title: Acute Gastroenteritis and Recreational Water: Highest Burden Among Young US Children.
abstract: To provide summary estimates of gastroenteritis risks and illness burden associated with recreational water exposure and determine whether children have higher risks and burden.
  
  
  
  We combined individual participant data from 13 prospective cohorts at marine and freshwater beaches throughout the United States (n = 84 411). We measured incident outcomes within 10 days of exposure: diarrhea, gastrointestinal illness, missed daily activity (work, school, vacation), and medical visits. We estimated the relationship between outcomes and 2 exposures: body immersion swimming and Enterococcus spp. fecal indicator bacteria levels in the water. We also estimated the population-attributable risk associated with these exposures.
  
  
  
  Water exposure accounted for 21% of diarrhea episodes and 9% of missed daily activities but was unassociated with gastroenteritis leading to medical consultation. Children aged 0 to 4 and 5 to 10 years had the most water exposure, exhibited stronger associations between levels of water quality and illness, and accounted for the largest attributable illness burden.
  
  
  
  The higher gastroenteritis risk and associated burden in young children presents important new information to inform future recreational water quality guidelines designed to protect public health.
authors.affiliation: Benjamin F. Arnold, Jade Benjamin-Chung, and John M. Colford Jr are with the Division of Epidemiology, School of Public Health, University of California, Berkeley. Timothy J. Wade is with the US Environmental Protection Agency (EPA), National Health and Environmental Effects Research Laboratory, Research Triangle Park, NC. Kenneth C. Schiff, John F. Griffith, and Stephen B. Weisberg are with the Southern California Coastal Water Research Project, Costa Mesa, CA. Alfred P. Dufour is with the US EPA, National Exposure Research Laboratory, Cincinnati, OH.
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Arnold
authors.affiliation: Benjamin F. Arnold, Jade Benjamin-Chung, and John M. Colford Jr are with the Division of Epidemiology, School of Public Health, University of California, Berkeley. Timothy J. Wade is with the US Environmental Protection Agency (EPA), National Health and Environmental Effects Research Laboratory, Research Triangle Park, NC. Kenneth C. Schiff, John F. Griffith, and Stephen B. Weisberg are with the Southern California Coastal Water Research Project, Costa Mesa, CA. Alfred P. Dufour is with the US EPA, National Exposure Research Laboratory, Cincinnati, OH.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Wade
authors.affiliation: Benjamin F. Arnold, Jade Benjamin-Chung, and John M. Colford Jr are with the Division of Epidemiology, School of Public Health, University of California, Berkeley. Timothy J. Wade is with the US Environmental Protection Agency (EPA), National Health and Environmental Effects Research Laboratory, Research Triangle Park, NC. Kenneth C. Schiff, John F. Griffith, and Stephen B. Weisberg are with the Southern California Coastal Water Research Project, Costa Mesa, CA. Alfred P. Dufour is with the US EPA, National Exposure Research Laboratory, Cincinnati, OH.
authors.forename: Jade
authors.initials: J
authors.lastname: Benjamin-Chung
authors.affiliation: Benjamin F. Arnold, Jade Benjamin-Chung, and John M. Colford Jr are with the Division of Epidemiology, School of Public Health, University of California, Berkeley. Timothy J. Wade is with the US Environmental Protection Agency (EPA), National Health and Environmental Effects Research Laboratory, Research Triangle Park, NC. Kenneth C. Schiff, John F. Griffith, and Stephen B. Weisberg are with the Southern California Coastal Water Research Project, Costa Mesa, CA. Alfred P. Dufour is with the US EPA, National Exposure Research Laboratory, Cincinnati, OH.
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Schiff
authors.affiliation: Benjamin F. Arnold, Jade Benjamin-Chung, and John M. Colford Jr are with the Division of Epidemiology, School of Public Health, University of California, Berkeley. Timothy J. Wade is with the US Environmental Protection Agency (EPA), National Health and Environmental Effects Research Laboratory, Research Triangle Park, NC. Kenneth C. Schiff, John F. Griffith, and Stephen B. Weisberg are with the Southern California Coastal Water Research Project, Costa Mesa, CA. Alfred P. Dufour is with the US EPA, National Exposure Research Laboratory, Cincinnati, OH.
authors.forename: John F
authors.initials: JF
authors.lastname: Griffith
authors.affiliation: Benjamin F. Arnold, Jade Benjamin-Chung, and John M. Colford Jr are with the Division of Epidemiology, School of Public Health, University of California, Berkeley. Timothy J. Wade is with the US Environmental Protection Agency (EPA), National Health and Environmental Effects Research Laboratory, Research Triangle Park, NC. Kenneth C. Schiff, John F. Griffith, and Stephen B. Weisberg are with the Southern California Coastal Water Research Project, Costa Mesa, CA. Alfred P. Dufour is with the US EPA, National Exposure Research Laboratory, Cincinnati, OH.
authors.forename: Alfred P
authors.initials: AP
authors.lastname: Dufour
authors.affiliation: Benjamin F. Arnold, Jade Benjamin-Chung, and John M. Colford Jr are with the Division of Epidemiology, School of Public Health, University of California, Berkeley. Timothy J. Wade is with the US Environmental Protection Agency (EPA), National Health and Environmental Effects Research Laboratory, Research Triangle Park, NC. Kenneth C. Schiff, John F. Griffith, and Stephen B. Weisberg are with the Southern California Coastal Water Research Project, Costa Mesa, CA. Alfred P. Dufour is with the US EPA, National Exposure Research Laboratory, Cincinnati, OH.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Weisberg
authors.affiliation: Benjamin F. Arnold, Jade Benjamin-Chung, and John M. Colford Jr are with the Division of Epidemiology, School of Public Health, University of California, Berkeley. Timothy J. Wade is with the US Environmental Protection Agency (EPA), National Health and Environmental Effects Research Laboratory, Research Triangle Park, NC. Kenneth C. Schiff, John F. Griffith, and Stephen B. Weisberg are with the Southern California Coastal Water Research Project, Costa Mesa, CA. Alfred P. Dufour is with the US EPA, National Exposure Research Laboratory, Cincinnati, OH.
authors.forename: John M
authors.initials: JM
authors.lastname: Colford
mesh_terms: D000208:Acute Disease; D002648:Child; D002675:Child, Preschool; D005243:Feces / Q000382:microbiology; D005260:Female; D005759:Gastroenteritis / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D011634:Public Health; D011998:Recreation; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014871:Water Microbiology; D060753:Water Quality