Estimate of Waterborne Disease Burden in the United States

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.

Computer screen of charts and figures

Estimated impact of waterborne disease in the United States

We estimated that 17 waterborne pathogens caused the following in 2014:

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

  • 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.