2009-2010 Drinking Water-associated Outbreak Surveillance Report: Supplemental Tables

These tables provide supplemental information not published in Surveillance for Waterborne Disease Outbreaks Associated with Drinking Water and Other Nonrecreational Water — United States, 2009–2010 (MMWR Weekly).

Waterborne Disease Outbreaks Associated with Drinking Water (N = 33) and Other Non-Recreational Water* (N = 12) by Year and State/Jurisdiction — Waterborne Disease and Outbreak Surveillance System, United States, 2009-2010.

Line list expanded to include class and deficiency.

Jurisdiction	Month	Year	Class†	Etiology	Predominant Illness§	No. cases	No. hospital-izations¶	No. deaths**	Water System††	Deficiency§§	Water Source	Setting
Drinking Water
Florida	Jul	2009	4	Legionella sp.	ARI	2	2	0	Community	5a	Well	Membership club
Idaho	May	2009	3	Campylobacter sp., Giardia intestinalis	AGI	7	0	0	Community	4	Well	Private residence
Maine	Jul	2009	3	Hepatitis A	Hep	2			Individual/Private	2	Well	Private residence
Maryland	Sep	2009	1	Legionella pneumophila serogroup 1, Knoxville 1	ARI	10	9	1	Community	5a	Lake/Reservoir	Apartment/Condo
Nevada	Dec	2009	3	Legionella pneumophila serogroup 1	ARI	10	1	0	Community	5a	Lake/Reservoir	Hotel/Motel
New York	Apr	2009	3	Legionella pneumophila serogroup 1	ARI	3	3	2	Community	5a	Lake/Reservoir	Hospital/Health care
New York	Dec	2009	3	Legionella pneumophila serogroup 1	ARI	3	3	1	Community	5a	Lake/Reservoir	Hospital/Health care
South Carolina	Jul	2009	3	Legionella pneumophila serogroup 1	ARI	3	3	0	Community	5a	Ground water	Hotel/Motel
Utah	Jun	2009	3	Legionella pneumophila serogroup 1	ARI	5	5	0	Community	5a	Well, spring	Hotel/Motel
Utah	Aug	2009	3	Giardia intestinalis	AGI	8	0	0	Community¶¶	4	Well, surface water	Subdivision/Neighborhood
California	Jun	2010	1	Norovirus	AGI	47			Transient Noncommunity	2	Well	Restaurant/Cafeteria
Georgia	Apr	2010	3	Legionella pneumophila serogroup 1	ARI	4	4	0	Community	5a	Well, spring	Hotel/Motel
Illinois	Nov	2010	3	Unidentified***	AGI; Other†††	3	3	0	Commercially bottled	11c	Unidentified	Church/Place of worship
Maryland	Aug	2010	3	Legionella pneumophila serogroup 1	ARI	2	2	0	Community	5a, 7	Surface water	Personal care home§§§
Minnesota	Jun	2010	2	Giardia intestinalis	AGI	6	0	0	Transient Noncommunity	2	Well	State park
Missouri	Feb	2010	4	Campylobacter jejuni	AGI	16	5	0	Community	2	Well	Community/Municipality
Missouri	Mar	2010	1	Campylobacter sp.	AGI	67	4	0	Community	4	Well	Community/Municipality
Missouri	Apr	2010	1	Escherichia coli O157:H7	AGI	28	4	0	Community¶¶¶	2	Well	Membership club
Missouri	Nov	2010	1	Escherichia coli O157:H7	AGI	11	3	1	Individual/Private	2	Well	Private residence
Montana	Jul	2010	1	Campylobacter jejuni	AGI	101	6	0	Nontransient Noncommunity	2, 4	Well	Resort
Nevada	Dec	2010	3	Legionella pneumophila serogroup 1	ARI	4	2	1	Community	5a	Well, river/stream	Hotel/Motel
New York	Apr	2010	3	Legionella pneumophila serogroup 1	ARI	3	3	1	Community	5a, 7	Lake/Reservoir	Hospital/Health care****
New York	Jun	2010	3	Legionella pneumophila serogroup 1	ARI	3	3	0	Community	5a	Lake/Reservoir	Prison/Jail
New York	Jul	2010	3	Legionella pneumophila serogroup 1	ARI	2	2	0	Community	5a	Lake/Reservoir	Hospital/Health care††††
New York	Jul	2010	3	Legionella pneumophila serogroup 1	ARI	5	3	0	Community	5a	Lake/Reservoir	Hospital/Health care
Ohio	Feb	2010	4	Legionella pneumophila	ARI	3	3	0	Community	5a	Unidentified	Long-term care facility
Pennsylvania	May	2010	3	Legionella pneumophila serogroup 1	ARI	3	3	1	Community§§§§	5a, 3, 6	Well	Personal care home
Pennsylvania	Jun	2010	3	Legionella pneumophila serogroup 1	ARI	2	2	0	Community	5a	River/Stream	Apartment/Condo
Pennsylvania	Jul	2010	2	Campylobacter jejuni, Cryptosporidium sp.	AGI	10	0	0	Individual/ Private	2	Well	Private residence
Utah	Apr	2010	3	Campylobacter jejuni	AGI	628	2	0	Community¶¶	4	Well, spring	Community/ Municipality
Utah	Aug	2010	3	Legionella pneumophila serogroup 1, Camperdown 1	ARI	2	2	1	Community	5a	Spring, creek	Hotel/Motel
Utah	Dec	2010	3	Legionella pneumophila serogroup 1	ARI	3	3	0	Community	5a	Well, surface water	Assisted living/ Rehab
Vermont	Jan	2010	1	Cryptosporidium sp.	AGI	34	0	0	Individual/ Private	2	Well	Vacation rental house
Other non-recreational water*
Alabama	Apr	2009	4	Campylobacter jejuni	AGI	11	0	0	Wilderness/Natural water source	12	River/Stream	Backcountry
Illinois	Sep	2009	3	Legionella pneumophila serogroup 1	ARI	8	8	2	Unknown	5c	Ornamental fountain, spa, irrigation¶¶¶¶	Assisted living/Rehab
Missouri	Jul	2009	3	Unidentified	AGI	75	0	0	Wilderness/ Natural water source	12	Spring	Camp/Cabin
New York	Aug	2009	3	Giardia intestinalis	AGI	26	1	0	Wilderness/ Natural source	12	Spring	Public outdoor area
Ohio	Sep	2009	4	Legionella sp.	ARI	2	2	0	Unknown	5c	Unknown	Long-term care facility
Idaho	Jul	2010	3	Campylobacter jejuni	AGI	3	0	0	Wilderness/ Natural source	12	River/Stream	Backcountry
Michigan	Jul	2010	1	Legionella pneumophila serogroup 1	ARI	64	17	0	Cooling/Air conditioning	5b	Cooling tower	Military facility
Mississippi	Jun	2010	1	Legionella pneumophila serogroup 1	ARI	9	6	1	Cooling/Air conditioning	5b	Cooling tower	Hotel/Motel
Nevada	Jun	2010	1	Giardia intestinalis	AGI	20	1	0	Irrigation	12	Puddle/ Canal/ Swamp	Public outdoor area
New York	Nov	2010	3	Legionella pneumophila serogroup 1	ARI	4	4	0	Industrial/ Occupational	5b	Mist/Steam device	Factory/ Industrial facility
Texas	May	2010	4	Legionella pneumophila serogroup 1	ARI	4	4	3	Unknown	5c	Unknown	Long-term care facility
Wisconsin	Feb	2010	3	Legionella pneumophila serogroup 1	ARI	8	8	0	Ornamental	5b	Ornamental fountain	Hospital/ Health care

Abbreviations: AGI = acute gastrointestinal illness; ARI = acute respiratory illness; Hep = Hepatitis; Other = undefined, illnesses, conditions, or symptoms or symptoms that cannot be categorized as gastrointestinal, respiratory, ear-related, eye-related, skin-related, neurological, hepatitis or caused by leptospirosis.

*Non-recreational waterborne disease outbreaks combines two previously-reported categories, ‘Water Not Intended for Drinking’ and ‘Water of Unknown Intent.’ It includes outbreaks not associated with public or private drinking water systems, as well as outbreaks for which the intended use of the water is not known. It does not include outbreaks associated with recreational water venues (e.g., swimming pools), which are reported separately.

† On the basis of epidemiologic, clinical laboratory, and environmental data (e.g., water quality data) provided to CDC.

§ The category of illness reported by ≥50% of ill respondents. All legionellosis outbreaks were categorized as ARI.

¶ Value was set to missing in reports where zero hospitalizations were reported and the number of people for whom information was available was also zero.

** Value was set to missing in reports where zero deaths were reported and the number of people for whom information was available was also zero.

†† Community and noncommunity water systems are public water systems that have ≥15 service connections or serve an average of ≥ 25 residents for ≥ 60 days/year. A community water system serves year-round residents of a community, subdivision, or mobile home park. A noncommunity water system serves an institution, industry, camp, park, hotel, or business and can be nontransient or transient. Nontransient systems serve ≥ 25 of the same persons for >6 months of the year but not year-round (e.g., factories and schools) whereas transient systems provide water to places in which persons do not remain for long periods of time (e.g., restaurants, highway rest stations, and parks). Individual water systems are small systems not owned or operated by a water utility that have <15 connections or serve <25 persons.

§§ Deficiency classification assigned to outbreaks associated with drinking water, other water, and unknown water exposures

¶¶ A cross-connection between potable and nonpotable water sources resulting in backflow was a suspected or confirmed factor in this outbreak.

*** Etiology unidentified: contamination of water with sodium hydroxide suspected based upon incubation period, symptoms, outbreak investigation and laboratory findings.

††† The other symptoms reported were chemical esophagitis and burns in mouth.

§§§ Facility had an onsite disinfection system that was not operational at the time of the outbreak.

¶¶¶ Setting was a recreational facility with multiple buildings. A private well that was originally used for a residence was reclassified as a community water system as a result of the outbreak investigation.

**** The facility had an onsite chlorine dioxide system; however, there were indicators that the system was not being monitored properly at the time of the outbreak.

†††† The facility had an onsite chlorine dioxide system and was being monitored for Legionella.

§§§§ Reported contributing factors included a temporary disruption in disinfection and a cross-connection between potable and nonpotable water sources resulting in backflow.

¶¶¶¶ Multiple water sources within the facility were identified as possible exposures in this outbreak.

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Number of Waterborne Disease Outbreaks, by Drinking Water System and Source — Waterborne Disease and Outbreak Surveillance System, United States, 2009-2010.

Drinking Water-associated Outbreaks by Etiology Group, 2009-2010

Etiology
	Outbreaks	Cases	Hospitalized	Died
Bacterium	25	923	82	9
Campylobacter	4	812	17	0
E. coli O157:H7	2	39	7	1
Legionella	19	72	58	8
Virus	2	49	0	0
Hepatitis	1	2	—	—
Norovirus	1	47	—	—
Parasite	3	48	0	0
Cryptosporidium	1	34	0	0
Giardia	2	14	0	0
Multiple	2	17	0	0
Unidentified	1	3	3	0
Suspected sodium hydroxide	1	3	3	0
Total	33	1040	85	9
	Note: Unknown hospitalization and death info denoted by ‘–‘

Community Water Systems

Etiology	Ground Water				Mixed Water				Surface Water				Unknown Water
	Outbreaks	Cases	Hospitalized	Died	Outbreaks	Cases	Hospitalized	Died	Outbreaks	Cases	Hospitalized	Died	Outbreaks	Cases	Hospitalized	Died
Bacterium	9	756	32	1	3	9	7	2	10	43	31	5	1	3	3	0
Campylobacter	3	711	11	0	0	0	0	0	0	0	0	0	0	0	0	0
E. coli O157:H7	1	28	4	0	0	0	0	0	0	0	0	0	0	0	0	0
Legionella	5	17	17	1	3	9	7	2	10*	43	31	5	1	3	3	0
Virus	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Hepatitis	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Norovirus	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Parasite	0	0	0	0	1	8	0	0	0	0	0	0	0	0	0	0
Cryptosporidium	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Giardia	0	0	0	0	1	8	0	0	0	0	0	0	0	0	0	0
Multiple	1	7	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Unidentified	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Suspected sodium hydroxide	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Total	10	763	32	1	4	17	7	2	10	43	31	5	1	3	3	0
	* Death information unknown for one of these outbreaks

Non-community Water Systems*

Etiology	Ground Water
	Outbreaks	Cases	Hospitalized	Died
Bacterium	1	101	6	0
Campylobacter	1	101	6	0
E.coli O157:H7	0	0	0	0
Legionella	0	0	0	0
Virus	1	47	0	0
Hepatitis	0	0	0	0
Norovirus	1	47	—	—
Parasite	1	6	0	0
Cryptosporidium	0	0	0	0
Giardia	1	6	0	0
Multiple	0	0	0	0
Unidentified	0	0	0	0
Suspected sodium hydroxide	0	0	0	0
Total	3	154	6	0
	*No reported outbreaks in public non-community water systems had mixed water, surface water, or unknown water source.
	Note: Unknown hospitalization and death info denoted by ‘–‘

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Individual Water Systems*

Etiology	Ground Water
	Outbreaks	Cases	Hospitalized	Died
Bacterium	1	11	3	1
Campylobacter	0	0	0	0
E.coli O157:H7	1	11	3	1
Legionella	0	0	0	0
Virus	1	2	0	0
Hepatitis	1	2	—	—
Norovirus	0	0	0	0
Parasite	1	34	0	0
Cryptosporidium	1	34	0	0
Giardia	0	0	0	0
Multiple	1	10	0	0
Unidentified	0	0	0	0
Suspected sodium hydroxide	0	0	0	0
Total	4	57	3	1
	*No reported outbreaks in individual water systems had mixed water, surface water, or unknown water source.
	Note: Unknown hospitalization and death info denoted by ‘–‘

Commercially-bottled Water*

Etiology	Unknown Water Source
	Outbreaks	Cases	Hospitalized	Died
Bacterium	0	0	0	0
Campylobacter	0	0	0	0
E. coli O157:H7	0	0	0	0
Legionella	0	0	0	0
Virus	0	0	0	0
Hepatitis	0	0	0	0
Norovirus	0	0	0	0
Parasite	0	0	0	0
Cryptosporidium	0	0	0	0
Giardia	0	0	0	0
Multiple	0	0	0	0
Unidentified	1	3	3	0
Suspected sodium hydroxide	1	3	3	0
Total	1	3	3	0
	*No reported outbreaks in bottled water systems had ground water, mixed water, or surface water source.

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