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Volume 27, Number 1—January 2021
Research

Estimate of Burden and Direct Healthcare Cost of Infectious Waterborne Disease in the United States

Sarah A. CollierComments to Author , Li Deng, Elizabeth A. Adam, Katharine M. Benedict, Elizabeth M. Beshearse, Anna J. Blackstock, Beau B. Bruce, Gordana Derado, Chris Edens, Kathleen E. Fullerton, Julia W. Gargano, Aimee L. Geissler, Aron J. Hall, Arie H. Havelaar, Vincent R. Hill, Robert M. Hoekstra, Sujan C. Reddy, Elaine Scallan, Erin K. Stokes, Jonathan S. Yoder, and Michael J. Beach
Author affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Main Article

Table 3

Estimated number of treat-and-release emergency department visits, hospitalizations, and deaths from domestically acquired waterborne transmission in 2014 for selected infectious diseases, United States*

Disease or syndrome Treat-and-release ED visits†
Hospitalizations
Deaths
Total visits (95% CrI) Domestic waterborne visits (95% CrI) % Admitted to hospital Total stays (95% CrI) Domestic waterborne stays (95% CrI) % Deaths Total deaths (95% CrI) Domestic waterborne deaths (95% CrI)
Campylobacteriosis 2,900
(1,620–4,630) 319
(31–966) 19.5 19,300
(8,790–34,900) 2,150
(192–6,900) 0.2 242
(0–1,150) 27
(0–146)
Cryptosporidiosis 1,260
(742–1,880) 492
(167–957) 19.2 2,870
(439–8,060) 1,120
(102–3,550) 0.3 61
(0–320) 24
(0–136)
Giardiasis 1,460
(902–2,090) 567
(185–1,120) 7.9 2,830
(1,760–4,070) 1,100
(364–2,180) <0.1 4
(0–11) 1
(0–5)
Legionnaires’ disease 691
(316–1,220) 667
(289–1,200) 98.1 11,200
(8,750–13,300) 10,800
(7,280–13,100) 9.0 1,030
(762–1,330) 995
(655–1,310)
NTM infection 7,150
(5,110–9,620) 5,080
(2,560–7,750) 74.8 72,400
(57,300–89,700) 51,400
(26,800–74,100) 5.5 5,350
(4,020–6,920) 3,800
(1,950–5,620)
Norovirus 429,000‡
(318,000–605,000) 26,300‡
(105–106,000) 0.4 78,100
(58,500–104,000) 4,780
(19–19,300) <0.1 885
(742–1,120) 54
(0–219)
Otitis externa 726,000
(466,000–994,000) 567,000
(337,000–823,000) 0.9 29,700
(19,200–40,600) 23,200
(13,900–33,600) <0.1 280
(144–452) 219
(107–367)
Pseudomonas pneumonia 580
(321–902) 291
(75–552) 97.2 30,800
(18,700–44,700) 15,500
(4,130–28,100) 4.6 1,450
(786–2,420) 730
(185–1,460)
Pseudomonas septicemia 164
(36–326) 36
(2–106) 97.2 25,300
(16,300–34,800) 5,590
(722–14,000) 12.1 3,140
(1,990–4,430) 695
(89–1,740)
Salmonellosis, nontyphoidal 3,410
(2,100–4,900) 194
(15–671) 28.4 26,600
(11,400–52,800) 1,520
(100–5,660) 0.5 421
(0–1,140) 24
(0–103)
STEC infection, serotype O157 252
(92–465) 12
(2–35) 38.5 2,640
(487–7,630) 138
(14–503) 0.7 36
(0–314) 2
(0–17)
STEC infection, serotype non-O157 75
(12–171) 4
(0–16) 16.0 1,420
(264–3,810) 74
(0–308) 0.2 16
(0–184) 1
(0–12)
Shigellosis
1,650
(540–2,870)
64
(5–311)

24.4
6,380
(929–20,300)
245
(12–1,140)

0.1
26
(0–218)
1
(0–9)
Vibrio spp. infection 366
(122–700) 76
(14–166) NA 782
(567–1,030) 251
(153–362) NA 113
(67–156) 60
(27–92)
V. alginolyticus NA§ NA§ 15.9 74
(38–141) 26
(8–58) 0.8 4
(0–11) 1
(0–5)
V. parahaemolyticus NA§ NA§ 22.3 264
(136–410) 60
(16–112) 1.4 16
(7–32) 4
(1–9)
V. vulnificus NA§ NA 85.4 213
(147–297) 161
(79–241) 28.8 72
(38–104) 54
(24–85)
Other Vibrio
NA§
NA§

42.5
231
(134–350)
5
(0–46)

3.8
20
(11–33)
0
(0–4)
Total 1,180,000
(877,000–1,490,000) 601,000
(364,000–866,000) NA 310,000
(263,000–360,000) 118,000
(86,800–150,000) NA 13,100
(10,600–15,900) 6,630
(4,520–8,870)

*Estimates rounded to 3 significant figures. CrI, credible interval; ED, emergency department; NA, not applicable; NTM, nontuberculous mycobacterial; STEC, Shiga toxin–producing Escherichia coli.
†Treat-and-release ED visits were defined as visits in which the person was not admitted to the hospital.
‡For norovirus infection only, ED visits in which the person was admitted to the hospital were included, for consistency with previous published estimates.
§No International Classification of Diseases, 9th Revision, Clinical Modification, codes are available for Vibrio spp. infections, only a general code for “Vibriosis and cholera.” ED visit estimates relied on administrative data that used these codes, and thus are presented only for Vibrio infection overall.

Main Article

Page created: September 21, 2020
Page updated: December 21, 2020
Page reviewed: December 21, 2020
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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