2009-2010 Recreational Water-associated Outbreak Surveillance Report Supplemental Tables

These tables provide supplemental information not published in Recreational Water–Associated Disease Outbreaks — United States, 2009–2010 (MMWR Weekly).

TABLE 1. Waterborne Disease Outbreaks Associated with Treated Recreational Water (n = 57) and Untreated Recreational Water (n = 24), by Year and Jurisdiction — Waterborne Disease and Outbreak Surveillance System, United States, 2009–2010

Treated Recreational Water

Treated Recreational Water

Jurisdiction	Month	Year	Class*	Etiology	Predominant Illness†	No. cases§	No. hospitalizations¶	Venue	Setting
Alabama	Aug	2010	4	Cryptosporidium sp.	AGI	9	0	Pool, wave pool	Waterpark
Alabama	Aug	2010	4	Cryptosporidium sp.	AGI	9	1	Pool, spa	Waterpark
Arizona	Aug	2010	3	Unidentified	AGI	4	0	Pool	Waterpark
California	Mar	2009	3	Legionella sp.	ARI	2	2	Spa	Apartment/Condo
California	Jul	2009	3	Legionella sp.	ARI	2	2	Pool, spa	Membership club
California	Dec	2010	4	Cryptosporidium sp.	AGI	2		Pool	Long-term care facility
Florida	Aug	2009	3	Cryptosporidium sp.	AGI	5	0	Pool	Hotel/Motel
Florida	Aug	2009	3	Cryptosporidium sp.	AGI	4	0	Pool	Community/Municipality
Florida	Aug	2009	3	Cryptosporidium sp.	AGI	5	0	Pool	Waterpark
Florida	Aug	2009	4	Cryptosporidium sp.	AGI	8	0	Pool	Apartment/Condo
Florida	Mar	2010	3	Legionella pneumophila	ARI	2	2	Spa	Membership club
Idaho	Apr	2010	3	Unidentified**	Skin	7	0	Pool, spa	Hotel/Motel
Illinois	Jul	2010	3	Cryptosporidium sp.††	AGI	43	3	Pool	Community/Municipality
Illinois	Jul	2010	4	Cryptosporidium sp.	AGI	4	0	Pool	Waterpark
Illinois	Aug	2010	4	Cryptosporidium sp.	AGI	4	1	Pool	Waterpark
Illinois	Aug	2010	4	Cryptosporidium sp.	AGI	4	2	Pool	Subdivision/Neighborhood
Illinois	Aug	2010	4	Cryptosporidium sp.	AGI	3	0	Pool	Waterpark
Indiana	Jun	2010	4	Cryptosporidium sp.	AGI	5	2	Pool	Waterpark
Iowa	Jul	2010	4	Cryptosporidium sp.	AGI	7	0	Pool	Community/Municipality
Iowa	Aug	2010	4	Cryptosporidium sp.	AGI	13	0	Fill-and-drain pool	Private residence
Iowa	Aug	2010	4	Cryptosporidium sp.	AGI	15	0	Pool	Waterpark
Kansas	Mar	2010	4	Unidentified**	Skin§§	26	0	Pool, spa	Hotel/Motel
Kentucky	Jun	2010	3	Unidentified¶¶	ARI	20		Pool	Community/Municipal park
Kentucky	Aug	2010	2	Cryptosporidium sp.	AGI	21	1	Pool	Hotel/Motel
Maine	Mar	2009	3	Unidentified***	ARI; Eye	280	0	Pool	School/College/University
Michigan	Mar	2009	4	Unidentified***	ARI	2	0	Pool	Unknown
Michigan	Apr	2009	4	Unidentified***	Skin	2	0	Pool	Hotel/Motel
Michigan	Jun	2009	3	Unidentified¶¶	ARI	6	1	Pool	School/College/University
Michigan	Jan	2010	4	Unidentified***	Skin	2	0	Pool	Hotel/Motel
Michigan	Feb	2010	4	Unidentified***	ARI; Eye; Skin	12	0	Pool	Waterpark
Minnesota	Feb	2009	3	Pseudomonas aeruginosa	Skin	8	0	Pool	Hotel/Motel
Minnesota	Jul	2009	2	Cryptosporidium hominis IbA10G2	AGI	33	0	Pool	Waterpark
Minnesota	Aug	2010	1	Cryptosporidium hominis IbA10G2	AGI	2	0	Pool	Waterpark
Missouri	Jul	2010	1	Cryptosporidium hominis IaA28R4†††	AGI	126	4	Pool, wading pool	Community/Municipality
New Mexico	May	2009	3	Unidentified***	Skin	5		Pool	Public outdoor area
New Mexico	Sep	2009	4	Unidentified§§§	AGI	23	0	Pool	Hotel/Motel
New Mexico	Mar	2010	3	Unidentified¶¶	Skin	3	0	Pool	Community/Municipality
New York	Feb	2009	3	Pseudomonas sp.	Skin	2	0	Spa	Hotel/Motel
New York	Feb	2009	3	Unidentified**	Skin	5	0	Pool	Hotel/Motel
New York	Mar	2009	3	Unidentified***	Eye; Skin	31	0	Pool, spa	Hotel/Motel
New York	Oct	2009	3	Unidentified**	AGI; Ear; Skin	7	0	Spa	Hotel/Motel
New York	Nov	2010	3	Legionella pneumophila serogroup 1	ARI	2	1	Spa	Hotel/Motel
Ohio	Apr	2009	1	Pseudomonas aeruginosa	Eye; Skin	23	0	Pool, spa	Hotel/Motel
Ohio	Mar	2010	3	Unidentified***	ARI	4	0	Pool	School/College/University
Ohio	Mar	2010	1	Pseudomonas aeruginosa	Skin¶¶¶	17	0	Pool, spa	Hotel/Motel
Ohio	Jul	2010	3	Cryptosporidium sp.	AGI	23	0	Pool	Waterpark
Oregon	Aug	2010	4	Cryptosporidium sp.	AGI	18	0	Pool	Hotel/Motel
Oregon	Oct	2010	4	Cryptosporidium sp.	AGI	12	0	Pool	Community/Municipality
Puerto Rico	Jun	2009	1	Unidentified§§§	AGI	68	13	Interactive fountain(s)	Community/Municipal park
South Carolina	Jul	2010	1	Cryptosporidium hominis IbA10G2	AGI	31	0	Interactive fountain(s)	Community/Municipality
Tennessee	May	2009	4	Shigella sonnei	AGI	3	0	Fill-and-drain pool	School/College/University
Tennessee	Jul	2009	2	Unidentified	Skin	11	0	Pool, spa	Hotel/Motel
Tennessee	Jun	2010	1	Escherichia coli O157:H7	AGI	14	4	Pool	Membership club
Virginia	Apr	2009	4	Unidentified**	Skin	10		Spa	Hotel/Motel
West Virginia	May	2010	4	Unidentified	Skin	6	0	Spa	Vacation rental house
Wyoming	Mar	2009	3	Unidentified	Skin	8	0	Pool, spa	Hotel/Motel
Wyoming	Aug	2010	4	Giardia intestinalis	AGI	7	1	Pool (hot spring)****	Waterpark

Untreated Recreational Water

Jurisdiction	Month	Year	Class*	Etiology	Predominant Illness†	No. cases§	No. hospitalizations¶	Venue	Setting
Alabama	May	2010	1	Norovirus genogroup II	AGI	69	2	Lake/Reservoir	State park
Arkansas	Jun	2010	4	Escherichia coli O157:H7	AGI	5	3	River/Stream	Public outdoor area
California	Jul	2010	4	Unidentified††††	Skin	9	0	Pond	Public outdoor area
Florida	Aug	2009	4	Cryptosporidium sp.	AGI	6	0	Lake/Reservoir	State park
Massachusetts	Jul	2009	1	Shigella sonnei	AGI	68	6	Lake/Reservoir	Public beach
Michigan	Jun	2010	3	Campylobacter jejuni	AGI	6	4	Lake/Reservoir	Public beach
Michigan	Jun	2010	4	Unidentified§§§§	Skin	3	0	Lake/Reservoir	Unknown
Minnesota	Jul	2010	2	Escherichia coli O157:H7	AGI	5	4	Lake/Reservoir	Public beach
Minnesota	Aug	2010	2	Cryptosporidium hominis IbA10G2	AGI	3	0	Lake/Reservoir	Public beach
New York	Jun	2009	3	Unidentified¶¶¶¶	ARI; Eye	2		Lake/Reservoir	Unknown
New York	Jun	2009	3	Unidentified¶¶¶¶	Skin	2	0	Lake/Reservoir	Public beach
New York	Aug	2009	3	Cyanobacterial toxin(s)*****	Skin	2	0	Lake/Reservoir	State park
New York	Oct	2010	4	Unidentified††††	Skin	2	0	Ocean	Membership club
Ohio	Jun	2010	3	Cyanobacterial toxin(s)†††††	AGI; ARI; Skin	8	1	Lake/Reservoir	State park
Ohio	Jul	2010	3	Cyanobacterial toxin(s)§§§§§	AGI	19	0	Lake/Reservoir	Camp/Cabin
Ohio	Jul	2010	3	Unidentified¶¶¶¶¶	Skin	7	0	Lake/Reservoir	State park
Ohio	Jul	2010	3	Cyanobacterial toxin(s)*****	Skin	9	0	Lake/Reservoir	Public outdoor area
Ohio	Aug	2010	3	Unidentified******	AGI; ARI; Neuro; Skin††††††	3	0	Lake/Reservoir	State park
Ohio	Aug	2010	3	Unidentified§§§§§§	AGI	2	0	Lake/Reservoir	State park
Oklahoma	May	2009	3	Campylobacter jejuni, norovirus genogroup I, Shigella sp.	AGI	45	0	River/Stream	Public outdoor area
Tennessee	Mar	2009	4	Cryptosporidium sp.	AGI	7		Lake/Reservoir, river/stream	Camp/Cabin
Washington	Jun	2009	4	Unidentified¶¶¶¶	AGI	4	1	Lake/Reservoir	State park
Washington	Jul	2009	4	Unidentified¶¶¶¶¶¶	AGI	3	0	Lake/Reservoir	State park
Wisconsin	Jun	2009	2	Escherichia coli O157:H7	AGI	7	1	Lake/Reservoir	State park

Abbreviations: AGI = acute gastrointestinal illness; ARI = acute respiratory illness; Ear = illnesses, conditions, or symptoms related to the ears; Eye = illnesses, conditions, or symptoms related to the eyes; Neuro = neurologic illnesses, conditions, or symptoms (e.g., meningitis); Skin = illnesses, conditions, or symptoms related to the skin.

* Based on epidemiologic, clinical laboratory, and environmental data (e.g., water quality data) reported to CDC. For more information, refer to the strength-of-evidence classification table.

† The category of illness reported by ≥50% of ill respondents. All legionellosis outbreaks were categorized as ARI.

§ No outbreak-related deaths were reported.

¶ Value was set to missing in reports when zero hospitalizations were reported and the reported number of people for whom these data were available was also zero.

** Etiology unidentified: Pseudomonas aeruginosa suspected based on reported venue(s) of exposure and clinical signs and symptoms.

†† Cryptosporidium was detected in stool specimens from multiple case-patients. Isolate from one case-patient was identified as Cryptosporidium hominis IaA28R4.

§§ Eleven case-patients reported earaches in addition to dermatologic symptoms.

¶¶ Etiology unidentified: chlorine (i.e., toxic chlorine gas or extremely elevated chlorine levels) suspected based on reported events.

*** Etiology unidentified: disinfection by-products (e.g., chloramines), altered water chemistry, or extremely elevated chlorine levels suspected based on reported data.

††† Isolates from stool specimens of six case-patients were identified as C. hominis IaA28R4; the isolate from another case-patient was identified as C. hominis IaA24R4; and the isolate from another case-patient was identified as C. hominis IdA15G1.

§§§ Etiology unidentified: norovirus suspected based on reported incubation period, symptoms, or duration of illness.

¶¶¶ Eight case-patients reported earaches in addition to dermatologic symptoms.

**** Pool is a manufactured venue that is filled with filtered but otherwise untreated hot spring water.

†††† Etiology unidentified: avian schistosomes suspected based on reported clinical diagnosis of cercarial dermatitis and environmental data.

§§§§ Etiology unidentified: copper suspected based on reported use of chemical treatment for algae.

¶¶¶¶ Etiology unidentified: cyanobacterial toxin(s) suspected based on reported clinical signs and symptoms, environmental data (e.g., confirmed algal bloom), and venue of exposure.

***** Microcystin toxin (≥20 ppb) detected in water samples collected during or within 1 day of dates of exposure. Other cyanobacterial toxin(s) suspected based on reported clinical signs and symptoms.

††††† Microcystin toxin (≥20 ppb), anatoxin-a, saxitoxin, and cylindospermopsin detected in water samples collected during or within 1 day of dates of exposure. 

§§§§§ Microcystin toxin (≥20 ppb) detected in water samples collected during or within 1 day of dates of exposure. 

¶¶¶¶¶ Etiology unidentified: microcystin toxin, saxitoxin, and other cyanobacterial toxin(s) suspected based on reported clinical signs and symptoms, environmental data (e.g., confirmed algal bloom), and venue of exposure. Microcystin toxin (<20 ppb) and saxitoxin detected in water samples collected during or within 1 day of dates of exposure. 

****** Etiology unidentified: microcystin toxin, anatoxin-a, and other cyanobacterial toxin(s) suspected based on reported clinical signs and symptoms, environmental data (e.g., confirmed algal bloom), and venue of exposure. Microcystin toxin (<20 ppb) and anatoxin-a detected in water samples collected during or within 1 day of dates of exposure. 

†††††† One or more case-patients reported symptoms in each illness category; however, no illness category was definitively reported by ≥50% of ill respondents. Therefore, all reported illness categories have been included.

§§§§§§ Etiology unidentified: microcystin toxin, anatoxin-a, and cylindrospermopsin suspected based on reported clinical signs and symptoms, environmental data (e.g., confirmed algal bloom), and venue of exposure. Microcystin toxin (<20 ppb), anatoxin-a, and cylindrospermopsin detected in water samples collected during or within 1 day of dates of exposure. 

¶¶¶¶¶¶ Etiology unidentified: microcystin toxin based on reported clinical signs and symptoms, environmental data (e.g., confirmed algal bloom), and venue of exposure. Microcystin toxin (<20 ppb) detected in water samples collected during or within 1 day of dates of exposure.

Note: For more detailed information on harmful algal bloom–associated outbreaks, refer to Algal Bloom–Associated Disease Outbreaks Among Users of Freshwater Lakes — United States, 2009–2010 (MMWR Weekly).

 Top of Page

Table 2. Number of Waterborne Disease Outbreaks Associated with Recreational Water (n = 81*), by Predominant Illness† and Type of Water Exposure — Waterborne Disease and Outbreak Surveillance System, 2009–2010

	Type of Water Exposure
	Treated			Untreated			Total
Predominant Illness	Outbreaks	Cases	Hospitalized	Outbreaks	Cases	Hospitalized	Outbreaks	%	Cases	%	Hospitalized	%
AGI	30	525	32	14	249	21	44	54.3%	774	58.4%	53	85.5%
AGI, ARI, Neuro, and Skin§	0	0	0	1	3	0	1	1.2%	3	0.2%	0	0.0%
AGI, ARI, and Skin	0	0	0	1	8	1	1	1.2%	8	0.6%	1	1.6%
AGI, Ear, and Skin	1	7	0	0	0	0	1	1.2%	7	0.5%	0	0.0%
ARI	8	40	8	0	0	0	8	9.9%	40	3.0%	8	12.9%
ARI and Eye	1	280	0	1	2	0	2	2.5%	282	21.3%	0	0.0%
ARI, Eye, and Skin	1	12	0	0	0	0	1	1.2%	12	0.9%	0	0.0%
Eye and Skin	2	54	0	0	0	0	2	2.5%	54	4.1%	0	0.0%
Skin	14	112	0	7	34	0	21	25.9%	146	11.0%	0	0.0%
Total (%)	57 (70.4%)	1,030 (77.7%)	40 (64.5%)	24 (29.6%)	296 (22.3%)	22 (35.5%)	81	100.0%	1,326	100.0%	62	100.0%

Abbreviations: AGI = acute gastrointestinal illness; ARI = acute respiratory illness; Ear = illnesses, conditions, or symptoms related to the ears; Eye = illnesses, conditions, or symptoms related to the eyes; Neuro = neurologic illnesses, conditions, or symptoms (e.g., meningitis); Skin = illnesses, conditions, or symptoms related to the skin.

* No outbreak-related deaths were reported.

† The category of illness reported by ≥50% of ill respondents. All legionellosis outbreaks were categorized as ARI.

§ One or more case-patients reported symptoms in each illness category; however, no illness category was definitively reported by ≥50% of ill respondents. Therefore, all reported illness categories have been included.

 Top of Page