Seasonal variations in the risk of gastrointestinal illness on a tropical recreational beach

Human adenovirus-associated health risk in the recreational waters of the Yal-ku lagoon in the Mexican Caribbean

The study objective was to evaluate human faecal contamination impacts in the Yal-ku lagoon in the Mexican Caribbean and to estimate adenovirus infection and illness risks associated with recreational exposure during water activities. A total of 20 water samples (10 from each site × two sites) (50 L) were collected monthly over a period of 12 months from two selected sampling sites in the swimming area of the Yal-ku lagoon. The occurrence of faecal-associated viruses was explored, and human adenovirus (HAdV) and pepper mild mottle virus (PMMoV) concentrations were quantified. A quantitative microbial risk assessment (QMRA) model was used to estimate exposure and subsequent adenovirus infection and illness risk for 1 h of swimming or snorkelling. Somatic and F + -specific coliphages occurred in 100% of the samples. Both HAdV and PMMoV were detected at a 60% frequency thereby indicating persistent faecal inputs. PMMoV concentrations (44-370 GC/L) were relatively lower than the concentrations of HAdV (64-1,000 GC/L). Estimated mean adenovirus risks were greater for snorkelling than for swimming by roughly one to two orders of magnitude and estimated mean illness risks for snorkelling were >32/1,000. Human faecal contamination is frequent in the Yal-ku lagoon, which is associated with human gastrointestinal illness.

Trends in regional enterococci levels at marine beaches and correlations with environmental, global oceanic changes, community populations, and wastewater infrastructure

An increase in the number of advisories issued for recreational beaches across south Florida (due to the fecal indicator bacteria, enterococci) has been observed in recent years. To evaluate the possible reasons for this increase, we reviewed weekly monitoring data for 18 beaches in Miami-Dade County, Florida, for the years 2000-2019. Our objective was to evaluate this dataset for trends in enterococci levels and correlations with various factors that might have influenced enterococci levels at these beaches. For statistical analyses, we divided the 20-year period of record into 5-year increments (2000-2004, 2005-2009, 2010-2014, and 2015-2019). The Wilcoxon rank sum test was used to identify statistically significant differences between the geometric mean of different periods. When all 18 beaches were collectively considered, a significant increase (p = 0.03) in enterococci was observed during 2015-2019, compared to the prior 15-year period of record. To better understand the potential causes for this increase, correlations were evaluated with environmental parameters (rainfall, air temperature, and water temperature), global oceanic changes (sea level and Sargassum), community populations (county population estimates and beach visitation numbers), and wastewater infrastructure (sewage effluent flow rates to ocean outfalls and deep well injection). In relation to the enterococci geometric mean, the correlation with Sargassum was statistically significant at a 95% confidence interval (p = 0.035). Population (p = 0.078), air temperature (p = 0.092), and sea level (p = 0.098) were statistically significant at 90% confidence intervals. Rainfall, water temperature, beach visitation numbers, and sewage effluent flow rates via deep well injection had positive correlations but were not significant factors. Sewage effluent flow rates to ocean outfalls had a negative correlation.

Bathing Water Quality Monitoring Practices in Europe and the United States

Many countries including EU Member States (EUMS) and the United States (U.S.) regularly monitor the microbial quality of bathing water to protect public health. This study comprehensively evaluates the EU bathing water directive (BWD) and the U.S. recreational water quality criteria (RWQC) as regulatory frameworks for monitoring microbial quality of bathing water. The major differences between these two regulatory frameworks are the provision of bathing water profiles, classification of bathing sites based on the pollution level, variations in the sampling frequency, accepted probable illness risk, epidemiological studies conducted during the development of guideline values, and monitoring methods. There are also similarities between the two approaches given that both enumerate viable fecal indicator bacteria (FIB) as an index of the potential risk to human health in bathing water and accept such risk up to a certain level. However, enumeration of FIB using methods outlined within these current regulatory frameworks does not consider the source of contamination nor variation in inactivation rates of enteric microbes in different ecological contexts, which is dependent on factors such as temperature, solar radiation, and salinity in various climatic regions within their geographical areas. A comprehensive "tool-box approach", i.e., coupling of FIB and viral pathogen indicators with microbial source tracking for regulatory purposes, offers potential for delivering improved understanding to better protect the health of bathers.

Microplastic pollution on sandy beaches of Puerto Rico

Caribbean islands, including Puerto Rico, are biodiversity hotspots threatened by microplastics (<5 mm). Little is known about the extent of microplastic pollution in coastal sandy beaches of Puerto Rico. Sand from six northern beaches was collected in the high tide line to determine microplastic abundance (0.3-4.75 mm). Península La Esperanza, the most polluted beach, exhibited higher average abundance (17 items/kg dw) and diversity. High urbanization, industrial/port activities, and riverine input are likely sources of plastic debris on this beach. The other beaches showed lower and similar average abundance (3 to 7 items/kg dw) despite having distinct potential point and non-point sources. Overall, fibers (40%), fragments (28%) and foams (27%) predominated (n = 102 particles). Results showed comparable levels to other world beaches, some classified as highly contaminated, but only when transforming units to items/m². Preliminary ATR-FTIR analysis identified mainly polyethylene. It is imperative to have plastics source reduction through waste management.

Fecal pollution source characterization at non-point source impacted beaches under dry and wet weather conditions

Though Lake Michigan beaches in Chicago are not impacted by stormwater or wastewater outfalls, several of those beaches often exceed USEPA Beach Action Values (BAVs). We investigated the role of microbial source tracking (MST) as a complement to routine beach monitoring at Chicago beaches. In summer 2016, water samples from nine Chicago beaches were analyzed for E. coli by culture and enterococci by qPCR. A total of 195 archived samples were then tested for human (HF183/BacR287, HumM2), canine (DG3, DG37), and avian (GFD) microbial source tracking (MST) markers. Associations between MST and general fecal indicator bacteria (FIB) measures were evaluated and stratified based on wet and dry weather definitions. Among the 195 samples, HF183/BacR287 was quantifiable in 4%, HumM2 in 1%, DG3 in 6%, DG37 in 2%, and GFD in 23%. The one beach with a dog area was far more likely to have DG3 present in the quantifiable range than other beaches. Exceedance of general FIB BAVs increased the odds of human, dog and avian marker detection. MST marker weighted-average fecal scores for DG3 was 2.4 times, DG37 was 2.1 times, and GFD was 1.6 times higher during wet compared to dry weather conditions. HF183/BacR287 weighted-average fecal scores were not associated with precipitation. Associations between FIB BAV exceedance and MST marker detection were generally stronger in wet weather. Incorporating MST testing into routine beach water monitoring can provide information that beach managers can use when developing protection plans for beaches not impacted by point sources.

Evaluating health risks associated with exposure to ambient surface waters during recreational activities: A systematic review and meta-analysis

Recreational water quality guidelines protect the public from health risks associated with water recreation by helping to prevent unacceptable concentrations of pathogenic organisms in ambient water. However, illness risk is associated with both the concentration of pathogens in the water and the degree of contact with those pathogens. Different recreational activities can result in different levels of contact with ambient water containing water-borne pathogens. We conducted a systematic literature review and meta-analysis to evaluate risks of illness associated with different recreational activities and different levels of contact to ambient surface waters. We screened 8,618 potentially relevant studies for quantitative measures of risk using inclusion/exclusion criteria established in advance. We categorized recreational activities as swimming, sports-related contact, minimal contact, and sand contact. We combined relative risks using a random effects meta-analysis for adverse health outcome categories representing gastrointestinal illness, respiratory illness, skin, eye, ear, nose, throat, and cold/flu illness. We identified 92 studies meeting our inclusion criteria. Pooled risk estimates indicate significant elevation of gastrointestinal illness with the recreational activity categories swimming (2.19, 95% CI: 1.82, 2.63) and sports-related contact (2.69, 95% CI: 1.04, 6.92), and nonsignificant elevation of gastrointestinal illness with minimal contact (1.27, 95% CI: 0.74, 2.16). We also found a significant elevation of respiratory illness with swimming (1.78, 95% CI: 1.38, 2.29) and sports-related contact (1.49, 95% CI: 1.00, 2.24), and no elevation of respiratory illness with minimal contact (0.90, 95% CI: 0.71, 1.14). This study suggests that exposures associated with different types of recreational activities are important characteristics of the exposure pathway when assessing illness risk associated with recreation in ambient surface waters.

First findings of potentially human pathogenic bacteria Vibrio in the south-eastern Baltic Sea coastal and transitional bathing waters

Vibrio spp. are bacteria that inhabit fresh and marine waters throughout the world and can cause severe infections in humans. This study aimed to investigate the presence of potentially pathogenic Vibrio bacteria in the coastal waters of the Lithuanian Baltic Sea and the Curonian Lagoon. The results of cultivation on TCBS media showed that total abundance of Vibrio spp. varied from 1.2 × 10² to 6 × 10⁴ CFU L^-1. Real-time PCR revealed that the V. vulnificus vvhA gene varied from 2.8 × 10³ to 3.7 × 10⁴ copies L^-1, with the highest amounts in sites with average water salinity of 7.1 PSU. Both green and blue-green algae and lower salinity play a role in the growth and spread of total Vibrio spp. Although potential infection risk was low at the time of this study, regular monitoring of Vibrio spp. and infection risk assessments are recommended.

Flood protection ecosystem services in the coast of Puerto Rico: Associations between extreme weather, flood hazard mitigation and gastrointestinal illness

Floods are becoming increasingly influential in coastal cities due to the intensification of extreme weather events. The impacts of flooding go beyond damages to infrastructure, it also affects human health. During floods, discharge of sewage into streets increases exposure to pathogens causing gastrointestinal (GI) illnesses. A potential strategy for coastal protection during weather hazards is the use of flood protection ecosystem services, but their effectiveness at ameliorating the impact of floods on GI illnesses remain understudied. Here we explore the relationship between extreme rainfall, flood protection ecosystem services, and the occurrence of Medicare claims for gastrointestinal (GI) illnesses in Puerto Rico. We first conducted model averaging to detect variables explaining flood impact for the years (1999-2014), and then used these variables as predictors in a spatio-temporal analysis of GI illness in the same period (1999-2013). Our results show that flood impact varies proportionally with extreme rainfall, and inversely with flood protection ecosystem services, particularly due to the presence of karst soils. The protective effect of karst soils is lost when there is a high percentage of people living in flood prone areas, as suggested by a significant interaction effect between these two variables. In support of our hypotheses, cases of GI illness also spike after extreme rainfall events and are affected by the interaction effect of karst soils and people living in flood prone areas. Our results support the linkage between extreme weather events, flood damages and GI illnesses, and suggests a buffering role of ecosystem services that promote rainfall infiltration. The relevance of these ecosystem services, however, is affected by planning decisions such as residential development in flood prone areas. Our results help inform planning strategies for future weather hazards, accounting for the role of natural and built infrastructure on minimizing flood impacts and human health effects.

Predicting culturable enterococci exceedances at Escambron Beach, San Juan, Puerto Rico using satellite remote sensing and artificial neural networks

Predicting recreational water quality is key to protecting public health from exposure to wastewater-associated pathogens. It is not feasible to monitor recreational waters for all pathogens; therefore, monitoring programs use fecal indicator bacteria (FIB), such as enterococci, to identify wastewater pollution. Artificial neural networks (ANNs) were used to predict when culturable enterococci concentrations exceeded the U.S. Environmental Protection Agency (U.S. EPA) Recreational Water Quality Criteria (RWQC) at Escambron Beach, San Juan, Puerto Rico. Ten years of culturable enterococci data were analyzed together with satellite-derived sea surface temperature (SST), direct normal irradiance (DNI), turbidity, and dew point, along with local observations of precipitation and mean sea level (MSL). The factors identified as the most relevant for enterococci exceedance predictions based on the U.S. EPA RWQC were DNI, turbidity, cumulative 48 h precipitation, MSL, and SST; they predicted culturable enterococci exceedances with an accuracy of 75% and power greater than 60% based on the Receiving Operating Characteristic curve and F-Measure metrics. Results show the applicability of satellite-derived data and ANNs to predict recreational water quality at Escambron Beach. Future work should incorporate local sanitary survey data to predict risky recreational water conditions and protect human health.

Environmental Factors Correlated with Culturable Enterococci Concentrations in Tropical Recreational Waters: A Case Study in Escambron Beach, San Juan, Puerto Rico

Enterococci concentration variability at Escambron Beach, San Juan, Puerto Rico, was examined in the context of environmental conditions observed during 2005–2015. Satellite-derived sea surface temperature (SST), turbidity, direct normal irradiance, and dew point were combined with local precipitation, winds, and mean sea level (MSL) observations in a stepwise multiple regression analyses (Akaike Information Criteria model selection). Precipitation, MSL, irradiance, SST, and turbidity explained 20% of the variation in observed enterococci concentrations based upon these analyses. Changes in these parameters preceded increases in enterococci concentrations by 24 h up to 11 days, particularly during positive anomalies of turbidity, SST, and 480–960 mm of accumulated (4 days) precipitation, which relates to bacterial ecology. Weaker, yet still significant, increases in enterococci concentrations were also observed during positive dew point anomalies. Enterococci concentrations decreased with elevated irradiance and MSL anomalies. Unsafe enterococci concentrations per US EPA recreational water quality guidelines occurred when 4-day cumulative precipitation ranged 481–960 mm; irradiance < 667 W·m⁻²; daily average turbidity anomaly >0.005 sr⁻¹; SST anomaly >0.8 °C; and 3-day average MSL anomaly <−18.8 cm. This case study shows that satellite-derived environmental data can be used to inform future water quality studies and protect human health.

Recreational Water and Infection: A Review of Recent Findings

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.