Purpose
These estimates show the health and cost impact of diseases spread through water in the United States. They also provide a description of which waterborne germs (bacteria, parasites, and viruses) cause the most diseases. This information helps CDC and others in their efforts to reduce waterborne disease outbreaks and protect the public’s health.
Estimated impact of waterborne disease in the United States
We estimated that 17 waterborne pathogens caused the following in 2014:
- 7.15 million illnesses
- Acute otitis externa and norovirus infection leading illnesses
- 601,000 emergency department visits
- 118,000 hospitalizations
- 6,630 deaths
- ~1,290 linked to recreational water
- 3,300 linked to drinking water
- $3.33 billion in direct healthcare costs for hospitalizations and emergency department visits
- Nontuberculous mycobacteria infection (46%), acute otitis externa (17%), Pseudomonas pneumonia (14%), and Legionnaires’ disease (12%) accounted for 89% of total costs
Notice
CDC estimates that each year, 1 in 44 people gets sick from waterborne diseases in the United States.
Top 5 charts for domestically acquired waterborne diseases
| Most common diseases | Estimated number of illnesses |
95% credible interval | % of total illnesses |
|---|---|---|---|
| Otitis externa/”swimmer’s ear” | 4,670,000 | 2,350,000-7,290,000 | 65% |
| Norovirus infection | 1,330,000 | 5,310-5,510,000 | 19% |
| Giardiasis | 415,000 | 140,000-816,000 | 6% |
| Cryptosporidiosis | 322,000 | 61,700-993,000 | 5% |
| Campylobacteriosis | 171,000 | 13,900-586,000 | 2% |
| Subtotal | 6,908,000 | 97% |
| Most emergency department (ED) visits | Estimated number of ED visits | 95% credible interval | % of ED visits |
|---|---|---|---|
| Otitis externa/”swimmer’s ear” | 567,000 | 337,000–823,000 | 94% |
| Norovirus infection | 26,300 | 105–106,000 | 4% |
| Nontuberculous mycobacterial infection | 5,080 | 2,560–7,750 | 1% |
| Legionnaires’ disease | 667 | 289–1,200 | <1% |
| Giardiasis | 567 | 185–1,120 | <1% |
| Subtotal | 599,614 | >99% |
| Most hospitalizations | Estimated number of hospitalizations | 95% credible interval | % of total hospitalizations |
|---|---|---|---|
| Nontuberculous mycobacterial infection | 51,400 | 26,800–74,100 | 44% |
| Otitis externa/”swimmer’s ear” | 23,200 | 13,900–33,600 | 20% |
| Pseudomonas pneumonia | 15,500 | 4,130–28,100 | 13% |
| Legionnaires’ disease | 10,800 | 7,280–13,100 | 9% |
| Pseudomonas septicemia | 5,590 | 722–14,000 | 5% |
| Subtotal | 106,490 | 90% |
| Most deaths | Estimated number of deaths | 95% credible interval | % of total deaths |
|---|---|---|---|
| Nontuberculous mycobacterial infection | 3,800 | 1,950–5,620 | 57% |
| Legionnaires’ disease | 995 | 655–1,310 | 15% |
| Pseudomonas pneumonia | 730 | 185–1,460 | 11% |
| Pseudomonas septicemia | 695 | 89–1,740 | 10% |
| Otitis externa/ “swimmer’s ear” | 219 | 107–367 | 3% |
| Subtotal | 6,439 | 97% |
| Highest costs for ED visits | Costs of ED visits (US dollars) | 95% credible interval | % of total ED costs |
|---|---|---|---|
| Otitis externa (“swimmer’s ear”) | $280,000,000 | 60,200,000–846,000,000 | 87% |
| Norovirus infection | $30,100,000 | For norovirus infection only, costs were derived from previously published estimates that did not include uncertainty intervals. | 9% |
| Nontuberculous mycobacterial infection | $8,170,000 | 584,000–34,000,000 | 3% |
| Cryptosporidiosis | $963,000 | 80,200–3,440,000 | <1% |
| Giardiasis | $917,000 | 86,100–3,780,000 | <1% |
| Subtotal | $320,150,000 | 99% |
| Highest hospitalization costs | Costs of hospitalization stays | 95% credible interval | % of total hospitalization costs |
|---|---|---|---|
| Nontuberculous mycobacterial infection | $1,520,000,000 | 266,000,000–6,370,000,000 | 50% |
| Pseudomonas pneumonia | $452,000,000 | 49,800,000–1,950,000,000 | 15% |
| Legionnaires’ disease | $401,000,000 | 79,000,000–1,690,000,000 | 13% |
| Otitis externa (“swimmer’s ear”) | $285,000,000 | 67,800,000–1,040,000,000 | 9% |
| Pseudomonas septicemia | $214,000,000 | 11,400,000–1,030,000,000 | 7% |
| Subtotal | $2,872,000,000 | 95% |
| Highest combined hospitalization and ED costs | Total annual direct healthcare costs (ED visits and hospitalizations) | 95% credible interval | % of total direct healthcare costs (ED visits and hospitalizations) |
|---|---|---|---|
| Nontuberculous mycobacterial infection | $1,530,000,000 | 272,000,000–6,380,000,000 | 46% |
| Otitis externa (“swimmer’s ear”) | $564,000,000 | 187,000,000–1,570,000,000 | 17% |
| Pseudomonas pneumonia | $453,000,000 | 49,900,000–1,950,000,000 | 14% |
| Legionnaires’ disease | $402,000,000 | 79,500,000–1,690,000,000 | 12% |
| Pseudomonas septicemia | $214,000,000 | 11,400,000–1,030,000,000 | 6% |
| Subtotal | $3,163,000,000 | 95% |
More Information
Methods Used to Estimate Waterborne Disease Burden
A description of the methods used to estimate waterborne disease burden
Waterborne Outbreaks Summary Reports
Summaries of reported waterborne disease outbreaks, including those linked to recreational, drinking...
- Collier, S. A., Deng, L., Adam, E. A., Benedict, K. M., Beshearse, E. M., Blackstock, A. J....Beach, M. J. (2021). Estimate of Burden and Direct Healthcare Cost of Infectious Waterborne Disease in the United States. Emerging Infectious Diseases, 27(1), 140-149. https://doi.org/10.3201/eid2701.190676.
- Gerdes, M. E., Miko, S., Kunz, J. M., Hannapel, E. J., Hlavsa, M. C., Hughes, M. J....Collier, S. A. (2023). Estimating Waterborne Infectious Disease Burden by Exposure Route, United States, 2014. Emerging Infectious Diseases, 29(7), 1357-1366. https://doi.org/10.3201/eid2907.230231.