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

Waterborne Disease Outbreaks Associated with Drinking Water (N = 33) and Other Non-Recreational Water* (N = 12) by Year and State/Jurisdiction — Waterborne Disease and Outbreak Surveillance System, United States, 2009-2010.

Line list expanded to include class and deficiency.


Jurisdiction Month Year Class† Etiology Predominant Illness§ No. cases No. hospital-izations¶ No. deaths** Water System†† Deficiency§§ Water Source Setting
Drinking Water
Florida Jul 2009 4 Legionella sp. ARI 2 2 0 Community 5a Well Membership club
Idaho May 2009 3 Campylobacter sp., Giardia intestinalis AGI 7 0 0 Community 4 Well Private residence
Maine Jul 2009 3 Hepatitis A Hep 2 Individual/
Private
2 Well Private residence
Maryland Sep 2009 1 Legionella pneumophila serogroup 1, Knoxville 1 ARI 10 9 1 Community 5a Lake/Reservoir Apartment/Condo
Nevada Dec 2009 3 Legionella pneumophila serogroup 1 ARI 10 1 0 Community 5a Lake/Reservoir Hotel/Motel
New York Apr 2009 3 Legionella pneumophila serogroup 1 ARI 3 3 2 Community 5a Lake/Reservoir Hospital/Health care
New York Dec 2009 3 Legionella pneumophila serogroup 1 ARI 3 3 1 Community 5a Lake/Reservoir Hospital/
Health care
South Carolina Jul 2009 3 Legionella pneumophila serogroup 1 ARI 3 3 0 Community 5a Ground water Hotel/Motel
Utah Jun 2009 3 Legionella pneumophila serogroup 1 ARI 5 5 0 Community 5a Well, spring Hotel/Motel
Utah Aug 2009 3 Giardia intestinalis AGI 8 0 0 Community¶¶ 4 Well, surface water Subdivision/
Neighborhood
California Jun 2010 1 Norovirus AGI 47 Transient Noncommunity 2 Well Restaurant/
Cafeteria
Georgia Apr 2010 3 Legionella pneumophila serogroup 1 ARI 4 4 0 Community 5a Well, spring Hotel/Motel
Illinois Nov 2010 3 Unidentified*** AGI; Other††† 3 3 0 Commercially bottled 11c Unidentified Church/Place of worship
Maryland Aug 2010 3 Legionella pneumophila serogroup 1 ARI 2 2 0 Community 5a, 7 Surface water Personal care home§§§
Minnesota Jun 2010 2 Giardia intestinalis AGI 6 0 0 Transient Noncommunity 2 Well State park
Missouri Feb 2010 4 Campylobacter jejuni AGI 16 5 0 Community 2 Well Community/
Municipality
Missouri Mar 2010 1 Campylobacter sp. AGI 67 4 0 Community 4 Well Community
/Municipality
Missouri Apr 2010 1 Escherichia coli O157:H7 AGI 28 4 0 Community¶¶¶ 2 Well Membership club
Missouri Nov 2010 1 Escherichia coli O157:H7 AGI 11 3 1 Individual/
Private
2 Well Private
residence
Montana Jul 2010 1 Campylobacter jejuni AGI 101 6 0 Nontransient
Noncommunity
2, 4 Well Resort
Nevada Dec 2010 3 Legionella pneumophila serogroup 1 ARI 4 2 1 Community 5a Well, river/stream Hotel/Motel
New York Apr 2010 3 Legionella pneumophila serogroup 1 ARI 3 3 1 Community 5a, 7 Lake/Reservoir Hospital/
Health care****
New York Jun 2010 3 Legionella pneumophila serogroup 1 ARI 3 3 0 Community 5a Lake/Reservoir Prison/Jail
New York Jul 2010 3 Legionella pneumophila serogroup 1 ARI 2 2 0 Community 5a Lake/Reservoir Hospital/
Health care††††
New York Jul 2010 3 Legionella pneumophila serogroup 1 ARI 5 3 0 Community 5a Lake/Reservoir Hospital/Health care
Ohio Feb 2010 4 Legionella pneumophila ARI 3 3 0 Community 5a Unidentified Long-term
care facility
Pennsylvania May 2010 3 Legionella pneumophila serogroup 1 ARI 3 3 1 Community§§§§ 5a, 3, 6 Well Personal care home
Pennsylvania Jun 2010 3 Legionella pneumophila serogroup 1 ARI 2 2 0 Community 5a River/Stream Apartment/Condo
Pennsylvania Jul 2010 2 Campylobacter jejuni, Cryptosporidium sp. AGI 10 0 0 Individual/
Private
2 Well Private
residence
Utah Apr 2010 3 Campylobacter jejuni AGI 628 2 0 Community¶¶ 4 Well, spring Community/
Municipality
Utah Aug 2010 3 Legionella pneumophila serogroup 1, Camperdown 1 ARI 2 2 1 Community 5a Spring, creek Hotel/Motel
Utah Dec 2010 3 Legionella pneumophila serogroup 1 ARI 3 3 0 Community 5a Well, surface water Assisted living/
Rehab
Vermont Jan 2010 1 Cryptosporidium sp. AGI 34 0 0 Individual/
Private
2 Well Vacation
rental house
Other non-recreational water*
Alabama Apr 2009 4 Campylobacter jejuni AGI 11 0 0 Wilderness/Natural water source 12 River/Stream Backcountry
Illinois Sep 2009 3 Legionella pneumophila serogroup 1 ARI 8 8 2 Unknown 5c Ornamental fountain, spa, irrigation¶¶¶¶ Assisted living/Rehab
Missouri Jul 2009 3 Unidentified AGI 75 0 0 Wilderness/
Natural water source
12 Spring Camp/Cabin
New York Aug 2009 3 Giardia intestinalis AGI 26 1 0 Wilderness/
Natural source
12 Spring Public outdoor area
Ohio Sep 2009 4 Legionella sp. ARI 2 2 0 Unknown 5c Unknown Long-term care facility
Idaho Jul 2010 Campylobacter jejuni AGI 3 0 0 Wilderness/
Natural source
River/Stream Backcountry
Michigan Jul 2010 1 Legionella pneumophila serogroup 1 ARI 64 17 0 Cooling/Air conditioning 5b Cooling tower Military facility
Mississippi Jun 2010 1 Legionella pneumophila serogroup 1 ARI 9 6 1 Cooling/Air conditioning 5b Cooling tower Hotel/Motel
Nevada Jun 2010 1 Giardia intestinalis AGI 20 1 0 Irrigation 12 Puddle/
Canal/
Swamp
Public outdoor area
New York Nov 2010 3 Legionella pneumophila serogroup 1 ARI 4 4 0 Industrial/
Occupational
5b Mist/Steam device Factory/
Industrial facility
Texas May 2010 4 Legionella pneumophila serogroup 1 ARI 4 4 3 Unknown 5c Unknown Long-term care
facility
Wisconsin Feb 2010 3 Legionella pneumophila serogroup 1 ARI 8 8 0 Ornamental 5b Ornamental fountain Hospital/
Health care

Abbreviations: AGI = acute gastrointestinal illness; ARI = acute respiratory illness; Hep = Hepatitis; Other = undefined, illnesses, conditions, or symptoms or symptoms that cannot be categorized as gastrointestinal, respiratory, ear-related, eye-related, skin-related, neurological, hepatitis or caused by leptospirosis.

*Non-recreational waterborne disease outbreaks combines two previously-reported categories, ‘Water Not Intended for Drinking’ and ‘Water of Unknown Intent.’ It includes outbreaks not associated with public or private drinking water systems, as well as outbreaks for which the intended use of the water is not known. It does not include outbreaks associated with recreational water venues (e.g., swimming pools), which are reported separately.

† On the basis of epidemiologic, clinical laboratory, and environmental data (e.g., water quality data) provided to CDC.

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

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

** Value was set to missing in reports where zero deaths were reported and the number of people for whom information was available was also zero.

†† Community and noncommunity water systems are public water systems that have ≥15 service connections or serve an average of ≥ 25 residents for ≥ 60 days/year. A community water system serves year-round residents of a community, subdivision, or mobile home park. A noncommunity water system serves an institution, industry, camp, park, hotel, or business and can be nontransient or transient. Nontransient systems serve ≥ 25 of the same persons for >6 months of the year but not year-round (e.g., factories and 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, and parks). Individual water systems are small systems not owned or operated by a water utility that have <15 connections or serve <25 persons.

§§ Deficiency classification assigned to outbreaks associated with drinking water, other water, and unknown water exposures

¶¶ A cross-connection between potable and nonpotable water sources resulting in backflow was a suspected or confirmed factor in this outbreak.

*** Etiology unidentified: contamination of water with sodium hydroxide suspected based upon incubation period, symptoms, outbreak investigation and laboratory findings.

††† The other symptoms reported were chemical esophagitis and burns in mouth.

§§§ Facility had an onsite disinfection system that was not operational at the time of the outbreak.

¶¶¶ Setting was a recreational facility with multiple buildings. A private well that was originally used for a residence was reclassified as a community water system as a result of the outbreak investigation.

**** The facility had an onsite chlorine dioxide system; however, there were indicators that the system was not being monitored properly at the time of the outbreak.

†††† The facility had an onsite chlorine dioxide system and was being monitored for Legionella.

§§§§ Reported contributing factors included a temporary disruption in disinfection and a cross-connection between potable and nonpotable water sources resulting in backflow.

¶¶¶¶ Multiple water sources within the facility were identified as possible exposures in this outbreak.

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Number of Waterborne Disease Outbreaks, by Drinking Water System and Source — Waterborne Disease and Outbreak Surveillance System, United States, 2009-2010.

Drinking Water-associated Outbreaks by Etiology Group, 2009-2010
Etiology        
Outbreaks Cases Hospitalized Died
Bacterium 25 923 82 9
Campylobacter 4 812 17 0
E. coli O157:H7 2 39 7 1
Legionella 19 72 58 8
Virus 2 49 0 0
Hepatitis 1 2 -- --
Norovirus 1 47 -- --
Parasite 3 48 0 0
Cryptosporidium 1 34 0 0
Giardia 2 14 0 0
Multiple 2 17 0 0
Unidentified 1 3 3 0
Suspected sodium hydroxide 1 3 3 0
Total 33 1040 85 9
Note: Unknown hospitalization and death info denoted by '--'


Community Water Systems
Etiology Ground Water Mixed Water Surface Water Unknown Water
Outbreaks Cases Hospitalized Died Outbreaks Cases Hospitalized Died Outbreaks Cases Hospitalized Died Outbreaks Cases Hospitalized Died
Bacterium 9 756 32 1 3 9 7 2 10 43 31 5 1 3 3 0
Campylobacter 3 711 11 0 0 0 0 0 0 0 0 0 0 0 0 0
E. coli O157:H7 1 28 4 0 0 0 0 0 0 0 0 0 0 0 0 0
Legionella 5 17 17 1 3 9 7 2 10* 43 31 5 1 3 3 0
Virus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Hepatitis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Norovirus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Parasite 0 0 0 0 1 8 0 0 0 0 0 0 0 0 0 0
Cryptosporidium 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Giardia 0 0 0 0 1 8 0 0 0 0 0 0 0 0 0 0
Multiple 1 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Unidentified 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Suspected sodium hydroxide 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Total 10 763 32 1 4 17 7 2 10 43 31 5 1 3 3 0
* Death information unknown for one of these outbreaks


Non-community Water Systems*
Etiology Ground Water
Outbreaks Cases Hospitalized Died
Bacterium 1 101 6 0
Campylobacter 1 101 6 0
E.coli O157:H7 0 0 0 0
Legionella 0 0 0 0
Virus 1 47 0 0
Hepatitis 0 0 0 0
Norovirus 1 47 -- --
Parasite 1 6 0 0
Cryptosporidium 0 0 0 0
Giardia 1 6 0 0
Multiple 0 0 0 0
Unidentified 0 0 0 0
Suspected sodium hydroxide 0 0 0 0
Total 3 154 6 0
*No reported outbreaks in public non-community water systems had mixed water, surface water, or unknown water source.
Note: Unknown hospitalization and death info denoted by '--'


Individual Water Systems*
Etiology Ground Water
Outbreaks Cases Hospitalized Died
Bacterium 1 11 3 1
Campylobacter 0 0 0 0
E.coli O157:H7 1 11 3 1
Legionella 0 0 0 0
Virus 1 2 0 0
Hepatitis 1 2 -- --
Norovirus 0 0 0 0
Parasite 1 34 0 0
Cryptosporidium 1 34 0 0
Giardia 0 0 0 0
Multiple 1 10 0 0
Unidentified 0 0 0 0
Suspected sodium hydroxide 0 0 0 0
Total 4 57 3 1
*No reported outbreaks in individual water systems had mixed water, surface water, or unknown water source.
Note: Unknown hospitalization and death info denoted by '--'


Commercially-bottled Water*
Etiology Unknown Water Source
Outbreaks Cases Hospitalized Died
Bacterium 0 0 0 0
Campylobacter 0 0 0 0
E. coli O157:H7 0 0 0 0
Legionella 0 0 0 0
Virus 0 0 0 0
Hepatitis 0 0 0 0
Norovirus 0 0 0 0
Parasite 0 0 0 0
Cryptosporidium 0 0 0 0
Giardia 0 0 0 0
Multiple 0 0 0 0
Unidentified 1 3 3 0
Suspected sodium hydroxide 1 3 3 0
Total 1 3 3 0
*No reported outbreaks in bottled water systems had ground water, mixed water, or surface water source.


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