The U.S. Centers for Disease Control and Prevention (CDC) is publishing a paper estimating the annual impact of waterborne diseases in the United States. Water utilities should be prepared for the possibility of media inquiries resulting from the study, particularly related to Legionella and other biofilm-associated pathogens. The paper, “Estimate of Burden and Direct Healthcare Cost of Infectious Waterborne Disease in the United States,” will be published on CDC’s website at 12 p.m ET on Dec 16. It will also appear in the January 2021 edition of its Emerging Infectious Diseases Journal . CDC examined data from 2000-15 to estimate of the overall burden of waterborne disease in the United States. Key points CDC will elevate in announcing the study include: Safe drinking water and sanitation in the United States is one of the greatest public health achievements of the 20th century. However, waterborne illness persists and new public health challenges are emerging, due to aging infrastructure, chlorine-tolerant and biofilm-associated pathogens, and increasing recreational water use. The study estimates that waterborne pathogens cause approximately 7.2 million illnesses, 118,000 hospitalizations, and 6,630 deaths every year. Common diseases like otitis externa (swimmer’s ear), norovirus infection, giardiasis, and cryptosporidiosis account for 95% of all waterborne illnesses. Despite accounting for a small proportion of overall illnesses, three biofilm-associated pathogens (nontuberculous mycobacteria, Legionella , and Pseudomonas ) cause the majority of hospitalizations and more than 90% of all deaths related to waterborne disease. Biofilm-related pathogens are also responsible for over 75% of the $3.3 billion in direct healthcare costs. The findings from this analysis highlight the evolving epidemiology of waterborne disease in the United States, the increasing role of biofilm-associated pathogens, and the need to focus public health resources to prevent and control these infections. AWWA has several resources to help utilities communicate about Legionella and other pathogens on its Communication and Outreach page , Waterborne Pathogens resource page and Coronavirus resource page . CDC has created a new web page to help homeowners understand what they can do to manage microbial risks. This page supports existing information on Building Water Management Plans . This research was briefly described by CDC in October during EPA’s M/DBP Stakeholder Event . Questions can be directed to Steve Via , AWWA director of federal relations, or Greg Kail , AWWA director of communications.