Most people in the United States have plenty of memories playing outside when they were young and drinking straight from the faucet or garden hose when they got thirsty. It didn’t matter if they lived in a rural community with well-water or in the city with a municipal supply, the thought of the water presenting a health risk never crossed anyone’s mind.

As a matter of fact, it wasn’t all that uncommon for hikers, hunters and outdoor enthusiasts to drink straight from a stream without any thought to there being a health hazard from doing so.

Sadly, those days are long gone.

Wild Waters

The truth is, thanks to years and years of unchecked industrial and agricultural activity there is no clean free running water left in the world much less in the United States. And, the numbers for the countries groundwater supply aren’t much better.

There is not a state in the country that does not suffer from some kind of groundwater pollution. Even Alaska with its remote local and vast expanses of unsullied land can no longer boast of a clean water supply.

Below displays the most common forms of groundwater pollution in the U.S. and the number of states they affect.

Contaminant Number of States Affected
Nitrates 49
VOCs 48
Petroleum 46
Metals 45
Pesticides 43
Brine 37
SOSs 36
Arsenic 28
Other Substances 26
Agricultural Runoff 23
Radioactivity 23
Fluoride 20
Inorganics 15

Municipal Water Supplies

As the ongoing drinking water crisis in Flint, Michigan indicates, receiving your water from a municipal supply or utility company is no longer a guarantee that it is completely safe to drink. According to some studies as many 6 percent in the continental United States receive their water from a system that is in violation of current health standards at any one time.

The most commonly cited cause for these exposures are:


  • Contamination from poorly or improperly maintained distribution systems


  • Local land use practices (fertilizers, pesticides, livestock)


  • Malfunctioning on-site wastewater treatment systems


  • Manufacturing processes (heavy metals, cyanide)


  • Naturally occurring chemicals and minerals


  • Sewage releases


Not only are the government-controlled water systems no longer a guaranteed source of safe water but there is a growing collection of evidence that chemicals introduced into the system by them may actually be toxic in its own right. Fluoride and its associated compounds can have an impact on insulin levels in the body, the function of the thyroid gland and have been shown to have many other long lasting effects on people and their children.

What to Watch Out For

There are water born diseases that can be contracted from a contaminated water supply. The list below indicates the most commonly occurring and their associated symptoms.

Disorder Symptoms
Adenovirus Infection Vary depending on the part of the body infected
Amebiasis Diarrhea, cramping and stomach pain
Cryptosporidiosis Cramps, dehydration, nausea, vomiting, fever and extreme weight loss
Cholera Watery diarrhea, vomiting and leg cramps
E. Coli Bloody diarrhea, abdominal pain, nausea, vomiting, fever, anemia and kidney failure
Hepatitis A Fever, fatigue, stomach pain, nausea, dark urine and Jaundice
Legionellosis Fever, chills, pneumonia, anorexia, muscle aches, diarrhea and vomiting
Viral Gastroenteritis Diarrhea, nausea, vomiting, cramps, Head ache, muscle aches, tiredness, fatigue and fever


Protect Yourself

Water is life. No other basic human need is as important to short-term survival and long-term health as clean and reliable drinking water.

Earlier this year, the Centers for Disease Control and Prevention observed “Drinking Water Week” to acknowledge the crucial role drinking water plays in our daily lives. This year’s theme, “Protect the Source,” urges people to learn as much information possible about the source of their drinking water and why its protection is important to our health.

That said, have you ever stopped to think about how many times a day you use water from a faucet? Drinking water refers to the water that comes out of our tap or bottled water. Americans utilize drinking water many times a day, every day, for a lot of activities such as drinking, bathing, cooking, and washing clothes, to name a few. The U.S. actually has one of the safest drinking water supplies in the world.

However, new challenges require us to continue to work to safeguard our water supply. Drinking water systems in the United States are aging, and most are long overdue for replacement.

According to the 2017 Intrastructure Report Card, Drinking water is delivered through one million miles of pipes across the country. Many of those pipes were established in the early to mid‐20th century with a lifespan of 75 to 100 years. The quality of drinking water in the United States remains high, but legacy and rising pollutants warrants some very close attention.

While water consumption has noticably waned, there are still an estimated 240,000 water main breaks per year in the country, wasting away more than two trillion gallons of treated drinking water. According to the American Water Works Association, an estimated $1 trillion is needed to maintain and expand service to meet the expected demands of the population in the next quarter century.

The United States makes use of 42 billion gallons of water each day to support everyday life and activities that range from cooking and bathing in homes to use in factories and offices all over the country. Around 80% of drinking water in the U.S. comes from rivers, lakes, reservoirs, and oceans, with 20% from groundwater aquifers. In all, there are approximately 155,000 active public drinking water systems all over the U.S.

Most Americans – numbering just under 300 million people – get their drinking water from one of the nation’s 51,356 community water systems. Of these, just 8,674 systems, or an estimated 17%, serve close to 92% of the total population, or approximately 272.6 million people. Small systems that serve the remaining 8% of the population often lack both economies of scale and financial, managerial, and technical capacity, which can lead to problems of meeting Safe Drinking Water Act standards.

Drinking water is delivered through one million miles of pipes across the U.S. A lot of those pipes were laid in the early to mid‐ 20th century and was expected to last anywhere between 75‐100 years. With utilities averaging a pipe replacement rate of 0.5% each year, it will take roughly 200 years to switch the system up – nearly double the useful life of the pipes.

Because America’s drinking water infrastructure delivers a very crucial service, substantial new investment and increased efficiencies are of the essence as filtration plants, pipes, and pumps go past their useful life. Each day, almost six billion gallons of treated drinking water are wasted away because of leaking pipes, with a projected 240,000 water main breaks happening each and every year. It is estimated that leaky, ancient pipes are wasting 14 to 18% of each day’s treated water; the amount of clean drinking water lost every day could actually reach a whopping 15 million households.

Although the United States has one of the safest drinking water supplies in the world, we must remain vigilant in our efforts to protect the water supply.

Keeping Tap Water Safe and Healthy

Over the last 100 years, many enhancements in the health, success, and lifespan of the U.S. population can be associated with the improvements that have been made when it comes to water quality. Offering safe drinking water was one of the most significant public health attainments of the 20th century. Water treatment and disinfection (processes to get eliminate specific germs or chemicals that can lead to diseases and illnesses) has helped guarantee access to healthy and safe water for millions of Americans.

Government regulations have also played a key role in reducing contamination of the bodies of water that actually supply our drinking water systems through the years. But treating water to eliminate or vanquish pollutants like germs or chemicals is still crucial to making sure sure that water is safe to drink for one and all. Contamination of drinking water sources can occur at a number of key points, including:

  • In the original water source (for example, a river)

  • Through inadequate water treatment

  • In storage tanks

  • In drinking water distribution systems (the pipes that carry water to homes, businesses, schools, and other buildings)

The Environmental Protection Agency (EPA) regulates drinking water quality in public water systems. Every public water system is required to provide its customers with an annual consumer confidence report (CCR), which provides information on local drinking water quality.

In addition, CDC’s Environmental Public Health Tracking Network has information and data about some of the most common environmental chemicals that may be found in community water supplies.

Drinking Water and Private Wells

EPA regulations are not applicable to privately owned wells, but some states do manage to regulate private wells. As a result, millions of Americans who claim their water from private wells are responsible for making sure that their water is secure and free from pollutants. A local health department or well water system professional can offer crucial assistance on well maintenance, new well construction, and water quality testing.

Water System Challenges

Drinking water systems in the country are up to a century old in some places. Broken pipes, water main breaks, and other age-related issues boost the chance for germs or chemicals to contaminate the water, resulting in boil water advisories. The American Water Works Association has projected that it will cost almost $1 trillion in the next 25 years to repair and develop our drinking water systems in order to meet the rising demands of a ever-growing population. Other issues that also need to be addressed include warming temperatures, which can heavily impact our water supply, and pollution of water sources with chemicals and toxins.

What is the CDC Doing?

CDC is hard at work in addressing these drinking water concerns through its water-related research, prevention, and policy activities and programs, including:

Research on Health Impacts


  • Providing support for state, local, and tribal health officials to research, report, and prevent diseases linked to contaminated drinking water.


  • Projecting the number of illnesses and costs linked to waterborne disease and outbreaks and ongoing exposures.


  • Determining the health effects of ancient drinking water infrastructure and well water usage to work on strategies for improvement.


  • Monitoring the epidemiology of established and emerging waterborne diseases.


  • Identifying and testing environmental elements that help in the propagation of waterborne disease.


  • Developing augmented laboratory methods for sampling, testing, and monitoring water quality.


Preventing Waterborne Disease and Protecting Public Health


  • Collaborating with EPA, state and local health groups, and other partners to offer the right information with regards to drinking water policy and research priorities.


  • Collaborating with national partners to deliver technical assistance, training and guidance on improving safe drinking water programs.


  • Working on and rolling out e-Learning courses to improve state and local safe drinking water programs.


  • Taking a close look on whether disruptions in drinking water service (like a pipe break) impact water quality and people’s health.


  • Working on tools and resources to respond to water-related emergencies.


  • Backing public health groups to augment their drinking water programs and tackle problems with wells and other private drinking water sources.


  • Implementing study findings to boost waterborne disease prevention outreach, education, policies, and practices.


  • Augmenting water quality data that can be used to determine risks, prevent exposures to harmful contaminants, and address community concerns.


  • Providing national leadership on community water fluoridation practice.


As mentioned, the U.S. has one of the safest public drinking water supplies in the world. More than 286 million Americans get their tap water from a community water system. The US Environmental Protection Agency (EPA) regulates drinking water quality in public water systems and sets maximum concentration levels for water chemicals and pollutants.

Sources of drinking water are prone to contamination and need the right treatment to eradicate disease-causing pollutants. Contamination of drinking water supplies can happen in the source water as well as in the distribution system after water treatment has already been conducted. There are many sources of water contamination, including naturally occurring chemicals and minerals (for example, arsenic, radon, uranium), local land use practices (fertilizers, pesticides, concentrated feeding operations), manufacturing processes, and sewer overflows or wastewater releases.

The presence of contaminants in water can result in adverse health effects. This includes gastrointestinal illness, reproductive problems, and neurological disorders. Infants, young children, pregnant women, the elderly, and people whose immune systems are compromised because of AIDS, chemotherapy, or transplant medications, may be especially prone to illness from some contaminants.

Top 10 Causes of Outbreaks in Public Water Systems


1. Giardia

Giardia is a microscopic parasite that causes the diarrheal illness known as giardiasis. Giardia (also known as Giardia intestinalis, Giardia lamblia, or Giardia duodenalis) is found on surfaces or in soil, food, or water that has been contaminated with feces (poop) from infected humans or animals.

Giardia is protected by an outer shell that allows it to survive outside the body for long periods of time and makes it tolerant to chlorine disinfection. While the parasite can be spread in different ways, water (drinking water and recreational water) is the most common mode of transmission.

Giardiasis is a global disease. It infects nearly 2% of adults and 6% to 8% of children in developed countries worldwide. Nearly 33% of people in developing countries have had giardiasis. In the United States, Giardiainfection is the most common intestinal parasitic disease affecting humans.

Anyone may become infected with Giardia. However, those at greatest risk are:


  • Travelers to countries where giardiasis is common


  • People in childcare settings


  • Those who are in close contact with someone who has the disease


  • People who swallow contaminated drinking water


  • Backpackers or campers who drink untreated water


  • People who have contact with animals who have the disease


  • Men who have sex with men


Signs and symptoms may vary and can last for 1 to 2 weeks or longer. In some cases, people infected with Giardia have no symptoms.

Acute symptoms include:


  • Diarrhea


  • Gas


  • Greasy stools that tend to float


  • Stomach or abdominal cramps


  • Upset stomach or nausea/vomiting


  • Dehydration (loss of fluids)

Other, less common symptoms include itchy skin, hives, and swelling of the eye and joints. Sometimes, the symptoms of giardiasis might seem to resolve, only to come back again after several days or weeks. Giardiasis can cause weight loss and failure to absorb fat, lactose, vitamin A and vitamin B12.

In children, severe giardiasis might delay physical and mental growth, slow development, and cause malnutrition.


Several drugs can be used to treat Giardia infection. Effective treatments include metronidazole, tinidazole, and nitazoxanide. Alternatives to these medications include paromomycin, quinacrine, and furazolidone. Some of these drugs may not be routinely available in the United States.

Different factors may shape how effective a drug regimen will be, including medical history, nutritional status, and condition of the immune system. Therefore, it is important to discuss treatment options with a healthcare provider.

2. Legionella

Legionnaires’ disease is a serious type of pneumonia (lung infection) caused by Legionella bacteria. Legionella can also cause a milder illness called Pontiac fever. People can get sick when they breathe in mist or accidentally ingest water into the lungs containing Legionella. Most people exposed to Legionella do not get sick. However, people 50 years or older, current or former smokers, and people with a weakened immune system or chronic disease are at increased risk.

Legionella is a type of bacterium found naturally in freshwater environments, like lakes and streams. It can become a health concern when it grows and spreads in human-made building water systems like

  • Showerheads and sink faucets


  • Cooling towers (structures that contain water and a fan as part of centralized air cooling systems for building or industrial processes)


  • Hot tubs that aren’t drained after each use


  • Decorative fountains and water features


  • Hot water tanks and heaters


  • Large plumbing systems

After Legionella grows and multiplies in a building water system, water containing Legionella then has to spread in droplets small enough for people to breathe in. People can get Legionnaires’ disease or Pontiac fever when they breathe in small droplets of water in the air that contain the bacteria.

Less commonly, people can get sick by aspiration of drinking water containing Legionella. This happens when water accidentally goes into the lungs while drinking. People at increased risk of aspiration include those with swallowing difficulties.


Legionnaires’ disease is very similar to other types of pneumonia (lung infection), with symptoms that include:

  • Cough


  • Shortness of breath


  • Fever


  • Muscle aches


  • Headaches

Legionnaires’ disease can also be associated with other symptoms such as diarrhea, nausea, and confusion. Symptoms usually begin 2 to 10 days after being exposed to the bacteria, but it can take longer so people should watch for symptoms for about 2 weeks after exposure.


Legionnaires’ disease requires treatment with antibiotics (medicines that kill bacteria in the body), and most cases of this illness can be treated successfully. Healthy people usually get better after being sick with Legionnaires’ disease, but they often need care in the hospital.

Possible complications of Legionnaires’ disease include:

  • Lung failure


  • Death

About 1 out of every 10 people who gets sick with Legionnaires’ disease will die due to complications from their illness. For those who get Legionnaires’ disease during a stay in a healthcare facility, about 1 out of every 4 will die.

3. Norovirus

Norovirus is a very contagious virus that causes vomiting and diarrhea. People of all ages can get infected and sick with norovirus.

You can get norovirus from:

  • Having direct contact with an infected person


  • Consuming contaminated food or water


  • Touching contaminated surfaces and then putting your unwashed hands in your mouth

You can get norovirus illness many times in your life because there are many different types of noroviruses. Infection with one type of norovirus may not protect you against other types. It is possible to develop immunity to (protection against) specific types. But, it is not known exactly how long immunity lasts. This may explain why so many people of all ages get infected during norovirus outbreaks. Also, whether you are susceptible to norovirus infection is also determined in part by your genes.


The most common symptoms of norovirus are:

  • diarrhea


  • vomiting


  • nausea


  • stomach pain


Other symptoms include:

  • fever


  • headache


  • body aches

Norovirus causes inflammation of the stomach or intestines. This is called acute gastroenteritis.

A person usually develops symptoms 12 to 48 hours after being exposed to norovirus. Most people with norovirus illness get better within 1 to 3 days.

If you have norovirus illness, you can feel extremely ill, and vomit or have diarrhea many times a day. This can lead to dehydration, especially in young children, older adults, and people with other illnesses.


There is no specific medicine to treat people with norovirus illness.

If you have norovirus illness, you should drink plenty of liquids to replace fluid lost from vomiting and diarrhea. This will help prevent dehydration.

Dehydration can lead to serious problems. Severe dehydration may require hospitalization for treatment with fluids given through your vein (intravenous or IV fluids).

Watch for signs of dehydration in children who have norovirus illness. Children who are dehydrated may cry with few or no tears and be unusually sleepy or fussy.

If you think you or someone you are caring for is severely dehydrated, call the doctor.

4. Shigella

Shigellosis is an infectious disease caused by a group of bacteria called Shigella. Most who are infected with Shigelladevelop diarrhea, fever, and stomach cramps starting a day or two after they are exposed to the bacteria. Shigellosis usually resolves in 5 to 7 days. Some people who are infected may have no symptoms at all, but may still pass the Shigella bacteria to others. The spread of Shigella can be stopped by frequent and careful handwashing with soap and taking other hygiene measures.


People who are sick from Shigella infection usually start experiencing symptoms 1 to 2 days after contact with the germ. Symptoms of shigellosis include:

  • Diarrhea (sometimes bloody)


  • Fever


  • Stomach pain


  • Feeling the need to pass stool [poop] even when the bowels are empty

Some people with shigellosis will not have any symptoms.

Symptoms usually last 5 to 7 days, but some people may experience symptoms anywhere from a few days to 4 or more weeks. In some cases, it may take several months before bowel habits (for example, how often someone passes stool and the consistency of their stool) are entirely normal.


Most people will recover from shigellosis without treatment in 5 to 7 days. People who have shigellosis should drink plenty of fluids to prevent dehydration. Contact your healthcare provider if you, or one of your family members, have a fever, bloody diarrhea, severe stomach cramping or tenderness, are dehydrated, or feel very sick. People who are in poor health or who have weakened immune systems, such as from HIV/AIDS or chemotherapy treatment for cancer, also should contact their healthcare provider because they are more likely to get sick for a longer period of time.

  • In some people, bismuth subsalicylate (for example, Pepto-Bismol) can help to relieve symptoms.


  • People with shigellosis should not use anti-diarrheal medication, such as loperamide (for example, Imodium) or diphenoxylate with atropine (for example, Lomotil). These medications may make symptoms worse.


  • Healthcare providers may prescribe antibiotics for some people who have severe cases of shigellosis. Antibiotics such as ciprofloxacin (common treatment for adults), and azithromycin (common treatment for children) are useful for severe cases of shigellosis because they can help people get better faster. However, some antibiotics are not effective against certain types of Shigella bacteria. Healthcare providers can order laboratory tests to determine which antibiotics are likely to work.

People who have shigellosis should follow their healthcare provider’s advice. If your healthcare provider prescribes antibiotics, let them know if you do not get better within a couple of days after starting the medication. They can do more tests to learn whether your type of Shigella bacteria can be treated effectively with the antibiotic you are taking. If not, your doctor may prescribe another type of antibiotic.

5. Campylobacter

Campylobacter causes an estimated 1.3 million illnesses each year in the United States.

Most illnesses likely occur due to eating raw or undercooked poultry, or to eating something that touched it. Some are due to contaminated water, contact with animals, or drinking raw (unpasteurized) milk.

Although people with Campylobacter infection usually recover on their own, some need medical treatment.


People with Campylobacter infection usually have diarrhea (often bloody), fever, and abdominal cramps. The diarrhea may be accompanied by nausea and vomiting. These symptoms usually start within 2 to 5 days after exposure and last about a week. Some infected people do not have any symptoms.

In people with weakened immune systems, such as people with the blood disorders thalassemia and hypogammaglobulinemia, AIDS, or people receiving chemotherapy, Campylobacter occasionally spreads to the bloodstream and causes a life-threatening infection.


Campylobacter infection is diagnosed when a laboratory test detects Campylobacter bacteria in stool, body tissue, or fluids. The test could be a culture that isolates the bacteria or a rapid diagnostic test that detects genetic material of the bacteria.

Most people with Campylobacter infection recover without specific treatment. Patients should drink extra fluids as long as diarrhea lasts. Antibiotics are needed only for patients who are very ill or at high risk for severe disease, such as people with severely weakened immune systems, such as people with the blood disorders thalassemia and hypogammaglobulinemia, AIDS, or people receiving chemotherapy.

One of the best ways to prevent water contamination is by installing a wholse house water filter in your household. Here’s a handy guide to find out what these are.


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