v>EPA
United States
Environmental Protection
Agency
Technical Support Document for the
Draft Fifth Contaminant Candidate List
(CCL 5) - Microbial Contaminants

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Office of Water (4607M)
EPA 815-R-21-007
July 2021
www. epa. gov/ safewater

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EPA-OGWDW Technical Support Document for the Draft Fifth Contaminant Candidate List EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Table of Contents
Table of Contents	i
Acronyms	iii
Chapter 1.0 Introduction	1
Section 1.2 Overview of Draft CCL 5 Process for Microbes	2
Chapter 2.0 Summary of CCL 5 Nominations for Microbial Contaminants	3
Section 2.1 Microbial Nominations for CCL 5	3
Section 2.2 Analysis of Nominated Microbial Contaminants	3
Chapter 3.0 Building the CCL 5 Microbial Universe	3
Section 3.1 Overview of the Microbial Universe	3
Chapter 4.0 Screening the Microbial Universe to Select the PCCL 5	4
Section 4.1 Application of Screening Criteria to the Microbial CCL Universe	9
Chapter 5.0 Determining the Draft Microbial CCL 5	10
Section 5.1 Application of Scoring Protocol to the PCCL and Selection of the Draft CCL 5
Microbes from the PCCL	14
Chapter 6.0 Microbial Data Sources for the Draft CCL 5	17
References	18
Appendix A: List of CCL 5 Microbial Nominations	A1
Appendix B: The CCL 5 Microbial Universe	B1
Appendix C: PCCL 5 Pathogen Scores	CI
Appendix D: The Draft CCL 5 for Microbes	D1
Appendix E: Microbial Contaminant Information Sheets (CISs)	El
Acinetobacter baumannii Scoring Data	E4
Adenovirus Scoring Data	E8
Aeromonas hydrophila Scoring Data	E12
Arcobacter butzleri Scoring Data	El 5
Aspergillus fumigatus Scoring Data	El9
Astrovirus Scoring Data	E24
Blastocystis hominis Scoring Data	E27
Calicivirus Scoring Data	E30
Campylobacter jejuni Scoring Data	E34
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Comamonas testosteroni Scoring Data	E38
Cyclospora cayetanensis Scoring Data	E41
Entamoeba histolytica Scoring Data	E44
Enterovirus Scoring Data	E48
Escherichia coli (0157)^ Scoring Data	E53
Exophiala jeanselmei Scoring Data	E58
Fusarium solani Scoring Data	E61
Helicobacter pylori Scoring Data	E65
Hepatitis A Virus Scoring Data	E69
Hepatitis E Virus Scoring Data	E73
Isospora belli Scoring Data	E77
Legionella pneumophila Scoring Data	E80
Microsporidia Scoring Data	E84
Mycobacterium abscessus Scoring Data	E87
Mycobacterium avium Scoring Data	E91
Naegleria fowleri Scoring Data	E95
Nontuberculous Mycobacteria (NTM) Scoring Data	E99
Pantoea agglomerans Scoring Data	El02
Plesiomonas shigelloides Scoring Data	El06
Pseudomonas Aeruginosa Scoring Data	El 10
Rotavirus Scoring Data	El 13
Salmonella enterica Scoring Data	El 17
Shigella sonnei Scoring Data	El21
Toxoplasma gondii Scoring Data	E125
Vibrio cholerae Scoring Data	E129
Yersinia enterocolitica Scoring Data	E133
Appendix F. CCL 5 Data Source Descriptions	F1
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Acronyms
CCL
Contaminant Candidate List
CCL 1
EPA's First Contaminant Candidate List
CCL 2
EPA's Second Contaminant Candidate List
CCL 3
EPA's Third Contaminant Candidate List
CCL 4
EPA's Fourth Contaminant Candidate List
CCL 5
EPA's Fifth Contaminant Candidate List
CDC
Centers for Disease Control and Prevention
CIS
Contaminant Information Sheet
CNS
Central Nervous System
EPA
Environmental Protection Agency
GWR
Ground Water Rule
MAC
Mycobacterium avium complex
MCL
Maximum Contaminant Level
MCM
Manual of Clinical Microbiology
MMWR
Morbidity and Mortality Weekly Reports
NDWAC
National Drinking Water Advisory Council
NIH
National Institute of Health
NORS
National Outbreak Reporting System
NPDWR
National Primary Drinking Water Regulation
NRC
National Research Council
NTM
Nontuberculous mycobacteria
OGWDW
Office of Groundwater and Drinking Water
PCCL
Preliminary Contaminant Candidate List
PWS
Public Water System
SAB
Science Advisory Board
SDWA
Safe Drinking Water Act
WBDO
Waterborne Disease Outbreak
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Chapter 1.0 Introduction
The 1996 Safe Drinking Water Act (SDWA) Amendments (section 1412(b)(1)) require the
United States Environmental Protection Agency (EPA) to publish every five years a list of
drinking water contaminants that are known or anticipated to occur in public water systems
(PWSs) and that may cause adverse health effects. SDWA specifies that the list (referred to as
the Contaminant Candidate List, or CCL) must include contaminants that are not subject to any
proposed or promulgated National Primary Drinking Water Regulations, are known or
anticipated to occur in PWSs, and may require regulation under SDWA.
EPA uses this list of unregulated contaminants to help identify priority contaminants for
regulatory decision making and prioritize research and data collection efforts. SDWA also
requires the agency to consult with the scientific community, including the Science Advisory
Board (SAB), and provide notice and opportunity for public comment prior to the publication of
the Final CCL. In addition, SDWA directs the agency to consider the health effects and
occurrence information for unregulated contaminants to identify those chemicals and microbial
pathogens that present the greatest public health concern related to exposure from drinking
water.
Section 1.1 Background to the CCL
The first CCL (CCL 1), published on March 2, 1998, (63 FR 10274, USEPA, 1998a) was
developed based on recommendations by the National Drinking Water Advisory Council
(NDWAC) and reviewed by technical experts. CCL 1 contained 50 chemicals and 10 microbial
contaminants/groups. EPA published the second CCL (CCL 2) on February 24, 2005 (70 FR
9071, USEPA, 2005). With CCL 2, EPA carried forward the 51 remaining chemical and
microbial contaminants from CCL 1 (that did not have regulatory determinations).
During the development of the CCL 3, EPA requested assistance from the Water Science and
Technology Board of the National Academy of Sciences' National Research Council (NRC) in
developing a more robust approach to identifying and prioritizing potential drinking water
contaminants. NRC formed the Committee on Drinking Water Contaminants, and the committee
published their recommendations in 1999 and 2001 (NRC, 1999a; NRC, 1999b; NRC, 2001).
EPA used these recommendations to develop the CCL classification process implemented during
CCL 3.
In developing the CCL 3, EPA established and implemented a multi-step process to select
contaminants (Figure 1). The steps listed below were established to select microbial
contaminants specifically. The NRC also provided recommendations for chemical contaminants,
the process for how EPA prioritizes chemical contaminants can be found in a separate document-
Technical Support Document for the Draft Fifth Contaminant Candidate List (CCL 5) -
Chemical Contaminants.
•	Step 1. Building a broad universe of all microbes that may cause human disease.
•	Step 2. Screening that universe of microbial contaminants to produce a Preliminary
CCL (PCCL).
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• Step 3. Selecting the Draft CCL microbial list by ranking the PCCL contaminants
based on occurrence in drinking water (including waterborne disease outbreaks) and
human health effects.
Figure 1: Draft CCL Development Process
Building the Universe
Universe
Screening
Preliminary CCL
(PCCL)
ro
Classification/
Selection
Draft CCL
CO
Following the process developed for CCL, CCL 3 was published October 8, 2009 (74 FR 51850,
USEPA, 2009a) and contained 104 chemicals or chemical groups and 12 microbial
contaminants.
EPA carried forward all microbes listed on the CCL 3 to the Fourth Draft CCL (CCL 4). EPA
also reviewed the nominations and supporting information provided by nominators to determine
if additional microbes should be added to the Draft CCL 4. This process involved evaluating new
data provided by the nominators that had not been previously evaluated for CCL 3. The agency
also collected additional data for the nominated contaminants, when available, from updated
CCL 3 data sources and any new data sources that were not available at the time of the CCL 3.
EPA evaluated the nominated contaminants utilizing the best available health effects and
occurrence data and followed the same process for screening and scoring contaminants used for
the CCL 3. The agency published its final CCL 4 on November 17, 2016 (81 FR 81099, USEPA,
2016a). The final CCL 4 contained 97 chemicals or chemical groups and 12 microbial
contaminants.
Section 1.2 Overview of Draft CCL 5 Process for Microbes
EPA developed the Draft Fifth CCL (CCL 5) using a similar process used for the CCL 3 and
CCL 4 including developing a microbial universe, PCCL, and Draft CCL, as described in detail
in Chapters 3, 4, and 5 of this document.
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Chapter 2.0 Summary of CCL 5 Nominations for Microbial Contaminants
EPA sought public nominations in a Federal Register notice on October 5, 2018 for unregulated
chemical and microbial contaminants to be considered for possible inclusion in the CCL 5 (83
FR 50364, USEPA, 2018). EPA compiled and reviewed the information from the nominations
process to identify the contaminants nominated and any sources of supporting data submitted
that could be used to supplement the data gathered by EPA to inform selection of the Draft CCL
5.
Section 2.1 Microbial Nominations for CCL 5
Sixteen unique microbial nominations were submitted by the public in response to EPA's request
for nominations for microbial contaminants to be considered for the Draft CCL 5. Eight
microbes were nominated by more than one organization or individual. Legionella pneumophila
received the most nominations, nominated by 18 organizations or individuals. Appendix A
shows the organisms or group of organisms that were nominated, along with the number of
nominators and any supporting information provided.
Section 2.2 Analysis of Nominated Microbial Contaminants
EPA reviewed the nominated microbial contaminants and the supporting information provided
by nominators to determine if any new data provided had not been previously evaluated.
Furthermore, the agency collected additional data for the nominated microbial contaminants by
updating both the CCL 3 and the CCL 4 data sources and conducting literature searches covering
the time between the CCL 4 and the CCL 5.
Chapter 3.0 Building the CCL 5 Microbial Universe
Section 3.1 Overview of the Microbial Universe
The microbial universe was defined as any pathogen that causes human disease. The microbial
CCL 5 Universe was developed based upon previous CCL universes, in particular, the CCL 3
and the CCL 4 Universes. During the development of the CCL 3, EPA followed the NDWAC's
recommendation to specifically use Taylor et al. (2001) and literature reviews as the starting
point for the microbial CCL 3 Universe (NDWAC, 2004). For the CCL 3, the agency added
organisms to the Taylor et al. (2001) list, with input from subject matter experts and data
collected through a literature search. For example, EPA reviewed fungi in drinking water
literature and identified six fungal species reported to occur in drinking water distribution
systems that did not appear on the Taylor et al. 2001 list. EPA also added reovirus to the CCL 3
Universe based on additional health effects information (Tyler et al., 2004). Additional microbes,
Methylobacterium (with two species) and mimivirus, were added to the universe during CCL 3.
Adding these two bacterial species, two viral groups (e.g., reovirus and mimivirus) and six
fungal species to the microbial universe brought the CCL 3 Universe list to 1,425 microbes.
These microbes remained in the CCL 4 Universe.
EPA conducted a literature search, sought input from subject matter experts, and reviewed
nominations for potential microbial contaminants to add to the CCL 5 Universe. As a result of
the literature search, 14 organisms were added to the CCL 5 Universe (Table 1). Changes to
nomenclature were made as necessary (in most cases combining two species into one organism
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group), which brought the total to 1,435 microbes. EPA recognizes that given the dynamic nature
of ongoing microbial research the listing of all human pathogens on the CCL universe needs to
be periodically updated to keep up with the latest science. The full microbial CCL 5 Universe is
presented in Appendix B.
Table 1. Organisms Added to the Microbial CCL 5 Universe
Organism
Reference
Alloscardovia omnicolens
(bacteria)
Brown, M. et al., 2016
Elizabethkingia anophelis
(bacteria)
Figueroa Castro, C.E. et al., 2017
Neoehrlichia mikurensis (bacteria)
Portillo, A. et al., 2018
Parachlamydia acanthamoebae
(bacteria)
Greub, G., 2009
Waddlia chondrophila (bacteria)
Baud, D. et al., 2014
Human bocavirus (virus)
Allander, T., 2008
Human coronavirus SARS-CoV-2
(virus)
Ciotti, et al., 2019
KI polyomavirus (virus)
Bofill-Mas, S., etal., 2010
Kobuvirus (virus)
Ramirez-Castillo et al., 2015
Lujo virus (virus)
https://www.cdc.gov/vhf/luio/transmission/index.html

Parvovirus 4 (virus)
Sharp, C.P., et al., 2010
WU polyomavirus (virus)
Bofill-Mas, S., 2010
Botrytsis cinerea (fungi)
Hashimoto et al., 2017
Epiccocum purpurascens (fungi)
httDs://www.insDa.ac.ca/en/moulds/fact-
sheets/epicoccum-purpurascens
Chapter 4.0 Screening the Microbial Universe to Select the PCCL 5
The development of the microbial Preliminary CCL 5 (PCCL 5) adhered to the process
developed for the CCL 3 with additional updates described below. The CCL 3 process followed
NRC recommendations to use a hierarchical framework for evaluating the potential occurrence
of microbial contaminants in drinking water (NRC, 2001). For CCL 3, EPA also followed
recommendations provided by NDWAC (2004) to select microbial contaminants for a PCCL
based upon an assessment of occurrence and health effects attributes. This assessment related the
plausibility of pathogen presence, survival, and transport through drinking water to disease
manifestations from drinking water exposure. The CCL 3 screening criteria were developed
based upon epidemiology, geographical distribution, and biological properties in the host and in
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the environment. The screening criteria were recommended by NDWAC and amended by EPA
following an external peer review resulting in 12 screening criteria used for initial screening of
pathogens in the microbial CCL 3 Universe for placement on the PCCL 3 (NDWAC, 2004).
Additional information on recommendations provided by NRC and NDWAC are described in
EPA's Final CCL 3 Microbes: Screening to the PCCL (USEPA, 2009b) and NRC (NRC, 2001)
and NDWAC reports (NDWAC, 2004).
The 12 exclusion criteria were used to evaluate the five microbial groups (bacteria, viruses,
fungi, helminths, and protozoa) but each criterion did not necessarily apply to every group. Some
evaluation criteria would never be used to exclude microbes in a group because of fundamental
characteristics of the microbes in that group. For example, Criterion 5: Microflora indigenous to
the gastrointestinal tract, skin, and mucous membranes was not used to evaluate viruses and
helminths. This was because viruses and helminths do not have a commensal relationship with a
human host and are not considered a part of normal human microflora (Davis, 1996). Criteria
that were not used are greyed out in their respective columns in the screening table presented in
Appendix B.
EPA restricted the PCCL to pathogens associated with source water, and recreational water (e.g.,
swimming pools, hot tubs) only if the source water was also utilized for drinking water. The
screening criteria excluded those pathogens whose biological properties are incompatible with
water transmission by ingestion, inhalation, or dermal contact, and those pathogens that are
typically introduced from sources other than drinking water.
For the CCL 5, EPA re-evaluated the 12 criteria utilized in the CCL 3 and the CCL 4 for
applicability to microbes and reviewed certain criteria in depth per recommendations received
from the SAB (USEPA, 2016c) and stakeholders during the development of the CCL 3 and CCL
4. In particular, Criterion 1 (anaerobes), Criterion 9 (natural habitat is in the environment without
epidemiological evidence of drinking water-related disease) and Criterion 10 (not endemic to
North America) were closely re-evaluated based on previous comments for the CCL 3 and the
CCL 4 from NDWAC, SAB, and the public. Upon further evaluation, EPA did not find
supporting evidence to modify Criterion 1 and Criterion 10. EPA's evaluation included literature
searches for new information, internal EPA expert review, as well as feedback from subject
matter experts at the Centers for Disease Control and Prevention (CDC).
To determine if Criterion 1, anaerobes, should be modified, EPA conducted a literature search
and found insufficient evidence supporting waterborne illnesses attributed to anaerobic microbes.
Therefore, Criterion 1 remains unchanged.
In response to the SAB's comments from CCL 3 and CCL 4 that Criterion 9 was too restrictive,
EPA evaluated and expanded Criterion 9 to include nosocomial infections where drinking water
is implicated. This expansion also recognized a growing concern for microbial contaminants
within distribution systems, building water systems, and biofilms. For past CCLs,
microorganisms that had outbreaks with no connection to contaminated distribution system water
as their cause were screened out. Thus, outbreaks occurring due to nosocomial exposure or
attributable to recreational water resulting from post-delivery contamination of drinking water
were not sufficient to place a microorganism on the PCCL unless the drinking water was shown
to be contaminated. A literature search was conducted for citations from 2009-2019 (post CCL 3
data collection) to look for evidence of waterborne diseases for certain microbes that were
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excluded using Criterion 9. There is now evidence of either aerosol transmission from water or
water-linked transmission for several microorganisms that were excluded from the PCCL 3.
EPA also evaluated Criterion 10 to determine if additional microbes not previously considered
endemic to North America should be passed through to the PCCL. The evaluation supported that
Criterion 10 should remain unchanged.
Upon completion of the re-evaluation of the 12 criteria, EPA screened all the microbes in the
CCL 5 Universe with the updated Criterion 9 along with the other criteria through the
exclusionary screening criteria listed and described below.
Criterion 1:
Anaerobes (microorganisms that cannot survive in oxygenated environments)
Anaerobes are microorganisms that cannot survive in the presence of oxygen (Murray et al.,
2007). Due to oxygen toxicity, anaerobes are unable to survive in the ambient water
environment, and they pose a negligible threat to human health from drinking water exposure.
Examples of anaerobes that were screened out based on this screening criterion included
members of the bacterial genera Actinomyces, Bacteroides, Clostridium, Eubacterium,
Fusobacterium, and Prevotella, among others (Murray et al., 2007).
Criterion 2:
Fastidious or obligate intracellular pathogens (environmental survival in water implausible)
Fastidious or obligate intracellular pathogens rely upon their host to provide essential nutrients
and growth factors that are not present in the environment, hence these pathogens cannot survive
outside their hosts. Many fastidious or obligate intracellular pathogens have a narrow
temperature and pH range as a result of host adaptation, and they cannot survive the wide range
of temperatures and pH common in the ambient environment. Examples of fastidious or obligate
intracellular pathogens that were screened out included members of the genera Chlamydophila,
Mycoplasma, and Orientia (Murray et al., 2007). This criterion was applied only to bacteria,
since all viruses are obligate intracellular pathogens (Knipe and Howley, 2007).
Criterion 3:
Pathogens exclusively transmitted by direct or indirect contact with blood or body fluids
(including sexually transmitted diseases)
Some pathogens are transmitted by direct or indirect contact with blood or body fluids, where
fecal-oral transmission or transmission by aerosolized water is not observed (Mandel et al.
2005). Pathogens causing bloodborne diseases and sexually transmitted diseases are highly host
adapted, fastidious, and are usually not present in feces. They do not survive under
environmental conditions, and they are not transmitted by the fecal-oral route, either by direct
contact with feces or indirect contact with contaminated drinking water. Examples of pathogens
transmitted by blood or body fluids include the etiologic agents of gonorrhea and syphilis,
Chlamydia, herpes virus, human immunodeficiency virus, and hepatitis virus B, C, D and G
(Murray et al., 2007).
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Criterion 4:
Pathogens transmitted by vectors
Vectors include arthropods and rodents (Acha and Szyfres, 2001). Pathogens transmitted by
vectors depend upon either insect or other bites, or close contact with rodents, and these
pathogens are not transmitted by contact with drinking water. Mosquitoes, ticks, and fleas are the
most common vectors of arthropod-borne diseases (Krause, et al., 2003). Examples of vector-
borne pathogens include bacteria, viruses, protozoa, and helminths. The genera Babesia,
Borrelia, Brugia, Dirofilaria, Ehrlichia, Leishmania, Plasmodium, Trypanosoma, Rickettsia, and
all arthropod-borne viruses were not moved to the PCCL (Murray et al., 2007).
Criterion 5:
Microflora indigenous to the gastrointestinal tract, skin, and mucous membranes
The human body is colonized with a rich and commensal microflora (Finegold et al., 1983;
Drasar and Barrrow, 1985; Isenberg and D'Amato, 1995). Some microbes that colonize the
human body are transitory, while others are part of the continuing normal flora of the body.
Microbes comprising normal flora have a characteristic ecological niche, but sometimes
conditions permit their access to areas of the body where they may exhibit pathogenic potential
resulting in infection and disease. Infections with normally innocuous microbes are called
opportunistic infections, because of their ability to exploit host conditions that may periodically
predispose them to disease. Exposure to normal flora microbes is continuous throughout life, and
because the populations of normal flora microbes exceed the number of these microbes present
in drinking water by many orders of magnitude, drinking water represents an improbable source
of infection and disease. Examples of normal flora include members of the genera
Capnocytophaga, Corynebacterium, Staphylococcus, Streptococcus, and several yeasts (Murray
et al., 2007).
Criterion 6:
Pathogens transmitted solely by respiratory secretions
Pathogens causing respiratory disease are typically transmitted by direct contact with respiratory
secretions, either by inhalation of aerosols, by direct person-to-person contact, or by contact with
fomites. Drinking water is an unlikely mode of transmission because the number of pathogens in
respiratory secretions and the continuity of exposure to respiratory secretions far exceed
exposure through drinking water (Bennet and Brachman, 2007). Examples of pathogens
transmitted by respiratory secretions include the etiologic agents of tuberculosis, diphtheria,
whooping cough, measles, rubella, and influenza (Knipe and Howley, 2007; Murray et al., 2007;
Mandel et al., 2005).
Criterion 7:
Pathogens whose life cycle is incompatible with drinking water transmission
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Some pathogens, such as helminths, require intermediate hosts to complete their life cycles, and
incidental infection of humans results in an interruption of their life cycle with subsequent death
of the pathogen (Acha and Szyfres, 2001). Some pathogens are adapted to a single route of
transmission such as rabies virus, which is transmitted by animal bites. Some pathogens are
specifically adapted to survive in a unique ecological niche, and they cannot withstand any
alteration of conditions to which they are adapted. For example, rabies virus, Dientamoeba
fragilis, Enterobius vermicularis, and many helminths remain in the microbial CCL 5 Universe
and were not considered for the PCCL based on this criterion (Murray et al., 2007; Ashford and
Crewe, 2003).
Criterion 8:
Pathogens where drinking water-related transmission is not implicated
Some pathogens cause such rare occurrences of disease that only a few cases have been reported
in medical literature, and these rare occurrences of disease present limited opportunity to protect
public health from drinking water exposure (Acha and Szyfres, 2001; Knipe and Howley, 2007;
Murray et al., 2007; Mandel et al., 2005). Some pathogens are associated with direct
transmission from animals to humans, or other transmission routes that do not involve drinking
water (Acha and Szyfres, 2001; Krause et al., 2003; Howard, 2003). Examples of pathogens that
remained in the microbial CCL 5 Universe after application of this criterion are Leptospira,
Listeria, Nosema, and the etiologic agents of several zoonotic virus infections (Knipe and
Howley, 2007; Murray et al., 2007).
Criterion 9:
Natural habitat is in the environment without epidemiological evidence of drinking water-related
disease and without evidence of drinking water-related nosocomial infection7.
The environment is teeming with microorganisms, at varying concentrations, and humans are in
constant contact with these microorganisms throughout their lives (Bennett and Brachman, 2007;
Isenberg and D'Amato, 1995). Microorganisms naturally present in the environment are not
considered a threat to public health as a result of drinking water exposure unless epidemiological
evidence demonstrates a potential for water-related disease. Thus, outbreaks occurring in
attributable to recreational water resulting from post-delivery contamination of drinking water
are not sufficient to place a microorganism on the PCCL unless the drinking water system was
shown to be contaminated (Wenzel, 2003). Gordonia, Nocardia, and most fungi were excluded
from the PCCL based on this criterion (Murray et al., 2007; Howard, 2003).
Criterion 10:
Pathogens not endemic to North America
1 Bolded language indicates CCL 5 update to previous CCL 3 and CCL 4 Criterion 9
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Some pathogens have an exclusive geographical distribution, and they are not naturally present
in North America (Ashford and Crewe, 2003; Murray et al., 2007; Palmer et al., 1998). Only
pathogens endemic to North America have the potential to contaminate drinking water in the
U.S. Several helminths such as most Diphyllobothrium, and Paragonimus species and several
viruses such as the hemorrhagic fever viruses and poxviruses would remain in the microbial CCL
universe after application of this criterion.
Criterion 11:
A genus and species or serotype may be chosen to represent a group of closely related organisms
EPA has chosen a few pathogens to represent a group based on all serotypes within a group
sharing essential biological properties in common with the group. Designation of a representative
group provides adequate protection of public health under the PCCL (Murray et al., 2007).
Pathogens that represent other pathogens in their group are the following: Arcobacter butzleri,
Campylobacter jejuni, Helicobacter pylori, Legionella pneumophila, Salmonella enterica,
Shigella sonnei, Adenovirus, Astrovirus, Enterovirus, Microsporidia, and Entamoeba histolytica.
For example, human adenovirus A, human adenovirus B, human adenovirus C, human
adenovirus D, human adenovirus E, and human adenovirus F were listed as a group under
adenovirus.
Criterion 12:
Current taxonomy does not support the classification listed by Taylor et al. (2001).
Microbial taxonomy and nomenclature are a dynamic science, and taxonomic classifications are
constantly changing. Original taxonomic classifications were based upon the phenotypic
characteristics of microorganisms, but these classifications are being revised as genotypic
information becomes available. New genera are formed, sometimes prematurely, based upon
partial genomic data, and taxonomists do not always agree with proposed changes. Under this
criterion, the genera Fluoribacter and Tatlockia were combined with the genus Legionella for
screening purposes (Murray et al., 2007).
Section 4.1 Application of Screening Criteria to the Microbial CCL Universe
As the pathogens are screened through the 12 criteria, a pathogen needs to only to meet one
criterion to be excluded from moving on to the PCCL. Some pathogens may meet multiple
criteria, however, because the pathogens are evaluated through the exclusionary screening
criteria sequentially, the criteria that the pathogen meets first will exclude the pathogen and the
pathogen will not be further evaluated through the rest of the criteria. For example, if a pathogen
could be excluded based on meeting Criteria 3 and 7, the pathogen will be screened out based on
meeting Criterion 3 and not further evaluated to see if any other criterion is met. The pathogen
will be documented as meeting just that one criterion.
All pathogens that pass through all screening criteria are moved to the PCCL. Bacteria, viruses,
protozoa, helminths, and fungi in the CCL 5 Universe are shown screened individually through
the CCL exclusionary screening criteria in Appendix B. Each table identifies the pathogens in
each category and indicates which screening criteria were applied to remove pathogens from
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further consideration in the CCL process. Those pathogens not excluded by at least 1 of the 10
screening criteria or consolidated under Criteria 11 or 12 pass on to the PCCL. Table 2
summarized the number of microbes in the CCL 5 Universe, the number of microbes screened
out by each criterion, and the resulting number of microbes passed on to the PCCL.
Table 2. Summary of Screening Microbial CCL 5 Universe
Pathogen
Class
Total
Number of Microbes Excluded by Each Screening Criterion
Pathogens
Screened Out
On
PCCL
1
2
3
4
5
6
7
8
9
10
11
12
Bacteria1
545
121
16
10
38
121
7
0
29
150
2
28
5
527
18
Viruses
225
0
0
29
104
0
20
1
20
0
36
8
0
218
7
Protozoa2
66
0
0
1
29
3
0
4
7
7
0
6
0
59
7
Helminths
286
0
0
0
25
0
0
105
0
0
156
0
0
286
0
Fungi
313
0
0
0
0
12
3
0
0
295
0
0
0
310
3
Total
1,435
121
16
40
196
136
30
110
56
452
194
42
5
1,400
35
1	NTM were included on the PCCL as a group as well as individual Mycobacterium species.
2	Cryptosporidium and Giardia (protozoa) are considered to be regulated by the Long-Term Surface Water
Treatment Rule (LT-2); even though counted in the microbial universe, they were not evaluated for screening.
Based upon this screening exercise conducted on 1,435 pathogens in the microbial CCL universe
1,400 pathogens were excluded from consideration while 35 pathogens passed on to the PCCL.
Thirteen of the 16 nominated microbial contaminants were listed on the PCCL 5. Appendix A
details which nominated microbes were included on the PCCL 5.
The modification made to Criterion 9 expanded the PCCL to include nosocomial infections
where drinking water was implicated. This resulted in the addition of five bacteria (Aeromonas
hydrophila, Acinetobacter baumannii, Comamonas testosteroni, Pseudomonas aerugionosa, and
Mycobacterium abscessus) to the PCCL 5 for further evaluation of the CCL process. The
specific screening decisions and references are presented in Appendix B.
Chapter 5.0 Determining the Draft Microbial CCL 5
EPA used scoring protocols to rank pathogens on the PCCL to produce a Draft CCL. This
section briefly describes the process developed under CCL 3 and explains the elements included
in the microbial Contaminant Information Sheets (CISs). EPA derived the CCL 3 scoring process
in part from recommendations of the NRC and an expert workgroup established by the NDWAC,
and two external workshops (USEPA, 2009c). EPA made two minor modifications to the CCL 3
microbial scoring process regarding data sources that were used to select microbial contaminants
from the PCCL for the CCL 5 as described below. For a more detailed discussion on the CCL 3
scoring process and rationale used to develop the scoring process see Final Contaminant
Candidate List 3 Microbes: PCCL to CCL Process (USEPA, 2009c).
Microbes were evaluated for their occurrence in water and their ability to cause adverse health
effects in humans. Pathogens on the PCCL were scored for placement on the CCL using a
scoring system to assign a numerical value to each pathogen and rank the pathogens based upon
both occurrence (waterborne disease outbreaks (WBDOs) and occurrence in water) and health
effects. Those microbes receiving high scores were considered for placement on the CCL.
Each microbe was scored using three scoring protocols, one protocol each for WBDOs,
occurrence in water, and health effects (both for general and sensitive populations). Data
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collected during CCL 3 and CCL 4 were not removed from consideration and remain on the
contaminant information sheets presented in Appendix E. If found, new data were added and
scores were adjusted as necessary. EPA compiled data sources identified from the CCL 3 and the
CCL 4, along with data sources recommended by the CCL 5 EPA workgroup and subject matter
experts. EPA accessed each potential data source and evaluated them using the following
assessment factors: relevance, completeness, redundancy, and retrievability.
Combining WBDO information and occurrence information allowed EPA to consider: 1)
pathogens that are tracked by public health surveillance programs (i.e., CDC's National
Outbreak Reporting System (NORS) (CDC, 2020); and 2) pathogens that are not yet tracked by
public health surveillance programs but for which occurrence information is available (i.e.,
emerging pathogens). To determine the WBDO score for CCL 3 and CCL 4, EPA utilized
outbreak information from CDC's Morbidity and Mortality Weekly Report (MMWR) (CDC,
2017). For the CCL 5, EPA also included the CDC's NORS data for outbreak information (note,
NORS was launched in 2009). CCL 3 and CCL 4 examined outbreaks that occurred between
1990 and 2004. For CCL 5, EPA determined outbreaks that occurred in and after 2009 to capture
the microbes of concern. The cutoff date was updated to reflect the impact of the Long Term 2
Enhanced Surface Water Treatment Rule (71 FR 654, USEPA, 2006a), and the Ground Water
Rule (GWR) (71 FR 65573, USEPA, 2006b), both promulgated in 2006 with three years to
comply. WBDOs were scored on a five-level hierarchy ranging from never caused a WBDO
(score of 1) to two or more documented WDBOs in the U.S. (score of 5) in the timeframe
specified (Table 3).
Table 3. Waterborne Disease Outbreak Scoring Protocol
Category
Score
Has caused multiple (2 or more) documented WBDOs in the U.S. reported by CDC
between 2009-2017
5
Has caused at least one documented WBDOs in U.S. reported by CDC between 2009-
2017
4
Has caused documented WBDOs at any time in the U.S.
3
Has caused documented WBDO in countries other than the U.S.
2
Has never caused WBDOs in any country, but has been epidemiologically associated with
water related disease
1
The second attribute of the scoring process evaluates the occurrence of a pathogen in drinking
water and source water. Because water-related illness may also occur in the absence of
recognized outbreaks, EPA scored the occurrence (direct detection) of microbes using cultural,
immunochemical, or molecular detection of pathogens in drinking water under the Occurrence
Protocol Occurrence characterizes pathogen introduction, survival, and distribution in the
environment. Occurrence implies that pathogens are present in water and that they may be
capable of surviving and moving through water to cause illness in persons exposed to drinking
water by ingestion, inhalation, or dermal contact.
Pathogen occurrence is considered broadly to include treated drinking water, and all waters using
a drinking water source for recreational purposes, ground water, and surface water bodies. This
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attribute does not characterize the extent to which a pathogen's occurrence poses a public health
threat from drinking water exposure. Occurrence was scored on a three-level hierarchy ranging
from not detected in the U.S. (score of 1) to detected in drinking water in the U.S. (score of 3)
(Table 4).
Table 4. Occurrence Scoring Protocol
Category
Score
Detected in drinking water in the U.S.
3
Detected in source water in the U.S.
2
Not detected in the U.S.
1
The health effects scoring protocol evaluated the extent of illness produced in humans from
drinking water. The severity of disease manifestations produced by a pathogen was evaluated
across a range of potential endpoints. Pathogens may produce a range of illness from
asymptomatic infection to severe illness progressing rapidly to death. The seven-level hierarchy
developed for this protocol begins with mild, self-limiting illness (score of 1) and progresses to
death (score of 7) (Table 5). The protocol scored the representative or more common clinical
presentation for the specific pathogen for the population category under consideration, rather
than the extremes. These scores were based on data from recent clinical microbiology manuals
(Carroll et al., 2019).
To obtain a representative characterization of health effects in all populations, EPA evaluated
separately the general population and four sensitive populations (children, elderly, pregnant
woman, and persons with chronic diseases) as to the common clinical presentation of illness for
that population. EPA added the general population score to the highest score among the four
sensitive populations for an overall health effects score. The resulting score acknowledged that
sensitive populations have increased risk for waterborne diseases. Table 6 shows the health
effects scoring protocol template for general and sensitive populations.
Table 5. Health Effects Scoring Protocol for Pathogens
Outcome Category
Score
Manifestation in Population Class
General
Population
Children/
Infants
Elderly
Pregnant
Women
Chronic
Disease
Does the organism cause
significant mortality (> 1/1,000
cases)?
7





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Outcome Category
Score
Manifestation in Population Class
General
Population
Children/
Infants
Elderly
Pregnant
Women
Chronic
Disease
Does the organism cause
pneumonia, meningitis, hepatitis,
encephalitis, endocarditis, cancer, or
other severe manifestations of
illness necessitating long term
hospitalization (> week)?
6





Does the illness result in long
term or permanent dysfunction or
disability (i.e., sequelae)?
5





Does the illness require short term
hospitalization (< week)?
4





Does the illness require physician
intervention?
3





Is the illness self-limiting within
72 hours (without requiring
medical intervention)?
2





Does the illness result in mild
symptoms with minimal or no
impact on daily activities?
1





EPA evaluated the possibility of using antibiotic susceptibility as part of the health effects
scoring protocol, and/or antibiotic resistance as scoring consideration for microbes as part of the
review process for the development of CCL 5. Each microbe on the CCL was evaluated for its
specific antibiotic resistance and mortality rate. The results of the literature search showed that
antibiotic resistance cannot be used as a scoring consideration for microbes in the CCL process
at this time. There was too much variability among individual microbes and across all microbial
groups to determine a criterion that would effectively apply to the universe of microbes.
The highest of the individual WBDO score or occurrence score was added to the normalized
health effects score to produce a composite pathogen score. Although the composite score was
not shown on the CISs, the scoring summary table at the top left corner of each CIS shows the
values used to calculate the composite score. The formula for the pathogen score was as follows:
General Population
Pathogen _ Highest Score	Score + Highest
Total Score between WBDO +	Sensitive
and Occurrence	Population

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EPA normalized the health effects score so that occurrence (or WBDO) and health effects had
equal value in determining the ranking of the CCL. The highest possible score for WBDO or
occurrence was 5 and the highest possible health effect score was 14. To normalize this
imbalance in the calculated total score, the agency multiplied the health effects score by 5/14. An
example of this calculation is shown in Appendix E.
The CISs that had been developed for CCL 3 were updated for each CCL 5 contaminant and new
CIS sheets were developed for those microbes not previously included. The references in the
CISs were also updated to reflect information that became available after EPA published the
final CCL 3 and CCL 4. Scores were based on new and previous data available for each CCL 5
contaminant. The CIS tables present the final scores for each of the data types under
consideration and a brief description of the data used to assign those scores with their respective
references.
Elements of each CIS include:
Scoring Summary - shows the scores used to calculate the final composite score for each
microbial contaminant which included the highest score between the WBDO and occurrence,
health effects score for the general population, and the highest health effects score of the
sensitive populations.
Data Table - shows the categories for each potential score, the scoring data, if applicable, and
reference(s) used to support a score. The highest-ranking score for each of the three scoring
categories is shown in bold font. The WBDOs scoring results are presented first, followed by the
occurrence results and the health effects.
References - presents the full references for the data presented in the table.
For more information on the microbes scoring process and the CISs, see Appendix E.
Section 5.1 Application of Scoring Protocol to the PCCL and Selection of the
Draft CCL 5 Microbes from the PCCL
The 35 PCCL pathogens were ranked according to an equal weighting of their summed scores
for normalized health effects and the higher of the individual scores for WBDO and occurrence
in drinking water. EPA determined that this ranking indicated the most important pathogens to
consider for the Draft CCL 5. To determine which of the 35 PCCL pathogens should be the
highest priority for EPA's drinking water program and included on the draft CCL 5, EPA
considered scientific factors and the opportunity to advance public health protection. These
factors included the PCCL scores for WBDO, occurrence, and health effects; comments and
recommendations from the various expert panels including EPA's internal workgroup and
CDC's subject matter experts; and the greatest opportunity to advance public health protection.
After consideration of these factors, EPA listed the 12 highest-ranked pathogens in the Draft
CCL 5 (Table 6). A comparison to previous CCLs can be found in Appendix D and scores can be
found in Appendix E.
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Table 6. The Draft Microbial CCL 5
Microbial Name
Microbial Class
Adenovirus
Virus
Caliciviruses
Virus
Campylobacter jejuni
Bacteria
Escherichia coli (0157)
Bacteria
Enteroviruses
Virus
Helicobacter pylori
Bacteria
Legionella pneumophila
Bacteria
Mycobacterium abcessus
Bacteria
Mycobacterium avium
Bacteria
Naegleria fowleri
Protozoa
Pseudomonas aeruginosa
Bacteria
Shigella sonnei
Bacteria
The selection of microbial pathogens for the Draft CCL 5 was similar to the method used for
CCL 3 with the exception that there were no "natural" breaks in the pathogen's scores, meaning
where there were no large numerical gaps in the PCCL scores (as was for the previous PCCL 3
microbes) for the Draft CCL 5 listing.
EPA determined that the overall rankings strongly reflected the best available scientific data and
high-quality expert input employed in the CCL selection process, and therefore should be
important factors in helping to identify the top priority pathogens for the Draft CCL 5.
Section 5.2 Microbial Organisms Covered by Existing Regulations
According to Section 1412(b)(1) of the 1996 SDWA Amendments, EPA must select CCL
contaminants that "at the time of publication, are not subject to any proposed or promulgated
national primary drinking water regulation." In promulgating regulations for contaminants in
drinking water, EPA can set either a legal limit (maximum contaminant level or MCL) and
require monitoring for the contaminant in drinking water or, for those contaminants that are
difficult to measure, EPA can establish a treatment technique requirement. The Surface Water
Treatment Rule (54 FR 27486, USEPA, 1989a) established maximum contaminant level goals
(MCLGs) of zero for Legionella, Giardia, and viruses because any amount of exposure to these
contaminants represents some public health risk. Since measuring disease-causing microbes in
drinking water was not considered to be feasible at the time of the development of the SWTR,
EPA established treatment technique requirements for these contaminants. The purpose of
subsequent treatment technique requirements (Interim Enhanced Surface Water Treatment Rule
(63 FR 69478, USEPA 1998a), Long Term 1 Surface Water Treatment Rule (67 FR 1813,
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USEPA, 2002a), and the Long Term 2 Surface Water Treatment Rule (71 FR 654, USEPA,
2006a), which included an MCLG of zero for Cryptosporidium, is to reduce disease incidence
associated with Cryptosporidium and other pathogenic microorganisms in drinking water. These
rules apply to all public water systems that use surface water or ground water under the direct
influence of surface water.
The Ground Water Rule (GWR) (71 FR 65573; USEPA, 2006c) set treatment technique
requirements to control for viruses (and pathogenic bacteria) because it was not feasible to
monitor for viruses (or pathogenic bacteria) in drinking water. Under the GWR, if systems detect
total coliforms in the distribution system, they are required to monitor for a fecal indicator (E.
coli, coliphage, or enterococci) in the source water. If fecal contamination is found in the source
water, the system must take remedial action to address contamination.
EPA considered Legionella and specific viruses in CCL even though they are regulated under the
Surface Water Treatment Rules (SWTR)). In this draft document, EPA proposes to specifically
list Legionella pneumophila, the primary pathogenic bacterium, on the Draft CCL 5 because it
has been identified in numerous WBDOs and is the most common cause of reported drinking
water-associated outbreaks in the U.S. Furthermore, reported Legionnaires' disease has increased
10-fold in the last 20 years (CDC, 2020b). A recent National Academies of Science report
estimated 52,000-70,000 cases of Legionnaires' disease annually, with 3-30% mortality
(NASEM, 2020).
EPA is also proposing to list certain viruses on the Draft CCL 5. Viruses include a wide range of
taxa and different viral taxa have been implicated in various WBDOs for which EPA did not
have dose response or treatment data when promulgating its treatment technique requirements.
Even though there are MCLGs for Legionella and viruses, and these contaminants are subject to
limitations as a class through the treatment techniques under the Surface Water Treatment Rules,
there are no monitoring, treatment, or notification requirements within those NPDWRs that are
specific to Legionella pneumophila or the specific viruses listed on CCL5 (although systems may
use coliphage for source water monitoring for ground water systems). Therefore, EPA considers
Legionella pneumophila and the specific viruses listed on CCL5 to be unregulated contaminants
for purposes of eligibility for the CCL. Additionally, EPA received public nomination for viruses
and Legionella for the Draft CCL 5, with Legionella pneumophila receiving the highest number
of nominations.
Section 5.3 Listing Outcomes for the Nominated Microbial Contaminants
All the microbes nominated for the CCL 5, except for Salmonella enterica, Aeromonas
hydrophila, and Hepatitis A, were listed on the Draft CCL 5. Salmonella enterica, Aeromonas
hydrophila and Hepatitis A did not produce sufficient composite scores to place them on the
Draft CCL 5. Although Salmonella enterica and Hepatitis A have numerous WBDOs, the route
of exposure was not explicitly waterborne. Non-tuberculous Mycobacterium (NTM) and
Mycobacterium (species broadly found in drinking water) were nominated for the CCL 5 and
were not listed on the Draft CCL 5 as a group; instead, they were listed as Mycobacterium avium
and Mycobacterium abscessus, two species of NTM that are found in drinking water.
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Chapter 6.0 Microbial Data Sources for the Draft CCL 5
Multiple data sources were used to gather the information for the development of the Draft CCL
5. The data sources used were evaluated by EPA to ensure they were authoritative and
appropriate. Under the CCL 3, for microbes, the universe list was defined as all known human
pathogens using the compilation of Taylor et al. (2001) as a practical starting point. This list was
supplemented with literature searches and nominations from the public. The Draft CCL 5 used
the previous universes from the CCL 3 and the CCL 4 and updated with literature searches of
peer reviewed sources and nominations.
The hierarchy of text-based resource materials begins with recently compiled authoritative
reference books such as The Manual of Clinical Microbiology (MCM), 9th Edition, and Field's
Virology, 5th Edition, both published in 2007. Both of these two-volume reference books have
become established as the leading authoritative reference sources in their respective fields. These
references have evolved through multiple editions and both publications are considered reference
standards to the scientific community for their scope and depth of coverage. They were edited by
world-recognized authorities, and chapters were written by an international team of subject
experts. The parasites of Homo sapiens, second edition, is a comprehensive source for
information on helminths. These and other compiled sources listed in the reference list in Section
7 provided the information for screening the pathogens in the microbial CCL 3 Universe. The
12th edition of the MCM was published in 2019 and was consulted for CCL 5 (Carroll et al.,
2019).
Web references were used to find information for screening rarely encountered viruses, protozoa,
and fungi, primarily for information related to Criterion 9, "natural habitat in the environment,"
or Criterion 10, "pathogen not endemic to North America". Selected Web references were
evaluated to ensure that the site sponsors possessed the expertise to authoritatively address the
issues of habitat and geographical distribution of the pathogen in question, and that the
information was presented objectively and reviewed by members of the scientific community.
Emphasis was placed upon websites sponsored and supported by government agencies or
academic institutions, with evidence of peer review, such as an editorial board and/or expert
contributors and reviewers.
Appendix B tabulates the screening decisions for the CCL 5 Microbial Universe and shows the
screening reference used to support the decision. Page ranges cited and Web addresses/links
provided are as narrow and specific as they can be, to identify the information related to the
screening criterion used. Many pathogens could be screened by several criteria, however only
one criterion is noted in the tabulation. Understanding the complete context and rationale for a
screening decision often requires a review of the complete chapter from which the specified page
range was taken.
The MCM (Carroll et al., 2019) was one of the main sources of information used to inform the
scoring of the PCCL microbes for Draft CCL 5. EPA also conducted a literature search covering
the time period between CCL 4 and CCL 5 (2016-2019). The literature search focused on health
effects and occurrence of the nominated microbial contaminants in water.
For CCL 5 WBDOs, the primary source for scoring data was outbreak information pulled from
CDC's NORS dashboard. Outbreak information was available from 2009-2017. NORS data was
used as an alternative to CDC's Morbidity and Mortality Weekly Reports (MMWR) for more
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recent outbreak data (as of August 2019, the most recent MMWR report was published in 2017).
Appendix F contains additional detail on data sources.
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Ashford, R.W. and W. Crewe. 2003. The parasites of Homo sapiens: An annotated checklist of
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1998.
United State Environmental Protection Agency (USEPA). 2002. Long Term 1 Enhanced Surface
Water Treatment Rule; Final Rule. Federal Register. Vol. 67, No. 9, p. 1813. January
14, 2002.
United States Environmental Protection Agency (USEPA). 2005. Drinking water Contaminant
Candidate List 2; Final Notice. Federal Register. Vol. 70, No.36, p.9071, February 24,
2005.
United States Environmental Protection Agency (USEPA) 2006a. Long Term 2 Enhanced
Surface Water Treatment Rule; Final Rule. Federal Register. Vol. 71, No. 3, p. 654,
January 5, 2006.
United State Environmental Protection Agency (USEPA). 2006b. National Primary Drinking
Water Regulations: Ground Water Rule; Final Rule. Federal Register. Vol. 71, No. 216,
p.65573- 65660. November 8, 2006.
United States Environmental Protection Agency (USEPA). 2009a. Drinking Water Contaminant
Candidate List 3-Final Notice. Federal Register. Vol. 74, No. 194, p. 51850 October 18,
2009.
United States Environmental Protection Agency (USEPA). 2009b. Final Contaminant Candidate
List 3 Microbes: Screening to the PCCL. EPA 815-R-09-0005. August 2009.
United States Environmental Protection Agency (USEPA). 2009c. Final Contaminant Candidate
List 3 Microbes: PCCL to CCL Process. EPA 815-R-09-009. August 2009.
Page 20 of 21

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EPA-OGWDW Technical Support Document for the Draft Fifth Contaminant Candidate List EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
United States Environmental Protection Agency (USEPA). 2016a. Drinking Water Contaminant
Candidate List 4—Final. Federal Register. Vol. 81, No. 222, p. 81099 November 17,
2016.
United States Environmental Protection Agency (USEPA). 2016b. Screening Document for the
Fourth Preliminary Contaminant Candidate List 4 (PCCL 4). EPA 815-R-16-008.
November, 2016.
United States Environmental Protection Agency (USEPA). 2016c. Response to the Science
Advisory Board's Recommendations on the Draft Fourth Contaminant Candidate List
(CCL 4). EPA 815-R-16-005. November, 2016.
United States Environmental Protection Agency (USEPA). 2018. Request for Nominations of
Drinking Water Contaminants for the Fifth Contaminant Candidate List. Federal
Register. Vol. 83 No. 194 p. 50364, October 5, 2018.
Wenzel, R.P. (ed.). 2003. Prevention and control of nosocomial infections. Lippincott Williams
& Wilkins, Philadelphia, PA.
Page 21 of 21

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EPA-OGWDW
Technical Support Document for the Draft Fifth Contaminant Candidate List
(CCL 5)-Microbiai Contaminants
EPA 815-R-21-007
July 2021
Appendix A: List of CCL 5 Microbial Nominations
Common Name
Nominators)
Health Effects
Information
Provided with
Nomination
Occurrence
Information
Provided with
Nomination
Additional
Information Provided
with Nomination
CCL
Universe
PCCL5
Draft
CCL 5
Aeromonas hydrophila
C.J. Volk
No information
provided
No information
provided
No information
provided
X
X

Adenovirus*
G. Tracy Mehan, AWWA
No information
provided
No information
provided
No information
provided
X
X
X
Caliciviruses*
G. Tracy Mehan, AWWA
No information
provided
No information
provided
No information
provided
X
X
X
Campylobacter jejuni *
C.J. Volk
No information
provided
No information
provided
No information
provided
X
X
X
G. Tracy Mehan, AWWA
No information
provided
No information
provided
No information
provided
CCL 4 contaminants (12
microbes)*
Mae Wu and Anna Reade,
NRDC
Known public health
threats.
No information
provided
No information
provided
X
X

Enterovirus*
G. Tracy Mehan, AWWA
No information
provided
No information
provided
No information
provided
X
X
X
Escherichia coli (0157)*
C.J. Volk
No information
provided
No information
provided
No information
provided
X
X
X
G. Tracy Mehan, AWWA
No information
provided
No information
provided
No information
provided
Helicobacter pylori *
C.J. Volk
No information
provided
No information
provided
No information
provided
X
X
X
G. Tracy Mehan, AWWA
No information
provided
No information
provided
No information
provided
Hepatitis A virus*
G. Tracy Mehan, AWWA
No information
provided
No information
provided
No information
provided
X
X

Legionella pneumophila m
Anonymous
No information
provided
Typically found in
biofilms
No information
provided
X
X
X
Paul McDermott, PJM-HS
Consulting Ltd
No information
provided
No information
provided
No information
provided
Jason Dobranic, EMSL
Analytical, Inc.
No information
provided
No information
provided
No information
provided
Matthew Freije, hcinfo.com
No information
provided
No information
provided
No information
provided
Anonymous
No information
provided
No information
provided
No information
provided
Cam Pham, Enthalpy
Analytical, LLC
No information
provided
No information
provided
No information
provided
W.E. Pearson II, BPEARSON
Consulting LLC
No information
provided
No information
provided
No information
provided
C.J. Volk
No information
provided
No information
provided
No information
provided
Page A1

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EPA-OGWDW
Technical Support Document for the Draft Fifth Contaminant Candidate List
(CCL 5)-Microbiai Contaminants
EPA 815-R-21-007
July 2021
Common Name
Nominators)
Health Effects
Information
Provided with
Nomination
Occurrence
Information
Provided with
Nomination
Additional
Information Provided
with Nomination
CCL
Universe
PCCL5
Draft
CCL 5

Sharon Sweeney, Central
Arkansas Water
No information
provided
No information
provided
No information
provided



Philippe Hartemann
No information
provided
No information
provided
No information
provided
Anonymous
No information
provided
No information
provided
No information
provided
Patsy Root, IDEXX
Laboratories, Inc.
No information
provided
No information
provided
No information
provided
Paul R. Easley, Central
Arkansas Water
No information
provided
No information
provided
No information
provided
Stan Hazan, NSF
According to the
CDC, reported cases
of
legionella increased
286% during the time
period 2000-2014.
The bacterium is
known to propagate in
premise plumbing and
other mechanical
systems. This places
the elderly and
individuals with
compromised immune
systems at risk when
water contaminated
with the bacteria
aerosolizes and
disperses.
No information
provided
Robert Bohannon, City of
Moline, Illinois
No information
provided
No information
provided
No information
provided
Mae Wu and Anna Reade,
NRDC
No information
provided
No information
provided
No information
provided
G. Tracy Mehan, AWWA
No information
provided
No information
provided
No information
provided
Jennifer Clancy, ESPRI
There are 8,000 to
18,000 people
hospitalized with LD
each year and
estimates of ten times
that many cases that
are unrecognized.
CDC estimates that it
costs $434,000,000
to treat LD in the US
annually; LD is now
the #1 cause of
WBDOs in the US
(CDC, 2015).
Based on CDC
outbreak data, LD is
responsible for 66% of
waterborne disease
outbreaks (WBDO)
attributable to the
distribution system.
No information
provided
Mycobacterium avium *
C.J. Volk
No information
provided
No information
provided
No information
provided
X
X
X
Page A2

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EPA-OGWDW
Technical Support Document for the Draft Fifth Contaminant Candidate List
(CCL 5)-Microbiai Contaminants
EPA 815-R-21-007
July 2021
Common Name
Nominators)
Health Effects
Information
Provided with
Nomination
Occurrence
Information
Provided with
Nomination
Additional
Information Provided
with Nomination
CCL
Universe
PCCL5
Draft
CCL 5

G. Tracy Mehan, AWWA
No information
provided
No information
provided
No information
provided



Mycobacterium species
predominantly found in finished
drinking water
Anonymous
No information
provided
Typically found in
biofilms
No information
provided
X


Naegleria fowleri *
G. Tracy Mehan, AWWA
No information
provided
No information
provided
No information
provided
X
X

Nontuberculous mycobacteria
(NTM)
Jennifer Clancy, ESPRI
Pseudomonas
aeruginosa which is
the most common
cause of hospital-
acquired pneumonia
and nontuberculous
mycobacteria (NTM),
an increasing cause
of lung infections in
both
immunocompromise
d and otherwise heath
individuals.
In the chloraminated
system, NTM
colonized the pipe
loops by the first
sampling round and
continued to be
observed in the bulk
water of all pipe
materials, with greater
numbers recovered
consistently from the
high use pipe loops.
No information
provided
X
X

Pseudomonas aeruginosa
Anonymous

Typically found in
biofilms

X
X
X
C.J. Volk
No information
provided
No information
provided
No information
provided
Jennifer Clancy, ESPRI
Pseudomonas
aeruginosa which is
the most common
cause of hospital-
acquired pneumonia
and nontuberculous
mycobacteria (NTM),
an increasing cause
of lung infections in
both
immunocompromise
d and otherwise heath
individuals.
No information
provided
No information
provided
Salmonella enterica*
C.J. Volk
No information
provided
No information
provided
No information
provided
X
X

G. Tracy Mehan, AWWA
No information
provided
No information
provided
No information
provided
Shigella sonnei *
C.J. Volk
No information
provided
No information
provided
No information
provided
X
X
X
G. Tracy Mehan, AWWA
No information
provided
No information
provided
No information
provided
*CCL 4 microbes
Page A3

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EPA-OGWDW
Technical Support Document for the Draft Fifth Contaminant Candidate List
(CCL 5)-Microbiai Contaminants
EPA 815-R-21-007
July 2021
Appendix B: The CCL 5 Microbial Universe
The CCL 5 Microbial Universe
Table B-l presents the CCL 5 Universe and the exclusion criteria used to keep a microbe in the universe. The source used for the
exclusion criteria is listed in the reference column. Those microbes for which a source could not found to support exclusion moved
forward to the PCCL.
The CCL 5 Microbes Exclusion Screening Criteria:
1.	All anaerobes.
2.	Obligate intracellular fastidious pathogens.
3.	Transmitted by contact with blood or body fluids.
4.	Transmitted by vectors.
5.	Indigenous to the gastrointestinal tract, skin and mucous membranes.
6.	Transmitted solely by respiratory secretions.
7.	Life cycle incompatible with drinking water transmission.
8.	Drinking water-related transmission is not implicated.
9.	Natural habitat is in the environment without epidemiological evidence of drinking water-related disease and without evidence of drinking
water-related nosocomial infection.
10.	Not endemic to North America.
11.	Represented by a pathogen for the entire genus or species (that are closely related).
12.	Current taxonomy changed from taxonomy used in Universe.
Table B-l: The CCL 5 Microbial Universe and Exclusion Criteria
Bacteria
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Reference
Abiotrophies defectiva




X







MCM-H* Edition
Achromobacter piechaudii






l

X




MCM-H^ Edition
Page B1

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EPA-OGWDW
Technical
Support Document for the Draft Fifth Contaminant Candidate List
(CCL 5)-Microbiai Contaminants
EPA 815-R-21-007
July 2021
Bacteria
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Reference
Achromobacter
xylosoxidans








X




MCM-H* Edition
Acidaminococcus
fermentans
X












MCM-H* Edition
Acinetobacter baumannii












Acinetobacter baumannii

Acinetobacter
calcoaceticus








X




MCM-H* Edition
Acinetobacter
haemolyticus








X




MCM-H* Edition
Acinetobacter johnsonii








X




MCM-H^ Edition
Acinetobacter junii








X




MCM-H* Edition
Acinetobacter hvoffii








X




MCM-H* Edition
Acinetobacter
radioresistens








X




MCM-H* Edition
Actinobacillus equuli


X










MCM-H* Edition
Actinobacillus hominis


X










MCM-H* Edition
Actinobacillus lignieresii


X










MCM-H* Edition
Actinobacillus
pleuropneumoniae


X










MCM-H* Edition
Actinobacillus suis


X










MCM-H* Edition
Actinobacillus ureae




X








MCM-H* Edition
Actinomyces georgiae
X












MCM-H^ Edition
Actinomyces gerencseriae
X












MCM-H^ Edition
Actinomyces israelii
X












MCM-H^ Edition
Actinomyces meyeri
X












MCM-H^ Edition
Actinomyces naeslundii
X





IK






MCM-H* Edition
Actinomyces neuii
X












MCM-H* Edition
Actinomyces odontolyticus
X












MCM-H* Edition
Page B2

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EPA-OGWDW
Technical
Support Document for the Draft Fifth Contaminant Candidate List
(CCL 5)-Microbiai Contaminants
EPA 815-R-21-007
July 2021
Bacteria
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Reference
Actinomyces radingae
X












MCM-H* Edition
Actinomyces turicensis
X












MCM-H* Edition
Aerococcus viridans








X




MCM-H^ Edition
Aeromonas caviae








X




MCM-H^ Edition
Aeromonas hydrophila












Aeromonas hydrophila

Aeromonas sobria








X




MCM-H* Edition
Aeromonas veronii








X




MCM-H* Edition
Aggregati bacter
actinomycetemcomitans



X








MCM-H* Edition
Aggregati bacter
aphrophilus




X








MCM-H* Edition
Alcaligenes odorans




X








MCM-H* Edition
Alloprevotella tannerae
X












MCM-H* Edition
Alloscardovia omnicolens




X








Brown, M et al., 2016
Amycolatopsis orientalis








X




MCM-H* Edition
Anaplasma
phagocy tophi lum



X









MCM-H* Edition
Arcanobacterium
heamolyticum




X

l






MCM-H^ Edition
Arcobacter butzleri






(§j





Arcobacter butzleri

Arcobacter cryaerophilus






i



X


MCM-H* Edition
Bacillus anthracis






pi

X




MCM-H^ Edition
Bacillus cereus






m

X




MCM-H^ Edition
Bacillus circulans






11

X




MCM-H* Edition
Bacillus coagulans






lii

X




MCM-H* Edition
Bacillus licheniformis






IK

X




MCM-H* Edition
Bacillus mycoides






Ml

X




MCM-H* Edition
Bacillus pumilus






1

X




MCM-H* Edition
Bacillus subtilis






ii

X




MCM-H* Edition
Page B3

-------
EPA-OGWDW
Technical Support Document for the Draft Fifth Contaminant Candidate List
(CCL 5)-Microbiai Contaminants
EPA 815-R-21-007
July 2021
Bacteria
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Reference
Bacillus thuringiensis








X




MCM-H* Edition
Bacteroides caccae
X












MCM-H* Edition
Bacteroides eggerthii
X





11






MCM-H^ Edition
Bacteroides fragilis
X





MH






MCM-H^ Edition
Bacteroides
galacturonicus
X





|






MCM-H* Edition
Bacteroides ovatus
X





iii






MCM-H* Edition
Bacteroides pectinophilus
X





1






MCM-H* Edition
Bacteroides stercoris
X





11






MCM-H* Edition
Bacteroides
thetaiotaomicron
X





1






MCM-H* Edition
Bacteroides uniformis
X





111






MCM-H* Edition
Bacteroides vulgatus
X





11






MCM-H* Edition
Bartonella bacilliformis



X


111






MCM-H* Edition
Bartonella elizabethae



X


iii






MCM-H* Edition
Bartonella henselae



X


¦






MCM-H* Edition
Bartonella quintana



X


—






MCM-H* Edition
Bergeyella zoohelcum




X

i






MCM-H^ Edition
Bifidobacterium dentium
X





(i






MCM-H^ Edition
Bilophila wadsworthia
X





Hi






MCM-H* Edition
Blautia producta
X





Hi






MCM-H* Edition
Bordetella avium





X
ii






MCM-H* Edition
Bordetella bronchiseptica





X
1






MCM-H* Edition
Bordetella parapertussis





X
iii






MCM-H* Edition
Bordetella pertussis





X







MCM-H* Edition
Borrelia brasiliensis



X









MCM-H* Edition
Borrelia burgdorferi



X









MCM-H* Edition
Borrelia caucasica



X









MCM-H^ Edition
Borrelia crocidurae



X









MCM-H* Edition
Page B4

-------
EPA-OGWDW
Technical
Support Document for the Draft Fifth Contaminant Candidate List
(CCL 5)-Microbiai Contaminants
EPA 815-R-21-007
July 2021
Bacteria
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Reference
Borrelia duttonii



X









MCM-H* Edition
Borrelia hermsii



X









MCM-H* Edition
Borrelia hispanica



X


BM






MCM-H^ Edition
Borrelia latyschewii



X


(HI






MCM-H^ Edition
Borrelia mazzottii



X


H






MCM-H* Edition
Borrelia parkeri



X


11






MCM-H* Edition
Borrelia persica



X


IB






MCM-H* Edition
Borrelia recurrentis



X


¦






MCM-H* Edition
Borrelia turicatae



X


¦il






MCM-H* Edition
Borrelia venezuelensis



X


811






MCM-H* Edition
Brevibacillus brevis






¦

X




MCM-H* Edition
Brevundimonas diminuta






|

X




MCM-H* Edition
Brevundimonas
vesicularis






1

X




MCM-H^ Edition
Brucella melitensis

X




il






MCM-H^ Edition
Burkholderia cepacia






11

X




MCM-H^ Edition
Burkholderia mallei









X



MCM-H* Edition
Burkholderia
pseudomallei








X




MCM-H* Edition
Campylobacter coli










X


MCM-H* Edition
Campylobacter concisus




X








MCM-H* Edition
Campylobacter curvus




X








MCM-H* Edition
Campylobacter fetus







X





MCM-H* Edition
Campylobacter gracilis




X

Mi






MCM-H* Edition
Campylobacter
hyointestinalis







X





MCM-H* Edition
Campylobacter jejuni












Campylobacter jejuni

Campylobacter lari










X


MCM-H* Edition
Campylobacter rectus




X








MCM-H* Edition
Page B5

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EPA-OGWDW	Technical Support Document for the Draft Fifth Contaminant Candidate List	EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Bacteria
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Reference
Campylobacter sputorum







X





MCM-H* Edition
Campylobacter
upsaliensis







X





MCM-H* Edition
Campylobacter
ureolyticus
X












MCM-H^ Edition
Capnocytophaga
canimorsus




X








MCM-H* Edition
Capnocytophaga
cynodegmi




X








MCM-H* Edition
Capnocytophaga
gingivalis




X








MCM-H^ Edition
Capnocytophaga
ochracea




X








MCM-H^ Edition
Capnocytophaga
sputigena




X








MCM-H* Edition
Cardiobacterium hominis




X








MCM-H* Edition
Cedecea davisae








X




MCM-H* Edition
Cedecea lapagei








X




MCM-H* Edition
Cedecea neteri








X




MCM-H* Edition
Cellulomonas turbata








X




MCM-H* Edition
Cellulosimicrobium
cellulans








X




MCM-H* Edition
Centipeda periodontii
X












MCM-H* Edition
Chlamydia trachomatis


X










MCM-H* Edition
Chlamydophila
pneumoniae

X











MCM-H* Edition
Chlamydophila psittaci

X











MCM-H* Edition
Chromobacterium
violaceum







X





MCM-H* Edition
Page B6

-------
EPA-OGWDW
Technical Support Document for the Draft Fifth Contaminant Candidate List
(CCL 5)-Microbiai Contaminants
EPA 815-R-21-007
July 2021
Bacteria
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Reference
Chryseobacterium
balustinum







X




MCM-H* Edition
Citrobacter amalonaticus




X








MCM-H* Edition
Citrobacter braakii




X








MCM-H^ Edition
Citrobacter farmeri




X

illll






MCM-H^ Edition
Citrobacter freundii




X








MCM-H* Edition
Citrobacter koseri




X







MCM-H* Edition
Citrobacter rodentium




X







MCM-H* Edition
Citrobacter sedlakii




X








MCM-H* Edition
Citrobacter werkmanii




X







MCM-H* Edition
Citrobacter youngae




X








MCM-H* Edition
Clostridium baratii
X











MCM-H* Edition
Paraclostridium
bifermentans
X












MCM-H* Edition
Clostridium botulinum
X












MCM-H* Edition
Clostridium butyricum
X












MCM-H* Edition
Clostridium chauvoei
X












MCM-H* Edition
Clostridoides difficile
X












MCM-H^ Edition
Clostridium fallax
X












MCM-H^ Edition
Clostridium histolyticum
X





Hi






MCM-H* Edition
Clostridium novyi
X





1






MCM-H* Edition
Clostridium perfringens
X











MCM-H* Edition
Clostridium ramosum
X











MCM-H* Edition
Clostridium septicum
X











MCM-H* Edition
Clostridium sordellii
X





1






MCM-H* Edition
Clostridium sporogenes
X











MCM-H* Edition
Clostridium tertium
X











MCM-H* Edition
Clostridium tetani
X











MCM-H* Edition
Collinsella aerofaciens
X











MCM-H^ Edition
Page B7

-------
EPA-OGWDW
Technical Support Document for the Draft Fifth Contaminant Candidate List
(CCL 5)-Microbiai Contaminants
EPA 815-R-21-007
July 2021
Bacteria
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Reference
Comamonas testosteroni












Comamonas testosteroni

Corynebacterium
afermentans




X








MCM-H* Edition
Corynebacterium
argentoratense




X








MCM-H^ Edition
Corynebacterium bovis




X








MCM-H* Edition
Corynebacterium
diphtheriae





X
Bill






MCM-H^ Edition
Corynebacterium jeikeium




X








MCM-H* Edition
Corynebacterium
kutscheri




X








MCM-H* Edition
Corynebacterium
macginleyi




X








MCM-H^ Edition
Corynebacterium
minutissimum




X








MCM-H* Edition
Corynebacterium
propinquum




X








MCM-H* Edition
Corynebacterium
pseudodiphthericum




X








MCM-H* Edition
Corynebacterium
pseudotuberculosis




X








MCM-H* Edition
Corynebacterium striatum




X








MCM-H* Edition
Corynebacterium ulcerans




X








MCM-H* Edition
Corynebacterium
urealyticum




X








MCM-H* Edition
Corynebacterium xerosis




X








MCM-H* Edition
Page B8

-------
EPA-OGWDW
Technical Support Document for the Draft Fifth Contaminant Candidate List
(CCL 5)-Microbiai Contaminants
EPA 815-R-21-007
July 2021
Bacteria
Coxiella burnetii
Cronobacter sakazakii
8
10
11
12
PCCL
Reference
MCM-12111 Edition
MCM-12111 Edition
Cutibacterium acnes
Cutibacterium avidum
Cutibacterium
granulosum
Delftia acidovorans
Dermatophilus
congolensis
Dichelobacter nodosus
Edwardsiella hoshinae
Edwardsiella tarda
Eggerthella lenta
Ehrlichia chaffeensis
Ehrlichia equi
Ehrlichia ewingii
Eikenella corrodens
Elizabethkingia anophelis
Elizabethkingia
meningoseptica
Enterobacter amnigenus
Enterobacter asburiae
Enterobacter
cancerogenus
Enterobacter cloacae
Enterobacter gergoviae
Enterobacter hormaechei
Enterococcus avium
MCM-12111 Edition
MCM-12111 Edition
MCM-12111 Edition
MCM-12111 Edition
MCM-12 Edition
MCM-12111 Edition
MCM-12111 Edition
MCM-12111 Edition
MCM-12 Edition
MCM-12111 Edition
MCM-12111 Edition
MCM-12111 Edition
MCM-12111 Edition
Figueroa Castro, Carlos E et
al„ 2017
MCM-12111 Edition
MCM-12111 Edition
MCM-12111 Edition
MCM-12 Edition
MCM-12111 Edition
MCM-12 Edition
MCM-12111 Edition
MCM-12 Edition
Page B9

-------
EPA-OGWDW
Technical
Support Document for the Draft Fifth Contaminant Candidate List
(CCL 5)-Microbiai Contaminants
EPA 815-R-21-007
July 2021
Bacteria
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Reference
Enterococcus
casseliflavus







X




MCM-H* Edition
Enterococcus durans








X




MCM-H* Edition
Enterococcus faecalis







X




MCM-H* Edition
Enterococcus faecium








X




MCM-H* Edition
Enterococcus flavescens







X




MCM-H^ Edition
Enterococcus gallinarum








X




MCM-H* Edition
Enterococcus hirae







X




MCM-H* Edition
Enterococcus mundtii








X




MCM-H* Edition
Enterococcus raffmosus








X




MCM-H* Edition
Erysipelothrix
rhusiopathiae







X




MCM-H* Edition
Escherichia coli












Escherichia coli

Eubacterium brachy
X











MCM-H* Edition
Eubacterium cylindroides
X












MCM-H* Edition
Eubacterium limosum
X











MCM-H* Edition
Eubacterium moniliforme
X












MCM-H* Edition
Eubacterium multiforme
X











MCM-H* Edition
Eubacterium nodatum
X











MCM-H* Edition
Eubacterium rectale
X











MCM-H^ Edition
Eubacterium saburreum
X












MCM-H^ Edition
Eubacterium saphenum
X











MCM-H* Edition
Eubacterium sulci
X












MCM-H* Edition
Eubacterium tenue
X












MCM-H* Edition
Ewingella americana




X








MCM-H* Edition
Faecalicatena contorta
X












MCM-H* Edition
Fibrobacter intestinalis
X





11






MCM-H* Edition
Page BIO

-------
EPA-OGWDW
Technical Support Document for the Draft Fifth Contaminant Candidate List
(CCL 5)-Microbiai Contaminants
EPA 815-R-21-007
July 2021
Bacteria
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Reference
Filifactor alocis
X












MCM-H* Edition
Finegoldia magna
X












MCM-H* Edition
Fluoribacter bozemanae











X

MCM-H^ Edition
Fluoribacter dumoffii











X

MCM-H^ Edition
Fluoribacter gormanii











X

MCM-H* Edition
Francisella tularensis



X









MCM-H* Edition
Fusobacterium
mortiferum
X












MCM-H* Edition
Fusobacterium
necrophorum
X












MCM-H* Edition
Fusobacterium nucleatum
X












MCM-H* Edition
Fusobacterium
periodonticum
X












MCM-H* Edition
Fusobacterium ulcerans
X












MCM-H* Edition
Fusobacterium varium
X












MCM-H* Edition
Gardnerella vaginalis




X








MCM-H* Edition
Gemella morbillorum




X








MCM-H^ Edition
Gordonia amarae








X




MCM-H^ Edition
Gordonia bronchialis








X




MCM-H* Edition
Gordonia rubropertincta








X




MCM-H* Edition
Gordonia sputi








X




MCM-H^ Edition
Gordonia terrae






IBB

X




MCM-H^ Edition
Granulicatella adiacens




X








MCM-H* Edition
Haemophilus ducreyi


X










MCM-H* Edition
Haemophilus
haemolyticus




X








MCM-H* Edition
Haemophilus influenzae




X








MCM-H* Edition
Haemophilus
parahaemolyticus




X








MCM-H* Edition
Page Bll

-------
EPA-OGWDW
Technical
Support Document for the Draft Fifth Contaminant Candidate List
(CCL 5)-Microbiai Contaminants
EPA 815-R-21-007
July 2021
Bacteria
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Reference
Haemophilus
parainfluenzae




X







MCM-H* Edition
Haemophilus
paraphrophilus




X








MCM-H* Edition
Haemophilus segnis




X








MCM-H^ Edition
Hafnia alvei






111111

X




MCM-H^ Edition
Helicobacter cinaedi










X


MCM-H* Edition
Helicobacter fennelliae









X


MCM-H* Edition
Helicobacter heilmannii









X


MCM-H* Edition
Helicobacter pullorum










X


MCM-H* Edition
Helicobacter pylori











Helicobacter pyori

Kingella denitrificans




X








MCM-H* Edition
Kingella kingae




X







MCM-H* Edition
Klebsiella aerogenes








X




MCM-H* Edition
Klebsiella granulomatis







X




MCM-H* Edition
Klebsiella oxytoca







X




MCM-H^ Edition
Klebsiella pneumoniae







X




MCM-H^ Edition
Kluyvera ascorbata








X




MCM-H* Edition
Kluyvera cryocrescens






111

X




MCM-H* Edition
Lactobacillus sp.
X





IBB






MCM-H^ Edition
Legionella anisa






m



X


MCM-H* Edition
Legionella
birminghamensis






|



X


MCM-H* Edition
Legionella cherrii









X


MCM-H* Edition
Legionella cincinnatiensis






1



X


MCM-H* Edition
Legionella feeleii









X


MCM-H* Edition
Legionella hackeliae






ill



X


MCM-H* Edition
Legionella jordanis






MM



X


MCM-H* Edition
Legionella lansingensis






1



X


MCM-H^ Edition
Legionella longbeachae









X


MCM-H* Edition
Page B12

-------
EPA-OGWDW
Technical
Support Document for the Draft Fifth Contaminant Candidate List
(CCL 5)-Microbiai Contaminants
EPA 815-R-21-007
July 2021
Bacteria
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Reference
Legionella oakridgensis










X


MCM-H* Edition
Legionella pneumophila












Legionella pneumophila

Legionella rubrilucens










X


MCM-H^ Edition
Legionella sainthelensi










X


MCM-H^ Edition
Legionella tucsonensis










X


MCM-H* Edition
Legionella wadsworthii










X


MCM-H* Edition
Leifsonia aquatica








X




MCM-H* Edition
Leptospira borgpetersenii







X





MCM-H* Edition
Leptospira inadai







X





MCM-H* Edition
Leptospira interrogans







X





MCM-H* Edition
Leptospira kirschneri







X





MCM-H* Edition
Leptospira meyeri







X





MCM-H^ Edition
Leptospira noguchii







X





MCM-H^ Edition
Leptospira santarosai






HI
X





MCM-H* Edition
Leptospira weilii







X





MCM-H* Edition
Leptotrichia buccalis
X












MCM-H^ Edition
Listeria ivanovii







X





MCM-H^ Edition
Listeria monocytogenes







X





MCM-H* Edition
Listeria seeligeri






|j|||g
X





MCM-H* Edition
Listeria welshimeri







X





MCM-H* Edition
Lysinibacillus sphaericus








X




MCM-H* Edition
Mannheimia haemolytica




X








MCM-H* Edition
Megamonas hypermegale
X












MCM-H* Edition
Megasphaera sp.
X












MCM-H* Edition
Methylobacterium
mesophilicum *







X





MCM-H* Edition
Page B13

-------
EPA-OGWDW
Technical Support Document for the Draft Fifth Contaminant Candidate List
(CCL 5)-Microbiai Contaminants
EPA 815-R-21-007
July 2021
Bacteria
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Reference
Methylobacterium
zatmanii *






X





MCM-H* Edition
Micromonas micros
X












MCM-H* Edition
Mogibacterium timidum
X











MCM-H* Edition
Moraxella atlantae




X








MCM-H* Edition
Moraxella bovis




X







MCM-H^ Edition
Moraxella catarrhalis




X








MCM-H* Edition
Moraxella caviae




X








MCM-H* Edition
Moraxella cuniculi




X







MCM-H* Edition
Moraxella lacunata




X







MCM-H* Edition
Moraxella lincolnii




X







MCM-H* Edition
Moraxella liquefaciens




X








MCM-H* Edition
Moraxella
nonliquefaciens




X








MCM-H^ Edition
Moraxella osloensis




X








MCM-H* Edition
Moraxella ovis




X







MCM-H^ Edition
Morganella morganii




X








MCM-H^ Edition
Mycobacterium abscessus












Mycobacterium abscessus

Mycobacterium africanum









X



MCM-H^ Edition
Mycobacterium asiaticum







X




MCM-H^ Edition
Mycobacterium avium






l





Mycobacterium avium

Mycobacterium bovis

X










MCM-H* Edition
Mycobacterium celatum






ill

X




MCM-H* Edition
Mycobacterium chelonae






|

X




MCM-H* Edition
Mycobacterium
conspicuum







X




MCM-H* Edition
Page B14

-------
EPA-OGWDW
Technical Support Document for the Draft Fifth Contaminant Candidate List
(CCL 5)-Microbiai Contaminants
EPA 815-R-21-007
July 2021
Bacteria
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Reference
Mycobacterium fortuitum








X




MCM-H* Edition
Mycobacterium genavense








X




MCM-H* Edition
Mycobacterium gordonae








X




MCM-H^ Edition
Mycobacterium
haemophilum








X




MCM-H* Edition
Mycobacterium kansasii








X




MCM-H* Edition
Mycobacterium leprae

X











MCM-H* Edition
Mycobacterium
malmoense








X




MCM-H^ Edition
Mycobacterium marinum








X




MCM-H* Edition
Mycobacterium
mucogenicum








X




MCM-H* Edition
Mycobacterium
peregrinum








X




MCM-H* Edition
Mycobacterium porcinum








X




MCM-H* Edition
Mycobacterium
scrofulaceum








X




MCM-H* Edition
Mycobacterium
senegalense








X




MCM-H* Edition
Mycobacterium shimoidei








X




MCM-H* Edition
Mycobacterium simiae






iilllll

X




MCM-H* Edition
Mycobacterium
smegmatis








X




MCM-H* Edition
Mycobacterium szulgai








X




MCM-H* Edition
Page B15

-------
EPA-OGWDW	Technical Support Document for the Draft Fifth Contaminant Candidate List	EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Bacteria
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Reference
Mycobacterium
tuberculosis





X







MCM-H* Edition
Mycobacterium ulcerans








X




MCM-H* Edition
Mycobacterium xenopi








X




MCM-H^ Edition
Mycoplasma fermentans

X




¦






MCM-H^ Edition
Mycoplasma genitalium

X











MCM-H^ Edition
Mycoplasma hominis

X











MCM-H* Edition
Mycoplasma pneumoniae

X











MCM-H* Edition
Mycoplasma salivarium

X











MCM-H* Edition
Myroides odoratus







X





MCM-H* Edition
Neisseria cinerea




X









MCM-H* Edition
Neisseria elongata




X









MCM-H* Edition
Neisseria flava




X









MCM-H* Edition
Neisseria flavescens




X









MCM-H* Edition
Neisseria gonorrhoeae


X











MCM-H^ Edition
Neisseria lactamica




X









MCM-H^ Edition
Neisseria meningitidis





X








MCM-H* Edition
Neisseria mucosa




X

Mi






MCM-H* Edition
Neisseria perflava




X

111






MCM-H^ Edition
Neisseria sicca




X

II






MCM-H^ Edition
Neisseria subflava




X

III






MCM-H* Edition
Neisseria weaveri




X

IB






MCM-H* Edition
Neoehrlichia mikurensis



X


M






Portillo, A et al., 2018
Neorickettsia sennetsu



X


WKH






MCM-H* Edition
Nocardia asteroides






111

X




MCM-H* Edition
Nocardia brasiliensis






BW

X




MCM-H* Edition
Nocardia caviae






1J1

X




MCM-H^ Edition
Nocardia farcinica






—

X




MCM-H* Edition
Page B16

-------
EPA-OGWDW
Technical
Support Document for the Draft Fifth Contaminant Candidate List
(CCL 5)-Microbiai Contaminants
EPA 815-R-21-007
July 2021
Bacteria
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Reference
Nocardia nova








X




MCM-H* Edition
Nocardia otitidiscaviarum








X




MCM-H* Edition
Nocardia
pseudobrasiliensis








X




MCM-H* Edition
Nocardia transvalensis








X




MCM-H^ Edition
Ochrobactrum anthropi








X




MCM-H* Edition
Odoribacter splanchnicus
X












MCM-H* Edition
Oligella ureolytica




X








MCM-H* Edition
Oligella urethralis




X








MCM-H* Edition
Orientia tsutsugamushi

X











MCM-H* Edition
Paenibacillus alvei








X




MCM-H* Edition
Paenibacillus macerans








X




MCM-H* Edition
Pantoea agglomerans












Pantoea agglomerans

Parabacteroides
distasonis
X












MCM-H* Edition
Parabacteroides merdae
X












MCM-H^ Edition
Parachlamydia
acanthamoebae

X











Greub, G., 2009
Pasteurella aerogenes




X







MCM-H* Edition
Pasteurella caballi




X








MCM-H* Edition
Pasteurella canis




X








MCM-H^ Edition
Pasteurella dagmatis




X








MCM-H^ Edition
Pasteurella multocida




X








MCM-H* Edition
Pasteurella stomatis




X








MCM-H* Edition
Peptococcus niger
X












MCM-H* Edition
Peptostreptococcus
anaerobius
X












MCM-H* Edition
Page B17

-------
EPA-OGWDW
Technical Support Document for the Draft Fifth Contaminant Candidate List
(CCL 5)-Microbiai Contaminants
EPA 815-R-21-007
July 2021
Bacteria
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Reference
Peptostreptococcus
asaccharolyticus
X












MCM-H* Edition
Peptostreptococcus
lactolyticus
X












MCM-H* Edition
Peptostreptococcus
prevotii
X












MCM-H^ Edition
Peptostreptococcus
vaginalis
X












MCM-H* Edition
Photobacterium damselae








X




MCM-H* Edition
Plesiomonas shigelloides












Plesiomonas shigelloides

Porphyromonas
asaccharolytica
X












MCM-H^ Edition
Porphyromonas catoniae
X












MCM-H* Edition
Porphyromonas
circumdentaria
X












MCM-H* Edition
Porphyromonas
endodontalis
X












MCM-H* Edition
Porphyromonas gingivalis
X












MCM-H* Edition
Porphyromonas levii
X












MCM-H* Edition
Porphyromonas macacae
X












MCM-H* Edition
Prevotella bivia
X












MCM-H* Edition
Prevotella buccae
X












MCM-H* Edition
Prevotella buccalis
X












MCM-H* Edition
Prevotella corporis
X





111






MCM-H* Edition
Prevotella dentalis
X





1






MCM-H^ Edition
Prevotella denticola
X





Hi






MCM-H^ Edition
Page B18

-------
EPA-OGWDW
Technical Support Document for the Draft Fifth Contaminant Candidate List
(CCL 5)-Microbiai Contaminants
EPA 815-R-21-007
July 2021
Bacteria
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Reference
Prevotella disiens
X












MCM-H* Edition
Prevotella enoeca
X












MCM-H* Edition
Prevotella heparinolytica
X





l






MCM-H^ Edition
Prevotella intermedia
X





M






MCM-H* Edition
Prevotella loescheii
X





—B






MCM-H^ Edition
Prevotella
melaninogenica
X





1






MCM-H* Edition
Prevotella nigrescens
X





mil






MCM-H* Edition
Prevotella oralis
X





lit






MCM-H* Edition
Prevotella oris
X





flk






MCM-H* Edition
Prevotella oulora
X





m






MCM-H* Edition
Prevotella ruminicola
X












MCM-H* Edition
Prevotella veroralis
X












MCM-H* Edition
Prevotella
zoogleoformans
X












MCM-H* Edition
Propionibacterium
propionicus
X












MCM-H* Edition
Proteus mirabilis








X




MCM-H^ Edition
Proteus penneri








X




MCM-H* Edition
Proteus vulgaris








X




MCM-H* Edition
Providencia alcalifaciens








X




MCM-H^ Edition
Providencia rettgeri








X




MCM-H* Edition
Providencia stuartii








X




MCM-H* Edition
Pseudomonas aeruginosa












Pseudomonas aeruginosa

Pseudomonas alcaligenes








X




MCM-H* Edition
Pseudomonas fluorescens








X




MCM-H* Edition
Page B19

-------
EPA-OGWDW
Technical
Support Document for the Draft Fifth Contaminant Candidate List
(CCL 5)-Microbiai Contaminants
EPA 815-R-21-007
July 2021
Bacteria
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Reference
Pseudomonas
pseudoalcaligenes








X




MCM-H* Edition
Pseudomonas putida








X




MCM-H* Edition
Pseudomonas stutzeri








X




MCM-H* Edition
Pseudonocardia
autotrophica








X




MCM-H* Edition
Pseudoramibacter
alactolyticus
X












MCM-H* Edition
Psychrobacter
phenylpyruvicus






l

X




MCM-H* Edition
Rahnella aquatilis






il

X




MCM-H^ Edition
Ralstonia pickettii






Bi

X




MCM-H* Edition
Raoultella ornithinolytica






1

X




MCM-H* Edition
Rhodococcus equi






11

X




MCM-H* Edition
Rhodococcus erythropolis






1

X




MCM-H* Edition
Rhodococcus fascians






111

X




MCM-H* Edition
Rhodococcus rhodnii






il

X




MCM-H* Edition
Rhodococcus rhodochrous






i

X




MCM-H* Edition
Rickettsia africae



X


i






MCM-H* Edition
Rickettsia akari



X


Ml






MCM-H^ Edition
Rickettsia australis



X


ill






MCM-H^ Edition
Rickettsia conorii



X


m






MCM-H* Edition
Rickettsia felis



X


m






MCM-H* Edition
Rickettsia honei



X


Hi






MCM-H^ Edition
Rickettsia japonica



X


MB






MCM-H* Edition
Rickettsia massiliae



X


Ml






MCM-H* Edition
Rickettsia prowazekii



X


BM






MCM-H* Edition
Rickettsia rickettsii



X


BB






MCM-H* Edition
Page B20

-------
EPA-OGWDW
Technical Support Document for the Draft Fifth Contaminant Candidate List
(CCL 5)-Microbiai Contaminants
EPA 815-R-21-007
July 2021
Bacteria
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Reference
Rickettsia sibirica



X









MCM-H* Edition
Rickettsia typhi



X









MCM-H* Edition
Rodentibacter
pneumotropicus




X








MCM-H^ Edition
Rothia dentocariosa




X








MCM-H* Edition
Saccharomonospora
viridis








X




MCM-H^ Edition
Saccharopolyspora
rectivirgula








X




MCM-H* Edition
Salmonella bongori










X


MCM-H* Edition
Salmonella choleraesuis










X


MCM-H* Edition
Salmonella enteritidis










X


MCM-H* Edition
Salmonella typhi










X


MCM-H* Edition
Salmonella typhimurium












Salmonella enterica

Sebaldella termitidis
X












MCM-H* Edition
Selenomonas artemidis
X












MCM-H* Edition
Selenomonas dianae
X












MCM-H^ Edition
Selenomonas flueggei
X












MCM-H^ Edition
Selenomonas infelix
X












MCM-H* Edition
Selenomonas noxia
X












MCM-H* Edition
Serratia ficaria








X




MCM-H^ Edition
Serratia marcescens








X




MCM-H^ Edition
Serratia odorifera








X




MCM-H* Edition
Serratia plymuthica








X




MCM-H* Edition
Serratia proteamaculans








X




MCM-H* Edition
Serratia rubidaea








X




MCM-H* Edition
Shigella boydii










X


MCM-H* Edition
Shigella dysenteriae










X


MCM-H* Edition
Shigella flexneri










X


MCM-H* Edition
Page B21

-------
EPA-OGWDW
Technical Support Document for the Draft Fifth Contaminant Candidate List
(CCL 5)-Microbiai Contaminants
EPA 815-R-21-007
July 2021
Bacteria
1
2
3
4
5
6
7 8
9
10
11
12
PCCL
Reference
Shigella sonnei











Shigella sonnei

Sphingomonas
paucimobilis







X




MCM-H* Edition
Spirillum minus

X










MCM-H* Edition
Staphylococcus aureus




X







MCM-H* Edition
Staphylococcus
epidermidis




X







MCM-H^ Edition
Staphylococcus
haemolyticus




X







MCM-H* Edition
Staphylococcus hyicus




X







MCM-H* Edition
Staphylococcus
intermedius




X







MCM-H* Edition
Staphylococcus
lugdunensis




X







MCM-H* Edition
Staphylococcus
saprophyticus




X







MCM-H* Edition
Staphylococcus warneri




X







MCM-H* Edition
Stenotrophomonas
maltophilia







X




MCM-H* Edition
Streptobacillus
moniliformis


X









MCM-H* Edition
Streptococcus
acidominimus




X







MCM-H* Edition
Streptococcus agalactiae




X







MCM-H* Edition
Streptococcus anginosus




X







MCM-H* Edition
Streptococcus bovis




X







MCM-H^ Edition
Streptococcus canis




X







MCM-H* Edition
Streptococcus constellatus




X







MCM-H* Edition
Page B22

-------
EPA-OGWDW
Technical Support Document for the Draft Fifth Contaminant Candidate List
(CCL 5)-Microbiai Contaminants
EPA 815-R-21-007
July 2021
Bacteria
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Reference
Streptococcus criceti




X








MCM-H* Edition
Streptococcus equi




X








MCM-H* Edition
Streptococcus gordonii




X








MCM-H^ Edition
Streptococcus intermedius




X








MCM-H^ Edition
Streptococcus milleri




X








MCM-H^ Edition
Streptococcus mitis




X








MCM-H* Edition
Streptococcus mutans




X








MCM-H* Edition
Streptococcus
pneumoniae




X








MCM-H* Edition
Streptococcus pyogenes




X








MCM-H* Edition
Streptococcus salivarius




X








MCM-H* Edition
Streptococcus sanguis




X

HI






MCM-H* Edition
Streptococcus sobrinus




X

im






MCM-H* Edition
Streptococcus suis




X








MCM-H* Edition
Streptococcus uberis




X








MCM-H* Edition
Sutterella wadsworthensis
X












MCM-H* Edition
Suttonella indologenes




X








MCM-H* Edition
Tanerella forsythia
X












MCM-H* Edition
Tatlockia maceachernii











X

MCM-H^ Edition
Tatlockia micdadei











X

MCM-H^ Edition
Tatumella ptyseos







X





MCM-H* Edition
Treponema carateum







X





MCM-H* Edition
Treponema pallidum


X










MCM-H* Edition
Tropheryma whippelii








X




MCM-H* Edition
Trueperella bernardiae




X

Ml






MCM-H* Edition
Trueperella pyogenes




X








MCM-H* Edition
Tsukamurella inchonensis








X




MCM-H^ Edition
Page B23

-------
EPA-OGWDW	Technical Support Document for the Draft Fifth Contaminant Candidate List	EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Bacteria
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Reference
Tsukamurella
paurometabola







X




MCM-H* Edition
Tsukamurella pulmonis








X




MCM-H* Edition
Tsukamurella
tyrosinosolvens







X




MCM-H* Edition
Ureaplasma urealyticum

X











MCM-H^ Edition
Veillonella atypica
X












MCM-H^ Edition
Veillonella dispar
X












MCM-H* Edition
Veillonella parvula
X











MCM-H* Edition
Vibrio alginolyticus








X




MCM-H* Edition
Vibrio cholerae






BB





Vibrio cholerae

Vibrio cincinnatiensis






1

X




MCM-H* Edition
Vibrio fluvialis







X




MCM-H* Edition
Vibrio furnissii






MM

X




MCM-H* Edition
Vibrio hollisae








X




MCM-H* Edition
Vibrio mimicus








X




MCM-H* Edition
Vibrio parahaemolyticus








X




MCM-H* Edition
Vibrio vulnificus







X




MCM-H^ Edition
Waddlia chondrophila

X










Baud, David et al., 2014
Wolinella succinogenes
X











MCM-H* Edition
Yersinia bercovieri






X





MCM-H* Edition
Yersinia enterocolitica












Yersinia enterocolitica

Yersinia frederiksenii







X





MCM-H* Edition
Yersinia intermedia






X





MCM-H* Edition
Yersinia kristensenii







X





MCM-H* Edition
Yersinia mollaretii






X





MCM-H* Edition
Yersinia pestis



X








MCM-H* Edition
Yersinia
pseudotuberculosis








X




MCM-H* Edition
Yersinia rohdei







X





MCM-H* Edition
Page B24

-------
EPA-OGWDW	Technical Support Document for the Draft Fifth Contaminant Candidate List	EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Bacteria
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Reference
Yersinia ruckeri







X





MCM-H* Edition

Viruses
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Page Reference
Andes virus








X



MCM-H* Edition
Apoi vims


X









Field's Virology, 5th Ed., p.
1153-1158, 1206
Australian bat lyssavirus


X









Field's Virology, 5th Ed., p.
1364
Bagaza virus


X









Field's Virology, 5th Ed., p.
1153-1158, 1199
Bangui virus


X









MCM-H* Edition
Banna virus


X









MCM-H* Edition
Banzi virus


X









MCM-H* Edition
Barmah Forest virus


X









MCM-H^ Edition
Batken virus


X









lUtD://Dhcnc.come. Columbia.cd
u/71 h Re do rt/s i t e s/de s c ri d t i o n s/
Orthomvxoviridae/tho eotoviru
s.htm
Bayou virus


X









MCM-H* Edition
Bebaru virus


X









Field's Virology, 5th. Ed., p.
1024
Bhanja virus


X









MCM-H*11 Edition
BK virus

X










MCM-H* Edition
Black creek canal virus


X









MCM-H* Edition
Borna disease virus




X







Field's Virology, 5th Ed., p.
1835
Bovine Ephemeral Fever
virus


X









Field's Virology, 5th Ed., p.
1367
Bovine Papular Stomatitis
virus

X










Field's Virology, 5th Ed., p.
2948, 2955-2956, 2963
Page B25

-------
EPA-OGWDW
Technical Support Document for the Draft Fifth Contaminant Candidate List
(CCL 5)-Microbiai Contaminants
EPA 815-R-21-007
July 2021
Viruses
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Page Reference
Bovine Spongiform
Encephalopathy (BSE)
agent








X



MCM-H* Edition
Buffalopox vims






X





Field's Virology, 5th Ed. p.
2955-2956
Bunyamwera vims


X









MCM-H^ Edition
Bussuquara virus


X









MCM-H* Edition
Bwamba virus


X









MCM-H* Edition
California encephalitis
virus


X









MCM-H* Edition
Candiru virus complex


X









MCM-H^ Edition
Caraparu virus


X









MCM-H^ Edition
Catu virus


X









MCM-H* Edition
Cercopithecine herpes
virus 1






X





Field's Virology, 5th Ed., p.
2895-2897
Chandipura virus


X









MCM-H* Edition
Changuinola virus


X









MCM-H^ Edition
Chikungunya virus


X









MCM-H^ Edition
Chim virus


X









lUtD://Dhcnc.come. Columbia.cd
u/ICTVdB/11000000.htm
Creutzfeld-Jokob Disease
(CJD) agent






X





Field's Virology, 5th Ed., p.
443-444, 3077-3078
Colorado tick fever virus


X









MCM-H* Edition
Cote d'lvoire Ebola virus








X



Field's Virology, 5th. Ed., p.
619, 1411-1412, 1432-1434
Cowpox virus








X



MCM-H* Edition
Crimea-Congo
Haemorrhagic Fever Virus








X



MCM-H* Edition
Dakar bat virus






X





Field's Virology, 5th Ed., p.
1158, 1206
Dengue virus


X









MCM-H^ Edition
Page B26

-------
EPA-OGWDW	Technical Support Document for the Draft Fifth Contaminant Candidate List	EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Viruses
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Page Reference
Dhori vims


X









MCM-H* Edition
Dobrava-Belgrade vims








X



MCM-H^ Edition
Dugbe vims


X









MCM-H* Edition
Duvenhage vims








X



Field's Virology, 5th Ed., p.
1364
Eastern equine
encephalitis vims


X









MCM-H* Edition
Edge Hill vims


X









MCM-H* Edition
Encephalomyocarditis
vims






X





Field's Virology, 5th Ed., p.
796, 840, 858-860
European bat lyssavirus 1








X



Field's Virology, 5th Ed., p.
1364
European bat lyssavirus 2








X



Field's Virology, 5th Ed., p.
1364
European Tick-borne
encephalitis virus


X









Field's Virology, 5th Ed., p.
1153-1158, 1200-1203
Everglades virus


X









MCM-12
Eyach virus


X









Krause et al., p. 87-89
Far eastern Tick-borne
encephalitis virus


X









Field's Virology, 5th Ed., p.
1153-1158, 1200-1203
Foot and mouth disease
virus






X





Field's Virology, 5th Ed., p.
796, 840, 858-860
Ganj am virus


X









MCM-H* Edition
Getah virus


X









Field's Virology, 5th Ed., p.
1024
Guama virus


X









MCM-H^ Edition
Guanarito virus








X



MCM-H* Edition
Guaroa virus


X









MCM-H* Edition
Hantaan virus








X



MCM-H* Edition
Hendra virus








X



MCM-H^ Edition
Hepatitis A virus











Hepatitis A

Hepatitis B virus

X










MCM-H* Edition
Page B27

-------
EPA-OGWDW
Technical Support Document for the Draft Fifth Contaminant Candidate List
(CCL 5)-Microbiai Contaminants
EPA 815-R-21-007
July 2021
Viruses
1 2
3
4
5
6
7
8
9
10
11
12
PCCL
Page Reference
Hepatitis C vims

X










MCM-H* Edition
Hepatitis delta vims
X







MCM-H^ Edition
Hepatitis E vims







Hepatitis E

Hepatitis G vims
X







MCM-H* Edition
HU39694 vims

X






litto ://www .cdc. eov/ncidod/dis
eases/hanta/hos/noframes/ohvs/
ecoloev.htm
Hughes virus

X






Field's Virology, 5th Ed., p.
1743-1745
Human adenovirus A







Adenovirus

Human adenovirus B


X





MCM-H^ Edition
Human adenovirus C






X

MCM-H* Edition
Human adenovirus D




X







MCM-H* Edition
Human adenovirus E


X





MCM-H* Edition
Human adenovirus F






X

MCM-H^ Edition
Human astrovirus







Astrovirus

Human bocavirus




X



Allander, T., 2008
Human Coronavirus 229E


X





MCM-H* Edition
Human Coronavirus
OC43


X





MCM-H* Edition
Human coronavirus
SARS-CoV-2


X





Ciotti, et al., 2019
Human enterovirus 68






X

MCM-H^ Edition
Human enterovirus 70






X

MCM-H* Edition
Human enterovirus A







Enterovirus

Human enterovirus B






X

MCM-H* Edition
Human enterovirus C






X

MCM-H* Edition
Human enterovirus D






X

MCM-H^ Edition
Human Herpesvirus 1
X







MCM-H* Edition
Human Herpesvirus 2
X







MCM-H* Edition
Human Herpesvirus 3
X







MCM-H* Edition
Page B28

-------
EPA-OGWDW	Technical Support Document for the Draft Fifth Contaminant Candidate List	EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Viruses
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Page Reference
Human Herpesvirus 4

X










MCM-H* Edition
Human Herpesvirus 5

X










MCM-H^ Edition
Human Herpesvirus 6

X










MCM-H* Edition
Human Herpesvirus 7

X










MCM-H* Edition
Human Herpesvirus 8

X










MCM-H* Edition
Human
Immunodeficiency Virus
1

X










MCM-H* Edition
Human
Immunodeficiency Virus
2

X










MCM-H^ Edition
Human papillomavirus

X










MCM-H* Edition
Human parainfluenza
virus 1

X










MCM-H* Edition
Human parainfluenza
virus 2




X







MCM-H* Edition
Human parainfluenza
virus 3




X







MCM-H* Edition
Human parainfluenza
virus 4




X







MCM-H* Edition
Human parechovirus type
1






X





MCM-H^ Edition
Human parechovirus type
2






X





MCM-H* Edition
Human Respiratory
Syncytial virus




X







MCM-H* Edition
Human Rhinovirus A




X







MCM-H^ Edition
Human Rhinovirus B




X







MCM-H* Edition
Human T-Lympho tropic
Virus 1

X










MCM-H* Edition
Igbo-ora virus


X









Field's Virology, 5th Ed., p.
1024, 1048
Page B29

-------
EPA-OGWDW	Technical Support Document for the Draft Fifth Contaminant Candidate List	EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Viruses
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Page Reference
Ilheus vims


X









MCM-H* Edition
Influenza A vims




X







MCM-H^ Edition
Influenza B virus




X







MCM-H* Edition
Influenza C virus




X







MCM-H* Edition
Issyk-Kul virus


X









MCM-H* Edition
Japanese encephalitis


X









MCM-H* Edition
virus













JC virus

X










MCM-H* Edition
Junin virus

X










MCM-H^ Edition
Juquitiba virus


X









Field's Virology, 5th Ed., p.
1743-1745
KI polyomavirus

X










Bofill-Mas, S., et al., 2010
Karshi virus








X



MCM-H* Edition
Kasokero virus


X









httD://Dhcne.CDinc. Columbia.ed
u/ICTVdB/11000000.htm
Kedougou virus


X









Field's Virology, 5th Ed., p.
1153-1158, 1199
Kemerovo virus


X









MCM-H* Edition
Kobuvirus






X





Ramirez-Castillo et al., 2015
Kokobera virus


X









MCM-H* Edition
Koutango virus


X









MCM-H* Edition
Kyasanur forest disease


X









MCM-H^ Edition
virus













Laguna Negra virus








X



MCM-H* Edition
Lanj an virus


X









httD://Dhcnc.come. Columbia.cd
u/ICTVdB/11000000.htm
Lassa virus








X



MCM-H* Edition
Lebombo virus


X









MCM-H* Edition
Lechiguanas virus


X









httD://Dhcne.come. Columbia.ed
u/71 h Re do rt/s i t e s/de s c ri d t i o n s/
Bunvaviridae/hantavirus.htm
Page B30

-------
EPA-OGWDW
Technical Support Document for the Draft Fifth Contaminant Candidate List
(CCL 5)-Microbiai Contaminants
EPA 815-R-21-007
July 2021
Viruses
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Page Reference
Louping ill virus


X









MCM-H* Edition
Lujo vims

X










httDS ://www.cdc. eov/vhf/lui o/tr
ansmission/index.html
Lymphocytic
choriomeningitis vims






X





MCM-H* Edition
Machupo vims








X



MCM-H* Edition
Madrid vims


X









MCM-H* Edition
Marburg virus

X










MCM-H* Edition
Marituba virus


X









MCM-H* Edition
Mayaro virus


X









MCM-H* Edition
Measles virus




X







MCM-H* Edition
Menangle virus








X



litto ://www .cdc. sov/ncidod/eid
/vol4no2/ohilbev. htm
Mimivirus1






X





Field's Virology, 5th Ed., p.
627-628, 637-638
Mokola virus


X









Field's Virology, 5th Ed., p.
1363-1364
Molluscum contagiosum
virus

X










MCM-H* Edition
Monkeypox virus








X



MCM-H* Edition
Monongahela virus


X









httD://Dhcnc.come. Columbia.cd
u/71 h Rc do rt/s i t c s/dc s c ri d t i o n s/
Bunvaviridae/hantavirus.htm
Mucambo virus


X









MCM-H^ Edition
Mumps virus

X










MCM-H* Edition
Murray Valley
encephalitis virus


X









MCM-H* Edition
New York virus


X









MCM-H* Edition
Newcastle disease virus




X







Field's Virology, 5th Ed., p.
1497-1498
Nipah virus








X



MCM-H* Edition
Page B31

-------
EPA-OGWDW	Technical Support Document for the Draft Fifth Contaminant Candidate List	EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Viruses
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Page Reference
Norwalk-like viruses











Calicivirus

Nyando vims


X









MCM-H^ Edition
Ockelbo vims


X









MCM-H* Edition
Omsk haemorrhagic fever
virus


X









MCM-H* Edition
O'nyong-nyong virus


X









MCM-H* Edition
Oran virus


X









lUtD://Dhcnc.come. Columbia.cd
u/71 h Re do rt/s i t e s/de s c ri d t i o n s/
Bunvaviridae/hantavirus.htm
Orf virus






X





MCM-H^ Edition
Oriboca virus


X









MCM-H^ Edition
Oropouche virus


X









MCM-H* Edition
Orungo virus


X









MCM-H* Edition
Parvovirus 4

X










Sharp, C. P., et al., 2010
Parvovirus B19




X







MCM-H* Edition
Phnom-Penh bat virus






X





Field's Virology, 5th Ed., p.
1153-1158, 1206
Picobirnavirus






X





MCM-H* Edition
Piry virus


X









MCM-H* Edition
Poliovirus









X


MCM-H* Edition
Powassan virus


X









MCM-H^ Edition
Pseudocowpox virus

X










Field's Virology, 5th Ed., p.
2948, 2960, 2963
Punta Toro virus


X









MCM-H* Edition
Puumala virus








X



MCM-H* Edition
Quaranfil Virus


X









MCM-H* Edition
Rabies virus





X






MCM-H* Edition
Reovirus






X





Field's Virology, 5th Ed., p.
1897-1900
Reston Ebola virus








X



MCM-H* Edition
Rift Valley fever virus








X



MCM-H* Edition
Page B32

-------
EPA-OGWDW	Technical Support Document for the Draft Fifth Contaminant Candidate List	EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Viruses
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Page Reference
Rio Bravo vims






X





Field's Virology, 5th Ed., p.
1153-1158, 1206
Rocio virus


X









MCM-H^ Edition
Ross River virus


X









MCM-H^ Edition
Rotavirus A











Rotavirus

Rotavirus B








X



MCM-H* Edition
Rotavirus C








X



MCM-H* Edition
Rotavirus D








X



MCM-H* Edition
Rotavirus E








X



MCM-H^ Edition
Rotavirus F








X



MCM-H* Edition
Royal Farm virus


X









Field's Virology, 5th Ed., p.
1153-1158, 1204
Rubella virus




X







MCM-H* Edition
Sabia virus








X



MCM-H^ Edition
Saimiriine herpesvirus 1






X





Field's Virology, 4th Ed., p.
2383,2483,2511,2848
Salehabad virus


X









lUtD://Dhcnc.come. Columbia.cd
u/ICTVdB/11041008.htm
Sandfly fever Naples virus


X









MCM-H* Edition
Sandfly fever virus group


X









MCM-H* Edition
Saumarez Reef virus


X









Field's Virology, 5th Ed., p.
1153-1158,1206
Sealpox virus






X





MCM-H* Edition
Semliki Forest virus


X









MCM-H* Edition
Seoul virus


X









MCM-H* Edition
Sepik virus








X



MCM-H* Edition
Sin Nombre virus


X









MCM-H* Edition
Sindbis virus








X



MCM-H* Edition
St. Louis encephalitis
virus


X









MCM-H* Edition
Sudan Ebola virus








X



MCM-H* Edition
Page B33

-------
EPA-OGWDW
Technical Support Document for the Draft Fifth Contaminant Candidate List
(CCL 5)-Microbiai Contaminants
EPA 815-R-21-007
July 2021
Viruses
1 2
3
4
5
6
7
8
9
10
11
12
PCCL
Page Reference
Suid herpesvirus






X





Field's Virology, 4th Ed., p.
2385, 2484, 2707
Swine vesicular disease
virus





X


Field's Virology, 5th Ed., p.
963
Tacaiuma virus

X






MCM-H^ Edition
Tamdy virus

X






MCM-H* Edition
Tanapox virus





X


MCM-H* Edition
Tataguine virus

X






MCM-H* Edition
Thogoto virus

X






MCM-H^ Edition
Trubanaman virus

X






MCM-H^ Edition
Tyuleniy virus

X






Field's Virology, 5th Ed., p.
1153-1158, 1206
Usutu virus

X






MCM-H* Edition
Variola virus
X







MCM-H* Edition
Venezuelan Equine
Encephalitis virus

X






MCM-H^ Edition
Vesicular stomatitis virus

X






MCM-H^ Edition
Wad Medani virus

X






Field's Virology, 5th Ed., p.
1975-1977
Wanowrie virus

X






MCM-H* Edition
Wesselsbron virus

X






MCM-H* Edition
West Nile virus

X






MCM-H* Edition
Western Equine
Encephalitis virus

X






MCM-H^ Edition
WU polyomavirus



X





Bofill-Mas, S., 2010
Wyeomyia virus


X









MCM-H* Edition
Yaba monkey tumor virus





X


MCM-H* Edition
Yellow fever virus

X






MCM-H* Edition
Yogue virus

X






lUtD://Dhcnc.come. Columbia.cd
u/ICTVdB/11000000.htm
Zaire Ebola virus





X


MCM-H* Edition
Page B34

-------
EPA-OGWDW
Technical Support Document for the Draft Fifth Contaminant Candidate List
(CCL 5)-Microbiai Contaminants
EPA 815-R-21-007
July 2021
Viruses
1 2
3
4
5
6
7
8
9
10
11
12
PCCL
Page Reference
Zika virus








X



MCM-H* Edition
Zinga vims

X






litto ://www. cdc. eov/mmwr/ore
view/mmwrhtml/00001253.ht
m
Protozoa
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Page Reference
Acanthamoeba astronyxis







\




MCM-H* Edition
Acanthamoeba castellani







\




MCM-H* Edition
Acanthamoeba
culbertsoni







\




MCM-H* Edition
Acanthamoeba hatchetti







\




MCM-H* Edition
Acanthamoeba
palestinensis







\




MCM-H* Edition
Acanthamoeba polyphaga







\




MCM-H^ Edition
Acanthamoeba rhysodes







\




MCM-H^ Edition
Babesia bovis


\









MCM-H* Edition
Babesia divergens


\









MCM-H^ Edition
Babesia gibsoni


\









MCM-H^ Edition
Babesia microti


\









MCM-H* Edition
Balamuthia mandrillaris






\





MCM-H* Edition
Balantidium coli






\





MCM-H* Edition
Blastocystis hominis











Blastocystis hominis

Cryptosporidium parvum1




Page B35

-------
EPA-OGWDW	Technical Support Document for the Draft Fifth Contaminant Candidate List	EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Protozoa
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Page Reference
Cyclospora cayetanensis











Cyclospora cayetanensis

Dientamoeba fragilis





X






MCM-H* Edition
Encephalitozoon cuniculi









\


MCM-H^ Edition
Encephalitozoon hellem









\


MCM-H* Edition
Encephalitozoon
intestinalis











Microsporidia

Entamoeba chattoni









\


litto ://www .its.be/its/Distance
Learnins/LectureNotesVanden
EndenE/06 AmocbiasisD2.htm
#IX 450
Entamoeba histolytica











Entamoeba histolytica

Entamoeba moshkovskii









\


litto ://www .its.be/its/Distance
Learnins/LectureNotesVanden
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#1X 450
Enterocytozoon bieneusi









\


MCM-H* Edition
Giardia duodenalis1





Isospora belli











Lsospora belli

Leishmania aethiopica


X









MCM-H^ Edition
Leishmania amazonensis


X









MCM-H* Edition
Leishmania braziliensis


X









MCM-H^ Edition
Leishmania chagasi


X









MCM-H^ Edition
Leishmania donovani


X









MCM-H* Edition
Leishmania guyanensis


X









MCM-H* Edition
Leishmania infantum


X









MCM-H* Edition
Leishmania lainsoni


X









MCM-H* Edition
Leishmania major


X









MCM-H* Edition
Page B36

-------
EPA-OGWDW	Technical Support Document for the Draft Fifth Contaminant Candidate List	EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Protozoa
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Page Reference
Leishmania mexicana


X









MCM-H^ Edition
Leishmania naiffi


X









MCM-H^ Edition
Leishmania panamensis


X









MCM-H* Edition
Leishmania peruviana


X









MCM-H* Edition
Leishmania pifanoi


X









MCM-H* Edition
Leishmania shawi


X









MCM-H* Edition
Leishmania tropica


X









MCM-H* Edition
Leishmania venezuelensis


X









MCM-H* Edition
Naegleria fowleri











Naegleria fowleri

Nosema africanum






X





MCM-H* Edition
Nosema ceylonensis






X





MCM-H* Edition
Nosema connori






X





MCM-H^ Edition
Nosema ocularum






X





MCM-H^ Edition
Pentatrichomonas
hominis



X








MCM-H* Edition
Plasmodium falciparum


X









MCM-H* Edition
Plasmodium knowlesi


X









MCM-H* Edition
Plasmodium malariae


X









MCM-H* Edition
Plasmodium ovale


X









MCM-H* Edition
Plasmodium simium


X









MCM-H* Edition
Plasmodium vivax


X









MCM-H* Edition
Retortamonas intestinalis



X








MCM-H* Edition
Sarcocystis hominis





X






MCM-H* Edition
Sarcocystis lindermanni





X






MCM-H* Edition
Sarcocystis suihominis





X






MCM-H^ Edition
Toxoplasma gondii











Toxoplasma gondii

Trachipleistophora
hominis









X


MCM-H* Edition
Page B37

-------
EPA-OGWDW
Technical Support Document for the Draft Fifth Contaminant Candidate List
(CCL 5)-Microbiai Contaminants
EPA 815-R-21-007
July 2021
Protozoa
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Page Reference
Trichomonas tenax



X








MCM-H^ Edition
Trichomonas vaginalis

X










MCM-H^ Edition
Trypanosoma brucei


X









MCM-H* Edition
Trypanosoma cruzi


X









MCM-H* Edition
Vittaforma corneae






X





MCM-H* Edition










Helminths
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Page Reference
Acanthocephalus rauschi



x




Ashford and Crewe, 2003
Achillurbainia nouveli





X


Ashford and Crewe, 2003
Achillurbainia recondita



X




Ashford and Crewe, 2003
Alaria americana



X




Ashford and Crewe, 2003
Alaria marcianae



X




Ashford and Crewe, 2003
Amphimerus
pseudofelineus





X


Ashford and Crewe, 2003
Anatrichosoma cutaneum





X


Ashford and Crewe, 2003
Ancylostoma braziliense



X




Ashford and Crewe, 2003
Ancylostoma caninum





X


Ashford and Crewe, 2003
Ancylostoma ceylanicum





X


Ashford and Crewe, 2003
Ancylostoma duodenale



X




Ashford and Crewe, 2003
Ancylostoma malayanum





X


Ashford and Crewe, 2003
Anisakis physeteris



X




Ashford and Crewe, 2003
Anisakis simplex



X




Ashford and Crewe, 2003
Aonchotheca
philippinensis





X


Ashford and Crewe, 2003
Apophallus donicus



X




Ashford and Crewe, 2003
Page B38

-------
EPA-OGWDW	Technical Support Document for the Draft Fifth Contaminant Candidate List	EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Helminths
12 3
4
5 6
7
8 9
10
11 12
PCCL
Page Reference
Artyfechinostomum
mehrai





X


Ashford and Crewe, 2003
Ascaris lumbricoides

\


Ashford and Crewe, 2003
Ascaris suum

\


Ashford and Crewe, 2003
Ascocotyle sp.

\


Ashford and Crewe, 2003
Australobilharzia
terrigalensis


X

Ashford and Crewe, 2003
Baylisascaris procyonis

\


Ashford and Crewe, 2003
Bertiella mucronata

\


Ashford and Crewe, 2003
Bertiella studeri


X

Ashford and Crewe, 2003
Bilharziella polonica


X

Ashford and Crewe, 2003
Bolbosoma sp.


X

Ashford and Crewe, 2003
Brugia beaveri
\



Ashford and Crewe, 2003
Brugia guyanensis
\



Ashford and Crewe, 2003
Brugia malayi
\



Ashford and Crewe, 2003
Brugia pahangi
\



Ashford and Crewe, 2003
Brugia timori
\



Ashford and Crewe, 2003
Bunostomum
phlebotomum

\


Ashford and Crewe, 2003
Calodium hepaticum

\


Ashford and Crewe, 2003
Carneocephallus
brevicaea


X

Ashford and Crewe, 2003
Cathaemasia cabrerai


X

Ashford and Crewe, 2003
Centrocestus armatus


X

Ashford and Crewe, 2003
Centrocestus formosanus


X

Ashford and Crewe, 2003
Cheilospirura sp.


X

Ashford and Crewe, 2003
Clinostomum
complanatum


X

Ashford and Crewe, 2003
Contracaecum osculatum


X

Ashford and Crewe, 2003
Page B39

-------
EPA-OGWDW	Technical Support Document for the Draft Fifth Contaminant Candidate List	EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Helminths
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Page Reference
Corynosoma strumosum



\




Ashford and Crewe, 2003
Cryptocotyle lingua





X


Ashford and Crewe, 2003
Cyclodontostomum





X


Ashford and Crewe, 2003
purvisi









Dicrocoelium dendriticum



\




Ashford and Crewe, 2003
Dicrocoelium hospes





X


Ashford and Crewe, 2003
Dioctophyme renale



\




Ashford and Crewe, 2003
Dipetalonema arbuta

\






Ashford and Crewe, 2003
Dipetalonema reconditum

\






MCM-8, p. 634, 1209
Diphyllobothrium





X


Ashford and Crewe, 2003
cameroni









Diphyllobothrium
cordatum



\




Ashford and Crewe, 2003
Diphyllobothrium dalliae



\




Ashford and Crewe, 2003
Diphyllobothrium
dendriticum



\




Ashford and Crewe, 2003
Diphyllobothrium elegans





X


Ashford and Crewe, 2003
Diphyllobothrium





X


Ashford and Crewe, 2003
erinaceieuropaei









Diphyllobothrium hians





X


Ashford and Crewe, 2003
Diphyllobothrium
houghtoni





X


Ashford and Crewe, 2003
Diphyllobothrium
nihonkaiense





X


Ashford and Crewe, 2003
Diphyllobothrium
lanceolatum



\




Ashford and Crewe, 2003
Dibothriocephalus latus



\




Ashford and Crewe, 2003
Page B40

-------
EPA-OGWDW
Technical Support Document for the Draft Fifth Contaminant Candidate List
(CCL 5)-Microbiai Contaminants
EPA 815-R-21-007
July 2021
Helminths
12 3
4
5 6
7
8 9
10
11 12
PCCL
Page Reference
Diphyllobothrium
mansonoides



\




Ashford and Crewe, 2003
Diphyllobothrium
klebanovskii


X

Ashford and Crewe, 2003
Diphyllobothrium orcini


X

Ashford and Crewe, 2003
Adenocephalus pacificus


X

Ashford and Crewe, 2003
Diphyllobothrium
scoticum


X

Ashford and Crewe, 2003
Diphyllobothrium
stemmacephalum

\


Ashford and Crewe, 2003
Diphyllobothrium theileri


X

Ashford and Crewe, 2003
Diplogonoporus
balaenopterae


X

Ashford and Crewe, 2003
Diplogonoporus brauni


X

Ashford and Crewe, 2003
Diplogonoporus
balaenopterae


X

Ashford and Crewe, 2003
Diplostomum spathaceum


X

Ashford and Crewe, 2003
Dipylidium caninum

\


Ashford and Crewe, 2003
Dirofilaria immitis

\






Ashford and Crewe, 2003
Dirofilaria repens
\



Ashford and Crewe, 2003
Dirofilaria striata
\



Ashford and Crewe, 2003
Dirofilaria subdermata
\



Ashford and Crewe, 2003
Dirofilaria tenuis
\



Ashford and Crewe, 2003
Dirofilaria ursi
\



Ashford and Crewe, 2003
Dracunculus insignis


X

Ashford and Crewe, 2003
Dracunculus medinensis


X

Ashford and Crewe, 2003
Drepanidotaenia
lanceolata

\


Ashford and Crewe, 2003
Page B41

-------
EPA-OGWDW	Technical Support Document for the Draft Fifth Contaminant Candidate List	EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Helminths
12 3
4
5 6
7
8 9
10
11 12
PCCL
Page Reference
Echinochasmus japonicus





X


Ashford and Crewe, 2003
Echinochasmus jiufoensis


X

Ashford and Crewe, 2003
Echinochasmus
perfoliatus


X

Ashford and Crewe, 2003
Echinococcus granulosus

\


Ashford and Crewe, 2003
Echinococcus
multilocularis

\


Ashford and Crewe, 2003
Echinococcus oligarthus


X

Ashford and Crewe, 2003
Echinococcus vogeli


X

Ashford and Crewe, 2003
Echinoparyphium
recurvatum


X

Ashford and Crewe, 2003
Echinostoma cinetorchis


X

Ashford and Crewe, 2003
Echinostoma echinatum


X

Ashford and Crewe, 2003
Echinostoma hortense


X

Ashford and Crewe, 2003
Echinostoma ilocanum


X

Ashford and Crewe, 2003
Echinostoma jassyense


X

Ashford and Crewe, 2003
Echinostoma macrorchis


X

Ashford and Crewe, 2003
Echinostoma malayanum


X

Ashford and Crewe, 2003
Echinostoma revolutum


X

Ashford and Crewe, 2003
Enterobius gregorii

\


Ashford and Crewe, 2003
Enterobius vermicularis

\


Ashford and Crewe, 2003
Episthmium caninum


X

Ashford and Crewe, 2003
Eucoleus aerophilus

\


Ashford and Crewe, 2003
Eurytrema pancreaticum

\


Ashford and Crewe, 2003
Eustrongylides sp.

\


Ashford and Crewe, 2003
Fasciola indica

\


Ashford and Crewe, 2003
Page B42

-------
EPA-OGWDW	Technical Support Document for the Draft Fifth Contaminant Candidate List	EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Helminths
12 3
4
5 6
7
8 9
10
11 12
PCCL
Page Reference
Fasciola hepatica



\




Ashford and Crewe, 2003
Fasciola indica

\


Ashford and Crewe, 2003
Fasciolopsis buski


X

Ashford and Crewe, 2003
Neodiplostomum
seoulense


X

Ashford and Crewe, 2003
Gastrodiscoides hominis


X

Ashford and Crewe, 2003
Gigantobilharzia huttoni

\


Ashford and Crewe, 2003
Gigantobilharzia sturniae


X

Ashford and Crewe, 2003
Gnathostoma doloresi


X

Ashford and Crewe, 2003
Gnathostoma hispidum


X

Ashford and Crewe, 2003
Gnathostoma nipponicum


X

Ashford and Crewe, 2003
Gnathostoma spinigerum

\


Ashford and Crewe, 2003
Gongylonema pulchrum

\


Ashford and Crewe, 2003
Gymnophalloides sp.


X

Ashford and Crewe, 2003
Haemonchus contortus


X

Ashford and Crewe, 2003
Haplorchis pumilo


X

Ashford and Crewe, 2003
Haplorchis taichui


X

Ashford and Crewe, 2003
Haplorchis vanissima

\


Ashford and Crewe, 2003
Haplorchis yokogawai

\


Ashford and Crewe, 2003
Heterobilharzia
americana

\


Ashford and Crewe, 2003
Heterophyes dispar


X

Ashford and Crewe, 2003
Heterophyes heterophyes


X

Ashford and Crewe, 2003
Heterophyes nocens


X

Ashford and Crewe, 2003
Heterophyopsis continua


X

Ashford and Crewe, 2003
Page B43

-------
EPA-OGWDW
Technical Support Document for the Draft Fifth Contaminant Candidate List
(CCL 5)-Microbiai Contaminants
EPA 815-R-21-007
July 2021
Helminths
12 3
4
5 6
7
8 9
10
11 12
PCCL
Page Reference
Himasthala muehlensi



\




Ashford and Crewe, 2003
Hymenolepis diminuta

\


Ashford and Crewe, 2003
Hymenolepis nana

\


Ashford and Crewe, 2003
Hypoderaeum conoideum


X

Ashford and Crewe, 2003
Inermicapsifer
madagascariensis


X

Ashford and Crewe, 2003
Isoparorchis hypselobagri


X

Ashford and Crewe, 2003
Lagochilascaris minor

\


Ashford and Crewe, 2003
Ligula intestinalis


X

Ashford and Crewe, 2003
Loa loa
\



Ashford and Crewe, 2003
Macracanthorhynchus
hirudinaceus


X

Ashford and Crewe, 2003
Macracanthorhynchus
ingens

\


Ashford and Crewe, 2003
Mammomonogamus
laryngeus


X

Ashford and Crewe, 2003
Mammomonogamus
nasicola


X

Ashford and Crewe, 2003
Mansonella ozzardi
\



Ashford and Crewe, 2003
Mansonella perstans
\



Ashford and Crewe, 2003
Mansonella rodhaini
\



Ashford and Crewe, 2003
Mansonella semiclarum
\



Ashford and Crewe, 2003
Mansonella streptocerca

\






Ashford and Crewe, 2003
Marshallagia marshalli


X

Ashford and Crewe, 2003
Mathevotaenia
symmetrica


X

Ashford and Crewe, 2003
Mecistocirrus digitatus

\


Ashford and Crewe, 2003
Meningonema peruzzii


X

Ashford and Crewe, 2003
Mesocestoides lineatus


X

Ashford and Crewe, 2003
Page B44

-------
EPA-OGWDW	Technical Support Document for the Draft Fifth Contaminant Candidate List	EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Helminths
12 3
4
5 6
7
8 9
10
11 12
PCCL
Page Reference
Mesocestoides variabilis



\




Ashford and Crewe, 2003
Metagonimus minutus


X

Ashford and Crewe, 2003
Metagonimus yokogawai


X

Ashford and Crewe, 2003
Metastrongylus apri

\


Ashford and Crewe, 2003
Metorchis albidus

\


Ashford and Crewe, 2003
Metorchis conjunctus

\


Ashford and Crewe, 2003
Microfilaria bolivarensis
\



Ashford and Crewe, 2003
Micronema deletrix

\


Ashford and Crewe, 2003
Moniezia expansa

\


Ashford and Crewe, 2003
Moniliformis moniliformis

\


Ashford and Crewe, 2003
Multiceps brauni


X

Ashford and Crewe, 2003
Taenia glomeratus


X

Ashford and Crewe, 2003
Multiceps longihamatus


X

Ashford and Crewe, 2003
Multiceps multiceps

\


Ashford and Crewe, 2003
Taenia serialis

\


Ashford and Crewe, 2003
Nanophyetus salmincola

\


Ashford and Crewe, 2003
Necator americanus

\


Ashford and Crewe, 2003
Nematodirus abnormalis

\


Ashford and Crewe, 2003
Neodiplostomum sp.


X

Ashford and Crewe, 2003
Oesophagostomum
aculeatum


X

Ashford and Crewe, 2003
Oesophagostomum
bifurcum


X

Ashford and Crewe, 2003
Oesophagostomum
stephanostomum

\


Ashford and Crewe, 2003
Onchocerca volvulus
\



Ashford and Crewe, 2003
Opisthorchis
(Chlonorchis) sinensis


X

Ashford and Crewe, 2003
Page B45

-------
EPA-OGWDW	Technical Support Document for the Draft Fifth Contaminant Candidate List	EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Helminths
12 3
4
5 6
7
8 9
10
11 12
PCCL
Page Reference
Opisthorchis felineus





X


Ashford and Crewe, 2003
Opisthorchis noverca

\


Ashford and Crewe, 2003
Opisthorchis viverrini


X

Ashford and Crewe, 2003
Orientobilharzia
turkestanica


X

Ashford and Crewe, 2003
Ornithobilharzia sp.


X

Kolarova, 2007
Ostertagia ostertagi


X

Ashford and Crewe, 2003
Paragonimus africanus


X

Ashford and Crewe, 2003
Paragonimus bankokensis

\


Ashford and Crewe, 2003
Paragonimus caliensis

\


Ashford and Crewe, 2003
Paragonimus
heterotremus


X

Ashford and Crewe, 2003
Paragonimus
hueitungensis


X

Ashford and Crewe, 2003
Paragonimus kellicotti

\


Ashford and Crewe, 2003
Paragonimus mexicanus

\


Ashford and Crewe, 2003
Paragonimus miyazakii


X

Ashford and Crewe, 2003
Paragonimus ohirai


X

Ashford and Crewe, 2003
Paragonimus
phillipinensis


X

Ashford and Crewe, 2003
Paragonimus sadoensis


X

Ashford and Crewe, 2003
Paragonimus siamensis


X

Palmer et al., 1998, p. 736
Paragonimus skrjabini


X

Ashford and Crewe, 2003
Paragonimus
uterobilateralis


X

Ashford and Crewe, 2003
Paragonimus westermani


X

Ashford and Crewe, 2003
Parascaris equorum

\


Ashford and Crewe, 2003
Page B46

-------
EPA-OGWDW	Technical Support Document for the Draft Fifth Contaminant Candidate List	EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Helminths
12 3
4
5 6
7
8 9
10
11 12
PCCL
Page Reference
Parastrongylus
cantonensis





X


Ashford and Crewe, 2003
Parastrongylus
costaricensis

\


Ashford and Crewe, 2003
Pearsonema plica

\


MCM-8, p. 1134
Pelodera strongyloides


X

Ashford and Crewe, 2003
Phaneropsolus bonnei


X

Ashford and Crewe, 2003
Philophthalmus
lacrymosus


X

Ashford and Crewe, 2003
Pseudoterranova
decipiens

\


Ashford and Crewe, 2003
Physaloptera caucasica

\


Ashford and Crewe, 2003
Physaloptera transfuga


X

Ashford and Crewe, 2003
Plagiorchis harinasutai


X

Ashford and Crewe, 2003
Plagiorchis javensis


X

Ashford and Crewe, 2003
Plagiorchis muris


X

Ashford and Crewe, 2003
Plagiorchis philippinensis


X

Ashford and Crewe, 2003
Poikilorchis congolensis


X

Ashford and Crewe, 2003
Procerovum calderoni


X

Ashford and Crewe, 2003
Prohemistomum vivax


X

Ashford and Crewe, 2003
Prosthodendrium
molenkampi


X

Ashford and Crewe, 2003
Pseudamphistomum
aethiopicum


X

Ashford and Crewe, 2003
Pseudamphistomum
truncatum


X

Ashford and Crewe, 2003
Psilorchis hominis

\


Ashford and Crewe, 2003
Pygidiopsis summa


X

Ashford and Crewe, 2003
Pyramicocephalus
anthrocephalus

\


Ashford and Crewe, 2003
Page B47

-------
EPA-OGWDW	Technical Support Document for the Draft Fifth Contaminant Candidate List	EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Helminths
12 3
4
5 6
7
8 9
10
11 12
PCCL
Page Reference
Raillietina celebensis





X


Ashford and Crewe, 2003
Raillietina demerariensis

\


Ashford and Crewe, 2003
Rhabditis elongata


X

Ashford and Crewe, 2003
Rhabditis inermis


X

Ashford and Crewe, 2003
Rhabditis niellyi

\


Ashford and Crewe, 2003
Rhabditis pellioditis

\


Ashford and Crewe, 2003
Rictularia sp.

\


Ashford and Crewe, 2003
Schistocephalus solidus

\


Ashford and Crewe, 2003
Schistosoma bovis


X

Ashford and Crewe, 2003
Schistosoma haematobium


X

Ashford and Crewe, 2003
Schistosoma intercalatum


X

Ashford and Crewe, 2003
Schistosoma japonicum


X

Ashford and Crewe, 2003
Schistosoma malayensis


X

Ashford and Crewe, 2003
Schistosoma mansoni

\


Ashford and Crewe, 2003
Schistosoma mattheei


X

Ashford and Crewe, 2003
Schistosoma mekongi


X

Ashford and Crewe, 2003
Schistosoma rodhaini


X

Ashford and Crewe, 2003
Schistosoma spindale


X

Ashford and Crewe, 2003
Schistosomatium douthitti

\


Ashford and Crewe, 2003
Setaria equina
\



Ashford and Crewe, 2003
Spirocerca lupi


X

Ashford and Crewe, 2003
Stellantchasmus falcatus

\


Ashford and Crewe, 2003
Stictodora fuscata


X

Ashford and Crewe, 2003
Strongyloides fuelleborni


X

Ashford and Crewe, 2003
Page B48

-------
EPA-OGWDW	Technical Support Document for the Draft Fifth Contaminant Candidate List	EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Helminths
12 3
4
5 6
7
8 9
10
11 12
PCCL
Page Reference
Strongyloides papillosus



\




Ashford and Crewe, 2003
Strongyloides ransomi

\


Ashford and Crewe, 2003
Strongyloides stercoralis

\


Ashford and Crewe, 2003
Strongyloides westeri

\


Ashford and Crewe, 2003
Syphacea obvelata


X

Ashford and Crewe, 2003
Taenia crassiceps

\


Ashford and Crewe, 2003
Taenia saginata

\


Ashford and Crewe, 2003
Taenia solium

\


Ashford and Crewe, 2003
Taenia taeniaeformis


X

Ashford and Crewe, 2003
Teladorsagia
circumcincta


X

Ashford and Crewe, 2003
Ternidens deminutus


X

Ashford and Crewe, 2003
Thelazia californiensis
\



Ashford and Crewe, 2003
Thelazia callipaeda


X

Ashford and Crewe, 2003
Thelazia rhodesi


X

MCM-8, p. 363
Toxascaris leonina

\


Ashford and Crewe, 2003
Toxocara canis

\


Ashford and Crewe, 2003
Toxocara cati

\


Ashford and Crewe, 2003
Trichinella britovi


X

Ashford and Crewe, 2003
Trichinella nativa

\


Ashford and Crewe, 2003
Trichinella nelsoni


X

Ashford and Crewe, 2003
Trichinella pseudospiralis


X

Ashford and Crewe, 2003
Trichinella spiralis

\


Ashford and Crewe, 2003
Trichinella T5

\


Ashford and Crewe, 2003
Trichobilharzia brevis


X

Ashford and Crewe, 2003
Trichobilharzia ocellata

\


Ashford and Crewe, 2003
Trichobilharzia
stagnicolae

\


Ashford and Crewe, 2003
Trichostrongylus affinis

\


Ashford and Crewe, 2003
Page B49

-------
EPA-OGWDW
Technical Support Document for the Draft Fifth Contaminant Candidate List
(CCL 5)-Microbiai Contaminants
EPA 815-R-21-007
July 2021
Helminths
12 3
4
5 6
7
8 9
10
11 12
PCCL
Page Reference
Trichostrongylus axei



\




Ashford and Crewe, 2003
Trichostrongylus brevis


X

Ashford and Crewe, 2003
Trichostrongylus
calcaratus


X

Ashford and Crewe, 2003
Trichostrongylus
capricola


X

Ashford and Crewe, 2003
Trichostrongylus
colubriformis

\


Ashford and Crewe, 2003
Trichostrongylus
instabilis


X

Ashford and Crewe, 2003
Trichostrongylus lerouxi


X

Ashford and Crewe, 2003
Trichostrongylus
orientalis


X

Ashford and Crewe, 2003
Trichostrongylus
probolurus


X

Ashford and Crewe, 2003
Trichostrongylus skrjabini


X

Ashford and Crewe, 2003
Trichostrongylus vitrinus


X

Ashford and Crewe, 2003
Trichuris suis

\


Ashford and Crewe, 2003
Trichuris trichiura

\


Ashford and Crewe, 2003
Trichuris vulpis

\


Ashford and Crewe, 2003
Uncinaria stenocephala

\


Ashford and Crewe, 2003
Watsonius macaci


X

Ashford and Crewe, 2003
Wuchereria bancrofti
\



Ashford and Crewe, 2003
Wuchereria lewisi
\



Ashford and Crewe, 2003
Page B50

-------
EPA-OGWDW	Technical Support Document for the Draft Fifth Contaminant Candidate List	EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Fungi
12 3 4
5
6
7 8
9
10
11 12
PCCL
Page Reference
Absidia corymbifera




X



MCM-H* Edition
Acremonium kiliense


X


MCM-H* Edition
Acremonium potronii


X


MCM-H^ Edition
Acremonium recifei


X


MCM-H^ Edition
Acremonium strictum


X


MCM-H* Edition
Acrophialophora
fusispora


X


MCM-H* Edition
Actinomadura madurae


X


MCM-H* Edition
Actinomadura pelletieri


X


MCM-H* Edition
Alternaria alternata


X


MCM-H* Edition
Alternaria caespitosa


X


Howard p. 575
Alternaria chlamydospora


X


MCM-H* Edition
Alternaria dianthicola


X


MCM-H* Edition
Alternaria infectoria


X


MCM-H* Edition
Alternaria longipes


X


MCM-H^ Edition
Alternaria stemphyloides


X


htto://www.doctorfuneus.ore/t
hefunei/ Alternaria. htm
Alternaria tenuissima


X


MCM-H^ Edition
Aphanoascus fulvescens


X


MCM-H^ Edition
Apophysomyces elegans


X


MCM-H^ Edition
Arachnomyces
nodosetosus


X


MCM-H* Edition
Arthrinium
phaeospermum


X


h 11 d : // w w w. doc t o rfu n e u s. o r e/t
hefunei/ Arthrinium. htm
Arthroderma uncinatum


X


MCM-H* Edition
Arthrographis kelrae*


X


Warris et al., 2001
Aspergillus candidus


X


MCM-H* Edition
Aspergillus clavatus


X


MCM-H* Edition
Page B51

-------
EPA-OGWDW	Technical Support Document for the Draft Fifth Contaminant Candidate List	EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Fungi
12 3 4
5
6
7 8
9
10
11 12
PCCL
Page Reference
Aspergillus fisherianus




X



MCM-H* Edition
Aspergillus flavipes


X


MCM-H* Edition
Aspergillus flavus group


X


MCM-H^ Edition
Aspergillus fumigatus
group




Aspergillus fumigatus

Aspergillus glaucus


X


MCM-H* Edition
Aspergillus nidulans
group


X


MCM-H* Edition
Aspergillus niger


X


MCM-H* Edition
Aspergillus oryzae


X


MCM-H* Edition
Aspergillus terreus group


X


MCM-H* Edition
Aspergillus versicolor


X


MCM-H^ Edition
Aspergillus wentii


X


MCM-H^ Edition
Aureobasidium pullulans


X


MCM-H* Edition
Basidiobolus ranarum


X


MCM-H* Edition
Beauveria bassiana


X


MCM-H* Edition
Bipolaris australiensis


X


MCM-H* Edition
Blastomyces dermatitidis


X


MCM-H* Edition
Botryosphaeria
subglobosa


X


litto ://newoortal. sbif. ore/soecie
s/14373513 and
litto ://www .cabri. ors/C ABRI/s
rs-bin/weetz?-newld+-e+-
Daac+ciRcsult+ICABI FIL-
id:'IMI%20287616'l
Botrytsis cinerea

X



Hashimoto et al., 2017
Byssochlamys spectabilis


X


MCM-H* Edition
Page B52

-------
EPA-OGWDW
Technical Support Document for the Draft Fifth Contaminant Candidate List
(CCL 5)-Microbiai Contaminants
EPA 815-R-21-007
July 2021
Fungi
12 3 4
5
6
7 8
9
10
11 12
PCCL
Page Reference
Candida
acidothermophilum




X



MCM-H* Edition
Candida albicans


X


MCM-H* Edition
Candida catenulata


X


MCM-H* Edition
Candida famata


X


MCM-H* Edition
Candida fimetaria var.
fimetaria


X


MCM-H^ Edition
Candida glabrata
X




MCM-H* Edition
Candida haemulonis


X


MCM-H* Edition
Candida intermedia


X


htto://www.doctorfuneus.ore/t
hefunei/Candida smhtm
Candida lodderae


X


MCM-H* Edition
Candida mycoderma var.
annulata


X


MCM-H* Edition
Candida parapsilosis


X


MCM-H* Edition
Candida tropicalis


X


MCM-H* Edition
Cephaliophora irregularis


X


htto://www.doctorfuneus.ore/i
maacban/sv nonvms/CcDhalioD
hora.htm
Cerinosterus cyanescens


X


1iUd://w w w .doctorfunaus.ora/t
hefunei/Soorothrix.htm
Chaetomium
atrobrunneum


X


MCM-H* Edition
Chaetomium funicola


X


1111 d : //www. doc t o ifu n a u s. o r a/t
hefunsi/Chaetomium.htm
Chaetomium globosum


X


MCM-H*1 Edition
Chaetomium perpulchrum


X


h 11 d : //www. doc t o ifu n a ii s. o r a/t
hefunsi/Chaetomium.htm
Chaetomium strumarium


X


MCM-H*1 Edition
Page B53

-------
EPA-OGWDW	Technical Support Document for the Draft Fifth Contaminant Candidate List	EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Fungi
12 3 4
5
6
7 8
9
10
11 12
PCCL
Page Reference
Chaetophoma dermo-
unguis




X



htto://www.doctorfuneus.ore/i
ma acban/sv nonv ms/ChactoDlio
ma.htm
Chlamydoabsidia padenii


X


htto://www.doctorfuneus.ore/i
maeeban/svnonvms/Chlamvdo
absidia.htm
Chlorella protothecoides


X


htto://t)caoxfordiournals.ore/c
ei/content/abstract/9/1/87
Chrysosporium zonatum*


X


Arvanitidou et al., 1999
Cladophialophora arxii


X


MCM-H* Edition
Cladophialophora
bantiana


X


MCM-H* Edition
Cladophialophora boppii


X


MCM-H* Edition
Cladophialophora
carrionii


X


MCM-H* Edition
Cladophialophora
devriesii


X


MCM-H* Edition
Cladorrhinum bulbillosum


X


littD ://uwadmnweb .uwvo .edu/b
otanv/Soil%20Microfuneal%2
0Collection/RMF%20collectio
n%20(Rockv%20Mountain%2
OFunai )oartI Ilitm
Cladosporium
cladosporioides


X


MCM-H* Edition
Cladosporium elatum


X


htto://www.doctorfuneus.ore/t
hefunsi/CladosBorium.htm
Cladosporium oxysporum


X


htto://www.doctorfuneus.ore/t
hefunsi/CladosDorium.htm
Cladosporium
sphaerosphermum


X


MCM-H^ Edition
Page B54

-------
EPA-OGWDW	Technical Support Document for the Draft Fifth Contaminant Candidate List	EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Fungi
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Page Reference
Clavispora lusitaniae




X



MCM-H* Edition
Coccidioides immitis




X



MCM-H* Edition
Cochliobolus pallescens




X



Howard p. 584-586
Cokeromyces recurvartus




X



MCM-H^ Edition
Colletotrichum coccodes




X



Howard p. 662-664
Colletotrichum
gloeosporioides




X



Howard p. 662-664
Conidiobolus coronatus




X



MCM-H* Edition
Conidiobolus incongruus




X



MCM-H* Edition
Conidiobolus lamprauges




X



Howard p. 133-137
Coniochaeta hoffinannii




X



MCM-H* Edition
Coniochaeta mutabilis




X



MCM-H* Edition
Coniothyrium fuckelii




X



htto://www.doctorfuneus.ore/i
maeeban/svnonvms/Coniothvri
um.htm
Coprinopsis cinerea




X



MCM-H* Edition
Cryptococcus neoformans




X



MCM-H^ Edition
Cunninghamella
bertholletiae




X



MCM-H* Edition
Curvularia brachyspora




X



Howard p. 584-586
Curvularia clavata




X



Howard p. 584-586
Curvularia geniculata




X



MCM-H^ Edition
Curvularia hawaiiensis




X



MCM-H^ Edition
Curvularia lunata




X



MCM-H* Edition
Curvularia senegalensis




X



Howard p. 584-586
Curvularia spicifera




X



MCM-H* Edition
Page B55

-------
EPA-OGWDW	Technical Support Document for the Draft Fifth Contaminant Candidate List	EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Fungi
12 3 4
5
6
7 8
9
10
11 12
PCCL
Page Reference
Curvularia verucculosa




X



Howard p. 584-586
Dichotomophthora
portulacae


X


htto://www.doctorfuneus.ore/i
maeeban/svnonvms/Dichotom
ODhthora.htm
Dichotomophthoropsis
nymphaerum


X


htto://www.doctorfuneus.ore/i
maeeban/svnonvms/Dichotom
ODhthoroDsis.htm
Dissitimurus exedrus


X


Howard p. 588
Diutina rugosa


X


MCM-12
Doratomyces stemonitis


X


htto://www.doctorfuneus.ore/i
maeeban/svnonvms/Doratomvc
es.htm
Emmonsia crescens


X


MCM-12111 Edition
Emmonsia parva


X


MCM-12111 Edition
Epiccocum purpurascens

X



lUtDs://\Yww.insDa.ac.ca/cn/mo
ulds/fact-sheets/emcoccum-
DiirDiirasccns
Epidermophyton
floccosum


X


MCM-12111 Edition
Exophiala dermatitidis


X


MCM-12111 Edition
Exophiala jeanselmei




Exophiala jeanselmei

Exophiala moniliae


X


Howard p. 590-596
Exophiala pisciphila


X


Howard p. 590-596
Exophiala psychrophila


X


htto://www.doctorfuneus.ore/t
hefunei/exoohiala. htm
Exophiala salmonis


X


Howard p. 590-596
Exophiala spinifera


X


MCM-12111 Edition
Exosporium dematium


X


Howard p. 662-664
Exserohilum
longirostratum


X


MCM-12111 Edition
Page B56

-------
EPA-OGWDW	Technical Support Document for the Draft Fifth Contaminant Candidate List	EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Fungi
12 3 4
5
6
7 8
9
10
11 12
PCCL
Page Reference
Exserohilum macginnisii




X



Howard p. 596-597
Falciformispora
senegalensis


X


MCM-H* Edition
Falciformispora
tompkinsii


X


MCM-H^ Edition
Fonsecaea compacta


X


htto://www.doctorfuneus.ore/t
hefunei/Fonsecaea.htm
Fusarium aquaeductuum


X


Howard p. 402
Fusarium
chlamydosporum


X


MCM-H^ Edition
Fusarium dimerum


X


MCM-H^ Edition
Fusarium falciforme


X


MCM-H* Edition
Fusarium moniliforme


X


MCM-H* Edition
Fusarium napiforme


X


MCM-H* Edition
Fusarium
neocosmosporiellum


X


Howard p. 434-436
Fusarium nivale


X


Howard p. 431
Fusarium oxysporum


X


MCM-H* Edition
Fusarium pallidoroseum


X


Howard p. 320,418-421
Fusarium proliferatum


X


MCM-H* Edition
Fusarium sacchari


X


MCM-H^ Edition
Fusarium solani




Fusarium solani

Fusarium subglutinans


X


MCM-H* Edition
Fusarium ventricosum


X


htto://www.doctorfuneus.ore/t
hefunei/fusarium. htm
Fusarium verticillioides


X


MCM-H* Edition
Geotrichum candidum *


X


Rosenzweig et al, 1986
Gliomastix roseogrisea


X


Howard, p. 384
Hansenula anomala


X


MCM-H* Edition
Page B57

-------
EPA-OGWDW	Technical Support Document for the Draft Fifth Contaminant Candidate List	EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Fungi
12 3 4
5
6
7 8
9
10
11 12
PCCL
Page Reference
Histoplasma capsulatum




X



MCM-H* Edition
Hortaea werneckii


X


MCM-H* Edition
Humicola lanuginosa


X


Howard p. 623
Hypocrea pseudokoningii


X


MCM-H* Edition
Kiflimonium curvulum


X


MCM-H* Edition
Kluyveromyces marxianus


X


MCM-H* Edition
Lasiodiplodia theobromae


X


MCM-H* Edition
Lophophyton gallinae


X


MCM-H* Edition
Madurella ikedae


X


MCM-H* Edition
Magnusiomyces capitatus


X


MCM-H* Edition
Malassezia globosa
X




MCM-H* Edition
Malassezia obtusa
X




MCM-H* Edition
Malassezia pachydermatis
X




MCM-H* Edition
Malassezia restricta
X




MCM-H* Edition
Malassezia sloofiae
X




MCM-H^ Edition
Malassezia sympodialis
X




MCM-H* Edition
Meyerozyma
guilliermondii


X


MCM-H* Edition
Microascus cinereus


X


MCM-H* Edition
Microascus cirrosus


X


MCM-H* Edition
Microsporum audouinii


X


MCM-H^ Edition
Microsporum canis


X


MCM-H* Edition
Microsporum equinum


X


MCM-H* Edition
Microsporum ferrugineum


X


MCM-H* Edition
Page B58

-------
EPA-OGWDW	Technical Support Document for the Draft Fifth Contaminant Candidate List	EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Fungi
12 3 4
5
6
7 8
9
10
11 12
PCCL
Page Reference
Microsporum nanum




X



MCM-H* Edition
Microsporum praecox


X


MCM-H* Edition
Moniliella suaveolens


X


htto://www.doctorfuneus.ore/i
maeeban/svnonvms/Moniliella.
htm
Mucor circinelloides


X


MCM-H* Edition
Mucor hiemalis


X


MCM-H* Edition
Mucor indicus


X


Howard p. 70, 98-99, 101
Mucor racemosus


X


MCM-H* Edition
Mucor ramosissimus


X


MCM-H* Edition
Myceliophthora
thermophila


X


MCM-H* Edition
Mycocentrospora acerina


X


Howard p. 602-603
Mycoleptodiscus indicus


X


Howard p. 602-603
Myriodontium
keratinophilum


X


MCM-H* Edition
Nannizzia cajetani


X


Howard p. 155
Nannizzia fulva


X


MCM-H* Edition
Nannizzia gypsea


X


MCM-H* Edition
Nannizzia persicolor


X


MCM-H^ Edition
Nannizzia racemosa


X


MCM-H* Edition
Nattrassia mangiferae


X


MCM-H* Edition
Neocosmospora
cyanescens


X


MCM-H* Edition
Neocosmospora
keratoplastica


X


Howard p. 394
Neocosmospora
lichenicola


X


MCM-H* Edition
Page B59

-------
EPA-OGWDW	Technical Support Document for the Draft Fifth Contaminant Candidate List	EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Fungi
12 3 4
5
6
7 8
9
10
11 12
PCCL
Page Reference
Neoscytalidium hyalinum




X



MCM-H* Edition
Neotestudina rosatii


X


MCM-H* Edition
Neurospora sitophila


X


htto://www.doctorfuneus.ore/i
maeeban/svnonvms/Chrvsonili
a. htm
Nigrospora sphaerica


X


htto://www.doctorfuneus.ore/t
hefunei/Nierosoora.htm
Ochroconis gallopava


X


MCM-H* Edition
Ochroconis tshawytschae


X


Howard p. 617
Oidiodendron cereale


X


htto://www.doctorfuneus.ore/i
maeeban/svnonvms/Oidiodend
ron.htm
Oidium chartarum


X


Doggett, 2000
Oospora sulphureo-
ochracea


X


Howard p. 230-232
Ovadendron ochraceum


X


litto ://www .catalo eueoflife .ore/
show soccics details.Dho?rcco
rd id=3330913
Paecilomyces farinosus


X


htto://www.doctorfuneus.ore/t
hefunei/Paecilomvces.htm
Paecilomyces
fumerosoreus


X


Howard p. 361-362
Paecilomyces javanicus


X


MCM-H^ Edition
Paecilomyces lilacinus


X


MCM-H* Edition
Paecilomyces marquandii


X


MCM-H* Edition
Paecilomyces viridis


X


Howard p. 357-359
Paracoccidioides
brasiliensis


X


lUtD ://w\vw. docto rlli naus. ora/t
hefunsi/Lacazia.htm
Page B60

-------
EPA-OGWDW	Technical Support Document for the Draft Fifth Contaminant Candidate List	EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Fungi
12 3 4
5
6
7 8
9
10
11 12
PCCL
Page Reference
Paracoccidioides
brasiliensis




X



MCM-H* Edition
Parendomyces
zeylanoides


X


MCM-H* Edition
Parengyodontium album


X


MCM-H^ Edition
Penicillium chrysogenum


X


MCM-H* Edition
Penicillium citrinum


X


MCM-H* Edition
Penicillium commune


X


MCM-H* Edition
Penicillium decumbens


X


MCM-H^ Edition
Penicillium expansum


X


MCM-H* Edition
Penicillium marneffei


X


MCM-H* Edition
Penicillium
purpurogenum


X


MCM-H* Edition
Phaeoanellomyces
elegans


X


Howard p. 605-606
Phaeoanellomyces
werneckii


X


MCM-H* Edition
Phaeosclera dematioides


X


htto://www.doctorfuneus.ore/i
maeeban/svnonvms/Phaeoscler
a. htm
Phaeotrichoconis
crotalariae


X


Howard p. 606-607
Phanerochaete
chrysosporium


X


Doggett, 2000
Phialemoniopsis curvata


X


MCM-H* Edition
Phialemonium obovatum


X


MCM-H* Edition
Phialophora bubakii


X


Howard p. 607-612
Page B61

-------
EPA-OGWDW	Technical Support Document for the Draft Fifth Contaminant Candidate List	EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Fungi
12 3 4
5
6
7 8
9
10
11 12
PCCL
Page Reference
Phialophora pedrosoi




X



lUtD ://\vw\v.docto rfii naus. ora/t
hefunei/Fonsecaea.htm
Phialophora richardsiae


X


MCM-H^ Edition
Phialophora verrucosa


X


MCM-H* Edition
Phoma cava


X


htto://www.doctorfuneus.ore/t
hefunei/ohoma.htm
Phoma cruris-hominis


X


Howard p. 666-668
Phoma eupyrena


X


Howard p. 666-668
Phoma glomerata


X


Howard p. 666-668
Phoma herbarum


X


htto://www.doctorfuneus.ore/t
hefunei/ohoma.htm
Phoma hibernica


X


Howard p. 666-668
Phoma minutella


X


Howard p. 666-668
Phoma oculo-hominis


X


Howard p. 666-668
Phyllosticta citricarpa


X


lUtD ://w\vw. docto rlli naus. ora/t
hefunei/ohoma.htm
Piedraia hortae


X


MCM-H* Edition
Pityrosporum orbiculare
X




MCM-H^ Edition
Pleurophoma pleurospora


X


Howard p. 666-668
Pleurostoma repens


X


MCM-H^ Edition
Pneumocystis carinii

X



MCM-H* Edition
Prototheca wickerhamii


X


MCM-H* Edition
Prototheca zopfii


X


MCM-H* Edition
Pseudoallescheria boydii


X


MCM-H* Edition
P seudomicrodochium
suttonii


X


MCM-H* Edition
Pyrenochaeta
mackinnonii


X


MCM-H* Edition
Pyrenochaeta romeroi


X


MCM-H* Edition
Page B62

-------
EPA-OGWDW	Technical Support Document for the Draft Fifth Contaminant Candidate List	EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Fungi
12 3 4
5
6
7 8
9
10
11 12
PCCL
Page Reference
Pyrenochaeta unguis-
hominis




X



Howard p. 666-668
Pyrenophora biseptata


X


Howard p. 588-589
Pythium insidiosum


X


MCM-H* Edition
Ramichloridium
obovoidea


X


htto://www.doctorfuneus.ore/i
maeeban/svnonvms/Ramichlor
idium.htm
Rhinocladiella
aquaspersa


X


MCM-H* Edition
Rhinocladiella schulzeri


X


htto://www.doctorfuneus.ore/i
maeeban/svnonvms/Ramichlor
idium.htm
Rhinosporidium seeberi


X


MCM-H* Edition
Rhizomucor miehei


X


MCM-H* Edition
Rhizomucor pusillus


X


MCM-H* Edition
Rhizopus azygosporus


X


MCM-H* Edition
Rhizopus microsporias


X


MCM-H^ Edition
Rhizopus oryzae


X


MCM-H* Edition
Rhizopus stolonifer


X


MCM-H* Edition
Rhodotorula glutinis
X




MCM-H^ Edition
Rhodotorula minuta
X




MCM-H^ Edition
Rhodotorula mucilaginosa
X




MCM-H* Edition
Rhodotorula rubra
X




MCM-H* Edition
Saccharomyces cerevisiae


X


MCM-H* Edition
Saksenaea vasiformis


X


MCM-H* Edition
Sarcinomyces
phaeomuriformis


X


MCM-H* Edition
Scedosporium prolificans


X


MCM-H* Edition
Page B63

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EPA-OGWDW	Technical Support Document for the Draft Fifth Contaminant Candidate List	EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Fungi
12 3 4
5
6
7 8
9
10
11 12
PCCL
Page Reference
Schizophyllum commune




X



MCM-H* Edition
Scolecobasidium
humicola


X


Howard p. 617
Scopulariopsis
acremonium


X


MCM-H^ Edition
Scopulariopsis asperula


X


MCM-H* Edition
Scopulariopsis brevicaulis


X


MCM-H^ Edition
Scopulariopsis brumptii


X


MCM-H* Edition
Scopulariopsis Candida


X


MCM-H^ Edition
Scopulariopsis flava


X


MCM-H* Edition
Scopulariopsis fusca


X


MCM-H* Edition
Scytalidium infestans


X


litto ://www. scielo .br/scielo ,v\m
'.'scriDt=sci arttext&md=S0036
46651999000500009&lne=r>t&
nrm=iso&tlna=Dt
Septonema exile


X


Howard p. 621
Setosphaeria rostrata


X


MCM-H* Edition
Sporothrix schenckii


X


MCM-H^ Edition
Stemphylium
macrosporoideum *


X


West 1986
Stenella araguata


X


htto://www.doctorfuneus.ore/i
maeeban/svnonvms/Stenella.ht
m
Streptomyces somaliensis


X


MCM-H^ Edition
Taeniolella stilbaspora


X


Howard p. 621
Tetraploa aristata


X


Howard p. 621-623
Thermomyces dupontii


X


Howard p. 340-346
Page B64

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EPA-OGWDW	Technical Support Document for the Draft Fifth Contaminant Candidate List	EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Fungi
1
2
3
4
5
6
7
8
9
10
11
12
PCCL
Page Reference
Thielavia terrestris




X



MCM-H* Edition
Torulopsis magnoliae




X



htto://www.doctorfuneus.ore/i
maeeban/svnonvms/T oailoosis
.htm
Trematosphaeria grisea




X



MCM-H* Edition
Trichoderma viride




X



MCM-H* Edition
Trichomaris invadens




X



htto ://www .rac .dfo-
m do . sc .ca/sci/shelldis/raees/ch
itfdcb e.htm
Trichophyton
concentricum




X



MCM-H* Edition
Trichophyton equinum




X



MCM-H* Edition
Trichophyton gallinae




X



MCM-H* Edition
Trichophyton gourvilii




X



MCM-H* Edition
Trichophyton megninii




X



MCM-H* Edition
Trichophyton
mentagrophytes




X



MCM-H* Edition
Trichophyton rubrum




X



MCM-H* Edition
Trichophyton schoenleinii




X



MCM-H* Edition
Trichophyton simii




X



MCM-H* Edition
Trichophyton soudanense




X



MCM-H* Edition
Trichophyton tonsurans




X



MCM-H* Edition
Trichophyton verrucosum




X



MCM-H* Edition
Trichophyton violaceum




X



MCM-H* Edition
Trichosporon asahii




X



MCM-H* Edition
Trichosporon beigelii




X



MCM-H* Edition
Trichosporon cutaneum




X



MCM-H* Edition
Trichosporon inkin




X



MCM-H* Edition
Page B65

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EPA-OGWDW
Technical Support Document for the Draft Fifth Contaminant Candidate List
(CCL 5)-Microbiai Contaminants
EPA 815-R-21-007
July 2021
Fungi
12 3 4
5
6
7 8
9
10
11 12
PCCL
Page Reference
Trichosporon mucoides




X



MCM-H* Edition
Trichosporon ovoides


X


MCM-H* Edition
Tritirachium oryzae


X


htto://www.doctorfuneus.ore/i
maeeban/svnonvms/T ritirachiu
m.htm
Tubercularia vulgaris


X


Howard p. 448-449
Ulocladium chartarum


X


Howard p. 623-624
Veronaea botryosa


X


htto://www.doctorfuneus.ore/i
maucban/sv nonv ms/V eronaea.
htm
Verticillium nigrescens


X


Howard p. 449-450
Volutella cinerescens


X


Howard p. 451
Yarrowia lipolytica


X


MCM-H* Edition
Page B66

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EPA-OGWDW Technical Support Document for the Draft Fifth Contaminant Candidate List EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Appendix C: PCCL 5 Pathogen Scores
Pathogen
WBDO
Occurrence
Normalized health
score
Total score
Naegleria fowleri
5
3
5.0
10.0
Legionella pneumophila
5
3
3.6
8.6
Escherichia coli (0157)
5
3
3.2
8.2
Pseudomonas aeruginosa
5
3
3.2
8.2
Helicobacter pylori
1
3
5.0
8.0
Campylobacter jejuni
5
3
2.5
7.5
Mycobacterium abcessus
4
3
3.2
7.2
Shigella sonnei
4
3
3.2
7.2
Caliciviruses
5
3
2.1
7.1
Mycobacterium avium
4
3
2.9
6.9
Adenovirus
2
3
3.6
6.6
Enterovirus
2
3
3.6
6.6
Pantoea agglomerans
4
3
2.5
6.5
Hepatitis A virus
3
2
3.2
6.2
Fusarium solani
1
3
2.9
5.9
Nontuberculous Mycobacteria (NTM)
3
3
2.9
5.9
Hepatitis E virus
2
1
3.6
5.6
Cyclospora cayetanensis
3
3
2.5
5.5
Rotavirus
2
3
2.5
5.5
Salmonella enterica
3
3
2.5
5.5
Toxoplasma gondii
2
1
3.2
5.2
Aspergillus fumigatus group
1
3
2.1
5.1
Entamoeba histolytica
3
3
2.1
5.1
Exophiala jeanselmei
1
3
2.1
5.1
Vibrio cholerae
3
3
2.1
5.1
Aeromonas hydrophila
1
3
1.8
4.8
Plesiomonas shigelloides
3
3
1.8
4.8
Blastocystis hominis
4
1
0.7
4.7
Acinetobacter baumannii
1
2
2.5
4.5
Comanonas testosteroni
1
2
2.5
4.5
Yersinia enterocolitica
3
3
1.4
4.4
Astrovirus
2
2
1.4
3.4
Microsporidia
1
2
1.4
3.4
Isospora belli
2
1
1.1
3.1
Page CI

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EPA-OGWDW Technical Support Document for the Draft Fifth Contaminant Candidate List EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Appendix D: The Draft CCL 5 for Microbes
Microbe
Final
CCL 3
Final
CCL 4
Draft
CCL 51
Adenovirus
X
X
X
Caliciviruses
X
X
X
Campylobacter jejuni
X
X
X
Enterovirus
X
X
X
Escherichia coli (0157)
X
X
X
Helicobacter pylori
X
X
X
Legionella pneumophila
X
X
X
Mycobacterium abcessus


X
Mycobacterium avium
X
X
X
Naegleria fowleri
X
X
X
Pseudomonas aerugionosa


X
Shigella sonnei
X
X
X
hepatitis A and Salmonella enterica were listed on CCL 3 and CCL 4 but are not listed on CCL 5.
Page D1

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EPA-OGWDW Technical Support Document for the Draft Fifth Contaminant Candidate List EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Appendix E: Microbial Contaminant Information Sheets (CISs)
Microbes Infographics
Selection of microbes from the CCL Universe for placement on the PCCL is based upon
exclusionary screening criteria that assess the potential of water-related transmission
(occurrence) and the plausibility of causing waterborne disease by ingestion, inhalation, or
dermal contact (health effects). Microbes that met any of the exclusionary criteria were not
included on the PCCL.
The pages below provide examples of the CCL decision making process Adenovirus, which
was included on the CCL 5. Following the example are CISs for each of the PCCL 5 and
nominated microbes.
Page El

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EPA-OGWDW Technical Support Document for the Draft Fifth Contaminant Candidate List EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
This infographic shows Adenovirus as an example of a contaminant that was listed on the CCL
5.
The graphic shows a box for each of the three attributes (Occurrence, WBDO, and Health
Effects) that serve as input to the scoring model.
The attribute boxes show:
•	The data used for scoring each attribute, in bold, and indicated by a "yes" in the right hand
column.
•	The score the contaminant received for that particular attribute (in the left hand column).
•	The occurrence score (of 3) for Adenovirus was chosen, as shown in the upper left hand corner,
because it is greater than the WBDO score (of 2).
•	The health effects scores for the general population (of 6) and the sensitive population (of 4) are
added together (equaling 10) and multiplied by 5/14 (the health effects score equalizing value),
which equals 3.6.
•	The occurrence score is added to the adjusted health effects score for a total score for Adenovirus
of 6.6,
Pathogen _ Highest Score
Total Score " between WBDO
and Occurrence
i ,j- General Population *1	\
t ? asr- \ •*» :•
\ % Population	/	,
Example: Calculation of Adenovirus Total Score
Adenovirus Total Score = 3 (Occurrence Score) + ((6 (General Population Score) + 4
(Children/CD) x 5/14); Adenovirus Total Score = 3 + 3.6;
Adenovirus Total Score = 6.6
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EPA-OGWDW Technical Support Document for the Draft Fifth Contaminant Candidate List EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Adenovirus: Microbe Included on the CCL 5
Scoring Summary
Adenovirus
Occurrence
3
Total Score: 6.6
Health Effects

General population
6
Waterborne Disease Outbreaks
Sensitive population
4
Score
Data Element
Scoring Data
Occurrence
5
Multiple WBDOs in US (2009-2017)

Score
Data Element
Scoring Data
4
At least one WBDOs in US (2009-2017)

3
Detected in drinking water in the
US
Yes23
3
Caused WBDOs at any time in US

2
Detected in Source water in the US

2
Caused WBDOs in countries other
than US
Yes: Europe1
1
Not detected in the US

1
Never caused WBDOs, associated w/
water related disease

Health Effects
Score
Data Element
Scoring Data
7
Does the organism cause significant mortality (>
1/1,000 cases)

6
Does the organism cause pneumonia, meningitis,
hepatitis, encephalitis, endocarditis, cancer, or
other severe manifestations of illness necessitating
long term hospitalization (> week)?
[General population] A frequent cause of pneumonia among
(unvaccinated) military recruits. Two deaths in previously-healthy
adults.4
ARD is still significant problem in military. Less common
5
Does the illness result in long term or permanent
dysfunction or disability, i.e. sequelae?

4
Does the illness require short term hospitalization (<
week) ?
[Chronic Disease] Children with chronic disease required respiratory
ventilation.6
fChildren/ Young adults mav contract acute respiratory disease.7
3
Does the illness require physician intervention?

2
Is the illness self-limiting within 72 hours (without
requiring medical intervention)?

1
Does the illness result in mild symptoms with minimal
or no impact on daily activities?

Pathogen Total Score = Highest Score between WBDO and Occurrence + ((General Population Score
+ Highest Sensitive population Score) x 5/14)
Adenovirus Total Score = 3 (Occurrence Score) + ((6 (General Population Score) + 4 (Children/CD) x
5/14); Adenovirus Total Score = 3 + 3.6 = 6.6
1	Kukkula, M., Arstila P., Klossner M.L., Maunula L., Bonsdorff C.H., and P. Jaatinen. 1997. Scandinavian Journal of Infectious Disease,
29(4): 415-418.
2	O'Reilly, C.E., A.B. Bowen, E.P. Nytzia, J.P. Sarisky, C.A. Shepherd, M.D. Miller, B.C. Hubbard, M. Herring, S.D. Buchanan, C.C.
Fitzgerald, V. Hill, M.J. Arrowood, L.X. Xiao, R.M. Hoekstra, E.D. Mintz, M.F. Lynch, and the Outbreak Working Group. 2007. A
Waterborne Outbreak of Gastroenteritis with Multiple Etiologies among Resort Island Visitors and Residents: Ohio, 2004. Clinical Infectious
Diseases, 44:506-512.
3	Fong, T., L. Mansfield, D. Wilson, D. Schwab, S. Molloy and J. Rose. 2007. Massive Microbiological Groundwater Contamination
Associated with a Waterborne Outbreak in Lake Erie, South Bass Island, OH. Environmental Health Perspectives. 115(6): 856-864.
4	Gray, G.C., P.R. Goswami, M.D. Malasig, A.W. Hawksworth, D.H. Trump, M.A. Ryan and D.P. Schnurr. 2001. Adult Adenovirus
Infections: Loss of Orphaned Vaccines Precipitates Military Respiratory Disease Epidemics. Clinical Infectious Diseases, 31: 663-70.
5	Robinson, C. and M. Echavarria. 2007. Adenoviruses. In Murray, P.R., E.J. Baron, J.H. Jorgensen, M.L. Landry, and M.A. Pfaller (ed.) The
Manual of Clinical Microbiology, 9th. edition, American Society for Microbiology, Washington, DC. Vol. 2: p. 1592.
6	CDC, 1983. Adenovirus type 7 outbreak in a pediatric chronic-care facility - Pennsylvania. 1972. MMWR, 1983:32;258-60.
7	CDC, 1998. Surveillance for Waterborne-Disease Outbreaks Associated with Drinking Water — United States, 1995—1996. MMWR
Surveillance Summaries, 47(SS-5); 1-33.
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EPA-OGWDW Technical Support Document for the Draft Fifth Contaminant Candidate List EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Acinetobacter baumannii Scoring Data
Scoring Summary1'2
Occurrence
2
Health Effects
General population
1
Sensitive subpopulation(s) [CD, P]
6
1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two scores were selected: the
general population [G] and the highest score for a sensitive subpopulation. These 2 scores were added and normalized by
multiplying by 5/14 for a final health effects score. The higher score between the WBDO and Occurrence protocols was used for
total pathogen score calculation. Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic
Disease
Score2
Data Element
Scoring Data
Reference3

Waterborne Disease Outbreaks
5
Has caused multiple (2 or
more) documented WBDOs
in the U.S. reported by CDC
between 2009-2017
No
CDC-NORS, 2020
4
Has caused at least one
documented WBDOs in U.S.
reported by CDC between
2009-2017
No
CDC-NORS, 2020
3
Has caused documented
WBDOs at any time in the
U.S.?


2
Has caused WBDOs in
countries other than the
U.S.?


1
Has never caused WBDOs in
any country, but has been
epidemiologically associated
with water related disease?
Yes. Outbreaks occur
most commonly in
hospitals to very ill
patients by person to
person contact or via
contaminated surfaces.
However, it is still can
occur and be
transmitted in water.
CDC, 2010
Page E4

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EPA-OGWDW Technical Support Document for the Draft Fifth Contaminant Candidate List EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Score2
Data Element
Scoring Data
Reference3

Occurrence
3
Detected in drinking water in
the U.S.?


2
Detected in source water in
the U.S.?
Yes. It was detected
in untreated
groundwater used as
drinking water in
Preston County, W.
VA.
Bifulco, 1989
1
Not detected in the U.S.?



Health Effects
7
Does the organism cause
significant mortality (>
1/1,000 cases)


6 [CD, P]
Does the organism cause
pneumonia, meningitis,
hepatitis, encephalitis,
endocarditis, cancer, or
other severe manifestations
of illness necessitating long
term hospitalization (>
week)?
People with
weakened immune
systems due to
chronic diseases or
serious illnesses are
the most susceptible.
It causes various
diseases including
pneumonia and
serious blood or
wound infections.
Acinetobacter
baumannii infection
during pregnancy
can lead to
premature
contractions and
chorioamnionitis. it
can also cause septic
complications in the
puerperium
associated with long
duration of
hospitalization.
CDC, 2010
Aivazova, 2009
Cools et al., in
MCM, 2019
Page E5

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EPA-OGWDW Technical Support Document for the Draft Fifth Contaminant Candidate List EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Score2
Data Element
Scoring Data
Reference3
5
Does the illness result in
long term or permanent
dysfunction or disability, i.e.
sequelae?


4
Does the illness require short
term hospitalization (<
week)?


3
Does the illness require
physician intervention?


2
Is the illness self-limiting
within 72 hours (without
requiring medical
intervention)?


1 [G, C, E]
Does the illness result in
mild symptoms with
minimal or no impact on
daily activities?
[G, C, E]
Acinetobacter
baumannii poses a
very limited health
threat to individuals
without a health
condition. Most
studies only report
outbreaks in
hospitals with
patients that have a
health condition.
CDC, 2010
1 Bolded text inc
icates the highest score for that particular protocol. For the health effects protocol two
scores were selected: the general population [G] and the highest score for a sensitive subpopulation.
These 2 scores were added and normalized by multiplying by 5/14 for a final health effects score. The
higher score between the WBDO and Occurrence protocols was used for total pathogen score calculation.
Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic Disease.
2See Final Contaminant Candidate List 3 Microbes: PCCL to CCL Process. EPA 815-R-09-009. Final.
August 2009 for a detailed description on how to calculate the total pathogen score.
3EPA based the WBDO scores on the CDC MMWR reports from 1991 -2017 and then collected
occurrence citations if there were no CDC WBDOs.
References
Aivazova, V., Kainer, F., Friese, K., & Mylonas, I., 2010. Acinetobacter baumannii infection
during pregnancy and puerperium. Archives of gynecology and obstetrics, 257(1), 171-174.
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EPA-OGWDW Technical Support Document for the Draft Fifth Contaminant Candidate List EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Bifulco, J. M., Shirey, J. J., & Bissonnette, G. K., 1989. Detection of Acinetobacter spp. in rural
drinking water supplies. Applied and Environmental Microbiology, 55(9), 2214-2219.
Centers for Disease Control and Prevention (CDC)., 2010. Acinetobacter in Healthcare Settings.
(2010, November 24). Retrieved from https://www.cdc.gov/hai/organisms/acinetobacter.html.
CDC, 2020. National Outbreak Reporting System (NORS).
https://wwwn.cdc.gov/norsdashboard/ Accessed August 31, 2020.
Coots et al., Acinetobacter, Chryseobacterium, Moraxella, and Other Nonfermaentive Gram-
Negative Rods. Chapter 46 in Carroll, K.C., Pfaller, M.A., Landry, M. L., McAdam, A.J., Patel,
R., Richter, S.S. and Warnock, D.W. (ed). 2019. Manual of Clinical Microbiology, Twelfth
Edition.
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EPA-OGWDW Technical Support Document for the Draft Fifth Contaminant Candidate List EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Adenovirus Scoring Data
Scoring Summary1'2
Occurrence
3
Health Effects
General population
6
Sensitive subpopulation(s) [CD, C]
4
1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two scores were selected: the
general population [G] and the highest score for a sensitive subpopulation. These 2 scores were added and normalized by
multiplying by 5/14 for a final health effects score. The higher score between the WBDO and Occurrence protocols was used for
total pathogen score calculation. Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic
Disease
Score2
Data Element
Scoring Data
Reference3

Waterborne Disease Outbreaks
5
Has caused multiple (2 or
more) documented WBDOs
in the U.S. reported by CDC
between 2009-2017
No
CDC-NORS, 2020
4
Has caused at least one
documented WBDOs in U.S.
reported by CDC between
2009-2017
No
CDC-NORS, 2020
3
Has caused documented
WBDOs at any time in the
U.S.?


2
Has caused WBDOs in
countries other than the
U.S.?
Yes
Europe; S. Korea
Kukkula et al., 1997
Lee et al., 2002
1
Has never caused WBDOs in
any country, but has been
epidemiologically associated
with water related disease?



Occurrence
3
Detected in drinking water
in the U.S.?
Yes
O'Reilly et al., 2007
Fong et al., 2007
Page E8

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EPA-OGWDW Technical Support Document for the Draft Fifth Contaminant Candidate List EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Score2
Data Element
Scoring Data
Reference3


PCR in connection with
an outbreak.

2
Detected in source water in
the U.S.?
Yes
38% of surface water
samples collected as part
of the Information
Collection Rule contained
Adenovirus 40 and
Adenovirus 41.
USEPA, 2007
1
Not detected in the U.S.?



Health Effects
7
Does the organism cause
significant mortality (>
1/1,000 cases)?


6 [G]
Does the organism cause
pneumonia, meningitis,
hepatitis, encephalitis,
endocarditis, cancer, or
other severe manifestations
of illness necessitating long
term hospitalization (>
week)?
[G] A frequent cause of
pneumonia among
(unvaccinated) military
recruits. Two deaths in
previously-healthy
adults.
ARD is still a significant
problem in military. Less
common manifestations
include fatal neonatal
disease,
meningoencephalitis and
myocarditis.
Gray et al., 2001
Robinson in
Murray, 2010
Heim in Carroll,
2019
5
Does the illness result in
long term or permanent
dysfunction or disability, i.e.
sequelae?
None reported

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EPA-OGWDW Technical Support Document for the Draft Fifth Contaminant Candidate List EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Score2
Data Element
Scoring Data
Reference3
4[C,
CD]
Does the illness require
short term hospitalization
(< week)?
[CD] Children with
chronic disease required
respiratory ventilation.
[C] Young adults may
contract acute
respiratory disease.
CDC, 1983
CDC, 1998
3
Does the illness require
physician intervention?
Physician office visits are
indicated for ocular
infections.
Robinson in Murray,
2010
2 [E, P]
Is the illness self-limiting
within 72 hours (without
requiring medical
intervention)?
[E, P] Approximately 50%
of cases are asymptomatic,
symptomatic cases usually
present as upper
respiratory infections
similar to the common
cold.
Robinson in Murray,
2010
1
Does the illness result in
mild symptoms with minimal
or no impact on daily
activities?


1 Bolded text indicates the highest score for that particular protocol. For the hea
th effects protocol two
scores were selected: the general population [G] and the highest score for a sensitive subpopulation.
These 2 scores were added and normalized by multiplying by 5/14 for a final health effects score. The
higher score between the WBDO and Occurrence protocols was used for total pathogen score calculation.
Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic Disease.
2See Final Contaminant Candidate List 3 Microbes: PCCL to CCL Process. EPA 815-R-09-009. Final.
August 2009 for a detailed description on how to calculate the total pathogen score.
3EPA based the WBDO scores on the CDC MMWR reports from 1991 -2017 and then collected
occurrence citations if there were no CDC WBDOs.
References
Centers for Disease Control and Prevention (CDC). 1983. Adenovirus type 7 outbreak in a
pediatric chronic-care facility - Pennsylvania. 1972. MMWR, 1983: 32; 258-60.
CDC. 1998. Civilian Outbreak of Adenovirus Acute Respiratory Disease - South Dakota, 1997.
MMWR 1998: 47(27); 567-570.
CDC. 2020. National Outbreak Reporting System (NORS).
https://wwwn.cdc.gov/norsdashboard/ Accessed August 31, 2020.
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EPA-OGWDW Technical Support Document for the Draft Fifth Contaminant Candidate List EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Fong, T., L. Mansfield, D. Wilson, D. Schwab, S. Molloy and J. Rose. 2007. Massive
Microbiological Groundwater Contamination Associated with a Waterborne Outbreak in Lake
Erie, South Bass Island, OH. Environmental health perspectives, 115(6), 856-864.
Gray, G.C., P.R. Goswami, M.D. Malasig, A.W. Hawksworth, D.H. Trump, M.A. Ryan and D.P.
Schnurr. 2001. Adult Adenovirus Infections: Loss of Orphaned Vaccines Precipitates Military
Respiratory Disease Epidemics. Clinical Infectious Diseases, 31: 663-70.
Heim et al., in Carroll, K.C., Pfaller, M.A., Landry, M.L., McAdam, A.J., Patel, R., Richter, S.S.
and Warnock, D.W. (ed). 2019. Manual of Clinical Microbiology, Twelfth Edition.
Kukkula, M., Arstila P., Klossner M.L., Maunula L., Bonsdorff C.H., and P. Jaatinen. 1997.
Waterborne outbreak of viral gastroenteritis. Scandinavian Journal of Infectious Disease, 29(4):
415-8.
Lee, S. & Kim, S. 2002. Detection of infectious enteroviruses and adenoviruses in tap water in
urban areas in Korea. Water research. 36. 248-56. 10.1016/S0043-1354(01)00199-3.
O'Reilly, C.E., A.B. Bowen, E.P. Nytzia, J.P. Sarisky, C.A. Shepherd, M.D. Miller, B.C.
Hubbard, M. Herring, S.D. Buchanan, C.C. Fitzgerald, V. Hill, M.J. Arrowood, L.X. Xiao, R.M.
Hoekstra, E.D. Mintz, M.F. Lynch, and the Outbreak Working Group. 2007. A Waterborne
Outbreak of Gastroenteritis with Multiple Etiologies among Resort Island Visitors and
Residents: Ohio, 2004. Clinical Infectious Diseases, 44: 506-512.
Robinson, C. and M. Echavarria. 2010. Adenoviruses. In Murray, P.R., E.J. Baron, J.H.
Jorgensen, M.L. Landry, and M.A. Pfaller (ed.) The Manual of Clinical Microbiology, 10th.
edition, American Society for Microbiology, Washington, DC. Vol. 2: p. 1600.
United States Environmental Protection Agency. 2007. Adenovirus Health and Criteria
Document (Draft).
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EPA-OGWDW Technical Support Document for the Draft Fifth Contaminant Candidate List EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Aeromonas hydrophila Scoring Data
Scoring Summary1'2
Occurrence
3
Health Effects
General population
2
Sensitive subpopulation(s) [C]
3
1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two scores were selected: the
general population [G] and the highest score for a sensitive subpopulation. These 2 scores were added and normalized by
multiplying by 5/14 for a final health effects score. The higher score between the WBDO and Occurrence protocols was used for
total pathogen score calculation. Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic
Disease
Score2
Data Element
Scoring Data
Reference3

Waterborne Disease Outbreaks
5
Has caused multiple (1 or more)
documented WBDOs in the
U.S. reported by CDC between
2009-2017
No
CDC-NORS, 2020
4
Has caused at least one
documented WBDOs in U.S.
reported by CDC between
2009-2017
No
CDC, 1991 - CDC, 2017
3
Has caused documented
WBDOs at any time in the
U.S.?
No

2
Has caused WBDOs in
countries other than the U.S.?
No

1
Has never caused WBDOs in
any country, but has been
epidemiologically associated
with water related disease?
Yes
Gavriel et al., 1998

Occurrence
3
Detected in drinking water in
the U.S.?
Yes

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Score2
Data Element
Scoring Data
Reference3


EPA found A.
hydrophila in the
distribution systems
of 42 public water
systems out of 293
systems tested.
EPA, 2006 and EPA,
2003
2
Detected in source water in the
U.S.?
Yes
Holmes et al., 1996
EPA, 2006
1
Not detected in the U.S.?



Health Effects
7
Does the organism cause
significant mortality (> 1/1,000
cases)?
Wound infections are
usually preceded by
injury that occurs in
contact with water.
These infections
range from cellulitis
to myronecrotic
infections with a poor
prognosis.
Horneman et al. in
Murray, 2010
6
Does the organism cause
pneumonia, meningitis,
hepatitis, encephalitis,
endocarditis, cancer, or other
severe manifestations of illness
necessitating long term
hospitalization (> week)?
Septicemia occurs
rarely in
immunocompetent
hosts. Can cause
HUS.
Horneman et al. in
Murray, 2010
5
Does the illness result in long
term or permanent dysfunction
or disability, i.e. sequelae?


4
Does the illness require short
term hospitalization (< week)?


3 [C]
Does the illness require
physician intervention?
[C] Children may
require
hospitalization due
to dehydration.
Horneman and Ali in
Murray, 2010
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Score2
Data Element
Scoring Data
Reference3
2 [G, P, E,
CD]
Is the illness self-limiting
within 72 hours (without
requiring medical
intervention)?
[G, P, E, CD] Acute
watery disease is the
most common form
as well as
abdominal pain,
vomiting, fever.
Horneman and Ali in
Murray, 2010
1
Does the illness result in mild
symptoms with minimal or no
impact on daily activities?


1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two
scores were selected: the general population [G] and the highest score for a sensitive subpopulation.
These 2 scores were added and normalized by multiplying by 5/14 for a final health effects score. The
higher score between the WBDO and Occurrence protocols was used for total pathogen score calculation.
Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic Disease.
2See Final Contaminant Candidate List 3 Microbes: PCCL to CCL Process. EPA 815-R-09-009. Final.
August 2009 for a detailed description on how to calculate the total pathogen score.
3EPA based the WBDO scores on the CDC MMWR reports from 1991 -2017 and then collected
occurrence citations if there were no CDC WBDOs.
References
Centers for Disease Control and Prevention (CDC). 2020. National Outbreak Reporting System
(NORS). https://wwwn.cdc.gov/norsdashboard/ Accessed August 31, 2020.
Gavriel, A.A., J.P.B. Landre, and A.J. Lamb. 1998. Incidence of mesophilic Aeromonas within a
public drinking water supply in northeast Scotland. Journal of Applied Bacteriology, 84: 383-
392.
Holmes, P., L.M. Niccolls, and D.P. Sartory. 1996. The ecology of mesophilic Aeromonas in the
aquatic environment. In Austin, B., M. Altwegg, P.J. Gosling, and S. Joseph, (ed.) The Genus
Aeromonas. John Wiley & Sons, Chichester, UK.
Horneman, A., A. Al. 2010. Aeromonas. In Murray, P.R., E.J. Baron, J.H. Jorgensen, M.L.
Landry, and M.A. Pfaller (ed.) The Manual of Clinical Microbiology, 10th. edition, American
Society for Microbiology, Washington, DC. Vol. 1: p. 658.
United States Environmental Protection Agency (USEPA). 2003. Unpublished data on
occurrence results from the Unregulated Contaminant Monitoring Rule.
http://www.epa.gov/safewater/ucmr/data.html. See 70 FR 49094, August 22, 2005 for more
information.
USEPA. 2006. Aeromonas: Human Health Criteria Document.
http://www.epa.gov/waterscience/criteria/humanhealth/microbial/aeromonas-200603.pdf.
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Arcobacter butzleri Scoring Data
Scoring Summary1'2
Waterborne Disease Outbreak
4
Health Effects
General population
3
Sensitive subpopulation(s) [CD, C, P,
E]
3
1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two scores were selected: the
general population [G] and the highest score for a sensitive subpopulation. These 2 scores were added and normalized by
multiplying by 5/14 for a final health effects score. The higher score between the WBDO and Occurrence protocols was used for
total pathogen score calculation. Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic
Disease
Score2
Data Element
Scoring Data
Reference3

Waterborne Disease Outbreaks
5
Has caused multiple (1 or
more) documented WBDOs
in the U.S. reported by CDC
between 2009-2017
No
CDC-NORS, 2020
4
Has caused at least one
documented WBDOs in
U.S. reported by CDC
between 2009-2017
Yes
Not listed in CDC's
MMWR, however,
linked to outbreak
and drinking water.
Symptom severity
also suggests
Arcobacter.
Fong et al., 2007
3
Has caused documented
WBDOs at any time in the
U.S.?


2
Has caused WBDOs in
countries other than the
U.S.?


1
Has never caused WBDOs
in any country, but has been
epidemiologically


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Score2
Data Element
Scoring Data
Reference3

associated with water
related disease?



Occurrence
3
Detected in drinking water
in the U.S.?
Yes
Fong et al., 2007
2
Detected in source water in
the U.S.?
Yes
Arcobacter butzleri
was isolated from
ground water in Idaho
after a WBDO.
Rice et al., 1999
1
Not detected in the U.S.?



Health Effects
7
Does the organism cause
significant mortality (>
1/1,000 cases)?
Unknown

6
Does the organism cause
pneumonia, meningitis,
hepatitis, encephalitis,
endocarditis, cancer, or
other severe manifestations
of illness necessitating long
term hospitalization (>
week)?
Persons with
underlying disease
such as liver disease,
cirrhosis, or alcoholism
may be at increased
risk of complications.
Has been isolated from
patients with
bacteremia,
endocarditis, peritonitis
and diarrhea. Clinical
significance unknown.
Hsueh et al., 1997
Lerner et al., 1994
Yan et al., 2000
Fitzgerald in Murray,
2010
5
Does the illness result in
long term or permanent
dysfunction or disability, i.e.
sequelae?


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Score2
Data Element
Scoring Data
Reference3
4
Does the illness require
short term hospitalization (<
week)?


3 [G, C, P,
E, CD]
Does the illness require
physician intervention?
[All populations]
Displays clinical
features similar to
Campylobacter jejuni,
however is more
frequently associated
with a persistent
diarrhea. Twenty-six
percent of Belgian
patients required
antibiotics.
Vandenberg et al.,
2004
2
Is the illness self-limiting
within 72 hours (without
requiring medical
intervention)?
Usual symptoms are
diarrhea, abdominal
pain, vomiting, and
nausea resolving in < 3
days.
Wybo et al., 2004
Rice et al., 1999
1
Does the illness result in
mild symptoms with
minimal or no impact on
daily activities?


1 Bolded text inc
icates the highest score for that particular protocol. For the health effects protocol two
scores were selected: the general population [G] and the highest score for a sensitive subpopulation.
These 2 scores were added and normalized by multiplying by 5/14 for a final health effects score. The
higher score between the WBDO and Occurrence protocols was used for total pathogen score calculation.
Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic Disease.
2See Final Contaminant Candidate List 3 Microbes: PCCL to CCL Process. EPA 815-R-09-009. Final.
August 2009 for a detailed description on how to calculate the total pathogen score.
3EPA based the WBDO scores on the CDC MMWR reports from 1991 -2017 and then collected
occurrence citations if there were no CDC WBDOs.
References
Centers for Disease Control and Prevention (CDC), 2020. National Outbreak Reporting System
(NORS). https://wwwn.cdc.gov/norsdashboard/ Accessed August 31, 2020.
Fitzgerald, C. and I. Nachamkin. 2010. Campylobacter and Arcobacter. In Murray, P.R., E.J.
Baron, J.H. Jorgensen, M.L. Landry, and M.A. Pfaller (ed.) The Manual of Clinical
Microbiology, 10th. edition, American Society for Microbiology, Washington, DC. Vol. 1: p.
885.
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(CCL 5)-Microbiai Contaminants	July 2021
Fong, T., L. Mansfield, D. Wilson, D. Schwab, S. Molloy and J. Rose. 2007. Massive
Microbiological Groundwater Contamination Associated with a Waterborne Outbreak in Lake
Erie, South Bass Island, OH. Environmental health perspectives, 115(6), 856-864.
Houf, K., L.A. Devriese, et al. 2001. Susceptibility of Arcobacter butzleri, Arcobacter
cryaerophilus, and Arcobacter skirrowii to antimicrobial agents used in selective media. Journal
of Clinical Microbiology, 39(4): 1654-1656.
Hsueh, P.R., L.J. Teng, et al. 1997. Bacteremia caused by Arcobacter cryaerophilus IB. Journal
of Clinical Microbiology, 35(2): 489-491.
Nachamkin. 2019. Campylobacter and Arcobacter In Carroll, K.C., Pfaller, M.A., Landry, M.L.,
McAdam, A. J., Patel, R., Richter, S.S. and Warnock, D.W. (ed). 2019. Manual of Clinical
Microbiology, Twelfth Edition.
Lerner, J., V. Brumberger, et al. 1994. Severe diarrhea associated with Arcobacter butzleri.
European Journal of Clinical Microbiology & Infectious Diseases, 13(8): 660-662.
Rice, E.W., M.R. Rodgers, I.V. Wesley, C.H. Johnson, and S.A. Tanner. 1999. Isolation of
Arcobacter butzleri from ground water. Letters in applied microbiology, 28: 31-35.
Vandenberg, O., A. Dediste, K. Houg, S. Ibekwen, H. Souayah, S. Cadranel, N. Douat, G. Zissis,
J. Butzler and P. Vandamme. 2004. Arcobacter Species in Humans. Emerging Infectious
Diseases. Vol. 10, No. 10, page 1863, October 2004.
Wybo, I., J. Breynaert, et al.. (2004). Isolation of Arcobacter skirrowii from a patient with
chronic diarrhea. Journal of Clinical Microbiology, 42(4): 1851-1852.
Yan, J.J., W.C. Ko, et al. (2000). Arcobacter butzleri bacteremia in a patient with liver cirrhosis.
Journal of the Formosan Medical Association, 99(2): 166-169.
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Aspergillus fumigatus Scoring Data
Scoring Summary1'2
Occurrence
3
Health Effects
General population
3
Sensitive subpopulation(s) [C, P, E, CD]
3
1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two scores were selected: the
general population [G] and the highest score for a sensitive subpopulation. These 2 scores were added and normalized by
multiplying by 5/14 for a final health effects score. The higher score between the WBDO and Occurrence protocols was used for
total pathogen score calculation. Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic
Disease
Score2
Data Element
Scoring Data
Reference3

Waterborne Disease Outbreaks
5
Has caused multiple (1 or
more) documented
WBDOs in the U.S.
reported by CDC between
2009-2017
No
CDC-NORS, 2020
4
Has caused at least one
documented WBDOs in
U.S. reported by CDC
between 2009-2017
No
CDC, 1991 - CDC,
2017
3
Has caused documented
WBDOs at any time in the
U.S.?
No

2
Has caused WBDOs in
countries other than the
U.S.?
No

1
Has never caused
WBDOs in any country,
but has been
epidemiologically
associated with water
related disease?
Yes
Study on two bone
marrow transplantation
units at a Little Rock,
AR hospital.
Anaissie et al., 2002
Anaissie et al., 2003
Warris et al., 2003

Occurrence
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Score2
Data Element
Scoring Data
Reference3

Detected in drinking
water in the U.S.?
Yes
Anaissie et al., 2002
Anaissie et al., 2003
1


Nagy and Olson,
1982
O


Rosenzweig et al.,
1986
Doggett, 2000
Vesper et al., 2007
2
Detected in source water
in the U.S.?
Yes
Nagy and Olson, 1982
1
Not detected in the U.S.?



Health Effects
7
Does the organism cause
significant mortality (>
1/1,000 cases)?
Invasive infections
caused by Aspergillus
species are associated
with high rates of
morbidity and mortality,
especially in
immunosuppressed
patients.
Verweij and Brandt in
Murray, 2010
Chen in Carroll, 2019

Does the organism cause
pneumonia, meningitis,
hepatitis, encephalitis,
endocarditis, cancer, or
other severe
manifestations of illness
necessitating long term
hospitalization (> week)?
Sporadic cases of
invasive aspergillosis
have been reported in
immunocompetent hosts
(chronic meningitis,
endocarditis, pericarditis,
osteomyelitys).
Bodey and
Vartivarian, 1989
6

Invasive aspergillosis is
primarily an infection of
severely
immunocompromi sed
patients.
Serious infection can also
occur in patients with

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Score2
Data Element
Scoring Data
Reference3


more modest
impairments of host
immune system such as
diabetics.
Nagy and Olson, 1982
5
Does the illness result in
long term or permanent
dysfunction or disability,
i.e. sequelae?
None reported.

4
Does the illness require
short term hospitalization
(< week)?
Requirement for
hospitalization depends
upon the manifestation of
disease (e.g., superficial
skin and ear infections do
not require
hospitalization).
Bodey and
Vartivarian, 1989
3 [G, C, P,
E, CD]
Does the illness require
physician intervention?
[All populations] Most
infections and allergies
caused by this organism
require physician
intervention.
Bodey and
Vartivarian, 1989
CDC, 2019
2
Is the illness self-limiting
within 72 hours (without
requiring medical
intervention)?


1
Does the illness result in
mild symptoms with
minimal or no impact on
daily activities?
Aspergillus spores are
allergens and persons
who become sensitized
experience symptoms of
allergy and asthma.
Horner et al., 1995
1 Bolded text inc
icates the highest score for that particular protocol. For the health effects protocol two
scores were selected: the general population [G] and the highest score for a sensitive subpopulation.
These 2 scores were added and normalized by multiplying by 5/14 for a final health effects score. The
higher score between the WBDO and Occurrence protocols was used for total pathogen score calculation.
Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic Disease.
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2See Final Contaminant Candidate List 3 Microbes: PCCL to CCL Process. EPA 815-R-09-009. Final.
August 2009 for a detailed description on how to calculate the total pathogen score.
3EPA based the WBDO scores on the CDC MMWR reports from 1991 -2017 and then collected
occurrence citations if there were no CDC WBDOs.
References
Anaissie, E.J., S.L. Stratton, M.C. Dignani, R.C. Summerbell, J.H. Rex, T.P. Monson, T.
Spencer, M. Kasai, A. Francesconi, and T.J. Walsh. 2002. Pathogenic Aspergillus species
recovered from a hospital water system: a 3-year prospectie study. Clinical Infectious Diseases,
34: 780-789.
Anaissie, E.J., S.L. Stratton, M.C. Dignani, C. Lee, R.C. Summerbell, J.H. Rex, T.P. Monson,
and T.J. Walsh. 2003. Pathogenic molds (including Aspergillus species) in hospital water
distribution systems: a 3-year prospective study and clinical implications for patients with
hematologic malignancies. Blood, 101(7): 2542-2546.
Bodey, G.P. and S. Vartivarian. 1989. Aspergillosis. European Journal of Clinical Microbiology
and infectious diseases, 8(5): 413-437.
Centers for Disease Control and Prevention (CDC). 2019. Aspergillus home page.
www.cdc.gov/fungal/diseases/aspergillosis/index.html
CDC, 2020. National Outbreak Reporting System (NORS).
https://wwwn.cdc.gov/norsdashboard/ Accessed August 31, 2020.
Chen. Apergillus, Talarmyces, and Penicillium. in Carroll, K.C., Pfaller, M.A., Landry, M. L.,
McAdam, A. J., Patel, R., Richter, S.S. and Warnock, D.W. (ed). 2019. Manual of Clinical
Microbiology, Twelfth Edition.
Doggett, M.S. 2000. Characterization of fungal biofilms within a municipal water distribution
system. AppliedandEnvironmentalMicrobiology, 66(3): 1249-1251.
Horner, W.E., A. Helbling, J.E. Salvaggio, and S.B. Lehrer. 1995. Fungal allergens.
ClinicalMicrobiology. Reviews, 8(2): 161-179.
Nagy, L.A. and B.H. Olson. 1982. The occurrence of filamentous fungi in drinking water
distribution systems. Canadian Journal of Microbiology, 28: 667-671.
Rosenzweig W.D., H. Minnigh, and W.O. Pipes. 1986. Fungi in potable water distribution
systems. JAWWA 78(1): 53-55.
Verweij, P.E. and M.E. Brandt. 2010. Aspergillus, Fusarium, and Other Opportunistic
Moniliaceous Fungi. In Murray, P.R., E.J. Baron, J.H. Jorgensen, M.L. Landry and M.A. Pfaller
(ed.) Manual of Clinical Microbiology, 10th. edition, American Society for Microbiology,
Washington, DC (Vol. 2). p. 1836.
Vesper, S.J., M.E. Rogers, A.N. Neely andR.A. Haugland. 2007. Opportunistic Aspergillus
pathogens measured in home and hospital tap water by quantitative PCR (QPCR). Journal of
Water and Health, 5(3): 427-431.
Warris, A., C.H. W. Klassen, J.F.G.M. Meis, M.T. de Ruiter, H.A. de Valk, T.G. Abrahamsen, P.
Gaustaad, and P.E. Verweij. 2003. Molecular epidemiology of Aspergillus fumigatus isolates
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recovered from water, air, and patients shows two clusters of genetically distinct strains. Journal
of Clinical Microbiology. 41(9): 4101-4106.
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Astrovirus Scoring Data
Scoring Summary1'2
Waterborne Disease Outbreak
2
Health Effects
General population
2
Sensitive subpopulation(s) [C, P, E, CD]
2
1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two scores were selected: the
general population [G] and the highest score for a sensitive subpopulation. These 2 scores were added and normalized by
multiplying by 5/14 for a final health effects score. The higher score between the WBDO and Occurrence protocols was used for
total pathogen score calculation. Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic
Disease
Score2
Data Element
Scoring Data
Reference3

Waterborne Disease Outbreaks
5
Has caused multiple (1 or
more) documented WBDOs
in the U.S. reported by CDC
between 2009-2017
No
CDC-NORS, 2020
4
Has caused at least one
documented WBDOs in
U.S. reported by CDC
between 2009-2017
No
CDC, 1991 - CDC, 2017
3
Has caused documented
WBDOs at any time in the
U.S.?
No

2
Has caused WBDOs in
countries other than the
U.S.?
Yes
England and Wales
Smith et al., 2006
1
Has never caused WBDOs
in any country, but has been
epidemiologically
associated with water
related disease?
Yes
Gofti-Laroche et al., 2003

Occurrence
3
Detected in drinking water
in the U.S.?
No

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Score2
Data Element
Scoring Data
Reference3
2
Detected in source water
in the U.S.?
Yes
Astrovirus was
detected in 15 of 29
samples collected
under the
Information
Collection Rule.
Chapron et al., 2000
1
Not detected in the U.S.?



Health Effects
7
Does the organism cause
significant mortality (>
1/1,000 cases)?
No

6
Does the organism cause
pneumonia, meningitis,
hepatitis, encephalitis,
endocarditis, cancer, or
other severe manifestations
of illness necessitating long
term hospitalization (>
week)?
No

5
Does the illness result in
long term or permanent
dysfunction or disability, i.e.
sequelae?
No

4
Does the illness require
short term hospitalization (<
week)?
No

3
Does the illness require
physician intervention?
No

2 [G, C,
P, E, CD]
Is the illness self-limiting
within 72 hours (without
requiring medical
intervention)?
[All populations]
Asymptomatic
infections common.
Moderate self-
limiting
gastroenteritis
(vomiting and
diarrhea).
Farkas in Murray, 2010
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Score2
Data Element
Scoring Data
Reference3
1
Does the illness result in
mild symptoms with
minimal or no impact on
daily activities?


1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two
scores were selected: the general population [G] and the highest score for a sensitive subpopulation.
These 2 scores were added and normalized by multiplying by 5/14 for a final health effects score. The
higher score between the WBDO and Occurrence protocols was used for total pathogen score calculation.
Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic Disease.
2See Final Contaminant Candidate List 3 Microbes: PCCL to CCL Process. EPA 815-R-09-009. Final.
August 2009 for a detailed description on how to calculate the total pathogen score.
3EPA based the WBDO scores on the CDC MMWR reports from 1991 -2017 and then collected
occurrence citations if there were no CDC WBDOs.
References
Centers for Disease Control and Prevention (CDC). 2020. National Outbreak Reporting System
(NORS). https://wwwn.cdc.gov/norsdashboard/ Accessed August 31, 2020.
Chapron, C.D., N.A. Ballester, J.H. Fontaine, C.N. Frades, and A.B. Margolin. 2000. Detection
of astroviruses, enteroviruses, and adnovirus types 40 and 41 in surface waters collected and
evaluated by the information collection rule and an integrated cell culture-nested PCR procedure.
Applied and Environmental. Microbiology, 66(6): 2520-2525.
Farkas, T. and X. Jiang. 2010. Rotaviruses, Caliciviruses, Astroviruses, Enteric Adenoviruses,
and Other Diarrheic Viruses. In Murray, P.R., E.J. Baron, J.H. Jorgensen, M.A. Pfaller, and R.H.
Yolken (ed.) The Manual of Clinical Microbiology, 10th edition, American Society for
Microbiology, Washington, DC Vol. 2; p. 1456.
Gofti-Laroche, L., B. Gratacap-Cavallier, D. Demanse, O. Genoulaz, J-M. Segneurin, andD.
Zmirou. 2003. Are waterborne astrovirus implicated in acute digestive morbidity (E.M.I.R.A.
study)? J. Clin. Virol. 27: 74-82.
Pang and Smieja. Gastroenteritis Viruses in Carroll, K.C., Pfaller, M.A., Landry, M.L.,
McAdam, A. J., Patel, R., Richter, S.S. and Warnock, D.W. (ed). 2019. Manual of Clinical
Microbiology, Twelfth Edition.
Smith, A., M. Reacher, W. Smerdon, G.K. Adak, G. Nichols and R.M. Chalmers. 2006.
Outbreaks of waterborne infectious intestinal disease in England and Wales, 1992-2003.
Epidemiology & Infection, 134(6): 1141-1149.
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(CCL 5)-Microbiai Contaminants	July 2021
Blastocystis hominis Scoring Data
Scoring Summary1'2
Waterborne Disease Outbreak
4
Health Effects
General population
1
Sensitive subpopulation(s) [C, P, E, CD]
1
1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two scores were selected: the
general population [G] and the highest score for a sensitive subpopulation. These 2 scores were added and normalized by
multiplying by 5/14 for a final health effects score. The higher score between the WBDO and Occurrence protocols was used for
total pathogen score calculation. Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic
Disease
Score2
Data Element
Scoring Data
Reference3

Waterborne Disease Outbreaks
5
Has caused multiple (1 or
more) documented
WBDOs in the U.S.
reported by CDC between
2009-2017
No
CDC-NORS, 2020
4
Has caused at least one
documented WBDOs in
U.S. reported by CDC
between 2009-2017
Yes
2012: 1 Transient
noncommunity
(suspected)
CDC-NORS, 2020
3
Has caused documented
WBDOs at any time in
the U.S.?
No

2
Has caused WBDOs in
countries other than the
U.S.?
No

1
Has never caused
WBDOs in any country,
but has been
epidemiologically
associated with water
related disease?
Yes
Drinking untreated water
has been associated with
infection.
Leelayoova et al.,
2004
Stenzel and Boreham,
1996
Taamasri et al., 2000
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Score2
Data Element
Scoring Data
Reference3

Occurrence
3
Detected in drinking
water in the U.S.?
No

2
Detected in source water
in the U.S.?
No

1
Not detected in the U.S.?
Yes
Karanis, 2006

Health Effects
7
Does the organism cause
significant mortality (>
1/1,000 cases)?
No

6
Does the organism cause
pneumonia, meningitis,
hepatitis, encephalitis,
endocarditis, cancer, or
other severe
manifestations of illness
necessitating long term
hospitalization (> week)?
No

5
Does the illness result in
long term or permanent
dysfunction or disability,
i.e. sequelae?
No

4
Does the illness require
short term hospitalization
(< week)?
No

3
Does the illness require
physician intervention?
No

2
Is the illness self-limiting
within 72 hours (without
requiring medical
intervention)?
Symptoms may be more
pronounced and prolonged
in immunocompromised;
neoplasia and abnormal
intestinal tract function.
Leber in Murray, 2010
1[G, C, P,
E, CD]
Does the illness result in
mild symptoms with
minimal or no impact on
daily activities?
[All populations]
Pathogenicity of B.
hominis is controversial.
Symptoms may include
Leber in Murray,
2010; Novak-
Weekly, 2019
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(CCL 5)-Microbiai Contaminants	July 2021
Score2
Data Element
Scoring Data
Reference3


diarrhea, vomiting and
abdominal pain.

1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two
scores were selected: the general population [G] and the highest score for a sensitive subpopulation.
These 2 scores were added and normalized by multiplying by 5/14 for a final health effects score. The
higher score between the WBDO and Occurrence protocols was used for total pathogen score calculation.
Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic Disease.
2See Final Contaminant Candidate List 3 Microbes: PCCL to CCL Process. EPA 815-R-09-009. Final.
August 2009 for a detailed description on how to calculate the total pathogen score.
3EPA based the WBDO scores on the CDC MMWR reports from 1991 -2017 and then collected
occurrence citations if there were no CDC WBDOs.
References
Centers for Disease Control and Prevention (CDC), 2020. National Outbreak Reporting System
(NORS). https://wwwn.cdc.gov/norsdashboard/ Accessed August 31, 2020.
Karanis P. 2006. A review of an emerging waterborne medical important parasitic protozoan.
Japanese Journal of Protozoology, 39(1): 5-19.
Leber, A. and S. Novak-Weekley. 2010. Intestinal and Urogenital Amebae, Flagellates, and
Ciliates. In Murray, P.R., E.J. Baron, J.H. Jorgensen, M.L. Landry, and M.A. Pfaller (ed.) The
Manual of Clinical Microbiology, 10th. edition, American Society for Microbiology,
Washington, DC. Vol. 2: pp. 2149.
Leelayoova, S., R. Rangsin, P. Taamasri, T. Naaglor, U. Thathaisong, and M. Mungthin. 2004.
Evidence of waterborne transmission of Blastocystis hominis. American Journal of Tropical
Medicine & Hygiene, 70(6): 658-662.
Novak-Weekly and Leber. Intestinal and Urogenital Amebae, Flagellates, and Ciliates. in
Carroll, K.C., Pfaller, M.A., Landry, M.L., McAdam, A.J., Patel, R., Richter, S.S. and Warnock,
D.W. (ed). 2019. Manual of Clinical Microbiology, Twelfth Edition.
Stenzel, D.J., and P.F. Boreham. 1996. Blastocystis hominis revisited. Clinical Microbiology
Reviews, 9(4): 563-584.
Taamasri, P., M. Mungthin, R. Rangsin, B. Tongupprakarn, W. Areekul, and S. Leelayoova.
2000. Transmission of intestinal blastocystosis related to the quality of drinking water. Southeast
Asian Journal of Tropical Medicine & Public Health, 31(1): 112-117.
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EPA-OGWDW Technical Support Document for the Draft Fifth Contaminant Candidate List EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Calicivirus Scoring Data
Scoring Summary1'2
Waterborne Disease Outbreak
5
Health Effects
General population
2
Sensitive subpopulation(s) [C, E, CD]
4
1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two scores were selected: the
general population [G] and the highest score for a sensitive subpopulation. These 2 scores were added and normalized by
multiplying by 5/14 for a final health effects score. The higher score between the WBDO and Occurrence protocols was used for
total pathogen score calculation. Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic
Disease
Score2
Data Element
Scoring Data
Reference3

Waterborne Disease Outbreaks
5
Has caused multiple (2
or more) documented
WBDOs in the U.S.
reported by CDC
between 2009-2017
Yes
2010: 1 Nontransient
noncommunity
2012: 1 Transient
noncommunity
2014: 2 Transient
noncommunity
2015: 1 community
CDC-NORS, 2020
4
Has caused at least one
documented WBDOs in
U.S. reported by CDC
between 2009-2017


3
Has caused
documented WBDOs at
any time in the U.S.?
1971-2008: 11 Community
30 Noncommunity
CDC-NORS, 2020
2
Has caused WBDOs in
countries other than the
U.S.?


1
Has never caused
WBDOs in any


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(CCL 5)-Microbiai Contaminants	July 2021
Score2
Data Element
Scoring Data
Reference3

country, but has been
epidemiologically
associated with water
related disease?



Occurrence
3
Detected in drinking
water in the U.S.?
Yes
Detection by PCR.
Huffman et al., 2003
2
Detected in source
water in the U.S.?
Yes
Detected in ground water by
PCR.
Borchardt et al., 2003
Fout et al., 2003
1
Not detected in the
U.S.?



Health Effects
7
Does the organism
cause significant
mortality (> 1/1,000
cases)?


6
Does the organism
cause pneumonia,
meningitis, hepatitis,
encephalitis,
endocarditis, cancer, or
other severe
manifestations of
illness necessitating
long term
hospitalization (>
week)?
No long term sequelae have
been reported.
CDC, 2001
5
Does the illness result
in long term or
permanent dysfunction
or disability, i.e.
sequelae?
No
CDC, 2001
4 [C, E, CD]
Does the illness
require short term
[E, CD] (Norovirus)
Although rare, severe
dehydration can be fatal,
with this outcome
CDC, 2019
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(CCL 5)-Microbiai Contaminants	July 2021
Score2
Data Element
Scoring Data
Reference3

hospitalization (<
week)?
occurring among
susceptible persons (e.g.,
older persons with
debilitating health
conditions).
[C] Sappoviruses cause
disease mainly in children.
Farkas in Murray,
2007
3
Does the illness require
physician intervention?


2[G, P]
Is the illness self-
limiting within 72
hours (without
requiring medical
intervention)?
[G, P] Acute
gastroenteritis. Highly
contagious, able to cause
large outbreaks and
environmentally stable.
Farkas in Murray,
2007
1
Does the illness result
in mild symptoms with
minimal or no impact
on daily activities?


1 Bolded text inc
icates the highest score for t
lat particular protocol. For the health effects protocol two
scores were selected: the general population [G] and the highest score for a sensitive subpopulation.
These 2 scores were added and normalized by multiplying by 5/14 for a final health effects score. The
higher score between the WBDO and Occurrence protocols was used for total pathogen score calculation.
Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic Disease.
2See Final Contaminant Candidate List 3 Microbes: PCCL to CCL Process. EPA 815-R-09-009. Final.
August 2009 for a detailed description on how to calculate the total pathogen score.
3EPA based the WBDO scores on the CDC MMWR reports from 1991 -2017 and then collected
occurrence citations if there were no CDC WBDOs.
References
Borchardt, M.A., P.D. Bertz, S.K. Spencer, and D.A. Battigelli. 2003. Incidence of enteric
viruses in groundwater from household wells in Wisconsin. Applied and Environmental.
Microbiology, 69: 1172-1180.
Centers for Disease Control and Prevention (CDC). 2001 Norwalk-like viruses: Public health
consequences and outbreak management. MMWR 50(RR-9):1-18.
CDC. 2003. Managing acute gastroenteritis among children. MMWR 52(RR-16):1-16.
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(CCL 5)-Microbiai Contaminants	July 2021
CDC. 2019. Norovirus home page, https://www.cdc.gov/norovirus/index.html
CDC. 2020. National Outbreak Reporting System (NORS).
https://wwwn.cdc.gov/norsdashboard/ Accessed August 31, 2020.
Farkas, T. and X. Jiang. 2007. Rotaviruses, Caliciviruses, Astroviruses, Enteric Adenoviruses,
and Other Diarrheic Viruses. In Murray, P.R., E.J. Baron, J.H. Jorgensen, M.A. Pfaller, and R.H.
Yolken (ed.) The Manual of Clinical Microbiology, 9th edition, American Society for
Microbiology, Washington, DC Vol. 2; pp. 1454-1457.
Fout, G.S., B.C. Martinson, M.W. Moyer, and D.R. Dahling. 2003. A multiplex reverse
transcription-PCR method for detection of human enteric viruses in groundwater. Applied and
Environmental Microbiology, 69: 3158-3164.
Huffman, D.E., K.L. Nelson, and J.B. Rose. 2003. Calicivirus - an emerging contaminant in
water: state of the art. Environmental engineering science, 20: 503-515.
Pang and Smieja. Gastroenteritis Viruses in Carroll, K.C., Pfaller, M.A., Landry, M. L.,
McAdam, A. J., Patel, R., Richter, S.S. and Warnock, D.W. (ed). 2019. Manual of Clinical
Microbiology, Twelfth Edition.
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EPA-OGWDW Technical Support Document for the Draft Fifth Contaminant Candidate List EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Campylobacter jejuni Scoring Data
Scoring Summary1'2
Waterborne Disease Outbreak
5
Health Effects
General population
3
Sensitive subpopulation(s) [C, E]
4
1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two scores were selected: the
general population [G] and the highest score for a sensitive subpopulation. These 2 scores were added and normalized by
multiplying by 5/14 for a final health effects score. The higher score between the WBDO and Occurrence protocols was used for
total pathogen score calculation. Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic
Disease
Score2
Data Element
Scoring Data
Reference3

Waterborne Disease Outbreaks
5
Has caused multiple (2
or more) documented
WBDOs in the U.S.
reported by CDC
between 2009-2017
Yes
2009: 1 Community
2010: 3 Community
1 Nontransient
Noncommunity
2012: 1 Community
(Campylobacter
unknown)
2015: 2 Community
2017: 1 Community
CDC-NORS, 2020
4
Has caused at least one
documented WBDOs in
U.S. reported by CDC
between 2009-2017


3
Has caused documented
WBDOs at any time in
the U.S.?
Yes
1971-2008: 13 Community
and 15 Noncommunity
CDC-NORS, 2020
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(CCL 5)-Microbiai Contaminants	July 2021
Score2
Data Element
Scoring Data
Reference3
2
Has caused WBDOs in
countries other than the
U.S.?
Yes
Finland, New Zealand
Kuusi, 2005;
waterandhealth. org
1
Has never caused
WBDOs in any country,
but has been
epidemiologically
associated with water
related disease?



Occurrence
3
Detected in drinking
water in the U.S.?
Yes
Sacks et al., 1986
O'Reilly, 2007
2
Detected in source
water in the U.S.?
Yes
Carter et al., 1987
1
Not detected in the
U.S.?



Health Effects
7
Does the organism
cause significant
mortality (> 1/1,000
cases)?
Death is uncommon.
Fitzgerald in Murray,
2007
6
Does the organism
cause pneumonia,
meningitis, hepatitis,
encephalitis,
endocarditis, cancer, or
other severe
manifestations of illness
necessitating long term
hospitalization (>
week)?
Complications include
hepatitis, bacteremia
cholecystitis, pancreatitis,
nephritis, abortion and
neonatal sepsis, urinary
tract infection, meningitis
and septic arthritis.
Bacteremia occurs in
0.15% of intestinal
infections with elderly
mostly affected.
Fitzgerald in Murray,
2007
5
Does the illness result
in long term or
permanent dysfunction


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Score2
Data Element
Scoring Data
Reference3

or disability, i.e.
sequelae?



Does the illness
require short term
hospitalization (<
week)?
[C, E] Most cases do not
require hospitalization,
pediatric cases and
elderly are more likely to
require hospitalization
than normal adult cases.
Fitzgerald in
Murray, 2007
4[C, E]

The highest incidence is in
children and infants.
Bacteremia occurs at 1.5
per 1,000 cases with the
highest rate occurring in
the elderly.


Does the illness
require physician
intervention?
[G, P, CD] Guillain-Barre
syndrome, reactive
arthritis.
Fitzgerald in
Murray, 2007
3 [G, P, CD]

Guillain-Barre 1/1000
cases.
Reactive arthritis 1/100
cases.
Altekruse et al., 1999
2
Is the illness self-
limiting within 72 hours
(without requiring
medical intervention)?
Duration 2-5 days, usually
self-limiting.
Several days to more than 1
week, self-limiting, relapse
in 5-10% cases.
Heymann, 2005
Fitzgerald in Murray,
2007
CDC,2019
1
Does the illness result
in mild symptoms with
minimal or no impact
on daily activities?
Asymptomatic to acute
diarrhea, abdominal pain,
malaise, and fever.
Fitzgerald in Murray,
2007
1 Bolded text inc
icates the highest score for that particular protocol. For the health effects protocol two
scores were selected: the general population [G] and the highest score for a sensitive subpopulation.
These 2 scores were added and normalized by multiplying by 5/14 for a final health effects score. The
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higher score between the WBDO and Occurrence protocols was used for total pathogen score calculation.
Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic Disease.
2See Final Contaminant Candidate List 3 Microbes: PCCL to CCL Process. EPA 815-R-09-009. Final.
August 2009 for a detailed description on how to calculate the total pathogen score.
3EPA based the WBDO scores on the CDC NORS reports from 1971 - 2017 and then collected
occurrence citations if there were no CDC WBDOs.
References
Altekruse, S.F., N.J. Stern, P.I. Fields, and D.L. Swerdlow. 1999. Campylobacter jejuni - An
Emerging Foodborne Pathogen. Emerging Infectious Diseases, 5(1): 28-35.
Carter, A.M., R. E. Pacha, G.W. Colark, and E.A. Williams. 1987. Seasonal occurrence of
Campylobacter spp. in surface waters and their correlation with standard indicator bacteria.
Applied and Environmental. Microbiology, 53(3): 523-526.
Centers for Disease Control and Prevention (CDC), 2019. Campylobacter home page.
https://www.cdc.gov/campylobacter/index.html
CDC, 2020. National Outbreak Reporting System (NORS).
https://wwwn.cdc.gov/norsdashboard/ Accessed August 31, 2020.
Heymann, D. (ed.). 2005. Control of Communicable Diseases Manual, 18th ed. American Public
Health Association, Washington, DC.
Kuusi, M., J.P. Nuorti, M.L. Hanninen, M. Koskela, V. Jussila, E. Kela, I. Miettinen, P. Ruutu. A
large outbreak of campylobacteriosis associated with a municipal water supply in Finland.
Epidemiology & Infection, 2005 Aug; 133(4): 593-601
Fitzgerald, C. and I. Nachamkin. 2007. Campylobacter and Arcobacter. In Murray, P.R., E.J.
Baron, J.H. Jorgensen, M.L. Landry, and M.A. Pfaller (ed.) The Manual of Clinical
Microbiology, 9th. edition, American Society for Microbiology, Washington, DC. Vol. 1: pp.
933 -935.
Nachamkin. 2019. Campylobacter and Arcobacter in Carroll, K.C., Pfaller, M.A., Landry, M.L.,
McAdam, A. J., Patel, R., Richter, S.S. and Warnock, D.W. (ed). 2019. Manual of Clinical
Microbiology, Twelfth Edition.
O'Reilly, C.E., A.B. Bowen, N.E. Perez, J.P. Sarisky, C.A. Shepherd, M.D. Miller, B.C.
Hubbard, M. Herring, S.D. Buchanan, C.C. Fitzgerald, V. Hill, M.J. Arrowood, L.X. Xiao, R.M.
Hoekstra, E.D. Mintz, F. Lynch, and Outbreak Working Group. 2007. A Waterborne Outbreak of
Gastroenteritis with Multiple Etiologies among Resort Island Visitors and Residents: Ohio, 2004.
Clinical Infectious Diseases, 44(4): 506-512.
Sacks, J.J., S. Lieb, L.M. Baldy, S. Berta, C.M. Patton, M.C. White, W.J. Bigler, and J.J. Witte.
1986. Epidemic campylobacteriosis associated with a community water supply. American
Journal of Public Health, 76(4): 424-429.
Waterandhealth.org, 2017. https://waterandhealth.org/safe-drinking-water/update-new-zealands-
largest-drinking-water-outbreak-2.
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(CCL 5)-Microbiai Contaminants	July 2021
Comamonas testosteroni Scoring Data
Scoring Summary1'2
Occurrence
2
Health Effects
General population
1
Sensitive subpopulation(s) [CD]
6
1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two scores were selected: the
general population [G] and the highest score for a sensitive subpopulation. These 2 scores were added and normalized by
multiplying by 5/14 for a final health effects score. The higher score between the WBDO and Occurrence protocols was used for
total pathogen score calculation. Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic
Disease
Score2
Data Element
Scoring Data
Reference3

Waterborne Disease Outbreaks
5
Has caused multiple (2 or
more) documented WBDOs
in the U.S. reported by CDC
between 2009-2017
No
CDC-NORS, 2020
4
Has caused at least one
documented WBDOs in U.S.
reported by CDC between
2009-2017
No
CDC-NORS, 2020
3
Has caused documented
WBDOs at any time in the
U.S.?


2
Has caused WBDOs in
countries other than the
U.S.?


1
Has never caused WBDOs
in any country, but has
been epidemiologically
associated with water
related disease?



Occurrence
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Score2
Data Element
Scoring Data
Reference3
3
Detected in drinking water in
the U.S.?


2
Detected in source water in
the U.S.?
Comamonas
testosteroni is often
found in freshwater,
soil, plants, and in
hospital devices such
as intravenous lines
and the reservoir
water in the
humidifiers of
respiratory therapy
equipment.
Tiwari and Nanda,
2019
1
Not detected in the U.S.?



Health Effects
7
Does the organism cause
significant mortality (>
1/1,000 cases)?


6 [CD, G]
Does the organism cause
pneumonia, meningitis,
hepatitis, encephalitis,
endocarditis, cancer, or
other severe manifestations
of illness necessitating long
term hospitalization (>
week)?
Comamonas
testosteroni has been
shown to cause
pneumonia in
patients with AIDS.
(Franzetti et al.,
1992). It has also
been documented
causing meningitis in
a patient that had
recurrent
cholesteatoma (Arda
et al., 2008). It also
been shown to infect
those who were
previously healthy.
Franzetti et al., 1992
Arda et al., 2008
Arda et al., in MCM,
2019
5
Does the illness result in
long term or permanent
dysfunction or disability, i.e.
sequelae?


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(CCL 5)-Microbiai Contaminants	July 2021
Score2
Data Element
Scoring Data
Reference3
4
Does the illness require short
term hospitalization (<
week)?


3
Does the illness require
physician intervention?


2
Is the illness self-limiting
within 72 hours (without
requiring medical
intervention)?


1 [G]
Does the illness result in
mild symptoms with
minimal or no impact on
daily activities?
Infrequently cause
human infections on
healthy individuals
Arda et al., in MCM,
2019
1 Bolded text inc
icates the highest score for that particular protocol. For the health effects protocol two
scores were selected: the general population [G] and the highest score for a sensitive subpopulation.
These 2 scores were added and normalized by multiplying by 5/14 for a final health effects score. The
higher score between the WBDO and Occurrence protocols was used for total pathogen score calculation.
Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic Disease.
2See Final Contaminant Candidate List 3 Microbes: PCCL to CCL Process. EPA 815-R-09-009. Final.
August 2009 for a detailed description on how to calculate the total pathogen score.
3EPA based the WBDO scores on the CDC MMWR reports from 1991 -2017 and then collected
occurrence citations if there were no CDC WBDOs.
References
Arda, B., Aydemir, S., Yamazhan, T., Hassan, A., Tiinger, A., & Serter, D. 2003. Comamonas
testosteroni meningitis in a patient with recurrent cholesteatoma: Case report. Apmis, 111(4),
474-476.
Franzetti, F., Cernuschi, M., Esposito, R., & Moroni, M. 1992. Pseudomonas infections in
patients with AIDS and AIDS-related complex. Journal of internal medicine, 231(4), 437-443.
Centers for Disease Control and Prevention (CDC). 2020. National Outbreak Reporting System
(NORS). https://wwwn.cdc.gov/norsdashboard/ Accessed August 31, 2020.
LaPuma et al., Burkholderia, Stenotrophomonas, Ralstonia, Cupriavidus, Pandoraea,
Brevundimonas, Comamonas, Delftia, and Acidovorax. Chapter 45 in Carroll, K.C., Pfaller,
M.A., Landry, M.L., McAdam, A.J., Patel, R., Richter, S.S. and Warnock, D.W. (ed). 2019.
Manual of Clinical Microbiology, Twelfth Edition.
Tiwari, S., & Nanda, M. 2019. Bacteremia caused by Comamonas testosteroni an unusual
pathogen. Journal of laboratory physicians, 11(1), 87.
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Cyclospora cayetanensis Scoring Data
Scoring Summary1'2
Waterborne Disease Outbreak
3
Health Effects
General population
3
Sensitive subpopulation(s) [C]
4
1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two scores were selected: the
general population [G] and the highest score for a sensitive subpopulation. These 2 scores were added and normalized by
multiplying by 5/14 for a final health effects score. The higher score between the WBDO and Occurrence protocols was used for
total pathogen score calculation. Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic
Disease
Score2
Data Element
Scoring Data
Reference3

Waterborne Disease Outbreaks
5
Has caused multiple (1 or
more) documented WBDOs
in the U.S. reported by CDC
between 2009-2017
No
CDC-NORS, 2020
4
Has caused at least one
documented WBDOs in U.S.
reported by CDC between
2009-2017
No
CDC-NORS, 2020
3
Has caused documented
WBDOs at any time in the
U.S.?
Yes
1971-2008:2
Community
CDC-NORS, 2020
2
Has caused WBDOs in
countries other than the
U.S.?


1
Has never caused WBDOs
in any country, but has been
epidemiologically associated
with water related disease?
Yes
Huang et al., 1995

Occurrence
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Score2
Data Element
Scoring Data
Reference3
3
Detected in drinking water
in the U.S.?
Yes
CDC, 2011
2
Detected in source water in
the U.S.?
No

1
Not detected in the U.S.?
Detected in drinking
water in Guatemala.
Dowd et al., 2003

Health Effects
7
Does the organism cause
significant mortality (>
1/1,000 cases)?
No

6
Does the organism cause
pneumonia, meningitis,
hepatitis, encephalitis,
endocarditis, cancer, or other
severe manifestations of
illness necessitating long
term hospitalization (>
week)?
No

5
Does the illness result in
long term or permanent
dysfunction or disability, i.e.
sequelae?
Guillain-Barre and
Reiter' s syndromes
have been reported.
Connor et al., 2001
4 [C]
Does the illness require
short term hospitalization
(< week)?
[C] Most cases do not
required
hospitalization,
infants may require
hospitalization for
rehydration therapy.
Fisk et al., 2005
3 [G, P, E,
C, CD]
Does the illness require
physician intervention?
[All populations] Can
cause diarrhea and
biliary disease.
In patients not
treated, illness can be
protracted with
relapsing symptoms.
Lindsay in Murray,
2010
Heymann, 2005
CDC, 2019
2
Is the illness self-limiting
within 72 hours (without


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Score2
Data Element
Scoring Data
Reference3

requiring medical
intervention)?


1
Does the illness result in
mild symptoms with
minimal or no impact on
daily activities?


1 Bolded text inc
icates the highest score for that particular protocol. For the health effects protocol two
scores were selected: the general population [G] and the highest score for a sensitive subpopulation.
These 2 scores were added and normalized by multiplying by 5/14 for a final health effects score. The
higher score between the WBDO and Occurrence protocols was used for total pathogen score calculation.
Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic Disease.
2See Final Contaminant Candidate List 3 Microbes: PCCL to CCL Process. EPA 815-R-09-009. Final.
August 2009 for a detailed description on how to calculate the total pathogen score.
3EPA based the WBDO scores on the CDC MMWR reports from 1991 -2017 and then collected
occurrence citations if there were no CDC WBDOs.
References
Centers for Disease Control and Prevention (CDC). 2019. Cyclospora home page.
https://www.cdc.gov/parasites/cyclosporiasis/index.html
CDC, 2020. National Outbreak Reporting System (NORS).
https://wwwn.cdc.gov/norsdashboard/ Accessed August 31, 2020.
Connor, B.A., E. Johnson and R. Soave. 2001. Reiter syndrome following protracted symptoms
of Cyclospora infection. Emerging infectious diseases, 7: 453-454.
Dowd, E.S., D. John, J. Eliopolus, C.P. Gerba, J. Naranjo, R. Klein, B. Lopez, M. de Mejia, C.E.
Mndoza and I. Pepper. 2003. Confirmed detection of Cyclospora cayetanesis, Encepalitozoon
intestinalis and Cryptosporidium parvum in water used for drinking. Journal of Water and
Health, 01 (3): 117-123.
Fisk, T.L., J.S. Keystone, and P. Kozarsky. 2005. In Mandel, G.L., J.E. Bennett, and R. Dolin
Ed. Mandel, Douglas and Bennett's Principles and Practice of Infectious Diseases, 6th Ed.,
Elsevier, Philadelphia.
Heymann, D.(ed.). 2005. Control of Communicable Diseases Manual, 18th ed. American Public
Health Association, Washington, DC.
Huang, P., J.T. Weber, D.M. Sosin, P.M. Griffin, E.G. Long, J.J. Murphy, F. Kocka, C. Peters,
C. Kallick. 1995. The first reported outbreak of diarrheal illness associated with Cyclospora in
the United States. Annals of internal medicine, 123: 409-414.
Lindsay, D., S. Upton and L. Weiss. 2010. Isospora, Cyclospora and Sarcocystis. In Murray,
P.R., E.J. Baron, J.H. Jorgensen, M.A. Pfaller, and R.H. Yolken (ed.) The Manual of Clinical
Microbiology, 10th edition, American Society for Microbiology, Washington, DC Vol. 2; p.
2172.
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Entamoeba histolytica Scoring Data
Scoring Summary1'2
Waterborne Disease Outbreak
3
Health Effects
General population
3
Sensitive subpopulation(s) [C, P, E, CD]
3
1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two scores were selected: the
general population [G] and the highest score for a sensitive subpopulation. These 2 scores were added and normalized by
multiplying by 5/14 for a final health effects score. The higher score between the WBDO and Occurrence protocols was used for
total pathogen score calculation. Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic
Disease
Score2
Data Element
Scoring Data
Reference3

Waterborne Disease Outbreaks
5
Has caused multiple (1 or
more) documented WBDOs
in the U.S. reported by CDC
between 2009-2017
No
CDC-NORS, 2020
4
Has caused at least one
documented WBDOs in U.S.
reported by CDC between
2009-2017
No
CDC-NORS, 2020
3
Has caused documented
WBDOs at any time in the
U.S.?
1971-2008:3
Community (one is
"Entamoeba
unknown')
1 Noncommunity
CDC-NORS, 2020
2
Has caused WBDOs in
countries other than the U.S.?


1
Has never caused WBDOs in
any country, but has been
epidemiologically associated
with water related disease?



Occurrence
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Score2
Data Element
Scoring Data
Reference3
3
Detected in drinking water
in the U.S.?
Found during WBDO.
CDC, 2006
2
Detected in source water in
the U.S.?


1
Not detected in the U.S.?



Health Effects
7
Does the organism cause
significant mortality (>
1/1,000 cases)?
500 million infected (E.
dispar and E.
histolytica) each year
with approximately 50
million cases of colitis
and liver abscess and
100,000 deaths
worldwide.
Leber in Murray,
2010
6
Does the organism cause
pneumonia, meningitis,
hepatitis, encephalitis,
endocarditis, cancer, or other
severe manifestations of
illness necessitating long
term hospitalization (>
week)?
Infections in the U.S.
rarely progress to
complications, amoebic
colitis may result in
perforation of the
intestinal wall, resulting
in peritonitis;
dissemination to
extraintestinal sites may
involve the liver, lungs,
or brain. Liver abscess
is the most common
complication.
Heymann, 2005
5
Does the illness result in long
term or permanent
dysfunction or disability, i.e.
sequelae?
Abdominal perforations
and peritonitis are rare
complications. Up to
5% develop liver
abscess.
Leber in Murray,
2010
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Score2
Data Element
Scoring Data
Reference3
4
Does the illness require short
term hospitalization (<
week)?
Intestinal invasion can
lead to lesions, ulcers.
Leber in Murray,
2010
3 [G, C, P,
E, CD]
Does the illness require
physician intervention?
[All populations]
Clinical symptoms are
dysentery, colitis or
rarely amoeboma).
Fulminant colitis
occurs most often in
children who present
with diffuse
abdominal pain,
profuse bloody
diarrhea and fever.
Leber in Murray,
2010
Marshall, 1997
2
Is the illness self-limiting
within 72 hours (without
requiring medical
intervention)?
Most human infections
(90%) are
asymptomatic,
symptomatic non-
invasive strains cause
gastrointestinal
symptoms such as
cramping and increased
frequency of bowel
movements,
constipation may
alternate with diarrhea,
invasive strains may
cause amoebic
dysentery.
Heymann, 2005
1
Does the illness result in mild
symptoms with minimal or
no impact on daily activities?


1 Bolded text inc
icates the highest score for that particular protocol. For the healt
i effects protocol two
scores were selected: the general population [G] and the highest score for a sensitive subpopulation.
These 2 scores were added and normalized by multiplying by 5/14 for a final health effects score. The
higher score between the WBDO and Occurrence protocols was used for total pathogen score calculation.
Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic Disease.
2See Final Contaminant Candidate List 3 Microbes: PCCL to CCL Process. EPA 815-R-09-009. Final.
August 2009 for a detailed description on how to calculate the total pathogen score.
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3EPA based the WBDO scores on the CDC MMWR reports from 1991 -2017 and then collected
occurrence citations if there were no CDC WBDOs.
References
Centers for Disease Control and Prevention (CDC). 2020. National Outbreak Reporting System
(NORS). https://wwwn.cdc.gov/norsdashboard/ Accessed August 31, 2020.
Heymann, D. (ed.). 2005. Control of Communicable Diseases Manual, 18th ed. American Public
Health Association, Washington, DC.
Leber, A. and S. Novak-Weekley. 2010. Intestinal and Urogenital Amebae, Flagellates, and
Ciliates. In Murray, P.R., E.J. Baron, J.H. Jorgensen, M.L. Landry, and M.A. Pfaller (ed.) The
Manual of Clinical Microbiology, 10th. edition, American Society for Microbiology,
Washington, DC. Vol. 2: p. 2149.
Marshall, M., D. Naumovitz, Y. Ortega and C. Sterling. 1997. Clinical Microbiology Reviews,
Jan. 1997, p. 73.
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Enterovirus Scoring Data
Scoring Summary1'2
Occurrence
3
Health Effects
General population
4
Sensitive subpopulation(s) [C]
6
1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two scores were selected: the
general population [G] and the highest score for a sensitive subpopulation. These 2 scores were added and normalized by
multiplying by 5/14 for a final health effects score. The higher score between the WBDO and Occurrence protocols was used for
total pathogen score calculation. Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic
Disease
Score2
Data Element
Scoring Data
Reference3

Waterborne Disease Outbreaks
5
Has caused multiple (2 or
more) documented
WBDOs in the U.S.
reported by CDC between
2009-2017
No
CDC-NORS, 2020
4
Has caused at least one
documented WBDOs in
U.S. reported by CDC
between 1990-2009
No
CDC-NORS, 2020
3
Has caused documented
WBDOs at any time in
the U.S.?
No

2
Has caused WBDOs in
countries other than the
U.S.?
Yes
Switzerland and others.
Hafliger et al., 2000
1
Has never caused
WBDOs in any country,
but has been
epidemiologically
associated with water
related disease?



Occurrence
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Score2
Data Element
Scoring Data
Reference3

Detected in drinking
Yes
Mack et al., 1972

water in the U.S.?

Lieberman et al.,
3


2003



Keswick et al., 1984
O
Detected in source water
Yes
Borchardt et al., 2003
L
in the U.S.?


1
Not detected in the U.S.?



Health Effects

Does the organism cause


7
significant mortality (>



1/1,000 cases)?



Does the organism cause
[C] Aseptic meningitis
Heymann, 2005

pneumonia, meningitis,
and neonatal sepsis are


hepatitis, encephalitis,
the most common


endocarditis, cancer, or
complications.


other severe



manifestations of illness



necessitating long term
EVs are the most


hospitalization (>
common cause of
Romero in Murray,

week)?
meningitis in the U.S.,
2007


over 80% of all viral



meningitides (estimated



30,000 to 50,000



hospitalizations for non-

6 [C]

polio EV each year


(principally echo and



coxsackie)).



Enterovirus causes



myocarditis, viral



meningitis, encephalitis



and



meningioencephalitis.




Khetsuriani et al.,



2002


Widespread illness in
Kim et al., 2001


children with asthma.
Khetsuriani, 2003
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Score2
Data Element
Scoring Data
Reference3



Midgely at al, 2015
5
Does the illness result in
long term or permanent
dysfunction or disability,
i.e. sequelae?
Diabetes has been
associated with
enterovirus infection.
Heymann, 2005
4 [G]
Does the illness require
short term
hospitalization (<
week)?
[G] Hospitalization may
be required for severe
manifestations of
disease. Approximately
20-30% of meningitis
outbreak cases in young
adults require
hospitalization.
During the summer and
fall, responsible for 50 -
60% of hospital
admissions for
evaluation of febrile
illnesses for infants and
children.
Sawyer, 2002
Romero in Murray,
2007
3
Does the illness require
physician intervention?
Children with acute
pharyngitis may be taken
to a physician to
differentiate between
streptococcal and viral
sore throat. Upper
respiratory illness lasts 4-
6 days, lower respiratory
illness lasts 5-7 days, and
meningitis lasts 7-10
days.
Romero in Murray,
2007
Heymann, 2005
2 [E, P, CD]
Is the illness self-limiting
within 72 hours (without
requiring medical
intervention)?
[E, P, CD] Most cases are
asymptomatic. Most
common symptoms are
acute nonspecific febrile
illness.
Romero in Murray,
2007
1
Does the illness result in
mild symptoms with


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Score2
Data Element
Scoring Data
Reference3

minimal or no impact on
daily activities?


1 Bolded text inc
icates the highest score for that particular protocol. For the health effects protocol two
scores were selected: the general population [G] and the highest score for a sensitive subpopulation.
These 2 scores were added and normalized by multiplying by 5/14 for a final health effects score. The
higher score between the WBDO and Occurrence protocols was used for total pathogen score calculation.
Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic Disease.
2See Final Contaminant Candidate List 3 Microbes: PCCL to CCL Process. EPA 815-R-09-009. Final.
August 2009 for a detailed description on how to calculate the total pathogen score.
3EPA based the WBDO scores on the CDC MMWR reports from 1991 -2017 and then collected
occurrence citations if there were no CDC WBDOs.
References
Borchardt, M.A., P.D. Bertz, S.K. Spencer, and D.A. Battigelli. 2003. Incidence of enteric
viruses in groundwater from household wells in Wisconsin. Applied and Environmental
Microbiology, 69(2): 1172-1180.
Centers for Disease Control and Prevention (CDC). 2020. National Outbreak Reporting System
(NORS). https://wwwn.cdc.gov/norsdashboard/ Accessed August 31, 2020.
Hafliger D., P. Hubner and J. Luthy. 2000. Outbreak of viral gastroenteritis due to sewage-
contaminated drinking water, International Journal of Food Microbiology, 54(1-2): 123 - 126.
Heymann, D. (ed.). 2005. Control of Communicable Diseases Manual, 18th ed. American Public
Health Association, Washington, DC.
Keswick, B., C. Gerba, H. DuPont, and J. Rose. 1984. Detection of Enteric Viruses in Treated
Drinking Water. Applied and Environmental Microbiology, June 1984, 1290- 1294.
Khetsuriani N., R. Holman, and L. Anderson. 2002. Burden of Encephalitis-Associated
Hospitalizations in the United States, 1988-1997. Clinical Infectious Diseases. 35(2): 175-182.
Khetsuriani, N., E.S. Quiroz, R.C. Holman and L.J. Anderson. 2003. Viral meningitis-associated
hospitalizations in the United States, 1988-1999. Neuroepidemiology, 22(6): 345-352.
Kim, K-S., G. Hufnagel, N.M. Chapman, S. Tracy. 2001. The group B coxsackieviruses and
myocarditis. Reviews in Medical Virology, 11(6): 355-368.
Lieberman, R.J., L.C. Shadix, B.S. Newport, C.P. Frebis, M.W.N. Moyer, R.S. Safferman, R.E.
Stetler, D. Lye, G.S. Fout and D. Dahling. 2002 "Microbial monitoring of vulnerable public
ground water supplies." AWWA Research Foundation and AWWA, p. 142.
Mack, W.N., L. Yue-Shoung, and D.B. Coohon. 1972 "Isolation of poliomyelitis virus from a
contaminated wellHealth Services Report, 87(3): 271-274.
Midgley, C.M., Watson, J.T., Nix, W.A., Curns, A.T., Rogers, S.L., Brown, B.A., Conover, C.,
Dominguez, S.R., Feikin, D.R., Gray, S. and Hassan, F., 2015. Severe respiratory illness
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associated with a nationwide outbreak of enterovirus D68 in the USA (2014): a descriptive
epidemiological investigation. The Lancet Respiratory medicine, 3(11), 879-887.
Romero, J. 2007. Enteroviruses and Parechoviruses. In Murray, P.R., E.J. Baron, J.H. Jorgensen,
M.L. Landry, and M. A. Pfaller (ed.) The Manual of Clinical Microbiology, 9th. edition,
American Society for Microbiology, Washington, DC. Vol. 2: p. 1394.
Sawyer, M.H. 2002. Enterovirus infections: diagnosis and treatment. Seminars in Pediatric
Infectious Diseases 13(1): 40-47.
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Escherichia coli (0157)' Scoring Data
Scoring Summary1'2
Waterborne Disease Outbreak
5
Health Effects
General population
3
Sensitive subpopulation(s) [C, E]
6
1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two scores were selected: the
general population [G] and the highest score for a sensitive subpopulation. These 2 scores were added and normalized by
multiplying by 5/14 for a final health effects score. The higher score between the WBDO and Occurrence protocols was used for
total pathogen score calculation. Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic
Disease
Score2
Data Element
Scoring Data
Reference3

Waterborne Disease Outbreaks

Has caused multiple (2 or
more) documented
WBDOs in the U.S.
reported by CDC between
2009-2017
Yes
2010: 1 Community
2011: 1 Transient
Noncommunity
CDC-NORS, 2020
5

2013: 1 Transient
Noncommunity
2014: 1 Nontransient
Noncommunity
2016: 1 Community

4
Has caused at least one
documented WBDOs in
U.S. reported by CDC
between 2009-2017


3
Has caused documented
WBDOs at any time in
the U.S.?
1971-2008: 5 Community
5 Noncommunity
CDC-NORS, 2020
2
Has caused WBDOs in
countries other than the
U.S.?


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Score2
Data Element
Scoring Data
Reference3
1
Has never caused
WBDOs in any country,
but has been
epidemiologically
associated with water
related disease?



Occurrence
3
Detected in drinking
water in the U.S.?
Yes
Bopp et al., 2003
2
Detected in source water
in the U.S.?
Yes
As a result of animal
fecal contamination.
Kramer etal., 1996
1
Not detected in the U.S.?



Health Effects
7
Does the organism cause
significant mortality (>
1/1,000 cases)?
No
Approximately 60 deaths
per 73,000 cases per year
(nearly >1/1,000) are
reported due to E. coli
(0157). A case fatality
rate of 0.5 has been
reported for outbreak-
related cases caused by
E. coli 0157:H7
Nataro in Murray, 2007
Rangel et al., 2005
Buchan in Carroll,
2019
6 [C, E]
Does the organism cause
pneumonia, meningitis,
hepatitis, encephalitis,
endocarditis, cancer, or
other severe
manifestations of illness
necessitating long term
hospitalization (>
week)?
[C, E] Patients at
extremes of age have an
increased risk for
infection and associated
complications.
Children under 5 are
most frequently
diagnosed with infection
and are at greatest risk
of developing HUS. The
elderly also appear to
be an increased risk of
complications.
Chinyu, 1995
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Score2
Data Element
Scoring Data
Reference3


HUS develops in 10% of
patients under the age
of 10.
Nataro and Kaper,
1998
Heymann, 2005
CDC, 2019

Does the illness result in
long term or permanent
dysfunction or disability,
i.e. sequelae?
25% of HUS survivors
develop long term renal
sequelae.
Garg et al., 2003
5

3.2% of children with
diarrhea plus HUS
develop diabetes.
Adults have a greater
likelihood of
hypertension and reduced
renal function.
Suri et al., 2005
Garg et al., 2005
4
Does the illness require
short term hospitalization
(< week)?


3 [G, P, CD]
Does the illness require
physician intervention?
[G, P, CD] Fluid
replacement is the
cornerstone of
treatment for EHEC
diarrhea; some
clinicians choose to
hospitalize all patients
with E. coli 0157:H7
for hydration to prevent
HUS.
Heymann, 2005
2
Is the illness self-limiting
within 72 hours (without


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Score2
Data Element
Scoring Data
Reference3

requiring medical
intervention)?


1
Does the illness result in
mild symptoms with
minimal or no impact on
daily activities?
Can present as mild
nonbloody diarrhea.
Nataro in Murray, 2007
"The names E. coli 0157 and E. coli 0157:H7 are used interchangeably for CCL 5 due to
ongoing taxonomical debate in the scientific literature.
1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two
scores were selected: the general population [G] and the highest score for a sensitive subpopulation.
These 2 scores were added and normalized by multiplying by 5/14 for a final health effects score. The
higher score between the WBDO and Occurrence protocols was used for total pathogen score calculation.
Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic Disease.
2See Final Contaminant Candidate List 3 Microbes: PCCL to CCL Process. EPA 815-R-09-009. Final.
August 2009 for a detailed description on how to calculate the total pathogen score.
3EPA based the WBDO scores on the CDC MMWR reports from 1991 -2017 and then collected
occurrence citations if there were no CDC WBDOs.
References
Bopp, D.J., B.D. Sauders, A.L. Waring, J. Ackelsberg, N. Dumas, E. Braun-Howland, D.
Dziewulski, B.J. Wallace, M. Kelly, T. Halse, K. ArudaMusser, P.F. Smith, D.L. Morse, and
R.J. Limberger. 2003. Detection, Isolation, and Molecular Subtyping of Escherichia coli
0157:H7 and Campylobacter jejuni Associated with a Large Waterborne Outbreak. Journal of
Clinical Microbiology. 41(1): 174-180.
Buchan. Escherichia, Shigella and Salmonella in in Carroll, K.C., Pfaller, M.A., Landry, M.L.,
McAdam, A. J., Patel, R., Richter, S.S. and Warnock, D.W. (ed). 2019. Manual of Clinical
Microbiology, Twelfth Edition.
Chinyu S., and L.J. Brandt. Escherichia coli: H7 Infection in Humans. 1995. Annals of Internal
Medicine. 123 (9): 698-707.
Centers for Disease Control and Prevention (CDC). 2019. E. coli home page.
https://www.cdc.gov/ecoli/index.html.
CDC, 2020. National Outbreak Reporting System (NORS).
https://wwwn.cdc.gov/norsdashboard/ Accessed August 31, 2020.
Garg, A.X., L. Moist, D. Matsel, H.R. Thiessen-Philbrook, R.B. Haynes, R.S. Suri, M. Salvadori,
J. Ray, and W.F. Clark. 2005. Risk of hypertension and reduced kidney function after acute
gastroenteritis from bacteria-contaminated drinking water. CMAJ August 2, 2005: 173 (3).
Garg, A.X., R.S. Suri, N. Barrowman, F. Rehman, D. Matsell, M.P. Rosas-Arellano, M.
Salvadori, R.B. Haynes, and W.F. Clark. 2003. Long-term Renal Prognosis of Diarrhea-
Associated Hemolytic Uremic Syndrome. JAMA; 290 (10): 1360 -1370.
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EPA-OGWDW Technical Support Document for the Draft Fifth Contaminant Candidate List EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Heymann, D. (ed.). 2005. Control of Communicable Diseases Manual, 18th ed. American Public
Health Association, Washington, DC.
Karch, H., P.I. Tarr and M. Bielaszewska. 2005. Enterohaemorrhagic Eschericia coli in human
medicine. International Journal of Medical Microbiology, 295: 405-418.
Kramer, M.H., B.L. Herwaldt, G.F. Craun, R.L. Calderon, and D.D. Juranek. 1996. Surveillance
for waterborne-disease outbreaks - United States, 1993-1994. MMWR45(SS-): 1-33.
Nataro, J., C. Bopp, P. Fields, J. Kaper and N. Strockbine. 2007. Escherichia, Shigella and
Salmonella. In Murray, P.R., E.J. Baron, J.H. Jorgensen, M.L. Landry, and M.A. Pfaller (ed.)
The Manual of Clinical Microbiology, 9th. edition, American Society for Microbiology,
Washington, DC. Vol. 1: pp. 670 - 672.
Nataro, J.P. and J.B. Kaper. 1998. Diarrheagenic Escherichia coli. Clinical microbiology
reviews, 11(1): 142-201.
Rangel, J.M., P.H. Sparling, C. Crowe, P.M. Griffin, and D.L. Swerdlow. 2005. Epidemiology of
Escherichia coli 0157:H7 outbreaks, United States, 1982-2002. Emerging infectious diseases,
11(4): 603-609.
Suri, R.S., W.F. Clark, N. Barrowman, J.L. Mahon, H.R. Thiessen-Philbrook, M.P. Rosas-
Arellano, K. Zarnke, J.S. Garland, and A.X. Garg. 2005. Diabetes during diarrhea-associated
hemolytic uremic syndrome: a systematic review and meta-analysis. Diabetes Care, 2005
October, 28(10): 2556-2562.
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(CCL 5)-Microbiai Contaminants	July 2021
Exophiala jeanselmei Scoring Data
Scoring Summary1
Occurrence
3
Health Effects
General population
3
Sensitive subpopulation(s) [C, P, E, CD]
3
1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two scores were selected: the
general population [G] and the highest score for a sensitive subpopulation. These 2 scores were added and normalized by
multiplying by 5/14 for a final health effects score. The higher score between the WBDO and Occurrence protocols was used for
total pathogen score calculation. Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic
Disease
Score2
Data Element
Scoring Data
Reference3

Waterborne Disease Outbreaks
5
Has caused multiple (1 or
more) documented WBDOs
in the U.S. reported by CDC
between 2009-2017
No
CDC-NORS, 2020
4
Has caused at least one
documented WBDOs in U.S.
reported by CDC between
2009-2017
No
CDC-NORS, 2020
3
Has caused documented
WBDOs at any time in the
U.S.?
No

2
Has caused WBDOs in
countries other than the U.S.?
No

1
Has never caused WBDOs
in any country, but has
been epidemiologically
associated with water
related disease?
Yes
Nucci et al., 2002

Occurrence
3
Detected in drinking water
in the U.S.?
Yes
West, 1986
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(CCL 5)-Microbiai Contaminants	July 2021
Score2
Data Element
Scoring Data
Reference3
2
Detected in source water in
the U.S.?
Yes
Nucci et al., 2001
1
Not detected in the U.S.?



Health Effects
7
Does the organism cause
significant mortality (>
1/1,000 cases)?
No

6
Does the organism cause
pneumonia, meningitis,
hepatitis, encephalitis,
endocarditis, cancer, or other
severe manifestations of
illness necessitating long
term hospitalization (>
week)?
Infections increase in
severity in patients
with impaired
immunity and
metabolic diseases
such as diabetes.
De Hoog in Murray,
2007
5
Does the illness result in long
term or permanent
dysfunction or disability, i.e.
sequelae?
No

4
Does the illness require short
term hospitalization (<
week)?
No

3 [G, C, P,
E, CD]
Does the illness require
physician intervention?
[All populations] A
chronic spreading
mycosis.
The frequency of
infection is low, yet
potential severe
outcome and high
degrees of resistance
to antifungal drugs
requires medical
attention.
Heymann, 2005
De Hoog in Murray,
2007
2
Is the illness self-limiting
within 72 hours (without
requiring medical
intervention)?


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(CCL 5)-Microbiai Contaminants	July 2021
Score2
Data Element
Scoring Data
Reference3
1
Does the illness result in mild
symptoms with minimal or
no impact on daily activities?


1 Bolded text inc
icates the highest score for that particular protocol. For the health effects protocol two
scores were selected: the general population [G] and the highest score for a sensitive subpopulation.
These 2 scores were added and normalized by multiplying by 5/14 for a final health effects score. The
higher score between the WBDO and Occurrence protocols was used for total pathogen score calculation.
Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic Disease.
2See Final Contaminant Candidate List 3 Microbes: PCCL to CCL Process. EPA 815-R-09-009. Final.
August 2009 for a detailed description on how to calculate the total pathogen score.
3EPA based the WBDO scores on the CDC MMWR reports from 1991 -2017 and then collected
occurrence citations if there were no CDC WBDOs.
References
Centers for Disease Control and Prevention (CDC). 2020. National Outbreak Reporting System
(NORS). https://wwwn.cdc.gov/norsdashboard/ Accessed August 31, 2020.
Heymann, D. (ed.). 2005. Control of Communicable Diseases Manual, 18th ed. American Public
Health Association, Washington, DC.
Nucci, M.T. Akiti, G. Barreiros, F. Silveira, S.G. Revankar, D.A. Sutton, and T.F. Patterson.
2001. Nosocomial fungemia due to Exophiala jeanselmei var. jeanselmei and a Rhinocladiella
species: newly described causes of bloodstream infection. Journal of Clinical. Microbiology,
39(2): 514-518.
Nucci, M.T., T. Akiti, G. Barreiros, F. Silveira, S.G. Revankar, B.L. Wickes, D.A. Sutton, and
T.F. Patterson. 2002. Nosocomial outbreak of Exophiala jeanselmei fungemia associated with
contamination of hospital water. Clinical infectious diseases, 34: 1475-1480.
De Hoog, G. and R. Vitale. 2007. Bipolaris, Exophiala, Scedosporium, Sporothrix, and Other
Dematiaceous Fungi. In Murray, P.R., E.J. Baron, J.H. Jorgensen, M.L. Landry, and M.A. Pfaller
(ed.) The Manual of Clinical Microbiology, 9th. edition, American Society for Microbiology,
Washington, DC. Vol. 2: pp. 1908 and 1918.
West, P.R. 1986. Isolation rates and characterization of fungi in drinking water distribution
systems. Proceedings of the Water Quality Technology Conference, American Water Works
Association, Denver, CO.
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(CCL 5)-Microbiai Contaminants	July 2021
l usarinm solani Scoring Data
Scoring Summary1'2
Occurrence
3
Health Effects
General population
4
Sensitive subpopulation(s) [C, P, E, CD]
4
1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two scores were selected: the
general population [G] and the highest score for a sensitive subpopulation. These 2 scores were added and normalized by
multiplying by 5/14 for a final health effects score. The higher score between the WBDO and Occurrence protocols was used for
total pathogen score calculation. Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic
Disease
Score2
Data Element
Scoring Data
Reference3

Waterborne Disease Outbreaks
5
Has caused multiple (1 or
more) documented WBDOs
in the U.S. reported by CDC
between 2009-2017
No
CDC-NORS, 2020
4
Has caused at least one
documented WBDOs in U.S.
reported by CDC between
2009-2017
No
CDC-NORS, 2020
3
Has caused documented
WBDOs at any time in the
U.S.?
No

2
Has caused WBDOs in
countries other than the U.S.?
No

1
Has never caused WBDOs
in any country, but has
been epidemiologically
associated with water
related disease?
Yes
Houston TX
Annaissie et al., 2001

Occurrence
3
Detected in drinking water
in the U.S.?
Yes
Nagy and Olson,
1982
Annaissie et al., 2001
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(CCL 5)-Microbiai Contaminants	July 2021
Score2
Data Element
Scoring Data
Reference3
2
Detected in source water in
the U.S.?
Yes

1
Not detected in the U.S.?



Health Effects
7
Does the organism cause
significant mortality (>
1/1,000 cases)?
Mortality associated
with cutaneous
Fusarium infection is
high in
immunocompromi sed
patients but low for
immunocompetent
hosts.
Nucci and Annaissie,
2002
6
Does the organism cause
pneumonia, meningitis,
hepatitis, encephalitis,
endocarditis, cancer, or other
severe manifestations of
illness necessitating long
term hospitalization (>
week)?
Most severe disease
occurs in severely
immunocompromised.
Fusarium has been
associated with
pneumonia and
disseminated
infections
Fridkin and Jarvis,
1996; Annaissie et al.,
2001
Sutton and Brandt, in
Murray, 2010
5
Does the illness result in long
term or permanent
dysfunction or disability, i.e.
sequelae?


4 [G, C, P,
E, CD]
Does the illness require short
term hospitalization (<
week)?
[All populations] Can
cause infections that
may require
hospitalization,
particularly in
immunocompromised
patients
(endophthalmitis,
central nervous
system infections,
endocarditis)
Dignani and
Anaissie, 2004
3
Does the illness require
physician intervention?
Treatment and/or
removal of the foreign
body is usually
Dignani and Anaissie,
2004
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(CCL 5)-Microbiai Contaminants	July 2021
Score2
Data Element
Scoring Data
Reference3


required as well as
antifungal therapy.
In immunocompetent
patients manifestations
include keratitis,
localized skin lesions,
onychomycosis, and
occasionally cellulitis
and peritonitis.

2
Is the illness self-limiting
within 72 hours (without
requiring medical
intervention)?


1
Does the illness result in mild
symptoms with minimal or
no impact on daily activities?


1 Bolded text inc
icates the highest score for that particular protocol. For the health effects protocol two
scores were selected: the general population [G] and the highest score for a sensitive subpopulation.
These 2 scores were added and normalized by multiplying by 5/14 for a final health effects score. The
higher score between the WBDO and Occurrence protocols was used for total pathogen score calculation.
Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic Disease.
2See Final Contaminant Candidate List 3 Microbes: PCCL to CCL Process. EPA 815-R-09-009. Final.
August 2009 for a detailed description on how to calculate the total pathogen score.
3EPA based the WBDO scores on the CDC MMWR reports from 1991 -2017 and then collected
occurrence citations if there were no CDC WBDOs.
References
Anaissie, E.J., R.T. Kuchar, J.H. Rex, A. Francesconi, M. Kasai, F-M.C. Muller, M. Lozano-
Chiu, R.C. Summerbell, M.C. Dignani, S.J. Chanock, and T.J. Walsh. 2001. Fusariosis
Associated with Pathogenic Fusarium Species Colonization of a Hospital Water System: A New
Paradigm for the Epidemiology of Opportunistic Mold Infections. Clinical Infectious diseases,
33: 1871-1878.
Centers for Disease Control and Prevention (CDC). 2020. National Outbreak Reporting System
(NORS). https://wwwn.cdc.gov/norsdashboard/ Accessed August 31, 2020.
Dignani, M. and E. Anaissie. 2004. Human Fusariosis. Clinical and Infection Microbiology, 1:
67-75.
Fridkin, S. and W. Jarvis. 1996. Epidemiology of Nosocomial Fungal Infections. Clinical
microbiology reviews, 9(4): 499-511.
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(CCL 5)-Microbiai Contaminants	July 2021
Nagy L., and Olson B. 1982. The occurrence of filamentous fungi in drinking water distribution
systems. Canadian Journal of Microbiology. 1982 Jun; 28(6): 667-71
Nucci, M. and E. Anaissie. 2002. Cutaneous infection by Fusarium species in health and
immunocompromised hosts: implications for diagnosis and management. Clinical Infectious
diseases,35: 909-920.
Sutton, D. and M. Brandt. 2007. Fusarium, and Other Opportunistic Hyaline Fungi. In Murray,
P.R., E.J. Baron, J.H. Jorgensen, M.L. Landry and M. A. Pfaller (ed.) Manual of Clinical
Microbiology, 10th. Edition, American Society for Microbiology, Washington, DC (Vol. 2). p:
1853.
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(CCL 5)-Microbiai Contaminants	July 2021
Helicobacter pylori Scoring Data
Scoring Summary1'2
Occurrence
3
Health Effects
General population
7
Sensitive subpopulation(s) [E]
7
1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two scores were selected: the
general population [G] and the highest score for a sensitive subpopulation. These 2 scores were added and normalized by
multiplying by 5/14 for a final health effects score. The higher score between the WBDO and Occurrence protocols was used for
total pathogen score calculation. Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic
Disease
Score2
Data Element
Scoring Data
Reference3

Waterborne Disease Outbreaks
5
Has caused multiple (2 or
more) documented WBDOs
in the U.S. reported by
CDC between 2009-2017
No
CDC-NORS, 2020
4
Has caused at least one
documented WBDOs in
U.S. reported by CDC
between 2009-2017.
No
CDC, 1991 - CDC,
2017
3
Has caused documented
WBDOs at any time in the
U.S.?
No

2
Has caused WBDOs in
countries other than the
U.S.?
No

1
Has never caused WBDOs
in any country, but has
been epidemiologically
associated with water
related disease?
Yes
Klein and Graham,
1991
Hulten et al., 1996
Rolle-Kampczyk,
2004
Aziz et al., 2015
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Score2
Data Element
Scoring Data
Reference3

Occurrence
3
Detected in drinking
water in the U.S.?
Yes
Hegarty and Baker,
1999
2
Detected in source water in
the U.S.?


1
Not detected in the U.S.?



Health Effects
7 [G, E]
Does the organism cause
significant mortality (>
1/1,000 cases)?
[G, E] 6500 deaths per
year.
1.2 Million acute cases
per year (>1/1,000
deaths).
46% of deaths occur
before age of 64.
CDC, 1997
Stratton et al., 2000
6
Does the organism cause
pneumonia, meningitis,
hepatitis, encephalitis,
endocarditis, cancer, or
other severe manifestations
of illness necessitating long
term hospitalization (>
week)?
40 - 50% infection
rates in the elderly.
More likely to suffer
from gastric ulcer,
gastric
adenocarcinomas and
MALT.
Fox in Murray, 2007
Couturier in Carroll,
2019
5
Does the illness result in
long term or permanent
dysfunction or disability,
i.e. sequelae?
Main cause for peptic
ulcers and a major risk
factor for gastric
cancer.
Fox in Murray, 2007
4
Does the illness require
short term hospitalization (<
week)?


3 [C, P, CD]
Does the illness require
physician intervention?
[C, P, CD] Many
patients have recurrent
abdominal symptoms;
16% develop duodenal
ulcers. NIH( 1994)
recommends diagnosis
and antimicrobial
Fox in Murray, 2007
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Score2
Data Element
Scoring Data
Reference3


treatment for anyone
with peptic ulcers.

2
Is the illness self-limiting
within 72 hours (without
requiring medical
intervention)?
No
Infection persists
lifelong without
treatment.
Fox in Murray, 2007
1
Does the illness result in
mild symptoms with
minimal or no impact on
daily activities?


1 Bolded text inc
icates the highest score for that particular protocol. For the health effects protocol two
scores were selected: the general population [G] and the highest score for a sensitive subpopulation.
These 2 scores were added and normalized by multiplying by 5/14 for a final health effects score. The
higher score between the WBDO and Occurrence protocols was used for total pathogen score calculation.
Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic Disease.
2See Final Contaminant Candidate List 3 Microbes: PCCL to CCL Process. EPA 815-R-09-009. Final.
August 2009 for a detailed description on how to calculate the total pathogen score.
3EPA based the WBDO scores on the CDC MMWR reports from 1991 -2017 and then collected
occurrence citations if there were no CDC WBDOs.
References
Aziz, R.K., Khalifa, M.M., and Sharaf, R. R. (2013). Contaminated water as a source of
Helicobacter pylori infection: A review. Journal of advanced research, 6(4): 539-547.
doi:10.1016/j.jare.2013.07.007.
Centers for Disease Control and Prevention (CDC). 1997. Knowledge About Causes of Peptic
Ulcer Disease — United States, March-April 1997, October 24, 1997 / 46(42): 985-987
CDC. 2020. National Outbreak Reporting System (NORS).
https://wwwn.cdc.gov/norsdashboard/ Accessed August 31, 2020.
Couturier Helicobacter in in Carroll, K.C., Pfaller, M.A., Landry, M.L., McAdam, A. J., Patel, R.,
Richter, S.S. and Warnock, D.W. (ed). 2019. Manual of Clinical Microbiology, Twelfth Edition.
Fox, G. and F. Megraud. 2007. Helicobacter. In Murray, P.R., E.J. Baron, J.H. Jorgensen, M.L.
Landry, and M. A. Pfaller (ed.) The Manual of Clinical Microbiology, 9th. edition, American
Society for Microbiology, Washington, DC. Vol. 1: p. 950.
Hegarty, J.P. and K.H. Baker. 1999. Occurrence of Helicobacter pylori in surface water in the
United States. Journal of Applied Microbiology, 87: 697-701.
Hulten, K., S.W. Han, H. Enroth, P.D. Klein, A.R. Opekun, R.H. Gilman D.G. Evans, L.
Engstrand, D.Y. Graham, and F.A.K. El-Zaatari. 1996. Helicobacter pylori in the drinking water
in Peru. Gastroenterology, 110: 1031-1035.
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Klein, P.D, D.Y. Graham, Gaillour, A, Opekun, A.R. and Smith, E.0.1991. Water source as risk
factor for Helicobacter pylori infection in Peruvian children. Lancet, 337(8756): 1503-1506.
Rolle-Kampczyk, U.E., G.J. Fritz, U. Diez, I. Lehman, M. Richter, and O. Herbarth. 2004. Well
water - one source for Helicobacter pylori colonization. International Journal of Hygiene and
Environmental Health, 207: 363-368.
Stratton, K., J. Durch, and R. Lawrence (Editors). 2000. Vaccines for the 21st Century. National
Academy of Sciences, National Academy of Press: 181-187.
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(CCL 5)-Microbiai Contaminants	July 2021
Hepatitis A Virus Scoring Data
Scoring Summary1'2
Waterborne Disease Outbreak
3
Health Effects
General population
3
Sensitive subpopulation(s) [E]
6
1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two scores were selected: the
general population [G] and the highest score for a sensitive subpopulation. These 2 scores were added and normalized by
multiplying by 5/14 for a final health effects score. The higher score between the WBDO and Occurrence protocols was used for
total pathogen score calculation. Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic
Disease
Score2
Data Element
Scoring Data
Reference3

Waterborne Disease Outbreaks
5
Has caused multiple (2
or more) documented
WBDOs in the U.S.
reported by CDC
between 2009-2017
No
CDC-NORS, 2020
4
Has caused at least one
documented WBDOs in
U.S. reported by CDC
between 2009-2017
No

3
Has caused
documented WBDOs
at any time in the
U.S.?
Yes
1 Community
1 Noncommunity
(Previously
unreported)/A
1971-2008: 10
Community
9 Noncommunity
CDC-NORS, 2020
2
Has caused WBDOs in
countries other than the
U.S.?


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(CCL 5)-Microbiai Contaminants	July 2021
Score2
Data Element
Scoring Data
Reference3
1
Has never caused
WBDOs in any country,
but has been
epidemiologically
associated with water
related disease?



Occurrence
3
Detected in drinking
water in the U.S.?


2
Detected in source
water in the U.S.?
Yes
Abbaszadegan et al.,
2003
Borchardt et al., 2004
1
Not detected in the
U.S.?



Health Effects
7
Does the organism
cause significant
mortality (> 1/1,000
cases)?
Reported case fatality is
normally low, 0.1% -
0.3%; it can reach 1.8%
for adults over 50.
Heymann, 2005
6[E]
Does the organism
cause pneumonia,
meningitis, hepatitis,
encephalitis,
endocarditis, cancer,
or other severe
manifestations of
illness necessitating
long term
hospitalization (>
week)?
[E] Fulminant hepatitis
may develop. Disease
severity shows a
general increase with
age.
Anderson in Murray,
2007
CDC, 2019
5
Does the illness result in
long term or permanent
dysfunction or
disability, i.e. sequelae?


4
Does the illness require
short term


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Score2
Data Element
Scoring Data
Reference3

hospitalization (<
week)?


3 [G, C, P,
CD]
Does the illness
require physician
intervention?
[G, C, P, CD]
Commonly begins with
"flu-like" symptoms.
May develop jaundice.
Physician office visit is
common for diagnosis
and/or vaccination.
Anderson in Murray,
2007
2
Is the illness self-
limiting within 72 hours
(without requiring
medical intervention)?


1
Does the illness result in
mild symptoms with
minimal or no impact
on daily activities?


1 Bolded text inc
icates the highest score for that particular protocol. For the
lealth effects protocol two
scores were selected: the general population [G] and the highest score for a sensitive subpopulation.
These 2 scores were added and normalized by multiplying by 5/14 for a final health effects score. The
higher score between the WBDO and Occurrence protocols was used for total pathogen score calculation.
Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic Disease.
2See Final Contaminant Candidate List 3 Microbes: PCCL to CCL Process. EPA 815-R-09-009. Final.
August 2009 for a detailed description on how to calculate the total pathogen score.
3EPA based the WBDO scores on the CDC MMWR reports from 1991 -2017 and then collected
occurrence citations if there were no CDC WBDOs.
References
Abbaszadegan, M., M. LeChevallier, and C. P. Gerba, 2003. Occurrence of viruses in U. S.
groundwaters. JAWWA95: 107-120.
Anderson, D. 2007. Hepatitis A and E Viruses. In Murray, P.R., E.J. Baron, J.H. Jorgensen, M.L.
Landry, and M. A. Pfaller (ed.) The Manual of Clinical Microbiology, 9th. edition, American
Society for Microbiology, Washington, DC. Vol. 2: pp. 1428 - 1429.
Borchardt, M.A., N.L. Haas and R.L. Hunt. 2004. Vulnerability of drinking-water wells in La
Crosse, Wisconsin to enteric-virus contamination from surface water contributions. Applied and
Environmental Microbiology, 10: 5937-5946.
Centers for Disease Control and Prevention (CDC). 2019. Hepatitis A home page.
https://www.cdc.gov/hepatitis/hav/index.htm.
CDC. 2020. National Outbreak Reporting System (NORS).
https://wwwn.cdc.gov/norsdashboard/ Accessed August 31, 2020.
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Heymann, D. (ed.). 2005. Control of Communicable Diseases Manual, 18th ed. American Public
Health Association, Washington, DC.
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Hepatitis E Virus Scoring Data
Scoring Summary1'2
Waterborne Disease Outbreak
2
Health Effects
General population
3
Sensitive subpopulation(s) [P]
7
1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two scores were selected: the
general population [G] and the highest score for a sensitive subpopulation. These 2 scores were added and normalized by
multiplying by 5/14 for a final health effects score. The higher score between the WBDO and Occurrence protocols was used for
total pathogen score calculation. Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic
Disease
Score2
Data Element
Scoring Data
Reference3

Waterborne Disease Outbreaks
5
Has caused multiple (1 or
more) documented WBDOs
in the U.S. reported by CDC
between 2009-2017
No
CDC-NORS, 2020
4
Has caused at least one
documented WBDOs in U.S.
reported by CDC between
2009-2017
No
CDC-NORS, 2020
3
Has caused documented
WBDOs at any time in the
U.S.?
No

2
Has caused WBDOs in
countries other than the
U.S.?
Yes
Waterborne
outbreaks have
occurred in Asia and
Africa.
Guthmann et al.,
2006
Panda et al., 2006
1
Has never caused WBDOs
in any country, but has been
epidemiologically associated
with water related disease?
Yes
California camping.
Tsang et al., 2000

Occurrence
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Score2
Data Element
Scoring Data
Reference3
3
Detected in drinking water
in the U.S.?
No

2
Detected in source water in
the U.S.?
No

1
Not detected in the U.S.?
Yes
India
Jothikumar et al.,
2000

Health Effects
7[P]
Does the organism cause
significant mortality (>
1/1,000 cases)?
[P] May progress to
fulminant disease in
pregnant women
when infection occurs
during the third
trimester. High
mortality (for fetus)
when infection occurs
during pregnancy.
The case-fatality rate
is similar to that of
hepatitis A except in
pregnant women,
where it may reach
20% among those
infected during the
third trimester of
pregnancy.
Anderson in
Murray, 2010;
Isopet and Kamar in
MCM 2019
Heymann, 2005
6 [E]
Does the organism cause
pneumonia, meningitis,
hepatitis, encephalitis,
endocarditis, cancer, or other
severe manifestations of
illness necessitating long
term hospitalization (>
week)?
[E] Fulminant hepatitis
may develop. Disease
severity shows a
general increase with
age.
Anderson in Murray,
2010
5
Does the illness result in
long term or permanent
dysfunction or disability, i.e.
sequelae?


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Score2
Data Element
Scoring Data
Reference3
4
Does the illness require short
term hospitalization (<
week)?


3 [G, C]
Does the illness require
physician intervention?
[G, C] Commonly
begins with "flu-like"
symptoms. May
develop jaundice.
Physician office visit
is common for
diagnosis and/or
vaccination.
Anderson in
Murray, 2010
2
Is the illness self-limiting
within 72 hours (without
requiring medical
intervention)?


1
Does the illness result in
mild symptoms with
minimal or no impact on
daily activities?


1 Bolded text inc
icates the highest score for that particular protocol. For the health effects protocol two
scores were selected: the general population [G] and the highest score for a sensitive subpopulation.
These 2 scores were added and normalized by multiplying by 5/14 for a final health effects score. The
higher score between the WBDO and Occurrence protocols was used for total pathogen score calculation.
Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic Disease.
2See Final Contaminant Candidate List 3 Microbes: PCCL to CCL Process. EPA 815-R-09-009. Final.
August 2009 for a detailed description on how to calculate the total pathogen score.
3EPA based the WBDO scores on the CDC MMWR reports from 1991 -2017 and then collected
occurrence citations if there were no CDC WBDOs.
References
Anderson, D., and N. Counahan. 2010. Hepatitis A and E Viruses. In Murray, P.R., E.J. Baron,
J.H. Jorgensen, M.L. Landry, and M.A. Pfaller (ed.) The Manual of Clinical Microbiology, 10th.
edition, American Society for Microbiology, Washington, DC. Vol. 2: pp. 1423.
Centers for Disease Control and Prevention (CDC). 2020. National Outbreak Reporting System
(NORS). https://wwwn.cdc.gov/norsdashboard/ Accessed August 31, 2020.
Guthmann, J-P., H. Klovstad, D. Boccia, N. Hamid, L. Pinoges, J-Y. Nizou, M. Tatay, F. Diaz,
A. Moren, R.F. Grais, I. Ciglenecki, E. Nicand, and P.J. Guerin. 2006. A large outbreak of
hepatitis E among a displaced population in Darfur, Sudan, 2004: the role of water treatment
methods. Clinical Infectious Diseases, 42: 1685-1691.
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Heymann, D. (ed.). 2005. Control of Communicable Diseases Manual, 18th ed. American Public
Health Association, Washington, DC.
Isopet and Kamar. Hepatitis A and E Viruses in Carroll, K.C., Pfaller, M.A., Landry, M.L.,
McAdam, A. J., Patel, R., Richter, S.S. and Warnock, D.W. (ed). 2019. Manual of Clinical
Microbiology, Twelfth Edition.
Jothikumar N., R. Paulmurugan, P. Padmanabhan, R.B. Sundari, S. Kamatchiammal, andK.S.
Rao. 2000. Duplex RT-PCR for simultaneous detection of hepatitis A and hepatitis E virus
isolated from drinking water samples. Journal of Environmental Monitoring. 2(6): 587-90.
Panda, S.K., D. Thakral, and S. Rehman. 2007. Hepatitis E virus. Reviews in medical virology,
17(3): 151-180.
Tsang, T.H., E.K. Denison, H.V. Williams, L.V. Venczel, M.M. Ginsberg, and D.J. Vugia.
Acute Hepatitis E Infection Acquired in California. Clinical Infectious Diseases, 30: 618-9.
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Isospora belli Scoring Data
Scoring Summary1'2
Waterborne Disease Outbreak
2
Health Effects
General population
1
Sensitive subpopulation(s) [C]
2
1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two scores were selected: the
general population [G] and the highest score for a sensitive subpopulation. These 2 scores were added and normalized by
multiplying by 5/14 for a final health effects score. The higher score between the WBDO and Occurrence protocols was used for
total pathogen score calculation. Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic
Disease
Score2
Data Element
Scoring Data
Reference3

Waterborne Disease Outbreaks
5
Has caused multiple (1 or
more) documented
WBDOs in the U.S.
reported by CDC between
2009-2017
No
CDC-NORS, 2020
4
Has caused at least one
documented WBDOs in
U.S. reported by CDC
between 2009-2017
No
CDC-NORS, 2020
3
Has caused documented
WBDOs at any time in the
U.S.?
No

2
Has caused WBDOs in
countries other than the
U.S.?
Yes
Karanis, 2006
1
Has never caused WBDOs
in any country, but has
been epidemiologically
associated with water
related disease?
Yes


Occurrence
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Score2
Data Element
Scoring Data
Reference3
3
Detected in drinking water
in the U.S.?
No

2
Detected in source water
in the U.S.?
No

1
Not detected in the U.S.?
No


Health Effects
7
Does the organism cause
significant mortality (>
1/1,000 cases)?


6
Does the organism cause
pneumonia, meningitis,
hepatitis, encephalitis,
endocarditis, cancer, or
other severe
manifestations of illness
necessitating long term
hospitalization (> week)?


5
Does the illness result in
long term or permanent
dysfunction or disability,
i.e. sequelae?


4
Does the illness require
short term hospitalization
(< week)?


3
Does the illness require
physician intervention?
Can cause serious and
sometimes fatal disease
in immunocompetent
humans, more severe in
immunocompromi sed
patients.
Lindsay in Murray,
2010
2 [C]
Is the illness self-limiting
within 72 hours (without
requiring medical
intervention)?
[C] Symptoms are more
severe in infants and
children.
Lindsay in Murray,
2010
1 [G]
Does the illness result in
mild symptoms with
[G] Symptoms include
diarrhea, steatorrhea,
headache, fever,
Lindsay in Murray,
2010
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Score2
Data Element
Scoring Data
Reference3

minimal or no impact on
daily activities?
malaise, abdominal
pain, vomiting,
dehydration, and
weight loss.

1 Bolded text inc
icates the highest score for that particular protocol. For the health effects protocol two
scores were selected: the general population [G] and the highest score for a sensitive subpopulation.
These 2 scores were added and normalized by multiplying by 5/14 for a final health effects score. The
higher score between the WBDO and Occurrence protocols was used for total pathogen score calculation.
Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic Disease.
2See Final Contaminant Candidate List 3 Microbes: PCCL to CCL Process. EPA 815-R-09-009. Final.
August 2009 for a detailed description on how to calculate the total pathogen score.
3EPA based the WBDO scores on the CDC MMWR reports from 1991 -2017 and then collected
occurrence citations if there were no CDC WBDOs.
References
Centers for Disease Control and Prevention (CDC). 2020. National Outbreak Reporting System
(NORS). https://wwwn.cdc.gov/norsdashboard/ Accessed August 31, 2020.
Karanis P. 2006 A review of an emerging waterborne medical important parasitic protozoan.
Japanese Journal of Protozoology, 39(1): 5-19.
Lindsay, D., S. Upton and L. Weiss. 2010. Isospora, Cyclospora and Sarcocystis. In Murray,
P.R., E.J. Baron, J.H. Jorgensen, M.A. Pfaller, and R.H. Yolken (ed.) The Manual of Clinical
Microbiology, 10th edition, American Society for Microbiology, Washington, DC Vol. 2; p.
2172.
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(CCL 5)-Microbiai Contaminants	July 2021
Legionella pneumophila Scoring Data
Scoring Summary1'2
Waterborne Disease Outbreak
5
Health Effects
General population
4
Sensitive subpopulation(s) [E, CD]
6
1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two scores were selected: the
general population [G] and the highest score for a sensitive subpopulation. These 2 scores were added and normalized by
multiplying by 5/14 for a final health effects score. The higher score between the WBDO and Occurrence protocols was used for
total pathogen score calculation. Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic
Disease
Score2
Data Element
Scoring Data
Reference3

Waterborne Disease Outbreaks

Has caused multiple (1 or
more) documented WBDOs
in the U.S. reported by
CDC between 2009-2017
Yes
9 Community (2009)
12 Community (2010)
11	Community (2011)
12	Community (2012)
CDC-NORS,
2020
5

6 Community (2013)
17 Community (2014)
13 Community (2015)
24 Community (2016)
21 Community (2017)

4
Has caused at least one
documented WBDOs in
U.S. reported by CDC
between 2009-2017


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Score2
Data Element
Scoring Data
Reference3
3
Has caused documented
WBDOs at any time in the
U.S.?
1971-2008: 30 Community
25 Noncommunity
CDC-NORS,
2020
2
Has caused WBDOs in
countries other than the
U.S.?


1
Has never caused WBDOs
in any country, but has been
epidemiologically
associated with water
related disease?



Occurrence
3
Detected in drinking
water in the U.S.?
Yes
AwwaRF, 2004
Lin et al., 1998
Maier et al.,
2000
2
Detected in source water in
the U.S.?
Yes
Maier et al., 2000
1
Not detected in the U.S.?



Health Effects

Does the organism cause
significant mortality (>
1/1,000 cases)?
Avg. 12% fatality rate; death
rates of 15% (general pop.) up
to 75%
(immunocompromised) if
untreated.
Edel stein in
Murray, 2007
7

Avg. 25% death rate (between
20-40% during an outbreak.
10-15%) death rate.
Fatality rate has been as high
as 39%) in hospitalized cases;
it is generally higher in those
AWWARF, 2004
CDC, 2005
Heymann, 2005
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Score2
Data Element
Scoring Data
Reference3


with compromised immunity.

6 [E, CD]
Does the organism cause
pneumonia, meningitis,
hepatitis, encephalitis,
endocarditis, cancer, or
other severe
manifestations of illness
necessitating long term
hospitalization (> week)?
[E, CD] Acute pneumonia
may progress to respiratory
collapse and death if
diagnosis and effective
antibiotic therapy are
delayed. The elderly and
individuals with chronic
diseases are at higher risk.
Edelstein in
Murray, 2007;
Carroll. 2019
CDC, 2005
5
Does the illness result in
long term or permanent
dysfunction or disability,
i.e. sequelae?
No

4 [G, C, P]
Does the illness require
short term hospitalization
(< week)?
[G, C, P] Hospitalization is
required for treatment of
acute pneumonia.
Edelstein in
Murray, 2007
3
Does the illness require
physician intervention?


2
Is the illness self-limiting
within 72 hours (without
requiring medical
intervention)?
Pontiac fever resolves without
treatment and has flu-like
symptoms.
Edelstein in
Murray, 2007
Heymann, 2005
1
Does the illness result in
mild symptoms with
minimal or no impact on
daily activities?


1 Bolded text indicates the highest score for that particular protocol. For the health e
Tccts protocol two
scores were selected: the general population [G] and the highest score for a sensitive subpopulation.
These 2 scores were added and normalized by multiplying by 5/14 for a final health effects score. The
higher score between the WBDO and Occurrence protocols was used for total pathogen score calculation.
Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic Disease.
2See Final Contaminant Candidate List 3 Microbes: PCCL to CCL Process. EPA 815-R-09-009. Final.
August 2009 for a detailed description on how to calculate the total pathogen score.
3EPA based the WBDO scores on the CDC MMWR reports from 1991 -2017 and then collected
occurrence citations if there were no CDC WBDOs.
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References
Centers for Disease Control and Prevention (CDC). 2005. Legionellosis: Legionnaires' Disease
(LD) and Pontiac Fever. Disease Listing. October 12, 2005.
http://www.cdc.gov/ncidod/dbmd/diseaseinfo/legionellosis t.htm
CDC. 2020. National Outbreak Reporting System (NORS).
https://wwwn.cdc.gov/norsdashboard/ Accessed August 31, 2020.
Edelstein, P. 2007. Legionella. In Murray, P.R., E.J. Baron, J.H. Jorgensen, M.L. Landry, and
M.A. Pfaller (ed.) The Manual of Clinical Microbiology, 9th. edition, American Society for
Microbiology, Washington, DC. Vol. 1: p. 837.
Edelstein, P. 2007. Legionella, in Carroll, K.C., Pfaller, M.A., Landry, M.L., McAdam, A.J.,
Patel, R., Richter, S.S. and Warnock, D.W. (ed). 2019. Manual of Clinical Microbiology,
Twelfth Edition.
Heymann, D.(ed.). 2005. Control of Communicable Diseases Manual, 18th ed. American Public
Health Association, Washington, DC.
Lin, Y.S., J.E. Stout, V.L. Yu, and R.D. Vidic. 1998. Disinfection of water distribution systems
for Legionella. Seminars in Respiratory Infections, 13: 147-159.
Maier, R.M., I.L. Pepper, C.P. Gerba. 2000. Environmental Microbiology. Academic Press, pp.
454-455, 539.
Riffard, S., Springthorpe, S., Filion, L. and Sattar, S., 2002. Occurrence of Legionella in
Groundwater (AWWA Research Foundation Reports). American Water Works Association
publisher.
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Microsporidia Scoring Data
Scoring Summary1'2
Occurrence
2
Health Effects
General population
2
Sensitive subpopulation(s) [CD, C, P, E]
2
1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two scores were selected: the
general population [G] and the highest score for a sensitive subpopulation. These 2 scores were added and normalized by
multiplying by 5/14 for a final health effects score. The higher score between the WBDO and Occurrence protocols was used for
total pathogen score calculation. Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic
Disease
Score2
Data Element
Scoring Data
Reference3

Waterborne Disease Outbreaks
5
Has caused multiple (1 or
more) documented
WBDOs in the U.S.
reported by CDC between
2009-2017
No
CDC-NORS, 2020
4
Has caused at least one
documented WBDOs in
U.S. reported by CDC
between 2009-2017
No
CDC-NORS, 2020
3
Has caused documented
WBDOs at any time in the
U.S.?
No

2
Has caused WBDOs in
countries other than the
U.S.?
No

1
Has never caused
WBDOs in any country,
but has been
epidemiologically
Yes
Cotte, et al., 1999
Enriquez et al., 1998
Hutin et al., 1998
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Score2
Data Element
Scoring Data
Reference3

associated with water
related disease?



Occurrence
3
Detected in drinking water
in the U.S.?
No

2
Detected in source water
in the U.S.?
Yes
Didier et al., 2004
Dowd et al., 1998
1
Not detected in the U.S.?



Health Effects
7
Does the organism cause
significant mortality (>
1/1,000 cases)?


6
Does the organism cause
pneumonia, meningitis,
hepatitis, encephalitis,
endocarditis, cancer, or
other severe
manifestations of illness
necessitating long term
hospitalization (> week)?


5
Does the illness result in
long term or permanent
dysfunction or disability,
i.e. sequelae?


4
Does the illness require
short term hospitalization
(< week)?


3
Does the illness require
physician intervention?
Antimicrobial therapy
available for
immunodeficient
patients.
Weber in Murray,
2010
2[G, C, P,
E, CD]
Is the illness self-limiting
within 72 hours (without
requiring medical
intervention)?
[All populations]
Diarrhea and weight
loss lasting in up to 2 - 3
weeks in
Weber in Murray,
2010
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Score2
Data Element
Scoring Data
Reference3


immunocompetent
hosts. Has been
identified among elderly
persons with acute or
chronic diarrhea.

1
Does the illness result in
mild symptoms with
minimal or no impact on
daily activities?


1 Bolded text inc
icates the highest score for that particular protocol. For the health effects protocol two
scores were selected: the general population [G] and the highest score for a sensitive subpopulation.
These 2 scores were added and normalized by multiplying by 5/14 for a final health effects score. The
higher score between the WBDO and Occurrence protocols was used for total pathogen score calculation.
Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic Disease.
2See Final Contaminant Candidate List 3 Microbes: PCCL to CCL Process. EPA 815-R-09-009. Final.
August 2009 for a detailed description on how to calculate the total pathogen score.
3EPA based the WBDO scores on the CDC MMWR reports from 1991 -2017 and then collected
occurrence citations if there were no CDC WBDOs.
References
Centers for Disease Control and Prevention (CDC). 2020. National Outbreak Reporting System
(NORS). https://wwwn.cdc.gov/norsdashboard/ Accessed August 31, 2020.
Cotte, L., M. Rabondonira, F. Chapuis, F. Bailly, F. Bissuel. C. Raynal. 1999. Waterborne
outbreak of intestinal microsporidiosis in persons with and without human immunodeficiency
virus infection. Journal of Infectious Diseases, 180: 2003-2008.
Didier, E.S., M.E. Stovall, L.C. Green, P.J. Brindley, K. Sestak, and P.J. Didier. 2004.
Veterinary parasitology, 126: 145-166.
Dowd, S.E., C.P. Gerba, I.L. Pepper. 1998. Confirmation of the human-pathogenic microsporidia
Enterocytozoon bieneusi, Encephalitozoon intestinalis, and Vittaforma corneae in water. Applied
and Environmental. Microbiology, 64(9): 3332-3335.
Enriquez, F.J., D. Taren, A. Cruz-Lopez, M. Muramoto, J.D. Palting, P. Cruz. 1998. Prevalence
of intestinal encephalitozoonosis in Mexico. Clinical Infectious Diseases, 26: 1227-1229.
Hutin, Y.J.F., M.N. Sombardier, O. Ligoury, C. Sarfati, F. Derouin, J. Modai, J.M. Molina. 1998.
Risk factors for intestinal micorspooridiosis in patients with human immunodeficiency virus
infection.: a case control study. Journal of Infectious Diseases, 178: 904-907.
Weber R., A. Mathis and P. Deplazes. 2010. Microsporidia. In Murray, P.R., E.J. Baron, J.H.
Jorgensen, M.A. Pfaller, and R.H. Yolken (ed.) The Manual of Clinical Microbiology, 10th
edition, American Society for Microbiology, Washington, DC Vol. 2; p. 2190.
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Mycobacterium abscessus Scoring Data
Scoring Summary1'2
Waterborne Disease Outbreak
4
Health Effects
General population
4
Sensitive subpopulation(s) [CD]
5
1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two scores were selected: the
general population [G] and the highest score for a sensitive subpopulation. These 2 scores were added and normalized by
multiplying by 5/14 for a final health effects score. The higher score between the WBDO and Occurrence protocols was used for
total pathogen score calculation. Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic
Disease
Score2
Data Element
Scoring Data
Reference3

Waterborne Disease Outbreaks
5
Has caused multiple (2 or
more) documented WBDOs
in the U.S. reported by CDC
between 2009-2017

CDC-NORS, 2020
4
Has caused at least one
documented WBDOs in
U.S. reported by CDC
between 2009-2017
2014: 1 Hospital
CDC-NORS, 2020
3
Has caused documented
WBDOs at any time in the
U.S.?


2
Has caused WBDOs in
countries other than the
U.S.?


1
Has never caused WBDOs in
any country, but has been
epidemiologically associated
with water related disease?



Occurrence
3
Detected in drinking water
in the U.S.?
Yes. Idaho public
health officials and
pediatric infectious
Baker et al., 2017
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Score2
Data Element
Scoring Data
Reference3


disease physicians
investigated a US
documented
outbreak of
Mycobacterium
abscessus skin
infections in children
whose only common
exposure was an
indoor wading pool
(Carter et al., 2019).
Another outbreak
occurred in the Duke
University Hospital
linked to the hospital
tap water (Baker et
al., 2017).
Carter et al., 2019
2
Detected in source water in
the U.S.?


1
Not detected in the U.S.?



Health Effects
7
Does the organism cause
significant mortality (>
1/1,000 cases)?


6
Does the organism cause
pneumonia, meningitis,
hepatitis, encephalitis,
endocarditis, cancer, or other
severe manifestations of
illness necessitating long
term hospitalization (>
week)?


5 [CD]
Does the illness result in
long term or permanent
dysfunction or disability,
i.e. sequelae?
[CD] M. abscessus
complex can cause
pulmonary disease,
especially in
vulnerable hosts with
underlying structural
lung disease, such as
cystic fibrosis,
Griffith, 2007
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Data Element
Scoring Data
Reference3


bronchiectasis, and
prior tuberculosis.

4 [G]
Does the illness require
short term hospitalization
(< week)?
Yes. Prolonged
intravenous (IV)
therapy and side
effects are often
necessary to treat
Mycobacterium
abscessus infections.
Novosad, 2016
3
Does the illness require
physician intervention?


2
Is the illness self-limiting
within 72 hours (without
requiring medical
intervention)?


1
Does the illness result in
mild symptoms with minimal
or no impact on daily
activities?


1 Bolded text inc
icates the highest score for that particular protocol. For the health effects protocol two
scores were selected: the general population [G] and the highest score for a sensitive subpopulation.
These 2 scores were added and normalized by multiplying by 5/14 for a final health effects score. The
higher score between the WBDO and Occurrence protocols was used for total pathogen score calculation.
Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic Disease.
2See Final Contaminant Candidate List 3 Microbes: PCCL to CCL Process. EPA 815-R-09-009. Final.
August 2009 for a detailed description on how to calculate the total pathogen score.
3EPA based the WBDO scores on the CDC MMWR reports from 1991 -2017 and then collected
occurrence citations if there were no CDC WBDOs.
References
Baker, A.W., Lewis, S.S., Alexander, B.D., Chen, L.F., Wallace Jr, R.J., Brown-Elliott, B.A.,
and Reynolds, J.M. 2017. Two-phase hospital-associated outbreak of Mycobacterium abscessus:
investigation and mitigation. Clinical Infectious Diseases, 64(7), 902-911.
Carter, K.K., Lundgren, I., Correll, S., Schmalz, T., McCarter, T., Stroud, J., and Hahn, C.G.
2018. First United States outbreak of Mycobacterium abscessus hand and foot disease among
children associated with a wading pool. Journal of the Pediatric Infectious Diseases Society.
Centers for Disease Control and Prevention (CDC). 2020. National Outbreak Reporting System
(NORS). https://wwwn.cdc.gov/norsdashboard/ Accessed August 31, 2020.
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Griffith, D.E., Aksamit, T., Brown-Elliott, B.A., Catanzaro, A., Daley, C., Gordin, F., and
Iseman, M. 2007. An official ATS/IDSA statement: diagnosis, treatment, and prevention of
nontuberculous mycobacterial diseases. American journal of respiratory and critical care
medicine, 775(4), 367-416.
Novosad, S.A., Beekmann, S.E., Polgreen, P.M., Mackey, K., and Winthrop, K.L. 2016.
Treatment of Mycobacterium abscessus infection. Emerging infectious diseases, 22(3), 511.
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Mycobacterium avium Scoring Data
Scoring Summary1'2
Waterborne Disease Outbreak
4
Health Effects
General population
3
Sensitive subpopulation(s) [E]
5
1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two scores were selected: the
general population [G] and the highest score for a sensitive subpopulation. These 2 scores were added and normalized by
multiplying by 5/14 for a final health effects score. The higher score between the WBDO and Occurrence protocols was used for
total pathogen score calculation. Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic
Disease
Score2
Data Element
Scoring Data
Reference3

Waterborne Disease Outbreaks
5
Has caused multiple (2 or
more) documented WBDOs
in the U.S. reported by CDC
between 2009-2017
No
CDC-NORS, 2020
4
Has caused at least one
documented WBDOs in
U.S. reported by CDC
between 2009-2017
Yes
2016: 1 Community
(Mycobacterium
"other")
CDC-NORS, 2020
3
Has caused documented
WBDOs at any time in the
U.S.?
Yes
Not listed in CDC's
NORS however, data
linking patient,
outbreak and drinking
water.
Tobin-D' Angelo et
al., 2004
2
Has caused WBDOs in
countries other than the
U.S.?
No

1
Has never caused WBDOs in
any country, but has been
Yes
Glover et al., 1994
Aronson et al., 1999
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Data Element
Scoring Data
Reference3

epidemiologically associated
with water related disease?

von Reyn et al., 1994

Occurrence
3
Detected in drinking water
in the U.S.?
Yes
Glover et al., 1994
Covert et al., 1999
Falkinham et al.,
2001
2
Detected in source water in
the U.S.?
Yes
Covert etal., 1999
Falkinham et al., 2004
1
Not detected in the U.S.?



Health Effects
7
Does the organism cause
significant mortality (>
1/1,000 cases)?


6
Does the organism cause
pneumonia, meningitis,
hepatitis, encephalitis,
endocarditis, cancer, or other
severe manifestations of
illness necessitating long
term hospitalization (>
week)?
Disseminated MAC
infections are a major
problem in HIV-
infected individuals.
Heymann, 2005
5[E]
Does the illness result in
long term or permanent
dysfunction or disability,
i.e. sequelae?
[E] Most commonly
immunocompetent
patients develop a
slowly evolving
cavitary disease that
resembles
tuberculosis. Elderly
non-smoking females,
can develop "Lady
Windermere's
syndrome" which has
been associated with
significant morbidity
and mortality.
Murray et al., 2005
Carroll et al., 2019
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Score2
Data Element
Scoring Data
Reference3
4 [CD]
Does the illness require short
term hospitalization (<
week)?
[CD] Tuberculosis-like
upper lobe
fibrocavitary disease
occurs typically in
men 45 - 60 who have
preexi siting lung
disease.
Pfyffer in Murray,
2007
3 [G]
Does the illness require
physician intervention?
[G] Symptoms of
infection include
pulmonary disease,
lymphadenitis, post-
traumatic wound
infection. Diagnosis
of disease and
treatment requires
physician
intervention.
Pfyffer in Murray,
2007
Heymann, 2005
2
Is the illness self-limiting
within 72 hours (without
requiring medical
intervention)?


1
Does the illness result in
mild symptoms with minimal
or no impact on daily
activities?


1 Bolded text inc
icates the highest score for that particular protocol. For the health effects protocol two
scores were selected: the general population [G] and the highest score for a sensitive subpopulation.
These 2 scores were added and normalized by multiplying by 5/14 for a final health effects score. The
higher score between the WBDO and Occurrence protocols was used for total pathogen score calculation.
Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic Disease.
2See Final Contaminant Candidate List 3 Microbes: PCCL to CCL Process. EPA 815-R-09-009. Final.
August 2009 for a detailed description on how to calculate the total pathogen score.
3EPA based the WBDO scores on the CDC MMWR reports from 1991 -2017 and then collected
occurrence citations if there were no CDC WBDOs.
References
Aronson, T., A. Holtzman, N. Glover, M. Boian, S. Froman, O.G.W. Berlin, H. Hill, and G.
Stelma, Jr. 1999. Comparison of large restriction fragments of Mycobacterium avium isolates
recovered from AIDS and non-AIDS patients with those of isolates from potable water. J. Clin.
Microbiol. 37: 1008-1012.
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Carroll, K.C., Pfaller, M.A., Landry, M.L., McAdam, A.J., Patel, R., Richter, S.S. and Warnock,
D.W.(ed). 2019. Manual of Clinical Microbiology, Twelfth Edition.
Centers for Disease Control and Prevention (CDC). 2020. National Outbreak Reporting System
(NORS). https://wwwn.cdc.gov/norsdashboard/ Accessed August 31, 2020.
Falkinham, J.O., III, C.D. Norton, and M.W. LeChevallier. 2001. Factors influencing numbers of
Mycobacterium avium, Mycobacterium intracellulare, and other mycobacteria in drinking water
distribution systems. Applied and Environmental Microbiology, 67: 1225-1231.
Falkinham, J.O., G. Nichols, J. Bartram, A. Dufour, and F. Portaels. 2004. Natural ecology and
survival in water of mycobacteria of potential public health importance. In Pedley, S., J. Bartram,
G. Rees, A. Dufour, and J. A. Cotruvo (Eds.) Pathogenic mycobacteria in water: a guide to public
health consequences, monitoring and management. IWA Publishing, London, UK.
Glover, N., A. Holtzman, T. Aronson, S. Froman, O.G.W. Berlin, P. Dominguez, K.A. Kunkel,
G. Overturf, G. Stelma, Jr., C. Smith, and M. Yakrus. 1994. The isolation and identification of
Mycobacterium avium complex (MAC) recovered from Los Angeles potable water, a possible
source of infection in AIDS patients. International Journal of Environmental Health Research,-4:
63-72.
Heymann, D. (ed.). 2005. Control of Communicable Diseases Manual, 18th ed. American Public
Health Association, Washington, DC.
Murray, P.R., K.S. Rosenthal and M.A. Pfaller. 2005. Medical Microbiology, 5th edition.
Elsevier Mosby. p. 304.
Pfyffer, G. 2007. Mycobacterium: General Characterises, Laboratory Detection, and Staining
Procedures. In Murray, P.R., E.J. Baron, J.H. Jorgensen, M.L. Landry, and M.A. Pfaller (ed.)
The Manual of Clinical Microbiology, 9th. edition, American Society for Microbiology,
Washington, DC. Vol. 1: pp. 547- 548.
Tobin-D'Angelo, M.J., M. A. Blass, C. del Rio, J.S. Halvosa, H.M. Blumberg, and C.R.
Horsburgh, Jr. 2004. Hospital water as a source of Mycobacterium avium complex isolates in
respiratory specimens. Journal of Infectious Diseases, 189: 98-104.
von Reyn, C.F., J.N. Maslow, T.W. Barber, J.O. Falkinham, III, and R.D. Arbeit. 1994.
Persistent colonization of potable water as a source of Mycobacterium avium infection in AIDS.
Lancet. 343: 1137-1141.
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Naegleria fowleri Scoring Data
Scoring Summary1'2
Waterborne Disease Outbreak
5
Health Effects
General population
7
Sensitive subpopulation(s) [C, P, E, CD]
7
1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two scores were selected: the
general population [G] and the highest score for a sensitive subpopulation. These 2 scores were added and normalized by
multiplying by 5/14 for a final health effects score. The higher score between the WBDO and Occurrence protocols was used for
total pathogen score calculation. Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic
Disease
Score2
Data Element
Scoring Data
Reference3

Waterborne Disease Outbreaks
5
Has caused multiple (2 or
more) documented
WBDOs in the U.S.
reported by CDC between
2009-2017
Yes, 1 Community (note
an outbreak is only one
case for Naegleria)
CDC, 2017
4
Has caused at least one
documented WBDOs in the
U.S. as reported by CDC
surveillance between 1990
and 2014?


3
Has caused documented
WBDOs at any time in the
U.S.?
1971-2008: 1 Community
CDC-NORS, 2020
2
Has caused WBDOs in
countries other than the
U.S.?


1
Has never caused WBDOs in
any country, but has been
epidemiologically associated
with water related disease?


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Data Element
Scoring Data
Reference3

Occurrence
3
Detected in drinking water
in the U.S.?
Yes
Arizona storage -
Sampled pre-treatment
multiple-well study in
Arizona.
Louisiana
Gerba et al., 2007
Marciano-Cabral et
al., 2003
LA, 2013
2
Detected in source water in
the U.S.?
Yes
Schuster and
Visvesvara, 2004
1
Not detected in the U.S.?



Health Effects
7[G, C, P,
E, CD]
Does the organism cause
significant mortality (>
1/1,000 cases)?
[All populations]
Recovery from primary
amoebic
meningoencephalitis is
rare.
Heymann, 2005
Cope and Ali, 2016.
6
Does the organism cause
pneumonia, meningitis,
hepatitis, encephalitis,
endocarditis, cancer, or other
severe manifestations of
illness necessitating long
term hospitalization (>
week)?
Acute fulminating
disease. Only a few
patients have survived.
Visvesvara in
Murray, 2010
Cope et al, in
Carroll, 2019
5
Does the illness result in
long term or permanent
dysfunction or disability, i.e.
sequelae?
No

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Score2
Data Element
Scoring Data
Reference3
4
Does the illness require short
term hospitalization (<
week)?
All cases are hospitalized
for diagnosis and
treatment.
Visvesvara in
Murray, 2010
3
Does the illness require
physician intervention?


2
Is the illness self-limiting
within 72 hours (without
requiring medical
intervention)?


1
Does the illness result in
mild symptoms with
minimal or no impact on
daily activities?


1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two
scores were selected: the general population [G] and the highest score for a sensitive subpopulation.
These 2 scores were added and normalized by multiplying by 5/14 for a final health effects score. The
higher score between the WBDO and Occurrence protocols was used for total pathogen score calculation.
Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic Disease.
2See Final Contaminant Candidate List 3 Microbes: PCCL to CCL Process. EPA 815-R-09-009. Final.
August 2009 for a detailed description on how to calculate the total pathogen score.
3EPA based the WBDO scores on the CDC MMWR reports from 1991 -2017 and then collected
occurrence citations if there were no CDC WBDOs.
References
Centers for Disease Control and Prevention (CDC). 2017. Naegleria fowleri in Louisiana Public
Water Systems, https://www.cdc.gov/parasites/naegleria/public-water-systems-louisiana.html
Cope, J.R., & Ali, I.K. 2016. Primary Amebic Meningoencephalitis: What Have We Learned in
the Last 5 Years?. Current infectious disease reports, 18(10), 31. https://doi.org/10.10Q7/sl 1908-
016-0539-4
Cope J.R., Pathogenic and Opportunistic Free-Living Amebae in Carroll, K.C., Pfaller, M.A.,
Landry, M.L., McAdam, A.J., Patel, R., Richter, S.S. and Warnock, D.W. (ed). 2019. Manual of
Clinical Microbiology, Twelfth Edition.
Gerba, C., B. Blair, P. Sarkar, and K. Bright. 2007. Occurrence and Control of Naegleria fowleri
in Well Water and Chlorine Resistance. Proceedings, Water Quality Technology Conference,
American Water Works Association, November 5-8, 2007.
Heymann, D. (ed.). 2005. Control of Communicable Diseases Manual, 18th ed. American Public
Health Association, Washington, DC. pp. 417-419.
Louisiana Department of Health, 2013. http://ldh.la.gov/index.cfm/newsroom/detail/2906
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Marciano-Cabral, F., R. MacLean, A. Mensah, and L. LaPat-Polasko. 2003. Identification of
Naegleria fowleri in domestic water source by nested PCR. Applied and Environmental
Microbiology, 69 (10): 5864-5869.
Schuster, F.L. and G.S. Visvesvara. 2004. Free-living amoebae as opportunistic and non-
opportunistic pathogens of humans and animals. International Journal for Parasitology, 34:
1001-1027.
Visvesvara, G. 2007. Pathogenic and Opportunistic Free-Living Amebae. In Murray, P.R., E.J.
Baron, J.H. Jorgensen, M.A. Pfaller, and R.H. Yolken (ed.) The Manual of Clinical
Microbiology, 10th edition, American Society for Microbiology, Washington, DC Vol. 2; p.
3129.
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(CCL 5)-Microbiai Contaminants	July 2021
Nontuberculous Mycobacteria (NTM) Scoring Data
Scoring Summary1'2
Occurrence
3
Health Effects
General population
3
Sensitive subpopulation(s) [E]
5
1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two scores were selected: the
general population [G] and the highest score for a sensitive subpopulation. These 2 scores were added and normalized by
multiplying by 5/14 for a final health effects score. The higher score between the WBDO and Occurrence protocols was used for
total pathogen score calculation. Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic
Disease
Score2
Data Element
Scoring Data
Reference3

Waterborne Disease Outbreaks
5
Has caused multiple (2 or
more) documented WBDOs
in the U.S. reported by CDC
between 2009-2017
No
CDC-NORS, 2020
4
Has caused at least one
documented WBDOs in U.S.
reported by CDC between
2009-2017
No
CDC-NORS, 2020
3
Has caused documented
WBDOs at any time in the
U.S.?
No

2
Has caused WBDOs in
countries other than the
U.S.?
No

1
Has never caused WBDOs
in any country, but has
been epidemiologically
associated with water
related disease?
Yes
Johnson and Odell,
1994

Occurrence
3
Detected in drinking water
in the U.S.?
Yes
Falkinham et al.,
2011
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Scoring Data
Reference3
2
Detected in source water in
the U.S.?
Yes
Covert etal., 1999
Falkinham et al., 2004
1
Not detected in the U.S.?



Health Effects
7
Does the organism cause
significant mortality (>
1/1,000 cases)?


6
Does the organism cause
pneumonia, meningitis,
hepatitis, encephalitis,
endocarditis, cancer, or other
severe manifestations of
illness necessitating long
term hospitalization (>
week)?
Disseminated MAC
infections are a major
problem in HIV-
infected individuals.
Heymann, 2005
5[E]
Does the illness result in
long term or permanent
dysfunction or disability,
i.e. sequelae?
[E] Most commonly
immunocompetent
patients develop a
slowly evolving
pulmonary disease.
Murray et al., 2005
4
Does the illness require short
term hospitalization (<
week)?


3 [G]
Does the illness require
physician intervention?
[G] Symptoms of
infection include
pulmonary disease;
diagnosis of disease
and treatment
requires physician
intervention.
Pfyffer in Murray,
2007
2
Is the illness self-limiting
within 72 hours (without
requiring medical
intervention)?


1
Does the illness result in
mild symptoms with minimal


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Scoring Data
Reference3

or no impact on daily
activities?


1 Bolded text inc
icates the highest score for that particular protocol. For the health effects protocol two
scores were selected: the general population [G] and the highest score for a sensitive subpopulation.
These 2 scores were added and normalized by multiplying by 5/14 for a final health effects score. The
higher score between the WBDO and Occurrence protocols was used for total pathogen score calculation.
Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic Disease.
2See Final Contaminant Candidate List 3 Microbes: PCCL to CCL Process. EPA 815-R-09-009. Final.
August 2009 for a detailed description on how to calculate the total pathogen score.
3EPA based the WBDO scores on the CDC MMWR reports from 1991 -2017 and then collected
occurrence citations if there were no CDC WBDOs.
References
Centers for Disease Control and Prevention (CDC). 2020. National Outbreak Reporting System
(NORS). https://wwwn.cdc.gov/norsdashboard/ Accessed August 31, 2020.
Falkinham J.O. III. 2011. Nontuberculous mycobacteria from household plumbing of patients
with nontuberculous mycobacteria disease. Emerging Infectious Diseases, 17:419-424
Hernandez-Garduno, E., & Elwood, K. 2012. Nontuberculous mycobacteria in tap water.
Emerging Infectious Diseases, 18(2), 353.
Johnson, M.M., & Odell, J.A. 2014. Nontuberculous mycobacterial pulmonary infections.
Journal of Thoracic Disease, 6(3), 210-220.
Murray, P.R., K.S. Rosenthal and M.A. Pfaller. 2005. Medical Microbiology, 5th edition.
Elsevier Mosby. p. 304.
Pfyffer, G. 2007. Mycobacterium: General Characterises, Laboratory Detection, and Staining
Procedures. In Murray, P.R., E.J. Baron, J.H. Jorgensen, M.L. Landry, and M.A. Pfaller (ed.)
The Manual of Clinical Microbiology, 9th. edition, American Society for Microbiology,
Washington, DC. Vol. 1: pp. 547- 548.
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Pantoea agglomerans Scoring Data
Scoring Summary1'2
Waterborne Disease Outbreak
4
Health Effects
General population
1
Sensitive subpopulation(s) [C, CD]
6
1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two scores were selected: the
general population [G] and the highest score for a sensitive subpopulation. These 2 scores were added and normalized by
multiplying by 5/14 for a final health effects score. The higher score between the WBDO and Occurrence protocols was used for
total pathogen score calculation. Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic
Disease
Score2
Data Element
Scoring Data
Reference3

Waterborne Disease Outbreaks
5
Has caused multiple (2 or
more) documented WBDOs
in the U.S. reported by CDC
between 2009-2017
No
CDC-NORS, 2020
4
Has caused at least one
documented WBDOs in U.S.
reported by CDC between
2009-2017
Yes.
2012: 1 Community
Outbreak of Pantoea
agglomerans
bloodstream infection
occurred in a health
care facility linked to
the drinking water
system.
CDC-NORS, 2020
3
Has caused documented
WBDOs at any time in the
U.S.?


2
Has caused WBDOs in
countries other than the
U.S.?


1
Has never caused WBDOs in
any country, but has been


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Score2
Data Element
Scoring Data
Reference3

epidemiologically associated
with water related disease?



Occurrence
3
Detected in drinking water
in the U.S.?
Yes. Outbreak of
Pantoea agglomerans
bloodstream infection
occurred in a health
care facility linked to
the drinking water
system.
CDC, 2015
2
Detected in source water in
the U.S.?


1
Not detected in the U.S.?



Health Effects
7
Does the organism cause
significant mortality (>
1/1,000 cases)?


6 [C, CD]
Does the organism cause
pneumonia, meningitis,
hepatitis, encephalitis,
endocarditis, cancer, or
other severe manifestations
of illness necessitating long
term hospitalization (>
week)?
[C, CD] Yes. There are
documented cases of
long-term
hospitalization and
death in children with
pneumonia Biiyiikcam
(2018).
It can also cause
infections in cuts and in
immunocompromised
individuals in health
care settings.
Septic arthritis or
synovitis appears as a
common clinical
outcome of exogenous
infection with P.
agglomerans, others
include
endophthalmitis,
periostitis, endocarditis
and osteomyelitis
Biiviikcam, 2018
Dutkiewicz J, et
al., 2016
Forsythe et al., in
MCM, 2019
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Score2
Data Element
Scoring Data
Reference3


(Dutkiewicz J, et al.
2016).

5
Does the illness result in
long term or permanent
dysfunction or disability, i.e.
sequelae?


4
Does the illness require short
term hospitalization (<
week)?


3
Does the illness require
physician intervention?


2
Is the illness self-limiting
within 72 hours (without
requiring medical
intervention)?


1 [G]
Does the illness result in
mild symptoms with
minimal or no impact on
daily activities?
Pantoea agglomerans is
not generally an
infections agent in
healthy humans
(Dutkiewicz J, et al.
2016).
Dutkiewicz J, et
al., 2016
1 Bolded text inc
icates the highest score for that particular protocol. For the health effects protocol two
scores were selected: the general population [G] and the highest score for a sensitive subpopulation.
These 2 scores were added and normalized by multiplying by 5/14 for a final health effects score. The
higher score between the WBDO and Occurrence protocols was used for total pathogen score calculation.
Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic Disease.
2See Final Contaminant Candidate List 3 Microbes: PCCL to CCL Process. EPA 815-R-09-009. Final.
August 2009 for a detailed description on how to calculate the total pathogen score.
3EPA based the WBDO scores on the CDC MMWR reports from 1991 -2017 and then collected
occurrence citations if there were no CDC WBDOs.
References
Buyiikcam, A., Tuncer, O., Giir, D., Sancak, B., Ceyhan, M., Cengiz, A.B., & Kara, A. 2018.
Clinical and microbiological characteristics of Pantoea agglomerans infection in children.
Journal of infection and public health, 11(3), 304-309.
Dutkiewicz, J., Mackiewicz, B., Lemieszek, M.K., Golec, M., & Milanowski, J. 2016. Pantoea
agglomerans: a mysterious bacterium of evil and good. Part III. Deleterious effects: infections of
humans, animals and plants. Annals of Agricultural and Environmental Medicine, 23(2).
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Centers for Disease Control and Prevention (CDC). 2020. National Outbreak Reporting System
(NORS). https://wwwn.cdc.gov/norsdashboard/ Accessed August 31, 2020.
Forsythe et al., Klebsiella and Selected Enterobacterales. Chapter 40 in Carroll, K.C., Pfaller,
M.A., Landry, M.L., McAdam, A.J., Patel, R., Richter, S.S. and Warnock, D.W. (ed). 2019.
Manual of Clinical Microbiology, Twelfth Edition.
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Plesiomonas shigelloides Scoring Data
Scoring Summary1'2
Waterborne Disease Outbreak
3
Health Effects
General population
2
Sensitive subpopulation(s) [C, E]
3
1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two scores were selected: the
general population [G] and the highest score for a sensitive subpopulation. These 2 scores were added and normalized by
multiplying by 5/14 for a final health effects score. The higher score between the WBDO and Occurrence protocols was used for
total pathogen score calculation. Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic
Disease
Score2
Data Element
Scoring Data
Reference3

Waterborne Disease Outbreaks
5
Has caused multiple (1 or
more) documented
WBDOs in the U.S.
reported by CDC between
2009-2017
No
CDC-NORS, 2020
4
Has caused at least one
documented WBDOs in
U.S. reported by CDC
between 2009-2017
No
CDC-NORS, 2020
3
Has caused documented
WBDOs at any time in
the U.S.?
1971-2008:2
Noncommunity
CDC-NORS, 2020
2
Has caused WBDOs in
countries other than the
U.S.?


1
Has never caused
WBDOs in any country,
but has been
epidemiologically
associated with water
related disease?


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Score2
Data Element
Scoring Data
Reference3

Occurrence
3
Detected in drinking
water in the U.S.?
Yes
CDC, 1998(a)

Detected in source water
in the U.S.?
Yes
Abbott in Murray,
2010
2


Holmberg and
Farmer, 1984
Holmberg et al., 1986
1
Not detected in the U.S.?



Health Effects
7
Does the organism cause
significant mortality (>
1/1,000 cases)?
No

6
Does the organism cause
pneumonia, meningitis,
hepatitis, encephalitis,
endocarditis, cancer, or
other severe
manifestations of illness
necessitating long term
hospitalization (> week)?
No

5
Does the illness result in
long term or permanent
dysfunction or disability,
i.e. sequelae?
No

4
Does the illness require
short term hospitalization
(< week)?
Hospitalization may be
required for severe
infections and/or
underlying diseases.
Abbott in Murray,
2010
3 [C, E]
Does the illness require
physician intervention?
[C, E] Physician
office visit may be
required for
diagnosis and
treatment of
dysenteric form of
the disease in
children or the
Abbott in Murray,
2010
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Score2
Data Element
Scoring Data
Reference3


elderly. Bacteremia
more common with
advanced age.

2 [G]
Is the illness self-
limiting within 72 hours
(without requiring
medical intervention)?
[G] Diarrhea may
persist up to two
weeks.
Abbott in Murray,
2010; Forsythe in
MCM, 2019
1
Does the illness result in
mild symptoms with
minimal or no impact on
daily activities?
Plesiomonas is
associated with
travelers' diarrhea or a
history of seafood
consumption, most
infections are self-
limiting.
Abbott in Murray,
2010
1 Bolded text indicates the highest score for that particular protocol. For the hea
th effects protocol two
scores were selected: the general population [G] and the highest score for a sensitive subpopulation.
These 2 scores were added and normalized by multiplying by 5/14 for a final health effects score. The
higher score between the WBDO and Occurrence protocols was used for total pathogen score calculation.
Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic Disease.
2See Final Contaminant Candidate List 3 Microbes: PCCL to CCL Process. EPA 815-R-09-009. Final.
August 2009 for a detailed description on how to calculate the total pathogen score.
3EPA based the WBDO scores on the CDC MMWR reports from 1991 -2017 and then collected
occurrence citations if there were no CDC WBDOs.
References
Abbott, S.L. 2007. Klebsiella, Enterobacter, Citrobacter, Serratia, Plesiomonas, and other
Enterobacteriaceae. In Murray, P.R., E.J. Baron, J.H. Jorgensen, M.A. Pfaller, and R.H. Yolken
(ed.) The Manual of Clinical Microbiology, 10th edition, American Society for Microbiology,
Washington, DC Vol. 1; p. 639.
Centers for Disease Control and Prevention (CDC). 1998. Plesiomonas shigelloides and
Salmonella serotype Hartford infections associated with a contaminated water supply -
Livingston County, New York, 1996. MMWR 47(19):394-396.
CDC, 2020. National Outbreak Reporting System (NORS).
https://wwwn.cdc.gov/norsdashboard/ Accessed August 31, 2020.
Forsythe et al., Klebsiella and Selected Enterobacterales. Chapter 40 in Carroll, K.C., Pfaller,
M.A., Landry, M.L., McAdam, A.J., Patel, R., Richter, S.S. and Warnock, D.W. (ed). 2019.
Manual of Clinical Microbiology, Twelfth Edition.
Holmberg, S.D. and J.J. Farmer. 1984. Aeromonas hydrophila and Plesiomonas shigelloides as
causes of intestinal infections. Rev. Infect. Dis. 6: 633-639.
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Holmberg, S.D., K. Wachsmith, F.W. Hickman-Brenner, P.A. Blake, and J.J. Farmer. 1986.
Plesiomonas enteric infections in the United States. Annals of Internal Medicine, 105(5): 690-
694.
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Pseudomonas Aeruginosa Scoring Data
Scoring Summary1'2
Waterborne Disease Outbreak
5
Health Effects
General population
3
Sensitive subpopulation(s) [C, CD]
6
1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two scores were selected: the
general population [G] and the highest score for a sensitive subpopulation. These 2 scores were added and normalized by
multiplying by 5/14 for a final health effects score. The higher score between the WBDO and Occurrence protocols was used for
total pathogen score calculation. Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic
Disease
Score2
Data Element
Scoring Data
Reference3

Waterborne Disease Outbreaks
5
Has caused multiple (2 or
more) documented WBDOs in
the U.S. reported by CDC
between 2009-2017
Yes
2013: 1 Community
2016: 1 Community
CDC-NORS, 2020
4
Has caused at least one
documented WBDOs in U.S.
reported by CDC between
2009-2017
No
CDC-NORS, 2020
3
Has caused documented
WBDOs at any time in the
U.S.?
Yes; tap water in
NICU
Kinsey et al., 2017
2
Has caused WBDOs in
countries other than the U.S.?
NA

1
Has never caused WBDOs in
any country, but has been
epidemiologically associated
with water related disease?
NA


Occurrence
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Score2
Data Element
Scoring Data
Reference3
3
Detected in drinking water in
the U.S.?
Yes
Kinsey et al., 2017
2
Detected in source water in the
U.S.?


1
Not detected in the U.S.?



Health Effects
7 [C]
Does the organism cause
significant mortality (> 1/1,000
cases)?
Nosocomial
pneumonia.
Henry and Speert in
Murray, 2010
6 [C, CD]
Does the organism cause
pneumonia, meningitis,
hepatitis, encephalitis,
endocarditis, cancer, or other
severe manifestations of
illness necessitating long term
hospitalization (> week)?
Septicemia and
meningitis occur
rarely in
immunocompetent
hosts, but can occur
in neonates and
cystic fibrosis
patients.
Henry and Speert et al.
in Murray, 2010
CDC, 2019
Hoiby et al., in MCM,
2019
5
Does the illness result in long
term or permanent dysfunction
or disability, i.e. sequelae?


4
Does the illness require short
term hospitalization (< week)?


3 [G]
Does the illness require
physician intervention?
Antibiotics
Henry and Speert in
Murray, 2010
2
Is the illness self-limiting
within 72 hours (without
requiring medical
intervention)?


1
Does the illness result in mild
symptoms with minimal or no
impact on daily activities?


1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two
scores were selected: the general population [G] and the highest score for a sensitive subpopulation.
These 2 scores were added and normalized by multiplying by 5/14 for a final health effects score. The
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higher score between the WBDO and Occurrence protocols was used for total pathogen score calculation.
Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic Disease.
2See Final Contaminant Candidate List 3 Microbes: PCCL to CCL Process. EPA 815-R-09-009. Final.
August 2009 for a detailed description on how to calculate the total pathogen score.
3EPA based the WBDO scores on the CDC MMWR reports from 1991 -2017 and then collected
occurrence citations if there were no CDC WBDOs.
References
Centers for Disease Control and Prevention (CDC). 2019. Pseudomonas aeruginosa home page.
https://www.cdc.gov/hai/organisms/pseudomonas.html
CDC, 2020. National Outbreak Reporting System (NORS).
https://wwwn.cdc.gov/norsdashboard/ Accessed August 31, 2020.
Henry, D. and D. Speert. 2010. Pseudomonas. In Murray, P.R., E.J. Baron, J.H. Jorgensen, M.A.
Pfaller, and R.H. Yolken (ed.) The Manual of Clinical Microbiology, 8th. edition, American
Society for Microbiology, Washington, DC. Vol. 1: p. 666.
Hoiby et al., Pseudomonas. Chapter 46 in Carroll, K.C., Pfaller, M.A., Landry, M.L., McAdam,
A.J., Patel, R., Richter, S.S. and Warnock, D.W. (ed). 2019. Manual of Clinical Microbiology,
Twelfth Edition.
Kinsey C.B., et al. P. aeruginosa outbreak in NICU linked to contaminated tap water. 2017.
Infection control & hospital epidemiology, 38(7), 801-808.
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Rotavirus Scoring Data
Scoring Summary1'2
Occurrence
3
Health Effects
General population
1
Sensitive subpopulation(s) [C]
6
1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two scores were selected: the
general population [G] and the highest score for a sensitive subpopulation. These 2 scores were added and normalized by
multiplying by 5/14 for a final health effects score. The higher score between the WBDO and Occurrence protocols was used for
total pathogen score calculation. Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic
Disease
Score2
Data Element
Scoring Data
Reference3

Waterborne Disease Outbreaks
5
Has caused multiple (1 or more)
documented WBDOs in the U.S.
reported by CDC between 2009-
2017
No
CDC-NORS, 2020
4
Has caused at least one
documented WBDOs in U.S.
reported by CDC between 2009-
2017
No
CDC-NORS, 2020
3
Has caused documented
WBDOs at any time in the
U.S.?
Yes
1971-2008: 1
Community
CDC-NORS,2020
2
Has caused WBDOs in countries
other than the U.S.?
Yes
China and Sweden.
Hardy, 1987
Gerba et al., 1996
1
Has never caused WBDOs in any
country, but has been
epidemiologically associated with
water related disease?



Occurrence
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Score2
Data Element
Scoring Data
Reference3
3
Detected in drinking water in
the U.S.?
Yes
USGS, 2001
Gerba et al., 1996
2
Detected in source water in the
U.S.?
Yes
Abbaszadegan et al., 2003
Gerba etal., 1996
1
Not detected in the U.S.?



Health Effects
7
Does the organism cause
significant mortality (> 1/1,000
cases)?
No
For children under 5
years of age:
Estimated 37 deaths
in 60,000
hospitalized cases per
year in U.S.(1/1621
hospitalizations).
Fischer et al., 2007

Does the organism cause
pneumonia, meningitis,
hepatitis, encephalitis,
endocarditis, cancer, or other
severe manifestations of illness
necessitating long term
hospitalization (> week)?
[C] Rotavirus
infects all children;
causes severe
gastroenteritis in
infants. Significant
numbers of
physician visits and
hospitalizations and
high medical and
societal costs.
Pang in Murray, 2010;
Carroll, 2019
CDC, 2019
6 [C]

A sporadic,
seasonal, often
severe
gastroenteritis of
infants and young
children,
characterized by
vomiting, fever and
watery diarrhea.
Rotaviral enteritis is
occasionally
associated with
severe dehydration

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Score2
Data Element
Scoring Data
Reference3


and death in young
children. In
developing
countries, an
estimated 600,000-
870,000 diarrheal
deaths each year.
Heymann, 2005
5
Does the illness result in long
term or permanent dysfunction or
disability, i.e. sequelae?


4
Does the illness require short
term hospitalization (< week)?


3
Does the illness require physician
intervention?


2
Is the illness self-limiting within
72 hours (without requiring
medical intervention)?


1[G, P,
E, CD]
Does the illness result in mild
symptoms with minimal or no
impact on daily activities?
[G, E, P, CD]
Self-limiting acute
watery diarrhea,
vomiting, fever.
Heymann, 2005
1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two
scores were selected: the general population [G] and the highest score for a sensitive subpopulation.
These 2 scores were added and normalized by multiplying by 5/14 for a final health effects score. The
higher score between the WBDO and Occurrence protocols was used for total pathogen score calculation.
Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic Disease.
2See Final Contaminant Candidate List 3 Microbes: PCCL to CCL Process. EPA 815-R-09-009. Final.
August 2009 for a detailed description on how to calculate the total pathogen score.
3EPA based the WBDO scores on the CDC MMWR reports from 1991 -2017 and then collected
occurrence citations if there were no CDC WBDOs.
References
Abbaszadegan, M., M. LeChevallier, and C.P. Gerba. 2003. Occurrence of viruses in U. S.
groundwaters, JAWWA 95: 107-120.
Centers for Disease Control and Prevention (CDC). 2019. Rotavirus home page.
https://www.cdc.gov/rotavirus/index.html
CDC, 2020. National Outbreak Reporting System (NORS).
https://wwwn.cdc.gov/norsdashboard/ Accessed August 31, 2020.
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Pang, X. and X. Jiang. 2010. Gastroenteritis Viruses. In Murray, P.R., E.J. Baron, J.H.
Jorgensen, M.A. Pfaller, and R.H. Yolken (ed.) The Manual of Clinical Microbiology, 10th
edition, American Society for Microbiology, Washington, DC Vol. 2; 1454-1457.
Pang and Smieja. Gastroenteritis Viruses in Carroll, K.C., Pfaller, M.A., Landry, M.L.,
McAdam, A. J., Patel, R., Richter, S.S. and Warnock, D.W.(ed). 2019. Manual of Clinical
Microbiology, Twelfth Edition.
United States Geological Service (USGS). 2001. W.S.L. Banks, C.A. Klohe and D.A. Battigelli.
Occurrence and Distribution of Enteric Viruses in Shallow Ground Water and Factors Affecting
Well Vulnerability to Microbiological Contamination in Worcester and Wicomico Counties,
Maryland. Water-Resources Investigations Report 01-4147: 14, 21.
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Salmonella enterica Scoring Data
Scoring Summary1'2
Waterborne Disease Outbreak
3
Health Effects
General population
3
Sensitive subpopulation(s) [C, E]
4
1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two scores were selected: the
general population [G] and the highest score for a sensitive subpopulation. These 2 scores were added and normalized by
multiplying by 5/14 for a final health effects score. The higher score between the WBDO and Occurrence protocols was used for
total pathogen score calculation. Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic
Disease
Score2
Data Element
Scoring Data
Reference3

Waterborne Disease Outbreaks
5
Has caused multiple (2 or
more) documented
WBDOs in the U.S.
reported by CDC between
2009-2017
No
CDC-NORS, 2020
4
Has caused at least one
documented WBDOs in
U.S. reported by CDC
between 2009-2017
No

3
Has caused documented
WBDOs at any time in
the U.S.?
Yes
1971-2008: 13
Community
7 Noncommunity
CDC-NORS, 2020
(some are "Salmonella
unknown")
2
Has caused WBDOs in
countries other than the
U.S.?


1
Has never caused WBDOs
in any country, but has
been epidemiologically
associated with water
related disease?



Occurrence
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Score2
Data Element
Scoring Data
Reference3
3
Detected in drinking
water in the U.S.?
Yes
Angulo et al., 1997
CDC, 1998(a).
2
Detected in source water
in the U.S.?


1
Not detected in the U.S.?



Health Effects

Does the organism cause
significant mortality (>
1/1,000 cases)?
Each year, 1.4 M cases
of illness and 600 deaths
are caused by non-
typhoidal salmonellosis
in the U.S.
Nataro et al. in Murray,
2007
Buchan in Carroll, 2019
7

Estimated 800 cases per
year of typhoid fever in
the U.S., with fewer than
5 deaths/yr.; >70% of
U.S. cases related to
foreign travel.

6
Does the organism cause
pneumonia, meningitis,
hepatitis, encephalitis,
endocarditis, cancer, or
other severe
manifestations of illness
necessitating long term
hospitalization (> week)?
Nontyphoidal
salmonellosis usually
causes intestinal
infection; can cause
extraintestinal infections
in rare cases (bacteremia,
urinary tract infection,
osteomyelitis), especially
in immunocompromised
persons.
Nataro et al. in Murray,
2007
5
Does the illness result in
long term or permanent
dysfunction or disability,
i.e. sequelae?
None reported.

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Score2
Data Element
Scoring Data
Reference3

Does the illness require
short term
hospitalization (< week)?
[C] Extra-intestinal
infections highest in
infants and young
children.
Nataro et al. in Murray,
2007
4[C, E]

[E] Dehydration,
especially among
infants or in the elderly,
may be severe. Deaths
are uncommon, except
in the young and old,
the debilitated and
immunosuppressed.
Heymann, 2005
CDC, 2019.
3 [G, P,
CD]
Does the illness require
physician intervention?
[G, P, CD] Antibiotic
and rehydration may
be necessary.
Heymann, 2005
2
Is the illness self-limiting
within 72 hours (without
requiring medical
intervention)?
Non-typhoidal
Salmonella usually cause
intestinal infection that
often lasts 1 week or
longer.
Nataro et al. in Murray,
2007
1
Does the illness result in
mild symptoms with
minimal or no impact on
daily activities?


1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two
scores were selected: the general population [G] and the highest score for a sensitive subpopulation.
These 2 scores were added and normalized by multiplying by 5/14 for a final health effects score. The
higher score between the WBDO and Occurrence protocols was used for total pathogen score calculation.
Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic Disease.
2See Final Contaminant Candidate List 3 Microbes: PCCL to CCL Process. EPA 815-R-09-009. Final.
August 2009 for a detailed description on how to calculate the total pathogen score.
3EPA based the WBDO scores on the CDC MMWR reports from 1991 -2017 and then collected
occurrence citations if there were no CDC WBDOs.
References
Angulo, F.J., S. Tippen, D. J. Sharp, B.J. Payne, C. Collier, J.E. Hill, T.J. Barrett, R.H. Clark,
E.E. Geldreich, H.D. Donnell, Jr., D.L. Swerdlow. 1997. A community waterborne outbreak of
salmonellosis and the effectiveness of a boil water order. American Journal of Public Health,
87(4): 580-584.
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Buchan. Escherichia, Shigella and Salmonella in in Carroll, K.C., Pfaller, M.A., Landry, M.L.,
McAdam, A. J., Patel, R., Richter, S.S. and Warnock, D.W.(ed). 2019. Manual of Clinical
Microbiology, Twelfth Edition.
Centers for Disease Control and Prevention (CDC). 1998. Plesiomonas shigelloides and
Salmonella serotype Hartford infections associated with a contaminated water supply -
Livingston County, New York, 1996. MMWR 47(19): 394-396.
CDC, 2019. Salmonella home page, https://www.cdc.gov/salmonella/index.html
CDC, 2020. National Outbreak Reporting System (NORS).
https://wwwn.cdc.gov/norsdashboard/ Accessed August 31, 2020.
Heyman, D. (ed.). 2005. Control of Communicable Diseases Manual, 18ed. American Public
Health Association, Washington, DC.
Nataro, J.P., C.A. Bopp, P.I. Fields, J.B. Kaper, andN.A. Strockbine. 2007. Escherichia,
Shigella, and Salmonella. In Murray, P.R., E.J. Baron, J.H. Jorgensen, M.L. Landry, and M.A.
Pfaller (ed.) The Manual of Clinical Microbiology, 9th. edition, American Society for
Microbiology, Washington, DC. Vol. 1: 680-687.
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Shigella sonnei Scoring Data
Scoring Summary1'2
Waterborne Disease Outbreak
4
Health Effects
General population
3
Sensitive subpopulation(s) [C, E]
6
1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two scores were selected: the
general population [G] and the highest score for a sensitive subpopulation. These 2 scores were added and normalized by
multiplying by 5/14 for a final health effects score. The higher score between the WBDO and Occurrence protocols was used for
total pathogen score calculation. Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic
Disease
Score2
Data Element
Scoring Data
Reference3

Waterborne Disease Outbreaks
5
Has caused multiple (2 or
more) documented WBDOs in
the U.S. reported by CDC
between 2009-2017
No
CDC-NORS, 2020
4
Has caused at least one
documented WBDOs in U.S.
reported by CDC between
2009-2017
Yes
2015: 1 Community
(suspected, not
confirmed)
CDC-NORS, 2020
3
Has caused documented
WBDOs at any time in the
U.S.?
1971-2008:15
Community
23 Noncommunity
(some unknown)
CDC-NORS, 2020
2
Has caused WBDOs in
countries other than the U.S.?


1
Has never caused WBDOs in
any country, but has been
epidemiologically associated
with water related disease?



Occurrence
3
Detected in drinking water in
the U.S.?
Yes
Craun, 2003
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Score2
Data Element
Scoring Data
Reference3
2
Detected in source water in the
U.S.?
Yes
Black et al., 1978
1
Not detected in the U.S.?



Health Effects
7
Does the organism cause
significant mortality (> 1/1,000
cases)?
In U.S. approximately
450,000 cases occur each
year with 70 deaths.
Nataro in Murray,
2007
Buchan in Carroll,
2019
6 [C, E]
Does the organism cause
pneumonia, meningitis,
hepatitis, encephalitis,
endocarditis, cancer, or other
severe manifestations of
illness necessitating long term
hospitalization (> week)?
[C, E] S. dysentariae is
associated with more
serious symptoms than
other species with
complications such as
toxic megacolon,
hemolytic uremic
syndrome and
intestinal perforation.
Cases may be severe in
infants and the elderly
and convulsions may
occur in young
children.
Heymann, 2005
5
Does the illness result in long
term or permanent dysfunction
or disability, i.e. sequelae?
Reiter's syndrome.
Heymann, 2005
4
Does the illness require short
term hospitalization (< week)?
Hospitalization is usually
required for intravenous
antibiotic therapy due to
bacteremia, which is
uncommon.
Heymann, 2005
3 [G]
Does the illness require
physician intervention?
[G] Most cases occur in
children under 10
years, infants under 6
months rarely infected,
increased severity in
children and elderly,
high secondary case
rate in outbreaks,
Heymann, 2005
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Score2
Data Element
Scoring Data
Reference3


outbreaks occur in
daycare centers,
institutions, refugee
camps, among
homosexual men, 20%
of U.S. cases result
from international
travel, specific
antibiotic therapy
available for prolonged
or severe cases, multi-
antibiotic resistance
occurs.

2
Is the illness self-limiting
within 72 hours (without
requiring medical
intervention)?
Acute diarrhea, fever,
nausea, vomiting,
cramps and tenesmus,
stools contain blood and
mucus (dysentery),
usually self-limiting in 4-
7 days without treatment.
Heymann, 2005
CDC, 2019
1
Does the illness result in mild
symptoms with minimal or no
impact on daily activities?
S. sonnei causes most of
the shigellosis cases in
the U.S., cases may be
asymptomatic or mildly
symptomatic, but they
are frequently acute.
Heymann, 2005
1 Bolded text indicates the highest score for that particular protocol. For the healt
i effects protocol two
scores were selected: the general population [G] and the highest score for a sensitive subpopulation.
These 2 scores were added and normalized by multiplying by 5/14 for a final health effects score. The
higher score between the WBDO and Occurrence protocols was used for total pathogen score calculation.
Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic Disease.
2See Final Contaminant Candidate List 3 Microbes: PCCL to CCL Process. EPA 815-R-09-009. Final.
August 2009 for a detailed description on how to calculate the total pathogen score.
3EPA based the WBDO scores on the CDC MMWR reports from 1991 -2017 and then collected
occurrence citations if there were no CDC WBDOs.
References
Black, R.E., G.F. Craun, and P. A. Blake. 1978. Epidemiology of common-source outbreaks of
shigellosis in the United States, 1961-1975. American journal of epidemiology, 108: 47-52.
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Buchan. Escherichia, Shigella and Salmonella in in Carroll, K.C., Pfaller, M.A., Landry, M.L.,
McAdam, A. J., Patel, R., Richter, S.S. and Warnock, D.W.(ed). 2019. Manual of Clinical
Microbiology, Twelfth Edition.
Centers for Disease Control and Prevention (CDC). 2019. Shigella home page.
https://www.cdc.gov/shigella/index.html.
CDC. 2020. National Outbreak Reporting System (NORS).
https://wwwn.cdc.gov/norsdashboard/ Accessed August 31, 2020.
Craun, G., R. Calderon, and M. Craun. 2003. Waterborne Outbreaks in the United States, 1971-
2000, in Drinking Water Regulation and Health. F. Pontius (ed.): pp. 45 - 60.
Heymann, D. (ed.). 2005. Control of communicable diseases manual. 18th edition. American
Public Health Association, Washington, DC.
Nataro, J., C. Bopp, P. Fields, J. Kaper and N. Strockbine. 2007. Escherichia, Shigella, and
Salmonella. In Murray, P.R., E.J. Baron, J.H. Jorgensen, M.A. Pfaller, and R.H. Yolken (ed.)
The Manual of Clinical Microbiology, 9th edition, American Society for Microbiology,
Washington, DC. Vol. 1: pp. 670, 677 - 678.
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Toxoplasma gondii Scoring Data
Scoring Summary1
Waterborne Disease Outbreak
2
Health Effects
General population
2
Sensitive subpopulation(s) [P]
7
1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two scores were selected: the
general population [G] and the highest score for a sensitive subpopulation. These 2 scores were added and normalized by
multiplying by 5/14 for a final health effects score. The higher score between the WBDO and Occurrence protocols was used for
total pathogen score calculation. Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic
Disease
Score2
Data Element
Scoring Data
Reference3

Waterborne Disease Outbreaks
5
Has caused multiple (1
or more) documented
WBDOs in the U.S.
reported by CDC
between 2009-2017
No
CDC-NORS, 2020
4
Has caused at least one
documented WBDOs
in U.S. reported by
CDC between 2009-
2017
No
CDC-NORS, 2020
3
Has caused
documented WBDOs
at any time in the U.S.?
No

2
Has caused WBDOs
in countries other
than the U.S.?
Yes
Canada and Brazil.
Bowie et al., 1997
de Moura, 2006
1
Has never caused
WBDOs in any
country, but has been
epidemiologically
associated with water
related disease?


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Score2
Data Element
Scoring Data
Reference3

Occurrence
3
Detected in drinking
water in the U.S.?
No

2
Detected in source
water in the U.S.?
No

1
Not detected in the
U.S.?
Yes
Groundwater in Poland
and Canada.
Sroka et al., 2006
Isaac-Renton et al.,
1998

Health Effects
7[P]
Does the organism
cause significant
mortality (> 1/1,000
cases)?
[P] Congenital infection
of neonates severe.
Infection during early
pregnancy may lead to
fetal infection with death
of the fetus or other
severe manifestations.
Later in pregnancy,
maternal infection
results in mild or
subclinical fetal disease.
Wilson in Murray,
2007; McAuley and
Singh in MCM,
2019
Heymann, 2005
6
Does the organism
cause pneumonia,
meningitis, hepatitis,
encephalitis,
endocarditis, cancer, or
other severe
manifestations of
illness necessitating
long term
hospitalization (>
week)?
Immunocompromi sed
hosts may experience
CNS, pneumonitis, and
myocarditis.
Wilson in Murray,
2007
5
Does the illness result
in long term or
permanent dysfunction
or disability, i.e.
sequelae?


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Score2
Data Element
Scoring Data
Reference3
4
Does the illness require
short term
hospitalization (<
week)?


3
Does the illness require
physician intervention?
Treatment is indicated
only for pregnant women,
infants and
immunocompromi sed
hosts.
Wilson in Murray,
2007
2 [G, C,
E, CD]
Is the illness self-
limiting within 72
hours (without
requiring medical
intervention)?
[G, C, E, CD] Infection
is generally
asymptomatic; however,
10 - 20% of patients
with acute infection may
develop cervical
lymphadenopathy
and/or flu-like
symptoms.
Wilson in Murray,
2007
1
Does the illness result
in mild symptoms with
minimal or no impact
on daily activities?


1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two
scores were selected: the general population [G] and the highest score for a sensitive subpopulation.
These 2 scores were added and normalized by multiplying by 5/14 for a final health effects score. The
higher score between the WBDO and Occurrence protocols was used for total pathogen score calculation.
Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic Disease.
2See Final Contaminant Candidate List 3 Microbes: PCCL to CCL Process. EPA 815-R-09-009. Final.
August 2009 for a detailed description on how to calculate the total pathogen score.
3EPA based the WBDO scores on the CDC MMWR reports from 1991 -2017 and then collected
occurrence citations if there were no CDC WBDOs.
References
Bowie, W.R., S.A. King, D.H. Werker, J.L. Isaac-Renton, A. Bell, S.B. Eng, and S.A. Marion.
1997. Outbreak of toxoplasmosis associated with municipal drinking water. Lancet, 350: 173-
177.
Centers for Disease Control and Prevention (CDC). 2020. National Outbreak Reporting System
(NORS). https://wwwn.cdc.gov/norsdashboard/ Accessed August 31, 2020.
Heymann, D. (ed.). 2005. Control of Communicable Diseases Manual, 18th ed. American Public
Health Association, Washington, DC.
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Isaac-Renton, J., W.R. Bowie, A. King, G.S. Irwin, C.S. Ong, C.P. Fung, M.O. Shokeir and J.P.
Dubey. 1998. Detection of Toxoplasma gondii Oocysts in Drinking Water. Applied and
Environmental Microbiology, 64(6): 2278-2280.
de Moura L., L.M. Bahia-Oliveira, M.Y. Wada, J.L. Jones, S.H. Tuboi, E.H. Carmo, W.M.
Ramalho, N.J. Camargo, R. Trevisan, R.M. Graca, A.J. da Silva, I. Moura, J.P. Dubey, and D.O.
Garrett. 2006. Waterborne toxoplasmosis, Brazil, from field to gene. Emerging Infectious
Diseases, 12(2): 326-9.
McAuley and Singh. Toxoplasma in Carroll, K.C., Pfaller, M.A., Landry, M.L., McAdam, A. J.,
Patel, R., Richter, S.S. and Warnock, D.W.(ed). 2019. Manual of Clinical Microbiology, Twelfth
Edition.
Sroka J., A. Wojcik-Fatla, J. Dutkiewicz. 2006. Occurrence of Toxoplasma Gondii in Water
from Wells Located on Farms. Annals of Agricultural and Environmental Medicine ,13: 169-175.
Wilson, M., J. Jones and J. McAuley. 2007. Toxoplasma. In Murray, P.R., E.J. Baron, J.H.
Jorgensen, M.L. Landry, and M. A. Pfaller (ed.) The Manual of Clinical Microbiology, 9th.
edition, American Society for Microbiology, Washington, DC. Vol. 2: p. 2070.
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Vibrio cholerae Scoring Data
Scoring Summary1'2
Waterborne Disease Outbreak
3
Health Effects
General population
3
Sensitive subpopulation(s) [C, E, P, CD]
3
1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two scores were selected: the
general population [G] and the highest score for a sensitive subpopulation. These 2 scores were added and normalized by
multiplying by 5/14 for a final health effects score. The higher score between the WBDO and Occurrence protocols was used for
total pathogen score calculation. Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic
Disease
Score2
Data Element
Scoring Data
Reference3

Waterborne Disease Outbreaks
5
Has caused multiple (2 or
more) documented WBDOs
in the U.S. reported by CDC
between 2009-2017
No
CDC-NORS, 2020
4
Has caused at least one
documented WBDOs in U.S.
reported by CDC between
2009-2017
No
CDC-NORS, 2020
3
Has caused documented
WBDOs at any time in the
U.S.?
1971-2008: 1 Bulk
Water Purchase
CDC-NORS, 2020
2
Has caused WBDOs in
countries other than the U.S.?


1
Has never caused WBDOs in
any country, but has been
epidemiologically associated
with water related disease?



Occurrence
3
Detected in drinking water
in the U.S.?
Yes (outbreak data)
CDC, 1996
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Score2
Data Element
Scoring Data
Reference3
2
Detected in source water in
the U.S.?
Yes
Rhodes et al., 1986
Kaper et al., 1982
1
Not detected in the U.S.?



Health Effects
7
Does the organism cause
significant mortality (>
1/1,000 cases)?
V cholerae Non-01:
third most commonly
isolated in U.S. -
Septicemia case fatality
rate from 47-65%.
Abbott in Murray,
2010; Tarr et al., in
MCM 2019
6
Does the organism cause
pneumonia, meningitis,
hepatitis, encephalitis,
endocarditis, cancer, or other
severe manifestations of
illness necessitating long
term hospitalization (>
week)?
V. cholerae 01:
Extremely rare cases
cause severe
extraintestinal infection.
If untreated, V. cholerae
01 infection causes
severe dehydration which
leads to hypovolemic
shock, acidosis,
circulatory collapse, and
death. Unlike 01 strains,
non-01 isolates are
commonly associated
with extrainstestinal
infections such as
septicemia.
Abbott in Murray,
2010
5
Does the illness result in long
term or permanent
dysfunction or disability, i.e.
sequelae?


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Score2
Data Element
Scoring Data
Reference3
4
Does the illness require short
term hospitalization (<
week)?
In severely dehydrated
cases (cholera gravis),
death may occur within a
few hours, and the case-
fatality rate may exceed
50%. With proper and
timely rehydration, this
can be less than 1%.
Heymann, 2005
3 [G, C,
P, E, CD]
Does the illness require
physician intervention?
[All populations] In
most cases infection is
asymptomatic or causes
self-limiting diarrhea.
Treatment consists of
fluid replacement by
oral rehydration
therapy and/or
intravenous fluids.
Abbott in Murray,
2010
2
Is the illness self-limiting
within 72 hours (without
requiring medical
intervention)?


1
Does the illness result in mild
symptoms with minimal or
no impact on daily activities?


1 Bolded text indicates the highest score for that particular protocol. For the hea
th effects protocol two
scores were selected: the general population [G] and the highest score for a sensitive subpopulation.
These 2 scores were added and normalized by multiplying by 5/14 for a final health effects score. The
higher score between the WBDO and Occurrence protocols was used for total pathogen score calculation.
Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic Disease.
2See Final Contaminant Candidate List 3 Microbes: PCCL to CCL Process. EPA 815-R-09-009. Final.
August 2009 for a detailed description on how to calculate the total pathogen score.
3EPA based the WBDO scores on the CDC MMWR reports from 1991 -2017 and then collected
occurrence citations if there were no CDC WBDOs.
References
Abbott, S.L., J.M. Janda, and J.J. Farmer. 2010. Vibrio and Related Organisms. In Murray, P.R.,
E.J. Baron, J.H. Jorgensen, M.A. Pfaller, and R.H. Yolken (ed.) The Manual of Clinical
Microbiology, 8th. edition, American Society for Microbiology, Washington, DC. Vol. 1: p. 666.
Centers for Disease Control and Prevention (CDC). 2020. National Outbreak Reporting System
(NORS). https://wwwn.cdc.gov/norsdashboard/ Accessed August 31, 2020.
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Heymann, D. (ed.). 2005. Control of Communicable Diseases Manual, 18th ed. American Public
Health Association, Washington, DC. pp. 113-127.
Kaper, J.B., H.B. Bradford, N.C. Roberts, and S. Falkow. 1982. Molecular epidemiology of
Vibrio cholerae in the U.S. Gulf Coast. Journal of Clinical Microbiology, 16(1): 129-134.
Rhodes, J.B., H.L. Smith Jr., and J.E. Ogg. 1986. Isolation of Non-01 Vibrio cholerae Serovars
from Surface Waters in Western Colorado. Applied and Environmental Microbiology, 51(6):
1216-1219.
Tarr et al., Vibrio and Related Organisms in Carroll, K.C., Pfaller, M.A., Landry, M.L.,
McAdam, A. J., Patel, R., Richter, S.S. and Warnock, D.W.(ed). 2019. Manual of Clinical
Microbiology, Twelfth Edition.
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Yersinia enterocolitica Scoring Data
Scoring Summary1'2
Waterborne Disease Outbreak
3
Health Effects
General population
2
Sensitive subpopulation(s) [C]
2
1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two scores were selected: the
general population [G] and the highest score for a sensitive subpopulation. These 2 scores were added and normalized by
multiplying by 5/14 for a final health effects score. The higher score between the WBDO and Occurrence protocols was used for
total pathogen score calculation. Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic
Disease
Score2
Data Element
Scoring Data
Reference3

Waterborne Disease Outbreaks
5
Has caused multiple (2
or more) documented
WBDOs in the U.S.
reported by CDC
between 2009-2017
No
CDC-NORS, 2020
4
Has caused at least one
documented WBDOs in
U.S. reported by CDC
between 2009-2017
No
CDC-NORS, 2020
3
Has caused
documented WBDOs
at any time in the
U.S.?
1971-2008: 1
Noncommunity
CDC-NORS, 2020
2
Has caused WBDOs in
countries other than the
U.S.?


1
Has never caused
WBDOs in any country,
but has been
epidemiologically
associated with water
related disease?



Occurrence
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Score2
Data Element
Scoring Data
Reference3
3
Detected in drinking
water in the U.S.?
Yes
Highsmith et al.,
1977
Eden et al., 1977
2
Detected in source
water in the U.S.?
Yes
Meadows and
Snudden, 1982
1
Not detected in the
U.S.?



Health Effects
7
Does the organism
cause significant
mortality (> 1/1,000
cases)?
No

6
Does the organism
cause pneumonia,
meningitis, hepatitis,
encephalitis,
endocarditis, cancer, or
other severe
manifestations of illness
necessitating long term
hospitalization (>
week)?
An uncommon
complication of
gastroenteritis is
septicemia for which the
elderly and
immunocompromised are
at higher risk, particularly
those with metabolic
diseases associated with
iron overload
(hemochromatosis),
cancer, liver disease and
steroid therapy.
Wanger in Murray,
2010; Kingry et al, in
MCM 2019
5
Does the illness result
in long term or
permanent dysfunction
or disability, i.e.
sequelae?
Uncommon sequelae
include: reactive arthritis,
inflammatory bowel
disease, autoimmune
thyroid disorders.
Wanger in Murray,
2010
4
Does the illness require
short term
hospitalization (<
week)?


3
Does the illness require
physician intervention?
The elderly are at greater
risk for septicemia.
Wanger in Murray,
2010
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Score2
Data Element
Scoring Data
Reference3

Is the illness self-
[G, C] (No information
Wanger in Murray,

limiting within 72
available for other
2010

hours (without
populations) Young


requiring medical
children most


intervention)?
commonly develop



gastroenteritis and



present with fever,



diarrhea, and



abdominal pain.

2 [G, C]

Symptoms typically


resolve within 7 days.



Infection typically



manifested by acute



febrile diarrhea with



abdominal pain



(especially in young
Heymann, 2005


children). Diarrhea may



be absent in up to a



third of Y. enterocolitica



infections.

1
Does the illness result
in mild symptoms with
minimal or no impact
on daily activities?


1 Bolded text indicates the highest score for that particular protocol. For the health effects protocol two
scores were selected: the general population [G] and the highest score for a sensitive subpopulation.
These 2 scores were added and normalized by multiplying by 5/14 for a final health effects score. The
higher score between the WBDO and Occurrence protocols was used for total pathogen score calculation.
Health Effects protocol: G - General, C - Child, E - Elderly, P - Pregnant Women, CD - Chronic Disease.
2See Final Contaminant Candidate List 3 Microbes: PCCL to CCL Process. EPA 815-R-09-009. Final.
August 2009 for a detailed description on how to calculate the total pathogen score.
3EPA based the WBDO scores on the CDC MMWR reports from 1991 -2017 and then collected
occurrence citations if there were no CDC WBDOs.
References
Centers for Disease Control and Prevention (CDC). 2020. National Outbreak Reporting System
(NORS). https://wwwn.cdc.gov/norsdashboard/ Accessed August 31, 2020.
Eden, K.V., M.L. Rosenberg, M. Stoopler, B.T. Wood, A.K. Highsmith, P. Skaliy, J.G. Wells,
J.C. Feeley. Waterborne gastrointestinal illness at a ski resort. Isolation of Yersinia enterocolitica
from drinking water. Public Health Report 1977, May - June. 92(3): 245-50.
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Heymann, D. (ed.). 2005. Control of Communicable Diseases Manual, 18th ed. American Public
Health Association, Washington, DC.
Highsmith, A.K., J.C. Feeley, P. Skaliy, J.G. Wells, and B.T. Wood. 1977. Isolation of Yersinia
enterocolitica from well water and growth in distilled water. Applied and Environmental
Microbiology, 34: 745-750.
Kingry et al., Yersinia., in Carroll, K.C., Pfaller, M.A., Landry, M.L., McAdam, A.J., Patel, R.,
Richter, S.S. and Warnock, D.W.(ed). 2019. Manual of Clinical Microbiology, Twelfth Edition.
Meadows, C.A. and B.H. Snudden. 1982. Prevalence of Yersinia enterocolitica in waters of the
lower Chippewa river basin, Wisconsin. Applied and Environmental Microbiology, 43: 953-954.
Schriefer, M. and J. Petersen. 2007. Yersinia. In Murray, P.R., E.J. Baron, J.H. Jorgensen, M.L.
Landry, and M.A. Pfaller (ed.) The Manual of Clinical Microbiology, 10th. edition, American
Society for Microbiology, Washington, DC. Vol. 1: 627.
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EPA 815-R-21-007
July 2021
Appendix F. CCL 5 Data Source Descriptions
Data Sources for Microbial Contaminants
Data Source Name
Data Source Description
The National Outbreak Reporting System (NORS)
Launched in 2009 for Health Departments to report to CDC cases
of enteric disease outbreaks caused by bacterial, viral, parasitic,
chemical, toxin, and unknown agents, as well as foodborne and
waterborne outbreaks of non-enteric disease. NORS was designed
to integrate data on waterborne as well as foodborne outbreaks, but
for CCL only the waterborne data were used.
Proprietor
Contact Information
CDC
CDC, 1600 Clifton Road, N.E., MS C-9,
Atlanta, GA 30333.
Telephone: 404-639-1700;
E-mail: healthywater@cdc.gov
Type of Data Elements
Relevance Explanation
Completeness Explanation
Redundancy Explanation
Retrievability Explanation
Source URL
Waterborne outbreak data
This source is considered relevant for the CCL process because it
contains information on drinking water outbreaks caused by
microbial contaminants which is a major component of the scoring
process.
It meets considerations because it is peer reviewed.
This source is not redundant.
This source meets retrievability criteria because it is in tabular
format.
https://www.cdc.gov/nors/index.html
Data Source Name	Center for Disease Control and Prevention's Morbidity and
Mortality Weekly Reports (MMWR)
Data Source Description Since 1971, CDC, EPA and the Council of State and Territorial
Epidemiologists (CSTE) have maintained a collaborative
surveillance system for collecting and periodically reporting data
related to occurrences and causes of Water Borne Disease
Outbreaks (WBDOs). These reports from the CDC are published
periodically in the MMWR. For CCL EPA used CDC's MMWR
summaries as the source for the WBDO scoring protocol. The
summaries include data on outbreaks associated with drinking
water, recreational water, water not intended for drinking
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EPA-OGWDW Technical Support Document for the Draft Fifth Contaminant Candidate List
(CCL 5)-Microbiai Contaminants
EPA 815-R-21-007
July 2021
(excluding recreational water) and water use of unknown intent.
Public health agencies are responsible for investigating outbreaks
and reporting them voluntarily to CDC using a standard form.
Only data on outbreaks associated with drinking water, water not
intended for drinking (excluding recreational water) and water use
of unknown intent are summarized in this report. CDC and EPA
acknowledge that the WBDOs reported in the surveillance system
represent only a portion of the burden of illness associated with
drinking water exposure. The surveillance information does not
include endemic waterborne disease risks. (Description adapted
from website.)
Proprietor
Contact Information
CDC
Division of Foodborne, Waterborne, and Environmental Diseases,
National Center for Emerging and Zoonotic Infectious Diseases,
CDC, 1600 Clifton Road, N.E., MS C-9,
Atlanta, GA 30333.
Telephone: 404-639-1700;
E-mail: healthywater@cdc.gov
Type of Data Elements
Relevance Explanation
Completeness Explanation
Redundancy Explanation
Retrievability Explanation
Source URL
Waterborne outbreak data
This source is considered relevant for the CCL process because it
contains information on drinking water outbreaks caused by
microbial contaminants which is a major component of the scoring
process.
It meets considerations because it is peer reviewed.
This source is not redundant.
This source meets retrievability criteria because it is in tabular
format.
http://www.cdc.gov/mmwr/indss 2011.html
Data Source Name
Data Source Description
Proprietor
Contact Information
EPA Literature Search for Supplemental Data for Microbial
Contaminants
As part of its ongoing assessment of microbes in drinking water,
EPA conducted a literature review of peer-reviewed, published
journal literature for health effects and occurrence data for
nominated microbes from 2016-2019. EPA reviewed all relevant
research reports found to identify papers that might present data for
the nominated microbes that might help inform CCL 5. EPA also
reviewed studies submitted and referenced by nominators.
U.S. EPA
Nicole Tucker
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EPA-OGWDW Technical Support Document for the Draft Fifth Contaminant Candidate List EPA 815-R-21-007
(CCL 5)-Microbiai Contaminants	July 2021
Email: Tucker.Nicole@epa.gov
Type of Data Elements
Relevance Explanation
Completeness Explanation
Redundancy Explanation
Retrievability Explanation
Source URL
Health effects, drinking water occurrence data elements
This source is considered relevant for the CCL process because it
contains information on health effects and occurrence in water.
It meets considerations because the studies were peer-reviewed.
This source is not redundant (though some, but not all, data may
overlap among papers by the same authors).
Data not retrievable. This source contains written and tabulated
data that can be copied and formatted.
Not applicable
Data Source Name
Data Source Description
Proprietor
Contact Information
Type of Data Elements
Relevance Explanation
Completeness Explanation
Redundancy Explanation
Retrievability Explanation
Source URL
Manual of Clinical Microbiology (MCM), 12th Edition
The 12th edition of the MCM is the result of collaborative efforts
of 22 editors and more than 267 authors from around the world, all
experienced researchers and practitioners in medical and
diagnostic microbiology. The manual has been brought fully up to
date, resulting in 149 chapters containing the latest research
findings, infectious agents, methods, practices and safety
guidelines. Now entering its fifth decade the Manual strives to
continue to be the leading, most authoritative reference for the
"real-world" practice of clinical microbiology. This publication
builds on the content of past editions. The process requires about 3
years of careful planning, design, writing and review of chapters
before the final phases of copyediting, composition, printing and
binding. (Description adapted from website.)
ASM Press, Washington, DC
James Versalovic
Microbiology Laboratories
Texas Children's Hospital
Houston, Texas
Production Volume
This source is considered relevant for the CCL Universe because it
contains health effects and occurrence information on microbial
pathogens.
It meets considerations because it is peer reviewed.
This source is not redundant.
This source is not automatically retrievable. It is a book available
for purchase.
Not applicable
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