Do U.S. Environmental Protection Agency water quality guidelines for recreational waters prevent gastrointestinal illness? A systematic review and meta-analysis

Environmental Health Perspectives

Volumn 111, Issue 8, 2003, Pages 1102-1109

  Wade, Timothy J ^a   Pai, Nitika ^b   Eisenberg, Joseph N S ^b   Colford Jr , John M ^b  

^a U S ENVIRONMENTAL PROTECTION AGENCY   (United States)

^b UNIVERSITY OF CALIFORNIA   (United States)

Author keywords

Bathing water; Diarrhea; Gastrointestinal illness; Indicator organisms; Meta analysis; Swimming; Systematic review; Water quality

Indexed keywords

FRESH WATER; SEA WATER;

CONFIDENCE INTERVAL; ENTEROCOCCUS; ENVIRONMENTAL EXPOSURE; ENVIRONMENTAL PROTECTION; ESCHERICHIA COLI; GASTROINTESTINAL DISEASE; HEALTH HAZARD; HUMAN; MARINE ENVIRONMENT; META ANALYSIS; MICROORGANISM; ORGANIZATION; PRACTICE GUIDELINE; PRIORITY JOURNAL; RECREATION; RETROSPECTIVE STUDY; REVIEW; SPORT; SWIMMING; UNITED STATES; VIRAL CONTAMINATION; WATER CONTAMINATION; WATER POLLUTION INDICATOR; WATER QUALITY;

BACTERIA (MICROORGANISMS); ENTEROCOCCUS; ESCHERICHIA COLI;

EID: 0038691961     PISSN: 00916765     EISSN: None     Source Type: Journal    
DOI: 10.1289/ehp.6241     Document Type: Review

References (75)

1. Alexander LM, Heaven A, Tennant A, Morris R. 1992. Symptomatology of children in contact with sea water contaminated with sewage. J Epidemiol Community Health 46:340-344.
2. Balarajan R, Soni Raleigh V, Yuen P, Wheeler D, Machin D, Cartwright R. 1991. Health risks associated with bathing in sea water. Br Med J 303:1444-1445.
3. Bandaranayake DR, Turner SJ, McBride GB, Lewis G, Till D. 1995. Health Effects of Bathing at Selected New Zealand Marine Beaches. Internal Report. Wellington:New Zealand Department of Health.
4. Baron RC, Murphy FD, Greenberg HB, Davis CE, Bregman DJ, Gary GW, et al. 1982. Norwalk gastrointestinal illness: an outbreak associated with swimming in a recreational lake and secondary person-to-person transmission. Am J Epidemiol 115:163-172.
5. Barwick RS, Levy DA, Craun GF, Beach MJ, Calderon RI. 2000. Surveillance for waterborne-disease outbreaks: United States, 1997-1998. Morb Mortal Wkly Rep 49:1-36.
6. Begg CB, Madachhanda M. 1994. Operating characteristics of a rank correlation test for publication bias. Biometrics 50:1088-1099.
7. Cabelli V. 1983. Health Effects Criteria for Marine Recreational Waters. U.S. EPA Report EPA-600/1-80-031. Cincinnati, OH:U.S. Environmental Protection Agency.
8. Cabelli V, Dufour A, Levin M, Habermann P. 1975. The impact of pollution on marine bathing beaches: an epidemiological study. In: Middle Atlantic Continental Shelf and the New York Bight: Proceedings of the Symposium, American Society of Limnology and Oceanography, New York City, 3-5 November. Lawrence, KS:American Society of Limnology and Oceanography, 424-432.
9. Cabelli VJ, Dufour AP, Levin MA, McCabe LJ, Haberman PW. 1979. Relationship of microbial indicators to health effects at marine bathing beaches. Am J Public Health 69:690-696.
10. Cabelli VJ, Dufour AP, McCabe LJ, Levin MA. 1982. Swimming-associated gastroenteritis and water quality. Am J Epidemiol 115:606-616.
11. Calderon R, Mood E. 1981. Epidemiological Studies of Otitis Externa: Report of a Prospective and of a Retrospective Study of Otitis Externa among Swimmers. Project Summary. EPA-600/S1-81-053. Cincinnati, OH:U.S. Environmental Protection Agency.
12. Calderon R, Mood E. 1982. An epidemiological assessment of water quality and "swimmer's ear." Arch Environ Health 37:300-305.
13. Calderon R, Mood E, Dufour A. 1991. Health effects of swimmers and nonpoint sources of contaminated water. Int J Environ Health Res 1:21-31.
14. Charoenca N, Fujioka R. 1995. Association of staphylococcal skin infections and swimming. Water Sci Technol 31:11-18.
15. Cheung WH, Chang KC, Hung RP, Kleevens JW. 1990. Health effects of beach water pollution in Hong Kong. Epidemiol Infect 105:139-162.
16. Corbett SJ, Rubin GL, Curry GK, Kleinbaum DG. 1993. The health effects of swimming at Sydney beaches. The Sydney Beach Users Study Advisory Group. Am J Public Health 83:1701-1706.
17. D'Alessio D, Minor TE, Allen CI, Tsiatis AA, Nelson DB. 1981. A study of the proportions of swimmers among well controls and children with enterovirus-like illness shedding or not shedding an enterovirus. Am J Epidemiol 113:533-541.
18. DerSimonian R, Laird N. 1986. Meta-analysis in clinical trials. Control Clin Trials 7:177-188.
19. Dufour A. 1984a. Health Effects Criteria for Fresh Recreational Waters. EPA-600-1-84-004. Cincinnati, OH:U.S. Environmental Protection Agency.
20. Dufour A. 1984b. Bacterial indicators of recreational water quality. Can J Public Health 75:49-56.
21. El-Sharkawi F, Hassan F. 1979. The relation between the state of pollution an Alexandria swimming beaches and the occurrence of typhoid among bathers. Bull High Inst Public Health Alexandria 9:337-351.
22. Fankhauser RL, Monroe SS, Noel JS, Humphrey CD, Bresee JS, Parashar UD, et al. 2002. Epidemiologic and molecular trends of "Norwalk-like viruses" associated with outbreaks of gastroenteritis in the United States. J Infect Dis 186:1-7.
23. Fattal B, Peleg-Olevsky E, Yoshpe-Purer Y, Shuval H. 1986. The association between morbidity among bathers and microbial quality of seawater. Wat Sci Technol 18:59-69.
24. Favero M, Drake C, Randall G. 1964. Use of staphyloccoci as indicators of swimming pool pollution. Public Health Rep 92:245-250.
25. Ferley JP, Zmirou D, Balducci F, Baleux B, Fera P, Larbaigt G, et al. 1989. Epidemiological significance of microbiological pollution criteria for river recreational waters. Int J Epidemiol 18:198-205.
26. Fewtrell L, Godfree AF, Jones F, Kay D, Salmon RL, Wyer MD. 1992. Health effects of white-water canoeing. Lancet 339:1587-1589.
27. Fewtrell L, Kay D, Salmon R, Wyer M, Newman G, Bowering G. 1994. The health effects of low-contact water activities in fresh and estuarine waters. J Inst Water Environ Manag 8:97-101.
28. Fleisher JM. 1992. U.S. federal bacteriological water quality standards: a re-analysis. In: Recreational Water Quality Management, Vol. 1: Coastal Waters (Kay D, ed). New York: Ellis Horwood, 113-127.
29. Fleisher JM, Jones F, Kay D, Stanwell-Smith R, Wyer M, Morano R. 1993. Water and non-water-related risk factors for gastroenteritis among bathers exposed to sewage-contaminated marine waters. Int J Epidemiol 22:698-708.
30. Fleisher JM, Kay D, Salmon RL, Jones F, Wyer MD, Godfree AF. 1996. Marine waters contaminated with domestic sewage: nonenteric illnesses associated with bather exposure in the United Kingdom. Am J Public Health 86:1228-1234.
31. Fleisher JM, Kay D, Wyer MD, Godfree AF. 1998. Estimates of the severity of illnesses associated with bathing in marine recreational waters contaminated with domestic sewage. Int J Epidemiol 27:722-726.
32. Foulon G, Maurin J, Quoi N, Martin -Buoyer G. 1983. Etude de la morbidite humaine en relation avec la pollutino bacteriologique des eaux de baignade en mer. Rev Fr Sci Eau 2:127-143.
33. Greenland S. 1998. Meta analysis. In: Modern Epidemiology (Rothman KJ, Greenland S, eds). Philadelphia, PA:Lippincott-Raven, 647-711.
34. Griffin DW, Donaldson KA, Paul JH, Rose JB. 2003. Pathogenic human viruses in coastal waters. Clin Microbiol Rev 16:129-143.
35. Haile RW, Witte JS, Gold M, Cressey R, McGee C, Millikan RC, et al. 1999. The health effects of swimming in ocean water contaminated by storm drain runoff. Epidemiology 10:355-363.
36. Harrington JF, Wilcox DN, Giles PS, Ashbolt NJ, Evans JC, Kirton HC. 1993. The health of Sydney surfers: an epidemiological study. Water Sci Technol 27:175-181.
37. Jessop EG, Horsley SD, Wood L. 1985. Recreational use of inland water and health: are Windermere and Coniston water a health hazard? Public Health 99:338-342.
38. Jones F, Kay D, Stanwell-Smith R, Wyer M. 1991. Results of the first pilot-scale controlled cohort epidemiological investigation into the possible health effects of bathing in seawater at Langland Bay, Swansea. J Int Water Environ Manag 5:91-97.
39. Kappus KD, Marks JS, Holman RC, Bryant JK, Baker C, Gary GW, et al. 1982. An outbreak of Norwalk gastroenteritis associated with swimming in a pool and secondary person-to-person transmission. Am J Epidemiol 116:834-839.
40. Kay D, Fleisher JM, Salmon RL, Jones F, Wyer MD, Godfree AF, et al. 1994. Predicting likelihood of gastroenteritis from sea bathing: results from randomised exposure. Lancet 344:905-909.
41. Ktsanes V, Anderson A, Diem J. 1981. Health Effects of Swimming in Lake Pontchartrain at New Orleans. EPA-600/S1-81-027. Cincinnati, OH:U.S. Environmental Protection Agency.
42. Kueh CSW, Tam TY, Lee T, Wong SL, Lloyd OL, Yu ITS, et al. 1995. Epidemiological study of swimming-associated illnesses relating to bathing-beach water quality. Water Sci Technol 31:1-4.
43. Lee JV, Dawson SR, Ward S, Surman SB, Neal KR. 1997. Bacteriophages are a better indicator of illness rates than bacteria amongst users of a white water course fed by a lowland river. Water Sci Technol 35:165-170.
44. Lee SH, Levy DA, Craub GF, Beach MJ, Calderon RL. 2002. Surveillance for waterborne disease outbreaks: United States, 1999-2000. Morb Mortal Wkly Rep 51:1-45.
45. Levy DA, Bens MS, Craun GF, Calderon RL, Herwaldt BL. 1998. Surveillance for waterborne-disease outbreaks - United States, 1995-1996. Morb Mortal Wkly Rep 47:1-34.
46. Lightfoot N. 1989 A prospective study of swimming related illness at six freshwater beaches in southern Ontario [Ph.D. Thesis]. Toronto, Canada:University of Toronto.
47. Marino F, Morinigo M, Martinez-Manzanares E, Borrego J. 1995. Microbiological-epidemiological study of selected marine beaches in Malaga (Spain). Water Sci Technol 31:5-9.
48. McBride GB, Salmondo CE, Bandaranayake DR, Turner SJ, Lewis GD, Till DG. 1998. Health effects of marine bathing in New Zealand. Int J Environ Health Res 8:173-189.
49. Mead PS, Slutsker L, Dietz V, McCraig LF, Bresee JS, Shapiro C, et al. 1999. Food-related illness and death in the United States. Emerg Infect Dis 5:607-625.
50. Medema G, Van Asperen I, Klokman-Houweling J, Nooitgedagt A, Van de Laar M. 1995. The relationship between health effects in triathletes and microbiological quality of freshwater. Water Sci Technol 31:19-26.
51. New Jersey Department of Health. 1989. A Study of the Relationship between Illness and Ocean Beach Water Quality. Interim Summary Report. Trenton, NJ:New Jersey Department of Health.
52. Philipp R, Evans EJ, Hughes AO, Grisdale SK, Enticott RG, Jephcott AE. 1985. Health risks of snorkel swimming in untreated water. Int J Epidemiol 14:624-627.
53. Philipp R, Waitkins S, Caul O, Roome A, MacMahon S, Enticott R. 1989. Leptospiral and hepatitis A antibodies amongst wind-surfers and waterskiers in Bristol city docks. Public Health 103:123-129.
54. Public Health Laboratory Service. 1959. Sewage contamination of coastal bathing waters in England and Wales. J Hygiene 43:435-472.
55. Pike E. 1990. Health Effects of Sea Bathing (ET 9511 SLG). Phase I - Pilot Studies at Langland Bay, 1989. WRC Report Number: DoE 2736-M 2518-M. Medmenham, UK:Water Research Centre.
56. Pike E. 1991. Health Effects of Sea Bathing (EM 9511), Phase II - Studies at Ramsgate and Moreton, 1990. WRC Report Number: DoE 2736-M. Medmenham, UK:Water Research Centre.
57. Pike E. 1994. Health Effects of Sea Bathing (WMI 9021), Phase III - Final Report to the Department of the Environment. WRC Report Number: DoE 3412/2. Medmenham, UK:Water Research Centre.
58. Pilotto LS, Douglas RM, Burch MD, Cameron S, Beers M, Rouch GJ, et al. 1997. Health effects of exposure to cyanobacteria (blue-green algae) during recreational water-related activities. Aust N Z J Public Health 21:562-566.
59. Prieto MD, Lopez B, Juanes JA, Revilla JA, Llorca J, Delgado-Rodriguez M. 2001. Recreation risks in coastal waters: health risks associated with bathing in sea water. J Epidemiol Community Health 55:442-447.
60. Pruss A. 1998. Review of epidemiological studies an health effects from exposure to recreational water. Int J Epidemiol 27:1-9.
61. Scott TM, Rose JB, Jenkins TM, Farrah SR, Lukasik J. 2002. Microbial source tracking: current methodology and future directions. Appl Environ Microbiol 68:5796-5803.
62. Seyfried PL, Tobin RS, Brown NE, Ness PF. 1985a. A prospective study of swimming-related illness. I. Swimming-associated health risk. Am J Public Health 75:1068-1070.
63. Seyfried PL, Tobin RS, Brown NE, Ness PF. 1985b. A prospective study of swimming-related illness. II. Morbidity and the microbiological quality of water. Am J Public Health 75:1071-1075.
64. Stata Corporation. 2002. Stata SE Version 7. 0. College Station, TX: Stata Corporation.
65. Stevenson A. 1953. Studies of bathing water quality and health. Am J Public Health Assoc 43:529-538.
66. Taylor MB, Becker PJ, Van Rensburg EJ, Harris BN, Bailey IW, Grabow WO. 1995. A serosurvey of water-borne pathogens amongst canoeists in South Africa. Epidemiol Infect 115:299-307.
67. Thompson SG, Sharp SJ. 1999. Explaining heterogeneity in meta-analysis: a comparison of methods. Stat Med 18:2693-2708.
68. U.S. EPA. 1986. Bacteriological Water Quality Criteria for Marine and Fresh Recreational Waters. EPA-440/5-84-002. Cincinnati, OH:U.S. Environmental Protection Agency, Office of Water Regulations and Standards.
69. U.S. EPA. 1997. Method 1600: Membrane Filter Test for Enterococci in Water. EPA-821-R-97-004. Washington, DC:U.S. Environmental Protection Agency, Office of Water.
70. U.S. EPA. 2002. Implantation Guidance for Ambient Water Quality Criteria for Bacteria. EPA-823-B-02-003. Washington, DC:U.S. Environmental Protection Agency, Office of Water.
71. van Asperen IA, de Rover CM, Schijven JF, Oetomo SB, Schellekens JF, van Leeuwen NJ, et al. 1995. Risk of otitis externa after swimming in recreational fresh water lakes containing Pseudomonas aeruginosa. Br Med J 311:1407-1410.
72. van Asperen IA, Medema G, Borgdorff MW, Sprenger MJ, Havelaar AH. 1998. Risk of gastroenteritis among triathletes in relation to faecal pollution of fresh waters. Int J Epidemiol 27:309-315.
73. von Schirnding YE, Kfir R, Cabelli V, Franklin L, Joubert G. 1992. Morbidity among bathers exposed to polluted seawater. A prospective epidemiological study. S Afr Med J 81:543-546.
74. World Health Organization. 2001. Bathing Water Quality and Human Health: Faecal Pollution. Outcome of an Expert Consultation. Farnham, UK:World Health Organization.
75. Zmirou D, Ferley JP, Balducci F, Moissonnier B, Blineau A, Boudot J. 1990. Evaluation des indicateurs du risque sanitaire lie' aux baignades en riviere. Rev Epidemiol Sante Publique 38:101-110.