Waterborne disease outbreaks and individual, sporadic cases (i.e., those that are not outbreak associated) of waterborne disease are reported by states to CDC through a variety of active or passive surveillance systems, such as WBDOSS (outbreaks), the Foodborne Diseases Active Surveillance Network (FoodNet) (sporadic and outbreak-associated cases), and the National Notifiable Diseases Surveillance System (NNDSS) (sporadic and outbreak-associated cases) (Table 1) (Yoder et al. 2010; CDC 2011, 2012, 2014; Adams et al. 2014; Crim et al. 2015). While outbreak and case surveillance reporting can reflect high-level trends in the epidemiology of waterborne disease in the United States, surveillance data do not adequately capture all illnesses or deaths from the large scope of waterborne diseases. Waterborne disease and outbreaks are investigated by local and state public health officials and voluntarily reported to the CDC. Prioritization and resources for waterborne disease and outbreak surveillance activities vary by state and by pathogen, thus these data are subject to under-reporting and can be inconsistent across jurisdictions. Additionally, these surveillance systems provide limited information on deaths, the information gathered on the case-patients can differ by pathogen, and national case surveillance systems do not exist for all waterborne pathogens of interest.
Select infections, transmission information, disease surveillance system coverage, and ICD-9-CM and ICD-10 codes included in analyses
| Infection . | Transmission information . | Individual disease/case surveillance system coveragea . | ICD-9-CM codesb . | ICD-10 codesc . |
|---|---|---|---|---|
| Transmission by fecal–oral route | ||||
| Campylobacter | Ingestion of contaminated food or water, person-to-person, or animal-to-person | Active surveillance in 10 geographic areas through the Foodborne Diseases Active Surveillance Network (FoodNet) | 008.43 | A04.5 |
| Cryptosporidium | Ingestion of contaminated food or water, person-to-person, or animal-to-person | Active surveillance in 10 geographic areas through FoodNet | 007.4 | A07.2 |
| E. coli | Ingestion of contaminated food or water, person-to-person, or animal-to-person | Active surveillance in 10 geographic areas through FoodNet for Shiga toxin-producing E. coli (STEC) O157 and non-O157 only | 008.00–008.09 | A04.0–A04.4 |
| Giardia | Ingestion of contaminated food or water, person-to-person, or animal-to-person | Passive surveillance through the NNDS (national case surveillance) | 007.1 | A07.1 |
| Hepatitis A | Ingestion of contaminated food or water or person-to-person | Passive surveillance through NNDSS | 070.0, 070.1 | B15.0, B15.9 |
| Salmonella, non-typhoidal | Ingestion of contaminated food or water, person-to-person, or animal-to-person | Active surveillance in 10 geographic areas through FoodNet | 003.0–003.9 | A02.0–A02.2, A02.8–A02.9 |
| Shigella | Ingestion of contaminated food or water or person-to-person | Active surveillance in 10 geographic areas through FoodNet | 004.0–004.9 | A03.0–A03.3, A03.8–A03.9 |
| Transmission by other routesd | ||||
| Free-living amebae | Naegleria fowleri, intranasal contact with water containing ameba. Acanthamoeba spp., contact with water containing ameba | Passive surveillance through Free-living Ameba Surveillance System | 136.2e | B60.1, B60.2 |
| Legionella (Legionnaires' disease) | Inhalation of aerosolized contaminated water | Passive surveillance through NNDSS, Supplemental Legionnaires' Disease Surveillance System | 482.84 | A48.1 |
| Nontuberculous mycobacteria (NTM) | Inhalation of or contact with aerosolized contaminated water; also inhalation of or contact with contaminated soil | No disease-specific surveillance | 031.0–031.9 | A31.0–A31.3, A31.8–A31.9 |
| Mycobacterium avium complex (MAC)f | 031.2 | |||
| Pulmonary NTM infection | 031.0 | A31.0 | ||
| Otitis externag,h | Contact with water contaminated by a variety of pathogens, including Pseudomonas | No disease-specific surveillance | 380.10, 380.12, 380.14 | H60.1, H60.2, H60.3, H60.8, H60.9 |
| Pseudomonas | Inhalation, contact, aspiration, ventilator or other medical device contamination. Fatal cases usually from pneumonia or septicemia. Ubiquitous in environment | No disease-specific surveillance | 041.7, 482.1, 038.43 | J15.1 |
| Pneumonia | 482.1 | J15.1 | ||
| Septicemiaf | 038.43 | |||
| Vibriod,g | Ingestion of seafood or contact with marine water | Passive surveillance through Cholera and Other Vibrio Surveillance | 001.0–001.9, 005.4, 005.81 | A00.0, A00.1, A05.3 |
| Infection . | Transmission information . | Individual disease/case surveillance system coveragea . | ICD-9-CM codesb . | ICD-10 codesc . |
|---|---|---|---|---|
| Transmission by fecal–oral route | ||||
| Campylobacter | Ingestion of contaminated food or water, person-to-person, or animal-to-person | Active surveillance in 10 geographic areas through the Foodborne Diseases Active Surveillance Network (FoodNet) | 008.43 | A04.5 |
| Cryptosporidium | Ingestion of contaminated food or water, person-to-person, or animal-to-person | Active surveillance in 10 geographic areas through FoodNet | 007.4 | A07.2 |
| E. coli | Ingestion of contaminated food or water, person-to-person, or animal-to-person | Active surveillance in 10 geographic areas through FoodNet for Shiga toxin-producing E. coli (STEC) O157 and non-O157 only | 008.00–008.09 | A04.0–A04.4 |
| Giardia | Ingestion of contaminated food or water, person-to-person, or animal-to-person | Passive surveillance through the NNDS (national case surveillance) | 007.1 | A07.1 |
| Hepatitis A | Ingestion of contaminated food or water or person-to-person | Passive surveillance through NNDSS | 070.0, 070.1 | B15.0, B15.9 |
| Salmonella, non-typhoidal | Ingestion of contaminated food or water, person-to-person, or animal-to-person | Active surveillance in 10 geographic areas through FoodNet | 003.0–003.9 | A02.0–A02.2, A02.8–A02.9 |
| Shigella | Ingestion of contaminated food or water or person-to-person | Active surveillance in 10 geographic areas through FoodNet | 004.0–004.9 | A03.0–A03.3, A03.8–A03.9 |
| Transmission by other routesd | ||||
| Free-living amebae | Naegleria fowleri, intranasal contact with water containing ameba. Acanthamoeba spp., contact with water containing ameba | Passive surveillance through Free-living Ameba Surveillance System | 136.2e | B60.1, B60.2 |
| Legionella (Legionnaires' disease) | Inhalation of aerosolized contaminated water | Passive surveillance through NNDSS, Supplemental Legionnaires' Disease Surveillance System | 482.84 | A48.1 |
| Nontuberculous mycobacteria (NTM) | Inhalation of or contact with aerosolized contaminated water; also inhalation of or contact with contaminated soil | No disease-specific surveillance | 031.0–031.9 | A31.0–A31.3, A31.8–A31.9 |
| Mycobacterium avium complex (MAC)f | 031.2 | |||
| Pulmonary NTM infection | 031.0 | A31.0 | ||
| Otitis externag,h | Contact with water contaminated by a variety of pathogens, including Pseudomonas | No disease-specific surveillance | 380.10, 380.12, 380.14 | H60.1, H60.2, H60.3, H60.8, H60.9 |
| Pseudomonas | Inhalation, contact, aspiration, ventilator or other medical device contamination. Fatal cases usually from pneumonia or septicemia. Ubiquitous in environment | No disease-specific surveillance | 041.7, 482.1, 038.43 | J15.1 |
| Pneumonia | 482.1 | J15.1 | ||
| Septicemiaf | 038.43 | |||
| Vibriod,g | Ingestion of seafood or contact with marine water | Passive surveillance through Cholera and Other Vibrio Surveillance | 001.0–001.9, 005.4, 005.81 | A00.0, A00.1, A05.3 |
aDoes not include information on waterborne disease outbreaks (multiple cases linked to a common water exposure), which can be reported to the CDC WBDOSS.
bInternational Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes are used to code clinical diagnoses in the NIS.
cInternational Classification of Diseases, 10th Revision (ICD-10) codes are used to code causes of death in the NVSS (US death certificates).
dSome Vibrio infections are transmitted by fecal–oral route, but most US deaths are associated with species acquired through ingestion of undercooked seafood contaminated with environmental Vibrio or contact with marine water.
eEffective October 1, 2008, ICD-9-CM code 136.2 was re-coded to 136.21 and 136.29.
fNot listed as a valid cause of death in the ICD-10 coding system.
gApproximate ICD-9-CM and ICD-10 coding match.
hExcludes people with concurrent cases of otitis media (ICD-9-CM 381.0–382.9, ICD-10 H65.0–H67.9).