294 435 Chemical poisoning 5 30 6
Gastroenteritis 11 27,756 0 Salmonellosis 3 16,425 3
1926–1930 Typhoid fever 100 3,072 234 Giardiasis 1 123 0
Gastroenteritis 17 63,902 0 Paratyphoid fever 1 5 0
1931–1935 Typhoid fever 85 2,114 140 1966–1970 Gastroenteritis 21 5,922 0
Gastroenteritis 25 7,664 0 Hepatitis A 19 562 1
Amebiasis 1 1,412 98 Shigellosis 14 1,215 0
Hepatitis A 1 28 0 Typhoid fever 4 45 0
1936–1940 Gastroenteritis 91 77,403 2 Salmonellosis 4 226 0
Typhoid fever 60 1,281 80 Toxigenic E. coil
AGI
4 188 4
Shigellosis 10 3,308 0 Chemical poisoning 4 15 0
Chemical poisoning
1 92 0 Amebiasis 3 39 2
Amebiasis 1 4 0 Giardiasis 2 53 0
1947–1945 Gastroenteritis 126 36,118 3 1971–1975 Gastroenteritis 63 17,752 0
Thyhoid fever 56 1,450 46 Shigellosis 14 2,803 0
Shigellosis 10 2,817 6 Hepatitis A 14 368 0
Salmonellosis 1 12 0 Giardiasis 13 5,136 0
Paratyphoid fever
2 14 0 Chemical poisoning 13 513 0
Chemical poisoning
1 30 0 Typhoid fever 4 222 0
1946–1950 Gastroenteritis 87 10,718 0 Salmonellosis 2 37 0
Typhoid fever 18 264 5 Toxigenic E. coil
AGI
1 1,000 0
Hepatitis A 5 173 0 1976–1980 Gastroenteritis 114 22,093 0
Shigellosis 4 2,321 1 Giardiasis 26 14,416 0
Paratyphoid fever
1 5 0 Chemical poisoning 25 3,081 1
Leptospirosis 1 9 0 Shigellosis 10 2,392 0
Tularemia 1 4 0 Viral gastroenteritis 10 3,147 0
1951–1955 Gastroenteritis 31 5,297 0 Salmonellosis 6 1,113 0
Typhoid fever 7 103 0 Campylobacteriosis 3 3,821 0
Hepatitis A 7 340 0 Hepatitis A 2 95 0
Shigellosis 4 732 1 1981–1984
Amebiasis 1 31 2 Gastroenteritis,
undetermined etiology
59 20,772 0
Salmonellosis 1 2 0 Giardiasis 48 4,048 0
Poliomyelitis 1 16 0 Chemical poisoning 11 179 0
1956–1960 Gastroenteritis 21 2,306 0 Shigellosis 7 532 0
Typhoid fever 13 128 3 Hepatitis A 7 274 0
Hepatitis A 11 417 0
Shigellosis 7 3,081 0 Viral gastroenteritis,
Norwalk agent
7 1,077 0
Chemical poisoning
3 14 4 Salmonellosis 2 1,150 0
Salmonellosis 2 17 0 Campylobacterosis 6 993 0
Amebiasis 1 5 0
Tularemia 1 2 0 Viral gastroenteritis,
rotavirus
1 1,761 0
1961–1965 Gastroenteritis 18 20,627 0 Cholera 1 17 0
Typhoid fever 11 63 0 Yersiniosis 1 16 0
Hepatitis A 10 334 0 Cryptosporidium 1 117 0
Shigellosis 7 520 4 Entamoeba 1 4 0
Source: From Craun, G.F., 1986,Waterborne Diseases in the United States, Copyright CRC Press, Inc., Boca Raton, FL. Reprinted with permission; amended with statistics from Center for Disease Control Annual Summaries, 1981–1984.
Table 10J.212 Etiologic Agents Most Frequently Identified in Waterborne Outbreaks of Infectious Diseases in the United States, 1971–1992
Etiologic Agent Outbreaks Cases of Illness
Giardialamblia 118 26,733
Shigella 57 9,967
Norwalk-like virus 24 10,908
Hepatitis A 29 807
Campylobacter 13 5,257
Salmonella 12 2,370
Cryptosporidiumparvum 7 17,194
All othersa 23 4,243
Total 283 77,479
a ToxigenicE. coli, Yersinia, rotavirus, S. typhi, V. cholera and others.
Source: From Chlorine Chemistry Council, 1997, Drinking Water Chrlorination White Paper,A Review of Disinfection Practices and Issues, June 12, 1997,www.c3.org.
Table 10J.213 Etiology of Waterborne Disease Outbreaks in the United States, by Type of Water System, 1991–2000
Community Water Systemsa Non-community Water Systemsb Individual Water Systemsc All Systems
Etiological Agent Outbreaks Cases Outbreaks Cases Outbreaks Cases Outbreaks Cases
Giardia 11 2,073 5 167 6 16 22 2,256
Cryptosporidiumd 7 407,642 2 578 2 39 11 408,259
Campylobacter jejuni 1 172 3 66 1 102 5 340
Salmonellae, nontyphoid 2 749 0 0 1 84 3 833
E. coli 3 208 3 39 3 12 9 259
E. coli O157:H7/C. jeuni 0 0 1 781 0 0 1 781
Shigella 1 83 5 484 2 38 8 605
Plesiomonas shigelloides 0 0 1 60 0 0 1 60
Non-01 V.cholerae 1 11 0 0 0 0 1 11
Hepatitis A virus 0 0 1 46 1 10 2 56
Norwalk-like viruses 1 594 4 1,806 0 0 3 2,400
Small, round-structured virus
1 148 1 70 0 0 2 218
Chemical 18 522 0 0 7 9 25 531
Undetermined 11 10,162 38 4,837 11 238 60 15,237
Total 57 422,364 64 8,934 34 548 155 431,846
Note: Data are compiled from CDC Morbidity and Mortality Weekly Report Surveillance Summaries for 1991–1992, 1993–1994, 1995–
1996, 1997–1998 and 1999–2000. Figures include adjustments to numbers of outbreaks and illness cases originally reported, based on more recent CDC data.
a Community water systems are those that serve communities of an average of at least 25 year-round residents and have at least 15 service connections.
b Non-community water systems are those that serve an average of at least 25 residents and have at least 15 service connections and are used at least 60 days yK1.
c Individual water systems are those serving less than 25 residents and have less than 15 service connections.
d There were 403,000 cases of illness reported in Milwaukee in 1993.
Source: From Chlorine Chemistry Council, 2003, Drinking Water Chlorination,A Review of Disinfection Practices and Issues, February 2003,www.c3.org.
Table 10J.214 Waterborne-Disease Outbreaks (nZ25) Associated with Drinking Water, by Etiologic Agent and Type of Water System (Excluding Outbreaks Caused byLegionellaSpecies) — United States, 2001–2002
Type of Water Systema
Community Noncommunity Individual Total
Etiologic Agent Outbreaks Cases Outbreaks Cases Outbreaks Cases Outbreaks Cases
Unknown 0 0 2 98 5 19 7 117
AGlb 0 0 2 98 5 19 7 117
Viruses 1 71 4 656 0 0 5 727
Norovirus 1 71 4 656 0 0 5 727
Parasitic 3 14 0 0 2 16 5 30
Giardia intestinalis 2 12 0 0 1 6 3 18
Cryptosporidiumspecies 0 0 0 0 1 10 1 10
Naegleriafowleri 1 2 0 0 0 0 1 2
Chemical 3 33 1 4 1 2 5 39
Copper 2 30 0 0 0 0 2 30
Copper and other minerals 0 0 1 4 0 0 1 4
Ethyl benzene, toluene, xylene
0 0 0 0 1 2 1 2
Ethylene glycol 1 3 0 0 0 0 1 3
Bacterial (other than Legionellaspecies)
0 0 1 12 2 15 3 27
Campylobacterjejuni 0 0 0 0 1 13 1 13
C. jejuni and Yersinia enterocolitica
0 0 1 12 0 0 1 12
Escherichia coliO157:H7 0 0 0 0 1 2 1 2
Total 7 118 8 770 10 52 25 940
Percentage (28.0) (12.6) (32.0) (81.9) (40.0) (5.5) (100.0) (100.0)
a Com, community; Ncom, noncommunity; Ind, individual. Community and noncommunity water systems are public water systems that serveO15 serv connections or an average ofR25 residents forR60 days/year. A community water system serves year-round residents of a community, subdivision, mobile home park withR15 service connections or an average ofR25 residents. A noncommunity water system can be nontransient or transient. Nontransient systems serveR25 of the same persons forO6 months of the year, but not year- round (e.g., factories or schools), whereas transient systems provide water to places in which persons do not remain for long periods of time (e.g., restaurants, highway rest stations, or parks). Individual water systems are small systems not owned or operated by a water utility that serve!15 connections or!25 persons. Outbreaks associated with water not intended for drinking (e.g., lakes, springs and creeks used by campers and boaters, irrigation water, and other nonpotable sources with or without taps) are also classified individual systems.
b Acute gastrointestinal illness of unknown etiology.
Table 10J.215 Total Outbreaks of Drinking-Water Related Disease, United States, 1973–2000
Schneiderb CDC Datac
Year
Heinz Centera
Outbreaks Outbreaks Cases Outbreaks Cases
1973 21
1974 20
1975 16
1976 29 22 3,860
1977 26 17 1,911
1978 22 33 11,435
1979 26 41 6,761
1980 29 49 20,005
1981 24 32 4,430
1982 30 40 3,456
1983 35 40 20,905
1984 20 26 1,755
1985 16 25 2,117
1986 18 22 1,569 22 25,846 (1986–1988)
1987 11 15 22,149 15
1988 15 15 2,159 13
1989 12 12 2,540 13
1990 10 14 1,748 14
1991 11 15 12,960 15 17,464 (1991–1992)
1992 18 27 4,724 27
1993 8 17 404,183 18 405,366 (1993–1994)
1994 11 13 1,178 12
1995 11 16 2,375 16 2,567 (1995–1996)
1996 3 6 192 6
1997 4 7 304 7 2,038 (1997–1998)
1998 7 10 1,734 10
1999 15 2,068 (1999–2000)
2000 24
Total 453 514 534,450 227 455,349
a Heinz CenterState of the Nations;Ecosystemreport, heinzctr.org/ecosystems/fr_water/datasets/freshwater_waterborne_ disease_
outbreaks.shtm.
b Data compiled by Dr. Orren D. Schneider and used by permission, water.sesep.drexel.edu/outbreaks/US_summaryto1998.htm.
c Data part of the Center for Disease Control. Surveillance for Waterborne-Disease Outbreaks program.Waterborne Disease Outbreaks, 1986–1988,www.cdc.gov/epo.mmwr/preview/mmwrhtml/00001596.htm;Waterborne-Disease Outbreaks, 1991–1992,www.cdc.gov/
epo.mmwr/preview/mmwrhtml/000025893.htm; Waterborne-Disease Outbreaks, 1993–1994, www.cdc.gov/epo.mmwr/preview/
mmwrhtml/0004088.htm; Waterborne-Disease Outbreaks, 1995–1996, www.cdc.gov/epo.mmwr/preview/mmwrhtml/00055820.htm;
Waterborne-Disease Outbreaks, 1997–1998, www.cdc.gov/epo.mmwr/preview/mmwrhtml/ss4904a1.htm; Waterborne-Disease Out- breaks, 1999–2000,www.cdc.gov/epo.mmwr/preview/mmwrhtml/ss5108a1.htm.
Source: FromWorld’s Water 2004–2005, by Peter Gleick. H. Copyrightq2004 Island Press. Reproduced by permission of Island Press, Washington, DC.
Table 10J.216 Number of Waterborne Outbreaks by Type of Water System and Etiology in the United States, 1971–2000 Water System Type
Unidentified
Agents Protozoa Viruses Bacteria Chemicals
Non-community 228 31 27 43 11
Community 98 96 20 40 54
Treated and untreated recreational watera
40 98 18 97 5
Individual 39 16 9 18 21
All water systems 405 241 74 198 91
a An outbreak attributed to algal toxins is not included. An outbreak of bothShigellaandCryptosporidiumis included in the protozoa category.
Source: From Cotruvo, J.A. et al., (ed.), 2004, Waterborne Zoonoses, Identification, Causes, and Control, Published on Behalf of the World Health Organization by IWA Publishing, CopyrightqWorld Health Organization 2004,www.who.int.
Table 10J.218 Waterborne Outbreaks Reported in United States Drinking Water Systems by Type of System and Water Source, 1991–1998
Number of Waterborne Outbreaks Water
Source
Community Systems
Non-Community Systems
Individual Systems
All Water Systems
Groundwatera 22 52 11 85
Surface waterb 22 2 1 25
Unknown 3 8 5 16
Totals 47 62 17 126
a Surfacewater, lakes, reservoirs, rivers, streams.
b Groundwater, wells and springs.
Source: From Craun, G.F., Calderon, R.L., and Nwachuku, N., 2003, Causes of waterborne outbreaks reported in the United States, 1991-1998 in Hunter, P.R., Waite, M., and Ronchi, El., (eds.),Drinking Water and Infectious Disease Establishing the Links, CRC Press LLC, Boca Raton, FL.
Table 10J.217 Drinking-Waterborne Outbreaks of Zoonotic Agents in the United States, 1971–2000
Type of Water Systema Water Sourceb
Etiologic Agent Total C NC I GW SW M/U
Giardia 126 83 29 14 31 90 5
Campylobacter 19 9 7 3 12 3 4
Cryptosporidium 15 11 2 2 8 5 2
Salmonella 15 11 2 2 11 2 2
E. coliO157:H7 11 4 4 3 8 2 1
Yersinia 2 — 1 1 2 — —
E. coliO6:H16 1 — 1 — 1 — —
E. coliO0157:H7 and Campylobacter
1 — 1 — 1 — —
Total 190 118 47 25 74 102 14
a C, community; NC, noncommunity; I, individual.
b GW, groundwater; SW, surface water; M/U, mixed or unknown.
Source: From Cotruvo, J.A. et al., (ed.), 2004, Waterborne Zoonoses, Identification, Causes, and Control, Published on Behalf of the World Health Organization by IWA Publishing, CopyrightqWorld Health Organization 2004, www.who.int.
Table 10J.219 Etiology of Waterborne Outbreaks in United States Drinking Water Systems, 1991–1998; Number of Outbreaks by Type of Water System and Water Source
Community Water Systems Non-Community Water Systems Etiological Agent
Surface- Water
Ground- Water
Unknown Source
Surface- Water
Ground- Water
Unknown Source
Undetermined 5 1 1 1 36 5
Chemical 7 9 1
Giardia 6 4 3
Cryptosporidium 3 3 1 1 1
Norwalk-like virus 1 1
Campylobacter 1 2 1
Salmonella,non-typhoid 1
Escherichia coliO157:H7 1 3 1
Shigella 1 5
Vibrio cholerae 1
Hepatitis A virus 1
Plesiomonas shigelloides 1
Total 22 22 3 2 52 8
Source: From Craun, G.F., Calderon, R.L., and Nwachuku, N., 2003, Causes of waterborne outbreaks reported in the United States, 1991–1998 in Hunter, P.R., Waite, M., and Ronchi, El., (eds.),Drinking Water and Infectious Disease Establishing the Links, CRC Press LLC, Boca Raton, FL.
Table 10J.220 Etiology of Waterborne Outbreaks Reporting in United States Drinking Water Systems; Cases of Illness by Type of Water System and Water Source, 1991–1998
Community Water Systems Noncommunity Water Systems Etiological Agent
Surface- Water
Ground- Water
Unknown Source
Surface- Water
Ground- Water
Unknown Source
Undetermined 10,210 18 67 250 4,789 101
Chemical 104 409 2
Giardia 1,937 49 128
Cryptosporidium 403,343 4,294 77 27 551
Norwalk-like virus 148 594
Campylobacter 172 51 7
Salmonella,non-typhoid 625
E. coliO157:H7 157 39 27
Shigella 83 484
Vibrio cholerae 11
Hepatitis A virus 46
Plesiomonas shigelloides 60
Total 415,742 6,401 155 277 6,148 137
Source: From Craun, G.F., Calderon, R.L., and Nwachuku, N., 2003, Causes of waterborne outbreaks reported in the United States, 1991–1998 in Hunter, P.R., Waite, M., and Ronchi, El., (eds.),Drinking Water and Infectious Disease Establishing the Links, CRC Press LLC, Boca Raton, FL.
Table 10J.221 Etiology of Waterborne Outbreaks in Individual Water Systems in the United States Outbreaks and Cases of Illness by Water Source, 1991–1998
Outbreaks Cases of Illness
Etiological Agent
Surface- Water
Ground- Water
Unknown Source
Surface- Water
Ground- Water
Unknown Source
Undetermined 0 2 1 0 43 8
Chemical 0 3 3 0 3 5
Giardia 1 1 0 2 10 0
Cryptosporidium 0 2 0 0 39 0
E. coli 0 1 0 0 3 0
Shigella 0 1 1 0 33 5
Hepatitis A virus 0 1 0 0 10 0
Total 1 11 5 2 141 18
Source: From Craun, G.F., Calderon, R.L., and Nwachuku, N., 2003, Causes of waterborne outbreaks reported in the United States, 1991–1998 in Hunter, P.R., Waite, M., and Ronchi, El., (eds.),Drinking Water and Infectious Disease Establishing the Links, CRC Press LLC, Boca Raton, FL.
Table 10J.222 Waterborne Disease Outbreaks Caused by Use of Contaminated, Untreated Surface Water in the United States, 1920–1980
Type of Water System
Community Noncommunity Individual All
Deficiency OBa Cases OBa Cases OBa Cases OBa Cases
Contamination on watershed
26 3,498 3 57 12 257 41 3,812
Use of surface water for supplemental source
7 3,613 7 245 2 115 16 3,973
Overflow of sewage or outfall near water intake
3 103 3 39 5 87 11 229
Flooding, heavy rains
2 125 1 93 1 77 4 295
Dead animals in reservoir
— — 1 100 — — 1 100
Insufficient data 27 1,228 24 726 28 436 79 2,390
Total 65 8,567 39 1,260 48 972 152 10,799
a Number of outbreaks.
Source: From Craun, G.F., 1986,Waterborne Diseases in the United States. Copyright CRC Press, Inc., Boca Raton, FL. Reprinted with permission.
Table 10J.223 Waterborne Disease Outbreaks Caused by Use of Contaminated, Untreated Groundwater (Springs) in the United States, 1920–1980
Type of Water System
Community Non-Community Individual All
Deficiency OBa Cases OBa Cases OBa Cases OBa Cases
Overflow or seepage of sewage
8 238 3 35 5 39 16 312
Surface runoff 11 265 5 162 7 75 23 502
Flooding 2 76 2 123 — — 4 199
Creviced limestone 1 200 3 213 — — 4 413
Contamination of raw water transmission line
2 284 1 7 — — 3 291
Improper construction — — 1 26 1 9 2 35
Insufficient data 12 508 18 1,961 20 415 50 2,884
Total 36 1,571 33 2,527 33 538 102 4,636
a Number of outbreaks.
Source: From Craun, G.F., 1986,Waterborne Diseases in the United States. Copyright CRC Press, Inc., Boca Raton, FL. Reprinted with permission.
Table 10J.225 Waterborne Disease Outbreak and Disease Rates Attributed to Source Contamination and Treatment Inadequacies in Community Systems in the United States Using Surface Water Sources, 1971–1985 Type of Community Water System
Waterborne Disease Outbreaks per 1,000 Water Systems
Waterborne Illnesses per Million- Person Years
Untreated 32.5 370.9
Disinfected only 40.5 66.3
Filtered and disinfected water 5.0 4.7
Source: From U.S. Environmental Protection Agency, 1987; Craun, G.F., 1987.
Table 10J.224 Waterborne Disease Outbreaks Caused by Use of Contaminated, Untreated Groundwater (Wells) in the United States, 1920–1980
Type of Water System
Community Noncommunity Individual All
Deficiency OBa Cases OBa Cases OBa Cases OBa Cases
Overflow or seepage of sewage 28 14,915 104 10,236 52 675 184 25,826
Surface runoff, heavy rains 25 2,492 26 947 34 824 85 4,263
Creviced limestone, fissured rock 9 1,404 19 2,044 12 660 40 4,108
Improper construction, faulty well casing
8 342 10 414 9 141 27 897
Flooding 9 5,883 3 107 5 211 17 6,201
Chemical contamination 3 77 2 16 10 68 15 161
Contamination by stream or river 3 445 6 392 3 48 12 885
Contamination of raw water transmission line
8 10,481 — — — — 8 10,481
Seepage from abandoned well 3 144 1 50 — — 4 194
Animal in well 1 34 1 238 2 19 4 291
Insufficient data 19 18,480 67 3,309 40 413 126 22,202
Total 116 54,697 239 17,753 167 3,059 522 75,509
a Number of outbreaks.
Source: From Craun, G.F., 1986,Waterborne Diseases in the Untied States, Copyright CRC Press, Inc. Boca Raton, FL. Reprinted with permission.
Table 10J.226 Water Supply Deficiencies Responsible for Waterborne Outbreaks in the United States, 1971–1985.
Source of Deficiency Outbreaks Reported Illnesses
Surface water source
No treatment 31 1,647
Disinfection only, or inadequate disinfection 67 23,028
Disinfection with other treatment (but no filtration) 5 969
Filtration and disinfection 20 9,852
Totals 123 35,496
Groundwater source
No treatment 154 11,266
Inadequate disinfection 90 40,893
Disinfection with other treatment 1 22
Totals 245 52,181
Distribution system
Cross-connection 44 8,124
Contamination of mains/plumbing 14 3,413
Contamination of storage 11 6,244
Corrosive water 10 147
Totals 79 17,928
Grand Total (reported)
Outbreaks 447
Illnesses 105,605
Source: From U.S. Environmental Protection Agency, 1987; Craun, G.F., 1987.