{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T22:45:23Z","timestamp":1777934723496,"version":"3.51.4"},"reference-count":22,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T00:00:00Z","timestamp":1748995200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Wilderness &amp; Environmental Medicine"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Freshwater sources (eg, lakes, ponds, rivers, or streams) can be contaminated by pathogens. Ingesting water from these sources can cause illness if the water is insufficiently treated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>The Waterborne Disease and Outbreak Surveillance System (WBDOSS) collects data on waterborne disease outbreaks associated with drinking water, recreational water, other nonrecreational water, and undetermined exposures to water. We analyzed outbreaks reported to WBDOSS that involved ingesting water from freshwater sources in outdoor settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>\n                      From 2000 through 2022, public health officials in 16 jurisdictions reported 32 outbreaks associated with ingesting water from insufficiently treated freshwater sources. These outbreaks resulted in 437 illnesses, 4 hospitalizations, and no reported deaths.\n                      <jats:italic toggle=\"yes\">Giardia<\/jats:italic>\n                      was implicated in 69% of outbreaks, and\n                      <jats:italic toggle=\"yes\">Campylobacter<\/jats:italic>\n                      was implicated in 28% of total cases. Water from rivers or streams was implicated in 75% of outbreaks. In half the reported outbreaks, water treatment was not attempted. Individuals were primarily exposed in outdoor recreational areas (eg, public outdoor areas, state parks, campgrounds), with most illnesses occurring in those aged 10\u201319 years.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This is the first summary dedicated to outbreaks associated with ingesting freshwater. These outbreaks can be mitigated using potable water sources, when available, or appropriate water treatment. Public health and provider efforts could include engaging the public\u2014especially those who spend time in the backcountry\u2014regarding health risks and encouraging hygiene, safe disposal of feces, and recommended water treatment methods. Healthcare providers should be encouraged to ask individuals about potential exposure to water from outdoor freshwater sources when presenting with gastrointestinal illness.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10806032251344070","type":"journal-article","created":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T04:34:06Z","timestamp":1749011646000},"page":"534-541","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Outbreaks Associated with Ingesting Water from Freshwater Sources in Outdoor Settings\u2014United States, 2000\u20132022"],"prefix":"10.1177","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3110-0800","authenticated-orcid":false,"given":"Muhammad","family":"Thuneibat","sequence":"first","affiliation":[{"name":"Chenega Enterprise Systems & Solutions LLC"},{"name":"Centers for Disease Control and Prevention"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8191-0943","authenticated-orcid":false,"given":"Allison D.","family":"Miller","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7382-6119","authenticated-orcid":false,"given":"Shanna","family":"Miko","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5889-2676","authenticated-orcid":false,"given":"Michelle E.","family":"Gleason","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hannah","family":"Lawinger","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8401-8296","authenticated-orcid":false,"given":"Jonathan S.","family":"Yoder","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7069-7737","authenticated-orcid":false,"given":"Vincent R.","family":"Hill","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1090-8704","authenticated-orcid":false,"given":"Virginia A.","family":"Roberts","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,6,4]]},"reference":[{"key":"e_1_3_3_2_2","unstructured":"Outdoor Foundation. Outdoor Participation Trends Report. Washington DC; 2022; available from 2022 Outdoor Participation Trends Report \u2013 Outdoor Foundation."},{"key":"e_1_3_3_3_2","unstructured":"U.S. Centers for Disease Control and Prevention (CDC). About Water Treatment Options When Hiking Camping or Traveling. 2024; available from About Water Treatment Options When Hiking Camping or Traveling | Drinking Water | CDC."},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/10806032231218722"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7215a6"},{"key":"e_1_3_3_6_2","unstructured":"Backer H Hill V. Water Disinfection: CDC Yellow Book 2024. 2023; Available from Water Disinfection | CDC Yellow Book 2024."},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.scitotenv.2021.150562"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.envpol.2020.114766"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.watres.2020.116421"},{"issue":"25","key":"e_1_3_3_10_2","first-page":"701","article-title":"Outbreaks associated with untreated recreational water\u2014United States, 2000-2014","volume":"67","author":"Graciaa DS","year":"2018","unstructured":"Graciaa DS, Cope JR, Roberts VA, et al. Outbreaks associated with untreated recreational water\u2014United States, 2000-2014. MMWR. 2018;67(25):701\u20136. https:\/\/doi.org\/10.15585\/mmwr.mm6725a1","journal-title":"MMWR"},{"issue":"44","key":"e_1_3_3_11_2","first-page":"1222","article-title":"Waterborne disease outbreaks associated with environmental and undetermined exposures to water \u2013 United States, 2013-2014","volume":"66","author":"McClung RP","year":"2017","unstructured":"McClung RP, Roth DM, Vigar M, et al. Waterborne disease outbreaks associated with environmental and undetermined exposures to water \u2013 United States, 2013-2014. MMWR. 2017;66(44):1222\u2013225. https:\/\/doi.org\/10.15585\/mmwr.mm6644a4","journal-title":"MMWR"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/bs.apar.2019.12.001"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1089\/fpd.2019.2652"},{"key":"e_1_3_3_14_2","unstructured":"U.S. Centers for Disease Control and Prevention (CDC). National Outbreak Reporting Systems (NORS) About NORS. 2023; Available from About National Outbreak Reporting System (NORS) | CDC."},{"key":"e_1_3_3_15_2","unstructured":"U.S. Centers for Disease Control and Prevention (CDC). BEAM (Bacteria Enterics Ameba and Mycotics) Dashboard. Atlanta Georgia: U.S. Department of Health and Human Services. 2024. Accessed 30 September 2024. www.cdc.gov\/ncezid\/dfwed\/BEAM-dashboard.html"},{"issue":"4212","key":"e_1_3_3_16_2","article-title":"Feral swine as sources of fecal contamination in recreational waters","volume":"11","author":"McKee AM","year":"2021","unstructured":"McKee AM, Bradley PM, Shelley D, McCarthy S, Molina M. Feral swine as sources of fecal contamination in recreational waters. Sci Rep. 2021;11(4212). https:\/\/doi.org\/10.1038\/s41598-021-83798-6","journal-title":"Sci Rep"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10661-011-1915-z"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jenvman.2010.11.018"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1580\/07-WEME-OR-1511.1"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1177\/10806032241245093"},{"key":"e_1_3_3_21_2","first-page":"997","article-title":"Notes from the Field: gastrointestinal illness among hikers on the Pacific Crest Trail\u2014Washington, August-October 2022","volume":"72","author":"Hamlet A","year":"2023","unstructured":"Hamlet A, Begley K, Miko S, et al. Notes from the Field: gastrointestinal illness among hikers on the Pacific Crest Trail\u2014Washington, August-October 2022. MMWR. 2023;72:997\u20138. http:\/\/dx.doi.org\/10.15585\/mmwr.mm7236a5","journal-title":"MMWR"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7138a2"},{"issue":"1","key":"e_1_3_3_23_2","first-page":"14","article-title":"Gastroenteritis associated with rafting the Middle Fork of the Salmon River\u2014Idaho, 2013","volume":"80","author":"Rosenthal M","year":"2017","unstructured":"Rosenthal M, Taylor M, Anderson KS, Carter KK. Gastroenteritis associated with rafting the Middle Fork of the Salmon River\u2014Idaho, 2013. 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