Implications of Waterborne Disease Estimates
Changes in Waterborne Disease
Diseases spread through water affect over 7 million people in the United States every year and cost our healthcare system over $3 billion.
CDC’s recent estimates of the impact of waterborne disease in the United States show a shift that has occurred over the last several decades in the types of diseases and routes of exposure that are most common. In the first part of the 20th century, germs in drinking water caused most waterborne diseases. These diseases, like cholera and typhoid, caused serious gastrointestinal illness and sometimes resulted in death. Once effective and consistent drinking water treatment, disinfection, and sanitation measures were put into place across the country, these diseases became rare.
Today we are realizing that waterborne diseases are responsible for many different types of illnesses—including respiratory illnesses, neurological illnesses, skin problems, gastrointestinal illnesses, and bloodstream infections. People are infected by waterborne germs not just when they drink water, but also when they breathe in contaminated water droplets or when water gets in their ears or nose.
To understand what caused the change in both the types of diseases we are facing and how people are becoming sick, we must look at the ways in which our water use has evolved over the last few decades. As the population grew, so did our need to use water on a larger scale and in new ways. To meet these demands, high rises, hospitals, water parks, and other structures were built. These new buildings required complicated water systems that went through thousands of gallons of water every day. The complex water systems used by these structures were added to existing piping systems, many of which were designed in the early 1900s.
Water travels further in these complex water systems because of the large number of pipes, drains, and other plumbing fixtures. This makes it harder to maintain water quality and to keep enough disinfectant in the system to kill germs. As a result, these pipes can become a home for water-related germs that grow in pipe slime (also known as biofilm). While biofilm germs cause only a small percentage of waterborne diseases, the illnesses resulting from these diseases are responsible for the majority of waterborne disease-related hospitalizations and deaths.
Water management programs help building managers and owners understand what is needed to limit the growth and spread of waterborne pathogens. These programs are now an industry standard for large buildings and required by the Centers for Medicare & Medicaid Services for healthcare facilities. CDC has created a toolkit to help building managers and owners develop their own water management programs.
To control these germs and help prevent future waterborne illnesses, we need a wide-ranging approach that brings together policy makers, industry partners, building managers, public health, and other stakeholders, and includes:
- Maintenance of and updates to our water system infrastructure
- Increased support for waterborne disease-focused public health work to support state, local, and territorial health departments in:
- Tracking, investigating, reporting, and preventing disease
- Understanding emerging issues and threats
- Updates to these estimates and development of additional burden estimates looking at disease attribution by water type
- Encouragement of owners/managers of large buildings—such as healthcare facilities, hotels, and recreational water facilities—to follow existing policies/regulations and best practices (for example, the Model Aquatic Health Code [MAHC] and water management programs)
- Continuation of research focused on waterborne disease and creation of best practices for waterborne disease prevention
- Support for public health partner efforts to develop prevention campaigns and disseminate prevention messages
- Education of the public on ways they can protect themselves from waterborne diseases
The health of our nation is closely tied to the safety of our water supply and water systems. The future of waterborne disease prevention will rely on maintaining the public health progress made over the last century while working on solutions, including these recommendations, to protect people from current and future threats.