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Dan Rahn of the University of Georgia writes about dangers that can lurk in recreational swimming water:

According to the Centers for Disease Control and Prevention, recreational water illnesses can spread quickly in swimming pools that arenít properly maintained.

Serious diseases caused by such bacteria as cryptospordidum, giardia, E. coli and shigella can be contracted by ingesting water contaminated with fecal matter. While symptoms can be as minor as diarrhea or skin, ear or eye infections, these illnesses can be fatal in people with weak immune systems.

Read more about recreational water illness in the full article at the Washington, Georgia News-Reporter Web site.

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26.jul.06
The Galveston County Daily News (TX)
Sally Robinson and Keith Bly

When people think of risks associated with swimming, they usually think of sunburns or drownings. Most swimmers donít realize that the water itself can make them sick.

Recreational water illnesses (RWIís) are spread by swallowing, breathing or coming in contact with water that has been contaminated in swimming pools or hot tubs, and at water parks, lakes, rivers or oceans.

Symptoms of RWIís include skin, ear, respiratory, eye and wound infections. The most commonly reported RWI is diarrhea, which is caused by germs such as Cryptosporidium, Giardia, Shingella and E. coli. If contaminated water is swallowed, a person may become sick; many diarrhea-causing germs do not have to be swallowed in large amounts to make a person ill.

If a swimmer has diarrhea, the germs that they carry can contaminate the water if they have an ìaccidentî in the pool, or if they donít clean themselves well after using the restroom. People with diarrhea can easily contaminate large pools or water parks, because their stools contain millions of germs. Lakes, rivers and the ocean can be contaminated by sewage spills, animal waste and water runoff following rainfall, and some common germs can live for long periods of time in salt water.

Chlorine in swimming pools kills the germs that may make people sick, but it doesnít kill them right away. Most germs that can cause RWIís are killed by chlorine in less than an hour, but some can survive for days, even if the pool has been properly disinfected.

Here are some tips to prevent the spread of recreational water illnesses:

Do not let children swim if they have diarrhea, especially if they wear diapers.

Tell your children not to swallow pool water and to try to avoid even having water get in their mouth.

Teach your children good hygiene habits, such as taking showers before swimming and washing hands after going to the bathroom. You should also be sure to wash your hands after changing diapers.

Wash your child thoroughly (especially their bottom) with soap and water before swimming. Everyone has invisible amounts of fecal matter on their bottoms.

Take children on bathroom breaks and check diapers often while swimming.

Change diapers in a bathroom, not beside the pool. Germs can spread to surfaces and objects in and around the pool and spread illness. And wash hands after changing diapers.

Other RWIís, such as eye, skin, ear and respiratory infections are caused by germs that live naturally in the environment. If a pool has not been properly treated, the germs can cause swimmers to be sick.

Children, pregnant women and people with compromised immune systems (such as those with AIDS, those who have received an organ transplant or those taking certain types of chemotherapy) are more likely to get sick from RWIís.

Remember, you share the pool with everyone in it. Healthy swimming behaviors can protect your family from RWIs and help stop germs from getting in the pool.

Sally Robinson is a professor of pediatrics at UTMB Childrenís Hospital, and Keith Bly is a hospitalist and assistant professor of pediatrics. This column is not intended to replace the advice of a physician. For information, contact your pediatrician. Or, contact Robinson and Bly at utmb.kids(at)utmb.edu. To view past articles, visit the UTMB Web site at www.utmb.edu/Childrens/RobinsonBly/HealthyKids.asp.

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Algonquin Countryside
July 6, 2006

McHenry County Department of Health has joined with the Centers for Disease Control and Prevention to remind families of the importance of healthy swimming behaviors.

Recreation water illnesses are spread by swallowing, breathing or having contact with contaminated water. The most commonly reported recreation water illness is diarrhea caused by pathogens, such as E. coli, shigella, giardia and cryptosporidium. Children, pregnant women and people with compromised immune systems are at greatest risk for infection from these pathogens. Other recreation water illnesses can cause various symptoms, including skin, ear, eye, respiratory and neurological infections.

The county Health Department samples beaches and public pools during the summer months to monitor bacterial levels and will continue testing the 39 beaches in the county through Labor Day to assess water quality.

More frequent sampling is done when elevated bacterial levels are found in an initial test. T Bacteria level standards have been established by the Illinois Department of Public Health for bathing beach waters.

A variety of sources contribute bacteria to surface water -- storm runoff following a rain, agricultural runoff, wild and domestic animal waste and bather defecation.

McHenry County samples its beaches for E. coli because it serves as a good indicator of bacterial contamination. Elevated counts increase the potential for infections and gastrointestinal illness. Samples are taken from both shallow and deep areas and tested at the department laboratory. Elevated E. coli counts will result in a swimmers advisory or closure of the beach until further sampling confirms the water quality at that beach is acceptable.

The Health Department will post signs at each beach, indicating any advisory or closure.

The following steps will help families make this summer a healthy swimming experience:

# Don't swim when you have diarrhea;

# Don't swallow pool water;

# Practice good hygiene -- shower before swimming and wash hands after using the toilet or changing diapers, because germs left on the body end up in the water;

# Take children on bathroom breaks;

# Use swim diapers on young children;

# Change diapers in bathrooms, not at poolside.

Anyone who becomes sick after swimming at a beach, notify McHenry County Department of Health at (815) 334-4585, as well as the beach operator. For updates on local beaches, call the county Health Department or log on to www.mcdh.com.

Additional tips about healthy swimming can be found at the Centers for Disease Control, www.cdc.gov/healthyswimming, and the Illinois Department of Public Health, www.idph.state.il.us/
envhealth/beachhome.

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Kelum Pelpola

HEALTHY SWIM: Next time you may have to think twice before you leap into the swimming pool. The reason for this is that a new entity named recreational water illnesses (RWI) has been described.

RWI refers to any illness or infection caused by organisms that contaminate water in pools, lakes, and oceans, resulting in diarrhoea, skin rashes, swimmer's ear and other conditions. And they are on the rise.

The rate has more than doubled in the past 10 years, according to data from the CDC(Centre for Disease Control in the USA).

However, there is definite good news. It's that some simple precautions would help you keep these illnesses at bay. Even though you get the disease, by being alert, quick treatment could be taken and complications could be very easily avoided.

What are the organisms causing RWIs?

Infection-producing germs that can lurk in water include Pseudomonas aeruginosa, a bacterium which causes swimmer's ear (an infection of the outer ear canal, known medically as otitis externa) and skin rash (dermatitis).

Meanwhile, organisms such as cryptosporidium, Giardia lamblia and bacteria such as Shigella, and E. coli can cause diarrhoea.

Although respiratory illnesses and colds could be transmitted through swimming pools or lakes, by far, skin rashes, swimmer's ear and gastrointestinal problems are the most common.

How do we get these illnesses?

Diarrhoea may occur when contaminated water is swallowed and driven into the mouth or nose. It may not begin immediately after a swim; sometimes it comes on one to two weeks later.

Swimmer's ear is easier to get. Excessive water in the ear canal breaks down the protective barriers in the ear and allows bacteria to get into the ear.

It is marked by one to two days of progressive ear pain that is worsened by chewing or when the ear is being pulled. Itching, pus and discharge often follow.

Swimmer's itch, also called cercarial dermatitis, is marked by tingling, burning, or itching of the skin, small reddish pimples, and/or small blisters that appear within minutes to days after swimming in contaminated water.

This skin rash is primarily caused by exposure to parasites or their larvae in fresh and salt water.

How can they be prevented?

Many people say that adding chlorine to a pool can kill all potentially disease-causing germs, and that's true, to a degree.

Chlorine in properly disinfected pools kills most germs that can cause RWIs in less than an hour, but it takes longer to kill some germs, such as cryptosporidium, which can survive for days in even a properly disinfected pool.

The best way to prevent diarrhoea is not to swallow water. Also, don't swim when you have diarrhoea because you can spread germs in the water and make other people sick. Take a shower before swimming and wash your hands after using the toilet, because germs on your body end up in the water.

Swimmer's ear may be prevented by drying ears thoroughly by tilting your head to the side and tugging the ear lobe to let the water out after swimming. Getting ear plugs, or wearing swim caps pulled over your ears also may help.

Showering before and after taking a dip in lakes, ponds and oceans can help with prevention of skin rashes.

Treatment

The above mentioned precautions definitely help to keep the RWIs at bay, but it's important to be on the alert.

If you have diarrhoea one to two weeks after swimming, drink plenty of fluids to prevent dehydration. Antidiarrhoeal medicine may help, but talk to your doctor before taking it.

As for swimmer's ear, new treatment guidelines suggest that antibiotic ear drops are the treatment of choice for swimmer's ear, but always consult your doctor before starting treatment. For pain, oral medication can be given immediately.

Most cases of swimmer's itch do not require medical attention, but not scratching and using anti-itch cream can help. Get advice from your doctor regarding such creams.

Anyway, the take home message is this. Swimming is a very good exercise which relaxes both mind and body. It's good for both adults and children.

However, these conditions which may be associated with swimming in swimming pools, lakes or sea could be easily prevented by taking the above precautions. Don't let these diseases ruin your precious swim.

The writer is a Final Year Medical Student Faculty of Medicine, Colombo.

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20.jun.06
Emerging Infectious Diseases
Centers for Disease Control

David M. Hartley,*Comments Karl C. Klontz,Üá Patricia Ryan,ß and J. Glenn Morris Jr*

*University of Maryland School of Medicine, Baltimore, Maryland, USA; ÜThe George Washington University School of Public Health and Health Services, Washington, DC, USA; áUS Food and Drug Administration, College Park, Maryland, USA; and ßMaryland Department of Health and Mental Hygiene, Baltimore, Maryland, USA

To the Editor: Floret et al. argue convincingly that natural disasters, including severe floods and windstorms, tend not to result in epidemics of infectious disease (1). This conclusion is consistent with the lack of epidemics of shigellosis and cryptosporidiosis after hurricane rains in Baltimore, Maryland.

Shigellosis and cryptosporidiosis are associated with waterborne and foodborne transmission (2,3). We examined Baltimore shigellosis and cryptosporidiosis incidence to assess whether disease risk was related to temperature or rainfall from January 1, 1998, to December 31, 2004. Maryland FoodNet supplied case data; population estimates were acquired from the Maryland Department of Planning State Data Center; and meteorologic data for Baltimore Washington International airport (≈10 miles from the city center) were obtained from the National Atmospheric and Oceanic Administration (4).

During the study period, 38 cases of cryptosporidiosis and 943 cases of shigellosis were reported in Baltimore. Temperature was strongly seasonal; precipitation was not. A dry period during 1999 was observed. No seasonal cryptosporidiosis patterns were identifiable. Two outbreaks of shigellosis occurred; in 2000 (≈50 cases) and 2002ñ2004 (≈870 cases). Sporadic cases of shigellosis were not seasonal.

Two hurricanes resulted in heavy rainfall in Baltimore during the study period (5). Hurricane Floyd inundated the city with rain on September 16, 1999, and on September 19, 2003, Hurricane Isabel produced heavy rains and storm surge in Baltimore (which is located near the northern end of Chesapeake Bay). Approximately 4 other named tropical storms or depressions directly affected Baltimore rainfall during the study. However, collectively, none of these events had distinguishable signatures in the incidence of shigellosis or cryptosporidiosis in this urban environment.

The institutional review boards of the University of Maryland School of Medicine, The George Washington University Medical Center, and the Maryland Department of Health and Mental Hygiene approved this study. Dr Hartley is supported by a National Institutes of Health Career Development Award (K25 AI-58956).

References

1.Floret N, Viel JF, Mauny F, Hoen B, Piarroux R. Negligible risk for epidemics after geophysical disasters. Emerg Infect Dis. 2006;12:543ñ8.
2.Centers for Disease Control and Prevention. FoodNet surveillance report for 2002. May 2004. [cited 2006 Apr 6]. Available from http://www.cdc.gov/foodnet/reports.htm
3.Naumova EN, Christodouleas J, Hunter PR, Syed Q. Effect of precipitation on seasonal variability in cryptosporidiosis recorded by the north west England surveillance system in 1990ñ1999. J Water Health. 2005;3:185ñ96.
4.National Oceanic and Atmospheric Administration. Federal climate complex global surface summary of day data. Version 6. National Oceanic and Atmospheric Administration National Climatic Data Center. [cited 2006 Feb 18]. Available from ftp://ftp.ncdc.noaa.gov/pub/data/globalsod/readme.txt
5.National Oceanic and Atmospheric Adminstration. Hurricane history. [cited 2006 Apr 6]. Available from http://www.nhc.noaa.gov/HAW2/english/history.shtml

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