Surveillance for waterborne disease and outbreaks associated with recreational water use and other aquatic facility-associated health events--United States, 2005-2006.
Surveillance for waterborne disease and outbreaks associated with recreational water use and other aquatic facility-associated health events--United States, 2005-2006.
复制标题
与娱乐用水和其他与水生设施相关的健康事件相关的水传播疾病和疫情的监测——美国，2005-2006 年。
DOI：
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发表时间：
2008
期刊：
影响因子：
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通讯作者：
M. Beach
中科院分区：
文献类型：
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作者：
J. Yoder;M. Hlavsa;G. Craun;V. Hill;Virginia A. Roberts;Patricia A Yu;Lauri A. Hicks;N. Alexander;R. Calderon;Sharon L Roy;M. Beach
问题/状况
自1971年以来，CDC、美国环境保护署和州和地区流行病学家理事会一直合作维护水传播疾病和爆发监测系统，以收集和报告与饮用水相关的水传播疾病爆发（WBDO）相关的数据。1978年，增加了与娱乐用水（天然水和处理水）相关的WBDO。该系统是有关美国娱乐用水相关疾病的范围和影响的主要数据来源。此外，还收集了与娱乐用水有关的疾病和感染以及在水上设施发生但与水接触无直接关系的健康事件的个案数据。
报告所述期间
所提供的数据总结了2005年1月至2006年12月期间发生的与娱乐用水有关的WBDO和病例报告，以及1978年至2004年期间以前未报告的疾病报告和暴发。
描述了系统
州、地区、地方和自由联系州（即，马歇尔群岛共和国、密克罗尼西亚联邦和帕劳共和国，以前是美国的一部分-太平洋岛屿托管领土）的主要责任是发现、调查和自愿向CDC报告WBDO。虽然监测系统包括WBDO数据和与饮用水、娱乐用水和非饮用水相关的病例，但本报告仅总结了与娱乐用水和水上设施卫生事件相关的病例和疫情。
结果
2005- 2006年期间，31个州共报告了78起与娱乐用水有关的WBDO。4 412人患病，116人住院，5人死亡。暴发规模的中位数为13人（范围：2- 2 307人）。在78起WBDO中，48起（61.5%）是由传染性病原体或化学品引起的胃肠炎暴发; 11起（14.1%）是急性呼吸道疾病暴发; 11起（14.1%）是皮炎或其他皮肤病暴发。其余八宗为钩端螺旋体病爆发（两宗）、原发性阿米巴脑膜脑炎爆发（一宗）及混合或其他疾病爆发（五宗）。与胃肠炎相关的WBDO导致4，412例疾病中的4，015例（91.0%）。58例（74.4%）WBDO发生在经处理的水场所，导致4，167例（94.4%）病例。在78例WBDO中，62例（79.5%）证实了病原体，12例（15.4%）疑似病原体，4例（5.1%）未确定病原体。34例（43.6%）WBDO的病因为寄生虫; 22例（28.2%）为细菌; 4例（5.1%）为病毒; 2例（2.6%）为化学或毒素。在48起胃肠炎爆发中，31起（64.6%）被确认为致病因子，除两起外，所有这些爆发都发生在经处理的水场所，其中隐孢子虫引起的胃肠炎爆发占82.9%（29/35）。与爆发分开讨论和分析的与娱乐用水暴露有关的病例报告包括向霍乱和其他弧菌疾病监测系统报告的3例致命奈格里亚病例和189例弧菌疾病。对于弧菌报告，最常报告的菌种是创伤弧菌、溶藻弧菌和副溶血弧菌。与娱乐用水暴露相关的创伤弧菌病的弧菌病住院率（77.6%）和死亡率（22.4%）最高。此外，32起与娱乐用水无关的水上设施相关健康事件（例如，从纽约收到了1983- 2006年期间发生的游泳池化学品混合事故。这些导致364人患病的事件包括在本报告中，但单独分析。
解释
本报告中总结的WBDO数量以及娱乐用水相关疾病和爆发的趋势表明，与往年相比，报告数量大幅增加。疫情，特别是最大的疫情，在夏季更频繁地发生在经处理的水场所，并造成胃肠道疾病。导致WBDO的缺陷包括水质、场地设计、使用和维护方面的问题。与娱乐用水相关的疾病病例报告通过进一步强调不太知名的游泳场所的贡献（例如，海洋）和疾病（例如，非胃肠疾病）。水上设施也是涉及游泳场馆运营中常规使用的化学品或设备的伤害的重点，从而说明一些水上工作人员缺乏培训。
公共卫生行动
疾病预防控制中心使用WBDO监测数据来1）确定病原体、水生场所类型、水处理系统以及与疫情和病例报告相关的缺陷; 2）评估努力的充分性（即，法规和公众意识活动），以提供安全的娱乐用水; 3）扩大对与游泳和水上运动设施相关的水传播疾病和健康事件的理解范围;以及4）建立公共卫生预防优先事项、数据和信息，从而可能导致地方、州和联邦各级的法规、指南和预防措施的改进。
PROBLEM/CONDITION
Since 1971, CDC, the U.S. Environmental Protection Agency, and the Council of State and Territorial Epidemiologists have collaboratively maintained the Waterborne Disease and Outbreak Surveillance System for collecting and reporting data related to waterborne-disease outbreaks (WBDOs) associated with drinking water. In 1978, WBDOs associated with recreational water (natural and treated water) were added. This system is the primary source of data regarding the scope and effects of disease associated with recreational water in the United States. In addition, data are collected on individual cases of recreational water-associated illnesses and infections and health events occurring at aquatic facilities but not directly related to water exposure.
REPORTING PERIOD
Data presented summarize WBDOs and case reports associated with recreational water use that occurred during January 2005--December 2006 and previously unreported disease reports and outbreaks during 1978--2004.
DESCRIPTION OF THE SYSTEM
Public health departments in the states, territories, localities, and the Freely Associated States (i.e., the Republic of the Marshall Islands, the Federated States of Micronesia, and the Republic of Palau, formerly parts of the U.S.-administered Trust Territory of the Pacific Islands) have primary responsibility for detecting, investigating, and voluntarily reporting WBDOs to CDC. Although the surveillance system includes data for WBDOs and cases associated with drinking water, recreational water, and water not intended for drinking, only cases and outbreaks associated with recreational water and health events at aquatic facilities are summarized in this report.
RESULTS
During 2005--2006, a total of 78 WBDOs associated with recreational water were reported by 31 states. Illness occurred in 4,412 persons, resulting in 116 hospitalizations and five deaths. The median outbreak size was 13 persons (range: 2--2,307 persons). Of the 78 WBDOs, 48 (61.5%) were outbreaks of gastroenteritis that resulted from infectious agents or chemicals; 11 (14.1%) were outbreaks of acute respiratory illness; and 11 (14.1%) were outbreaks of dermatitis or other skin conditions. The remaining eight were outbreaks of leptospirosis (n = two), primary amebic meningoencephalitis (n = one), and mixed or other illnesses (n = five). WBDOs associated with gastroenteritis resulted in 4,015 (91.0%) of 4,412 illnesses. Fifty-eight (74.4%) WBDOs occurred at treated water venues, resulting in 4,167 (94.4%) cases of illness. The etiologic agent was confirmed in 62 (79.5%) of the 78 WBDOs, suspected in 12 (15.4%), and unidentified in four (5.1%). Thirty-four (43.6%) WBDOs had a parasitic etiology; 22 (28.2%), bacterial; four (5.1%), viral; and two (2.6%), chemical or toxin. Among the 48 gastroenteritis outbreaks, Cryptosporidium was confirmed as the causal agent in 31 (64.6%), and all except two of these outbreaks occurred in treated water venues where Cryptosporidium caused 82.9% (29/35) of the gastroenteritis outbreaks. Case reports associated with recreational water exposure that were discussed and analyzed separately from outbreaks include three fatal Naegleria cases and 189 Vibrio illnesses reported to the Cholera and Other Vibrio Illness Surveillance System. For Vibrio reporting, the most commonly reported species were Vibrio vulnificus, V. alginolyticus, and V. parahaemolyticus. V. vulnificus illnesses associated with recreational water exposure had the highest Vibrio illness hospitalization (77.6%) and mortality (22.4%) rates. In addition, 32 aquatic facility-related health events not associated with recreational water use (e.g., pool chemical mixing accidents) that occurred during 1983--2006 were received from New York. These events, which caused illness in 364 persons, are included in this report but analyzed separately.
INTERPRETATIONS
The number of WBDOs summarized in this report and the trends in recreational water-associated disease and outbreaks demonstrate a substantial increase in number of reports from previous years. Outbreaks, especially the largest ones, occurred more frequently in the summer at treated water venues and caused gastrointestinal illness. Deficiencies leading to WBDOs included problems with water-quality, venue design, usage, and maintenance. Case reports of illness associated with recreational water use expand our understanding of the scope of waterborne illness by further underscoring the contribution of less well-recognized swimming venues (e.g., oceans) and illness (e.g., nongastrointestinal illness). Aquatic facilities are also a focus for injuries involving chemicals or equipment used routinely in the operation of swimming venues, thus illustrating the lack of training of some aquatics staff.
PUBLIC HEALTH ACTIONS
CDC uses WBDO surveillance data to 1) identify the etiologic agents, types of aquatic venues, water-treatment systems, and deficiencies associated with outbreaks and case reports; 2) evaluate the adequacy of efforts (i.e., regulations and public awareness activities) to provide safe recreational water; 3) expand the scope of understanding about waterborne disease and health events associated with swimming and aquatics facilities; and 4) establish public health prevention priorities, data, and messaging that might lead to improved regulations, guidelines, and prevention measures at the local, state, and federal levels.