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Need for a Comprehensive Waterborne Disease Burden Estimate

Many stakeholders can benefit from a waterborne disease burden estimate. Surveillance and outbreak data suggest waterborne pathogens are still important causes of illness in the U.S.; however, the overall prevalence of waterborne illness in the U.S. is unknown. To determine how many people in the U.S. are affected by waterborne illnesses, which populations are most susceptible, and inform prevention planning efforts, it is necessary to measure water-related illness across all water sectors, considering all water uses and exposures.

How a waterborne disease burden estimate can help prevent waterborne illness in the U.S.

  • Target resources and preventive measures
  • Drive new data collection that will refine the estimate over time
  • Drive inclusion of new items (such as chemicals)
  • Drive partnerships
  • Provide metrics to follow over time
  • Address emerging issues

The ideal waterborne disease burden estimate

The ideal waterborne disease burden estimate will provide a cohesive umbrella estimate that covers:

All water uses, including:

All water venues, including:

  • Drinking water systems (public, private)
  • Natural swimming waters (beaches, fresh water)
  • Chlorinated swimming venues (pools, hot tubs/spas, water parks, foot spas)
  • Premise plumbing and building distribution systems
  • Irrigation and food processing water systems
  • Reclaimed water, graywater

Premise plumbing

Premise plumbing is the drinking water system that is inside housing, schools, and other buildings. It connects to the main drinking water distribution system, but the water utility does not monitor its safety. A large proportion of drinking water outbreaks are linked to pathogens that grow in premise plumbing and building water system parts—like hot water tanks, cooling towers, decorative fountains, shower heads, and water taps—and are inhaled through steam or aerosol 1-5.


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