Swimming is the second most popular exercise activity in the United States, with over 400 million annual visits to recreational swimming venues such as pools and hot tubs and fresh and marine waters. Considering the massive exposure of the population to recreational water, what factors are currently impacting the quality of the water that they swim in? Enteric pathogens such as Giardia and Cryptosporidium can be found in most surface water in the United States. Other pathogens such as E. coli O157:H7, Shigella, and the Norwalk-like viruses have also been documented as recreational water illnesses (RWI’s) and many of these pathogens are environmentally stable, have low infectious doses, and may be shed for weeks after the cessation of diarrhea. The high incidence of diarrhea in the United States (>1 diarrheal episode/person/year), high bather loads, and heavy use by diapered and toddler-aged children make the shared water/communal bathing experience an ideal venue for spreading and amplifying community illness. There has been a significant increase in the number of recreational water outbreaks over the past decade. Surveillance data from pool inspections illustrates the need for stronger compliance with existing pool regulations. These data and lessons learned from recent RWI outbreaks illustrate the urgent need for development of a broad based prevention plan for preventing the spread of RWI’s. Michael J. Beach, Ph.D. is the Acting Associate Director for Health Water, National Center for Zoonotic, Vector-Borne and Enteric Diseases (NCZVED) & Team Leader, Water and Environment Activity in the Division of Parasitic Diseases at the Centers for Disease Control and Prevention in Atlanta, Georgia. He has a Ph.D. in biochemistry from Purdue University and is a graduate of the Epidemic Intelligence Service, CDC’s disease detective group and has worked on a large number of outbreak investigations of food and waterborne pathogens in his 15 years at CDC. He founded and leads CDC’s Healthy Swimming Program to help reduce the spread of recreational water illnesses and improve the public’s swimming experience. He collaborates with EPA, state and local health authorities, and the private sector on issues related to the public health implications arising from the spread of recreational water illnesses, in particular Cryptosporidium and Giardia, in both recreational and drinking water and on development of appropriate prevention measures. He also does field work on water quality issues with EPA and directs public education, waterborne disease surveillance, and swimming-related laboratory efforts back at CDC.
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