Water Recreation and Disease

3,07

MB

260

stron

5454

ID

World Health Organization

2005

rok

Contents

Foreword ix

Acknowledgements xii

List of Acronyms and Abbreviations xiv

Executive Summary xvi

1 Introduction 1

1.1 Background 1

1.2 Evidence of adverse health outcomes associated with recreational water use 4

1.3 Severe outcomes 8

1.3.1 Infections with potentially severe acute symptoms 9

1.3.2 Evidence for sequelae of waterborne diseases 9

1.3.3 Severe outcomes in special populations 12

1.4 Management of severe illnesses 13

1.5 Summary 13

1.6 Document overview 14

References

2 Hazard Identification and Factors Related to Infection and Disease 21

2.1 Hazard identification 21

2.1.1 Epidemiology 22

2.1.2 Quantitative microbial risk assessment 24

2.2 Factors influencing hazard encounter and infection 25

2.2.1 Water contact 25

2.2.2 Recreational water types 26

2.3 Factors related to infection and disease 28

2.3.1 Status of host 28

2.3.2 Process of infection 30

References 32

3 Credibility of Association and Severity Criteria Index 35

3.1 Sources of available evidence 35

3.1.1 Limitations of the evidence 36

3.2 Surveillance 36

3.3 Credibility of association with recreational water 39

3.4 Evidence for severity 40

3.4.1 Severity index 40

3.5 Summary 54

References 54

4 Bacteria 59

Campylobacter 60

E. coli O157 65

Helicobacter pylori 71

Legionella 76

Leptospira 93

Mycobacterium avium complex 101

Salmonella typhi 107

Shigella 113

Vibrio vulnificus 119

References 123

5 Protozoa and Trematodes 147

Cryptosporidium parvum 148

Giardia duodenalis 157

Microsporidia 163

Naegleria fowleri 170

Trematode worm 176

References 182

6 Viruses 191

Human adenovirus 192

Coxsackievirus 199

Echovirus 204

Hepatitis A 208

Hepatitis E 215

References 219

Index 231