Risk factors for gastroenteritis associated with canal swimming in two cities in the Netherlands during the summer of 2015: A prospective study

Joosten, Rosa; Sonder, Gerard J.B.; Parkkali, Saara; Brandwagt, Diederik; Fanoy, Ewout; Mughini‐Gras, Lapo; Lodder, Willemijn J.; Ruland, Erik; Siedenburg, E; Kliffen, Suzanne; Pelt, Wilfrid van

doi:10.1371/journal.pone.0174732

Cited by 16 publications

(14 citation statements)

References 25 publications

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“…Results from the current ACS study, with an attack rate of AGI of 6%, are consistent with two earlier studies of swimming events in the Netherlands [ 11 , 12 ]. The average age of the exposed group was significantly different from the non-exposed group.…”

Section: Discussionsupporting

confidence: 91%

“…The study design is the same as that of the study conducted in 2015 [ 12 ]. Two prospective cohort studies were conducted among participants of two fundraising swimming events in city canals in the Netherlands: the Utrecht SingelSwim 2016 (USS) and the Amsterdam City Swim 2016 (ACS).…”

Section: Methodsmentioning

confidence: 99%

“…In the questionnaire we asked respondents detailed information about their health complaints before and after the event, general health status, medical and travel history, dietary habits, known illness among family or friends, the use of catering, toilets and/or showers during the event, and specific details about their participation in the event (e.g., distance, duration, water ingestion, swimming technique, type of wetsuit, previous training in open water). Responses were categorized based on literature (e.g., mouthfuls of water, medication use) or to make them comparable with results from our previous study (i.e., age, number of sips, medication use) [ 12 ] ( S1 – S4 Files).…”

Section: Methodsmentioning

confidence: 99%

“…In order to assess their safety, the PHS investigated two city canal swimming events in 2015. One of the events, the Amsterdam City Swim in 2015, led to an outbreak of gastroenteritis with 427 cases (attack rate 31%), the second event reported 7 cases among swimmers (attack rate 9%) [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Infection risks of city canal swimming events in the Netherlands in 2016

et al. 2018

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IntroductionSwimming events in city canals are gaining popularity in the Netherlands, even though canal water is usually not officially designated for recreational use. Knowledge regarding the risk of infection after swimming in canals is limited. An outbreak was reported in 2015 following a canal swimming event in Utrecht, the Netherlands. Local governments were concerned about the health risks of such events. In order to assess the safety of canal swimming, the Public Health Service (PHS) prospectively investigated two city canal swimming events in 2015. In 2016, we repeated this study, aiming to prospectively determine the risks of infection during two urban swimming events, the Utrecht SingelSwim 2016 (USS) and the Amsterdam City Swim 2016 (ACS).MethodsWe sent online questionnaires to 271 USS participants and 2697 ACS participants, concerning personal characteristics, symptoms, and exposure. Participants were asked to forward the questionnaire to three relatives, i.e., non-exposed. We analyzed water samples from the USS venue taken during the event, as well as stool samples of USS participants with acute gastrointestinal illness (AGI). AGI was defined as diarrhea and/or vomiting within seven days after the event. We calculated adjusted risk ratios (RR) for AGI in the exposed group compared with non-exposed respondents, using binomial regression models.ResultsThe questionnaire was returned by 160 USS participants (exposed) (59%) and 40 non-exposed relatives. Five percent of the exposed (n = 17) and 3% of non-exposed (n = 1) reported AGI (RR = 1.69; 95% CI: 0.23–12.46). Norovirus genogroup II was detected in two of six USS water samples and in none of the three stool samples. In one of three stool samples, rotavirus was detected.The questionnaire was returned by 1169 ACS participants (exposed) (43%) and 410 non-exposed relatives. Six percent of the exposed (n = 71) and 1% of non-exposed (n = 5) reported AGI (RR 4.86; 95% CI: 1.98–11.97).ConclusionResults of the ACS event showed a higher risk for AGI among the exposed, indicating that participants of events in urban canals in the Netherlands could be at a higher risk for AGI than those not participating. The inconclusive results from the USS are likely due to the small sample size. Swimming in non-monitored open water can bring health risks and more knowledge about environmental and human risk factors helps reduce the risk by being able to more specifically advise organizations and governments.

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Section: Discussionsupporting

confidence: 91%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Infection risks of city canal swimming events in the Netherlands in 2016

et al. 2018

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“…The presence of NoV and HAdV in freshwater and coastal marine waters has been reported for a substantial number of studies worldwide (Jiang et al ; Wyn‐Jones et al ; Mans et al ; Teixeira et al ; Cooksey et al ). Although water is not the main route by which these viruses are transmitted, their presence in recreational water pose a public health threat because of the potential for human exposure at popular tourist sites (Sinclair et al ; Joosten et al ; Schets et al ). The results reported here demonstrate for the first time the widespread contamination of sinkholes or ‘cenotes’ and brackish water used for recreational activities from the YP karst aquifer with NoV and HAdV, both viruses known to be pathogenic to humans.…”

Section: Discussionmentioning

confidence: 99%

Norovirus and human adenovirus occurrence and diversity in recreational water in a karst aquifer in the Yucatan Peninsula, Mexico

Rosiles‐González¹,

Ávila‐Torres²,

Moreno‐Valenzuela

et al. 2019

J Appl Microbiol

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Aims To determine the seasonal occurrence and diversity of norovirus (NoV) and human adenovirus (HAdV) in groundwater from sinkholes, and brackish water used for recreational activities in the karst aquifer of the Yucatan Peninsula, Mexico. Methods and results Hollow fibre ultrafiltration was used to concentrate viruses and standard plaque assay methods were used to enumerate somatic and F+ specific coliphages as viral indicators. Real‐time quantitative polymerase chain reaction assays were used to estimate the number of genome copies for NoV strains GI, and GII, and HAdVs. The predominant NoV genotypes and HAdV serotypes were identified by comparative sequence analysis. Somatic and male F+ specific coliphages were detected at concentrations up to 94 and 60 plaque‐forming units per 100 ml respectively. The NoV genogroup I (GI) was associated with 50% of the sampled sites during the rainy season only, at concentrations ranging from 120 to 1600 genome copies per litre (GC l−1). The NoV genogroup II (GII) was detected in 30 and 40% of the sampled sites during the rainy and dry seasons, respectively, at concentrations ranging from 10 to 290 GC l−1. During the rainy and dry seasons, HAdVs were detected in 20% of the sites, at concentrations ranging from 24 to 690 GC l−1. Identification of viral types revealed the presence of NoV GI.2, GII.Pe, GII.P16 and GII.P17, and HAdV F serotypes 40 and 41. Conclusions These findings demonstrate that NoVs and HAdVs are prevalent as virus contaminants in the karst aquifer, representing potential health risks particularly during the rainy season, in one of the most important areas used for tourism in Mexico. Significance and Impact of the Study This is one of the few studies conducted in karst aquifers that provide a foundational baseline of the distribution, concentrations and diversity of NoVs and HadVs in these particular environments.

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