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Book Details
Abstract
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 disease symptoms associated with recreational water contact are acute, such as diarrhoea and respiratory infections.Â
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.Â
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.Â
About the author: Dr Kathy Pond, Robens Centre for Public and Environmental Health, University of Surrey, UK
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Cover | Cover | ||
| Contents | v | ||
| Foreword | ix | ||
| Acknowledgements | xii | ||
| List of Acronyms and Abbreviations | xiv | ||
| Executive Summary | xvi | ||
| 1:\rIntroduction | 1 | ||
| 1.1 BACKGROUND | 1 | ||
| 1.2 EVIDENCE FOR ADVERSE HEALTH OUTCOMES ASSOCIATED WITH RECREATIONAL WATER USE | 4 | ||
| 1.3 SEVERE OUTCOMES | 8 | ||
| 1.3.1 Infections with potentially severe acute symptoms | 9 | ||
| 1.3.2 Evidence for sequelae of waterborne diseases | 9 | ||
| 1.3.3 Severe outcomes in special populations | 12 | ||
| 1.4 MANAGEMENT OF SEVERE ILLNESSES | 13 | ||
| 1.5 SUMMARY | 13 | ||
| 1.6 DOCUMENT OVERVIEW | 14 | ||
| REFERENCES | 14 | ||
| 2:\rHazard Identification and Factors Related to Infection and Disease | 21 | ||
| 2.1 HAZARD IDENTIFICATION | 21 | ||
| 2.1.1 Epidemiology | 22 | ||
| 2.1.2 Quantitative Microbial Risk Assessment | 24 | ||
| 2.2 FACTORS INFLUENCING HAZARD ENCOUNTER\r | 25 | ||
| 2.2.1 Water contact | 25 | ||
| 2.2.2 Recreational water types | 26 | ||
| 2.3 FACTORS RELATED TO INFECTION AND DISEASE\r | 28 | ||
| 2.3.1 Status of host | 28 | ||
| 2.3.2 Process of infection | 30 | ||
| REFERENCES | 32 | ||
| 3:\rCredibility of Association and Severity Criteria Index | 35 | ||
| 3.1 SOURCES OF AVAILABLE EVIDENCE | 35 | ||
| 3.1.1 Limitations of the evidence | 36 | ||
| 3.2 SURVEILLANCE | 36 | ||
| 3.3 CREDIBILITY OF ASSOCIATION WITH RECREATIONAL WATER | 39 | ||
| 3.4 EVIDENCE FOR SEVERITY | 40 | ||
| 3.4.1 Severity Index | 40 | ||
| 3.5 SUMMARY | 54 | ||
| REFERENCES | 54 | ||
| 4:\rBacteria | 59 | ||
| CAMPYLOBACTER | 60 | ||
| I Organism | 60 | ||
| Pathogen | 60 | ||
| Taxonomy | 60 | ||
| Reservoir | 60 | ||
| Distribution | 60 | ||
| Characteristics | 60 | ||
| II Health aspects | 60 | ||
| Primary disease symptoms and sequelae | 60 | ||
| Exposure/mechanism of infection | 62 | ||
| Disease incidence | 62 | ||
| Incubation period | 63 | ||
| Infectivity | 63 | ||
| Sensitive groups | 63 | ||
| III Evidence for association of campylobacter with recreational waters | 63 | ||
| IV Conclusions | 64 | ||
| E. COLI O157 | 65 | ||
| I Organism | 65 | ||
| Pathogen | 65 | ||
| Taxonomy | 65 | ||
| Reservoir | 66 | ||
| Distribution | 66 | ||
| Characteristics | 66 | ||
| II Health aspects | 67 | ||
| Primary disease symptoms and sequelae | 67 | ||
| Exposure/mechanism of infection | 67 | ||
| Disease incidence | 68 | ||
| Incubation period | 68 | ||
| Infectivity | 68 | ||
| Sensitive groups | 68 | ||
| III Evidence for association of E. coli O157 with recreational waters\r | 68 | ||
| IV Conclusions | 70 | ||
| HELICOBACTER PYLORI | 71 | ||
| I Organism | 71 | ||
| Pathogen | 71 | ||
| Taxonomy | 71 | ||
| Reservoir | 71 | ||
| Distribution | 71 | ||
| Characteristics | 71 | ||
| II Health aspects | 71 | ||
| Primary disease symptoms and sequelae | 71 | ||
| Exposure/mechanism of infection | 73 | ||
| Disease incidence | 74 | ||
| Incubation period | 74 | ||
| Infectivity | 74 | ||
| Sensitive groups | 74 | ||
| III Evidence for association of Helicobacter pylori with\rrecreational waters | 74 | ||
| IV Conclusions | 75 | ||
| LEGIONELLA | 76 | ||
| I Organism | 76 | ||
| Pathogen | 76 | ||
| Taxonomy | 76 | ||
| Reservoir | 76 | ||
| Distribution | 76 | ||
| Characteristics | 77 | ||
| II Health aspects | 78 | ||
| Primary disease symptoms and sequelae | 78 | ||
| Exposure/mechanism of infection | 79 | ||
| Disease incidence | 79 | ||
| Incubation period | 80 | ||
| Infectivity | 80 | ||
| Sensitive groups | 80 | ||
| III Evidence for association of Legionnaires’ disease with recreational waters | 81 | ||
| Surveillance data | 82 | ||
| Denmark | 82 | ||
| England and Wales | 83 | ||
| Spain | 83 | ||
| Published cases of Legionnaires’ disease associated with recreational waters | 84 | ||
| Open waters | 85 | ||
| Cases of Legionnaires’ disease associated with hot springs/hydrothermal areas | 85 | ||
| Occurrence or likely occurrence of legionella in swimming pools | 87 | ||
| Cases of Legionnaires’ disease associated with swimming pools | 88 | ||
| Occurrence or likely occurrence of legionella in hot tubs andsaunas | 88 | ||
| Cases of Legionnaires’ disease associated with display hot tubs | 90 | ||
| Travel-related Legionnaires’ disease | 91 | ||
| IV Conclusions | 92 | ||
| LEPTOSPIRA | 93 | ||
| I Organism | 93 | ||
| Pathogen | 93 | ||
| Taxonomy | 93 | ||
| Reservoir | 93 | ||
| Distribution | 93 | ||
| Charactersitics | 93 | ||
| II Health aspects | 94 | ||
| Primary disease symptoms and sequelae | 94 | ||
| Exposure/mechanism of infection | 95 | ||
| Disease incidence | 95 | ||
| Incubation period | 95 | ||
| Infectivity | 95 | ||
| Sensitive groups | 97 | ||
| III Evidence for association of leptospirosis with recreational waters | 97 | ||
| Surveillance data | 99 | ||
| IV Conclusions | 100 | ||
| MYCOBACTERIUM | 101 | ||
| I Organism | 101 | ||
| Pathogen | 101 | ||
| Taxonomy | 101 | ||
| Reservoir | 102 | ||
| Distribution | 102 | ||
| Characteristics | 102 | ||
| II Health aspects | 102 | ||
| Primary disease symptoms and sequelae | 102 | ||
| Exposure/mechanism of infection | 104 | ||
| Disease incidence | 104 | ||
| Incubation period | 104 | ||
| Infectivity | 104 | ||
| Sensitive groups | 104 | ||
| III Evidence of association of mycobacterium with recreational waters | 105 | ||
| IV Conclusions | 106 | ||
| SALMONELLA | 107 | ||
| I Organism | 107 | ||
| Pathogen | 107 | ||
| Taxonomy | 107 | ||
| Reservoir | 107 | ||
| Distribution | 107 | ||
| Characteristics | 108 | ||
| II Health aspects | 108 | ||
| Primary disease symptoms and sequelae | 108 | ||
| Exposure/mechanism of infection | 109 | ||
| Disease incidence | 110 | ||
| Incubation period | 110 | ||
| Infectivity | 111 | ||
| Sensitive groups | 111 | ||
| III Evidence for association of salmonellosis with recreational waters | 111 | ||
| IV Conclusions | 112 | ||
| SHIGELLA | 113 | ||
| I Organism | 113 | ||
| Pathogen | 113 | ||
| Taxonomy | 113 | ||
| Reservoir | 113 | ||
| Distribution | 113 | ||
| Characteristics | 113 | ||
| II Health aspects | 113 | ||
| Primary disease symptoms and sequelae | 113 | ||
| Exposure/mechanism of infection | 114 | ||
| Disease incidence | 115 | ||
| Incubation period | 115 | ||
| Infectivity | 115 | ||
| Sensitive groups | 115 | ||
| III Evidence for association of shigellosis with recreational waters | 116 | ||
| Surveillance data | 116 | ||
| IV Conclusions | 117 | ||
| VIBRIO VULNIFICUS | 119 | ||
| I Organism | 119 | ||
| Pathogen | 119 | ||
| Taxonomy | 119 | ||
| Reservoir | 119 | ||
| Distribution | 119 | ||
| Characteristics | 119 | ||
| II Health aspects | 119 | ||
| Primary disease symptoms and sequelae | 119 | ||
| Exposure/mechanism of infection | 120 | ||
| Disease incidence | 120 | ||
| Incubation period | 120 | ||
| Infectivity | 120 | ||
| Sensitive groups | 121 | ||
| III Evidence for association of Vibrio vulnificus with\rrecreational waters | 121 | ||
| IV Conclusions | 122 | ||
| REFERENCES | 123 | ||
| 5:\rProtozoa and Trematodes | 147 | ||
| CRYPTOSPORIDIUM PARVUM | 148 | ||
| I Organism | 148 | ||
| Pathogen | 148 | ||
| Taxonomy | 148 | ||
| Reservoir | 148 | ||
| Distribution | 148 | ||
| Characteristics | 148 | ||
| II Health aspects | 149 | ||
| Primary disease symptoms and sequelae | 149 | ||
| Exposure/mechanisms of infection | 150 | ||
| Disease incidence | 150 | ||
| Incubation period | 151 | ||
| Infectivity | 151 | ||
| Sensitive groups | 151 | ||
| III Evidence for association of cryptosporidiosis with recreational waters | 151 | ||
| Swimming pools | 153 | ||
| Cryptosporidiosis and surface waters | 154 | ||
| Fountains | 155 | ||
| IV Conclusions | 156 | ||
| GIARDIA DUODENALIS | 157 | ||
| I Organism | 157 | ||
| Pathogen | 157 | ||
| Taxonomy | 157 | ||
| Reservoir | 157 | ||
| Distribution | 157 | ||
| Characteristics | 157 | ||
| II Health aspects | 157 | ||
| Primary disease symptoms and sequelae | 157 | ||
| Exposure/mechanisms of infection | 158 | ||
| Disease incidence | 159 | ||
| Incubation period | 159 | ||
| Infectivity | 159 | ||
| Sensitive groups | 159 | ||
| III Evidence for association of Giardia with recreational waters | 160 | ||
| Surveillance data | 161 | ||
| IV Conclusions | 162 | ||
| MICROSPORIDIA | 163 | ||
| I Organism | 163 | ||
| Pathogen | 163 | ||
| Taxonomy | 163 | ||
| Reservoir | 164 | ||
| Distribution | 164 | ||
| Characteristics | 164 | ||
| II Health aspects | 165 | ||
| Primary disease symptoms and sequelae | 165 | ||
| Exposure/mechanisms of infection | 165 | ||
| Disease incidence | 165 | ||
| Incubation period | 165 | ||
| Infectivity | 166 | ||
| Sensitive groups | 166 | ||
| III Evidence for association of microsporidiosis with recreational waters | 167 | ||
| IV Conclusions | 169 | ||
| NAEGLERIA FOWLERI | 170 | ||
| I Organism | 170 | ||
| Pathogen | 170 | ||
| Taxonomy | 170 | ||
| Reservoir | 170 | ||
| Distribution | 170 | ||
| Characteristics | 170 | ||
| II Health aspects | 171 | ||
| Primary disease symptoms and sequelae | 171 | ||
| Exposure/mechanisms of infection | 171 | ||
| Disease incidence | 171 | ||
| Incubation period | 172 | ||
| Infectivity | 172 | ||
| Sensitive groups | 172 | ||
| III Evidence for association of Naegleria fowleri with recreational water use\r | 172 | ||
| Surveillance data | 175 | ||
| IV Conclusions | 175 | ||
| TREMATODE WORM | 176 | ||
| I Organism | 176 | ||
| Pathogen | 176 | ||
| Taxonomy | 176 | ||
| Reservoir | 176 | ||
| Distribution | 176 | ||
| Characteristics | 176 | ||
| II Health aspects | 177 | ||
| Primary disease symptoms and sequelae | 177 | ||
| Exposure/mechanism of infection | 178 | ||
| Disease incidence | 179 | ||
| Incubation period | 179 | ||
| Infectivity | 179 | ||
| Sensitive groups | 179 | ||
| III Evidence for association with recreational waters | 179 | ||
| IV Conclusions | 182 | ||
| REFERENCES | 182 | ||
| 6:\rViruses | 191 | ||
| HUMAN ADENOVIRUS | 192 | ||
| I Organism | 192 | ||
| Pathogen | 192 | ||
| Taxonomy | 192 | ||
| Reservoir | 192 | ||
| Distribution | 192 | ||
| Characteristics | 192 | ||
| II Health aspects | 193 | ||
| Primary disease symptoms and sequelae | 193 | ||
| Exposure/mechanism of infection | 194 | ||
| Disease incidence | 195 | ||
| Incubation period | 195 | ||
| Infectivity | 195 | ||
| Sensitive groups | 195 | ||
| III Evidence for association of adenovirus with recreational waters | 196 | ||
| IV Conclusions | 197 | ||
| COXSACKIEVIRUS | 199 | ||
| I Organism | 199 | ||
| Pathogen | 199 | ||
| Taxonomy | 199 | ||
| Reservoir | 199 | ||
| Distribution | 199 | ||
| Characteristics | 199 | ||
| II Health aspects | 199 | ||
| Primary disease symptoms and sequelae | 199 | ||
| Exposure/mechanisms of infection | 201 | ||
| Disease incidence | 201 | ||
| Incubation period | 202 | ||
| Infectivity | 202 | ||
| Sensitive groups | 202 | ||
| III Evidence for association of coxsackievirus with recreational waters | 202 | ||
| IV Conclusions | 203 | ||
| ECHOVIRUS | 204 | ||
| I Organism | 204 | ||
| Pathogen | 204 | ||
| Taxonomy | 204 | ||
| Reservoir | 204 | ||
| Distribution | 204 | ||
| Characteristics | 204 | ||
| II Health aspects | 204 | ||
| Primary disease symptoms and sequelae | 204 | ||
| Exposure/mechanism of infection | 205 | ||
| Disease incidence | 206 | ||
| Incubation period | 206 | ||
| Infectivity | 206 | ||
| Sensitive groups | 206 | ||
| III Evidence for association of echovirus with recreational waters | 207 | ||
| IV Conclusions | 207 | ||
| HEPATITIS A | 208 | ||
| I Organism | 208 | ||
| Pathogen | 208 | ||
| Taxonomy | 208 | ||
| Reservoir | 208 | ||
| Distribution | 208 | ||
| Characteristics | 209 | ||
| II Health aspects | 209 | ||
| Primary disease symptoms and sequelae | 209 | ||
| Exposure/mechanism of infection | 210 | ||
| Disease incidence | 210 | ||
| Incubation period | 211 | ||
| Infectivity | 211 | ||
| Sensitive groups | 211 | ||
| III Evidence for association of hepatitis A with recreational waters | 211 | ||
| Surveillance data | 212 | ||
| Published cases of hepatitis A associated with recreational waters | 212 | ||
| Anecdotal cases/other sources | 214 | ||
| IV Conclusions | 214 | ||
| HEPATITIS E | 215 | ||
| I Organism | 215 | ||
| Pathogen | 215 | ||
| Taxonomy | 215 | ||
| Reservoir | 215 | ||
| Distribution | 215 | ||
| Characteristics | 215 | ||
| II Health aspects | 215 | ||
| Primary disease symptoms and sequelae | 215 | ||
| Exposure/mechanisms of infection | 216 | ||
| Disease incidence | 216 | ||
| Incubation period | 217 | ||
| Infectivity | 217 | ||
| Sensitive groups | 217 | ||
| III Evidence for association of hepatitis E with recreational waters | 217 | ||
| IV Conclusions | 218 | ||
| REFERENCES | 219 | ||
| Index | 231 |