Abstract
Infectious agents, including bacteria, viruses, protozoa, and molds, may threaten the health of swimming pool bathers. Viruses are a major cause of recreationally-associated waterborne diseases linked to pools, lakes, ponds, thermal pools/spas, rivers, and hot springs. They can make their way into waters through the accidental release of fecal matter, body fluids (saliva, mucus), or skin flakes by symptomatic or asymptomatic carriers. We present an updated overview of epidemiological data on viral outbreaks, a project motivated, among other things, by the availability of improved viral detection methodologies. Special attention is paid to outbreak investigations (source of the outbreak, pathways of transmission, chlorination/disinfection). Epidemiological studies on incidents of viral contamination of swimming pools under non-epidemic conditions are also reviewed.
Highlights
Swimming pools have been implicated in the transmission of infections
We carried out a comprehensive literature review aimed at investigating waterborne viral outbreaks linked to swimming pools, to explore the etiological agents implicated, pathways of transmission, associations between indicator organisms and disease, and key issues related to chlorination/disinfection procedures
In 2013–2014, a study investigated the presence of human enteric viruses in indoor and outdoor swimming pool waters in Rome
Summary
Swimming pools have been implicated in the transmission of infections. Failure in disinfection has been recorded as the main cause of many of the outbreaks associated with swimming pools. The majority of reported swimming pool-related outbreaks have been caused by enteric viruses [1,2]. Sinclair and collaborators reported that 48% of viral outbreaks occur in swimming pools, 40% in lakes or ponds, and the remaining 12% in fountains, hot springs, and rivers (4% each) [1]. The presence of viruses in a swimming pool is the result of direct contamination by bathers, who may shed viruses through unintentional fecal release, or through the release of body fluids such as saliva, mucus, or vomitus [3]. Evidence suggests that skin may be a potential source of pathogenic viruses
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