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More education urged for preventing recreational water illnesses

IDC NY 2011

NEW YORK — Several high-profile outbreaks of cryptosporidiosis and other gastrointestinal illnesses have highlighted the potential risks of swimming pools, and pediatricians can play a key role in counseling parents and patients about water safety, according to a speaker here at the 24th Annual Infectious Diseases in Children Symposium.

Michael J. Beach, PhD, associate director for healthy water, National Center for Emerging and Zoonotic Infectious Diseases at the CDC, said clinicians should be aware that ova and parasite testing may not include testing for Cryptosporidium, so the test may need to be specifically requested. Nitazoxanide can be used to treat cryptosporidiosis in immunocompetent children who are older than 1 year.

Beach said parents and patients should be advised to avoid recreational water activities if they have diarrhea. Even after the diarrhea has ceased, patients with cryptosporidiosis should avoid swimming for an additional 2 weeks, and those patients who have an infection caused by other waterborne pathogens should avoid the pool for an additional week. In addition, swimmers should shower with soap and water before entering the water. All swimmers should avoid ingesting recreational water and take frequent bathroom breaks, and parents should change diapers often for young children.

He said these are all important measures to avoid cryptosporidiosis outbreaks, which make up about three-quarters of all waterborne outbreaks. He cited two high-profile outbreaks in New York and Utah.

In the summer 2005 in New York, an outbreak of cryptosporidiosis affected a reported 4,000 people. The results of the investigation revealed that the outbreak was related to a communal pool with a splash pad design. In Utah in 2007, Beach said about 2,000 people had laboratory-confirmed cases of cryptosporidiosis that was associated with 450 recreational water venues. This outbreak demonstrated the vulnerability of the pediatric population, as most of the cases were in children aged younger than 5 years. To quell the outbreak, children aged younger than 5 years were banned temporarily from public pools.

Beach said other gastrointestinal illnesses, such as Shigella, Escherichia coli and Giardia, have also been related to outbreaks at pools.

Another common pathogen associated with swimming pools is acute otitis externa (AOE). According to Beach, AOE is associated with about 2.4 million annual outpatient cases, and about $500 million per year of systemic antibiotics, “so this is another pathogen pediatricians need to keep on the radar,” he said.

It is important for pediatricians to help identify these waterborne pathogens and report them when appropriate. Beach said the CDC is currently developing a national consortium to “try and bring uniformity and increase reporting performance of these illnesses.”

Disclosure: Dr. Beach reports no relevant financial disclosures.

For more information:

• Beach MJ. Diseases from the neighborhood pool: What health care providers, parents and swimmers need to know. Presented at: the 24th Annual Infectious Diseases in Children Symposium; Nov. 18-20, 2011; New York.

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