Estimating Waterborne Infectious Disease Burden by Exposure Route, United States, 2014

Area of Science:

• Environmental Health
• Epidemiology
• Public Health

Background:

• Waterborne illnesses represent a significant public health burden in the United States.
• In 2014, over 7.15 million cases of domestically acquired infectious waterborne illnesses resulted in 120,000 hospitalizations and 6,600 deaths.
• Pathogens in water are linked to recreational, drinking, and nonrecreational nondrinking (NRND) exposure routes.

Purpose of the Study:

• To estimate the disease incidence and burden of waterborne illnesses by exposure route.
• To identify the primary sources and pathways of waterborne disease transmission.
• To inform targeted prevention and water management strategies.

Main Methods:

• Utilized previously published estimates to calculate disease incidence for 17 pathogens.
• Categorized water exposure into recreational, drinking, and NRND routes.
• Analyzed hospitalization data attributed to each exposure route.

Main Results:

• In 2014, recreational water exposure linked to 5.61 million illnesses, drinking water to 1.13 million, and NRND water to 407,000.
• Drinking water exposure accounted for the highest percentage of hospitalizations (40%), followed by recreational water (36%) and NRND water (24%).
• Pathogens found in biofilms were associated with the most direct costs.

Conclusions:

• Estimating disease burden by water exposure route is crucial for effective prevention.
• Water management programs are essential to control biofilm-associated pathogen growth across all exposure routes.
• Public health programs are needed to prevent diseases linked to biofilms in water systems.