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Open AccessFeature PaperReview

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

Department of Biomedical Sciences, University of West Attica, 12243 Egaleo, Greece
Central Public Health Laboratory, Hellenic Centre of Disease Control and Prevention, 15123 Maroussi, Greece
West Attica General Hospital, “Santa Barbara”, 12351 Santa Barbara, Greece
Institute of Infection and Global Health, University of Liverpool, Liverpool L69 3BX, UK
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2018, 15(12), 2730;
Received: 5 October 2018 / Revised: 18 November 2018 / Accepted: 29 November 2018 / Published: 3 December 2018
(This article belongs to the Special Issue Recreational Water Illnesses)
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. View Full-Text
Keywords: swimming pools; tropics; subtropics; pool assessment; infectious diseases swimming pools; tropics; subtropics; pool assessment; infectious diseases
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Mavridou, A.; Pappa, O.; Papatzitze, O.; Dioli, C.; Kefala, A.M.; Drossos, P.; Beloukas, A. Exotic Tourist Destinations and Transmission of Infections by Swimming Pools and Hot Springs—A Literature Review. Int. J. Environ. Res. Public Health 2018, 15, 2730.

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