Current Waterborne Disease Burden Data & Gaps

Scope

• Hospitalization and outpatient healthcare costs associated with 10 primarily and partially waterborne pathogens ¹
• Gastroenteritis deaths associated with norovirus and Clostridium difficile ²

Estimates

• Diseases (giardiasis, cryptosporidiosis, Legionnaires’ disease, otitis externa, and non-tuberculous mycobacterial infection) caused by primarily waterborne pathogens were associated with more than 40,000 hospitalizations, costing $970 million per year ¹.
• Diseases (campylobacteriosis, salmonellosis, shigellosis, HUS, toxoplasmosis) caused by partially waterborne pathogens were associated with 50,000 hospitalizations, costing $860 million per year ¹.
• Approximately 800 deaths are associated with norovirus each year ².
• Approximately 7,900 deaths are associated with Clostridium difficile each year ².

What is not included in the scope of this 2012 pathogen-specific illness and cost estimate?

• Estimates do not include all pathogens that could potentially be spread via water ¹.
• Estimates do not include the percentage of each illness attributable to waterborne transmission ¹.
• Estimates do not include the percentage of each illness attributable to waterborne transmission ².
• Estimates do not include less severe illness (illnesses that did not result in death) ².

References

1. Collier SA, Stockman LJ, Hicks LA, Garrison LE, Zhou FJ, Beach MJ. Direct healthcare costs of selected diseases primarily or partially transmitted by water. Epidemiol Infect. 2012;140(11):2003-13.
2. Hall AJ, Curns AT, McDonald LC, Parashar UD, Lopman BA. The roles of Clostridium difficile and norovirus among gastroenteritis-associated deaths in the United States, 1999-2007. Clin Infect Dis. 2012;55(2):216-23.

Scope

• National number of hospitalizations associated with pulmonary nontuberculous mycobacteria (NTM) diagnosis during 1998-2005
• Demographic characteristics of hospitalized patients and trends over time

Estimate

• 23,213 pulmonary NTM hospitalizations occurred during 1998-2005.
  • Seven out of 10 of these NTM hospitalizations (71%) occurred in patients without HIV/AIDS.
  • Over half of these NTM hospitalizations (57%) were among women.
  • Over half of these NTM hospitalizations (55%) were among patients who were over 70 years old.

What is not included in the scope of this 2009 pathogen-specific illness estimate?

• Estimate does not include the percentage of illness attributable to waterborne transmission.
• Estimate does not include pulmonary-NTM illness that did not result in hospitalization.
• Estimate does not include NTM illness affecting other body systems (for example, skin or disseminated nontuberculous mycobacterial infection.)

Reference

• Billinger ME, Olivier KN, Viboud C, de Oca RM, Steiner C, Holland SM, Prevots DR. Nontuberculous mycobacteria-associated lung disease in hospitalized persons, United States, 1998-2005. Emerg Infect Dis. 2009; Oct;15(10):1562-9.

Scope

• National incidence of community-acquired pneumonia (CAP) hospitalizations
• Legionella-specific estimate of annual number of CAP cases requiring hospitalization

Estimate

• 8,000-18,000 cases of Legionella cause CAP hospitalizations each year

What is not included in the scope of this 1997 pathogen-specific illness estimate?

• Estimate does not include the percentage of illness attributable to waterborne transmission.
• Estimate does not include Legionella illness that did not result in hospitalization.

Reference

• Marston BJ, Plouffe JF, File TM, Hackman BA, Salstrom SJ, Lipman HB, Kolczak MS, Breiman, RF. Incidence of community-acquired pneumonia requiring hospitalization. Results of a population-based active surveillance study in Ohio. The Community-Based Pneumonia Incidence Study Group. Arch Intern Med. 1997;157(15):1709-18.

Scope

• Cost of illness due to sea food consumption and contact with marine pathogens
• Pathogen-specific cost estimates also included

Estimates

• 5 million excess cases of gastrointestinal illness each year due to marine beach exposure, costing $300 million each year in healthcare expenses
• In pathogen-specific analyses, researchers estimated that direct exposure to Vibrio species (V. vulnificus, V. parahaemolyticus, V. alginolyticus and K. brevis) costs approximately $30 million each year in healthcare costs

What is not included in the scope of the 2011 marine water burden estimates?

• Estimates do not include waterborne illness from non-marine recreational water sources including freshwater beaches and rivers, lakes, and streams.
• Estimates do not include recreational waterborne illness from chlorinated venues including pools, splash parks, spas, and hot tubs.

Reference

• Ralston EP, Kite-Powell H, Beet A. An estimate of the cost of acute health effects from food- and water-borne marine pathogens and toxins in the USA. J Water Health. 2011;9(4):680-694.

Scope

• Burden of all illnesses from public drinking water systems
• Separate illness contributions for community ground water, non-community ground water, and municipal source water systems

Estimate

• In total, an estimated 19.5 million cases of waterborne illness each year

Estimate break-down by type of public drinking water systems

• 5.4 million cases of waterborne illness due to contaminated community groundwater (from wells serving 25 or more year-round residents)
• 1.1 million cases of waterborne illness due to contaminated non-community groundwater systems (from wells serving at least 25 of the same people for at least 6 months, but not year-round)
• 13 million cases of waterborne illness due to contaminated municipal source water systems (public drinking water distributed by the water utility).

For more information, see Public Water Systems.

What is not included in the scope of the 2008 drinking water burden estimates?

• Estimates do not include waterborne illness from drinking water from private wells, small water systems, building water systems, or premise plumbing.
• Estimates do not include waterborne illness from non-drinking water sources including recreational water venues or water systems for alternative uses including industry, agriculture, and medical uses.

Reference

• Reynolds KA, Mena KD, Gerba CP. Risk of waterborne illness via drinking water in the United States. Rev Environ Contam Toxicol. 2008;192:117-158.

Scope

• Burden of acute gastrointestinal illness (AGI) from public drinking water systems

Estimate

• A range of 4.26–11.69 million AGI cases each year ¹
• A mean of 16.4 million AGI cases (range of 5.47–32.80 million cases) each year ²

What is not included in the scope of the 2006 drinking water burden estimates?

• Estimates do not include waterborne illness from drinking water in private wells, small water systems, building water systems, or premise plumbing.
• Estimates do not include waterborne illness from non-drinking water sources including recreational water venues or water systems for alternative uses including industry, agriculture, and medical uses.
• Estimates do not include respiratory or other non-diarrheal waterborne illness.

References

1. Colford JM, Roy S, Beach MJ, Hightower A, Shaw SE, Wade TJ. A review of household drinking water intervention trials and an approach to the estimation of endemic waterborne gastroenteritis in the United States. J Water Health. 2006;4(Suppl 2):71-88.
2. Messner M, Shaw S, Regli S, Rotert K, Blank V, Soller J. An approach for developing a national estimate of waterborne disease due to drinking water and a national estimate model application. J Water Health. 2006;4(Suppl 2):201-40.