Water recreation and disease : plausibility of associated infections : acute effects, sequelae, and mortality

Worldwide, the popularity of recreational activities, which involve contact with water, is continuing to grow. Moreover, ease of travel and change in human behavior has altered the use of water for recreational purposes. Users should be aware that recreational exposures to pathogens may result in disease. Susceptible populations including people with reduced immune function (e.g. resulting from disease (cancer, HIV) genetic susceptibility, age, etc.) or lack of immunity to locally endemic diseases (e.g. tourists) may be at higher risk of contracting illnesses. In most cases the primary disease symptoms associated with recreational water contact are acute, such as diarrhea and respiratory infections. Although less frequently reported, more serious and potentially fatal disease is a risk to recreational users of water especially in certain susceptible populations. In addition to diseases which have severe primary outcomes (e.g. primary amoebic meningoencephalitis, typhoid, leptospirosis) a number of infections may lead to sequelae with serious consequences including renal disease (from E. coli O157:H7 for example) cardiac and nutritional disorders. This is the first book to provide a comprehensive review and analysis of potential severe disease outcomes, including acute effects and sequelae associated with recreational water activities. This book will be useful to all those concerned with recreational water quality, including environmental and public health professionals, local authorities, user groups, and tourists. Water Recreation and Disease sets out to identify the more severe waterborne diseases and their sequelae, which may be acquired while undertaking water-based recreation in marine, freshwater, spas/whirlpools and swimming pools. The review systematically brings information together on the ecology and health aspects of a variety of pathogens where cases attributed to recreational use of water have been documented. This is the only available guide to bring together information on the more severe waterborne diseases to assist decision-making in recreational water management. WHO Library Cataloguing-in-Publication Data......Page 4 1.1 BACKGROUND......Page 21 1.2 EVIDENCE FOR ADVERSE HEALTH OUTCOMES ASSOCIATED WITH RECREATIONAL WATER USE......Page 24 1.3 SEVERE OUTCOMES......Page 28 1.3.2 Evidence for sequelae of waterborne diseases......Page 29 Naegleria fowleri......Page 30 1.3.3 Severe outcomes in special populations......Page 32 1.5 SUMMARY......Page 33 REFERENCES......Page 34 2.1 HAZARD IDENTIFICATION......Page 41 2.1.1 Epidemiology......Page 42 2.1.2 Quantitative Microbial Risk Assessment......Page 44 2.2.1 Water contact......Page 45 2.2.2 Recreational water types......Page 46 2.3.1 Status of host......Page 48 2.3.2 Process of infection......Page 50 REFERENCES......Page 52 3.1 SOURCES OF AVAILABLE EVIDENCE......Page 55 3.2 SURVEILLANCE......Page 56 3.3 CREDIBILITY OF ASSOCIATION WITH RECREATIONAL WATER......Page 59 3.4.1 Severity Index......Page 60 REFERENCES......Page 74 Primary disease symptoms and sequelae......Page 80 Disease incidence......Page 82 III Evidence for association of campylobacter with recreational waters......Page 83 IV Conclusions......Page 84 Taxonomy......Page 85 Characteristics......Page 86 Exposure/mechanism of infection......Page 87 III Evidence for association of E. coli O157 with recreational waters......Page 88 IV Conclusions......Page 90 Primary disease symptoms and sequelae......Page 91 Exposure/mechanism of infection......Page 93 III Evidence for association of Helicobacter pylori with recreational waters......Page 94 IV Conclusions......Page 95 Distribution......Page 96 Characteristics......Page 97 Primary disease symptoms and sequelae......Page 98 Disease incidence......Page 99 Sensitive groups......Page 100 III Evidence for association of Legionnaires’ disease with recreational waters......Page 101 Denmark......Page 102 Spain......Page 103 Published cases of Legionnaires’ disease associated with recreational waters......Page 104 Cases of Legionnaires’ disease associated with hot springs/ hydrothermal areas......Page 105 Occurrence or likely occurrence of legionella in swimming pools......Page 107 Occurrence or likely occurrence of legionella in hot tubs and saunas......Page 108 Cases of Legionnaires’ disease associated with display hot tubs......Page 110 Travel-related Legionnaires’ disease......Page 111 IV Conclusions......Page 112 Charactersitics......Page 113 Primary disease symptoms and sequelae......Page 114 Infectivity......Page 115 III Evidence for association of leptospirosis with recreational waters......Page 117 Surveillance data......Page 119 IV Conclusions......Page 120 Taxonomy......Page 121 Primary disease symptoms and sequelae......Page 122 Sensitive groups......Page 124 III Evidence of association of mycobacterium with recreational waters......Page 125 IV Conclusions......Page 126 Distribution......Page 127 Primary disease symptoms and sequelae......Page 128 Exposure/mechanism of infection......Page 129 Incubation period......Page 130 III Evidence for association of salmonellosis with recreational waters......Page 131 IV Conclusions......Page 132 Primary disease symptoms and sequelae......Page 133 Exposure/mechanism of infection......Page 134 Sensitive groups......Page 135 Surveillance data......Page 136 IV Conclusions......Page 137 Primary disease symptoms and sequelae......Page 139 Infectivity......Page 140 III Evidence for association of Vibrio vulnificus with recreational waters......Page 141 IV Conclusions......Page 142 REFERENCES......Page 143 Characteristics......Page 168 Primary disease symptoms and sequelae......Page 169 Disease incidence......Page 170 III Evidence for association of cryptosporidiosis with recreational waters......Page 171 Swimming pools......Page 173 Cryptosporidiosis and surface waters......Page 174 Fountains......Page 175 IV Conclusions......Page 176 Primary disease symptoms and sequelae......Page 177 Exposure/mechanisms of infection......Page 178 Sensitive groups......Page 179 III Evidence for association of Giardia with recreational waters......Page 180 Surveillance data......Page 181 IV Conclusions......Page 182 Taxonomy......Page 183 Characteristics......Page 184 Incubation period......Page 185 Sensitive groups......Page 186 III Evidence for association of microsporidiosis with recreational waters......Page 187 IV Conclusions......Page 189 Characteristics......Page 190 Disease incidence......Page 191 III Evidence for association of Naegleria fowleri with recreational water use......Page 192 IV Conclusions......Page 195 Characteristics......Page 196 Primary disease symptoms and sequelae......Page 197 Exposure/mechanism of infection......Page 198 III Evidence for association with recreational waters......Page 199 REFERENCES......Page 202 Characteristics......Page 212 Primary disease symptoms and sequelae......Page 213 Exposure/mechanism of infection......Page 214 Sensitive groups......Page 215 III Evidence for association of adenovirus with recreational waters......Page 216 IV Conclusions......Page 217 Primary disease symptoms and sequelae......Page 219 Disease incidence......Page 221 III Evidence for association of coxsackievirus with recreational waters......Page 222 IV Conclusions......Page 223 Primary disease symptoms and sequelae......Page 224 Exposure/mechanism of infection......Page 225 Sensitive groups......Page 226 IV Conclusions......Page 227 Distribution......Page 228 Primary disease symptoms and sequelae......Page 229 Disease incidence......Page 230 III Evidence for association of hepatitis A with recreational waters......Page 231 Published cases of hepatitis A associated with recreational waters......Page 232 IV Conclusions......Page 234 Primary disease symptoms and sequelae......Page 235 Disease incidence......Page 236 III Evidence for association of hepatitis E with recreational waters......Page 237 IV Conclusions......Page 238 REFERENCES......Page 239 Worldwide, the popularity of recreational activities which involve contact with water is continuing to grow. Moreover, ease of travel and change in human behaviour has altered the use of water for recreational purposes. Users should be aware that recreational exposures to pathogens may result in disease. Susceptible populations including people with reduced immune function (e.g., resulting from disease (cancer, HIV), genetic susceptibility, age, etc.) or lack of immunity to locally endemic diseases (e.g., tourists) may be at higher risk of contracting illnesses. In most cases the primary disea Recreational users of water may be at risk of serious and potentially fatal diseases. In addition to disease with severe primary outcomes (e.g. typhoid, leptospirosis), a number of infections may lead to sequelae with seriious consequences. Susceptible populations, including people with reduced immune function or lack of immunity to locally endemic diseases (tourists, for example), are at higher risk of contracting severe illnesses