title: Elevated bathing-associated disease risks despite certified water quality: a cohort study.
abstract: Bacteriological water quality criteria have been recommended to ensure bathers' health. However, this risk-assessment approach is based mainly on routine measurements of fecal pollution indicator bacteria in seawater, and may not be adequate to protect bathers effectively. The aim of this study was to assess the risks of symptoms related to infectious diseases among bathers after exposure to seawater which was of excellent quality according to EU guidelines. This study is a cohort study recruiting bathers and non-bathers. Water samples were collected for estimating bacterial indicators. Univariable and multivariable analysis was performed to compare the risks of developing symptoms/diseases between bathers and non-bathers. A total of 3805 bathers and 572 non-bathers were included in the study. Water analysis results demonstrated excellent quality of bathing water. Significantly increased risks of symptoms related to gastrointestinal infections (OR = 3.60, 95% CI 1.28-10.13), respiratory infections (OR = 1.92, 95% CI 1.00-3.67), eye infections (OR = 2.43, 95% CI 1.27-4.63) and ear infections (OR = 17.21, 95% CI 2.42-122.34) were observed among bathers compared with non-bathers. Increased rates of medical consultation and medication use were also observed among bathers. There was evidence that bathers experienced increased morbidity compared with non-bathers though the bathing waters met bacteriological water quality criteria. These results suggest that risk assessments of recreational seawaters should not only focus on bacteriological water quality criteria.
authors: Department of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 22 Papakyriazi Str., Larissa 41222, Greece. panpapast@med.uth.gr
authors: Panagiotis
authors: P
authors: Papastergiou
authors: Varvara
authors: V
authors: Mouchtouri
authors: Ourania
authors: O
authors: Pinaka
authors: Anna
authors: A
authors: Katsiaflaka
authors: George
authors: G
authors: Rachiotis
authors: Christos
authors: C
authors: Hadjichristodoulou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058491:Bacterial Load; D001493:Bathing Beaches / Q000592:standards; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003141:Communicable Diseases / Q000453:epidemiology*; D004755:Enterobacteriaceae / Q000302:isolation & purification; D016983:Enterococcus / Q000302:isolation & purification; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012623:Seawater / Q000382:microbiology*; D055815:Young Adult