Assessment of Microbiological Safety of Water in Public Swimming Pools in Guangzhou, China

Physicochemical and bacteriological quality of swimming pools water in Kombolcha Town, Northeastern Ethiopia

Introduction

The use of swimming pool water for recreation, rehabilitation, and athletics is widespread around the world, especially in large Cities and Towns. However, poorly managed swimming pool water can facilitate the spread of illnesses connected to recreational water. Despite this, there is no evidence on quality of swimming pools water in Kombolcha Town. Therefore, this study was aimed to evaluate the physicochemical and bacteriological quality of swimming pools water in Kombolcha Town.

Methods

A laboratory-based cross-sectional study was conducted from February to April, 2021 in Kombolcha Town. A total of 90 water samples were collected from the three outdoor swimming pools. The collected data of both physicochemical and bacteriological parameters were entered into Microsoft Excel 2010 and analyzed using SPSS version 25.0. One-way ANOVA was used to test whether there were statistically significant differences between different swimming pools. The level of significance was declared at a p-value of <0.05.

Results

In this study, out of all the pool water samples that were examined, 37.8% had pH values between 7.2 and 7.8, 36.7% had temperatures between 21°C and 32°C, and 26.7% had turbidity values that were within the WHO standard. Furthermore, only 16.7% of the pool water samples showed residual chlorine levels of 2-3 mg/L. In addition, only 27.8, 35.6, and 32.2% of the samples, respectively, met the WHO criterion for total coliform, fecal coliform, and heterotrophic plate count.

Conclusion

The result indicates that most pool water samples did not fulfill both the physicochemical and bacteriological quality of the WHO standard limit for swimming pools. Thus, it is crucial to clean and regularly check the pool water, apply pool safety requirements, and raise pool user's awareness about the danger of pool water pollution through training.

Prevalence and molecular characterization of Giardia duodenalis in dairy cattle in Central Inner Mongolia, Northern China

Giardia duodenalis is a gastrointestinal protozoan ubiquitous in nature. It is a confirmed zoonotic pathogen, and cattle are considered a source of giardiasis outbreaks in humans. This study aimed to evaluate the prevalence and multilocus genotype (MLG) of G. duodenalis in dairy cattle in Central Inner Mongolia. This study was based on the small subunit ribosomal RNA (SSU rRNA), glutamate dehydrogenase (gdh), triosephosphate isomerase (tpi), and beta-giardin (bg) genes of G. duodenalis. DNA extraction, polymerase chain reaction (PCR), and sequence analysis were performed on 505 dairy cattle fecal samples collected in 2021 from six sampling sites and four age groups in Central Inner Mongolia to determine the prevalence and MLG distribution of G. duodenalis. The PCR results of SSU rRNA revealed that the overall prevalence of G. duodenalis was 29.5% (149/505) and that the overall prevalence of the diarrhea and nondiarrhea samples was 31.5% (46/146) and 28.5% (103/359), respectively; the difference was not significant (p > 0.05). SSU rRNA sequence analysis revealed that G. duodenalis assemblage E (91.1%, 133/146) was primarily detected and that assemblage A (8.9%, 13/146) was detected in 13 samples. The G. duodenalis-positive samples were PCR amplified and sequenced for gdh, tpi, and bg, from which 38, 47, and 70 amplified sequences were obtained, respectively. A combination of G. duodenalis assemblages A and E were detected in seven samples. Multilocus genotyping yielded 25 different assemblage E MLGs, which formed six subgroups. To the best of our knowledge, this is the first report regarding G. duodenalis infection in dairy cattle in Inner Mongolia, China. This study revealed that Inner Mongolian cattle pose a risk of giardiasis transmission to humans and that the distribution of local cattle G. duodenalis assemblage E MLGs is diverse. The findings of this study can bridge the knowledge gap in the molecular epidemiological investigation of giardiasis in Central Inner Mongolia.

Cu(II) assisted peroxymonosulfate for antibiotic resistant bacteria inactivation: A potential disinfection technology in swimming pool

Alternative disinfection technology to chlorination is required to control the risk of antibiotic resistance in swimming pools. In this study, copper ions (Cu(II)), which often exist in swimming pools as algicides, were used to activate peroxymonosulfate (PMS) for the inactivation of ampicillin-resistant E. coli. Cu(II) and PMS showed synergistic effects on E. coli inactivation in weak alkaline conditions, obtaining 3.4 log inactivation in 20 min with 10 μM Cu(II) and 100 μM PMS at pH 8.0. Quenching experiments indicated that radicals (i.e., OH and SO₄^-) were not the main disinfectors for E. coli inactivation. Based on the structure of Cu(II) and density functional theory calculations, the Cu(II)-PMS complex (Cu(H₂O)₅SO₅) was recommended as the active species for E. coli inactivation. Under the experimental conditions, the PMS concentration had a greater influence on E. coli inactivation than the Cu(II) concentration, possibly because increasing PMS concentration accelerates ligand exchange reaction and facilitates active species generation. By forming hypohalous acids, halogen ions could improve the disinfection efficiency of Cu(II)/PMS. The addition of HCO₃^- concentration (from 0 to 1.0 mM) and humic acid (0.5 and 1.5 mg/l) did not significantly inhibit the E. coli inactivation. The feasibility of adding PMS to waters containing Cu(II) for the inactivation of antibiotic-resistant bacteria was validated in actual swimming pool waters, where 4.7 log inactivation of E. coli was achieved in 60 min.

Risk Analysis of Otitis Externa (Swimmer’s Ear) in Children Pool Swimmers: A Case Study from Greece

Otitis is an ear inflammation characterized by an accumulation of polluted fluids in the ear, inflating the drum, causing ear pain, and draining the mucous membrane (pus) into the ear canal if the drum is perforated. Swimmer’s otitis, also known as acute external otitis, is a medical condition that frequently affects competitive swimmers. The risk factor analysis study was based on data obtained between May 2018 and May 2019 from four public swimming pools in Patras, Achaia. A checklist was created to evaluate the pools’ operational conditions, and it included information on the pools’ sanitation as well as swimming pool hygiene guidelines. In addition, a questionnaire was devised to collect data on pool swimmers’ use of the pools. Microbiological testing of the pool water was done ahead of time, and data on external otitis cases from hospitals was gathered. Based on this information, a risk factor analysis was conducted. Gender, weight, and age do not appear to have an impact on the number of otitis media cases that occur because of swimming in the pools. There is also no statistically significant link between episodes and the frequency of otitis events in locker rooms, restrooms, or swimming pools. The frequency with which swimmers utilize the pool, rather than the pool’s microbial burden, is the most significant determinant in otitis episodes. Furthermore, there is no statistically significant link between chlorine odor and otitis episodes. Additionally, several abnormalities in the ear or the child’s history do not appear to affect otitis episodes. More research is needed to determine whether infections are linked to microbial load or if other factors are responsible for the emergence of waterborne infections.

Risks of antibiotic resistance genes and antimicrobial resistance under chlorination disinfection with public health concerns

As a widely used disinfection technology, the effects of chlorination on antibiotic resistome and bacterial community received great scientific concerns, while the pathogens associated health risks kept largely unknown. With this concern, the present study used metagenomic analysis combined with culture method to reveal chlorination effects on antibiotic resistance genes (ARGs) and their bacterial hosts (total microbes and Escherichia coli) through simulating the chlorination dosage with human health concerns (drinking water and swimming pool). The resistome profiling showed that chlorination process could significantly decrease both abundance and diversity of total ARGs, while with limited removal rates of 6.0-8.7% for opportunistic pathogens E. coli isolates. Of all the observed 515 ARG subtypes, 105 core subtypes were identified and persistent during chlorination for both total microbes and E. coli. Antibiotic susceptibility test showed that chlorination treatment could efficiently remove multi-resistant E. coli isolates but select for tetracycline resistant isolates. Five ARG-carrying genomes (assigned to Bacteroidetes, Firmicutes, Actinobacteria) enriched by 18.1-102% after chlorination were retrieved by using metagenomic binning strategies. Bray-Curtis dissimilarity, network and procrustes analyses all indicated the remained antibiotic resistome and bacterial community were mainly chlorination-driven. Furthermore, a systematic pipeline for monitoring chlorination-associated antimicrobial resistance risks was proposed. These together enhance our knowledge of chlorination treatment associated public concerns, as important reference and guidance for surveillance and control of antibiotic resistance.

Occurrence of P. aeruginosa in Water Intended for Human Consumption and in Swimming Pool Water

Considering the fact that water is a basic need of every living being, it is important to ensure its safety. In this work, the data on the presence of the opportunistic pathogen P. aeruginosa in drinking water (n = 4171) as well as in pool water (n = 5059) in Primorje-Gorski Kotar County in Croatia in the five-year period (2016–2020) were analysed. In addition, the national criteria were compared with those of neighboring countries and worldwide. The proportion of P. aeruginosa-positive samples was similar for drinking water (3.9%) and pool water (4.6%). The prevalence of this bacterium was most pronounced in the warmer season. P. aeruginosa-positive drinking water samples were mostly collected during building commissioning, while pool samples were from entertainment and spa/hydromassage pools. Outdoor pools showed a higher percentage of positive samples than indoor pools, as well as the pools filled with freshwater rather than seawater. The highest P. aeruginosa load was found in rehabilitation pools. Croatia, Serbia and Montenegro are countries that have included P. aeruginosa in their national regulations as an indicator of the safety of water for human consumption as well as for bottled water, while Slovenia and Bosnia and Herzegovina have limited this requirement to bottled water only. In the case of swimming pool water, this parameter is mandatory in all countries considered in this study.

Dissemination of antibiotic resistance genes in swimming pools and implication for human skin

Swimming pools are crowd-gathering places that are associated with numerous outbreaks of water-borne diseases. Herein, we investigated the distribution of antibiotic resistance genes (ARGs) and bacterial communities in swimming pools and determined the influencing factors and potential human exposure. Sixteen swimming pools with different bather loads (0.01-0.16 person/m²·h) were investigated. Water samples were collected, before opening and after closing of the facilities, from six swimming pools, and skin samples were collected from volunteers. Comprehensive approaches, high-throughput qPCR and 16S rRNA gene sequencing, were used. The results showed that swimming pools contained a higher relative abundance (0.62 gene copies/16S rRNA) and absolute abundance (6.57×10⁸ gene copies/L) of ARGs on average. Bather loads contributed to the increase of core ARGs, and the absolute abundance of ARGs significantly increased by 1.47-1.94 orders of magnitude when the bather load was more than 0.1 person/m²·h. Dermal contact was estimated as the main exposure route of ARGs. Eighteen ARGs that were not detected before swimming were found on human skin and remained after showering. Furthermore, the event intake burden of ARGs via dermal contact was higher than that via ingestion when swimming. This study provides an assessment of ARGs and antibiotic-resistant bacteria (ARB) in swimming pools and helps to define the health risks to swimmers.

Impact of swimming pool water treatment system factors on the content of selected disinfection by-products

Recommendations regarding disinfection by-products (DBPs) in pool waters consider the content of trihalomethanes (THMs) and combined chlorine (CC) as indicators of DBPs based on which the health risk for swimmers and staff of pool facility can be determined. However, the content of DBPs in swimming pools depends on many factors. In this paper, the influence of selected factors (physicochemical parameters of water and technological parameters) on the content of THMs and CC in pool water was determined. During the 6-month period, 9 pools of various functions were analyzed. The water in pools was subjected to the same method of treatment. The content of THMs and CC was compared against the content of organic matter, free chlorine and nitrates, pH, temperature, redox potential and turbidity, technological, and operational parameters. The THM content did not exceed the limit value of 0.1 mg/L. The content of CC varied significantly, from 0.05 to 1.13 mg Cl2/L. It was found that a very large water volume per person, in comparison to a very small one, contributed to the low content of CC and THMs. The high load expressed as m3 of water per person or m2 of water per person and the specific function of hot tubs (HT1 and HT2) led to the average concentration of CC in these pools exceeding 0.3 mg Cl2/L. The THM concentrations in hot tubs (especially in HT1) were also among the largest (0.038-0.058 mg/L). In terms of the analyzed microbiological indicators, the quality of the tested pool water samples was not in doubt. It was found that the purpose of the pool, its volume, and number of swimmers should be the key parameters that determine the choice of methods of water treatment. The research on the pool water quality in the actual working conditions of swimming pool facilities is necessary due to the need to preserve the health safety of swimmers and staff.

A retrospective epidemiological analysis of human Cryptosporidium infection in China during the past three decades (1987-2018)

Background

Cryptosporidiosis is an emerging infectious disease of public health significance worldwide. The burden of disease caused by Cryptosporidium varies between and within countries/areas. To have a comprehensive understanding of epidemiological status and characteristics of human Cryptosporidium infection in China since the first report in 1987, a retrospective epidemiological analysis was conducted by presenting differences in the prevalence of Cryptosporidium by province, year, population, living environment and season and possible transmission routes and risk factors as well as genetic characteristics of Cryptosporidium in humans.

Methodology/Principal findings

A systematic search was conducted to obtain epidemiological papers of human Cryptosporidium infection/cryptosporidiosis from PubMed and Chinese databases. Finally, 164 papers were included in our analysis. At least 200,054 people from 27 provinces were involved in investigational studies of Cryptosporidium, with an average prevalence of 2.97%. The prevalence changed slightly over time. Variable prevalences were observed: 0.65–11.15% by province, 1.89–47.79% by population, 1.77–12.87% and 0–3.70% in rural and urban areas, respectively. The prevalence peak occurred in summer or autumn. Indirect person-to-person transmission was documented in one outbreak of cryptosporidiosis in a pediatric hospital. 263 Cryptosporidium isolates were obtained, and seven Cryptosporidium species were identified: C. hominis (48.3%), C. andersoni (22.43%), C. parvum (16.7%), C. meleagridis (8.36%), C. felis (3.04%), C. canis (0.76%) and C. suis (0.38%).

Conclusions/Significances

This systematic review reflects current epidemiological status and characteristics of Cryptosporidium in humans in China. These data will be helpful to develop efficient control strategies to intervene with and prevent occurrence of human Cryptosporidium infection/cryptosporidiosis in China as well as have a reference effect to other countries. Further studies should focus on addressing a high frequency of C. andersoni in humans and a new challenge with respect to cryptosporidiosis with an increasing population of elderly people and patients with immunosuppressive diseases.

Cryptosporidium is a major cause of diarrheal disease in humans globally. Due to the lack of effective drug treatment and vaccine prevention against cryptosporidiosis, it is particularly important to develop efficient control strategies to intervene with and prevent Cryptosporidium infection in humans. The present review presented and analyzed epidemiological status and characteristics of Cryptosporidium infection in humans in China since the first report in 1987. To date, epidemiological investigations of Cryptosporidium infecion have been carried out in different populations in 27 provinces, autonomous regions, and municipalities. Average prevalence of Cryptosporidium was 2.97% (5,933/200,054). Like other infectious disease, due to poor sanitation conditions in rural areas, people living in rural areas had a significantly higher prevalence of Cryptosporidium (1.77–12.87%) than those living in urban areas (0–3.70%). Seven Cryptosporidium species were identified, including C. hominis, C. andersoni, C. parvum, C. meleagridis, C. felis, C. canis and C. suis. This retrospective epidemiological analysis indicates wide geographical distribution of human Cryptosporidium infection/cryptosporidiosis in China.

Analysis of Free and Combined Chlorine Concentrations in Swimming Pool Water and an Attempt to Determine a Reliable Water Sampling Point

The analysis of free chlorine concentrations in swimming pool water makes it possible to assess the antiseptic effect of the disinfectant. The concentration of combined chlorine determines the comfort of swimming and indicates if there is a threat from DBP (disinfection by-products). The distribution of free and combined chlorine concentration was analyzed in four basins differing in seasonality of use and in the applied water flow systems. After considering the distribution of free and combined chlorine content in characteristic points of pools, an attempt was made to determine the most reliable point for assessing the quality of water and its suitability for swimming. Such searches should aim to identify the places with the worst water quality. The most uniform distribution of the concentrations of both free and combined chlorine was observed at the middle point of swimming pools, while at points near the corners and walls of swimming pools a varied distribution was observed. Such a control strategy, based on the least favorable test results at a point considered as characteristic, would make it possible to verify the parameters of the swimming pool water treatment system and thus minimize the risk to swimmers’ health.

Microbiological Contamination of Strawberries from U-Pick Farms in Guangzhou, China

This study quantified the association of rodent fruit damage and the microbiological quality of irrigation water on the risk of microbiological contamination of strawberries collected from 18 U-pick farms across five different districts in the Guangzhou metropolitan region of southern China. Fifty-four composite strawberries samples, with or without evidence of rodent or avian foraging damage (i.e., bitten), along with 16 irrigation water samples, were collected during the spring of 2014 and winter of 2015 from our cohort of 18 farms. Composite strawberry samples and irrigation water were analyzed for total coliforms, E. coli, Salmonella, E. coli O157, Giardia, and Cryptosporidium. Total coliforms and E. coli were detected in 100% and ~90% of irrigation water samples, respectively. In contrast, Cryptosporidium was detected in only two water samples, while Salmonella, E. coli O157, and Giardia were not detected in any water samples. Strawberries with signs of being bitten by wildlife had significantly higher concentrations of total coliforms and E. coli, compared to strawberries with no physical evidence of rodent damage (p < 0.001). Similarly, Cryptosporidium was detected in 7/18 (39%) of bitten, 4/18 (22%) of edge, and 5/18 (28%) of central strawberry samples, respectively. Concentration of E. coli on strawberries (p < 0.001), air temperature (p = 0.025), and presence of Cryptosporidium in irrigation water (p < 0.001) were all associated with the risk of Cryptosporidium contamination on strawberries. Salmonella and Giardia were detected in <4% strawberry samples and E. coli O157 was not detected in any samples. These results indicate the potential food safety and public health risks of consuming unwashed strawberries from U-pick farms, and the need for improved rodent biosecurity of U-pick strawberry fields and enhanced microbiological quality of irrigation water used at these facilities.

Exotic Tourist Destinations and Transmission of Infections by Swimming Pools and Hot Springs-A Literature Review

A growing number of people undertake international travel, and yet faster growth of such travel is expected in the tropics. Information on the hazards presented by pool and hot spring waters in tropical countries is very limited. This review aims to collate available information on pool water quality, alongside data on cases and outbreaks associated with swimming in pools in tropical regions affecting both local populations and travellers. Bacteria species commonly causing cases and outbreaks in the tropics as well as elsewhere in the world were excluded, and the review focuses on studies related to pathogens that, with the exception of Cryptosporidium, are unusual in more temperate climates. Studies concerning subtropical countries were included in the light of climate change. Diseases transmitted by vectors breeding in poorly maintained, neglected or abandoned pools were also included. 83 studies dealing with Microsporidia, Leptospira spp., Schistosomas spp., Cryptosporidium spp., Acanthamoeba spp., Naegleria spp., Clostridium trachomatis, viruses, and vectors breeding in swimming pool and hot tub waters, and fulfilling predefined criteria, have been included in our survey of the literature. In conclusion, prevention strategies for pool safety in the tropics are imperative. Public health authorities need to provide guidance to westerners travelling to exotic destinations on how to protect their health in swimming pools.