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Need for a Comprehensive Waterborne Disease Burden Estimate

Many stakeholders can benefit from a waterborne disease burden estimate. Surveillance and outbreak data suggest waterborne pathogens are still important causes of illness in the U.S.; however, the overall prevalence of waterborne illness in the U.S. is unknown. To determine how many people in the U.S. are affected by waterborne illnesses, which populations are most susceptible, and inform prevention planning efforts, it is necessary to measure water-related illness across all water sectors, considering all water uses and exposures.

Premise Plumbing

Premise plumbing is the drinking water system that is inside housing, schools, and other buildings. It connects to the main drinking water distribution system, but the water utility does not monitor its safety. A large proportion of drinking water outbreaks are linked to pathogens that grow in premise plumbing and building water system parts—like hot water tanks, cooling towers, decorative fountains, shower heads, and water taps—and are inhaled through steam or aerosol 1-5.

  1. Haupt TE, Heffernan RT, Kazmierczak JJ, Nehls-Lowe H, Rheineck B, Powell C, Leonhardt KK, Chitnis AS, Davis JP. An outbreak of Legionnaires’ disease associated with a decorative water wall fountain in a hospital. Infect Control Hosp Epidemiol. 2012; 33(2):185-91.
  2. Falkinham JO 3rd. Nontuberculous mycobacteria from household plumbing of patients with nontuberculous mycobacteria disease. Emerg Infect Dis. 2011;  17(3):419-24.
  3. Falkinham JO 3rd. Hospital water filters as a source of Mycobacterium avium complex. J Med Microbiol. 2010; 59(Pt 10):1198-202.
  4. Tobin-D'Angelo MJ, Blass MA, del Rio C, Halvosa JS, Blumberg HM, Horsburgh CR. Hospital water as a source of Mycobacterium avium complex isolates in respiratory specimens. J Infect Dis. 2004;189(1):98-104.
  5. Fields BS, Benson RF, Besser RE. Legionella and Legionnaires’ disease: 25 years of investigation. Clin Microbiol Rev. 2002;15(3):506–26.
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