Skip directly to search Skip directly to A to Z list Skip directly to navigation Skip directly to page options Skip directly to site content

2011-2012 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 — United States, 2011–2012 (MMWR Weekly).

Table 1. Waterborne Disease Outbreaks Associated with Drinking Water (N=32) by Year and Exposure State/Jurisdiction — Waterborne Disease and Outbreak Surveillance System, United States, 2011–2012.

Exposure Category and State, Jurisdiction Month Year Class* Etiology (Confirmed, Suspected) Predominant Illness† No. cases No. hospital-izations§ No. deaths¶ Water System** Deficiency†† Water Source Setting
Alaska Jun 2012 3 Giardia intestinalis (C) AGI 21 0 0 Transient Noncommunity 1, 2 Spring, Well, River, Stream§§ Camp, Cabin Setting
Arizona Mar 2011 4 Unknown AGI 7 0 0 Nontransient Noncommunity 2 Spring Outdoor Place of Work
Colorado Oct 2012 3 Propylene glycol (S)¶¶ AGI 26 0 0 Community 6 Lake, Reservoir, Impoundment Hospital, Health Care
Florida Aug 2009*** 3 Legionella pneumophila serogroup 1 (C)   ARI 10 4 1 Community 5a Unknown Hotel, Motel, Lodge, Inn
Florida Jul 2011 3 Shigella sonnei subgroup D (C)   AGI 22 0 0 Commercially-Bottled 11c Unknown Indoor Workplace, Office
Florida Mar 2012 4 Unknown†††  AGI 3 0 0 Commercially-Bottled 99b Well Indoor Workplace, Office
Idaho May 2012 3 Campylobacter (C), Giardia intestinalis (C) AGI 7 0 0 Community 6 River, Stream, Well Community, Municipality
Illinois Aug 2012 1 Pantoea agglomerans (C)§§§ Other 12 9 0 Community 99 Lake, Reservoir, Impoundment Hospital, Health Care
Maryland May 2011 3 Legionella pneumophila serogroup 1 (C)   ARI 7 6 1 Community 5a Well Hotel, Motel, Lodge, Inn
Maryland May 2012 3 Legionella pneumophila serogroup 1 (C)   ARI 3 2 1 Community 5a Lake, Reservoir, Impoundment Hospital, Health Care
New Mexico Jun 2011 3 Norovirus (C)  AGI 119 0 0 Transient Noncommunity 2 Spring¶¶¶ Camp, Cabin Setting
New York Apr 2009**** 1 Legionella pneumophila serogroup 1 © ARI 4 4 0 Community 5a Lake, Reservoir, Impoundment Apartment, Condo
New York Jun 2011 3 Legionella pneumophila serogroup 1 (C)   ARI 2 2   Community 5a River, Stream Hospital, Health Care
New York Sep 2011 3 Legionella pneumophila serogroup 1 (C)   ARI 12 10 0 Community 5a Lake, Reservoir, Impoundment Hotel, Motel, Lodge, Inn
New York Sep 2011 3 Legionella pneumophila serogroup 1 (C)   ARI 3   0 Community 5a Lake, Reservoir, Impoundment Hospital, Health Care
New York Jan 2012 3 Legionella pneumophila serogroup 1 (C)   ARI 3     Community 5a Lake, Reservoir, Impoundment Hotel, Motel, Lodge, Inn
New York Mar 2012 4 Legionella pneumophila serogroup 1 (C)   ARI 2 1 0 Community 5a Lake, Reservoir, Impoundment Hospital, Health Care
New York Apr 2012 3 Legionella pneumophila serogroup 1 (C)   ARI 2 2   Community 5a Lake, Reservoir, Impoundment Apartment, Condo
New York Oct 2012 3 Legionella pneumophila serogroup 1 (C)   ARI 2 1 0 Community 5a Lake, Reservoir, Impoundment Hospital, Health Care
New York Nov 2012 3 Legionella pneumophila serogroup 1 (C)   ARI 2 2 0 Community 5a Lake, Reservoir, Impoundment Hospital, Health Care
Ohio Jan 2011 3 Legionella pneumophila serogroup 1 (C)   ARI 11 11 1 Community 5a Well Hospital, Health Care
Ohio Mar 2011 3 Legionella pneumophila serogroup 1 (C)   ARI 8 7 0 Community 5a Lake, Reservoir, Impoundment Hospital, Health Care
Ohio Aug 2011 3 Legionella pneumophila (C) ARI 10 4 2 Community 5a Lake, Reservoir, Impoundment Hospital, Health Care
Ohio Nov 2012 4 Legionella pneumophila serogroup 1 (C)   ARI 2 2 0 Community 5a Lake, Reservoir, Impoundment Hospital, Health Care
Pennsylvania Feb 2011 1 Legionella pneumophila serogroup 1 (C)   ARI 22 22 5 Community 5a Lake, Reservoir, Impoundment Hospital, Health Care††††
Pennsylvania May 2011 3 Legionella pneumophila serogroup 1 (C)   ARI 2 2 0 Community 5a Well Long Term Care Facility
Pennsylvania Aug 2011 3 Legionella pneumophila serogroup 1 (C)   ARI 6 5 1 Community 5a Well Hospital, Health Care
Pennsylvania Mar 2012 4 Legionella pneumophila (C)  ARI 2 2 1 Community 5a Lake, Reservoir, Impoundment Hospital, Health Care
Pennsylvania Nov 2012 4 Legionella pneumophila serogroup 1 (C)   ARI 4 4 1 Community 5a River, Stream Apartment, Condo
Utah Aug 2011 4 Shiga toxin-producing E. coli O121 (C), Shiga toxin-producing E. coli O157:H7 (C) AGI§§§§ 56 2 0 Transient noncommunity 2 Spring Camp, Cabin Setting
Utah Jul 2012 3 Legionella pneumophila serogroup 1 (C)   ARI 3 3 0 Community 5a Lake, Reservoir, Impoundment Hotel, Motel, Lodge, Inn
Utah Aug 2012 3 Giardia intestinalis (C)  AGI 28 0 0 Community 4 Well Subdivision, neighborhood
Washington Jan 2011 3 Legionella pneumophila serogroup 1 (C)   ARI 3 3 1 Community 5a Well Hospital, Health Care
Wisconsin Aug 2012 1 Norovirus Genogroup I GI_2  (C) AGI 19 0 0 Transient noncommunity 2 Well¶¶¶¶ Hall, Meeting Facility

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

* Strength-of-evidence class determined on the basis of epidemiologic, clinical laboratory, and environmental data (e.g., water quality data) provided to CDC. For more information, see Strength-of-Evidence Classification for Waterborne Disease & Outbreaks.

†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. Water systems in this table include community, noncommunity and bottled water.

†† Deficiency classification assigned to all outbreaks associated with drinking water. For more information, see Deficiency Classification for Drinking Water and Other, Non-recreational Waterborne Disease Outbreaks.

§§Spring water source contaminated during temporary connection with contaminated surface water source (stream).

¶¶Skin and eye symptoms in addition to AGI; other possible chemical exposures from cross contamination between drinking water and boiler water.

***The first case of illness in this outbreak occurred prior to 2011-2012, but the outbreak was reported later and not previously described in a surveillance report.

†††Chemical contamination suspected due to short incubation period; three bottled water samples tested, no chemical contamination detected.

§§§Outbreak of Pantoea agglomerans bloodstream infection in a healthcare facility linked to the drinking water system. Oncology clinic patients received infusions contaminated with P. agglomerans via central line, and environmental samples from the clinic and pharmacy where infusions were prepared shared the PFGE pattern found in patient blood samples. P. agglomerans was isolated from the pharmacy sink where the infusates were prepared, as well as from the oncology clinic ice maker. This is the first report of a Pantoea infection outbreak in a healthcare facility, and in a drinking water-associated outbreak surveillance report.

¶¶¶Outbreak occurred at the same venue with same etiology and water source as an outbreak previously reported in 1999. Contamination by surface water was suspected, based on the 1999 investigation.

****The first ill cases were identified in 2009, and were linked by molecular subtyping in 2012 to additional ill individuals living in the same apartment complex with onset dates in 2011 and 2012.

††††Hospital had a copper/silver ionization system in place to control Legionella at the time of the outbreak; copper and silver ion concentrations were at manufacturer-recommended levels.

§§§§Zero outbreak-associated cases of hemolytic uremic syndrome (HUS) were reported.

¶¶¶¶Setting was a meeting facility. The facility owner was not aware that the facility had a septic system, and was not maintaining this system. The outbreak occurred after the septic system overflowed and contaminated the well.

Download PDF

 Top of Page

Table 2. Number of Waterborne Disease Outbreaks, by Drinking Water System and Source — Waterborne Disease and Outbreak Surveillance System, United States, 2011-2012.

Drinking Water-associated Outbreaks by Etiology Group, 2011-2012

Etiology        
Outbreaks Cases Hospitalized Died
Bacterium 3 90 11 0
E. coli O157:H7 1 56 2 0
Pantoea agglomerans 1 12 9 0
Shigella sonnei 1 22 0 0
Bacteria, Legionella spp. 21* 111 91 14
Legionella spp.  21 111 91 14
Virus 2 138 0 0
Norovirus 2 138 0 0
Parasite 2 49 0 0
Giardia 2 49 0 0
Chemical 1 26 0 0
Suspected propylene glycol 1 26 0 0
Multiple† 1 7 0 0
Unidentified 2 10 0 0
Total 32 431 102 14

*Hospital information is unknown for two of these outbreaks, and death information is unknown for three of these outbreaks.

†One outbreak had multiple etiologic agent types. The etiologies were Campylobacter spp. (i.e., bacterium) and Giardia intestinalis (i.e., parasite).

Download PDF

 Top of Page

Community Water Systems*

Etiology Ground Water Mixed Water† Surface Water
Outbreaks Cases Hospitalized Died Outbreaks Cases Hospitalized Died Outbreaks Cases Hospitalized Died
Bacteria, non-Legionella spp. 0 0 0 0 0 0 0 0 1 12 9 0
E. coli O157:H7 0 0 0 0 0 0 0 0 0 0 0 0
Pantoea agglomerans 0 0 0 0 0 0 0 0 1 12 9 0
Shigella sonnei 0 0 0 0 0 0 0 0 0 0 0 0
Bacteria, Legionella spp. 5 29 27 4 0 0 0 0 16§ 82 64 10
Legionella spp. 5 29 27 4 0 0 0 0 16 82 64 10
Virus 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
Parasite 1 28 0 0 0 0 0 0 0 0 0 0
Giardia 1 28 0 0 0 0 0 0 0 0 0 0
Chemical 0 0 0 0 0 0 0 0 1 26 0 0
Suspected propylene glycol 0 0 0 0 0 0 0 0 1 26 0 0
Multiple¶ 0 0 0 0 1 7 0 0 0 0 0 0
Unidentified 0 0 0 0 0 0 0 0 0 0 0 0
Total 6 57 27 4 1 7 0 0 18 120 73 10

*No reported outbreaks in public non-community water systems had surface water or unknown water source.

†Includes outbreaks with mixed water sources (i.e. ground water and surface water). Two giardiasis outbreaks were associated with mixed source community.

§One outbreak had multiple etiologic agent types. The etiologies were Campylobacter spp. (i.e., bacterium) and Giardia intestinalis (i.e., parasite).

Download PDF

 Top of Page

Non-community Water Systems*

Non-community Water Systems*
Etiology Ground Water Mixed Water†
Outbreaks Cases Hospitalized Died Outbreaks Cases Hospitalized Died
Bacteria, non-Legionella spp. 1 56 2 0 0 0 0 0
E. coli O157:H7 1 56 2 0 0 0 0 0
Pantoea agglomerans 0 0 0 0 0 0 0 0
Shigella sonnei 0 0 0 0 0 0 0 0
Bacteria, Legionella spp. 0 0 0 0 0 0 0 0
Legionella spp.  0 0 0 0 0 0 0 0
Virus 2 138 0 0 0 0 0 0
Norovirus 2 138 0 0 0 0 0 0
Parasite 0 0 0 0 1 21 0 0
Giardia 0 0 0 0 1 21 0 0
Chemical 0 0 0 0 0 0 0 0
Suspected propylene glycol 0 0 0 0 0 0 0 0
Multiple§ 0 0 0 0 0 0 0 0
Unidentified 1 7 0 0 0 0 0 0
Total 4 201 2 0 1 21 0 0

*No reported outbreaks in public non-community water systems had surface water or unknown water source.

†Includes outbreaks with mixed water sources (i.e. ground water and surface water). Two giardiasis outbreaks were associated with mixed source community.

§One outbreak had multiple etiologic agent types. The etiologies were Campylobacter spp. (i.e., bacterium) and Giardia intestinalis (i.e., parasite).

Download PDF

 Top of Page

Commercially-bottled Water*

Commercially-bottled Water*
Etiology Ground Water Unknown Water
Outbreaks Cases Hospitalized Died Outbreaks Cases Hospitalized Died
Bacteria, non-Legionella spp. 0 0 0 0 1 22 0 0
E. coli O157:H7 0 0 0 0 0 0 0 0
Pantoea agglomerans 0 0 0 0 0 0 0 0
Shigella sonnei 0 0 0 0 1 22 0 0
Bacteria, Legionella spp. 0 0 0 0 0 0 0 0
Legionella spp.  0 0 0 0 0 0 0 0
Virus 0 0 0 0 0 0 0 0
Norovirus 0 0 0 0 0 0 0 0
Parasite 0 0 0 0 0 0 0 0
Giardia 0 0 0 0 0 0 0 0
Chemical 0 0 0 0 0 0 0 0
Suspected propylene glycol 0 0 0 0 0 0 0 0
Multiple† 0 0 0 0 0 0 0 0
Unidentified 1 3 0 0 0 0 0 0
Total 1 3 0 0 1 22 0 0

*No reported outbreaks in bottled water systems had mixed water or surface water source.

†One outbreak had multiple etiologic agent types. The etiologies were Campylobacter spp. (i.e., bacterium) and Giardia intestinalis (i.e., parasite).

Download PDF

 Top of Page

Top