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Healthy Recreational Waters: Sanitation and Safety Issues

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A special issue of Water (ISSN 2073-4441). This special issue belongs to the section "Water and One Health".

Deadline for manuscript submissions: closed (15 November 2021) | Viewed by 38241

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Prof. Dr. Athena Mavridou

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Guest Editor

Department of Medical Laboratories, University of West Attica, Athens, Greece
Interests: water quality; water microbiology; recreational waters

Special Issue Information

Dear Colleagues,

Recreational water activities offer substantial benefits to health and well-being. According to “WHO Guidelines for Safe Recreational Water Environments”, swimming pools, beaches, lakes, rivers, and spa waters provide environments for rest and relaxation, physical activity, exercise, and fun. Yet, they also present risks to health. Today, procedures set out by public health services based on solid data, risk assessment, and modelling are required in order to combine pleasure with safety in such waters. Each water body has its own identity and requires handling in line with its particular characteristics, which depend on the specific water parameters, the environmental factors of the geographical area in question, the human activities around the body of water, and sociological and human behavioral factors. Thus, to study recreational water environments, the scientific community and public health staff and structures must respond to both individual and complex challenges, including public awareness and education. The procedures and processes are far from simple, and the COVID-19 pandemic adds a further challenge.

This Special Issue invites research articles on all the aforesaid aspects of studying, handling, and managing recreational water bodies. We look forward to your contributions, which can address any one of these themes, as well as interdisciplinary approaches.

Prof. Dr. Athena Mavridou
Guest Editor

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Keywords

recreational waters
pathogens
COVID-19
swimming pool
bathing waters
spa waters
risk assessment
disinfection
modeling
regulations

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Published Papers (9 papers)

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Research

9 pages, 1868 KiB

Open AccessArticle

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

by G. Pantazidou, ME. Dimitrakopoulou, C. Kotsalou, J. Velissari and A. Vantarakis

Water 2022, 14(13), 1983; https://doi.org/10.3390/w14131983 - 21 Jun 2022

Cited by 2 | Viewed by 5301

Abstract

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. Full article

(This article belongs to the Special Issue Healthy Recreational Waters: Sanitation and Safety Issues)

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10 pages, 494 KiB

Open AccessArticle

Swimming Pool Regulations in the COVID-19 Era: Assessing Acceptability and Compliance in Greek Hotels in Two Consecutive Summer Touristic Periods

by Kassiani Mellou, Athina Mplougoura, Georgia Mandilara, Antonios Papadakis, Dimosthenis Chochlakis, Anna Psaroulaki and Athena Mavridou

Water 2022, 14(5), 796; https://doi.org/10.3390/w14050796 - 3 Mar 2022

Cited by 4 | Viewed by 4564

Abstract

The COVID-19 pandemic has urged many countries to issue new regulations to assure safety in pool environments. Greece enforced stricter requirements in 2020 and 2021 for hotel pools. However, even though regulations are important, they can only be effective when accepted by the pool managers and users. The aim of this study was to (a) assess the acceptability of the regulations by hotel managers; (b) assess compliance during the summer touristic periods in 2020 and 2021; and (c) identify challenges during the implementation of the regulations that need to be addressed. Several non-compliances from the regulations were identified. Continuous chlorination with an automatic chlorinator was not a regular practice and suggested water circulation rates were poorly met. The microbiological and chemical testing frequency of the pool water and keeping the number of bathers allowed per surface area in the pool were reported as the most difficult requirements to meet. Most pool managers agreed that new measures contribute to the pool users’ safety; however, they reported increased cost as the main impediment for their implementation. The modernization of regulations governing swimming pools’ function, in terms of risk assessment orientation, will contribute to the adoption of an integrated compliance strategy on emerging health issues, such as COVID-19. Full article

(This article belongs to the Special Issue Healthy Recreational Waters: Sanitation and Safety Issues)

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12 pages, 2583 KiB

Open AccessFeature PaperArticle

Quantification of Hypochlorite in Water Using the Nutritional Food Additive Pyridoxamine

by Kamilla M. S. Kaarsholm, Argyro Kokkoli, Eleni Keliri, Paul D. Mines, Maria G. Antoniou, Mogens Havsteen Jakobsen and Henrik R. Andersen

Water 2021, 13(24), 3616; https://doi.org/10.3390/w13243616 - 16 Dec 2021

Cited by 3 | Viewed by 3835

Abstract

Chlorine is a widely used disinfectant and oxidant used for an array of municipal and industrial applications, including potable water, swimming pools, and cleaning of membranes. The most popular method to verify the concentration of free chlorine is the colorimetric method based on DPD (N, N-diethyl-p-phenylenediamine), which is fast and reasonably cheap, but DPD and its product are potentially toxic. Therefore, a novel, environmentally friendly colorimetric method for the quantification of residual chlorine based on the food additive pyridoxamine (4-(aminomethyl)-5-(hydroxymethyl)-2-methylpyridin-3-ol) was investigated. Pyridoxamine is a B6 vitamin with an absorption maximum at 324 nm and fluorescence emission at 396 nm. Pyridoxamine reacts rapidly and selectively with free chlorine, resulting in a linear decrease both in absorbance and in emission, giving therefore calibration curves with a negative slope. The pyridoxamine method was successfully applied for the quantification of free chlorine from 0.2 to 250 mg/L. Using 1 cm cuvettes, the limit of quantification was 0.12 mg Cl₂/L. The pyridoxamine and the DPD methods were applied to actual environmental samples, and the deviation between results was between 4% and 9%. While pyridoxamine does not react with chloramine, quantification of monochloramine was possible when iodide was added, but the reaction is unfavourably slow. Full article

(This article belongs to the Special Issue Healthy Recreational Waters: Sanitation and Safety Issues)

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11 pages, 718 KiB

Open AccessFeature PaperArticle

Viral Cutaneous Infections in Swimmers: A Preliminary Study

by Eleni Sfyri, Vasiliki Kefala, Effie Papageorgiou, Athena Mavridou, Apostolos Beloukas and Efstathios Rallis

Water 2021, 13(23), 3401; https://doi.org/10.3390/w13233401 - 2 Dec 2021

Cited by 4 | Viewed by 4481

Abstract

Molluscum contagiosum (MC) and warts are common viral infections of the skin. Data regarding the prevalence of MC and verruca in swimmers are very poor and lacking in the literature. The purpose of this study was to determine the incidence of Molluscum Contagiosum (MC) and warts cases among young competitive swimmers participating in Greek swimming clubs. Of 244 swimmers enrolled in this study, 12.3% reported MC and 43% warts, during their swimming career, diagnosed and treated by dermatologists. There was no difference between sexes for MC but diagnoses of warts were higher in females. Axillae and trunk were the most common sites of primary infection for MC but warts mainly appeared on the soles. The incidence of MC and warts in swimmers who use outdoor facilities was higher. In our study, the incidence of warts and MC in Greek swimmers is considered high. Moist walking surfaces, placing towels on locker room benches, and sharing equipment are behaviors that cause infections. An early diagnosis of warts and MC lesions must be implemented in every swimmer through dermatological examination. Taking proper measures for reducing the risk of warts and MC transmission in Greek swimmers is mandatory. Full article

(This article belongs to the Special Issue Healthy Recreational Waters: Sanitation and Safety Issues)

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12 pages, 693 KiB

Open AccessArticle

Swimming Pool-Related Outbreak of a Rare gp60 Subtype of Cryptosporidium hominis, England, October 2016

by Helen Bagnall, Rachel M. Chalmers, Michelle Henderson, Stewart Sorrell, Guy Robinson, Kristin Elwin and Gayle Dolan

Water 2021, 13(22), 3152; https://doi.org/10.3390/w13223152 - 9 Nov 2021

Cited by 1 | Viewed by 2733

Abstract

In October 2016, Public Health England was initially notified of four cases of cryptosporidiosis among users of two swimming pools. We investigated to identify further cases, the outbreak source, and ensure the implementation of appropriate control measures. Probable primary cases had diarrhoea and reported swimming in the pools 1–12 days prior to illness; confirmed cases were verified by the reference laboratory. Secondary cases had contact with primary cases 1–12 days prior to illness. We identified twenty-two cases: eleven were primary (eight confirmed) and eleven were secondary (five confirmed). Four cases were infected with C. parvum (different gp60 subtypes); all were primary and swam at two pools. Seven primary and secondary cases were infected with C. hominis gp60 subtype IdA16, and all were associated one pool. Failings in pool water treatment and management were identified that likely contributed to the load on the filters and their efficiency. Our investigation identified a complex outbreak, with secondary transmission, involving exposures to two swimming pools. C. hominis IdA16 is rare; it has been isolated from only three previous UK cases. We hypothesize that C. hominis cases arose from a common exposure, and the C. parvum cases were likely sporadic. This investigation highlights the value of integrating epidemiology and microbiology to investigate clusters of Cryptosporidium cases, defining the extent of the outbreak and the likely transmission pathways. Full article

(This article belongs to the Special Issue Healthy Recreational Waters: Sanitation and Safety Issues)

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20 pages, 1735 KiB

Open AccessArticle

Modelling Bathing Water Quality Using Official Monitoring Data

by Daniela Džal, Ivana Nižetić Kosović, Toni Mastelić, Damir Ivanković, Tatjana Puljak and Slaven Jozić

Water 2021, 13(21), 3005; https://doi.org/10.3390/w13213005 - 26 Oct 2021

Cited by 10 | Viewed by 3951

Abstract

Predictive models of bathing water quality are a useful support to traditional monitoring and provide timely and adequate information for the protection of public health. When developing models, it is critical to select an appropriate model type and appropriate metrics to reduce errors so that the predicted outcome is reliable. It is usually necessary to conduct intensive sampling to collect a sufficient amount of data. This paper presents the process of developing a predictive model in Kaštela Bay (Adriatic Sea) using only data from regular (official) bathing water quality monitoring collected during five bathing seasons. The predictive modelling process, which included data preprocessing, model training, and model tuning, showed no silver bullet model and selected two model types that met the specified requirements: a neural network (ANN) for Escherichia coli and a random forest (RF) for intestinal enterococci. The different model types are probably the result of the different persistence of two indicator bacteria to the effects of marine environmental factors and consequently the different die-off rates. By combining these two models, the bathing water samples were classified with acceptable performances, an informedness of 71.7%, an F-score of 47.1%, and an overall accuracy of 80.6%. Full article

(This article belongs to the Special Issue Healthy Recreational Waters: Sanitation and Safety Issues)

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16 pages, 5928 KiB

Open AccessArticle

Inland and Coastal Bathing Water Quality in the Last Decade (2011–2020): Croatia vs. Region vs. EU

by Slaven Jozić, Vanja Baljak, Arijana Cenov, Dražen Lušić, Dominik Galić, Marin Glad, Daniel Maestro, Nerma Maestro, Damir Kapetanović, Romina Kraus, Sandra Marinac-Pupavac and Darija Vukić Lušić

Water 2021, 13(17), 2440; https://doi.org/10.3390/w13172440 - 5 Sep 2021

Cited by 2 | Viewed by 3961

Abstract

Europe is one of the leading tourist destinations where tourism is one of the key economic sectors. The quality of bathing waters is a very important factor when choosing a vacation destination. Croatia recognized this early and was one of the first Mediterranean countries to start systematic monitoring of bathing waters. On the other hand, monitoring of inland bathing waters is relatively new and includes a much smaller number of sites (41) compared to coastal waters (894). The aim of this paper was to summarize and analyze the water quality of inland and coastal bathing sites of Croatia, closer regions (non-EU Member States) and in the EU for the last decade. The share of excellent water quality in EU Member States increased by 10.1% and 6.6% for inland and coastal waters, respectively (2011–2020). Germany recorded the highest proportion of excellent water quality for inland waters (92.2%) and Cyprus for coastal waters (99.3%). Looking at the 10-year average of the proportion of bathing waters with excellent quality, the proportion of coastal bathing sites exceeds that of inland waters by 7.1%. It is clear that additional efforts should be made to improve the management and monitoring of inland waters. Full article

(This article belongs to the Special Issue Healthy Recreational Waters: Sanitation and Safety Issues)

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17 pages, 1498 KiB

Open AccessArticle

Revisiting the Gage–Bidwell Law of Dilution in Relation to the Effectiveness of Swimming Pool Filtration and the Risk to Swimming Pool Users from Cryptosporidium

by Lester P. Simmonds, Guy E. Simmonds, Martin Wood, Tim I. Marjoribanks and James E. Amburgey

Water 2021, 13(17), 2350; https://doi.org/10.3390/w13172350 - 27 Aug 2021

Cited by 1 | Viewed by 4032

Abstract

The transfer of water from a swimming pool to the treatment location is key in determining the effectiveness of water treatment by filtration in removing turbidity and managing the risk from particulate material, including microbial pathogens, such as Cryptosporidium spp. A key recommendation for pool operators when dealing with an accidental faecal release (the likely main source of high Cryptosporidium oocyst concentrations in pools) is that the pool water should be filtered for at least six turnover cycles prior to use. This paper briefly outlines the theoretical basis of what has become known as the Gage–Bidwell Law of Dilution, which provides a basis for this recommendation, and extends the idea to account for the impact of filter efficiency. The Gage–Bidwell Law reveals that for each pool turnover 63% of the water resident in the pool at the start of the turnover period will have been recirculated. Building on this, we demonstrate that both filter efficiency and water-turnover time are important in determining filtration effectiveness and can be combined through a single parameter we term ‘particle-turnover’. We consider the implications of the Gage–Bidwell Law (as referred to in the original 1926 paper) for the dynamics of the ‘dirt’ content of pool water, whether in terms of a specific particle size range (e.g., Cryptosporidium oocysts) or turbidity. Full article

(This article belongs to the Special Issue Healthy Recreational Waters: Sanitation and Safety Issues)

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21 pages, 1186 KiB

Open AccessEditor’s ChoiceArticle

Occurrence of Cryptosporidium Oocysts in Leisure Pools in the UK, 2017, and Modelling of Oocyst Contamination Events

by Rachel M. Chalmers, Lester P. Simmonds, Martin Wood, Megan Luxford, Rob Miller and Rob Johnston

Water 2021, 13(11), 1503; https://doi.org/10.3390/w13111503 - 27 May 2021

Cited by 4 | Viewed by 3666

Abstract

Cryptosporidium is a major cause of diarrhoea outbreaks linked to swimming pools, but little is known about the frequency of contamination. The primary aim was to investigate the occurrence and concentration, through sampling and modelling, of Cryptosporidium oocysts in leisure pools. Secondary aims were to compare detections with operational parameters, provide the evidence-base for guidance, and improve sampling capacity and interpretation for public health investigations. Up to 1000 L pool water was sampled during swim sessions once weekly for 10 weeks from 8 August 2017 at six volunteer pools. Oocysts were detected by microscopy in 12/59 (20%) pool water samples, at least once in each pool; 8/12 (66%) detections were in August when bather loads were highest. At three pools, 1 L filter backwash was sampled weekly and oocysts were detected in 2/29 (7%) samples, following detections in pool water. The probabilities of a bather contaminating the pool ranged from 1 in 1000 to over 1 in 10,000. Monte Carlo analysis showed that when high bather numbers caused contamination on over 70% of days, multiple events per day were more likely than single events. In these generally well-managed leisure pools, Cryptosporidium risk related to high bather loads. We conclude that public awareness campaigns for bather hygiene, and reminding pool operators of current guidance for managing faecal accidents, should be ahead of peak swim season. Full article

(This article belongs to the Special Issue Healthy Recreational Waters: Sanitation and Safety Issues)

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