Outbreaks Associated with Treated Recreational Water - United States, 2000-2014

MMWR. Morbidity and Mortality Weekly Report
Michele C HlavsaJonathan S Yoder

Abstract

Outbreaks associated with exposure to treated recreational water can be caused by pathogens or chemicals in venues such as pools, hot tubs/spas, and interactive water play venues (i.e., water playgrounds). During 2000-2014, public health officials from 46 states and Puerto Rico reported 493 outbreaks associated with treated recreational water. These outbreaks resulted in at least 27,219 cases and eight deaths. Among the 363 outbreaks with a confirmed infectious etiology, 212 (58%) were caused by Cryptosporidium (which causes predominantly gastrointestinal illness), 57 (16%) by Legionella (which causes Legionnaires' disease, a severe pneumonia, and Pontiac fever, a milder illness with flu-like symptoms), and 47 (13%) by Pseudomonas (which causes folliculitis ["hot tub rash"] and otitis externa ["swimmers' ear"]). Investigations of the 363 outbreaks identified 24,453 cases; 21,766 (89%) were caused by Cryptosporidium, 920 (4%) by Pseudomonas, and 624 (3%) by Legionella. At least six of the eight reported deaths occurred in persons affected by outbreaks caused by Legionella. Hotels were the leading setting, associated with 157 (32%) of the 493 outbreaks. Overall, the outbreaks had a bimodal temporal distribution: 275 (56%) outbrea...Continue Reading

References

Aug 27, 2002·Emerging Infectious Diseases·Rodney M Donlan
Apr 11, 2008·Journal of Water and Health·Joan M ShieldsMichael J Beach
Jun 5, 2015·Environmental Science & Technology·Jennifer L MurphyVincent R Hill
May 21, 2016·MMWR. Surveillance Summaries : Morbidity and Mortality Weekly Report. Surveillance Summaries·Michele C HlavsaMichael J Beach
Jun 10, 2016·MMWR. Morbidity and Mortality Weekly Report·Laurel E GarrisonCynthia G Whitney

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Citations

Jun 29, 2018·MMWR. Morbidity and Mortality Weekly Report·Daniel S GraciaaMichele C Hlavsa
May 17, 2019·MMWR. Morbidity and Mortality Weekly Report·Kayla L Vanden EsschertMichele C Hlavsa
Jun 28, 2019·MMWR. Morbidity and Mortality Weekly Report·Radhika GharpureMichele C Hlavsa
Dec 31, 2019·Pediatric Transplantation·John McAteerInci Yildirim
Feb 13, 2020·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Cushla M CoffeyKatharine M Benedict
Jul 3, 2020·PLoS Neglected Tropical Diseases·Robert K M Choy, Christopher D Huston
Nov 6, 2018·International Journal of Environmental Research and Public Health·Laura M SuppesKelly A Reynolds
Aug 23, 2018·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Daniel S GraciaaMichele C Hlavsa
Jun 30, 2019·Nature Communications·Christopher S LundeChristopher D Huston
Aug 28, 2019·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Radhika GharpureMichele C Hlavsa
Dec 23, 2020·Emerging Infectious Diseases·Sarah A CollierMichael J Beach
Jan 26, 2021·Current Opinion in Infectious Diseases·Nikolaos SpernovasilisGaryfallia Poulakou
Nov 9, 2021·Antimicrobial Agents and Chemotherapy·Cindy X ZhangSamuel L M Arnold

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