TABLE 1.
Waterborne disease outbreaks associated with drinking water (N = 32), by state/jurisdiction and month of first case onset — Waterborne Disease and Outbreak Surveillance System, United States, 2011–2012
| State/ Jurisdiction | Month | Year | Etiology* | Predominant illness† | No. cases | No. hospitalizations§ | No. deaths¶ | Water system** | Water source | Setting |
|---|---|---|---|---|---|---|---|---|---|---|
| Alaska | Jun | 2012 | Giardia intestinalis | AGI | 21 | 0 | 0 | Transient noncommunity | Spring, Well, River/Stream†† | Camp/Cabin |
| Arizona | Mar | 2011 | Unknown | AGI | 3 | 0 | 0 | Nontransient noncommunity | Spring | Outdoor workplace |
| Colorado | Oct | 2012 | Propylene glycol suspected§§ | AGI | 7 | 0 | 0 | Community | Lake/Reservoir/Impoundment | Hospital/Health care |
| Florida | Aug | 2009¶¶ | L. pneumophila serogroup 1 | ARI | 10 | 4 | 1 | Community | Unknown | Hotel/Motel/Lodge/Inn |
| Florida | Jul | 2011 | Shigella sonnei subgroup D | AGI | 22 | 0 | 0 | Commercially bottled | Unknown | Indoor workplace/Office |
| Florida | Mar | 2012 | Unknown*** | AGI | 3 | 0 | 0 | Commercially bottled | Well | Indoor workplace/Office |
| Idaho | May | 2012 | Campylobacter, Giardia intestinalis | AGI | 7 | 0 | 0 | Community | River/Stream/Well | Community/Municipality |
| Illinois | Aug | 2012 | Pantoea agglomerans ††† | Other | 12 | 9 | 0 | Community | Lake/Reservoir/Impoundment | Hospital/Health care |
| Maryland | May | 2011 | L. pneumophila serogroup 1 | ARI | 7 | 6 | 1 | Community | Well | Hotel/Motel/Lodge/Inn |
| Maryland | May | 2012 | L. pneumophila serogroup 1 | ARI | 3 | 2 | 1 | Community | Lake/Reservoir/Impoundment | Hospital/Health care |
| New Mexico | Jun | 2011 | Norovirus | AGI | 119 | 0 | 0 | Transient noncommunity | Spring§§§ | Camp/Cabin |
| New York | Apr | 2009¶¶¶ | L. pneumophila serogroup 1 | ARI | 4 | 4 | 0 | Community | Lake/Reservoir/Impoundment | Apartment/Condo |
| New York | Jun | 2011 | L. pneumophila serogroup 1 | ARI | 2 | 2 | Community | River/Stream | Hospital/Health care | |
| New York | Sep | 2011 | L. pneumophila serogroup 1 | ARI | 12 | 10 | 0 | Community | Lake/Reservoir/Impoundment | Hotel/Motel/Lodge/Inn |
| New York | Sep | 2011 | L. pneumophila serogroup 1 | ARI | 3 | 0 | Community | Lake/Reservoir/Impoundment | Hospital/Health care | |
| New York | Jan | 2012 | L. pneumophila serogroup 1 | ARI | 3 | Community | Lake/Reservoir/Impoundment | Hotel/Motel/Lodge/Inn | ||
| New York | Mar | 2012 | L. pneumophila serogroup 1 | ARI | 2 | 1 | 0 | Community | Lake/Reservoir/Impoundment | Hospital/Health care |
| New York | Apr | 2012 | L. pneumophila serogroup 1 | ARI | 2 | 2 | Community | Lake/Reservoir/Impoundment | Apartment/Condo | |
| New York | Oct | 2012 | L. pneumophila serogroup 1 | ARI | 2 | 1 | 0 | Community | Lake/Reservoir/Impoundment | Hospital/Health care |
| New York | Nov | 2012 | L. pneumophila serogroup 1 | ARI | 2 | 2 | 0 | Community | Lake/Reservoir/Impoundment | Hospital/Health care |
| Ohio | Jan | 2011 | L. pneumophila serogroup 1 | ARI | 11 | 11 | 1 | Community | Well | Hospital/Health care |
| Ohio | Mar | 2011 | L. pneumophila serogroup 1 | ARI | 8 | 7 | 0 | Community | Lake/reservoir/impoundment | Hospital/Health care |
| Ohio | Aug | 2011 | L. pneumophila | ARI | 10 | 4 | 2 | Community | Lake/Reservoir/Impoundment | Hospital/Health care |
| Ohio | Nov | 2012 | L. pneumophila serogroup 1 | ARI | 2 | 2 | 0 | Community | Lake/Reservoir/Impoundment | Hospital/Health care |
| Pennsylvania | Feb | 2011 | L. pneumophila serogroup 1 | ARI | 22 | 22 | 5 | Community | Lake/Reservoir/Impoundment | Hospital/Health care**** |
| Pennsylvania | May | 2011 | L. pneumophila serogroup 1 | ARI | 2 | 2 | 0 | Community | Well | Long-term care facility |
| Pennsylvania | Aug | 2011 | L. pneumophila serogroup 1 | ARI | 6 | 5 | 1 | Community | Well | Hospital/Health care |
| Pennsylvania | Mar | 2012 | L. pneumophila | ARI | 2 | 2 | 1 | Community | Lake/Reservoir/Impoundment | Hospital/Health care |
| Pennsylvania | Nov | 2012 | L. pneumophila serogroup 1 | ARI | 4 | 4 | 1 | Community | River/Stream | Apartment/Condo |
| Utah | Aug | 2011 | STEC O121, STEC O157:H7 | AGI†††† | 56 | 2 | 0 | Transient noncommunity | Spring | Camp/Cabin |
| Utah | Jul | 2012 | L. pneumophila serogroup 1 | ARI | 3 | 3 | 0 | Community | Lake/Reservoir/Impoundment | Hotel/Motel/Lodge/Inn |
| Utah | Aug | 2012 | Giardia intestinalis | AGI | 28 | 0 | 0 | Community | Well | Subdivision/Neighborhood |
| Washington | Jan | 2011 | L. pneumophila serogroup 1 | ARI | 3 | 3 | 1 | Community | Well | Hospital/Health care |
| Wisconsin | Aug | 2012 | Norovirus Genogroup I.2 | AGI | 19 | 0 | 0 | Transient noncommunity | Well§§§§ | Hall/Meeting facility |
Abbreviations: AGI = acute gastrointestinal illness; ARI = acute respiratory illness; L. pneumophila = Legionella pneumophila; other = undefined, illnesses, conditions, or symptoms that cannot be categorized as gastrointestinal, respiratory, ear-related, eye-related, skin-related, neurologic, hepatitis, or caused by leptospirosis; STEC = Shiga toxin–producing Escherichia coli.
Etiologies listed are confirmed, unless indicated “suspected.” For multiple-etiology outbreaks, etiologies are listed in alphabetical order.
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). Water systems in this table include community, noncommunity and bottled.
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 before 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 health care 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 icemaker. This is the first report of a Pantoea infection outbreak in a health care 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, with concentrations at manufacturer-recommended levels, in place to control Legionella at the time of the outbreak.
No outbreak-associated cases of hemolytic uremic syndrome (HUS) were reported.
Setting was a meeting facility, where owner was unaware of and not maintaining septic system; system overflowed and contaminated the well.