Estimating the incidence of waterborne infectious disease related to drinking water in the United States

The available data concerning outbreaks of waterborne infectious disease (WBID), incidence of infectious diseases and prevalence of pathogens in drinking water in the United States were used to estimate the rates of morbidity and mortality from WBID. Bacterial disease rates were estimated based on isolates reported to the Centers for Disease Control and Prevention (CDC), estimated rates for under-reporting of isolates, and cases per isolate as estimated by outbreak studies. Diseases due to parasites and viruses were estimated based upon the prevalence of specific pathogens or pathogen groups in drinking water coupled with models of infectivity. The incidence of infections from waterborne pathogens for which data were not available was estimated using expert estimates from a CDC study. Point estimates of 560 000 cases of moderate to severe cases of WBID infectious disease and 7.1 million cases of mild to moderate infections were obtained with an estimated annual mortality rate of 1200. The study also demonstrates the inadequacy of available data.