title: Marine waters contaminated with domestic sewage: nonenteric illnesses associated with bather exposure in the United Kingdom.
abstract: OBJECTIVE
  This study identified possible dose-response relationships among bathers exposed to marine waters contaminated with domestic sewage and subsequent risk of nonenteric illness.
  
  
  METHODS
  Four intervention follow-up studies were conducted within the United Kingdom. Healthy volunteers (n = 1273) were randomized into bather and nonbather groups. Intensive water-quality monitoring was used to assign five bacteriological indices of water quality to individual bathers. Illnesses studied were acute febrile respiratory illness, and eye, ear, and skin ailments.
  
  
  RESULTS
  Fecal streptococci exposure was predictive of acute febrile respiratory illness, while fecal coliform exposure was predictive of ear ailments. Estimated thresholds of effect occurred at bather exposures above 60 fecal streptococci and 100 fecal coliform per 100 ml of water, respectively. Although no relationship was found between eye ailments and indicator organism exposure, compared with nonbathers, bathers were at higher risk for eye ailments.
  
  
  CONCLUSIONS
  Nonenteric illness can be transmitted via recreational contact with marine waters contaminated with sewage. These results argue against the use of a single indicator to establish water quality standards.
authors.affiliation: Department of Preventive Medicine and Community Health, State University of New York, Brooklyn 11203-2098, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Fleisher
authors.forename: D
authors.initials: D
authors.lastname: Kay
authors.forename: R L
authors.initials: RL
authors.lastname: Salmon
authors.forename: F
authors.initials: F
authors.lastname: Jones
authors.forename: M D
authors.initials: MD
authors.lastname: Wyer
authors.forename: A F
authors.initials: AF
authors.lastname: Godfree
mesh_terms: D000328:Adult; D001424:Bacterial Infections / Q000209:etiology*; D016009:Chi-Square Distribution; D004427:Ear Diseases / Q000209:etiology; D004755:Enterobacteriaceae / Q000302:isolation & purification; D015818:Eye Infections, Bacterial / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D012141:Respiratory Tract Infections / Q000209:etiology; D012722:Sewage; D012871:Skin Diseases / Q000209:etiology; D013291:Streptococcus / Q000302:isolation & purification; D013550:Swimming; D006113:United Kingdom; D014871:Water Microbiology; D014876:Water Pollution / Q000009:adverse effects*
chemical_list: D012722:Sewage