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\nNaegleria fowleri infects people when water containing the ameba enters the body through the nose. Infection is rare and typically occurs when people go swimming or diving in warm freshwater places, like lakes and rivers. Very rarely, infections have been reported when people put their heads fully underwater, cleanse their noses during religious practices, or irrigate their sinuses (nose) using contaminated tap or faucet water.
\nNaegleria fowleri can grow in pipes, hot water heaters, and water systems, including treated public drinking water systems. You cannot get infected from drinking water contaminated with Naegleria. You can only be infected when contaminated water goes up into your nose.
\nNaegleria fowleri is found naturally in freshwater lakes, rivers, and hot springs in the United States1-3,, particularly in southern-tier states4-8, but has caused infections as far north as Minnesota9. No data exist to accurately estimate the true risk of PAM. Hundreds of millions of visits to swimming venues occur each year in the United States10 that result in 0-8 infections per year 11. It is unknown why certain people become infected with the amebae while millions of others exposed to warm recreational fresh waters do not, including those who were swimming with people who became infected.
\nAttempts have been made to determine what concentration of Naegleria fowleri in the environment poses an unacceptable risk12. However, no method currently exists that accurately and reproducibly measures the numbers of amebae in the water. This makes it unclear how a standard might be set to protect human health and how public health officials would measure and enforce such a standard. However, the risk of Naegleria fowleri infection is very low. There have been 29 reported infections in the United States in the 10 years from 2013 to 2022, despite hundreds of millions of recreational water exposures each year10. By comparison, in the 10 years from 2011 to 2020, there were an estimated 4,012 unintentional drowning deaths each year in the United States.
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