Outbreaks Associated with Untreated Recreational Water — California, Maine, and Minnesota, 2018–2019

The European Union One Health 2019 Zoonoses Report

“…Although ‘meat and meat products’ ranked first among strong‐evidence outbreaks (two strong‐evidence outbreak, four weak‐evidence outbreaks), ‘water’ was the source most frequently suspected (one strong‐evidence outbreak, 10 weak‐evidence outbreaks). This finding deserves attention because waterborne outbreaks caused by STEC, even severe and large events, have been reported in the literature due to contamination of either public or private drinking water, recreational water, lake, rivers, wells (Vanden Esschert et al., 2020). Interestingly, among all items described in STEC outbreaks in the last 10 years, water was the most frequently reported item (79 outbreaks between 2010 and 2018).…”

Whole-Genome Sequencing and Virulome Analysis of Escherichia coli Isolated from New Zealand Environments of Contrasting Observed Land Use

“…Nevertheless, 68 of 189 (36.0%) environmental sample enrichments were stx 1 and/or stx 2 positive, and STEC isolates were isolated from the native bush site, despite the absence of most mammals, in addition to the other four field sampling sites impacted by pastoral farming. Overseas, small outbreaks of STEC infection involving a few infected individuals have been identified from recreational exposure during swimming in lakes ( 9 , 10 ). STEC isolates were also recovered in low numbers from freshwater rivers in France (0.9%, 6/651) ( 11 ), Argentina (4 stx 2 -positive STEC isolates) ( 12 ), and Poland (7.3%, 14/192) ( 13 ).…”

“…A previous case-control study in New Zealand identified “contact with recreational waters” as a significant environmental risk factor associated with human diarrheal disease caused by STEC ( 8 ), but little work has been undertaken to confirm and identify stx -positive isolates from such samples, and the potential health risk from water contact has not been explored fully. Several overseas STEC-outbreak investigations have identified the same STEC isolates from recreational lake water studies and those recovered from STEC-infected clinical cases ( 9 , 10 ), but the public health risk assessments of the hazard that STEC poses in freshwater rivers and streams is less well understood ( 11 – 13 ) due to the limitations of culture-based approaches. Therefore, the aim of this work was to (i) examine the prevalence of STEC and (ii) undertake WGS analysis of generic E. coli isolated from environmental samples (deposited animal and avian feces, water, soil, sediment, and periphyton, biofilm material attached to submerged surfaces) sourced from sites of contrasting observed land use (native forest, dairy, or sheep and beef farming) to examine the spatiotemporal distribution and identify the genomic frequency of virulence traits (virulome) associated with human disease.…”

A Waterborne Gastroenteritis Outbreak Caused by a GII Norovirus in a Holiday Camp in Catalonia (Spain), 2017

“…Human NoV causes waterborne outbreaks worldwide suggesting their ability to persist and survive for extended periods in the environment [14][15][16][17][18][25][26][27][28][29][30][31][32]. The natural area surroundings included the Sanctuary and a restaurant that could be the source of contamination due to the wastewater discharges.…”

“…Both, the microbiological examination of water and stool samples, with subsequent NoV identification, and the epidemiological investigation of the outbreak strongly indicated that contamination of the water by faecal indicator bacteria was the original source of exposure [ 24 , 25 , 26 , 35 ]. Rapid clinical diagnosis and early control measures implemented by Epidemiological Surveillance Services prevented further transmission by person-to-person [ 36 ].…”