Health and safety in recreational waters

Bull World Health Organ 2014;92:79 | doi: http://dx.doi.org/10.2471/BLT.13.126391 Editorials 79 The recreational use of waters has in- creased in recent decades all over the world. Swimming pools and other recre- ational water facilities offer opportunities for enjoyment and health promotion, but they also may involve health risks, de- spite the fact that better management and modern technologies for water treatment and quality monitoring (e.g. real-time protocols for detecting bacteria), have made such facilities safer.1,2 Several communicable diseases – cryptosporidiosis, giardiasis, leptospiro- sis, legionellosis, bacterial and viral gas- troenteritis – are commonly associated with bathing in recreational waters.3,4 According to field study surveys in dif- ferent countries, the rate of diarrhoeal illness among swimmers ranges from 3 to 8%.5,6 Injuries are also common. In the United Kingdom of Great Britain and Northern Ireland alone, more than 13 000 injuries are estimated to occur annually, on average, among bathers.3,4 Preventing injuries, drownings, the toxic effects of chemical contaminants and outbreaks of waterborne diseases in people who swim in recreational waters calls for a sustained, concerted, multisectoral effort involving epidemi- ologists, physicians, microbiologists, toxicologists, builders, public opinion leaders and public health authorities. Swimming pools and spas are used by millions of people seeking recreation, rehabilitation, wellness and other health benefits. According to 2011 market data issued by the European Union of Swim- ming Pool and Spa Associations, 5.7 mil- lion pools exist in Europe, or about one for every 150 inhabitants.7 A large part of the world’s population is exposed to the health risks posed by swimming pools, which account for much of the world’s water consumption.8 This includes chil- dren, the elderly, pregnant women and people with immunodeficiency and dis- abilities. People in certain occupations, such as swimming coaches, water sport professionals and pool operators, are also exposed to such risks. In the twenty-first century, interna- tional safety standards or harmonized national safety laws are essential in light of the booming tourist industry – now the third largest in the world. From a global health perspective, water facilities must be made safe not just for resident populations, but also for travellers. The absence of an international regulatory framework for pool and spa safety and the presence of incomplete national regulations in many countries put lo- cal populations and visitors at risk. For example, Europe’s lack of a directive on safety in swimming pools and other rec- reational water facilities limits standard- ization and harmonization throughout the continent. Several institutions have recognized the need for international pool and spa safety regulations. This point was dis- cussed in Rome last April, at the Fifth International Conference on Swimming Pool and Spa.9 The Conference focused on the role of aquatic recreational envi- ronments in health promotion but also called attention to the need for good sur- veillance and prevention to reduce safety hazards. Engineers, chemists, biologists, public health experts, architects, sociol- ogists, occupational medicine specialists and ecologists were in attendance. This large and committed panel of experts can update safety guidelines periodically and support their local dissemination through universities and research cen- tres, public health authorities, swim- ming pool managers and sports clubs and organizations catering to tourists and local residents. Conference attendees also dis- cussed new technologies for monitor- ing the microbiological and chemical safety of recreational waters. Techno- logical innovations can play a pivotal role in prevention. Rapid techniques for monitoring water quality can al- low for quick measures in response to contamination. The new technologies are gradually shifting the focus from mandatory safety requirements towards expectations of good water quality and towards the implementation of collab- orative surveillance strategies based on the hazard analysis and critical control point model. Use of the new technolo- gies must, of course, be harmonized and adopted in consultation with public health institutions to avoid any risk to bathers from the application of unvali- dated procedures. Appropriate water sanitation and safety measures are not the only pri- orities, however. Water is a scarce com- modity. The conservation of this most precious resource and its rational use in recreation calls for advanced water management in the context of sustain- able development. This and other issues will be discussed in Amsterdam in 2015 at the Sixth International Conference on Swimming Pool and Spa,10 which scien- tists are currently organizing, together with World Water Day (22 March 2014) and other activities promoted by agen- cies such as UN-Water and the United Nations Educational, Scientific and Cultural Organization. ■ References 1. Guidelines for safe recreational water environments. Volume 2: Swimming pools and similar environments. Geneva: World Health Organization; 2006. 2. World Health Organization [Internet]. World Water Day 2001: water for positive health. Geneva: WHO; 2013. 3. The Royal Society for the Prevention of Accidents [Internet]. Home and leisure accident statistics. Birmingham: RoSPA; 2013. 4. Sanborn M, Takaro T. Recreational water-related illness: office management and prevention. Can Fam Physician 2013;59:491–5. 5. Fournet N, Deege MP, Urbanus AT, Nichols G, Rosner BM, Chalmers RM et al. Simultaneous increase of Cryptosporidium infections in the Netherlands, the United Kingdom and Germany in late summer season, 2012. Euro Surveill 2013;18. 6. Dwight RH, Baker DB, Semenza JC, Olson BH. Health effects associated with recreational coastal water use: urban versus rural California. Am J Public Health 2004;94:565–7. 7. European Union of Swimming Pool and Spa Associations. Brussels: EUSA; 2013. 8. EarthCheck Research Institute. White paper on tourism and water. Brisbane (QLD): EarthCheck; 2013. 9. Fifth International Conference on Swimming Pool and Spa, Rome, 2013 [Internet]. Rome: ICSPS; 2012. 10. Sixth International Conference on Swimming Pool and Spa, the Netherlands, 2015 [Internet]. Rome: ICSPS; 2013. Health and safety in recreational waters Saverio Giampaolia & Vincenzo Romano Spicaa a Public Health Unit, University of Rome “Foro Italico”, Rome, Italy. Correspondence to Vincenzo Romano Spica (e-mail: vincenzo.romanospica@uniroma4.it).