2013–2014 Recreational Water–associated Outbreak Surveillance Report Supplemental Tables

These tables provide supplemental information not published in Outbreaks Associated with Treated Recreational Water — United States, 2000–2014 (MMWR Weekly) and Outbreaks Associated with Untreated Recreational Water — United States, 2000–2014 (MMWR Weekly).

Table 1. Waterborne Disease Outbreaks* Associated with Treated Recreational Water or Untreated Recreational Water, by Year and Jurisdiction — Waterborne Disease and Outbreak Surveillance System, United States, 2013–2014

Treated Recreational Water

Treated Recreational Water
Jurisdiction Month Year Class† Etiology§ Predominant Illness¶ No. Cases No. Hospitalizations Venue Setting
California July 2013 III Legionella pneumophila serogroup 1 ARI 5 4 Spa Recreational facility
California October 2014 IV Legionella pneumophila serogroup 1 (S) ARI 2 1 Spa Trailer Park
Colorado April 2013 III Legionella pneumophila serogroup 1 ARI 3 0 Spa Hotel/Motel/Lodge/Inn
Colorado March 2014 III Legionella pneumophila serogroup 1 ARI 2 2 Spa Club (Requires Membership)
Colorado August 2014 IV Chemical-Unknown (S) Eye; Skin 13 0 Pool Hotel/Motel/Lodge/Inn
Florida April 2013 IV Legionella pneumophila serogroup 1 ARI 4 3 Spa Trailer Park
Florida June 2013 II Legionella sp. ARI 2 2 Spa Apartment/Condo
Florida September 2013 III Cryptosporidium sp. AGI 15 2 Pool Hotel/Motel/Lodge/Inn
Florida June 2014 I Cryptosporidium hominis AGI 26 0 Pool Club (Requires Membership)
Florida June 2014 II Cryptosporidium hominis AGI 47 0 Pool Park – Amusement
Florida June 2014 III Cryptosporidium sp. AGI 19 0 Interactive fountain(s) Park – Community/Municipal
Florida June 2014 III Cryptosporidium sp. AGI 4 0 Pool Club (Requires Membership)
Florida July 2014 III Shigella sp. AGI 6 0 Interactive fountain(s) Park – Community/Municipal
Florida August 2014 IV Cryptosporidium sp. AGI 10 0 Wading pool Child Care/Daycare Center
Florida September 2014 III Cryptosporidium sp. AGI 21 0 Temporary water slide Private Residence
Georgia July 2013 IV Cryptosporidium sp. AGI 5 0 Pool Park – Waterpark
Georgia August 2013 IV Legionella pneumophila serogroup 1 ARI 5 3 Pool, spa Hotel/Motel/Lodge/Inn
Georgia August 2014 I Cryptosporidium hominis IfA12G1 AGI 63 0 Pool, wading pool Club (Requires Membership)
Georgia August 2014 II Cryptosporidium spp. AGI 18 1 Interactive fountain(s) Park – Community/Municipal
Idaho January 2013 I Mycobacterium abscessus Skin 11 0 Wading pool Club (Requires Membership)
Illinois July 2013 IV Cryptosporidium sp. AGI 3 0 Pool Community/Municipality
Illinois October 2013 III Legionella pneumophila serogroup 1 ARI 2 2 Spa Club (Requires Membership)
Illinois March 2014 III Pseudomonas aeruginosa (S) AGI; Skin 2 0 Spa Hotel/Motel/Lodge/Inn
Iowa June 2013 II Cryptosporidium sp. AGI 10 0 Wading pool Park – Community/Municipal
Iowa July 2013 II Cryptosporidium sp. AGI 5 0 Pool Park – Community/Municipal
Iowa July 2013 II Cryptosporidium sp. AGI 8 0 Wading pool Park – Community/Municipal
Kansas February 2014 III Legionella pneumophila serogroup 1 ARI 2 Spa Hotel/Motel/Lodge/Inn
Kentucky July 2014 III Legionella pneumophila serogroup 1 ARI 3 2 Spa Hospital/Health Care
Louisiana June 2013 IV Cryptosporidium sp. AGI 141 39 Unreported Unreported
Louisiana July 2013 IV Cryptosporidium sp., Giardia duodenalis AGI 3 0 Wading pool Private Residence
Louisiana June 2014 IV Cryptosporidium sp. AGI 26 1 Pool, temporary water slide Unreported
Louisiana July 2014 IV Cryptosporidium sp. AGI 6 0 Unreported Unreported
Louisiana July 2014 IV Giardia duodenalis AGI 3 0 Pool Unreported
Louisiana August 2014 IV Cryptosporidium sp. AGI 22 0 Unreported Unreported
Maryland July 2014 III Chlorine gas ARI 14 7 Pool Camp/Cabin Setting
Michigan December 2014 IV Chemical-Unknown (S) Skin 5 Pool Hotel/Motel/Lodge/Inn
Minnesota February 2013 III Pseudomonas aeruginosa (S) Skin 3 0 Spa Hotel/Motel/Lodge/Inn
Minnesota August 2013 III Cryptosporidium hominis IaA28R4 AGI 10 0 Pool Community/Municipality
Minnesota October 2013 III Chloramines (S) ARI; Eye 5 0 Pool, wading pool, spa Hotel/Motel/Lodge/Inn
Minnesota December 2013 III Chemical-Unknown (S) ARI; Skin 8 0 Pool Hotel/Motel/Lodge/Inn
Minnesota March 2014 III Chloramines (S) AGI; ARI; Eye 8 0 Pool Hotel/Motel/Lodge/Inn
Minnesota March 2014 III Chloramines (S) ARI 71 0 Pool Hotel/Motel/Lodge/Inn
Minnesota September 2014 II Cryptosporidium hominis IdA17 AGI 3 0 Pool Recreational facility
Montana June 2013 IV Legionella pneumophila serogroup 1 ARI 2 2 Unreported Hotel/Motel/Lodge/Inn
Montana August 2013 IV Cryptosporidium sp. AGI 18 Pools Community/Municipality
New York March 2014 III Chemical-Unknown (S) ARI; Eye 75 0 Pool School/College/University
North Dakota July 2014 III Cryptosporidium spp. AGI 11 1 Pool Community/Municipality
Ohio April 2013 III Pseudomonas aeruginosa (S) Skin 5 0 Pool Hotel/Motel/Lodge/Inn
Ohio April 2013 IV Chemical-Unknown (S) Skin 4 0 Spa Hotel/Motel/Lodge/Inn
Ohio June 2013 IV Legionella pneumophila serogroup 1 ARI 11 1 Unreported Private Residence
Ohio April 2014 III Pseudomonas aeruginosa (S) Skin 2 Pool, spa Hotel/Motel/Lodge/Inn
Ohio June 2014 III Chlorine gas ARI 16 3 Pool School/College/University
Ohio July 2014 IV Legionella pneumophila serogroup 1 ARI 10 1 Spa Private Residence
Ohio August 2014 III Chemical-Unknown (S) AGI; ARI; Skin 2 0 Pool Club (Requires Membership)
Oklahoma May 2013 IV Chlorine (S) Skin 17 0 Interactive fountain(s) Park – Unknown
Pennsylvania August 2013 IV Cryptosporidium sp. AGI 2 0 Interactive fountain(s) Community/Municipality
Pennsylvania June 2014 I Legionella pneumophila serogroup 1 ARI 2 1 Spa Private Residence
Tennessee June 2013 III Legionella pneumophila serogroup 1 ARI 9 8 Pool, spa Club (Requires Membership)
Tennessee July 2013 III Legionella pneumophila serogroup 1 ARI 2 2 Spa Apartment/Condo
Tennessee May 2014 I Salmonella enterica Newport AGI 5 2 Interactive fountain(s) Community/Municipality
Texas May 2014 IV Unknown** AGI 15 2 Temporary water slide School/College/University
Texas June 2014 IV Cryptosporidium sp. AGI 2 Temporary water slide Private Residence
Virginia July 2014 I Legionella pneumophila serogroup 1 ARI 2 2 Spa Private Residence
Washington July 2013 II Norovirus AGI 11 0 Wading pool Park – Community/Municipal
West Virginia June 2014 IV Legionella pneumophila serogroup 1 ARI 4 0 Spa Hotel/Motel/Lodge/Inn
Wisconsin August 2013 I Cryptosporidium hominis IfA12G1 AGI 37 0 Pools Club (Requires Membership); School/College/University
Wisconsin October 2013 II Cryptosporidium hominis IfA12G1 AGI 2 0 Pool Resort
Wisconsin October 2013 III Chlorine gas ARI 24 0 Pool Resort
Wisconsin March 2014 I Norovirus Genogroup II GII_5 AGI 23 0 Pool Resort
Wisconsin August 2014 I Cryptosporidium hominis IdA17 AGI 3 0 Pool Hotel/Motel/Lodge/Inn
Wisconsin October 2014 IV Cryptosporidium sp. AGI 3 0 Pool Recreational facility

Untreated Recreational Water

Untreated Recreational Water
Jurisdiction Month Year Class† Etiology§ Predominant Illness¶ No. Cases No. Hospitalizations Venue Setting
Idaho July 2014 I Norovirus Genogroup I GI_3B, GII_4 Sydney (2012), GII_6, AGI 97 0 Pond Beach – Public
Illinois July 2013 III Urushiol/Poison Ivy (S) Skin 1,341 Other Private Outdoor Area
Indiana September 2013 IV Norovirus (S) AGI 16 0 River/stream Public Outdoor Area
Michigan June 2013 I Norovirus Genogroup II GII_2 AGI 597 3 Other Public Outdoor Area
Minnesota July 2013 I Escherichia coli, Shiga toxin-producing O157:H7 AGI 3 1 Lake/Reservoir Public Outdoor Area
Minnesota August 2013 II Norovirus Genogroup II GII_13 AGI 10 0 Lake/Reservoir Beach – Public
Minnesota August 2014 II Norovirus Genogroup II GII_7 AGI 10 0 Lake/Reservoir Beach – Public
Ohio June 2014 III Leptospira sp. LEP 2 2 Lake/Reservoir Park – State Park
Oregon July 2014 II Norovirus Genogroup I GI_1 AGI 67 0 Lake/Reservoir Park – Community/Municipal
Oregon July 2014 III Escherichia coli, Shiga toxin-producing O157:H7 AGI 3 0 River/stream Public Outdoor Area
Rhode Island July 2013 I Shigella sonnei Subgroup D AGI 141 19 Pond Beach – Public
South Carolina June 2013 IV Cryptosporidium sp. AGI 5 0 Lake/Reservoir Beach – Public
Virginia June 2013 III Escherichia coli, Shiga toxin-producing O26:NM AGI 5 0 Lake/Reservoir Camp/Cabin Setting
Washington July 2014 I Norovirus GII_5 AGI 260 Lake/Reservoir Park – Community/Municipal
Washington August 2014 IV Norovirus AGI 20 0 River/stream Park – Community/Municipal
Wisconsin July 2013 II Escherichia coli, Shiga toxin-producing O145 AGI 3 0 Lake/Reservoir Camp/Cabin Setting

Previously Unreported

Previously Unreported
Jurisdiction Month Year Class† Etiology§ Predominant Illness¶ No. Cases No. Hospitalizations Venue Setting
Colorado March 2010 IV Unknown (S)** Skin 3 0 Pool, wading pool Recreational facility
Colorado January 2011 III Mycobacterium avium complex ARI 3 Spa Hotel/Motel/Lodge/Inn
Colorado August 2011 I Legionella pneumophila serogroup 1 ARI 9 8 Spa Hotel/Motel/Lodge/Inn
Michigan August 2012 IV Chemical-Unknown (S) ARI; Skin 2 0 Spa Hotel/Motel/Lodge/Inn
Texas August 2011 IV Cryptosporidium sp. AGI 130 Pools Unknown; Other

Abbreviations:

AGI = acute gastrointestinal illness; ARI = acute respiratory illness; Eye = illnesses, conditions, or symptoms related to the eyes; LEP = leptospirosis; Skin = illnesses, conditions, or symptoms related to the skin.

*n=87, treated water, n=71 untreated water, n=16; Five previously unreported outbreaks associated with treated recreational water occurred during 2010–2012 and are not included in 2013–2014 tables and figures.

† Based on epidemiologic and environmental health data (e.g., water quality data) reported to CDC. For more information, refer to the strength-of-evidence classification table.

§ Etiologies listed are confirmed; however, suspected etiologies denoted with “(S)”. For multiple-etiology outbreaks, etiologies are listed in alphabetical order.

¶ The category of illness reported by 50% of ill respondents. All legionellosis outbreaks were categorized as ARI.

** No data reported.

Table 2. Number of Waterborne Disease Outbreaks Associated with Recreational Water, by Predominant Illness* and Type of Water Exposure — Waterborne Disease and Outbreak Surveillance System, 2013–2014

Recreational Water Outbreaks, by Predominant Illness and Type of Water Exposure

Recreational Water Outbreaks, by Predominant Illness and Type of Water Exposure
Type of Water Exposure
Treated Water Untreated Water Total
Predominant Illness Outbreaks Cases Hospitalized Died Outbreaks Cases Hospitalized Died Outbreaks % Cases % Hospitalized % Died %
AGI 35 606 48 0 14 1,237 23 0 49 56.3 1,843 52.0 71 59.7 0 0
ARI 22 197 46 4 0 0 0 0 22 25.3 197 5.6 46 38.7 4 100
AGI, ARI, and Eye 1 8 0 0 0 0 0 0 1 1.1 8 0.2 0 0 0 0
AGI, ARI, and Skin 1 2 0 0 0 0 0 0 1 1.1 2 0.1 0 0 0 0
AGI and Skin 1 2 0 0 0 0 0 0 1 1.1 2 0.1 0 0 0 0
ARI and Eye 2 80 0 0 0 0 0 0 2 2.3 80 2.3 0 0 0 0
ARI and Skin 1 8 0 0 0 0 0 0 1 1.1 8 0.2 0 0 0 0
Eye and Skin 1 13 0 0 0 0 0 0 1 1.1 13 0.4 0 0 0 0
LEP 0 0 0 0 1 2 2 0 1 1.1 2 0.1 2 1.7 0 0
Skin 7 47 0 0 1 1,341 0 0 8 9.2 1,388 39.2 0 0 0 0
Total (%) 71 (82) 963 94 4 (100) 16(18) 2,580 25 0 87 100 3,543 100 119 100 4 100

Abbreviations: AGI = acute gastrointestinal illness; ARI = acute respiratory illness; Eye = illnesses, conditions, or symptoms related to the eyes; LEP = leptospirosis; Skin = illnesses, conditions, or symptoms related to the skin.

*n=87; The category of illness reported by 50% of ill respondents. All legionellosis outbreaks were categorized as ARI.