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

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

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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• Line List - Recreational Water Outbreaks, 2011-2012 [PDF - 5 pages]

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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

	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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• Number of Waterborne Disease Outbreaks Associated with Recreational Water, by Predominant Illness and Type of Water Exposure, 2011-2012 [PDF - 1 page]

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