are the vectors. A related term is "water-related disease" which is defined as "any significant or widespread adverse effects on human health, such as death, disability, illness or disorders, caused directly or indirectly by the condition, or changes in the quantity or quality of any water". Water-related diseases are grouped according to their transmission mechanism: water borne, water hygiene, water based, water related. The main transmission mode for waterborne diseases is ingestion of contaminated water. Causes Lack of clean water supply, sanitation and hygiene (WASH) are major causes for the spread of waterborne diseases in a community. The fecal–oral route is a disease transmission pathway for waterborne diseases. Poverty also increases the risk of communities to be affected by waterborne diseases. For example, the economic level of a community impacts their ability to have access to clean water. Less developed countries might be more at risk for potential outbreaks of waterborne diseases but more developed regions also are at risk to waterborne disease outbreaks. Diseases by type of pathogen Protozoa Bacteria Viruses Algae Parasitic worms Prevention Reliable access to clean drinking water and sanitation is the main method to prevent waterborne diseases. The aim is to break the fecal–oral route of disease transmission. Epidemiology According to the World Health Organization, waterborne diseases account for an estimated 3.6% of the total DALY (disability- adjusted life year) global burden of disease, and cause about 1.5 million human deaths annually. The World Health Organization estimates that 58% of that burden, or 842,000 deaths per year, is attributable to a lack of safe drinking water supply, sanitation and hygiene (summarized as WASH). United States The Waterborne Disease and Outbreak Surveillance System (WBDOSS) is the principal database used to identify the causative agents, deficiencies, water systems, and sources associated with waterborne disease and outbreaks in the United States. Since 1971, the Centers for Disease Control and Prevention (CDC), the Council of State and Territorial Epidemiologists (CSTE), and the US Environmental Protection Agency (EPA) have maintained this surveillance system for collecting and reporting data on "waterborne disease and outbreaks associated with recreational water, drinking water, environmental, and undetermined exposures to water." "Data from WBDOSS have supported EPA efforts to develop drinking water regulations and have provided guidance for CDC's recreational water activities." WBDOSS relies on complete and accurate data from public health departments in individual states, territories, and other U.S. jurisdictions regarding waterborne disease and outbreak