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Outbreaks associated with recreational water in the United States, 1995-2004
Citation:
Craun, G. F. AND T. J. WADE. Outbreaks associated with recreational water in the United States, 1995-2004. Hygiena. Statni Zdravotni Ustav (SZU), Praha, Czechoslovakia, 3(53):76, (2008).
Impact/Purpose:
research results
Description:
In this article, we review the causes of 212 recreational waterborne outbreaks and 17975 cases of illness reported during 1995-2004. Gastroenteritis was the most frequently (91%) reported illness. Conditions or symptoms related to the skin, ear, or eye occurred less frequently (6%). Also reported were cases ofleptospriosis, acute respiratory illness, meningitis, and primary amebic meningoencephalitis. A bacterial or protozoan etiology was identified in most (71%) outbreaks; 8% of the outbreaks were viral in origin. An etiology was not confirmed for 17% ofthe outbreaks. Cryptosporidium spp., Pseudomonas aeruginosoa, norovirus, and chemicals were confirmed as the cause of most (69%) outbreaks in treated recreational waters such as swimming and wading pools. Naegleria fowleri, E. coli 0157:H7, norovirus, Shigella spp., and avian Schistosomatidae were confirmed as the cause ofmost (72%) outbreaks in untreated recreational waters such as lakes, ponds, and streams. Bathers themselves were the most important sources of contamination (e.g, fecal accidents, bathing while ill, large numbers ofbathers) for outbreaks in both treated and untreated recreational waters. Sewage discharges, watershed runoff during heavy rainfall, algal blooms, and various animal and avian species were also important sources ofcontamination for untreated recreational waters. Inadequate operation, maintenance, or water treatment was an important contributing risk factor for outbreaks in treated recreational waters. Waterborne outbreak surveillance can help identify the etiologic agents, sources of contamination, and treatment/operational deficiencies so that effective prevention and control programs can be implemented. However, the outbreak statistics may not accurately reflect the risks of sporadic or endemic waterborne illness associated with recreational activities in fresh and marine waters. Information from epidemiologic studies that are now being conducted can lead to guidelines to reduce endemic illness risks.
