January 2021

Emerging Infectious Diseases Journal

Highlights: Emerging Infectious Diseases, Vol. 27, No. 1, Jan 2021

Important Note: Not all articles that EID publishes represent work done at CDC or by CDC staff. In your stories, please clarify whether a study was conducted by CDC (“a CDC study”) or by another institution (“a study published by CDC in the EID journal”). Opinions expressed by authors contributing to EID do not necessarily reflect the opinions of CDC or the institutions with which the authors are affiliated. EID requests that, when possible, you include a live link to the actual journal article in your stories. Once the embargo lifts, this month’s articles will be found in the Ahead of Print section of the EID website at https://wwwnc.cdc.gov/eid/ahead-of-print.

The articles of interest summarized below will appear in the January 2021 issue of Emerging Infectious Diseases, CDC’s monthly peer-reviewed public health journal. This issue will feature Emerging Viruses. The articles are embargoed until December 16, 2020, at 12 p.m. EDT.

1.  Estimate of Burden and Direct Healthcare Cost of Infectious Waterborne Disease, United States, Sarah A. Collier et al.

Safe drinking water and sanitation in the United States is one of the greatest public health achievements of the 20th century. However, waterborne illness persists and new public health challenges are emerging, due to aging infrastructure, chlorine-tolerant and biofilm-associated pathogens, and increasing recreational water use. Researchers examined data for 2000-2015 on water exposure and water sources to produce the first estimates of the overall burden of waterborne disease in the United States. They estimated that waterborne pathogens cause approximately 7.2 million illnesses, 118,000 hospitalizations, and 6,630 deaths every year. In addition to the health burden, waterborne diseases account for $3.33 billion annually in direct healthcare costs (in 2014 US dollars). Otitis externa (swimmer’s ear) and norovirus infections were the most common illnesses. Despite accounting for a small proportion of overall illnesses, three biofilm-associated pathogens (nontuberculous mycobacteria, Legionella, and Pseudomonas) cause the majority of hospitalizations and more than 90% of all deaths related to waterborne disease. Those biofilm-associated microorganisms, which often live inside plumbing pipes, differ from those that used to cause waterborne diseases before drinking water treatment and sanitation systems were developed (like cholera or typhoid). The findings from this analysis highlight the evolving epidemiology of waterborne disease in the United States, the increasing role of biofilm-associated pathogens, and the need to focus public health resources to prevent and control these infections.

Contact: CDC Media Relations, phone: 404-639-3286 or email: media@cdc.gov

2.  Economic Burden of Legionnaires’ Disease, United States, 2014, Madeleine Baker-Goering et al.

Legionnaires’ disease is a severe form of pneumonia that often results in hospitalization. The disease is caused by the Legionella bacteria, which can grow and spread in poorly maintained manufactured water systems and can then be inhaled in airborne water droplets. In the United States, reported cases of Legionnaires’ disease have been increasing since 2000, yet evidence suggests that many outbreaks are related to failures in maintaining water systems in buildings and might be preventable. The costs associated with outbreaks are considerable. CDC estimated productivity losses caused by absenteeism and premature deaths, which, when combined with estimates of medical costs, provide a more comprehensive estimate of the lifetime economic impact of Legionnaires’ disease in the United States in 2014. The estimated lifetime economic burden was $835 million, including $21 million in productivity losses caused by absenteeism and $412 million in productivity losses caused by premature deaths. Because the economic burden of Legionnaires’ disease more than doubles when lifetime productivity losses are added to medical costs, estimates like these can help demonstrate the value of investments in preventing Legionnaires’ disease through such means as water management programs and outbreak investigations.

Contact: CDC Media Relations, phone: 404-639-3286 or email: media@cdc.gov

3.  Geographic Range of Recreational Water-Associated Primary Amebic Meningoencephalitis, USA, 1978–2018, Radhika Gharpure et al.

Primary amebic meningoencephalitis (PAM) is a rare brain infection caused by Naegleria fowleri, an ameba found in soil and warm freshwater. Infections are almost always fatal and occur most commonly among males and children. In the United States, most infections result from recreational exposure to warm, untreated freshwater (e.g., lakes, ponds, reservoirs, rivers, streams) in southern states during the summer. To determine whether infection trends are changing in the United States, researchers analyzed recreational water exposures associated with PAM during 1978–2018. They found that although the number of new cases remained stable, the geographic range of exposure locations has expanded northward, particularly to the midwestern United States. This suggests that rising temperatures and possible increases in recreational water use may be contributing to the changing patterns of PAM. These findings can help public health officials predict who is at risk and better tailor communications efforts to help prevent infection.

Contact: CDC Media Relations, phone: 404-639-3286 or email: media@cdc.gov



Page last reviewed: March 15, 2021