Water Quality Indicators and the Risk of Illness at Beaches With Nonpoint Sources of Fecal Contamination

Colford, John M.; Wade, Timothy J.; Schiff, Kenneth; Wright, Catherine C.; Griffith, John F.; Sandhu, Sukhminder K.; Burns, Susan E.; Sobsey, Mark D.; Lovelace, Greg; Weisberg, Stephen B.

doi:10.1097/01.ede.0000249425.32990.b9

Cited by 318 publications

(268 citation statements)

References 27 publications

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“…Recent waterbody closures at Brazilian Olympic venues 4 and Waikiki beach, Hawaii 5 illustrate recreational water contamination's public health and economic reach. Several cohort studies and randomized trials have measured swimming-related health risks and risks associated with exposure to waters containing elevated fecal indicator bacteria levels, [6][7][8][9][10][11][12][13][14][15][16][17] but individual studies are usually too small to estimate the public health burden associated with water exposure with respect to missed daily activities (work, school, vacation) or medical visits and hospitalizations that result from gastroenteritis. Moreover, individual studies have not typically enrolled enough swimmers to estimate risks separately for children.…”

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confidence: 99%

“…2,21 We conducted a pooled analysis of 13 prospective cohorts in the United States (84 411 participants). [7][8][9][10][11][12][13][14] We coordinated studies to ensure similar designs and measurement methods. This approach enabled us to calculate summary estimates for gastroenteritis risk and related medical and daily activity impacts associated with recreational water exposure and Enterococcus levels; it also enabled us to report for the first time, to our knowledge, separate estimates for children aged 0 to 4 and 5 to 10 years.…”

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confidence: 99%

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Acute Gastroenteritis and Recreational Water: Highest Burden Among Young US Children

et al. 2016

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Objectives. To provide summary estimates of gastroenteritis risks and illness burden associated with recreational water exposure and determine whether children have higher risks and burden. Methods. We combined individual participant data from 13 prospective cohorts at marine and freshwater beaches throughout the United States (n = 84 411). We measured incident outcomes within 10 days of exposure: diarrhea, gastrointestinal illness, missed daily activity (work, school, vacation), and medical visits. We estimated the relationship between outcomes and 2 exposures: body immersion swimming and Enterococcus spp. fecal indicator bacteria levels in the water. We also estimated the population-attributable risk associated with these exposures. Results. Water exposure accounted for 21% of diarrhea episodes and 9% of missed daily activities but was unassociated with gastroenteritis leading to medical consultation. Children aged 0 to 4 and 5 to 10 years had the most water exposure, exhibited stronger associations between levels of water quality and illness, and accounted for the largest attributable illness burden. Conclusions. The higher gastroenteritis risk and associated burden in young children presents important new information to inform future recreational water quality guidelines designed to protect public health.

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Acute Gastroenteritis and Recreational Water: Highest Burden Among Young US Children

et al. 2016

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“…from three coastal locations of Northern Ireland (27). Gulls can be major contributors of fecal contamination in recreational beaches, with loadings of up to 10 8 Escherichia coli bacteria per fecal dropping (1); however, in areas predominantly impacted by seagulls, the level of contamination appears to be unassociated with health risks (5). This suggests that many of the Campylobacter species contaminating beaches may not be infectious to humans.…”

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confidence: 99%

“…are in gull excreta. In particular, there are no published data for California gulls (Larus californicus), even though they are ubiquitous in western coastal areas of the United States and have been suspected to be an important source of fecal pollution for recreational beaches (5). Quantification of potentially human infectious Campylobacter spp.…”

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Molecular Detection of Campylobacter spp. in California Gull (Larus californicus) Excreta

Ryu

Domingo

et al. 2011

Appl Environ Microbiol

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We examined the prevalence, quantity, and diversity of Campylobacter species in the excreta of 159 California gull (Larus californicus) samples using culture-, PCR-, and quantitative PCR (qPCR)-based detection assays. Campylobacter prevalence and abundance were relatively high in the gull excreta examined; however, C. jejuni and C. lari were detected in fewer than 2% of the isolates and DNA extracts from the fecal samples that tested positive. Moreover, molecular and sequencing data indicated that most L. californicus campylobacters were novel (<97% 16S rRNA gene sequence identity to known Campylobacter species) and not closely related to species commonly associated with human illness. Campylobacter estimates were positively related with those of fecal indicators, including a gull fecal marker based on the Catellicoccus marimammalium 16S rRNA gene.

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“…Studies have indicated that risk of gastrointestinal illness associated with exposure to recreational waters impacted by animal feces may not be different from waters impacted by human sources. Nonetheless, human health risk from exposure to recreational waters impacted by non-human sources is still not well understood; some studies did not find statistically significant associations between illness risk and fecal contamination of water by animal sources [17,18].…”

Section: Identify Potential Sources Of Fecal Contamination Of Recreatmentioning

confidence: 99%

Monitoring Recreational Waters: How to Integrate Environmental Determinants

Turgeon¹

2012

JEP

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Recreational waters are associated with a higher risk of disease for people engaged in activities that bring them into contact with these waters. The primary cause of contamination of recreational waters is fecal microorganisms, which may originate from various sources and involve several modulating factors, making it a complex public health and environmental issue. Monitoring recreational water quality should include two key components: Microbial water testing and monitoring environmental determinants associated with higher risks of contamination. Conducting both activities provides the foundation for a comprehensive assessment according to risk and the actual level of fecal pollution and thus could promote good management actions to ensure safe water quality. Nevertheless, monitoring of environmental determinants is rarely fully integrated in monitoring programs and is also harder to achieve, especially when water pollution is mainly associated with nonpoint sources. In order to achieve identification and monitoring of environmental determinants associated with fecal contamination of recreational waters, some specific steps should be followed and some questions must be answered. The objective of this review article is to present current knowledge on this topic and to suggest and discuss recommendations. Potential sources of contamination and factors able to modulate them should be identified and measured after the geographical area influencing fecal contamination of recreational water has been delineated. Statistical models have been developed to identify the relative importance of these environmental characteristics on fecal pollution of recreational waters but they do not allow for a full comprehension of the exact processes leading to this pollution, thus other methods should also be used to better understand these processes.

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Water Quality Indicators and the Risk of Illness at Beaches With Nonpoint Sources of Fecal Contamination

Abstract: Traditional fecal indicators currently used to monitor these beaches were not associated with health risks. These results suggest a need for alternative indicators of water quality where nonpoint sources are dominant fecal contributors.

Cited by 318 publications

References 27 publications

Acute Gastroenteritis and Recreational Water: Highest Burden Among Young US Children

Acute Gastroenteritis and Recreational Water: Highest Burden Among Young US Children

Molecular Detection of Campylobacter spp. in California Gull (Larus californicus) Excreta

Monitoring Recreational Waters: How to Integrate Environmental Determinants

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