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Abstract
Available as eBook only.
Cyanobacteria are a concern for water authorities worldwide as their persistence in water supplies causes numerous problems for water treatment plants. However, the major concern associated with the presence of cyanobacteria is the metabolites they produce, taste and odour compounds, particularly 2-methyl isoborneol and geosmin, and a range of toxic compounds known collectively as algal toxins, or cyanotoxins.
The management of cyanobacteria and cyanotoxins is one of the priority issues in the research agenda of the Global Water Research Coalition and this international guidance manual aims to consolidate the available knowledge and information: to understand the importance of cyanobacteria and the toxins they produce to assess the risks associated with a particular water source to develop a monitoring program and incident management strategies consistent with the WHO Water Safety Planning process to instigate management procedures both in the source water and treatment plants to mitigate the risks posed by the presence of toxic compounds in drinking water.
The International Guidance Manual for the Management of Toxic Cyanobacteria is a user-friendly document that can be accessed on several levels, from basic information for the water quality manager who knows very little about cyanobacteria, to those requiring more detailed guidance on, for example, source water management methods, or doses of activated carbon required to reduce toxin concentration to below the WHO guideline. It is hoped this manual is accessed by water utilities world-wide, and feedback on its application will be used to update and implement revisions to maintain and enhance its usefulness to the international water industry.
Table of Contents
Section Title | Page | Action | Price |
---|---|---|---|
Cover page | 1 | ||
Title page | 3 | ||
Copyrights page | 4 | ||
TABLE OF CONTENTS | 5 | ||
GLOBAL WATER RESEARCH COALITION | 10 | ||
ACKNOWLEDGEMENTS | 11 | ||
REVIEWERS | 11 | ||
PROJECT STEERING COMMITTEE MEMBERS | 12 | ||
CONTRIBUTORS | 12 | ||
ORGANISATIONS | 13 | ||
DOCUMENTS USED EXTENSIVELY IN THIS GUIDE | 14 | ||
PREFACE | 15 | ||
SCOPE OF THE GUIDANCE MANUAL | 15 | ||
HOW TO USE THE MANUAL | 16 | ||
CHAPTER 1 INTRODUCTION (LEVEL 1) | 17 | ||
CYANOBACTERIA | 17 | ||
FACTORS INFLUENCING OCCURRENCE | 18 | ||
UTILISATION OF THE AQUATIC ENVIRONMENT BY CYANOBACTERIA | 18 | ||
THE CYANOBACTERIAL LIFE CYCLE | 19 | ||
FACTORS INFLUENCING GROWTH | 20 | ||
NUTRIENTS | 20 | ||
LIGHT | 20 | ||
TEMPERATURE | 21 | ||
CYANOTOXINS | 21 | ||
CYANOTOXIN DRINKING WATER GUIDELINES | 23 | ||
CHAPTER 1 INTRODUCTION (LEVEL 2) | 24 | ||
CYANOBACTERIA | 24 | ||
POTENTIALLY TOXIC CYANOBACTERIA | 24 | ||
FACTORS INFLUENCING OCCURRENCE | 25 | ||
BUOYANCY REGULATION | 25 | ||
FACTORS INFLUENCING GROWTH | 25 | ||
STRATIFICATION OF WATER BODIES | 25 | ||
CYANOTOXINS | 26 | ||
PEPTIDE HEPATOTOXINS (MICROCYSTINS AND NODULARIN) | 26 | ||
NEUROTOXINS | 28 | ||
ANATOXINS | 28 | ||
SAXITOXINS (PARALYTIC SHELLFISH POISONS, PSPS) | 28 | ||
CYLINDROSPERMOPSIN | 31 | ||
Β-N-METHYLAMINO-L-ALANINE (BMAA) | 31 | ||
LIPOPOLYSACCHARIDE ENDOTOXINS | 32 | ||
EXAMPLES OF TOXICITY OF BENTHIC CYANOBACTERIA | 32 | ||
ADVERSE HUMAN HEALTH EPISODES DUE TO CYANOTOXINS | 32 | ||
CYANOTOXIN DRINKING WATER GUIDELINES | 33 | ||
INTERNATIONAL GUIDELINES FOR CYANOTOXINS | 33 | ||
PROCEDURES FOR GUIDELINE DERIVATION | 35 | ||
REFERENCES | 36 | ||
CHAPTER 2 HAZARD IDENTIFICATION AND RISK ASSESSMENT IN SOURCE WATERS (LEVEL 1) | 41 | ||
BACKGROUND | 41 | ||
FACTORS INFLUENCING CYANOBACTERIAL BLOOM OCCURRENCE | 42 | ||
ASSESSING THE RISK OF CYANOBACTERIAL GROWTH | 44 | ||
BENTHIC CYANOBACTERIA | 44 | ||
PLANKTONIC CYANOBACTERIA | 44 | ||
ASSESSING THE POTENTIAL FOR TOXIN PRODUCTION | 45 | ||
RESIDUAL RISK | 46 | ||
CHAPTER 2 HAZARD IDENTIFICATION AND RISK ASSESSMENT IN SOURCE WATERS (LEVEL 2) | 47 | ||
FACTORS INFLUENCING CYANOBACTERIAL BLOOM OCCURRENCE | 47 | ||
PHOSPHOROUS LEVEL ASSESSMENT | 47 | ||
ANALYSIS | 47 | ||
NUTRIENT LOADING ASSESSMENT | 50 | ||
WHAT IS NEAP? | 50 | ||
THE NEAP DEVELOPMENT PHILOSOPHY | 51 | ||
WHAT IS NEAP'S LEVEL OF RESOLUTION? | 51 | ||
INTRODUCTION TO THE MODEL BASE OF NEAP | 52 | ||
FEATURES OF NEAP | 53 | ||
USER UNDERSTANDING OF EUTROPHICATION | 53 | ||
ASSESSING THE POTENTIAL FOR TOXIN PRODUCTION | 54 | ||
ASSUMPTIONS USED IN THE CYANOTOXIN PRODUCTION RISK ASSESSMENT MODEL | 54 | ||
POTENTIAL ALGAL GROWTH SCENARIOS FOR HUMBUG SCRUB RESERVOIR | 55 | ||
INTRODUCTION | 55 | ||
PROCESS | 55 | ||
DERIVATION OF SCENARIOS | 56 | ||
RESULTS | 57 | ||
HUMBUG SCRUB RESERVOIR –SITE A | 57 | ||
CALCULATIONS | 57 | ||
MOST LIKELY CASE | 57 | ||
CHAPTER 3 DEVELOPMENT AND IMPLEMENTATION OF A MONITORING PROGRAM (LEVEL 1) | 68 | ||
BACKGROUND | 68 | ||
VISUAL INSPECTION | 68 | ||
SAMPLING PROGRAM DESIGN | 71 | ||
ACCESS FOR SAMPLE COLLECTION | 72 | ||
SAMPLE COLLECTION METHODS | 72 | ||
SAMPLES FOR BENTHIC CYANOBACTERIAL SURVEYS | 73 | ||
WATER SAMPLES FOR CYANOBACTERIAL IDENTIFICATION AND COUNTING | 73 | ||
RESERVOIR/RIVER SAMPLING BY BOAT | 73 | ||
SURFACE GRAB SAMPLES FROM SHORELINE | 73 | ||
SAMPLES FOR TOXIN ANALYSIS | 74 | ||
QUANTITATIVE | 75 | ||
SAMPLING FREQUENCY | 75 | ||
SAMPLING REPLICATION | 76 | ||
TRANSPORT AND STORAGE OF SAMPLES | 78 | ||
SAMPLES FOR CYANOBACTERIAL IDENTIFICATION AND ENUMERATION | 78 | ||
SAMPLES FOR TOXIN ANALYSIS | 78 | ||
ANALYSIS FOR CYANOBACTERIA AND THEIR TOXINS | 78 | ||
CYANOBACTERIA | 78 | ||
DIRECT CELL COUNTING AND IDENTIFICATION | 79 | ||
PRECISION OF CELL COUNTING | 80 | ||
MEASUREMENT OF PIGMENT CONCENTRATIONS | 81 | ||
CYANOTOXINS | 81 | ||
MEASUREMENT OF PARAMETERS INFLUENCING THE GROWTH OF CYANOBACTERIA | 84 | ||
TEMPERATURE | 84 | ||
PHOSPHORUS | 84 | ||
SECCHI DEPTH | 84 | ||
PH AND DISSOLVED OXYGEN | 85 | ||
TURBIDITY | 85 | ||
PARTICLES | 85 | ||
CHAPTER 3 DEVELOPMENT AND IMPLEMENTATION OF A MONITORING PROGRAM (LEVEL 2) | 86 | ||
VISUAL INSPECTION | 86 | ||
RECORDING SHEET FOR A VISUAL INSPECTION | 86 | ||
SAMPLING FOR CYANOBACTERIAL IDENTIFICATION AND COUNTING | 87 | ||
INTEGRATED WATER COLUMN SAMPLES | 87 | ||
DISCRETE DEPTH SAMPLES | 87 | ||
WORKED EXAMPLE ILLUSTRATING THE IMPACT OF SAMPLE REPLICATION | 88 | ||
A CASE STUDY OF SAMPLING PROGRAM DESIGN FOR CYANOBACTERIA FOR MYPONGA RESERVOIR, SOUTH AUSTRALIA. | 89 | ||
SITE DESCRIPTION | 90 | ||
ROUTINE SAMPLING PROGRAM | 90 | ||
PRECISION OF CELL COUNTING | 90 | ||
ANALYSIS FOR CYANOBACTERIA AND THEIR TOXINS | 91 | ||
ELISA | 91 | ||
PROTEIN PHOSPHATASE INHIBITION ASSAYS | 92 | ||
INSTRUMENTAL ANALYSIS | 92 | ||
SAMPLE CONCENTRATION | 93 | ||
MEASUREMENT OF TOTAL, INTRACELLULAR AND EXTRACELLULAR CYANOTOXINS | 93 | ||
CHAPTER 3 DEVELOPMENT AND IMPLEMENTATION OF A MONITORING PROGRAM (LEVEL 3: DETAILED EXPERIMENTAL PROCEDURES) | 94 | ||
ANALYSIS FOR CYANOBACTERIA AND THEIR TOXINS | 94 | ||
CYANOBACTERIA IDENTIFICATION AND ENUMERATION BY MEANS OF A SEDIMENTATION METHOD. | 94 | ||
PRINCIPLE OF THE METHOD | 94 | ||
APPARATUS, MATERIALS AND REAGENTS | 94 | ||
INSTRUMENTS AND EQUIPMENT | 94 | ||
GLASSWARE | 94 | ||
OTHER MATERIALS | 95 | ||
REAGENTS | 95 | ||
PROCEDURE | 95 | ||
SAMPLE PREPARATION | 95 | ||
IDENTIFICATION AND ENUMERATION | 96 | ||
SAFETY PRECAUTIONS | 98 | ||
HAZARD WARNING | 98 | ||
SAFETY INSTRUCTIONS WHEN WORKING WITH FORMALDEHYDE (MERCK, 2004) | 98 | ||
SAFETY INSTRUCTIONS WHEN WORKING WITH ETHANOL (MERCK, 2006) | 98 | ||
CALCULATIONS AND EXPRESSION OF RESULTS | 98 | ||
CALCULATION OF THE PHYTOPLANKTON BIOMASS AS CELLS/M | 98 | ||
REPORTING PHYTOPLANKTON RESULTS | 99 | ||
PHYTOPLANKTON IDENTIFICATION AND ENUMERATION BY MEANS OF THE FILTRATION METHOD | 100 | ||
BACKGROUND | 100 | ||
PRINCIPLE OF THE METHOD | 100 | ||
APPARATUS, MATERIALS AND REAGENTS | 100 | ||
INSTRUMENTS AND EQUIPMENT | 100 | ||
GLASSWARE | 101 | ||
OTHER MATERIALS | 101 | ||
REAGENTS | 101 | ||
PROCEDURE | 102 | ||
SAMPLE PREPARATION | 102 | ||
IDENTIFICATION AND ENUMERATION | 103 | ||
SAFETY PRECAUTIONS | 103 | ||
HAZARD WARNING | 103 | ||
CALCULATION AND EXPRESSION OF RESULTS | 103 | ||
BIOVOLUME CALCULATION OF PHYTOPLANKTON AND CYANOBACTERIA [25] | 104 | ||
SPECTROPHOTOMETRIC TECHNIQUE FOR THE DETERMINATION OF CHLOROPHYLL-A CONCENTRATION | 108 | ||
BACKGROUND | 108 | ||
APPARATUS, MATERIALS AND REAGENTS | 108 | ||
INSTRUMENTS AND EQUIPMENT | 108 | ||
GLASSWARE | 109 | ||
OTHER MATERIALS | 109 | ||
REAGENTS | 109 | ||
PROCEDURE | 109 | ||
SAFETY PRECAUTIONS | 110 | ||
HAZARD WARNING | 110 | ||
CLOTHING | 110 | ||
SAFETY INSTRUCTIONS WHEN WORKING WITH ETHANOL | 110 | ||
SAFETY INSTRUCTIONS WHEN WORKING WITH ACID | 110 | ||
CALCULATION AND EXPRESSION OF RESULTS | 110 | ||
FLOW INJECTION ANALYSIS AND PHOTOMETRIC DETECTION OF ORTHO PHOSPHATE. | 111 | ||
BACKGROUND | 111 | ||
PRINCIPLE OF THE METHOD | 111 | ||
APPARATUS, MATERIAL AND REAGENTS | 111 | ||
APPARATUS | 111 | ||
MATERIAL: | 112 | ||
REAGENTS: | 112 | ||
PROCEDURE | 112 | ||
PREPARING OF SOLUTIONS: | 112 | ||
AMMONIUM MOLYBDATE SOLUTION | 112 | ||
POTASSIUM ANTIMONY TARTRATE SOLUTION | 113 | ||
MOLYBDATE COLOUR REAGENT | 113 | ||
ASCORBIC ACID REDUCING SOLUTION | 113 | ||
SODIUM HYDROXIDE TITRIPLEX RINSE | 113 | ||
CALIBRATION OF STOCK SOLUTIONS: | 113 | ||
ORTHOPHOSPHATE WORKING STOCK (100 MG/L (PPM)) | 113 | ||
CALIBRATION STANDARDS | 113 | ||
SAMPLE PREPARATION: | 114 | ||
OPERATING INSTRUCTIONS OF ANALYZER / DATA SYSTEM: | 114 | ||
CALCULATION AND EXPRESSION OF RESULTS: | 114 | ||
SECCHI DEPTH MEASUREMENTS | 114 | ||
PROCEDURE | 114 | ||
DETERMINING TEMPERATURE IN THE FIELD | 115 | ||
BACKGROUND | 115 | ||
APPARATUS, MATERIAL AND REAGENTS | 115 | ||
APPARATUS | 115 | ||
REAGENTS | 115 | ||
PROCEDURE | 116 | ||
TEMPERATURE VERIFICATION (QUALITY CONTROL) IN THE LABORATORY | 116 | ||
TEMPERATURE READING IN THE FIELD | 116 | ||
DETERMINING PH IN THE FIELD | 117 | ||
BACKGROUND | 117 | ||
PRINCIPLE OF THE METHOD | 117 | ||
APPARATUS, MATERIAL AND REAGENTS | 117 | ||
APPARATUS | 117 | ||
REAGENTS | 117 | ||
PROCEDURE PH CALIBRATION: | 118 | ||
PH READING IN THE FIELD | 119 | ||
DETERMINATION OF DISSOLVED OXYGEN IN THE FIELD | 120 | ||
BACKGROUND | 120 | ||
PRINCIPLE OF THE METHOD | 120 | ||
APPARATUS, MATERIAL AND REAGENTS | 121 | ||
APPARATUS | 121 | ||
REAGENTS | 121 | ||
PROCEDURE | 121 | ||
CALIBRATION | 121 | ||
DISSOLVED OXYGEN READING IN THE FIELD | 121 | ||
METHOD FOR THE DETERMINATION OF TURBIDITY | 122 | ||
BACKGROUND | 122 | ||
PRINCIPLE OF THE METHOD | 122 | ||
APPARATUS, MATERIAL AND REAGENT | 123 | ||
APPARATUS: | 123 | ||
MATERIALS: | 123 | ||
REAGENTS: | 123 | ||
PROCEDURE | 123 | ||
CALIBRATION OF INSTRUMENT | 123 | ||
MEASUREMENT PROCEDURE: | 124 | ||
REFERENCES | 125 | ||
CHAPTER 4 MANAGEMENT AND CONTROL IN SOURCE WATERS (LEVEL 1) | 127 | ||
BACKGROUND | 127 | ||
PHYSICAL CONTROLS | 127 | ||
MIXING TECHNIQUES | 127 | ||
AERATORS | 128 | ||
MECHANICAL MIXERS | 128 | ||
MANIPULATION OF RIVER FLOWS | 130 | ||
OTHER PHYSICAL METHODS | 130 | ||
CHEMICAL CONTROLS | 131 | ||
CHEMICAL CONTROL OF NUTRIENTS | 131 | ||
HYPOLIMNETIC OXYGENATION | 131 | ||
PHOSPHORUS PRECIPITATION AND CAPPING | 131 | ||
CHEMICAL CONTROL OF CYANOBACTERIA | 132 | ||
COAGULANTS | 132 | ||
ALGICIDES | 132 | ||
COPPER BASED ALGICIDES | 133 | ||
OTHER ALGICIDES | 134 | ||
ISSUES ASSOCIATED WITH ALGICIDES AND OTHER CHEMICAL CONTROLS | 135 | ||
BIOLOGICAL CONTROLS | 136 | ||
INCREASING GRAZING PRESSURE | 136 | ||
ENHANCING COMPETITION BY INTRODUCING MACROPHYTES | 136 | ||
OTHER BIOLOGICAL STRATEGIES | 136 | ||
ISSUES ASSOCIATED WITH IMPLEMENTATION | 137 | ||
ALTERNATIVE METHODS | 137 | ||
BARLEY STRAW | 137 | ||
ULTRASOUND | 137 | ||
CHAPTER 4 MANAGEMENT AND CONTROL IN SOURCE WATERS (LEVEL 2) | 138 | ||
PHYSICAL CONTROLS | 138 | ||
POSITIONING OF AERATORS IN A RESERVOIR | 138 | ||
MIXING CASE STUDY – MYPONGA RESERVOIR | 138 | ||
THE PHYTOPLANKTON COMMUNITY | 138 | ||
ARTIFICIAL DESTRATIFICATION TO CONTROL THE NUTRIENT LOAD | 139 | ||
RELATING NUTRIENTS TO ALGAL BIOMASS | 140 | ||
MODELLING ALGAL GROWTH | 141 | ||
SIMULATION OF VARIOUS MANAGEMENT STRATEGIES | 142 | ||
FACTORS INFLUENCING DESTRATIFICATION | 144 | ||
CHEMICAL CONTROLS | 144 | ||
PHOSPHORUS PRECIPITATION CASE STUDY | 144 | ||
RECOMMENDATIONS FOR COPPER SULPHATE DOSING | 145 | ||
BIOLOGICAL CONTROLS | 146 | ||
IMPACTS OF MANIPULATION OF THE FOODWEB | 146 | ||
CASE STUDY OF BIOMANIPULATION | 150 | ||
REFERENCES | 150 | ||
CHAPTER 5 TREATMENT OPTIONS (LEVEL 1) | 154 | ||
OFF-TAKE MANIPULATION | 154 | ||
CYANOBACTERIAL CELL REMOVAL | 154 | ||
PRE-OXIDATION | 154 | ||
MICROSTRAINING | 155 | ||
RIVERBANK, SLOW SAND AND BIOLOGICAL FILTRATION | 155 | ||
GENERAL CONSIDERATIONS | 155 | ||
CONVENTIONAL TREATMENT | 156 | ||
COAGULATION AND FLOCCULATION GENERAL CONSIDERATIONS | 157 | ||
SLUDGE AND BACKWASH DISPOSAL | 158 | ||
MEMBRANE FILTRATION | 158 | ||
CYANOTOXIN REMOVAL | 159 | ||
PHYSICAL PROCESSES | 160 | ||
ACTIVATED CARBON | 160 | ||
POWDERED ACTIVATED CARBON | 160 | ||
APPLICATION OF PAC FOR OPTIMUM PERFORMANCE | 160 | ||
PAC TYPE AND DOSE REQUIREMENTS | 161 | ||
MICROCYSTINS. | 161 | ||
SAXITOXINS. | 162 | ||
CYLINDROSPERMOPSIN. | 162 | ||
ANATOXIN-A. | 162 | ||
GRANULAR ACTIVATED CARBON | 163 | ||
APPLICATION OF GAC | 163 | ||
TYPES OF GAC | 165 | ||
LIFETIME OF GAC | 165 | ||
MICROCYSTINS AND CYLINDROSPERMOPSIN. | 166 | ||
SAXITOXINS. | 166 | ||
ANATOXIN-A. | 166 | ||
MEMBRANE FILTRATION | 166 | ||
CHEMICAL PROCESSES | 166 | ||
CHLORINE | 166 | ||
MICROCYSTINS | 167 | ||
SAXITOXINS | 167 | ||
CYLINDROSPERMOPSIN | 167 | ||
ANATOXIN-A | 167 | ||
GENERAL RECOMMENDATIONS | 168 | ||
CHLORINE DIOXIDE | 168 | ||
CHLORAMINES | 168 | ||
OZONE AND OZONE/PEROXIDE | 168 | ||
MICROCYSTINS | 168 | ||
CHAPTER 5 TREATMENT OPTIONS (LEVEL 2) | 171 | ||
CYANOBACTERIA CELL REMOVAL | 171 | ||
MICROSTRAINERS | 171 | ||
GENERAL CONSIDERATIONS | 171 | ||
CHAPTER 6 INCIDENT MANAGEMENT PLANS (LEVEL 1) | 208 | ||
BACKGROUND | 208 | ||
OVERVIEW OF THE DEVELOPMENT OF ALERT LEVELS FRAMEWORKS | 208 | ||
SELECTION AND APPLICATION OF THE APPROPRIATE ALERT LEVELS FRAMEWORK FOR DRINKING WATER PRODUCTION | 208 | ||
ALERT LEVELS FRAMEWORK USING CYANOBACTERIA CELL COUNTS AS TRIGGER (NEWCOMBE ET AL. 2009) [1] | 209 | ||
ALERT LEVELS FRAMEWORK USING CYANOBACTERIAL IDENTIFICATION AND ENUMERATION AS PRIMARY TRIGGER (DU PREEZ AND VAN BAALEN 2006) [2] | 212 | ||
ALERT LEVELS FRAMEWORK USING CHLOROPHYLL-A CONCENTRATION AS THE PRIMARY TRIGGER (DU PREEZ AND VAN BAALEN 2006) [2] | 212 | ||
COMMUNICATION | 215 | ||
DEVELOPMENT OF AN INCIDENT MANAGEMENT PLAN | 215 | ||
CHAPTER 6 INCIDENT MANAGEMENT PLANS (LEVEL 2) | 216 | ||
OVERVIEW OF THE DEVELOPMENT OF ALERT LEVELS FRAMEWORKS | 216 | ||
ALF, BURCH, 1993 | 216 | ||
ALF, WHO, 1999 | 216 | ||
CIMF, VAN BAALEN AND DU PREEZ, 2001 | 217 | ||
DRAFT NATIONAL PROTOCOL FOR THE MONITORING OF CYANOBACTERIA AND CYANOTOXINS, BURCH ET AL., 2003 | 217 | ||
SELECTION AND APPLICATION OF THE APPROPRIATE ALERT LEVELS FRAMEWORK FOR DRINKING WATER PRODUCTION | 217 | ||
DETAILED ACTIONS OF ALF, NEWCOMBE ET AL., 2009 [1] | 217 | ||
LEVELS OF THE FRAMEWORK | 217 | ||
DETECTION LEVEL | 217 | ||
ALERT LEVEL 1 | 218 | ||
ALERT LEVEL 2 | 219 | ||
ALERT LEVEL 3 | 219 | ||
CUSTOMER AND MEDIA INFORMATION | 220 | ||
DETAILED ACTIONS FOR THE ALERT LEVELS FRAMEWORK USING CYANOBACTERIAL IDENTIFICATION AND ENUMERATION AS PRIMARY TRIGGER (DU PREEZ AND VAN BAALEN 2006) [9] | 221 | ||
ROUTINE MONITORING LEVEL | 221 | ||
ANALYSIS | 221 | ||
STEPPING–UP ACTIVATION | 221 | ||
VIGILANCE LEVEL | 221 | ||
REGULAR SURVEILLANCE OF SOURCE WATER | 221 | ||
CHAPTER 7 IMPLICATIONS FOR RECREATIONAL WATERS | 250 | ||
BACKGROUND | 250 | ||
WHY ARE CYANOBACTERIA A PROBLEM IN RECREATIONAL WATERS? | 250 | ||
PUBLIC HEALTH CONCERNS | 250 | ||
RECREATIONAL ACTIVITIES AND LEVEL OF EXPOSURE | 251 | ||
MANAGING AND RESPONDING TO THE RISK | 251 | ||
MONITORING | 251 | ||
GUIDELINE LEVELS AND ACTIONS | 253 | ||
REFERENCES AND FURTHER READING | 254 |