TABLE 1. Waterborne disease outbreaks associated with drinking water (N = 42), by state/jurisdiction and month of first case onset — Waterborne Disease and Outbreak Surveillance System, United States, 2013–2014.
| State/ Jurisdiction | Month | Year | Etiology* | Predominant illness† | No. of cases | No. of hospitalizations§ | No. of deaths¶ | Type of water system** | Water source | Setting |
|---|---|---|---|---|---|---|---|---|---|---|
| Alaska |
Aug |
2014 |
Giardia duodenalis
††
|
AGI |
5 |
0 |
0 |
Community |
River/Stream |
Community/Municipality |
| Arizona |
Jan |
2014 |
Norovirus (S) |
AGI |
4 |
0 |
0 |
Transient, noncommunity |
Unknown |
Camp/Cabin Setting |
| Florida |
Sep |
2013 |
L. pneumophila serogroup 1 |
ARI |
4 |
4 |
0 |
Community |
Well |
Hospital/Health care |
| Florida |
Nov |
2013 |
L. pneumophila serogroup 1 |
ARI |
4 |
4 |
0 |
Community |
Other |
Other§§ |
| Florida |
Apr |
2014 |
L. pneumophila serogroup 1 |
ARI |
2 |
2 |
0 |
Community |
Well |
Hotel/Motel/Lodge/Inn |
| Florida |
Jun |
2014 |
L. pneumophila serogroup 1 |
ARI |
3 |
2 |
0 |
Community |
Unknown |
Long-term care facility |
| Florida |
Aug |
2014 |
L. pneumophila serogroup 1 |
ARI |
6 |
4 |
0 |
Community |
Unknown |
Hotel/Motel/Lodge/Inn |
| Idaho |
Sep |
2014 |
Giardia duodenalis
|
AGI |
2 |
0 |
0 |
Unknown |
Unknown |
Hotel/Motel/Lodge/Inn |
| Indiana |
Jul |
2013 |
Cryptosporidium sp. |
AGI |
7 |
0 |
0 |
Community |
Unknown |
Mobile home park |
| Indiana |
Nov |
2014 |
Unknown |
AGI |
3 |
0 |
0 |
Community |
Unknown |
Apartment/Condo |
| Kansas |
Jun |
2014 |
L. pneumophila serogroup 1 |
ARI |
2 |
2 |
0 |
Community |
Unknown |
Hospital/Health care |
| Maryland |
Nov |
2012 |
L. pneumophila serogroup 1 |
ARI |
2¶¶ |
2¶¶ |
0 |
Community |
Well |
Hotel/Motel/Lodge/Inn |
| Maryland |
Feb |
2013 |
Nitrite*** |
AGI, Neuro |
14 |
|
0 |
Community |
Lake/Reservoir/ Impoundment |
Indoor workplace/Office |
| Maryland |
Apr |
2014 |
L. pneumophila serogroup 1 |
ARI |
2 |
2 |
0 |
Community |
Lake/Reservoir/ Impoundment |
Apartment/Condo |
| Maryland |
Jul |
2014 |
L. pneumophila serogroup 1 |
ARI |
2 |
1 |
0 |
Community |
Well |
Hotel/Motel/Lodge/Inn |
| Maryland |
Aug |
2014 |
L. pneumophila serogroup 1 |
ARI |
2 |
2 |
0 |
Community |
River/Stream |
Prison/Jail (Juvenile/Adult) |
| Michigan |
Jun |
2014 |
L. pneumophila serogroup 1 |
ARI |
45 |
45 |
7 |
Community |
River/Stream |
Hospital/Health care, Community/Municipality††† |
| Montana |
Jul |
2014 |
Norovirus GII.Pe-GII.4 Sydney |
AGI |
62 |
0 |
0 |
Transient, noncommunity |
Well |
Hotel/Motel/Lodge/Inn |
| New York |
Jul |
2013 |
L. pneumophila serogroup 1 |
ARI |
2 |
2 |
0 |
Community |
Lake/Reservoir/ Impoundment |
Hospital/Health care |
| New York |
Jun |
2014 |
L. pneumophila serogroup 1 |
ARI |
2 |
2 |
0 |
Community |
Well |
Hospital/Health care |
| North Carolina |
Dec |
2013 |
L. pneumophila serogroup 1 |
ARI |
3 |
2 |
0 |
Community |
Unknown |
Long-term care facility |
| North Carolina |
Dec |
2013 |
L. pneumophila serogroup 1 |
ARI |
7 |
3 |
0 |
Community |
Unknown |
Long-term care facility |
| North Carolina |
May |
2014 |
L. pneumophila serogroup 1 |
ARI |
7 |
6 |
1 |
Community |
Other |
Long-term care facility |
| North Carolina |
Jun |
2014 |
L. pneumophila serogroup 1 |
ARI |
3 |
3 |
0 |
Community |
Unknown |
Long-term care facility |
| North Carolina |
Jul |
2014 |
L. pneumophila serogroup 1 |
ARI |
3 |
2 |
1 |
Community |
Unreported |
Long-term care facility |
| Ohio |
Apr |
2013 |
L. pneumophila
|
ARI |
2 |
2 |
1 |
Unknown |
Unknown |
Long-term care facility |
| Ohio§§§ |
Sep |
2013 |
Cyanobacterial toxin¶¶¶ |
AGI |
6 |
0 |
0 |
Community |
Lake/Reservoir/ Impoundment |
Community/Municipality |
| Ohio |
Jul |
2014 |
L. pneumophila serogroup 1 |
ARI |
14 |
4 |
0 |
Community |
River/Stream |
Long-term care facility |
| Ohio |
Aug |
2014 |
Cyanobacterial toxin¶¶¶ |
AGI |
110 |
|
|
Community |
Lake/Reservoir/ Impoundment |
Community/Municipality |
| Ohio |
Oct |
2014 |
Cryptosporidium sp. (S)**** |
AGI |
100 |
0 |
0 |
Individual |
River/Stream |
Farm/Agricultural setting |
| Ohio |
Dec |
2014 |
Viral, unknown (S) |
AGI |
2 |
0 |
0 |
Commercially bottled |
Unknown |
Private residence |
| Oregon |
Jun |
2013 |
Cryptosporidium parvum IIaA15G2R1 |
AGI |
119 |
2 |
0 |
Community |
Lake/Reservoir/ Impoundment |
Community/Municipality |
| Oregon |
Sep |
2014 |
L. pneumophila serogroup 1 |
ARI |
4 |
4 |
1 |
Community |
Well |
Apartment/Condo |
| Pennsylvania |
Dec |
2013 |
L. pneumophila serogroup 1 |
ARI |
2 |
2 |
0 |
Unknown |
Unknown |
Hospital/Health care |
| Pennsylvania |
Feb |
2014 |
L. pneumophila serogroup 1 |
ARI |
5 |
5 |
0 |
Community |
River/Stream |
Long-term care facility |
| Pennsylvania |
Oct |
2014 |
L. pneumophila
|
ARI |
2 |
2 |
1 |
Community |
Unknown |
Long-term care facility |
| Rhode Island |
Apr |
2013 |
L. pneumophila serogroup 1 |
ARI |
2 |
2 |
1 |
Community |
Lake/Reservoir/ Impoundment |
Hospital/Health care |
| Tennessee |
Jul |
2013 |
Cryptosporidium parvum
|
AGI |
34 |
0 |
0 |
Transient, noncommunity†††† |
Spring |
Camp/Cabin setting |
| Tennessee |
Jun |
2014 |
Clostridium difficile (S); Escherichia coli, Enteropathogenic (S) |
AGI |
12 |
0 |
0 |
Nontransient, noncommunity |
Well |
Camp/Cabin setting; Community/Municipality |
| Virginia |
Jun |
2013 |
Cryptosporidium sp. |
AGI |
19 |
0 |
0 |
Individual |
Well |
Farm/Agricultural setting |
| West Virginia |
Jan |
2014 |
4-Methylcyclo hexanemethanol (MCHM)§§§§ |
AGI |
369 |
13 |
0 |
Community |
River/Stream |
Community/Municipality |
| Wisconsin |
Aug |
2014 |
Giardia duodenalis
|
AGI |
3 |
0 |
0 |
Nontransient, noncommunity |
Other |
National forest |
| Wisconsin | Sep | 2014 | Campylobacter jejuni | AGI | 5 | 0 | 0 | Individual | Well | Private residence |
Abbreviations: AGI = acute gastrointestinal illness; ARI = acute respiratory illness; L. pneumophila = Legionella pneumophila; Neuro = neurologic illnesses, conditions, or symptoms (e.g., meningitis); S = suspected.
* Etiologies listed are confirmed, unless indicated as 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 persons for whom information was available was also zero or for instances where reports are missing hospitalization data.
¶ Value was set to “missing” in reports where zero deaths were reported and the number of persons for whom information was available was also zero or for instances where reports are missing data on associated deaths.
** Community and noncommunity water systems are public water systems that have ≥15 service connections or serve an average of ≥25 residents for ≥60 days per 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.
†† Classification of all reported Giardia cases has changed from Giardia intestinalis to Giardia duodenalis to align with laboratory standards.
§§ Setting is listed as “other” because implicated facility houses both independent living and assisted living facilities.
¶¶ This count was not included in the analysis of the current report. This outbreak occurred in 2012 and was not reported in the previous drinking water outbreak report.
*** Patients’ methemoglobin levels ranged from 1.6% to 32.3%. Water was determined to be the source rather than food because all cases had direct exposure to water. Of the 14 cases, five used the water to make oatmeal or cream of wheat.
††† This report includes both community and hospital-associated cases (27 of 45 patients reported health care/hospital exposure).
§§§ This is the first drinking water–associated outbreak of this etiology reported to the National Outbreak Reporting System.
¶¶¶ Microcystin was detected in finished water sampled from a community water system; levels exceeded state thresholds and resulted in a “Do not drink” advisory.
**** Cryptosporidium was detected in water samples but not in any clinical specimens.
†††† This system was registered as a community system as a result of the outbreak investigation.
§§§§ Illnesses were associated with exposure to 4-methylcyclohexanemethanol following a documented industrial spill into water supplying a public water system. However, individual levels of exposure could not be quantified in clinical specimens. Propylene glycol phenyl ether was also present in the spill at low concentrations.