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Outbreaks Associated with Treated Recreational Water — United States, 2015–2019

What is already known about this topic? Outbreaks associated with treated recreational water in pools, hot tubs, and water playgrounds can be caused by pathogens or chemicals. What is added by this report? For the period 2015–2019, a total of 208 outbreaks associated with treated recreational water were reported to CDC. Cryptosporidium caused 76 outbreaks, resulting in 2,492 cases. Legionella caused 65 outbreaks, resulting in 13 deaths. What are the implications for public health practice? To help prevent outbreaks, operators of public aquatic venues and U.S. jurisdictions can voluntarily adopt CDC’s Model Aquatic Health Code, Legionella Control Toolkit, and Water Management Program Toolkit recommendations, and swimmers can follow CDC’s healthy swimming steps.

Early Release - Attribution of Illnesses Transmitted by Food and Water to Comprehensive Transmission Pathways Using Structured Expert Judgment, United States - Volume 27, Number 1—January 2021 - Emerging Infectious Diseases journal

13). For some pathogens, subdivisions into categories by serotype, patient age, or clinical manifestations of interest were included because transmission pathways were assumed to be different. For example, for Salmonella, the 5 most common serotypes were included along with 2 groups of rarer serotypes based on a ranking of their coefficients of variation (CVs) calculated from the patients’ ages, sexes, states of residence, and the year and month specimens were obtained (group 1, lowest CVs; group 2, highest CVs) as described by Boore et al. ( 14). This compilation resulted in a total of 33 pathogens and 47 target questions, or categories, for estimation. The 47 target questions were grouped into 15 panels on the basis of similarities between pathogen microbiology and ecology (Table 1).

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