Swimming-Associated Gastroenteritis and Water Quality

Abstract

A direct, linear relationship between swimming-associated gastrointestinal illness and the quality of the bathing water was obtained from a multi-year, multiple-location prospective epidemiologic-microbiologic research program conducted in New York City, 1973-1975, Lake Pontchartrain, Louisiana, 1977-1978, and Boston, Massachusetts, 1978. Several microbial indicators were used in attempting to define the quality of the water; and, of those examined, enterococci showed the best correlation to total and "highly credible" gastrointestinal symptoms. The frequency of gastrointestinal symptoms also had a high degree of association with distance from known sources of municipal wastewater. A striking feature of the relationship was the very low enterococcus and Escherichia coli densities in the water (10/100 ml) associated with appreciable attack rates (about 10/1000 persons) for "highly credible" gastrointestinal symptoms. Moreover, the ratio of the swimmer to nonswimmer symptom rates indicated that swimming in even marginally polluted marine bathing water is a significant route of transmission for the observed gastroenteritis.

Enterococci Concentrations in Diverse Coastal Environments Exhibit Extreme Variability

“…Exposure to FIB from municipal wastewater and urban runoff in marine waters correlates to adverse health outcomes in swimmers according to formal epidemiology studies (1)(2)(3). Monitoring results are used for public notification of water quality via beach advisories and closures.…”

Regional Public Health Cost Estimates of Contaminated Coastal Waters: A Case Study of Gastroenteritis at Southern California Beaches

“…Of all the illnesses considered in the literature, GI is most commonly associated with exposure to polluted water (10)(11)(12)(21)(22)(23)(24)(25)(26). To estimate the risk of GI from swimming in contaminated marine waters in southern CA, we utilized two dose-response models (11,12) (Table 1) developed in epidemiology studies conducted elsewhere (in marine waters of the East U.S. coast and United Kingdom) (18,27). A local dose-response model for GI would be preferable, but does not exist.…”

Environmental Health Indicators

“…Contaminated lakes, rivers and coastal waters when used for recreation can also cause healthrelated problems including gastrointestinal, respiratory, ear, eye and skin symptoms (Cabelli, Dufour et al 1982;Kay, Fleisher et al 1994).…”

“…For urban catchments, contamination at beaches could be elevated by inflow and infiltration of storm water into the sewer system. Exposure to pathogens in recreational water have been associated with gastrointestinal, respiratory, ear, eye and skin symptoms (Cabelli, Dufour et al 1982;Kay, Fleisher et al 1994). …”