title: Fecal indicators in sand, sand contact, and risk of enteric illness among beachgoers.
abstract: BACKGROUND
  Beach sand can harbor fecal indicator organisms and pathogens, but enteric illness risk associated with sand contact remains unclear.
  
  
  METHODS
  In 2007, visitors at 2 recreational marine beaches were asked on the day of their visit about sand contact. Ten to 12 days later, participants answered questions about health symptoms since the visit. F+ coliphage, Enterococcus, Bacteroidales, fecal Bacteroides, and Clostridium spp. in wet sand were measured using culture and molecular methods.
  
  
  RESULTS
  We analyzed 144 wet sand samples and completed 4999 interviews. Adjusted odds ratios (aORs) were computed, comparing those in the highest tertile of fecal indicator exposure with those who reported no sand contact. Among those digging in sand compared with those not digging in sand, a molecular measure of Enterococcus spp. (calibrator cell equivalents/g) in sand was positively associated with gastrointestinal (GI) illness (aOR = 2.0 [95% confidence interval (CI) = 1.2-3.2]) and diarrhea (2.4 [1.4-4.2]). Among those buried in sand, point estimates were greater for GI illness (3.3 [1.3-7.9]) and diarrhea (4.9 [1.8-13]). Positive associations were also observed for culture-based Enterococcus (colony-forming units/g) with GI illness (aOR digging = 1.7 [1.1-2.7]) and diarrhea (2.1 [1.3-3.4]). Associations were not found among nonswimmers with sand exposure.
  
  
  CONCLUSIONS
  We observed a positive relationship between sand-contact activities and enteric illness as a function of concentrations of fecal microbial pollution in beach sand.
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill, NC, USA. cheaney@jhsph.eduD
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Heaney
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Sams
authors.forename: Alfred P
authors.initials: AP
authors.lastname: Dufour
authors.forename: Kristen P
authors.initials: KP
authors.lastname: Brenner
authors.forename: Richard A
authors.initials: RA
authors.lastname: Haugland
authors.forename: Eunice
authors.initials: E
authors.lastname: Chern
authors.forename: Steve
authors.initials: S
authors.lastname: Wing
authors.forename: Stephen
authors.initials: S
authors.lastname: Marshall
authors.forename: David C
authors.initials: DC
authors.lastname: Love
authors.forename: Marc
authors.initials: M
authors.lastname: Serre
authors.forename: Rachel
authors.initials: R
authors.lastname: Noble
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Wade
mesh_terms: D000293:Adolescent; D000328:Adult; D000407:Alabama / Q000453:epidemiology; D001439:Bacteroides; D001493:Bathing Beaches / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003013:Clostridium; D004756:Enterobacteriaceae Infections / Q000453:epidemiology / Q000209:etiology*; D016983:Enterococcus; D004783:Environmental Microbiology; D005243:Feces / Q000382:microbiology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012237:Rhode Island / Q000453:epidemiology; D012307:Risk Factors; D012822:Silicon Dioxide; D055815:Young Adult
chemical_list: D012822:Silicon Dioxide