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1.
MMWR Morb Mortal Wkly Rep ; 70(36): 1242-1244, 2021 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-34499630

RESUMO

Wastewater surveillance, the measurement of pathogen levels in wastewater, is used to evaluate community-level infection trends, augment traditional surveillance that leverages clinical tests and services (e.g., case reporting), and monitor public health interventions (1). Approximately 40% of persons infected with SARS-CoV-2, the virus that causes COVID-19, shed virus RNA in their stool (2); therefore, community-level trends in SARS-CoV-2 infections, both symptomatic and asymptomatic (2) can be tracked through wastewater testing (3-6). CDC launched the National Wastewater Surveillance System (NWSS) in September 2020 to coordinate wastewater surveillance programs implemented by state, tribal, local, and territorial health departments to support the COVID-19 pandemic response. In the United States, wastewater surveillance was not previously implemented at the national level. As of August 2021, NWSS includes 37 states, four cities, and two territories. This report summarizes NWSS activities and describes innovative applications of wastewater surveillance data by two states, which have included generating alerts to local jurisdictions, allocating mobile testing resources, evaluating irregularities in traditional surveillance, refining health messaging, and forecasting clinical resource needs. NWSS complements traditional surveillance and enables health departments to intervene earlier with focused support in communities experiencing increasing concentrations of SARS-CoV-2 in wastewater. The ability to conduct wastewater surveillance is not affected by access to health care or the clinical testing capacity in the community. Robust, sustainable implementation of wastewater surveillance requires public health capacity for wastewater testing, analysis, and interpretation. Partnerships between wastewater utilities and public health departments are needed to leverage wastewater surveillance data for the COVID-19 response for rapid assessment of emerging threats and preparedness for future pandemics.


Assuntos
COVID-19/prevenção & controle , Pandemias/prevenção & controle , Vigilância em Saúde Pública/métodos , SARS-CoV-2/isolamento & purificação , Águas Residuárias/virologia , COVID-19/epidemiologia , Centers for Disease Control and Prevention, U.S. , Humanos , Estados Unidos/epidemiologia
2.
MMWR Morb Mortal Wkly Rep ; 70(35): 1191-1194, 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34473685

RESUMO

Harmful algal and cyanobacterial blooms (harmful algal blooms) are large colonies of algae or cyanobacteria that can harm humans, animals, and the environment (1-3). The number of algal blooms has been increasing in the United States, augmented by increasing water temperatures and nutrients in water from industry and agricultural run-off (4,5). The extent to which harmful algal bloom exposures cause human illness or long-term health effects is unknown. As the number of blooms increases annually, the likelihood of negative health outcomes (e.g., respiratory or gastrointestinal illness) from exposure also increases (4,5). To explore the utility of syndromic surveillance data for studying health effects from harmful algal bloom exposures, CDC queried emergency department (ED) visit data from the National Syndromic Surveillance Program (NSSP) for harmful algal bloom exposure-associated administrative discharge diagnosis codes and chief complaint text terms related to harmful algal bloom exposure (6). A total of 321 harmful algal bloom-associated ED visits were identified during January 1, 2017-December 31, 2019. An increase in harmful algal bloom-associated ED visits occurred during warmer months (June-October), consistent with seasonal fluctuations of blooms and recent publications (6,7). Although syndromic surveillance data are helpful for understanding harmful algal bloom-associated ED visits in the United States, exposures were documented infrequently with discharge diagnosis codes; 67% of harmful algal bloom-associated ED visits were identified through querying chief complaint text. Improving the documentation of harmful algal bloom exposures in medical records would further benefit future health studies.


Assuntos
Doenças Transmissíveis/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Exposição Ambiental/efeitos adversos , Proliferação Nociva de Algas , Vigilância de Evento Sentinela , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Doenças Transmissíveis/terapia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estações do Ano , Estados Unidos/epidemiologia , Adulto Jovem
3.
MMWR Morb Mortal Wkly Rep ; 69(50): 1889-1894, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33332289

RESUMO

Harmful algal bloom events can result from the rapid growth, or bloom, of photosynthesizing organisms in natural bodies of fresh, brackish, and salt water. These events can be exacerbated by nutrient pollution (e.g., phosphorus) and warming waters and other climate change effects (1); have a negative impact on the health of humans, animals, and the environment; and damage local economies (2,3). U.S. harmful algal bloom events of public health concern are centered on a subset of phytoplankton: diatoms, dinoflagellates, and cyanobacteria (also called blue-green algae). CDC launched the One Health Harmful Algal Bloom System (OHHABS) in 2016 to inform efforts to prevent human and animal illnesses associated with harmful algal bloom events. A total of 18 states reported 421 harmful algal bloom events, 389 cases of human illness, and 413 cases of animal illness that occurred during 2016-2018. The majority of harmful algal bloom events occurred during May-October (413; 98%) and in freshwater bodies (377; 90%). Human and animal illnesses primarily occurred during June-September (378; 98%) and May-September (410; 100%). Gastrointestinal or generalized illness signs or symptoms were the most frequently reported (>40% of human cases and >50% of animal cases); however, multiple other signs and symptoms were reported. Surveillance data from harmful algal bloom events, exposures, and health effects provide a systematic description of these occurrences and can be used to inform control and prevention of harmful algal bloom-associated illnesses.


Assuntos
Doenças Transmissíveis/epidemiologia , Exposição Ambiental/efeitos adversos , Proliferação Nociva de Algas , Saúde Única , Vigilância em Saúde Pública/métodos , Adolescente , Adulto , Idoso , Doenças dos Animais/epidemiologia , Animais , Criança , Pré-Escolar , Doenças Transmissíveis/veterinária , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
4.
MMWR Morb Mortal Wkly Rep ; 69(25): 781-783, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32584799

RESUMO

Outbreaks associated with fresh or marine (i.e., untreated) recreational water can be caused by pathogens or chemicals, including toxins. Voluntary reporting of these outbreaks to CDC's National Outbreak Reporting System (NORS) began in 2009. NORS data for 2009-2017 are finalized, and data for 2018-2019 are provisional. During 2009-2019 (as of May 13, 2020), public health officials from 31 states voluntarily reported 119 untreated recreational water-associated outbreaks, resulting at least 5,240 cases; 103 of the outbreaks (87%) started during June-August. Among the 119 outbreaks, 88 (74%) had confirmed etiologies. The leading etiologies were enteric pathogens: norovirus (19 [22%] outbreaks; 1,858 cases); Shiga toxin-producing Escherichia coli (STEC) (19 [22%]; 240), Cryptosporidium (17 [19%]; 237), and Shigella (14 [16%]; 713). This report highlights three examples of outbreaks that occurred during 2018-2019, were caused by leading etiologies (Shigella, norovirus, or STEC), and demonstrate the wide geographic distribution of such outbreaks across the United States. Detection and investigation of untreated recreational water-associated outbreaks are challenging, and the sources of these outbreaks often are not identified. Tools for controlling and preventing transmission of enteric pathogens through untreated recreational water include epidemiologic investigations, regular monitoring of water quality (i.e., testing for fecal indicator bacteria), microbial source tracking, and health policy and communications (e.g., observing beach closure signs and not swimming while ill with diarrhea).


Assuntos
Doenças Transmissíveis/epidemiologia , Surtos de Doenças , Recreação , Microbiologia da Água , Adolescente , Adulto , Idoso , California/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Maine/epidemiologia , Masculino , Pessoa de Meia-Idade , Minnesota/epidemiologia , Purificação da Água , Adulto Jovem
5.
MMWR Morb Mortal Wkly Rep ; 68(35): 766-770, 2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31487277

RESUMO

Hepatitis A virus (HAV) is an RNA virus primarily transmitted via the fecal-oral route and, in rare cases, causes liver failure and death in infected persons. Although drinking water-associated hepatitis A outbreaks in the United States are rarely reported (1), HAV was the most commonly reported etiology for outbreaks associated with untreated ground water during 1971-2008 (2), and HAV can remain infectious in water for months (3). This report analyzes drinking water-associated hepatitis A outbreaks reported to the Waterborne Disease and Outbreak Surveillance System (WBDOSS) during 1971-2017. During that period, 32 outbreaks resulting in 857 cases were reported, all before 2010. Untreated ground water was associated with 23 (72%) outbreaks, resulting in 585 (68.3%) reported cases. Reported outbreaks significantly decreased after introduction of Advisory Committee on Immunization Practices (ACIP) hepatitis A vaccination recommendations* and U.S. Environmental Protection Agency's (USEPA) public ground water system regulations.† Individual water systems, which are not required to meet national drinking water standards,§ were the only contaminated drinking water systems to cause the last four reported hepatitis A outbreaks during 1995-2009. No waterborne outbreaks were reported during 2009-2017. Water testing and treatment are important considerations to protect persons who use these unregulated systems from HAV infection.


Assuntos
Surtos de Doenças/prevenção & controle , Água Potável/virologia , Hepatite A/epidemiologia , Hepatite A/prevenção & controle , Prática de Saúde Pública , Regulamentação Governamental , Vacinas contra Hepatite A/administração & dosagem , Humanos , Avaliação de Programas e Projetos de Saúde , Estados Unidos/epidemiologia , United States Environmental Protection Agency , Abastecimento de Água/legislação & jurisprudência
6.
J Pediatric Infect Dis Soc ; 8(5): 392-399, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-30085136

RESUMO

BACKGROUND: Approximately 14 million children attend more than 14000 US camps every year. Shared accommodations and activities can facilitate acute gastroenteritis (AGE) outbreaks. METHODS: We analyzed data from the National Outbreak Reporting System on US youth camp-associated AGE outbreaks that occurred between 2009 and 2016. We also conducted a systematic literature search of youth camp-associated AGE outbreaks that have occurred around the world and a gray literature search for existing recommendations on outbreak prevention and control at camps worldwide. RESULTS: Thirty-nine US jurisdictions reported a total of 229 youth camp-associated AGE outbreaks to the National Outbreak Reporting System. Of the 226 outbreaks included in our analyses, 120 (53%) were reported to have resulted from person-to-person transmission, 42 (19%) from an unknown transmission mode, 38 (17%) from foodborne transmission, 19 (8%) from waterborne transmission, 5 (2%) from animal contact, and 2 (<1%) from environmental contamination. Among 170 (75%) outbreaks with a single suspected or confirmed etiology, norovirus (107 [63%] outbreaks), Salmonella spp (16 [9%]), and Shiga-toxin producing Escherichia coli (12 [7%]) were implicated most frequently. We identified 43 additional youth camp-associated AGE outbreaks in the literature that occurred in various countries between 1938 and 2014. Control measures identified through the literature search included camp closure, separation of ill campers, environmental disinfection, and education on food preparation and hand hygiene. CONCLUSIONS: Youth camp-associated AGE outbreaks are caused by numerous pathogens every year. These outbreaks are facilitated by factors that include improper food preparation, inadequate cleaning and disinfection, shared accommodations, and contact with animals. Health education focused on proper hygiene and preventing disease transmission could help control or prevent these outbreaks.


Assuntos
Surtos de Doenças/prevenção & controle , Gastroenterite/epidemiologia , Gastroenterite/prevenção & controle , Doença Aguda , Adolescente , Acampamento , Criança , Transmissão de Doença Infecciosa/prevenção & controle , Manipulação de Alimentos , Gastroenterite/etiologia , Humanos , Higiene , Guias de Prática Clínica como Assunto , Fatores de Risco , Estados Unidos/epidemiologia
7.
MMWR Morb Mortal Wkly Rep ; 67(25): 701-706, 2018 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-29953425

RESUMO

Outbreaks associated with untreated recreational water can be caused by pathogens, toxins, or chemicals in fresh water (e.g., lakes, rivers) or marine water (e.g., ocean). During 2000-2014, public health officials from 35 states and Guam voluntarily reported 140 untreated recreational water-associated outbreaks to CDC. These outbreaks resulted in at least 4,958 cases of disease and two deaths. Among the 95 outbreaks with a confirmed infectious etiology, enteric pathogens caused 80 (84%); 21 (22%) were caused by norovirus, 19 (20%) by Escherichia coli, 14 (15%) by Shigella, and 12 (13%) by Cryptosporidium. Investigations of these 95 outbreaks identified 3,125 cases; 2,704 (87%) were caused by enteric pathogens, including 1,459 (47%) by norovirus, 362 (12%) by Shigella, 314 (10%) by Cryptosporidium, and 155 (5%) by E. coli. Avian schistosomes were identified as the cause in 345 (11%) of the 3,125 cases. The two deaths were in persons affected by a single outbreak (two cases) caused by Naegleria fowleri. Public parks (50 [36%]) and beaches (45 [32%]) were the leading settings associated with the 140 outbreaks. Overall, the majority of outbreaks started during June-August (113 [81%]); 65 (58%) started in July. Swimmers and parents of young swimmers can take steps to minimize the risk for exposure to pathogens, toxins, and chemicals in untreated recreational water by heeding posted advisories closing the beach to swimming; not swimming in discolored, smelly, foamy, or scummy water; not swimming while sick with diarrhea; and limiting water entering the nose when swimming in warm freshwater.


Assuntos
Doenças Transmissíveis/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Água Doce , Recreação , Praias/estatística & dados numéricos , Água Doce/microbiologia , Água Doce/parasitologia , Água Doce/virologia , Humanos , Lagos/microbiologia , Lagos/parasitologia , Lagos/virologia , Parques Recreativos/estatística & dados numéricos , Lagoas/microbiologia , Lagoas/parasitologia , Lagoas/virologia , Rios/microbiologia , Rios/parasitologia , Rios/virologia , Fatores de Tempo , Estados Unidos/epidemiologia , Purificação da Água
8.
MMWR Morb Mortal Wkly Rep ; 67(19): 547-551, 2018 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-29771872

RESUMO

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%) outbreaks started during June-August and 46 (9%) in March. Assessment of trends in the annual counts of outbreaks caused by Cryptosporidium, Legionella, or Pseudomonas indicate mixed progress in preventing transmission. Pathogens able to evade chlorine inactivation have become leading outbreak etiologies. The consequent outbreak and case counts and mortality underscore the utility of CDC's Model Aquatic Health Code (https://www.cdc.gov/mahc) to prevent outbreaks associated with treated recreational water.


Assuntos
Surtos de Doenças/estatística & dados numéricos , Recreação , Microbiologia da Água , Purificação da Água/estatística & dados numéricos , Humanos , Estados Unidos/epidemiologia
10.
MMWR Morb Mortal Wkly Rep ; 66(44): 1222-1225, 2017 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-29120997

RESUMO

Waterborne disease outbreaks in the United States are associated with a wide variety of water exposures and are reported annually to CDC on a voluntary basis by state and territorial health departments through the National Outbreak Reporting System (NORS). A majority of outbreaks arise from exposure to drinking water (1) or recreational water (2), whereas others are caused by an environmental exposure to water or an undetermined exposure to water. During 2013-2014, 15 outbreaks associated with an environmental exposure to water and 12 outbreaks with an undetermined exposure to water were reported, resulting in at least 289 cases of illness, 108 hospitalizations, and 17 deaths. Legionella was responsible for 63% of the outbreaks, 94% of hospitalizations, and all deaths. Outbreaks were also caused by Cryptosporidium, Pseudomonas, and Giardia, including six outbreaks of giardiasis caused by ingestion of water from a river, stream, or spring. Water management programs can effectively prevent outbreaks caused by environmental exposure to water from human-made water systems, while proper point-of-use treatment of water can prevent outbreaks caused by ingestion of water from natural water systems.


Assuntos
Surtos de Doenças/estatística & dados numéricos , Exposição Ambiental/efeitos adversos , Poluição da Água/efeitos adversos , Doenças Transmitidas pela Água/epidemiologia , Humanos , Estados Unidos/epidemiologia , Poluição da Água/estatística & dados numéricos
11.
MMWR Morb Mortal Wkly Rep ; 66(44): 1216-1221, 2017 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-29121003

RESUMO

Provision of safe water in the United States is vital to protecting public health (1). Public health agencies in the U.S. states and territories* report information on waterborne disease outbreaks to CDC through the National Outbreak Reporting System (NORS) (https://www.cdc.gov/healthywater/surveillance/index.html). During 2013-2014, 42 drinking water-associated† outbreaks were reported, accounting for at least 1,006 cases of illness, 124 hospitalizations, and 13 deaths. Legionella was associated with 57% of these outbreaks and all of the deaths. Sixty-nine percent of the reported illnesses occurred in four outbreaks in which the etiology was determined to be either a chemical or toxin or the parasite Cryptosporidium. Drinking water contamination events can cause disruptions in water service, large impacts on public health, and persistent community concern about drinking water quality. Effective water treatment and regulations can protect public drinking water supplies in the United States, and rapid detection, identification of the cause, and response to illness reports can reduce the transmission of infectious pathogens and harmful chemicals and toxins.


Assuntos
Surtos de Doenças/estatística & dados numéricos , Água Potável , Vigilância da População , Doenças Transmitidas pela Água/epidemiologia , Humanos , Estados Unidos/epidemiologia
12.
MMWR Morb Mortal Wkly Rep ; 63(55): 79-84, 2016 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-27736832

RESUMO

CDC collects data on foodborne and waterborne disease outbreaks reported by all U.S. states and territories through the Foodborne Disease Outbreak Surveillance System (FDOSS) (http://www.cdc.gov/foodsafety/fdoss/surveillance/index.html) and the Waterborne Disease and Outbreak Surveillance System (WBDOSS) http://www.cdc.gov/healthywater/surveillance), respectively. These two systems are the primary source of national data describing the number of reported outbreaks; outbreak-associated illnesses, hospitalizations, and deaths; etiologic agents; water source or implicated foods; settings of exposure; and other factors associated with recognized foodborne and waterborne disease outbreaks in the United States.


Assuntos
Surtos de Doenças/estatística & dados numéricos , Doenças Transmitidas por Alimentos/epidemiologia , Vigilância da População , Doenças Transmitidas pela Água/epidemiologia , Humanos , Estados Unidos/epidemiologia
13.
MMWR Morb Mortal Wkly Rep ; 64(31): 842-8, 2015 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-26270059

RESUMO

Advances in water management and sanitation have substantially reduced waterborne disease in the United States, although outbreaks continue to occur. Public health agencies in the U.S. states and territories* report information on waterborne disease outbreaks to the CDC Waterborne Disease and Outbreak Surveillance System (http://www.cdc.gov/healthywater/surveillance/index.html). For 2011-2012, 32 drinking water-associated outbreaks were reported, accounting for at least 431 cases of illness, 102 hospitalizations, and 14 deaths. Legionella was responsible for 66% of outbreaks and 26% of illnesses, and viruses and non-Legionella bacteria together accounted for 16% of outbreaks and 53% of illnesses. The two most commonly identified deficiencies† leading to drinking water-associated outbreaks were Legionella in building plumbing§ systems (66%) and untreated groundwater (13%). Continued vigilance by public health, regulatory, and industry professionals to identify and correct deficiencies associated with building plumbing systems and groundwater systems could prevent most reported outbreaks and illnesses associated with drinking water systems.


Assuntos
Surtos de Doenças/estatística & dados numéricos , Água Potável , Gastroenteropatias/epidemiologia , Vigilância da População , Doenças Respiratórias/epidemiologia , Microbiologia da Água , Poluição da Água/efeitos adversos , Doença Aguda , Água Potável/microbiologia , Água Potável/parasitologia , Água Potável/virologia , Gastroenteropatias/microbiologia , Gastroenteropatias/parasitologia , Gastroenteropatias/virologia , Humanos , Legionella/isolamento & purificação , Legionelose/epidemiologia , Doenças Respiratórias/microbiologia , Estados Unidos/epidemiologia
14.
MMWR Morb Mortal Wkly Rep ; 64(31): 849-51, 2015 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-26270060

RESUMO

Exposures to contaminated water can lead to waterborne disease outbreaks associated with various sources, including many that are classified and reported separately as drinking water or recreational water. Waterborne disease outbreaks can also involve a variety of other exposures (e.g., consuming water directly from backcountry or wilderness streams, or inhaling aerosols from cooling towers and ornamental fountains). Additionally, outbreaks might be epidemiologically linked to multiple water sources or may not have a specific water source implicated.


Assuntos
Surtos de Doenças/estatística & dados numéricos , Exposição Ambiental/efeitos adversos , Gastroenteropatias/epidemiologia , Doenças Respiratórias/epidemiologia , Microbiologia da Água , Poluição da Água , Doença Aguda , Água Potável/microbiologia , Água Doce/parasitologia , Gastroenteropatias/parasitologia , Giardia/isolamento & purificação , Humanos , Legionella/isolamento & purificação , Doenças Respiratórias/microbiologia , Estados Unidos/epidemiologia
15.
MMWR Morb Mortal Wkly Rep ; 64(24): 668-72, 2015 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-26110837

RESUMO

Outbreaks of illness associated with recreational water use result from exposure to chemicals or infectious pathogens in recreational water venues that are treated (e.g., pools and hot tubs or spas) or untreated (e.g., lakes and oceans). For 2011-2012, the most recent years for which finalized data were available, public health officials from 32 states and Puerto Rico reported 90 recreational water-associated outbreaks to CDC's Waterborne Disease and Outbreak Surveillance System (WBDOSS) via the National Outbreak Reporting System (NORS). The 90 outbreaks resulted in at least 1,788 cases, 95 hospitalizations, and one death. Among 69 (77%) outbreaks associated with treated recreational water, 36 (52%) were caused by Cryptosporidium. Among 21 (23%) outbreaks associated with untreated recreational water, seven (33%) were caused by Escherichia coli (E. coli O157:H7 or E. coli O111). Guidance, such as the Model Aquatic Health Code (MAHC), for preventing and controlling recreational water-associated outbreaks can be optimized when informed by national outbreak and laboratory (e.g., molecular typing of Cryptosporidium) data.


Assuntos
Doenças Transmissíveis/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Vigilância da População , Recreação , Banhos/efeitos adversos , Doenças Transmissíveis/etiologia , Estâncias para Tratamento de Saúde , Humanos , Lagos/química , Lagos/microbiologia , Lagos/parasitologia , Água do Mar/química , Água do Mar/microbiologia , Água do Mar/parasitologia , Piscinas , Fatores de Tempo , Estados Unidos/epidemiologia , Microbiologia da Água , Poluição da Água , Purificação da Água/estatística & dados numéricos
16.
MMWR Morb Mortal Wkly Rep ; 63(1): 6-10, 2014 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-24402466

RESUMO

Recreational water-associated disease outbreaks result from exposure to infectious pathogens or chemical agents in treated recreational water venues (e.g., pools and hot tubs or spas) or untreated recreational water venues (e.g., lakes and oceans). For 2009-2010, the most recent years for which finalized data are available, public health officials from 28 states and Puerto Rico electronically reported 81 recreational water-associated disease outbreaks to CDC's Waterborne Disease and Outbreak Surveillance System (WBDOSS) via the National Outbreak Reporting System (NORS). This report summarizes the characteristics of those outbreaks. Among the 57 outbreaks associated with treated recreational water, 24 (42%) were caused by Cryptosporidium. Among the 24 outbreaks associated with untreated recreational water, 11 (46%) were confirmed or suspected to have been caused by cyanobacterial toxins. In total, the 81 outbreaks resulted in at least 1,326 cases of illness and 62 hospitalizations; no deaths were reported. Laboratory and environmental data, in addition to epidemiologic data, can be used to direct and optimize the prevention and control of recreational water-associated disease outbreaks.


Assuntos
Doenças Transmissíveis/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Vigilância da População , Recreação , Banhos/efeitos adversos , Doenças Transmissíveis/etiologia , Estâncias para Tratamento de Saúde , Humanos , Lagos/química , Lagos/microbiologia , Lagos/parasitologia , Água do Mar/química , Água do Mar/microbiologia , Água do Mar/parasitologia , Piscinas , Fatores de Tempo , Estados Unidos/epidemiologia , Microbiologia da Água , Poluição da Água , Purificação da Água/estatística & dados numéricos
17.
MMWR Morb Mortal Wkly Rep ; 63(1): 11-5, 2014 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-24402467

RESUMO

Harmful algal blooms (HABs) are excessive accumulations of microscopic photosynthesizing aquatic organisms (phytoplankton) that produce biotoxins or otherwise adversely affect humans, animals, and ecosystems. HABs occur sporadically and often produce a visible algal scum on the water. This report summarizes human health data and water sampling results voluntarily reported to CDC's Waterborne Disease and Outbreak Surveillance System (WBDOSS) via the National Outbreak Reporting System (NORS) and the Harmful Algal Bloom-Related Illness Surveillance System (HABISS)* for the years 2009-2010. For 2009-2010, 11 waterborne disease outbreaks associated with algal blooms were reported; these HABs all occurred in freshwater lakes. The outbreaks occurred in three states and affected at least 61 persons. Health effects included dermatologic, gastrointestinal, respiratory, and neurologic signs and symptoms. These 11 HAB-associated outbreaks represented 46% of the 24 outbreaks associated with untreated recreational water reported for 2009-2010, and 79% of the 14 freshwater HAB-associated outbreaks that have been reported to CDC since 1978. Clinicians should be aware of the potential for HAB-associated illness among patients with a history of exposure to freshwater.


Assuntos
Doenças Transmissíveis/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Proliferação Nociva de Algas , Lagos/microbiologia , Vigilância da População , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
18.
Ground Water ; 52(6): 886-97, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24116713

RESUMO

Disease outbreaks associated with drinking water drawn from untreated groundwater sources represent a substantial proportion (30.3%) of the 818 drinking water outbreaks reported to CDC's Waterborne Disease and Outbreak Surveillance System (WBDOSS) during 1971 to 2008. The objectives of this study were to identify underlying contributing factors, suggest improvements for data collection during outbreaks, and inform outbreak prevention efforts. Two researchers independently reviewed all qualifying outbreak reports (1971 to 2008), assigned contributing factors and abstracted additional information (e.g., cases, etiology, and water system attributes). The 248 outbreaks resulted in at least 23,478 cases of illness, 390 hospitalizations, and 13 deaths. The majority of outbreaks had an unidentified etiology (n = 135, 54.4%). When identified, the primary etiologies were hepatitis A virus (n = 21, 8.5%), Shigella spp. (n = 20, 8.1%), and Giardia intestinalis (n = 14, 5.7%). Among the 172 (69.4%) outbreaks with contributing factor data available, the leading contamination sources included human sewage (n = 57, 33.1%), animal contamination (n = 16, 9.3%), and contamination entering via the distribution system (n = 12, 7.0%). Groundwater contamination was most often facilitated by improper design, maintenance or location of the water source or nearby waste water disposal system (i.e., septic tank; n = 116, 67.4%). Other contributing factors included rapid pathogen transport through hydrogeologic formations (e.g., karst limestone; n = 45, 26.2%) and preceding heavy rainfall or flooding (n = 36, 20.9%). This analysis underscores the importance of identifying untreated groundwater system vulnerabilities through frequent inspection and routine maintenance, as recommended by protective regulations such as Environmental Protection Agency's (EPA's) Groundwater Rule, and the need for special consideration of the local hydrogeology.


Assuntos
Surtos de Doenças , Água Subterrânea/química , Microbiologia da Água , Purificação da Água , Qualidade da Água , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/etiologia , Monitoramento Ambiental , Humanos , Doenças Parasitárias/epidemiologia , Doenças Parasitárias/etiologia , Engenharia Sanitária , Fatores de Tempo , Estados Unidos/epidemiologia , Viroses/epidemiologia , Viroses/etiologia
19.
Emerg Infect Dis ; 19(8): 1305-9, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23876187

RESUMO

Implemented in 2009, the National Outbreak Reporting System provides surveillance for acute gastroenteritis outbreaks in the United States resulting from any transmission mode. Data from the first 2 years of surveillance highlight the predominant role of norovirus. The pathogen-specific transmission pathways and exposure settings identified can help inform prevention efforts.


Assuntos
Infecções por Caliciviridae/epidemiologia , Surtos de Doenças , Gastroenterite/epidemiologia , Doença Aguda , Infecções por Caliciviridae/transmissão , Monitoramento Epidemiológico , Gastroenterite/virologia , Humanos , Intoxicação Alimentar por Salmonella/epidemiologia , Intoxicação Alimentar por Salmonella/transmissão , Infecções por Salmonella/epidemiologia , Infecções por Salmonella/transmissão , Estações do Ano , Estados Unidos/epidemiologia
20.
MMWR Surveill Summ ; 60(12): 1-32, 2011 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-21937976

RESUMO

PROBLEM/CONDITION: Since 1978, CDC, the U.S. Environmental Protection Agency, and the Council of State and Territorial Epidemiologists have collaborated on the Waterborne Disease and Outbreak Surveillance System (WBDOSS) for collecting and reporting data on waterborne disease outbreaks associated with recreational water. This surveillance system is the primary source of data concerning the scope and health effects of waterborne disease outbreaks in the United States. In addition, data are collected on other select recreational water--associated health events, including pool chemical--associated health events and single cases of Vibrio wound infection and primary amebic meningoencephalitis (PAM). REPORTING PERIOD: Data presented summarize recreational water--associated outbreaks and other health events that occurred during January 2007--December 2008. Previously unreported data on outbreaks that have occurred since 1978 also are presented. DESCRIPTION OF THE SYSTEM: The WBDOSS database includes data on outbreaks associated with recreational water, drinking water, water not intended for drinking (excluding recreational water), and water use of unknown intent. Public health agencies in the states, the District of Columbia, U.S. territories, and Freely Associated States are primarily responsible for detecting and investigating waterborne disease outbreaks and voluntarily reporting them to CDC using a standard form. Only data on outbreaks associated with recreational water are summarized in this report. Data on other recreational water--associated health events reported to CDC, the Agency for Toxic Substances and Disease Registry (ATSDR), and the U.S. Consumer Product Safety Commission (CPSC) also are summarized. RESULTS: A total of 134 recreational water--associated outbreaks were reported by 38 states and Puerto Rico for 2007--2008. These outbreaks resulted in at least 13,966 cases. The median outbreak size was 11 cases (range: 2--5,697 cases). A total of 116 (86.6%) outbreaks were associated with treated recreational water (e.g., pools and interactive fountains) and resulted in 13,480 (96.5%) cases. Of the 134 outbreaks, 81 (60.4%) were outbreaks of acute gastrointestinal illness (AGI); 24 (17.9%) were outbreaks of dermatologic illnesses, conditions, or symptoms; and 17 (12.7%) were outbreaks of acute respiratory illness. Outbreaks of AGI resulted in 12,477 (89.3%) cases. The etiology was laboratory-confirmed for 105 (78.4%) of the 134 outbreaks. Of the 105 outbreaks with a laboratory-confirmed etiology, 68 (64.8%) were caused by parasites, 22 (21.0%) by bacteria, five (4.8%) by viruses, nine (8.6%) by chemicals or toxins, and one (1.0%) by multiple etiology types. Cryptosporidium was confirmed as the etiologic agent of 60 (44.8%) of 134 outbreaks, resulting in 12,154 (87.0%) cases; 58 (96.7%) of these outbreaks, resulting in a total of 12,137 (99.9%) cases, were associated with treated recreational water. A total of 32 pool chemical--associated health events that occurred in a public or residential setting were reported to WBDOSS by Maryland and Michigan. These events resulted in 48 cases of illness or injury; 26 (81.3%) events could be attributed at least partially to chemical handling errors (e.g., mixing incompatible chemicals). ATSDR's Hazardous Substance Emergency Events Surveillance System received 92 reports of hazardous substance events that occurred at aquatic facilities. More than half of these events (55 [59.8%]) involved injured persons; the most frequently reported primary contributing factor was human error. Estimates based on CPSC's National Electronic Injury Surveillance System (NEISS) data indicate that 4,574 (95% confidence interval [CI]: 2,703--6,446) emergency department (ED) visits attributable to pool chemical--associated injuries occurred in 2008; the most frequent diagnosis was poisoning (1,784 ED visits [95% CI: 585--2,984]). NEISS data indicate that pool chemical--associated health events occur frequently in residential settings. A total of 236 Vibrio wound infections were reported to be associated with recreational water exposure; 36 (48.6%) of the 74 hospitalized vibriosis patients and six (66.7%) of the nine vibriosis patients who died had V. vulnificus infections. Eight fatal cases of PAM occurred after exposure to warm untreated freshwater. INTERPRETATIONS: The 134 recreational water--associated outbreaks reported for 2007--2008 represent a substantial increase over the 78 outbreaks reported for 2005--2006 and the largest number of outbreaks ever reported to WBDOSS for a 2-year period. Outbreaks, especially the largest ones, were most frequently associated with treated recreational water and characterized by AGI. Cryptosporidium remains the leading etiologic agent. Pool chemical--associated health events occur frequently but are preventable. Data on other select recreational water--associated health events further elucidate the epidemiology of U.S. waterborne disease by highlighting less frequently implicated types of recreational water (e.g., oceans) and detected types of recreational water--associated illness (i.e., not AGI). PUBLIC HEALTH ACTIONS: CDC uses waterborne disease outbreak surveillance data to 1) identify the types of etiologic agents, recreational water venues, and settings associated with waterborne disease outbreaks; 2) evaluate the adequacy of regulations and public awareness activities to promote healthy and safe swimming; and 3) establish public health priorities to improve prevention efforts, guidelines, and regulations at the local, state, and federal levels.


Assuntos
Surtos de Doenças , Gastroenteropatias/epidemiologia , Vigilância da População , Recreação , Microbiologia da Água , Doença Aguda , Adolescente , Adulto , Criança , Pré-Escolar , Criptosporidiose , Cryptosporidium/isolamento & purificação , Feminino , Gastroenteropatias/microbiologia , Gastroenteropatias/parasitologia , Gastroenteropatias/virologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Natação , Piscinas , Estados Unidos/epidemiologia
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