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A CUP OF HEALTH WITH CDC
Your Health, Swimming, and Waterborne Illnesses
Surveillance for Waterborne Disease and Outbreaks Associated
with Recreational Water – United States, 2003-2004
May 18, 2007

[Announcer] This podcast is presented by the Centers for Disease Control and
Prevention. CDC – safer, healthier people.

[Matthew Reynolds] Welcome to A Cup of Health with CDC, a weekly broadcast of the
MMWR, the Morbidity and Mortality Weekly Report. I’m your host, Matthew Reynolds.
Swimming is a good way to exercise and to cool down during the summer months. Each
year, millions enjoy swimming in public pools, lakes, rivers, and the ocean. But the cost
of cooling off can sometimes be high: a recent CDC report found that nearly three
thousand Americans got sick from water in recreational areas between 2003 and 2004.

Here to discuss how to be safe when swimming in public pools, lakes, and oceans is Dr.
Michael Beach, of CDC’s Coordinating Center for Infectious Diseases. Dr. Beach and
his colleagues recently published a report on waterborne disease outbreaks in the
United States from 2003 to 2004.

Welcome to the show, Dr. Beach.

[Dr. Beach] Thank you, Matthew. It’s a pleasure to be here

[Matthew Reynolds] Dr. Beach, just so our listeners understand, exactly what are
recreational waters?

[Dr. Beach] Well, when we track outbreaks associated with recreational water use, we
include the natural waters, such as lakes, rivers, and oceans, as well as the manmade
settings like swimming pools, water parks, spas, and even fountains.

[Matthew Reynolds] Dr. Beach, people – especially children – look forward to summer
vacations and having fun in the water swimming, playing on the beach, boating, but I
know in your research you learned about health hazards that can be connected to those
activities. What kinds of illnesses can people get from swimming or playing in
recreational waters?

[Dr. Beach] Well, we find a variety of illnesses associated with recreational water use.
These include diarrhea; skin, ear, eye and respiratory infections; even neurologic
infections; as well as infections of unhealed wounds. Basically these occur by
swallowing, breathing, or having other contact with contaminated water.

[Matthew Reynolds] Tell us more about what actually causes these illnesses. How does
the water become contaminated?

[Dr. Beach] Contamination occurs in multiple ways. In natural environments like lakes or
beaches, we find that runoff from contaminated watersheds or sewage treatment plants
can dump contaminated waste into swimming areas. In chlorinated swimming areas like
swimming pools, as well as in natural environments, we see also that people
contaminate the water. So someone who’s ill with diarrhea may go swimming and
contaminate the water, then anyone who swallows the water afterwards can become ill.

[Matthew Reynolds] Have you seen changes in the frequency or severity of outbreaks
associated with recreational water activity?

[Dr. Beach] Yes, we actually have. There’s been a steady increase in outbreaks of
diarrheal illness since the mid 1980’s. This is really due to the emergence of a chlorineresistant
parasite called Cryptosporidium, and this parasite actually now accounts for
over half of the pool-associated outbreaks that we document, primarily because what
we find is it now bypasses that major barrier that we find in swimming pools, which is
chlorination.

[Matthew Reynolds] If my family is swimming in a pool, what preventive measures can
we take to reduce the possibility of infection?

[Dr. Beach] First, let’s keep in mind that most outbreaks are prevented by good pool
maintenance. But if you want to reduce risk even further, when you visit the public pool,
if you or your child are ill with diarrhea, you don’t go swimming. Remember that this is
communal bathing water and so you want to minimize how much water you get in your
mouth and certainty how much you swallow. And finally, we need to improve hygiene,
so shower before you get in the pool, change diapers in a restroom where you can
wash up afterwards. Talk to your pool operator. Understand better how they’re
operating their pool. Are they well trained to do that? Ask about the inspection score
that they got the last time from the health department. We ask about it for food in
restaurants. Why don’t we ask about it at the local pool? Think about taking some action
yourself. You can buy test strips to measure chlorine and pH at the pool. If it’s low, ask
your operator why they’re not there protecting your health. If you own a private pool, you
need to understand how to operate that pool properly and how to handle the chemicals
that you use during that operation.

[Matthew Reynolds] Since beaches and lakes don’t use chlorination and filtration, what
other things can someone do to protect themselves from water-related illness at the
beach?

[Dr. Beach] Well, clearly one needs to follow all the precautions I just mentioned as far
as taking personal action. But there are several other things to keep in mind. In a
natural environment, you really want to avoid swimming at the beach or the lake and so
on following heavy rains because we are washing in potentially contaminated material
from the watershed. Also, if you see exposed storm drains or other drains where you
see liquid coming into the swimming area, you don’t want to swim around those,
because you’re not clear about whether that water’s contaminated. And finally, I think a
key is that you should ask your state or local health department whether there’s
indicator testing at the beach to look at water quality. Many times this is posted on the
internet so you can actually view it before you go to the beach. The key is education.
But I think one thing we need to keep in perspective here is that hundreds of millions of
swimming visits occur every year and most of those people aren’t getting ill. We’re just
bringing out new information to try and help you reduce the risk even further.

[Matthew Reynolds] Where can I learn more about recreational water outbreaks and
other things I can do to help keep my family healthy?

[Dr. Beach] Well, we want you to educate yourself and we think a key resource here is
the CDC Healthy Swimming website which can be found at
www.cdc.gov/healthyswimming as one word.

[Matthew Reynolds] Thank you for taking the time to talk to us today Dr. Beach.

[Dr. Beach] You’re welcome. Thanks so much for inviting me.

[Matthew Reynolds] That’s it for this week’s show. Don’t forget to join us next week.
Until then, be well. This is Matthew Reynolds for A Cup of Health with CDC.

[Announcer] To access the most accurate and relevant health information that affects
you, your family and your community, please visit www.cdc.gov.