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de Andrés Aguayo A, Millet JP, Álvarez-Bruned L, Palma D, Gómez A, Gallés P, Sabaté S, Álvarez G, Rodriguez V, Cornejo T, Rius C. Clostridium and Cryptosporidium outbreak linked to a splash pad. BMC Public Health 2024; 24:1578. [PMID: 38867266 PMCID: PMC11167891 DOI: 10.1186/s12889-024-18870-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/16/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND . Splash pads for recreational purposes are widespread. Using these pads can pose a health risk if they lack installation regulation and water quality supervision. Our aim was to describe a waterborne disease outbreak caused by Clostridium perfringens and Cryptosporidium spp. in a Barcelona district and the measures taken for its control. METHODS . On August 2018, 71 cases of acute gastroenteritis were detected, affecting people who used a splash pad or were in contact with a user. Microbiological and environmental investigations were carried out. A descriptive analysis of the sample and Poisson regression models adjusted for age and sex were performed, obtaining frequencies, median values, and adjusted prevalence ratios with their 95% confidence intervals. RESULTS The median age of the cases was 6.7 years, 27 (38%) required medical care, and three (4.2%) were hospitalized. The greater the number of times a person entered the area, the greater the number of symptoms and their severity. Nineteen (76%) of the 25 stool samples collected from cases showed the presence of one or both pathogens. Environmental investigations showed deficiencies in the facilities and identified the presence of both species in the splash pad. Health education and hygiene measures were carried out, and 14 days after the closure of the facilities, no more cases related to the pad were recorded. CONCLUSIONS . Specific regulations are needed on the use of splash pads for recreational purposes. Until these regulations are in place, these types of facility should comply with the regulations that apply to swimming pools and spas, including those related to the design of the tanks, water recirculation systems, and adequate disinfection systems.
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Affiliation(s)
- Anna de Andrés Aguayo
- Servei d'Epidemiología. Agència de Salut Pública de Barcelona, Plaza Lesseps 1, Barcelona, 08023, Spain
| | - Joan-Pau Millet
- Agència de Salut Pública de Barcelona, Plaza Lesseps 1, Barcelona, 08023, Spain.
| | - Laia Álvarez-Bruned
- Agència de Salut Pública de Barcelona, Plaza Lesseps 1, Barcelona, 08023, Spain
| | - David Palma
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Plaza Lesseps 1, Barcelona, 08023, Spain
| | - Anna Gómez
- Agència de Salut Pública de Barcelona, Plaza Lesseps 1, Barcelona, 08023, Spain
| | - Pau Gallés
- Public Health Department of Reus City Council, Ample, Reus, 13-43202, Spain
| | - Sara Sabaté
- Agència de Salut Pública de Barcelona, Plaza Lesseps 1, Barcelona, 08023, Spain
| | - Gabriela Álvarez
- Agència de Salut Pública de Barcelona, Plaza Lesseps 1, Barcelona, 08023, Spain
| | - Virginia Rodriguez
- Vall d'Hebron Hospital Universitari, Plaza Lesseps 1, Barcelona, 08023, Spain
| | - Thais Cornejo
- Vall d'Hebron Hospital Universitari, Plaza Lesseps 1, Barcelona, 08023, Spain
| | - Cristina Rius
- Agència de Salut Pública de Barcelona, Plaza Lesseps 1, Barcelona, 08023, Spain
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Fradette MS, Culley AI, Charette SJ. Detection of Cryptosporidium spp. and Giardia spp. in Environmental Water Samples: A Journey into the Past and New Perspectives. Microorganisms 2022; 10:microorganisms10061175. [PMID: 35744692 PMCID: PMC9228427 DOI: 10.3390/microorganisms10061175] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/03/2022] [Accepted: 06/04/2022] [Indexed: 01/27/2023] Open
Abstract
Among the major issues linked with producing safe water for consumption is the presence of the parasitic protozoa Cryptosporidium spp. and Giardia spp. Since they are both responsible for gastrointestinal illnesses that can be waterborne, their monitoring is crucial, especially in water sources feeding treatment plants. Although their discovery was made in the early 1900s and even before, it was only in 1999 that the U.S. Environmental Protection Agency (EPA) published a standardized protocol for the detection of these parasites, modified and named today the U.S. EPA 1623.1 Method. It involves the flow-through filtration of a large volume of the water of interest, the elution of the biological material retained on the filter, the purification of the (oo)cysts, and the detection by immunofluorescence of the target parasites. Since the 1990s, several molecular-biology-based techniques were also developed to detect Cryptosporidium and Giardia cells from environmental or clinical samples. The application of U.S. EPA 1623.1 as well as numerous biomolecular methods are reviewed in this article, and their advantages and disadvantages are discussed guiding the readers, such as graduate students, researchers, drinking water managers, epidemiologists, and public health specialists, through the ever-expanding number of techniques available in the literature for the detection of Cryptosporidium spp. and Giardia spp. in water.
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Affiliation(s)
- Marie-Stéphanie Fradette
- Institut de Biologie Intégrative et des Systèmes (IBIS), Université Laval, Québec City, QC G1V 0A6, Canada; (A.I.C.); (S.J.C.)
- Département de Biochimie, de Microbiologie et de Bio-Informatique, Faculté des Sciences et Génie, Université Laval, Québec City, QC G1V 0A6, Canada
- Centre de Recherche en Aménagement et Développement du Territoire (CRAD), Université Laval, Québec City, QC G1V 0A6, Canada
- Correspondence:
| | - Alexander I. Culley
- Institut de Biologie Intégrative et des Systèmes (IBIS), Université Laval, Québec City, QC G1V 0A6, Canada; (A.I.C.); (S.J.C.)
- Département de Biochimie, de Microbiologie et de Bio-Informatique, Faculté des Sciences et Génie, Université Laval, Québec City, QC G1V 0A6, Canada
- Groupe de Recherche en Écologie Buccale (GREB), Faculté de Médecine Dentaire, Université Laval, Québec City, QC G1V 0A6, Canada
| | - Steve J. Charette
- Institut de Biologie Intégrative et des Systèmes (IBIS), Université Laval, Québec City, QC G1V 0A6, Canada; (A.I.C.); (S.J.C.)
- Département de Biochimie, de Microbiologie et de Bio-Informatique, Faculté des Sciences et Génie, Université Laval, Québec City, QC G1V 0A6, Canada
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, QC G1V 0A6, Canada
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3
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Cullinan L, Dunn L, McLean S, Palombo E. Waterborne disease outbreaks in treated recreational water facilities: a Socio-Ecological Model perspective. Health Promot Int 2022; 37:6646638. [PMID: 35853153 DOI: 10.1093/heapro/daac090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Treated recreational water facilities, including swimming pools and water play parks, have often been implicated in infectious disease outbreaks. Addressing this problem is complex due to the multiple and interrelated factors contributing to outbreaks in these settings. These factors may relate to inappropriate behaviours of users and operators, lack of and inconsistent regulation of these facilities, insufficient facility maintenance, and problems associated with the design of these facilities. Given the complexity of this issue, we argue that the Socio-Ecological Model (SEM) provides a useful framework to help identify the multi-level influences and factors that have implications for designing interventions to prevent this public health problem, whilst assisting in guiding future research in this area. We apply the SEM to the current literature to help identify the influences and factors contributing to infectious disease outbreaks in treated recreational water facilities to support this argument. We also identify several gaps in the existing research that would benefit from further examination to help prevent infectious disease outbreaks in treated recreational water facilities such as public swimming pools and water play parks.
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Affiliation(s)
- Lauren Cullinan
- Department of Chemistry and Biotechnology, Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
| | - Louise Dunn
- Department of Chemistry and Biotechnology, Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
| | - Sarah McLean
- Department of Chemistry and Biotechnology, Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
| | - Enzo Palombo
- Department of Chemistry and Biotechnology, Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
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4
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Zhang CM, Xu PC, Du WW, Wang XC. Exposure parameters and health risk of Cryptosporidium and Giardia in the recreational water activities for urban residents in China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:1573-1583. [PMID: 34363153 DOI: 10.1007/s11356-021-15463-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 07/12/2021] [Indexed: 06/13/2023]
Abstract
Knowledge gaps in the exposure parameters for recreational water activities make quantitative risk assessment related to water recreation difficult. Therefore, the annual exposure frequency and single exposure duration for the recreational water activities of residents from ten cities in the North and South of China were investigated. Questionnaire interviews were carried on recreational water activities comprising swimming (SW), boating (BA), playing in interactive fountains (PF), and watching fountains (WF). Quantitative microbial risk assessment for the exposure of urban residents to Cryptosporidium and Giardia was also performed. For the four recreational water activities, the participation rates of urban residents in SW and WF were higher than the others. For SW and BA, the mean annual exposure frequency and single exposure duration for males were significantly higher than those for females. PF and WF showed the opposite. The annual exposure frequency for above 35-year-old residents was higher than that for young residents (18-35 years). However, the single exposure duration for young residents was highest in SW, BA, and PF. The mean annual exposure frequency and single exposure duration for North China residents were higher than those for South China residents in all recreational water activities, except for SW. Overall, the annual exposure frequency and single exposure duration in recreational water activities for all urban residents followed a lognormal distribution. In the four recreational water activities, the total annual infection risk of male exposure to Cryptosporidium was 1.0 × 10-2, with the confidence intervals between 95 and 5% of [4.3 × 10-4, 3.7 × 10-2], whereas that for females was 6.8 × 10-3 and [4.2 × 10-4, 2.4 × 10-2]. Also, the annual infection risk of males to Giardia was 8.8 × 10-3 and [5.1×10-4, 3.2×10-2], and that of females was 5.3 × 10-3 and [4.0 × 10-4, 1.8 × 10-2]. These results demonstrated that SW and PF made the highest contribution to the total annual infection risk. Sensitivity analysis highlighted that the characterization of exposure parameters plays a critical role in health risk assessment, which may provide a scientific basis for recreational water quality standards formulation.
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Affiliation(s)
- Chong-Miao Zhang
- School of Environmental and Municipal Engineering, Xi'an University of Architecture and Technology, Xi'an, 710055, China.
- Key Laboratory of Northwest Water Resource, Environment and Ecology, Ministry of Education, Xi'an University of Architecture and Technology, Xi'an, 710055, China.
- Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an, 710055, China.
- International Science and Technology Cooperation Center for Urban Alternative Water Resources Development, Xi'an University of Architecture and Technology, Xi'an, 710055, China.
| | - Peng-Cheng Xu
- School of Environmental and Municipal Engineering, Xi'an University of Architecture and Technology, Xi'an, 710055, China
- Key Laboratory of Northwest Water Resource, Environment and Ecology, Ministry of Education, Xi'an University of Architecture and Technology, Xi'an, 710055, China
- Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an, 710055, China
- International Science and Technology Cooperation Center for Urban Alternative Water Resources Development, Xi'an University of Architecture and Technology, Xi'an, 710055, China
| | - Wei-Wei Du
- School of Environmental and Municipal Engineering, Xi'an University of Architecture and Technology, Xi'an, 710055, China
- Key Laboratory of Northwest Water Resource, Environment and Ecology, Ministry of Education, Xi'an University of Architecture and Technology, Xi'an, 710055, China
- Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an, 710055, China
| | - Xiaochang C Wang
- Key Laboratory of Northwest Water Resource, Environment and Ecology, Ministry of Education, Xi'an University of Architecture and Technology, Xi'an, 710055, China
- International Science and Technology Cooperation Center for Urban Alternative Water Resources Development, Xi'an University of Architecture and Technology, Xi'an, 710055, China
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5
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Farrell ML, Joyce A, Duane S, Fitzhenry K, Hooban B, Burke LP, Morris D. Evaluating the potential for exposure to organisms of public health concern in naturally occurring bathing waters in Europe: A scoping review. WATER RESEARCH 2021; 206:117711. [PMID: 34637971 DOI: 10.1016/j.watres.2021.117711] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 09/13/2021] [Accepted: 09/22/2021] [Indexed: 06/13/2023]
Abstract
Globally, water-based bathing pastimes are important for both mental and physical health. However, exposure to waterborne organisms could present a substantial public health issue. Bathing waters are shown to contribute to the transmission of illness and disease and represent a reservoir and pathway for the dissemination of antimicrobial resistant (AMR) organisms. Current bathing water quality regulations focus on enumeration of faecal indicator organisms and are not designed for detection of specific waterborne organisms of public health concern (WOPHC), such as antimicrobial resistant (AMR)/pathogenic bacteria, or viruses. This investigation presents the first scoping review of the occurrence of waterborne organisms of public health concern (WOPHC) in identified natural bathing waters across the European Union (EU), which aimed to critically evaluate the potential risk of human exposure and to assess the appropriateness of the current EU bathing water regulations for the protection of public health. Accordingly, this review sought to identify and synthesise all literature pertaining to a selection of bacterial (Campylobacter spp., Escherichia coli, Salmonella spp., Shigella spp., Vibrio spp., Pseudomonas spp., AMR bacteria), viral (Hepatitis spp., enteroviruses, rotavirus, adenovirus, norovirus), and protozoan (Giardia spp., and Cryptosporidium spp.) contaminants in EU bathing waters. Sixty investigations were identified as eligible for inclusion and data was extracted. Peer-reviewed investigations included were from 18 countries across the EU, totalling 87 investigations across a period of 35 years, with 30% published between 2011 and 2015. A variety of water bodies were identified, with 27 investigations exclusively assessing coastal waters. Waterborne organisms were classified into three categories; bacteria, viruses, and protozoa; amounting to 58%, 36% and 17% of the total investigations, respectively. The total number of samples across all investigations was 8,118, with detection of one or more organisms in 2,449 (30%) of these. Viruses were detected in 1281 (52%) of all samples where WOPHC were found, followed by bacteria (865(35%)) and protozoa (303(12%)). Where assessed (442 samples), AMR bacteria had a 47% detection rate, emphasising their widespread occurrence in bathing waters. Results of this scoping review highlight the potential public health risk of exposure to WOPHC in bathing waters that normally remain undetected within the current monitoring parameters.
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Affiliation(s)
- Maeve Louise Farrell
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland Galway, Ireland; Centre for One Health, Ryan Institute, National University of Ireland Galway, Ireland.
| | - Aoife Joyce
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland Galway, Ireland; Centre for One Health, Ryan Institute, National University of Ireland Galway, Ireland
| | - Sinead Duane
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland Galway, Ireland; Centre for One Health, Ryan Institute, National University of Ireland Galway, Ireland; Whitaker Institute, National University of Ireland Galway, Ireland
| | - Kelly Fitzhenry
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland Galway, Ireland; Centre for One Health, Ryan Institute, National University of Ireland Galway, Ireland
| | - Brigid Hooban
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland Galway, Ireland; Centre for One Health, Ryan Institute, National University of Ireland Galway, Ireland
| | - Liam P Burke
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland Galway, Ireland; Centre for One Health, Ryan Institute, National University of Ireland Galway, Ireland
| | - Dearbháile Morris
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland Galway, Ireland; Centre for One Health, Ryan Institute, National University of Ireland Galway, Ireland
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6
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Ligda P, Claerebout E, Kostopoulou D, Zdragas A, Casaert S, Robertson LJ, Sotiraki S. Cryptosporidium and Giardia in surface water and drinking water: Animal sources and towards the use of a machine-learning approach as a tool for predicting contamination. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2020; 264:114766. [PMID: 32417583 DOI: 10.1016/j.envpol.2020.114766] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/16/2020] [Accepted: 05/06/2020] [Indexed: 06/11/2023]
Abstract
Cryptosporidium and Giardia are important parasites due to their zoonotic potential and impact on human health, often causing waterborne outbreaks of disease. Detection of (oo)cysts in water matrices is challenging and few countries have legislated water monitoring for their presence. The aim of this study was to investigate the presence and origin of these parasites in different water sources in Northern Greece and identify interactions between biotic/abiotic factors in order to develop risk-assessment models. During a 2-year period, using a longitudinal, repeated sampling approach, 12 locations in 4 rivers, irrigation canals, and a water production company, were monitored for Cryptosporidium and Giardia, using standard methods. Furthermore, 254 faecal samples from animals were collected from 15 cattle and 12 sheep farms located near the water sampling points and screened for both parasites, in order to estimate their potential contribution to water contamination. River water samples were frequently contaminated with Cryptosporidium (47.1%) and Giardia (66.2%), with higher contamination rates during winter and spring. During a 5-month period, (oo)cysts were detected in drinking-water (<1/litre). Animals on all farms were infected by both parasites, with 16.7% of calves and 17.2% of lambs excreting Cryptosporidium oocysts and 41.3% of calves and 43.1% of lambs excreting Giardia cysts. The most prevalent species identified in both water and animal samples were C. parvum and G. duodenalis assemblage AII. The presence of G. duodenalis assemblage AII in drinking water and C. parvum IIaA15G2R1 in surface water highlights the potential risk of waterborne infection. No correlation was found between (oo)cyst counts and faecal-indicator bacteria. Machine-learning models that can predict contamination intensity with Cryptosporidium (75% accuracy) and Giardia (69% accuracy), combining biological, physicochemical and meteorological factors, were developed. Although these prediction accuracies may be insufficient for public health purposes, they could be useful for augmenting and informing risk-based sampling plans.
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Affiliation(s)
- Panagiota Ligda
- Laboratory of Parasitology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, B-9820, Merelbeke, Belgium; Laboratory of Infectious and Parasitic Diseases, Veterinary Research Institute, Hellenic Agricultural Organization - DEMETER, 57001, Thermi, Thessaloniki, Greece.
| | - Edwin Claerebout
- Laboratory of Parasitology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, B-9820, Merelbeke, Belgium.
| | - Despoina Kostopoulou
- Laboratory of Infectious and Parasitic Diseases, Veterinary Research Institute, Hellenic Agricultural Organization - DEMETER, 57001, Thermi, Thessaloniki, Greece.
| | - Antonios Zdragas
- Laboratory of Infectious and Parasitic Diseases, Veterinary Research Institute, Hellenic Agricultural Organization - DEMETER, 57001, Thermi, Thessaloniki, Greece.
| | - Stijn Casaert
- Laboratory of Parasitology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, B-9820, Merelbeke, Belgium.
| | - Lucy J Robertson
- Parasitology, Department of Paraclinical Science, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, PO Box 369 Sentrum, 0102, Oslo, Norway.
| | - Smaragda Sotiraki
- Laboratory of Infectious and Parasitic Diseases, Veterinary Research Institute, Hellenic Agricultural Organization - DEMETER, 57001, Thermi, Thessaloniki, Greece.
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Pineda CO, Leal DAG, Fiuza VRDS, Jose J, Borelli G, Durigan M, Pena HFJ, Bueno Franco RM. Toxoplasma
gondii
oocysts,
Giardia
cysts and
Cryptosporidium
oocysts in outdoor swimming pools in Brazil. Zoonoses Public Health 2020; 67:785-795. [DOI: 10.1111/zph.12757] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/07/2020] [Accepted: 07/10/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Carolina Ortiz Pineda
- Laboratório de Protozoologia Departamento de Biologia Animal Instituto de Biologia Universidade Estadual de Campinas (UNICAMP) Campinas Brazil
| | - Diego Averaldo Guiguet Leal
- Laboratório de Parasitologia Ambiental Departamento de Patologia Básica, Setor de Ciências Biológicas Universidade Federal do Paraná (UFPR) Curitiba Brazil
| | - Vagner Ricardo da Silva Fiuza
- Instituto de Biociências, Parasitologia Animal Universidade Federal do Mato Grosso do Sul (UFMS) Campo Grande Brazil
| | - Juliana Jose
- Laboratório de Genômica e Expressão Departamento de Genética Evolução e Bioagentes Instituto de Biologia Universidade Estadual de Campinas (UNICAMP) Campinas Brazil
| | - Guilherme Borelli
- Laboratório de Genômica e Expressão Departamento de Genética Evolução e Bioagentes Instituto de Biologia Universidade Estadual de Campinas (UNICAMP) Campinas Brazil
| | | | - Hilda Fátima Jesus Pena
- Laboratório de Doenças Parasitárias Departamento de Medicina Veterinária Preventiva e Saúde Animal Faculdade de Medicina Veterinária e Zootecnia Universidade de São Paulo (USP) São Paulo Brazil
| | - Regina Maura Bueno Franco
- Laboratório de Protozoologia Departamento de Biologia Animal Instituto de Biologia Universidade Estadual de Campinas (UNICAMP) Campinas Brazil
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Lagière J, Labarthe S, Dubourg K, Bauduer F. Influence of hydrotherapy pool water recirculation regime on Staphylococcus species concentration at subsurface: Preliminary experimental data from a pilot. ENVIRONMENT INTERNATIONAL 2020; 136:105382. [PMID: 31884410 DOI: 10.1016/j.envint.2019.105382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/31/2019] [Accepted: 12/01/2019] [Indexed: 06/10/2023]
Abstract
Pools are prone to contamination from microbial pathogens from human external microbiota, including mainly Staphylococcus species. These bacteria originate mainly from the skin and rhinopharynx and tend to concentrate at the surface/subsurface. Being protected by films derived from mucus and sebum, they are markedly resistant to biocides. Our study aimed to evaluate the respective impact of mixed and reverse hydraulicity techniques on the concentration of Staphylococcus species at the subsurface following bathing by four individuals in an experimental pool. Disinfection, filtration and water renewal of the pool were stopped in order to study only the influence of the water recirculation regime. We found a significant reduction of 31.7% (Test 1), 50.9% (Test 2) and 41.9% (Test 3) in total Staphylococcus species counts at the subsurface when using reverse versus mixed hydraulicity. However, this reduction is not a pollution cut but a pollution shift, resulting from an increase in the outlet water flow rate by overflow channel from 49.3 to 100%. This experimental model was far removed from real life conditions and associated with a series of limitations. However, it seems that the type of water recirculation regime is a critical factor in the bacterial quality of pool water. These preliminary findings need to be confirmed in additional studies using more realistic conditions.
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Affiliation(s)
- Joël Lagière
- Institut du Thermalisme, Université de Bordeaux, 8, Rue Ste Ursule, 40100 Dax, France
| | - Sébastien Labarthe
- Institut du Thermalisme, Université de Bordeaux, 8, Rue Ste Ursule, 40100 Dax, France.
| | - Karine Dubourg
- Institut du Thermalisme, Université de Bordeaux, 8, Rue Ste Ursule, 40100 Dax, France
| | - Frédéric Bauduer
- Institut du Thermalisme, Université de Bordeaux, 8, Rue Ste Ursule, 40100 Dax, France
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9
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Suppes LM, Ernst KC, Abrell L, Reynolds KA. Validation of Questionnaire Methods to Quantify Recreational Water Ingestion. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2435. [PMID: 30388798 PMCID: PMC6265721 DOI: 10.3390/ijerph15112435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 10/14/2018] [Accepted: 10/19/2018] [Indexed: 11/16/2022]
Abstract
Swimming pool water ingestion volumes are necessary for assessing infection risk from swimming. Pool water ingestion volumes can be estimated by questionnaire or measuring a chemical tracer in swimmer urine. Questionnaires are often preferred to the chemical tracer method because surveys are less time consuming, but no research exists validating questionnaires accurately quantify pool water ingestion volumes. The objective of this study was to explore if questionnaires are a reliable tool for collecting pool water ingestion volumes. A questionnaire was issued at four pool sites in Tucson, Arizona to 46 swimmers who also submitted a urine sample for analyzing cyanuric acid, a chemical tracer. Perceived ingestion volumes reported on the questionnaire were compared with pool water ingestion volumes, quantified by analyzing cyanuric acid in swimmer urine. Swimmers were asked if they swallowed (1) no water or only a few drops, (2) one to two mouthfuls, (3) three to five mouthfuls, or (4) six to eight mouthfuls. One mouthful is the equivalent of 27 mL of water. The majority (81%) of swimmers ingested <27 mL of pool water but reported ingesting >27 mL ("one mouthful") on the questionnaire. More than half (52%) of swimmers overestimated their ingestion volume. These findings suggest swimmers are over-estimating pool water ingestion because they perceive one mouthful is <27 mL. The questionnaire did not reliably collect pool water ingestion volumes and should be improved for future exposure assessment studies. Images of the ingestion volume categories should be included on the questionnaire to help swimmers visualize the response options.
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Affiliation(s)
- Laura M Suppes
- Environmental Public Health Program, The University of Wisconsin-Eau Claire, 105 Garfield Avenue, Eau Claire, WI 54702, USA.
| | - Kacey C Ernst
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, P.O. Box 245163, Tucson, AZ 85724, USA.
| | - Leif Abrell
- Department of Soil, Water & Environmental Science, The University of Arizona, Gould-Simpson Building Room 611, 1040 East 4th Street, Tucson, AZ 85721, USA.
| | - Kelly A Reynolds
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, P.O. Box 245163, Tucson, AZ 85724, USA.
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Xiao S, Yin P, Zhang Y, Zhao X, Sun L, Yuan H, Lu J, Hu S. Occurrence, genotyping, and health risk of Cryptosporidium and Giardia in recreational lakes in Tianjin, China. WATER RESEARCH 2018; 141:46-56. [PMID: 29775772 DOI: 10.1016/j.watres.2018.05.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 05/09/2018] [Accepted: 05/10/2018] [Indexed: 06/08/2023]
Abstract
Cryptosporidium and Giardia are critical parasites in the etiology of diarrhea worldwide, and often cause waterborne outbreaks. The presence of Cryptosporidium and Giardia in recreational lakes was investigated with molecular characterization, and a comprehensive quantitative microbial risk assessment (QMRA) of protozoan infections was performed, considering multiple exposure pathways, differences in age, sex, and disease severity, and the genotypes of the protozoa. Forty-three (82.7%) and 51 (98.1%) water samples were positive for Cryptosporidium oocysts and Giardia cysts, respectively, with average counts of 3.65 oocysts/10 L and 12.58 cysts/10 L, respectively. Six Cryptosporidium species and three Giardia lamblia assemblages were confirmed with molecular analyses. The protozoan concentration was significantly associated with water turbidity, but not with the total coliform numbers. Swimming in the lakes entailed the highest incidence risk of 5.72 × 10-4 per person per year (pppy) (95% confidence interval (CI): 0.03-43.33 × 10-4) for Cryptosporidium and 4.04 × 10-4 pppy (95% CI: 0.01-32.66 × 10-4) for Giardia, whereas wading entailed the lowest risk (2.20 × 10-4 and 1.70 × 10-4 pppy, respectively). The annual burdens attributable to recreational-water-associated cryptosporidiosis and giardiasis were 3.44 (95% CI: 0.04-23.51) and 1.81 (95% CI: 0.01-12.96) disability-adjusted life years per 1,000,000 individuals per year, respectively. Children were more likely to have an individual disease burden than adults, and males were more likely than females. Sensitivity analysis highlighted the great importance of controlling the proportion of exposed individuals and reducing the frequency of exposure. The methodology and results of this study will allow us to better evaluate and reduce the burden of Cryptosporidium and/or Giardia infections associated with recreational water use in China and other countries.
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Affiliation(s)
- Shumin Xiao
- School of Environmental and Municipal Engineering, Tianjin Chengjian University, Tianjin 300384, PR China; Tianjin Key Laboratory of Aquatic Science and Technology, Tianjin 300384, PR China.
| | - Pengna Yin
- School of Environmental and Municipal Engineering, Tianjin Chengjian University, Tianjin 300384, PR China
| | - Yan Zhang
- School of Environmental and Municipal Engineering, Tianjin Chengjian University, Tianjin 300384, PR China
| | - Xiaoyun Zhao
- School of Environmental and Municipal Engineering, Tianjin Chengjian University, Tianjin 300384, PR China
| | - Liping Sun
- School of Environmental and Municipal Engineering, Tianjin Chengjian University, Tianjin 300384, PR China
| | - Hongying Yuan
- School of Environmental and Municipal Engineering, Tianjin Chengjian University, Tianjin 300384, PR China
| | - Jingfang Lu
- School of Environmental and Municipal Engineering, Tianjin Chengjian University, Tianjin 300384, PR China
| | - Sike Hu
- School of Medicine, Nankai University, Tianjin 300071, PR China.
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Hamilton KA, Waso M, Reyneke B, Saeidi N, Levine A, Lalancette C, Besner MC, Khan W, Ahmed W. Cryptosporidium and Giardia in Wastewater and Surface Water Environments. JOURNAL OF ENVIRONMENTAL QUALITY 2018; 47:1006-1023. [PMID: 30272766 DOI: 10.2134/jeq2018.04.0132] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
and spp. are significant contributors to the global waterborne disease burden. Waterways used as sources of drinking water and for recreational activity can become contaminated through the introduction of fecal materials derived from humans and animals. Multiple studies have reported the occurence or concentrations of these pathogens in the environment. However, this information has not been comprehensively reviewed. Quantitative microbial risk assessment (QMRA) for and can be beneficial, but it often relies on the concentrations in environmental sources reported from the literature. A thorough literature review was conducted to develop an inventory of reported and concentrations in wastewater and surface water available in the literature. This information can be used to develop QMRA inputs. and (oo)cyst concentrations in untreated wastewater were up to 60,000 oocysts L and 100,000 cysts L, respectively. The maximum reported concentrations for and in surface water were 8400 oocysts L and 1000 cysts L, respectively. A summary of the factors for interpretation of concentration information including common quantification methods, survival and persistence, biofilm interactions, genotyping, and treatment removal is provided in this review. This information can help in identifying assumptions implicit in various QMRA parameters, thus providing the context and rationale to guide model formulation and application. Additionally, it can provide valuable information for water quality practitioners striving to meet the recreational water quality or treatment criteria. The goal is for the information provided in the current review to aid in developing source water protection and monitoring strategies that will minimize public health risks.
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12
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Molecular and phylogenetic evidences of dispersion of human-infecting microsporidia to vegetable farms via irrigation with treated wastewater: One-year follow up. Int J Hyg Environ Health 2018; 221:642-651. [DOI: 10.1016/j.ijheh.2018.03.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/03/2018] [Accepted: 03/15/2018] [Indexed: 12/07/2022]
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13
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ALEXANDER CL, CURRIE S, POLLOCK K, SMITH-PALMER A, JONES BL. An audit of Cryptosporidium and Giardia detection in Scottish National Health Service Diagnostic Microbiology Laboratories. Epidemiol Infect 2017; 145:1584-1590. [PMID: 28274291 PMCID: PMC9203310 DOI: 10.1017/s0950268817000462] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 02/08/2017] [Accepted: 02/08/2017] [Indexed: 01/04/2023] Open
Abstract
Giardia duodenalis and Cryptosporidium species are protozoan parasites capable of causing gastrointestinal disease in humans and animals through the ingestion of infective faeces. Whereas Cryptosporidium species can be acquired locally or through foreign travel, there is the mis-conception that giardiasis is considered to be largely travel-associated, which results in differences in laboratory testing algorithms. In order to determine the level of variation in testing criteria and detection methods between diagnostic laboratories for both pathogens across Scotland, an audit was performed. Twenty Scottish diagnostic microbiology laboratories were invited to participate with questions on sample acceptance criteria, testing methods, testing rates and future plans for pathogen detection. Reponses were received from 19 of the 20 laboratories representing each of the 14 territorial Health Boards. Detection methods varied between laboratories with the majority performing microscopy, one using a lateral flow immunochromatographic antigen assay, another using a manually washed plate-based enzyme immunoassay (EIA) and one laboratory trialling a plate-based EIA automated with an EIA plate washer. Whereas all laboratories except one screened every stool for Cryptosporidium species, an important finding was that significant variation in the testing algorithm for detecting Giardia was noted with only four laboratories testing all diagnostic stools. The most common criteria were 'travel history' (11 laboratories) and/or 'when requested' (14 laboratories). Despite only a small proportion of stools being examined in 15 laboratories for Giardia (2%-18% of the total number of stools submitted), of interest is the finding that a higher positivity rate was observed for Giardia than Cryptosporidium in 10 of these 15 laboratories. These findings highlight that the underreporting of Giardia in Scotland is likely based on current selection and testing algorithms.
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Affiliation(s)
- C. L. ALEXANDER
- Scottish Parasite Diagnostic and Reference Laboratory, Glasgow, Scotland, UK
| | - S. CURRIE
- Scottish Parasite Diagnostic and Reference Laboratory, Glasgow, Scotland, UK
| | - K. POLLOCK
- Health Protection Scotland, Glasgow, Scotland, UK
| | | | - B. L. JONES
- Scottish Parasite Diagnostic and Reference Laboratory, Glasgow, Scotland, UK
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Ryan U, Lawler S, Reid S. Limiting swimming pool outbreaks of cryptosporidiosis - the roles of regulations, staff, patrons and research. JOURNAL OF WATER AND HEALTH 2017; 15:1-16. [PMID: 28151435 DOI: 10.2166/wh.2016.160] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Cryptosporidium is the leading cause of swimming pool outbreaks of gastroenteritis. Transmission occurs through the ingestion of oocysts that are passed in the faeces of an infected person or animal when an accidental faecal release event occurs. Cryptosporidium parasites present specific challenges for infection control as oocysts are highly resistant to chlorine levels used for pool disinfection, infected individuals can shed large numbers of oocysts, there is a long incubation period and shedding of oocysts occurs even after symptom resolution. The purposes of this review are to identify key barriers to limiting swimming pool-associated outbreaks of cryptosporidiosis and to outline needs for research and collaboration to advance co-ordinated management practices. We reviewed swimming pool-associated cryptosporidiosis outbreaks, disinfection teachniques, current regulations and the role of staff and patrons. Key barriers to limiting swimming pool-associated outbreaks of cryptosporidiosis are a lack of uniform national and international standards, poor adherence and understanding of regulations governing staff and patron behaviour, and low levels of public knowledge and awareness.
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Affiliation(s)
- Una Ryan
- School of Veterinary and Life Sciences, Murdoch University, Perth, Australia E-mail:
| | - Sheleigh Lawler
- The University of Queensland, School of Public Health, Herston, Queensland 4006, Australia
| | - Simon Reid
- The University of Queensland, School of Public Health, Herston, Queensland 4006, Australia
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