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

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

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

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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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Table 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

Predominant Illness and Type of Exposure
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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