Another Feather in the Cap of Tourism: Waterborne Diseases

One-Third of Waterborne Infections Linked to Hotel Pools, Hot Tubs –CDC

Crypto parasite continues to cause most outbreaks and illnesses linked to pools and water playgrounds.

New data from the Centers for Disease Control (CDC) shows one-third of recreational waterborne infections are acquired in hotel pools or hot tubs.

The parasite, Cryptosporidium [“Crypto”] bacteria, which causes the majority of outbreaks and illnesses, is spread by swallowing water contaminated with feces.

Morbidity and Mortality Weekly Report (MMWR) – Outbreaks Associated with Treated Recreational Water — United States, 2000–2014

Outbreaks associated with exposure to treated recreational water can be caused by pathogens or chemicals in venues such as pools, hot tubs/spas, and interactive water play venues (i.e., water playgrounds). During 2000–2014, public health officials from 46 states and Puerto Rico reported 493 outbreaks associated with treated recreational water. These outbreaks resulted in at least 27,219 cases and eight deaths. Among the 363 outbreaks with a confirmed infectious etiology, 212 (58%) were caused by Cryptosporidium (which causes predominantly gastrointestinal illness), 57 (16%) by Legionella (which causes Legionnaires’ disease, a severe pneumonia, and Pontiac fever, a milder illness with flu-like symptoms), and 47 (13%) by Pseudomonas (which causes folliculitis [“hot tub rash”] and otitis externa [“swimmers’ ear”]). Investigations of the 363 outbreaks identified 24,453 cases; 21,766 (89%) were caused by Cryptosporidium, 920 (4%) by Pseudomonas, and 624 (3%) by Legionella. At least six of the eight reported deaths occurred in persons affected by outbreaks caused by Legionella. Hotels were the leading setting, associated with 157 (32%) of the 493 outbreaks. Overall, the outbreaks had a bimodal temporal distribution: 275 (56%) outbreaks started during June–August and 46 (9%) in March. Assessment of trends in the annual counts of outbreaks caused by Cryptosporidium, Legionella, or Pseudomonas indicate mixed progress in preventing transmission. Pathogens able to evade chlorine inactivation have become leading outbreak etiologies. The consequent outbreak and case counts and mortality underscore the utility of CDC’s Model Aquatic Health Code (https://www.cdc.gov/mahc) to prevent outbreaks associated with treated recreational water.

46 outbreaks infect more than 27,000 people

During 2000–2014, public health officials from 46 states and Puerto Rico reported 493 outbreaks associated with treated recreational water, which resulted in at least 27,219 cases and eight deaths. Etiology was confirmed for 385 (78%) outbreaks. Among these, 363 (94%) were caused by pathogens (including four caused by both Cryptosporidium and Giardia) and resulted in at least 24,453 cases. Twenty-two (6%) outbreaks were caused by chemicals and resulted in at least 1,028 cases. Among the 363 outbreaks with a confirmed infectious etiology, 212 (58%) were caused by Cryptosporidium, 57 (16%) by Legionella, and 47 (13%) by Pseudomonas. Of the 24,453 cases, 21,766 (89%) were caused by Cryptosporidium, 920 (4%) by Pseudomonas, and 624 (3%) by Legionella. Of the 212 outbreaks caused by Cryptosporidium, 24 (11%) each affected >100 persons; four of these outbreaks each affected ≥2,000 persons. At least six of the eight deaths,^¶ which all occurred after 2004, were in persons affected by outbreaks caused by Legionella.

32% of infections acquired in hotels

Hotels** (i.e., hotels, motels, lodges, or inns) were the leading setting associated with 157 (32%) of the 493 outbreaks. Of the 157 hotel-related outbreaks, 94 (60%)^†† had a confirmed infectious etiology, 40 (43%) were caused by Pseudomonas, 29 (31%) by Legionella, and 17 (18%) by Cryptosporidium.^§§ Sixty-five (41%) hotel-related outbreaks were associated with hot tubs/spas, and 47 (30%) started during February–March. Among all 493 outbreaks, a bimodal temporal distribution was observed. The 275 (56%) outbreaks that started during June–August were predominantly caused by Cryptosporidium, whereas the 46 (9%) that started in March were predominantly caused by an unidentified etiology or pathogens other than Cryptosporidium. Negative binomial regression analysis indicated that during 2000–2007, the annual number of outbreaks caused by Cryptosporidium increased by an average of 25% (95% confidence interval [CI] = 7%–45%) per year. No significant trend was found after 2007.^¶¶ Poisson regression analysis indicated that during 2000–2014 the annual number of outbreaks caused by Legionella increased by an average of 13% (95% CI = 6%–21%) per year, and the annual number of Pseudomonas folliculitis outbreaks (a total of 41 outbreaks during 2000–2014) decreased by an average of 22% (95% CI = 14%–29%) per year.*** [Source: CDC MMWR]

Legionella Outbreak in Scotland: 1 Dead, 16 Critical

The worst single outbreak of Legionnaires’ disease in Scotland kills one, leaves 16 in critical condition

At least one person has died and 16 others are in a critical condition in hospital in the worst single outbreak of Legionnaires’ disease in Scotland.

A further 15 suspected cases of the illness are being investigated by the health authorities in Edinburgh, reports said.

The worst legionella outbreak in the UK occurred in 2002 in Barrow-in-Furness, Cumbria, where at least 172 people were infected and seven died from the illness. It’s believed that a contaminated cooling tower was the source of that outbreak.

Legionella bacteria.  Legionnaires’ disease  is caused by a type of bacteria called Legionella. Each year, up to 18,000 people are hospitalized with Legionnaires’ disease in the U.S.  However, many infections are not diagnosed or reported, so this number may be higher. Legionnaires’ disease can have symptoms like many other forms of pneumonia, so it can be hard to diagnose at first. Signs of the disease can include: a high fever, chills, and a cough. Some people may also suffer from muscle aches and headaches. Chest X-rays are needed to find the pneumonia caused by the bacteria, and other tests can be done on sputum (phlegm), as well as blood or urine to find evidence of the bacteria in the body. These symptoms usually begin up to 14 days after exposure to the bacteria.  Legionnaires’ disease can be very serious and can cause death in up to 30% of cases.  Source CDC.

Other Global Disasters, Significant Events

• Florida, USA.The Centers for Disease Control and Prevention (CDC) has reported a 16 percent increase in tuberculosis (TB) cases in Duval County in the past year, making it the largest outbreak of TB in the U.S.
  • Most of the cases are reportedly among the homeless.
  • There were 85 cases of TB reported in Florida of which 67 were in Duval County.

• Washington, USA.  Whooping cough epidemic in the state of Washington has so far surpassed 2,000 reported cases.

• Utah and S. Dakota, USA.  Hantavirus, a rodent-borne disease has claimed at least 2 lives in the State of Utah and a thir in South Dakota.
  • “We get maybe one case a year,” Baker said Tuesday. “It’s unusual to see two fatalities so early in the summer.” Utah Department of Health epidemiologist JoDee Baker said.
  • The third victim, who died from the infection is SD was a 7-year-old girl.
  • In 2011, some 587 cases of the disease throughout the U.S. were reported to CDC, including 16 in S. Dakota.
  • The young girl’s death is the fifth in the state from hantavirus, so far this year, said the South Dakota Department of Health.

• Global.  Multi-drug resistant Neisseria gonorrhea.  The numbers of sexually transmitted infections (STIs, STDs) have climbed to about 500 million new cases globally each year.  The STIs include Gonorrhea, syphilis, chlamydia and trichomoniasis.
  •  Gonorrhea represents about a fifth (~ 100 million cases) of all STIs  annually.
  • A superbug strain of gonorrhea, first identified in Japan, which  is resistant to all recommended antibiotics, has spread to  many more countries around the globe, including Australia, China, France, Hong Kong, New Zealand, Norway, Sweden and the U.K., UN WHO reported.
  • The strain is found to be resistant to cephalosporin antibiotics, the last treatment option against gonorrhoea, WHO said.
  • “There are verified treatment failures to cefixime (oral cephalosporin) treatment in Japan and Norway as well as reports from China (Hong Kong SAR) and the United Kingdom. This emergence of decreased susceptibility of N. gonorrhoeae to the ‘last line’ treatment option of cephalosporins together with AMR already shown to penicillins, sulphonamides, tetracyclines, quinolones and macrolides (including azithromycin) make N. gonorrhoeae a multidrug-resistant organism.” WHO reported.
  • “Antimicrobial resistance is caused by the unrestricted access to antimicrobials, overuse and poor quality of antibiotics, as well as natural genetic mutations within disease organisms. In addition, gonorrhoea strains tend to retain genetic resistance to previous antibiotics even after their use has been discontinued. The extent of this resistance worldwide is not known due to lack of reliable data for gonorrhoea in many countries and insufficient research”

Gonorrhea is a common sexually-transmitted disease (STD), caused by the bacteria Neisseria gonorrhoeae. An electron micrograph of gonorrhea bacteria.  Image courtesy http://women.webmd.com/slideshow-pelvic-pain-causes

See also:

• Superbugs Invasion Has Begun Posted on May 19, 2012
• Gonorrhea: First superbug strain found Posted on July 12, 2011
• Resurgence of C. difficile in Ontario, Canada Posted on July 4, 2011
• New superbug spreading from India Posted on August 11, 2010
• New superbug spreading from India Posted on August 11, 2010

Global Disasters: Links, Forecasts and Background

• The First Wave of World’s Collapsing Cities
• Back to the Primordial Future
• The Fate of Energy Dinosaurs
• Mass Die-offs

• 2010 Disasters [Links to 2010 Disaster Calendar]
• Mega Disasters
• 2011 Disaster Calendar
• 2012 Disaster Calendar