Ingestion of swimming pool water by recreational swimmers.

The volume of water ingested by swimmers while swimming is of great interest to individuals who develop risk assessments using quantitative microbial risk assessment or epidemiological approaches. We have used chloroisocyanurate disinfected swimming pool waters to determine the amount of water swallowed by swimmers during swimming activity. The chloroisocyanurate, which is in equilibrium with chlorine and cyanuric acid in the pool water, provides a biomarker, cyanuric acid, that once swallowed passes through the body into the urine unchanged. The concentration of cyanuric acid in a 24 hour urine specimen and the concentration in pool water can be used to calculate the amount of water swallowed. Our study population of 549 participants, which was about evenly divided by gender, and young and adult swimmers, indicated that swimmers ingest about 32 mL per hour (arithmetic mean) and that children swallowed about four times as much water as adults during swimming activities. It was also observed that males had a tendency to swallow more water than females during swimming activity and that children spent about twice as much time in the water than adults.

Self-Reported Acute Health Effects and Exposure to Companion Animals.

To understand the etiological burden of disease associated with acute health symptoms [e.g. gastrointestinal (GI), respiratory, dermatological], it is important to understand how common exposures influence these symptoms. Exposures to familiar and unfamiliar animals can result in a variety of health symptoms related to infection, irritation and allergy; however, few studies have examined this association in a large-scale cohort setting. Cross-sectional data collected from 50 507 participants in the United States enrolled from 2003 to 2009 were used to examine associations between animal contact and acute health symptoms during a 10-12 day period. Fixed-effects multivariable logistic regression estimated adjusted odds ratios (AORs) and 95% confident intervals (CI) for associations between animal exposures and outcomes of GI illness, respiratory illness and skin/eye symptoms. Two-thirds of the study population (63.2%) reported direct contact with animals, of which 7.7% had contact with at least one unfamiliar animal. Participants exposed to unfamiliar animals had significantly higher odds of self-reporting all three acute health symptoms, when compared to non-animal-exposed participants (GI: AOR = 1.4, CI = 1.2-1.7; respiratory: AOR = 1.5, CI = 1.2-1.8; and skin/eye: AOR = 1.9, CI = 1.6-2.3), as well as when compared to participants who only had contact with familiar animals. Specific contact with dogs, cats or pet birds was also significantly associated with at least one acute health symptom; AORs ranged from 1.1 to 1.5, when compared to participants not exposed to each animal. These results indicate that contact with animals, especially unfamiliar animals, was significantly associated with GI, respiratory and skin/eye symptoms. Such associations could be attributable to zoonotic infections and allergic reactions. Etiological models for acute health symptoms should consider contact with companion animals, particularly exposure to unfamiliar animals. Prevention of pet-associated zoonotic diseases includes commonsense measures such as hand-washing, but are often overlooked by pet owners and non-pet owners alike.

Improving waterborne disease outbreak investigations.

This article is a summary of discussions held and recommendations made at a workshop for the investigation of waterborne disease outbreaks in Chapel Hill, North Carolina, December 7-8, 1998. Suspected waterborne outbreaks in the United States are primarily investigated by state and local public health officials who may infrequently conduct enteric disease outbreak investigations. Thus, it is important that officials have a formal plan to ensure that epidemiological studies are methodologically sound and that effective collaboration occurs among the epidemiologists, scientists, and engineers who will conduct the investigations. Laboratory support to analyze water samples and clinical specimens should be arranged well in advance of when services may be needed. Enhanced surveillance activities can help officials recognize additional outbreaks and initiate investigations in a timely manner. Epidemiologists should pay more attention early in the investigation to study design, questionnaire development, and sources of bias, especially recall bias, that may affect the interpretation of observed associations. Improved investigations can increase our knowledge about important etiological agents, water systems deficiencies, and sources of water contamination so that waterborne outbreaks can be more effectively prevented.

HPLC determination of cyanuric acid in swimming pool waters using phenyl and confirmatory porous graphitic carbon columns.

The chlorinated salts of cyanuric acid have found an important role in recreational swimming pool waters across the United States. Upon application to pool water, they can (1) release disinfectant chlorine or (2) stabilize the free available chlorine by acting as chlorine reservoirs in the form of cyanuric acid, preventing the photolytic destruction of residual chlorine by sunlight. Recommended levels of the cyanuric acid stabilizer are in the 10-100 mg/L concentration range according to the National Swimming Pool Foundation (San Antonio, TX). Two isocratic HPLC methods with UV detection (213 nm) employing phenyl and porous graphitic carbon (PGC) columns and phosphate buffer eluents (pH 6.7 and pH 9.1, respectively) were developed to accurately measure cyanuric acid in swimming pools. The two methods allowed fast separation and detection of the stabilizer in 4 (phenyl) and 8 (PGC) min. Both methods offered practical sensitivities with method detection limits of 0.07 (phenyl) and 0.02 mg/L (PGC). Neither one of the two methods required the use of sample cleanup cartridges. They exhibit chromatograms with excellent baseline stability enabling low-level quantitation. Most important, the PGC column had a useful lifetime of five months and 500 sample analyses/column. Eleven pool water samples were fortified with 4.8-50.0 mg/L stabilizer, and the average recovery was 99.8%. Finally, statistical analysis on the relative precisions of the two methods indicated equivalence at the 0.05 critical level.

An HPLC method with UV detection, pH control, and reductive ascorbic acid for cyanuric acid analysis in water.

Every year over 250 million pounds of cyanuric acid (CA) and chlorinated isocyanurates are produced industrially. These compounds are standard ingredients in formulations for household bleaches, industrial cleansers, dishwasher compounds, general sanitizers, and chlorine stabilizers. The method developed for CA using high-performance liquid chromatography (HPLC) with UV detection simplifies and optimizes certain parameters of previous methodologies by effective pH control of the eluent (95% phosphate buffer: 5% methanol, v/v) to the narrow pH range of 7.2-7.4. UV detection was set at the optimum wavelength of 213 nm where the cyanuric ion absorbs strongly. Analysis at the lower pH range of 6.8-7.1 proved inadequate due to CA keto-enol tautomerism, while at pHs of <6.8 there were substantial losses in analytical sensitivity. In contrast, pHs of >7.4 proved more sensitive but their use was rejected because of CA elution at the chromatographic void volume and due to chemical interferences. The complex equilibria of chlorinated isocyanurates and associated species were suppressed by using reductive ascorbic acid to restrict the products to CA. UV, HPLC-UV, and electrospray ionization mass spectrometry techniques were combined to monitor the reactive chlorinated isocyanurates and to support the use of ascorbic acid. The resulting method is reproducible and measures CA in the 0.5-125 mg/L linear concentration range with a method detection limit of 0.05 mg/L in water.

Criteria for evaluation of proposed protozoan detection methods.

There has been a proliferation of techniques and methods reported for analysis of water samples to determine the presence of the protozoan pathogens Cryptosporidium parvum and Giardia lamblia. Many of the proposed methods are presented as complete procedures, which include sampling, processing, staining, or detection steps while other methods are not complete. Some proposed methods have been extensively tested in multi-laboratory settings, however, others are still in the developmental stage. A set of evaluation criteria has been developed to evaluate the many proposed methods. These criteria have been applied as an example, to an existing method. These criteria should be useful to individuals attempting to evaluate methods developed for detecting protozoa in water, and conversely, they should serve as a guideline for individuals interested in developing methods, allowing them to gather data with and about their methods, and present this data in a manner that is both logical and easily evaluated.

A rapid, specific membrane filtration procedure for enumeration of enterococci in recreational water.

A two-step membrane filter (MF) method with mE medium, upon which the membrane must be incubated for 48 h and then transferred to a substrate medium to differentiate enterococci, is recommended by the U.S. Environmental Protection Agency to measure enterococci in fresh and marine recreational waters. The original mE medium was modified by reducing the triphenyltetrazolium chloride from 0.15 to 0.02 g/liter and adding 0.75 g of indoxyl beta-D-glucoside per liter. The new MF medium, mEI medium, detected levels of enterococci in 24 h comparable to those detected by the original mE medium in 48 h, with the same level of statistical confidence. In addition, the use of mEI medium eliminated the need to transfer the membrane to a substrate medium to differentiate enterococci from other genera of the fecal streptococcal group. Colonies from mEI medium were examined to determine the rates of false-positive and false-negative occurrences. mEI medium had a false-positive rate of 6.0% and a false-negative rate of 6.5%. Interlaboratory testing of the MF method with mEI medium demonstrated that the relative reproducibility standard deviations among laboratories ranged from 2.2% for marine water to 18.9% for freshwater. The comparative recovery studies, specificity determinations, and multilaboratory evaluation indicated that mEI medium has analytical performance characteristics equivalent to those of mE medium. The simplicity of use and decreased incubation time with mEI medium will facilitate the detection and quantification of enterococci in fresh and marine recreational waters.

New medium for the simultaneous detection of total coliforms and Escherichia coli in water.

A new membrane filter agar medium (MI agar) containing a chromogen, indoxyl-beta-D-glucuronide, and a fluorogen, 4-methylumbelliferyl-beta-D-galactopyranoside, was developed to simultaneously detect and enumerate Escherichia coli and total coliforms (TC) in water samples on the basis of their enzyme activities. TC produced beta-galactosidase, which cleaved 4-methylumbelliferyl-beta-D-galactopyranoside to form 4-methylumbelliferone, a compound that fluoresced under longwave UV light (366 nm), while E. coli produced beta-glucuronidase, which cleaved indoxyl-beta-D-glucuronide to form a blue color. The new medium TC and E. coli recoveries were compared with those of mEndo agar and two E. coli media, mTEC agar and nutrient agar supplemented with 4-methylumbelliferyl-beta-D-glucuronide, using natural water samples and spiked drinking water samples. On average, the new medium recovered 1.8 times as many TC as mEndo agar, with greatly reduced background counts (< or = 7%). These differences were statistically significant (significance level, 0.05). Although the overall analysis revealed no statistically significant difference between the E. coli recoveries on MI agar and mTEC agar, the new medium recovered more E. coli in 16 of 23 samples (69.6%). Both MI agar and mTEC agar recovered significantly more E. coli than nutrient agar supplemented with 4-methylumbelliferyl-beta-D-glucuronide. Specificities for E. coli, TC, and noncoliforms on MI agar were 95.7% (66 of 69 samples), 93.1% (161 of 173 samples), and 93.8% (61 of 65 samples), respectively. The E. coli false-positive and false-negative rates were both 4.3%. This selective and specific medium, which employs familiar membrane filter technology [corrected] to analyze several types of water samples, is less expensive than the liquid chromogen and fluorogen media and may be useful for compliance monitoring of drinking water.

Health risks from contaminated water: do class and race matter?

The impact of contaminants in water on minorities and economically disadvantaged persons was reviewed. Environmental legislation governing water was summarized as background information against which relevant studies were evaluated. The majority of the available information was anecdotal or case study and did not lend itself to making quantitative comparisons or analyses. However, the data did present certain trends that led to the conclusion that inequities concerning exposure to contaminants in water may exist. The following recommendations were made: current data bases should be analyzed and new data bases created to facilitate assessments of exposure to waterborne contaminants to all populations; an analysis of populations not covered by the Safe Drinking Water Act should be undertaken; a survey should be conducted of the drinking water infrastructure and the results evaluated to identify any impacts to minorities and economically disadvantaged persons; the social, cultural and economic characteristics that influence human exposure to waterborne contaminants need to be identified; and better educational and community outreach programs need to be developed and implemented.

A membrane filter procedure for assaying cytotoxic activity in heterotrophic bacteria isolated from drinking water.

Cytotoxic activity assays of Gram-negative, heterotrophic bacteria are often laborious and time consuming. The objective of this study was to develop in situ procedures for testing potential cytotoxic activities of heterotrophic bacteria isolated from drinking water systems. Water samples were passed through 0.45 microns membrane filters which were then placed upon appropriate media incubated. After incubation, each membrane filter was transferred to the surface of Y-1 mouse adrenal cells overlaid with 1% agar. The filters were removed after exposure for 15 min. The Y-1 cells were then incubated at 37 degrees C in 2.5% CO2 for an additional 24 h. The release of putative cytotoxic and cytotonic products from the bacterial colonies was recognized by zones of cellular lysis and injury of Y-1 cells that appeared immediately beneath the membrane. Cytotoxic strains of Aeromonas, Vibrio, Escherichia, and Legionella spp. were readily recognized by this method. About 1% of the bacteria isolated from drinking water also released cytotoxic products. This frequency was dependent upon the primary medium used and the density of bacteria present. The majority of cytotoxic strains isolated from drinking water also expressed protease activity (95%) and haemolytic activity (70%). This in situ membrane filter procedure is a facile method for simultaneously testing many different bacterial colonies.

Health effects of swimmers and nonpoint sources of contaminated water.

Microbiological contamination from nonpoint sources of pollution is usually related to animal faecal wastes through urban, pastureland and forest run-off of stormwater. Currently-used bacterial water quality indicators cannot discriminate between human and animal faecal contamination and, therefore, it is common practice to treat the risk associated with exposure to water polluted by animal or human wastes as equally hazardous. The purpose of this study was to determine if there is a risk of gastrointestinal illness after a swimming exposure to water contaminated with animal faecal wastes. The health status and swimming activity of volunteer study participants was followed for 49 days during June, July and August. Multiple bacterial indicators of water quality were monitored daily during the course of the study. Swimming-associated symptomatic gastrointestinal illness was observed in individuals who swam in animal nonpoint source contaminated water. Swimmer illness was not associated with high densities of common faecal indicator bacteria or high volume rainy days. Swimmer illness was associated with high numbers of swimmers per day and high densities of staphylococci. The observed illnesses appeared to be caused by a swimmer to swimmer transmission via the water.

Swimming-associated gastroenteritis and water quality.

A direct, linear relationship between swimming-associated gastrointestinal illness and the quality of the bathing water was obtained from a multi-year, multiple-location prospective epidemiologic-microbiologic research program conducted in New York City, 1973-1975, Lake Pontchartrain, Louisiana, 1977-1978, and Boston, Massachusetts, 1978. Several microbial indicators were used in attempting to define the quality of the water; and, of those examined, enterococci showed the best correlation to total and "highly credible" gastrointestinal symptoms. The frequency of gastrointestinal symptoms also had a high degree of association with distance from known sources of municipal wastewater. A striking feature of the relationship was the very low enterococcus and Escherichia coli densities in the water (10/100 ml) associated with appreciable attack rates (about 10/1000 persons) for "highly credible" gastrointestinal symptoms. Moreover, the ratio of the swimmer to nonswimmer symptom rates indicated that swimming in even marginally polluted marine bathing water is a significant route of transmission for the observed gastroenteritis.

Source and extent of Klebsiella pneumoniae in the paper industry.

Three pulp and paper mill processing plants were evaluated for fecal coliform and Klebsiella pneumoniae bacterial concentrations. Freshwater consumed by paper industries contained minimum detectable levels of K. pneumoniae, less than 10 organisms per 100 ml. Elevated concentrations of K. pneumoniae could be traced from early pulping stages to water processing reuse systems. Concentrations of K. pneumoniae (thermotolerant and thermointolerant) ranged from 40,000 organisms per 100 ml to an estimated 3 x 10(6) organisms per 100 ml. K. pneumoniae biotyping provided evidence for the selective growth and persistence of K. pneumoniae from the initial wood washing stages through to the final effluent discharge. Wastewater treatment had limited effects in reducing K. pneumoniae concentrations. K. pneumoniae levels ranged from 40 organisms per 100 ml to an estimated 10(6) organisms per 100 ml. The presence of K. pneumoniae in water indicates degraded water quality, and its significance with regard to human health effects has yet to be examined.

Membrane filter method for enumerating Escherichia coli.

A membrane filter procedure for enumerating Escherichia coli was developed and evaluated. The method quantifies E. coli within 24 h without requiring subculture and identification of isolates. It incorporates a primary selective-differential medium for gram-negative, lactose-fermenting bacteria; resuscitation of weakened organisms by incubation for 2 h at 35 degrees C before incubation at 44.5 degrees C for 18 to 22 h; and an in situ urease test to differentiate E. coli from other thermotolerant, lactose-positive organisms. The recovery of E. coli from marine, estuarine, and freshwater samples exceeded 90%. Of the presumptively positive colonies, 91% were verified as E. coli. Less than 1% of all of the verified E. coli colonies failed to react typically.

Relationship of microbial indicators to health effects at marine bathing beaches.

Findings are described from the second year of an epidemiological-microbiological study conducted at New York City beaches as part of the U.S. Environmental Protection Agency program to develop health effects-recreational water quality criteria. Symptomatology rates among swimmers (defined as immersion of the head in the water) relative to nonswimming but beach-going controls at a "barely acceptable" (BA) beach and a "relatively unpolluted" (RU) beach were examined. Data were collected by contacting family groups at the beach on weekends, obtaining information on bathing activity, and then questioning them by phone some 8--10 days later. In addition measurements were made for a number of potential water quality indicators. It was observed that the symptom rates, categorized as gastrointestinal (GI), respiratory, "other", and "disabling" (stayed home, stayed in bed, consulted a physician), were higher among swimmers than nonswimmers. As in the pretest conducted the previous year, the rate of GI symptoms was significantly higher among swimmers relative to nonswimmers at the BA but not the RU beach. Children, Hispanic Americans, and the low-middle socioeconomic groups were identified as the most susceptible portions of the population.

Membrane filter procedure for enumerating the component genera of the coliform group in seawater.

A facile, quantitative, membrane filter procedure (mC) for defining the distribution of coliform populations in seawater according to the component genera was developed. The procedure, which utilizes a series of in situ substrate tests to obviate the picking of colonies for identification, also provides an estimate of the total coliform density. When pure cultures of Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae were suspended in seawater and held at 4 C for 24 h, between 56 and 100% of the cells which grew on nutrient agar spread plates at 35 C could be recovered by the mC procedure. Confirmation as coliforms of typical colonies from natural samples was about 95%. Assay variability was found to be insignificant. The recovery of coliforms from marine waters by the mC procedure was comparable to those obtainable by current methods. Klebsiella was differentiated by the urease reaction and E. coli by its ability to form indole. The confirmation frequencies for colonies designated as Klebsiella and E. coli by the in situ tests approached 95% for the former and 98% for the latter.