2011–2012 Recreational Water–associated Outbreak Surveillance Report Supplemental Tables
These tables provide supplemental information not published in Outbreaks of illness associated with recreational water — United States, 2011–2012 (MMWR Weekly).
Table 1. Waterborne Disease Outbreaks* Associated with Treated Recreational Water and Untreated Recreational Water, by Year and Jurisdiction — Waterborne Disease and Outbreak Surveillance System, United States, 2011–2012
Treated Recreational Water
Jurisdiction | Month | Year | Class* | Etiology | Predominant Illness† | No. cases§ | No. hospitalizations¶ | Venue | Setting |
---|---|---|---|---|---|---|---|---|---|
Alabama | Jun | 2011 | I | Escherichia coli O157:H7 (C) | AGI | 19 | 3 | Interactive fountain(s), pool | Recreational facility |
Arizona | Apr | 2012 | IV | Norovirus (S) | AGI | 3 | 0 | Pool | Resort |
Colorado | Jul | 2011 | II | Cryptosporidium hominis IaA28R4 (C) | AGI | 33 | 0 | Pool | Waterpark |
Colorado | Jun | 2012 | IV | Cryptosporidium sp. (C) | AGI | 5 | 0 | Interactive fountain(s), pools, spas | Membership club |
Georgia | May | 2011 | IV | Shigella sonnei subgroup D (C) | AGI | 5 | 1 | Pool | Waterpark |
Georgia | Oct | 2012 | III | Legionella pneumophila serogroup 1 (C) | ARI | 2 | 2 | Pool, spas | Recreational facility |
Idaho | Sep | 2011 | III | Escherichia coli O157:H7 (C) | AGI | 2 | 2 | Fill-and-drain pool†† | Private residence |
Idaho | Jun | 2012 | III | Cryptosporidium sp. (C) | AGI | 82 | 3 | Pools | Community/Municipal park, membership club, waterpark |
Idaho | Aug | 2012 | IV | Cryptosporidium sp. (C) | AGI | 2 | 0 | Pool | Community/Municipality |
Illinois | Jun | 2011 | IV | Cryptosporidium sp. (C) | AGI | 23 | 0 | Temporary water slide | Community/Municipal park |
Iowa | Mar | 2012 | III | Norovirus genogroup I (C) | AGI | 75 | 0 | Pool, spa, wading pool, water slide | Hotel/Motel, indoor waterpark |
Iowa | Aug | 2012 | IV | Cryptosporidium sp. (C) | AGI | 24 | 0 | Wading pool | Community/Municipal park |
Kansas | Jul | 2011 | III | Cryptosporidium sp. (C) | AGI | 144 | 10 | Pool | Apartment/Condo |
Kansas | Aug | 2011 | IV | Cryptosporidium sp. (C) | AGI | 9 | 1 | Pool | Community/Municipality |
Kansas | Apr | 2012 | III | Legionella sp. (C) | ARI | 3 | §§ | Spa | Hotel/Motel |
Kentucky¶¶ | May | 2011 | III | Cryptosporidium sp. (C) | AGI | 130 | 13 | Pool | Unknown |
Louisiana | Dec | 2012 | IV | Legionella pneumophila (C) | ARI | 4 | 4 | Unknown | Unknown |
Maryland | Jul | 2011 | IV | Giardia intestinalis (C) | AGI | 21 | 0 | Wading pool | Membership club |
Michigan | Jun | 2012 | IV | Legionella pneumophila serogroup 2 (C) | ARI | 9 | 4 | Pool, spa | Private residence |
Michigan | Jul | 2012 | IV | Chemical (pool chemical) (S)*** | ARI | 3 | §§ | Pool | Unknown |
Michigan | Jul | 2012 | I | Cryptosporidium sp. (C) | AGI | 27 | 0 | Pool | Private residence |
Michigan | Aug | 2012 | III | Cryptosporidium parvum IIaA15G2R1 (C) | AGI | 9 | 0 | Interactive fountain(s) | County park |
Minnesota | Mar | 2011 | I | Legionella sp. (S) | ARI | 48 | 1 | Spa | Recreational facility |
Minnesota | Aug | 2011 | I | Cryptosporidium hominis IaA15R3 (C) | AGI | 11 | 0 | Pool | Recreational facility, school/college/university |
Minnesota | Mar | 2012 | I | Cryptosporidium parvum IIaA15G2R1 (C) | AGI | 97 | 1 | Pool | Hotel/Motel, indoor waterpark |
Minnesota | Mar | 2012 | I††† | Cryptosporidium parvum IIaA16G3R1 (C) | AGI | 43 | 1 | Pool | Hotel/Motel, indoor waterpark |
Minnesota | Apr | 2012 | III | Pseudomonas aeruginosa (S) | Skin | 7 | 0 | Pool, spa | Hotel/Motel |
Minnesota | Jun | 2012 | III | Cryptosporidium sp. (C) | AGI | 7 | 2 | Pool | Community/Municipality |
Minnesota | Jul | 2012 | II | Cryptosporidium parvum IIaA15G2R1 (C) | AGI | 5 | 1 | Swim pond§§§ | Community/Municipal park |
Minnesota | Jul | 2012 | II | Cryptosporidium parvum IIaA16G2R2 (C) | AGI | 2 | 0 | Interactive fountain(s) | Community/Municipal park |
Minnesota | Jul | 2012 | II | Cryptosporidium parvum IIaA16G2R2 (C) | AGI | 2 | 0 | Interactive fountain(s) | Community/Municipality |
Minnesota | Aug | 2012 | II | Cryptosporidium parvum IIaA15G2R1 (C) | AGI | 6 | 0 | Pool | Community/Municipality |
Minnesota | Aug | 2012 | I | Cryptosporidium parvum IIaA15G2R1 (C) | AGI | 2 | 1 | Pool | Community/Municipality |
Minnesota | Nov | 2012 | III | Legionella sp. (S) | ARI | 4 | 0 | Spa | Private residence |
Missouri | Jul | 2011 | III | Cryptosporidium sp. (C) | AGI | 38 | 3 | Pool | Waterpark |
Missouri | Jul | 2011 | III | Chloramines (S) | ARI | 9 | 0 | Pool, spa | Hotel/Motel |
Missouri | Jun | 2012 | III | Legionella pneumophila serogroup 1 (C) | ARI | 3 | 3 | Interactive fountain(s), pool, spa | Resort |
Nevada | Oct | 2011 | III | Chlorine (S) | Skin | 12 | 0 | Spa | Hotel/Motel |
New Hampshire | Aug | 2011 | IV | Pseudomonas aeruginosa (C) | Skin | 9 | 0 | Spa | Private residence |
New York | Jan | 2011 | III | Chloramines (S) | Skin | 4 | 0 | Interactive fountain(s), pool | Indoor waterpark |
New York | Apr | 2011 | III | Chlorine gas (C) | ARI; Eye; Skin | 11 | 0 | Pool | Membership club |
New York | May | 2011 | III | Chlorine gas (S)¶¶¶ | ARI; Eye | 3 | 0 | Pool | Recreational facility |
New York | Jun | 2012 | III | Chlorine (C)**** | Eye; Skin | 30 | §§ | Wading pool | Community/Municipal park |
North Carolina | Sep | 2012 | I | Norovirus genogroup I (C) | AGI | 47 | 0 | Pool | Recreational facility |
Ohio | Jan | 2011 | IV | Cryptosporidium sp. (C) | AGI | 87 | 3 | Pool | Hotel/Motel, indoor waterpark |
Ohio | Jul | 2011 | IV | Cryptosporidium sp. (C)†††† | AGI | 3 | 1 | Pool | Apartment/Condo |
Ohio | Jul | 2011 | IV | Cryptosporidium sp. (C)†††† | AGI | 2 | 0 | Pool | Membership club |
Ohio | Jul | 2011 | III | Cryptosporidium sp. (C)†††† | AGI | 7 | 1 | Interactive fountain(s) | Community/Municipal park |
Ohio | Jul | 2011 | IV | Cryptosporidium sp. (C)†††† | AGI | 19 | 0 | Pool | Amusement park |
Ohio | Aug | 2011 | IV | Cryptosporidium sp. (C)†††† | AGI | 2 | 0 | Pool | Waterpark |
Ohio | Aug | 2011 | IV | Cryptosporidium sp. (C) | AGI | 2 | 0 | Pool | Recreational facility |
Ohio | Aug | 2011 | IV | Cryptosporidium sp. (C)†††† | AGI | 4 | 0 | Pool | Recreational facility |
Ohio | Aug | 2011 | IV | Cryptosporidium sp. (C)†††† | AGI | 8 | 0 | Pool | Recreational facility |
Ohio | Aug | 2011 | IV | Cryptosporidium sp. (C)†††† | AGI | 4 | 1 | Interactive fountain(s) | Community/Municipal park |
Ohio | Aug | 2011 | IV | Cryptosporidium sp. (C)†††† | AGI | 3 | 0 | Interactive fountain(s) | Community/Municipal park |
Ohio | Aug | 2011 | IV | Cryptosporidium sp. (C) | AGI | 2 | 1 | Pool, wading pool | Recreational facility |
Ohio | Sep | 2011 | I | Pseudomonas aeruginosa (C) | Skin§§§§ | 7 | 0 | Pool, spa | Hotel/Motel |
Ohio | Dec | 2011 | III | Legionella pneumophila serogroup 1 (C) | ARI | 2 | 2 | Pool, spa | Membership club |
Ohio | Apr | 2012 | IV | Pseudomonas aeruginosa (S) | Skin§§§§ | 40 | 0 | Spa | Hotel/Motel |
Ohio | Jun | 2012 | III | Chlorine (C) | Eye; Skin | 16 | 0 | Interactive fountain(s), pool, wading pool | Recreational facility |
Ohio | Jul | 2012 | III | Cryptosporidium sp. (C) | AGI | 12 | 1 | Pool | Waterpark |
Ohio | Dec | 2012 | IV | Pseudomonas aeruginosa (S) | Skin | 4 | 0 | Spa¶¶¶¶ | Hotel/Motel |
Pennsylvania | Sep | 2011 | III | Legionella pneumophila serogroup 1 (C) | ARI | 6 | 0 | Spa | Hotel/Motel |
Pennsylvania | Jan | 2012 | III | Legionella pneumophila serogroup 1 (C) | ARI | 2 | 2 | Spa | Hotel/Motel |
Puerto Rico | Dec | 2012 | III | Norovirus (S) | AGI | 18 | 4 | Interactive fountain(s) | Community/Municipal park |
South Carolina | Jun | 2012 | IV | Legionella sp. (C) | ARI | 2 | 1 | Pool, spa | Apartment/Condo |
Utah | Aug | 2012 | IV | Cryptosporidium sp. (C) | AGI | 2 | 0 | Pool | Waterpark |
Virginia | Mar | 2012 | IV | Pseudomonas aeruginosa (S) | Skin | 5 | 0 | Spa | Private residence |
Wisconsin | Jul | 2011 | IV | Cryptosporidium sp. (C) | AGI | 16 | 0 | Pool | Community/Municipality |
Untreated Recreational Water
Jurisdiction | Month | Year | Class† | Etiology (C/S)§ | Predominant Illness¶ | No. cases** | No. hospitalizations | Venue | Setting |
---|---|---|---|---|---|---|---|---|---|
California | Apr | 2012 | IV | Avian schistosomes (S) | Skin | 2 | §§ | Lake/Reservoir | Beach |
Colorado | Jul | 2012 | II | Shigella sonnei subgroup D (C) | AGI | 31 | 2 | Lake/Reservoir | Public beach |
Connecticut | Jul | 2012 | II | Norovirus genogroup I (C) | AGI | 24 | 0 | Lake/Reservoir | Amusement park |
Florida | Apr | 2011 | I | Norovirus genogroup II (C) | AGI | 29 | 0 | Lake/Reservoir | Park |
Illinois | Aug | 2011 | IV | Giardia intestinalis (C) | AGI | 10 | 0 | Lake/Reservoir | Membership club |
Illinois | Jul | 2012 | IV | Avian schistosomes (S) | Skin | 4 | 1 | Lake/Reservoir | Beach |
Illinois | Jul | 2012 | II | Escherichia coli O111 (C) | AGI | 7 | 0 | Lake/Reservoir | Private beach |
Illinois | Jul | 2012 | III | Adenovirus (C) | Eye***** | 32 | 1 | Lake/Reservoir | Private beach |
Massachusetts | Jul | 2011 | I | Escherichia coli O157:H7 (C) | AGI | 8 | 3 | Ocean††††† | Public beach |
Minnesota | Jul | 2012 | II | Cryptosporidium hominis IbA10G2 (C) | AGI | 16 | 0 | Lake/Reservoir | Camp/Cabin |
New York | May | 2011 | III | Avian schistosomes (C) | Skin§§§§§ | 43 | 0 | Lake/Reservoir | Public beach |
New York | Jul | 2011 | III | Cyanobacterial toxin(s) (C)¶¶¶¶¶ | Eye | 8 | §§ | Lake/Reservoir | Private beach, public beach |
New York | Jul | 2012 | IV | Avian schistosomes (S) | Skin | 16 | §§ | Lake/Reservoir | Public beach |
North Dakota | Jul | 2012 | IV | Giardia intestinalis (C) | AGI | 3 | 0 | Lake/Reservoir | Public outdoor area |
Pennsylvania | Jul | 2011 | II | Escherichia coli O157:H7 (C) | AGI | 16 | 9 | Lake/Reservoir | State park |
Texas | Jun | 2011 | IV | Escherichia coli (C), Plesiomonas shigelloides (C), Shigella sonnei subgroup D (C) | AGI | 56 | 1 | Lake/Reservoir | Public outdoor area |
Vermont | Jul | 2012 | IV | Norovirus (S) | AGI | 35 | 0 | Lake/Reservoir | State park |
Washington | Jul | 2012 | IV | Shigella sonnei subgroup D (C) | AGI | 3 | 1 | Pond | Community/Municipality |
Wisconsin | Jul | 2011 | I | Escherichia coli O111 (C) | AGI | 4 | 0 | Lake/Reservoir | Public beach, public outdoor area |
Wisconsin | Jul | 2012 | I | Giardia intestinalis (C), norovirus genogroup I GI_3 (C) | AGI | 125 | 1 | Lake/Reservoir | State park |
Wisconsin | Jul | 2012 | II | Escherichia coli O157:H7 (C) | AGI | 7 | 3 | Lake/Reservoir | Lake-sandbar |
Abbreviations: AGI = acute gastrointestinal illness; ARI = acute respiratory illness; Eye = illnesses, conditions, or symptoms related to the eyes; Skin = illnesses, conditions, or symptoms related to the skin.
* n=90; treated water, n=69; untreated water, n=21
† 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.
§ Provides information about etiologies and whether these were confirmed—denoted as “etiology (C)”—or suspected—denoted as “etiology (S)”.
¶ The category of illness reported by 50% of ill respondents. All legionellosis outbreaks were categorized as ARI.
** One outbreak-related death was reported.
†† Pool was a manufactured venue that is filled with untreated irrigation water.
§§ No information reported
¶¶ Exposures to recreational water venues in Ohio were also documented for this outbreak.
*** Etiology unidentified: disinfection by-products (e.g., chloramines), altered water chemistry, or extremely elevated chlorine levels suspected based on reported data.
††† Replacement of burned out bulbs for the UV disinfection system was considered a treatment deficiency since there was a chance of the problem being fixed prior to the outbreak.
§§§ Pond was a manufactured venue that is filled with filtered and chlorinated water.
¶¶¶ Aerosolized disinfectant was also a possible etiology for this outbreak.
**** Free chlorine (5ppm) and combined chlorine (10ppm) detected in water samples collected during or within 1 day of dates of exposure.
†††† These nine Cryptosporidium outbreaks in Ohio during the summer of 2011 may have been part of a community-wide/state-wide outbreak.
§§§§ Case-patients reported earaches in addition to dermatologic symptoms
¶¶¶¶ Spa was a portable venue.
***** One or more case-patients reported fever, headache, cough, vomiting or diarrhea in addition to eye-related symptoms.
††††† Venue is a creek that flows into an ocean.
§§§§§ One or more case-patients reported wound infections and respiratory, gastrointestinal, ear and eye symptoms in addition to skin symptoms.
¶¶¶¶¶ Microcystin toxin (20 ppb) detected in water samples collected during or within 1 day of dates of exposure. Anabaena, Aphanizomenon, Gloetrichia, Microcystis, Oscillatoria, Lyngbya spp. detected from algal samples.
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Top of PageTable 2. Number of Waterborne Disease Outbreaks Associated with Recreational Water, by Predominant Illness* and Type of Water Exposure — Waterborne Disease and Outbreak Surveillance System, 2011–2012
Type of Water Exposure | ||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Treated | Untreated | Total | ||||||||||||||
Predominant Illness | Outbreaks | Cases | Hospitalized | Died | Outbreaks | Cases | Hospitalized | Died | Outbreaks | % | Cases | % | Hospitalized | % | Died | % |
AGI | 44 | 1,064 | 54 | 0 | 15 | 374 | 20 | 0 | 59 | 65.6% | 1,438 | 80.4% | 74 | 77.9% | 0 | 0.0% |
ARI | 13 | 97 | 19 | 1 | 0 | 0 | 0 | 0 | 13 | 14.4% | 97 | 5.4% | 19 | 20.0% | 1 | 100.0% |
ARI and Eye | 1 | 3 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 1.1% | 3 | 0.2% | 0 | 0.0% | 0 | 0.0% |
ARI, Eye, and Skin | 1 | 11 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 1.1% | 11 | 0.6% | 0 | 0.0% | 0 | 0.0% |
Eye | 0 | 0 | 0 | 0 | 2 | 40 | 1 | 0 | 2 | 2.2% | 40 | 2.2% | 1 | 1.1% | 0 | 0.0% |
Eye and Skin | 2 | 46 | 0 | 0 | 0 | 0 | 0 | 0 | 2 | 2.2% | 46 | 2.6% | 0 | 0.0% | 0 | 0.0% |
Skin | 8 | 88 | 0 | 0 | 4 | 65 | 1 | 0 | 12 | 13.3% | 153 | 8.6% | 1 | 1.1% | 0 | 0.0% |
Total (%) | 69 (76.7%) | 1,309 (73.2%) | 73 (76.8%) | 1 (100.0%) | 21 (23.3%) | 479 (26.8%) | 22 (23.2%) | 0 (0.0%) | 90 | 100.0% | 1788 | 100.0% | 95 | 100.0% | 1 | 100.0% |
Abbreviations: AGI = acute gastrointestinal illness; ARI = acute respiratory illness; Eye = illnesses, conditions, or symptoms related to the eyes; Skin = illnesses, conditions, or symptoms related to the skin.
*n=90; The category of illness reported by 50% of ill respondents. All legionellosis outbreaks were categorized as ARI.
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