Influence of physical activity in the intake of trihalomethanes in indoor swimming pools

Surveillance of Legionella pneumophila: Detection in Public Swimming Pool Environment

The bacterium Legionella pneumophila is a ubiquitous microorganism naturally present in water environments. The actual presence of this opportunistic premise plumbing pathogen in recreational swimming pools and hot tubs in the northwestern part of Croatia has not been investigated. This study aimed to analyze the presence of the opportunistic pathogen L. pneumophila in public swimming pool water in Primorje-Gorski Kotar County (N = 4587) over a four-year period (2018-2021). Additionally, the second aim was to investigate the connection between the presence of L. pneumophila and pool water physicochemical parameters using mathematical predictive models. The presence of L. pneumophila was detected in six pool samples. Five positive samples were found in the water of indoor hot tubs filled with fresh water, and one positive sample in an outdoor recreational saltwater pool. A predictive mathematical model showed the simultaneous influence of chemical parameters dominated by the temperature in saltwater and freshwater pools, as well as the significant influence of free residual chlorine and trihalomethanes. Our results pointed out that keeping all physicochemical parameters in perfect harmony is necessary to reach the best disinfection procedure and to avoid the optimum conditions for L. pneumophila occurrence.

Health effects of exposure to chlorination by-products in swimming pools

Concerns have been raised regarding the potential negative effects on human health of water disinfectants used in swimming pools. Among the disinfection options, the approaches using chlorine-based products have been typically preferred. Chlorine readily reacts with natural organic matter that are introduced in the water mainly through the bathers, leading to the formation of potentially harmful chlorination by-products (CBPs). The formation of CBPs is of particular concern since some have been epidemiologically associated with the development of various clinical manifestations. The higher the concentration of volatile CBPs in the water, the higher their concentration in the air above the pool, and different routes of exposure to chemicals in swimming pools (water ingestion, skin absorption, and inhalation) contribute to the individual exposome. Some CBPs may affect the respiratory and skin health of those who stay indoor for long periods, such as swimming instructors, pool staff, and competitive swimmers. Whether those who use chlorinated pools as customers, particularly children, may also be affected has been a matter of debate. In this article, we discuss the current evidence regarding the health effects of both acute and chronic exposures in different populations (work-related exposures, intensive sports, and recreational attendance) and identify the main recommendations and unmet needs for research in this area.

Pilot Test on Pre-Swim Hygiene as a Factor Limiting Trihalomethane Precursors in Pool Water by Reducing Organic Matter in an Operational Facility

Pool water must be constantly disinfected. Chlorine compounds used to disinfect pools react with organic substances such as sweat, urine, and personal care products introduced into pool water by users and results in the formation of disinfection byproducts. Trihalomethanes (THM), including chloroform and dissolved organic carbon (DOC) concentrations, were quantified using a two-stage process: determining initial THM and chloroform levels; then searching for a cheap and easy-to-use method to improve water quality. The method proposed here to limit THM and DOC concentrations in water is controlled showering. At three swimming pool facilities, chloroform concentrations (13.8 ± 0.33 µg/L, 15.5 ± 0.44 µg/L, and 13.9 ± 0.06 µg/L) were below the threshold concentration of 30 μg/L. At a fourth facility, however, the chloroform concentration exceeded that threshold (40.7 ± 9.68 μg/L) when showering was not controlled. Those conditions improved after the introduction of a mandatory shower; concentrations of DOC, THMs, and chloroform all decreased. The chloroform concentration decreased to 29.4 ± 3.8 μg/L, the THM concentration was 31.3 ± 3.9 μg/L, and the DOC concentration was 6.09 ± 0.05 mg/L. Pilot tests were carried out at real facilities to determine whether the control of pre-swim hygiene was possible. The introduction of proper pre-swim hygiene limited the concentration of DOC in water and can lead to a healthier environment for everyone attending the swimming facility.

Factors Associated with Exposure to Trihalomethanes, NHANES 2001-2012

Disinfection is critical for maintaining a safe water supply, but the use of chlorine or chloramine leads to exposure to disinfection byproducts (DBPs), including trihalomethanes (THMs), which have been associated with adverse reproductive outcomes and bladder cancer. The U.S. Environmental Protection Agency revised the DBP regulations starting in 1998 to further limit levels of THMs in household water. We analyzed data from the National Health and Nutrition Examination Survey (NHANES) collected between 2001 and 2012 (with 2 years per cycle) using models with and without water-related predictors to examine the utility of including these measures. Median blood chloroform levels (25th-75th percentiles) were 16.2 (9.13-31.2) ng/L in 2001-2002 and 5.97 (2.92-12.3) ng/L in 2011-2012. Median blood bromodichloromethane (BDCM) levels (25th-75th percentiles) were 2.22 (1.06-4.61) ng/L in 2001-2002 and 1.18 (<limit of detection-2.92) ng/L in 2011-2012. THM water concentrations and measures of the recency since time spent in water use activities were associated with blood THM levels. Being in a pool/hot tub/sauna within 24 h or taking a shower/bath within 6 h of blood collection was associated with elevated blood levels of chloroform and BDCM. When possible, it is important to include recency and external dose when assessing associations to internal dose levels for nonpersistent compounds.

Exposure to disinfection by-products in swimming pools and biomarkers of genotoxicity and respiratory damage - The PISCINA2 Study

BACKGROUND

Swimming in pools is a healthy activity that entails exposure to disinfection by-products (DBPs), some of which are irritant and genotoxic.

OBJECTIVES

We evaluated exposure to DBPs during swimming in a chlorinated pool and the association with short-term changes in genotoxicity and lung epithelium permeability biomarkers.

METHODS

Non-smoker adults (N = 116) swimming 40 min in an indoor pool were included. We measured a range of biomarkers before and at different times after swimming: trihalomethanes (THMs) in exhaled breath (5 min), trichloroacetic acid (TCAA) in urine (30 min), micronuclei in lymphocytes (1 h), serum club cell protein (CC16) (1 h), urine mutagenicity (2 h) and micronuclei in reticulocytes (4 days in a subset, N = 19). Several DBPs in water and trichloramine in air were measured, and physical activity was extensively assessed. We estimated interactions with polymorphisms in genes related to DBP metabolism.

RESULTS

Median level of chloroform, brominated and total THMs in water was 37.3, 9.5 and 48.5, μg/L, respectively, and trichloramine in air was 472.6 μg/m³. Median exhaled chloroform, brominated and total THMs increased after swimming by 10.9, 2.6 and 13.4, μg/m³, respectively. Creatinine-adjusted urinary TCAA increased by 3.1 μmol/mol. Micronuclei in lymphocytes and reticulocytes, urine mutagenicity and serum CC16 levels remained unchanged after swimming. Spearman correlation coefficients showed no association between DBP exposure and micronuclei in lymphocytes, urine mutagenicity and CC16. Moderate associations were observed for micronuclei in reticulocytes and DBP exposure.

CONCLUSIONS

The unchanged levels of the short-term effect biomarkers after swimming and null associations with personal estimates of exposure to DBPs suggest no measurable effect on genotoxicity in lymphocytes, urine mutagenicity and lung epithelium permeability at the observed exposure levels. The moderate associations with micronuclei in reticulocytes require cautious interpretation given the reduced sample size.

Occurrence of disinfection by-products in swimming pools and the estimated resulting cytotoxicity

Swimming pools are disinfected to protect against the risk of microbial disease, however, the formation of disinfection by-products (DBPs) is an unwanted consequence. While many studies have reported the occurrence of commonly investigated DBPs (trihalomethanes and haloacetic acids) in pools, few studies have investigated emerging DBP classes, such as the haloketones or haloacetaldehydes, and the nitrogenous haloacetamides, halonitromethanes, haloacetonitriles and N-nitrosamines. This study investigated the occurrence of sixty four DBPs from the eight aforementioned DBP classes in pools employing different treatment methods. Approximately 70% of the DBPs were detected in at least one of the pools, with most concentrations being equal to or greater than those previously reported. Chloral hydrate (trichloroacetaldehyde) was one of many DBPs detected in all chlorinated waters (202 to 1313 μg/L), and, on a molar basis, was the predominant DBP. Several other DBPs, namely chloroacetic acid, dichloroacetic acid, trichloroacetic acid, dichloroacetamide, dibromoacetamide, dibromochloroacetamide and trichloroacetamide, and many of the N-nitrosamines, were measured at concentrations greater than previously reported: up to 200 to 479 μg/L for the haloacetic acids, 56 to 736 μg/L for the haloacetamides and up to 1093 ng/L for some N-nitrosamines. The higher disinfectant residuals required to be employed in Australian pools, and poor pool management (e.g. of chlorine residual and pH) are likely factors contributing to these relatively high DBP concentrations. Where possible, the cytotoxicity values of the investigated DBPs were evaluated, with chloral hydrate representing over 90% of the total chronic cytotoxicity despite only representing up to 64% of the total molar DBP concentration. This study is the first report of bromodichloroacetaldehyde and bromochloroacetaldehyde in pools and is the first investigation of N-nitrosamines in a brominated pool. Furthermore, this work aids in understanding DBPs in both chlorine and bromine treated pools, the latter being the subject of only limited previous studies.

Investigating the effects of design and management factors on DBPs levels in indoor aquatic centres

Disinfection by-products (DBPs) in indoor swimming pool water and air have long been a critical human health risk concern. This study investigated the effects of several indoor swimming pool design and management factors (e.g. ventilation, water treatment, pool operations, pool type) on the concentrations of DBPs, such as trihalomethanes (THMs) and chloramines, in pool water and air. Two sampling campaigns, A and B, were carried out to measure the concentrations of DBPs under different conditions. In both campaigns, 46 pool water samples, seven tap water samples, and 28 ambient air samples were collected and analyzed. Regression models were also developed and validated for investigating the combined effects of design and management factors on total trihalomethanes (TTHM) and trichloramine. The model results show that pool water characteristics (e.g., total organic content, temperature, conductivity, pH and alkalinity) and management factors (e.g., the number of bathers and sprayers) have direct effects on DBP concentrations. Pool water characteristics such as UV absorbance, hardness, and oxidation-reduction potential and a management factor UV intensity have inverse effects on DBPs levels. Based on the correlation analysis, other factors such as fan speed, fresh air, pool age, and basin area were found to be correlated with the concentrations of individual THMs and trichloramine in both water and air. It was also observed that the concentration of THMs varies with pool type. It is note worthy that the effects of the number of sprayers was quantified for the first time. This study comprehensively assessed pool design and management factors and identified their effects on DBPs, providing indoor swimming pool facilities with useful information to control DBPs in the indoor swimming environment.

Formation of trihalomethanes in swimming pool waters using sodium dichloroisocyanurate as an alternative disinfectant

Disinfection is essential to preventing infection caused by microbial pathogens in swimming pool water. The most commonly used disinfection methods are chlorine disinfectant, including sodium hypochlorite (NaOCl) and sodium dichloroisocyanurate (SDIC, C₃O₃N₃Cl₂Na) with characteristics of available chlorine formation and stability. In this study, we estimate the formation of trihalomethanes (THM₄) in indoor swimming pools filled with seawater that adopt these disinfection methods, and we investigated the factors influencing the formation of THM₄. Formation of THM₄ by free chlorine (FC) and SDIC respectively is 327.8 μg L^-1 and 307.6 μg L^-1; Br-THMs is 226.7 μg L^-1 for FC, 198 μg L^-1 for SDIC. SDIC has less THM₄ formation than FC in the same molar Br^- dosage (10 μM) and total chlorine dosage (20 μM), and bromoform is the main Br-THMs species. The occurrence of THM₄ is inhibited at high dosages of natural organic matter and Br^-. The total Br-THMs increase from 75 μg L^-1 to 189.7 μg L^-1 and from 64.6 μg L^-1 to 190 μg L^-1 by FC and SDIC at pH 5.0-9.0, both of which are highly dependent on pH. In real water, similar results were found in Br^--containing water (1 mg-Br^- L^-1).

Effects of exposure to water disinfection by-products in a swimming pool: A metabolome-wide association study

BACKGROUND

Exposure to disinfection by-products (DBPs) in drinking water and chlorinated swimming pools are associated with adverse health outcomes, but biological mechanisms remain poorly understood.

OBJECTIVES

Evaluate short-term changes in metabolic profiles in response to DBP exposure while swimming in a chlorinated pool.

MATERIALS AND METHODS

The PISCINA-II study (EXPOsOMICS project) includes 60 volunteers swimming 40min in an indoor pool. Levels of most common DBPs were measured in water and in exhaled breath before and after swimming. Blood samples, collected before and 2h after swimming, were used for metabolic profiling by liquid-chromatography coupled to high-resolution mass-spectrometry. Metabolome-wide association between DBP exposures and each metabolic feature was evaluated using multivariate normal (MVN) models. Sensitivity analyses and compound annotation were conducted.

RESULTS

Exposure levels of all DBPs in exhaled breath were higher after the experiment. A total of 6,471 metabolic features were detected and 293 features were associated with at least one DBP in exhaled breath following Bonferroni correction. A total of 333 metabolic features were associated to at least one DBP measured in water or urine. Uptake of DBPs and physical activity were strongly correlated and mutual adjustment reduced the number of statistically significant associations. From the 293 features, 20 could be identified corresponding to 13 metabolites including compounds in the tryptophan metabolism pathway.

CONCLUSION

Our study identified numerous molecular changes following a swim in a chlorinated pool. While we could not explicitly evaluate which experiment-related factors induced these associations, molecular characterization highlighted metabolic features associated with exposure changes during swimming.

Occurrence and formation of disinfection by-products in the swimming pool environment: A critical review

Disinfection of water for human use is essential to protect against microbial disease; however, disinfection also leads to formation of disinfection by-products (DBPs), some of which are of health concern. From a chemical perspective, swimming pools are a complex matrix, with continual addition of a wide range of natural and anthropogenic chemicals via filling waters, disinfectant addition, pharmaceuticals and personal care products and human body excretions. Natural organic matter, trace amounts of DBPs and chlorine or chloramines may be introduced by the filling water, which is commonly disinfected distributed drinking water. Chlorine and/or bromine is continually introduced via the addition of chemical disinfectants to the pool. Human body excretions (sweat, urine and saliva) and pharmaceuticals and personal care products (sunscreens, cosmetics, hair products and lotions) are introduced by swimmers. High addition of disinfectant leads to a high formation of DBPs from reaction of some of the chemicals with the disinfectant. Swimming pool air is also of concern as volatile DBPs partition into the air above the pool. The presence of bromine leads to the formation of a wide range of bromo- and bromo/chloro-DBPs, and Br-DBPs are more toxic than their chlorinated analogues. This is particularly important for seawater-filled pools or pools using a bromine-based disinfectant. This review summarises chemical contaminants and DBPs in swimming pool waters, as well as in the air above pools. Factors that have been found to affect DBP formation in pools are discussed. The impact of the swimming pool environment on human health is reviewed.

Acute changes in serum immune markers due to swimming in a chlorinated pool

BACKGROUND

Exposure to disinfectants and disinfection byproducts (DBPs) due to swimming in chlorinated water has been associated with allergic and respiratory health effects, including asthma.

OBJECTIVES

Biological mechanisms contributing to these associations are largely unknown. We hypothesized a potential pathway involving modulation of the immune system.

METHODS

We assessed levels of immune markers (CCL11, CCL22, CXCL10, CRP, EGF, GCSF, IL-8, IL-17, IL-1RA, MPO, VEGF, Periostin) in serum collected from 30 women and 29 men before and after 40min of swimming in a chlorinated pool. Exposure to DBPs was assessed by measuring bromodichloromethane, bromoform, chloroform, and dibromochloromethane in exhaled breath before and after swimming. Covariate data including information on physical activity was available through questionnaires and measurements. We assessed the association between indicators of swimming in a chlorinated pool and changes in serum immune marker concentrations using linear regression with bivariate normal distributions and adjusted for multiple comparisons by applying the Benjamini-Hochberg procedure.

RESULTS

We observed a significant decrease in serum concentrations of IL-8 (-12.53%; q=2.00e-03), CCL22 (-7.28%; q=4.00e-04), CCL11 (-7.15%; q=9.48e-02), CRP (-7.06%; q=4.68e-05), and CXCL10 (-13.03%; q=6.34e-14) and a significant increase in IL-1RA (20.16%; q=4.18e-06) from before to after swimming. Associations with quantitative measurements of DBPs or physical activity were similar in direction and strength. Most of the observed associations became non-significant when we adjusted the effects of exposure to DBPs for physical activity or vice-versa.

CONCLUSIONS

Our study indicates that swimming in a chlorinated pool induces perturbations of the immune response through acute alterations of patterns of cytokine and chemokine secretion. The observed effects could not be uniquely attributed to either exposure to DBPs or physical activity. Evidence in the literature suggests that observed decreases in immune markers are possibly due to an immunosuppressive effect of DBPs, while the increase in IL-1RA might be due to physical activity.

Gene expression changes in blood RNA after swimming in a chlorinated pool

Exposure to disinfection by-products (DBP) such as trihalomethanes (THM) in swimming pools has been linked to adverse health effects in humans, but their biological mechanisms are unclear. We evaluated short-term changes in blood gene expression of adult recreational swimmers after swimming in a chlorinated pool. Volunteers swam 40min in an indoor chlorinated pool. Blood samples were drawn and four THM (chloroform, bromodichloromethane, dibromochloromethane and bromoform) were measured in exhaled breath before and after swimming. Intensity of physical activity was measured as metabolic equivalents (METs). Gene expression in whole blood mRNA was evaluated using IlluminaHumanHT-12v3 Expression-BeadChip. Linear mixed models were used to evaluate the relationship between gene expression changes and THM exposure. Thirty-seven before-after pairs were analyzed. The median increase from baseline to after swimming were: 0.7 to 2.3 for MET, and 1.4 to 7.1μg/m³ for exhaled total THM (sum of the four THM). Exhaled THM increased on average 0.94μg/m³ per 1 MET. While 1643 probes were differentially expressed post-exposure. Of them, 189 were also associated with exhaled levels of individual/total THM or MET after False Discovery Rate. The observed associations with the exhaled THM were low to moderate (Log-fold change range: -0.17 to 0.15). In conclusion, we identified short-term gene expression changes associated with swimming in a pool that were minor in magnitude and their biological meaning was unspecific. The high collinearity between exhaled THM levels and intensity of physical activity precluded mutually adjusted models with both covariates. These exploratory results should be validated in future studies.

Environmental and personal determinants of the uptake of disinfection by-products during swimming

BACKGROUND

Trihalomethanes (THMs) in exhaled breath and trichloroacetic acid (TCAA) in urine are internal dose biomarkers of exposure to disinfection by-products (DBPs) in swimming pools.

OBJECTIVE

We assessed how these biomarkers reflect the levels of a battery of DBPs in pool water and trichloramine in air, and evaluated personal determinants.

METHODS

A total of 116 adults swam during 40min in a chlorinated indoor pool. We measured chloroform, bromodichloromethane, dibromochloromethane and bromoform in exhaled breath and TCAA in urine before and after swimming, trichloramine in air and several DBPs in water. Personal determinants included sex, age, body mass index (BMI), distance swum, energy expenditure, heart rate and 12 polymorphisms in GSTT1, GSTZ1 and CYP2E1 genes.

RESULTS

Median level of exhaled total THMs and creatinine adjusted urine TCAA increased from 0.5 to 14.4µg/m(3) and from 2.5 to 5.8µmol/mol after swimming, respectively. The increase in exhaled brominated THMs was correlated with brominated THMs, haloacetic acids, haloacetonitriles, haloketones, chloramines, total organic carbon and total organic halogen in water and trichloramine in air. Such correlations were not detected for exhaled chloroform, total THMs or urine TCAA. Exhaled THM increased more in men, urine TCAA increased more in women, and both were affected by exercise intensity. Genetic variants were associated with differential increases in exposure biomarkers.

CONCLUSION

Our findings suggest that, although affected by sex, physical activity and polymorphisms in key metabolizing enzymes, brominated THMs in exhaled breath could be used as a non-invasive DBP exposure biomarker in swimming pools with bromide-containing source waters. This warrants confirmation with new studies.