A rise in media coverage of Zika and water sanitation issues at the Olympic Games has increased attention to water-related illnesses. Given the focus on and, perhaps, fear of the issues, physicians should expect to hear many more patients asking about the safety of the pools, beaches, rivers, and lakes they plan to visit this summer.
Patients can be reassured that water-related illnesses, specifically recreational water illnesses (RWIs) are far less common in the United States than in developing nations, where diarrhea is a leading cause of infant mortality. But that doesn’t mean there aren’t dangerous microorganisms lurking in U.S. waters. Recent reports of brain-eating amoebas and flesh-eating bacteria have already made headlines this summer.
In fact, RWI outbreaks related to swimming have been on the rise in the U.S., and prevention challenges remain. Cryptosporidium, the protozoan that causes a rare disease called cryptosporidiosis, is difficult to remove through conventional filtration and is resistant to chlorination; it can survive for days even in properly disinfected pools. New treatment issues have also arisen.
The effect of climate change on RWIs is also being studied. Research from the National Institute of Environmental Health Sciences concluded “although the United States has prevention and treatment strategies for waterborne diseases, surveillance is still spotty, diagnoses are not uniform, and understanding of the impact of climate change on these diseases is not well established.” More than half of waterborne disease outbreaks in the U.S. over the last 50 years have been associated with heavy rain, according to the Natural Resources Defense Council.
Answering patients’ questions
Patients need to be informed on the best ways to protect themselves from illnesses ranging from uncomfortable to life threatening. First, it’s important to ensure patients understand the different kinds of water-related illnesses and what they’re most likely to be exposed to. They are:
Patients may ask one or several of the following questions if they are preparing for a trip involving recreational swimming or if they have recently returned from a similar outing.
Which waterborne illnesses am I most likely to be exposed to?
Here are five RWIs patients should be aware of:
WWho is most at risk for waterborne illnesses?
People who come in contact with contaminated water can contract waterborne illnesses, but individuals with compromised immune systems, people who have received an organ transplant, infants, the elderly, and pregnant women are at greater risk.
Where are waterborne illnesses most likely?
People are more likely to contract an RWI from fresh water than salt water. There are many organisms that cause RWIs, such as N. fowleri and Giardia, which thrive exclusively in fresh water. Additionally, pools, hot tubs, and other swimming environments where transmission is more likely are usually fresh water-based.
Does wearing goggles and keeping eyes closed underwater help prevent RWIs?
In general, eyes are relatively impervious to infections. Opening the eyes underwater does not increase the risk of contracting a RWI, and goggles are not necessary for protection.
How can people reduce the risk of contracting an RWI?
Provide patients headed to the pool, beach, or lake with the following general guidelines for avoiding RWIs:
You can refer patients to the consumer version of the Merck Manual to give them a more accurate understanding of common RWIs and key steps to take before, during, and after swimming.