title: Recreational Water and Infection: A Review of Recent Findings.
abstract: This paper reviews the latest evidence provided by epidemiological studies and quantitative microbial risk assessments (QMRAs) of infection risk from recreational water use. Studies for review were selected following a PubMed search for articles published between January 2010 and April 2014. Epidemiological studies show a generally elevated risk of gastrointestinal illness in bathers compared to non-bathers but often no clear association with water quality as measured by faecal indicator bacteria; this is especially true where study sites are impacted by non-point source pollution. Evidence from QMRAs support the lack of a consistent water quality association for non-point source-impacted beaches. It is suggested that source attribution, through quantified microbial source apportionment, linked with appropriate use of microbial source tracking methods should be employed as an integral part of future epidemiological surveys.
authors.affiliation: Centre for Research into Environment and Health (CREH), Department of Geography and Earth Sciences, Aberystwyth University, Ceredigion, SY23 3DB UK.
authors.forename: Lorna
authors.initials: L
authors.lastname: Fewtrell
authors.affiliation: Centre for Research into Environment and Health (CREH), Department of Geography and Earth Sciences, Aberystwyth University, Ceredigion, SY23 3DB UK.
authors.forename: David
authors.initials: D
authors.lastname: Kay
mesh_terms: D001493:Bathing Beaches; D016983:Enterococcus / Q000472:pathogenicity; D004781:Environmental Exposure / Q000009:adverse effects*; D005767:Gastrointestinal Diseases / Q000453:epidemiology* / Q000382:microbiology; D006304:Health Status; D006801:Humans; D007239:Infections / Q000453:epidemiology* / Q000209:etiology; D011998:Recreation; D012623:Seawater / Q000382:microbiology; D012722:Sewage / Q000382:microbiology; D013550:Swimming; D014867:Water; D014876:Water Pollution / Q000009:adverse effects* / Q000032:analysis; D060753:Water Quality / Q000592:standards
chemical_list: D012722:Sewage; D014867:Water
keywords: Epidemiology; Exposure; Gastrointestinal illness; Point and non-point source pollution; Quantitative microbial risk assessment; Water quality
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