Abstract
This paper reviews the latest evidence provided by epidemiological studies and quantitative microbial risk assessments (QMRAs) of infection risk from recreational water use. Studies for review were selected following a PubMed search for articles published between January 2010 and April 2014. Epidemiological studies show a generally elevated risk of gastrointestinal illness in bathers compared to non-bathers but often no clear association with water quality as measured by faecal indicator bacteria; this is especially true where study sites are impacted by non-point source pollution. Evidence from QMRAs support the lack of a consistent water quality association for non-point source-impacted beaches. It is suggested that source attribution, through quantified microbial source apportionment, linked with appropriate use of microbial source tracking methods should be employed as an integral part of future epidemiological surveys.
Highlights
This paper reviews the recent literature related to recreational water use and infection
Surveillance data from the United States of America (USA) showed that, during 2009 and 2010, there were 24 recreational water disease outbreaks associated with the use of natural waters, 11 of these were attributed to cyanobacterial toxins
Dufour [36] reviewed a number of epidemiological studies, all conducted before 2010, and found that there was no evidence for associations between swimming-associated gastrointestinal illness and exposure to natural recreational water polluted with faeces from non-human sources
Summary
This paper reviews the recent literature related to recreational water use (in natural waters) and infection. The studies employed two broad protocols, a prospective beach survey in which the exposure status of the respondents was self-determined and a randomised controlled trial in which exposure status was randomised Water quality in these studies was quantified for a range of indicators using both culture and molecular methods, with the quality to which bathers were exposed being assigned by either aggregate water quality measures (e.g., a daily average) or by a series of participant-specific levels. The importance of being aware and accounting for local conditions is illustrated by two studies [18, 25] where the risk of swimming-related gastrointestinal illness was elevated when stream [18] and submarine groundwater discharge [25] was high In both cases there was a relationship between water quality and gastrointestinal illness only when the pollution sources were discharging to the recreational water. 5,454 participants (2,559 bathers and 1,895 non-bathers) followed up at 10-19 days
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