CDC: ‘New Waterborne Disease Challenges Have Emerged’

Dew Drops

In December 2020, the CDC disclosed that United States has one of the safest drinking water supplies in the world; yet every year an estimated 7.2 million people get sick, 600,000 receive emergency department care, 120,000 require hospitalization and 7,000 people die at a cost of $3.3 billion in direct healthcare caused by pathogens in water systems.

water pouring on hands

Emerging Infectious Diseases’, a recently published scientific report states, “…new waterborne disease challenges have emerged” due to “…aging infrastructure systems and chlorine-tolerant and biofilm-related pathogens”.

“People are infected by waterborne germs not just when they drink water, but also when they breathe in contaminated water droplets or when water gets in their ears or nose,” the report adds.

A great number of water systems in hospitals, high-rise apartments, resorts, schools, hotels,  and commercial and industrial buildings are not only complex and overburdened but also quite old.  These aging infrastructure systems make it difficult to maintain safe drinking water and prevent biofilm from living on the interior surfaces of more than 6 million miles of plumbing.

Illnesses Caused by Biofilm in Water Systems

Ingestion, contact and inhalation of contaminated water cause respiratory, gastrointestinal and neurological illnesses, skin diseases and bloodstream infections.

Biofilm, a slimy, gummy substance, is directly responsible for the majority of waterborne diseases, such as:  campylobacteriosis, cryptosporidiosis, giardiasis, Legionnaires’ disease, nontuberculous mycobacterial infection, norovirus infection, acute otitis externa – also known as swimmer’s ear, Pseudomonas pneumonia and septicaemia, Shiga-toxin producing Escherichia coli, non-0157 STEC infection, salmonellosis, shigellosis and vibriosis. 

They are a mouthful, aren’t they?  The easy part is trying to pronounce the names of these diseases; the hard part is living with them.

laboratory testing

“Warmer oceans have led to Vibrio-associated wound infections farther north than previously documented,” states the report.

Water parks, playgrounds, fountains, swimming pools and hot tubs have all had high incidences of pathogen (bacteria, virus and parasite) related illnesses due to chlorine resistance.

Emerging Infectious Diseases’ was authored by 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.

Private Water Wells and Unregulated Water Systems in the US

water pump on farm

Private water wells and unregulated water systems that serve an estimated 43 million people across the United States have commonly failed to meet state and federal safety standards.  20% of private wells, not under the jurisdiction of EPA regulations, have contaminants that far exceed federal safety standards. 

Very high levels of nitrate, a nitrogen-rich fertilizer, and manure from livestock, seep into well water.  When well water is ingested, these nitrates bind to haemoglobin (a protein found in red blood cells that carries oxygen) and form methemoglobin, which greatly decreases oxygen carrying capacity in the blood.

Symptoms of nitrate/nitrite poisoning include:

  • Bluish skin (especially around the mouth and lips)
  • Difficulty breathing
  • Nausea, diarrhea and vomiting
  • Dehydration (from loss of bodily fluids)
  • Fast pulse, dizziness, weakness, convulsions and coma

The CDC acknowledges that babies younger than four-months-of-age are the highest risk group for physical harm and poisoning from exposure to nitrates.  When well water containing nitrates is mixed with baby formula, it can lead to vomiting, diarrhea, enteric infections and methemoglobinemia.

While nitrogen is a vital nutrient that helps plants and crops grow, high concentrations can be very harmful to people causing diseases such as colorectal cancer, bladder and breast cancer, thyroid disease and neural tube defects. 

Pregnant women ingesting nitrates from well water have a high risk factor for “…spontaneous abortion, fetal death, intrauterine growth retardation, low birth weight, congenital malformations and neonatal death,” as reported in a research article entitled ‘Drinking Water Nitrate and Human Health: An Updated Review’ published by the National Institute of Health in 2018.

Nitrates Directive from the European Union

water well on a farm

“For almost 30 years, the Nitrate Directive has been the main European reference for the protection of water threatened by over-exploitation of agricultural land and the resulting nitrate contamination,” states European Union.

“…groundwater nitrate contamination is still a serious threat to ecosystems and human health,” the European Union adds. 

quote 1 for nitrogen in water

Environmental Monitoring and Assessment completed a research study in Poland that was published by the US National Institute of Health in 2016, which stated, “Severe shortage of phosphorus and potassium in applied fertilizers is one of the major factors causing leaching of nitrogen due to limited possibilities of its consumption by plants.”

Boiling well water will not remove nitrates, nor will mechanical filters and chlorination.  Nitrates can only be removed from water with ion exchange, distillation and reverse osmosis.

The Center for Sustainable Systems at the University of Michigan states, “In 2017, the amount of irrigated farmland in the U.S. was over 58 million acres, 2 million more acres than in 2012.”

Flint, Michigan – Water Crisis

children drinking water from an outside faucet

After residents in Flint, Michigan endured six long years of blatant, outright lies about the contaminated water coming out of their taps, state government officials replaced lead piping with copper piping to 9,769 residential homes at a cost of $ 400 million dollars.  An additional $ 650 million dollars was designated for residents who suffered physical, economical and psychological despair.

State and city officials concluded it was economically feasible to temporarily draw water from a system at Flint River (not used since the 1960s and commonly known to be a dumping ground for cars and industrial waste), while a pipeline to a much-needed new water source in Lake Huron was being completed.

It wasn’t long before residents experienced brown water and strange odours coming from their taps along with enduring physical ailments such as excessive itching, hair loss, body chills, bouts of coughing, high fevers and difficulty breathing. 

In 2015, the US Environmental Protection Agency found dangerous levels of lead in the water in Flint, Michigan. 

Over time, bacteria and acid corroded the water pipes allowing lead to leach into the water system – and eventually to every home.  During the 18 months that Flint drew its water from Flint River, twelve people died from two separate outbreaks of Legionnaires’ disease, a severe form of pneumonia, and 79 people became very ill.  PBS’s Frontline states that 115 people died from pneumonia during that same time period.

quote - 2 for nitrogen in water

The Canadian Paediatric Society published an article in 2019 entitled, ‘Lead toxicity with a new focus: Addressing low-level lead exposure in Canadian children’ which states: 

“Lead exposure can start prenatally, from exogenous lead exposures during pregnancy as well as from a mother’s endogenous stores.  Following birth, exposure can occur via ingestion, inhalation and/or dermal absorption.  Preschool children can absorb approximately 40% of the lead they happen to ingest, while adults absorb only about 10%.  Approximately 70% of the body’s stored lead is in bones and can be re-released into the bloodstream during remodelling of bones during childhood, adolescence or old age, or in response to stress, pregnancy or malnutrition.”

Michigan State and City Officials Indicted on 42 Counts

9 former state and city officials, including Michigan state’s former republican governor, Rick Snyder, were indicted on a total of 42 counts “…relating to a series of alleged actions and inactions that created the historic injustice of the Flint water crisis,” said Michigan’s Solicitor General, Fadwa Hammoud and Kym L Worth, Wayne County’s Prosecutor.

When residents of Flint, Michigan desperately needed leadership and accountability from state and city officials, it was not to be found.  After all is said and done, many lives were lost and thousands suffered, and continue to suffer, for what could have been entirely preventable.

By not addressing the water crisis at the very inception, state and city officials were not only saying they do not have faith in their own leadership and management skills; they were saying the residents of Flint, Michigan did not deserve the truth. 

CDC's Waterborne Disease Outbreak Investigation Toolkit

The Centers for Disease Control and Prevention (CDC) is pleased to announce that its new Waterborne Disease Outbreak Investigation Toolkit is now available online. This toolkit was developed to assist state, local, territorial, and tribal health departments with investigating waterborne disease outbreaks and address the unique challenges they face during these investigations. Based on the experiences of frontline epidemiologists, this toolkit describes best practices in preparing for, detecting, investigating, and preventing waterborne disease outbreaks.

The toolkit is available in two formats:

  • As a full manual, which can be downloaded as a PDF
  • As individual modules to assist with each step of an outbreak investigation, which can be accessed via the toolkit website.


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