Waterborne Diseases
Waterborne diseases are those in which the consumption of or exposure to water and/or water systems leads to illness. Common waterborne diseases include, but are not limited to, giardiasis, cryptosporidiosis, vibriosis, shigellosis, and legionellosis. Gastrointestinal, respiratory, and wound infections are typical signs and symptoms of these diseases. These diseases implicate compromised water sanitation and safety that have the potential to affect a large number of people. ADPH is committed to informing you of potential risks that lead to waterborne illnesses, investigating transmission of pathogens that may result in such illnesses, and implementing strategies to reduce the spread of further sickness.
Healthy and Safe Swimming
Beaches
Planning a trip to one of Alabama's coastal beaches? Be sure to visit the Coastal Alabama Beach Monitoring Program page for details on routine sample testing results that assess water quality. Additionally, the beach flag warning system and weather forecast of coastal areas are helpful tools to keep swimmers educated in preparation for beach trips. You can find some additional sources for safe beach trips below.
- Beaches (U.S. Environmental Protection Agency)
- Swimming Safely at the Beach (American Red Cross)
- Top Ten Beach and Water Safety Tips (United States Lifesaving Association)
Pools
When you go swimming, you may be bringing some nasty germs with you. While pools are treated with chemicals to fight germs, the things people add to the water --- things like pee, poop, sweat, and dirt --- can stretch the abilities of those chemicals thin. The results can vary for everyone in the pool, ranging from diarrhea outbreaks to skin, ear, and lung infections.
Use the resources below to learn more about germs commonly found in pools and how to make summer swim sessions healthier for everyone.
- Guidelines for Healthy and Safe Swimming
- Preventing Swimming-related Illnesses
- Share the Fun...Not the Germs...and Make a Healthy Splash! (Centers for Disease Control and Prevention)
- Stay Safe and Healthy at Water Parks
Vibriosis Surveillance in Alabama
Vibriosis is a reportable condition in Alabama. Necrotizing fasciitis (NF), a severe infection commonly referred to in media reports as ‘flesh-eating bacteria’, is not reportable. NF can result from bacterial pathogens, including Vibrio and Vancomycin-Intermediate/Resistant Staphylococcus aureus (VISA/VRSA). During routine disease surveillance, complications that result from Vibrio infection may occur after patient interviews and, therefore, may not be reported. Specimen sites provide insight into the type of infections cases may have experienced. These are illustrated in the table below.
| Reported Specimen Sites for Alabama Vibriosis Cases, by MMWR Year | |||
| Specimen Site* | 2023 | 2024 | 2025¥ |
| Blood or other normally sterile | 2 | 9 | 1 |
| Gastrointestinal (GI) | 25 | 30 | 12 |
| Skin or soft tissue (SST) | 5 | 7 | 2 |
| Multiple | 0 | 0 | 0 |
| Other, non-sterile | 1 | 4 | 3 |
| Unknown | 4 | 3 | 0 |
| Total | 37 | 53 | 18 |
| Note:Collection of these data began in calendar year 2017. Data for specimen sites before 2017 are not available. | |||
| *Specimen site category definitions: | |||
| 1. Blood or other normally sterile site: blood, cerebrospinal fluid, peritoneal fluid, lumbar disc fluid, lymph node, bullae | |||
| 2. Gastrointestinal site: stool, bile, appendix, rectum, gall bladder, colon | |||
| 3. Multiple sites: specimen sites do not fall into a single category | |||
| 4. Other, non-sterile site: urine, sputum, aspirate, bronchial washing, effusion, catheter, endotracheal, eye, nasal, placenta, respiratory, sinus, tonsil | |||
| 5. Skin or soft tissue site: wound, ear (other than otitis media and middle ear, which are included in 'other, non-sterile site'), appendage, tissue | |||
| 6. Unknown: no specimen site was reported or clinical specimen testing was not performed | |||
| ¥ Year-to-date counts - these counts will be updated by the 7th day of each month. | |||
Legionella
Infection with Legionella (also called legionellosis) can vary in severity from a mild febrile illness, Pontiac Fever, to a serious and sometimes fatal form of pneumonia - Legionnaires' disease. Both illnesses are caused by the bacteria Legionella, which is naturally found in freshwater sources such as lakes and streams. However, Legionella bacteria can grow and spread in human-made water systems, such as hot tubs, cooling towers (which use water to cool air as part of centralized air conditioning systems for buildings or industrial processes), hot water tanks, decorative fountains, and large buildings with complex water systems.
Visit our Legionella website for more information.
Resources
General
- How to Disinfect Your Water Well
- Learn more about oceans, lakes, and rivers
- Stay Healthy: Avoid Harmful Algae and Cyanobacteria (Blue-Green Algae)
For Providers
For Operators of Aquatic Venues
- Developing a Water Management Program
- Pool/Spa Inspector Training
- Model Aquatic Health Code
- Free training is available for Legionnaires' disease prevention! CDC and partners developed this training for a variety of professionals involved in water management programs. CEUs are available from the National Environmental Health Association (NEHA).
Water Safety During an Emergency
Page last updated: July 9, 2025
