Skip directly to search Skip directly to A to Z list Skip directly to site content
CDC Home

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
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

 
USA.gov: The U.S. Government's Official Web PortalDepartment of Health and Human Services
Centers for Disease Control and Prevention   1600 Clifton Road Atlanta, GA 30329-4027, USA
800-CDC-INFO (800-232-4636) TTY: (888) 232-6348 - Contact CDC–INFO
A-Z Index
  1. A
  2. B
  3. C
  4. D
  5. E
  6. F
  7. G
  8. H
  9. I
  10. J
  11. K
  12. L
  13. M
  14. N
  15. O
  16. P
  17. Q
  18. R
  19. S
  20. T
  21. U
  22. V
  23. W
  24. X
  25. Y
  26. Z
  27. #