Prospective epidemiological studies of beach water pollution were conducted in Hong Kong in the summers of 1986 and 1987. For the main study in 1987, a total of 18741 usable responses were obtained from beachgoers on nine beaches at weekends. The study indicated the overall perceived symptom rates for gastrointestinal, ear, eye, skin, respiratory, fever and total illness were significantly higher for swimmers than non-swimmers; and the swimming-associated symptom rates for gastrointestinal, skin, respiratory and total illness were higher at 'barely acceptable' beaches than at 'relatively unpolluted' ones. Escherichia coli was found to be the best indicator of the health effects associated with swimming in the beaches of Hong Kong. It showed the highest correlation with combined swimming-associated gastroenteritis and skin symptom rates when compared with other microbial indicators. A linear relationship between E. coli and the combined symptom rates was established. Staphylococci were correlated with ear, respiratory and total illness, but could not be used for predicting swimming-associated health risks. They should be used to complement E. coli. The setting of health-related bathing-water quality standards based on such a study is discussed.

Daily and hourly variations in microbial indicators densities in the beach-waters of Hong Kong have been described. The levels of Escherichia coli at a number of beaches was observed to be influenced by tide, and for staphylococci, by bather numbers. The tidal influence was most obvious during spring tides; and for the effect of bathers, during neap tides. Both organisms are present in high densities in external sources of faecal pollution of bathing beaches, with the average staphylococci to E. coli ratios being 0.04-3. Staphylococci may serve as an indicator of bather density and the risk of cross-infection amongst bathers (rather than as another indicator of faecal contamination) when the average staphylococci to E. coli ratio for a bathing beach is considerably higher than 3. The variability of microbial indicator densities means the routine sampling of bathing beaches should be carried out on weekend days with maximum numbers of swimmers exposed to the water, and spread throughout the bathing season.

A prospective epidemiological study was undertaken in Hong Kong in 1987, in which 18,741 usable responses were obtained. It showed bathing in the coastal beaches of Hong Kong poses an increased risk of developing gastrointestinal, ear, eye, skin, respiratory and total illness. Swimmers immersed in the more polluted beach waters are exposed to a significantly higher risk of contracting swimming-associated gastrointestinal, skin, respiratory and total illness. E. coli was found to be the best indicator for swimming-associated gastroenteritis and skin symptoms amongst the bathers, and a linear relationship could be established. Staphylococci was a good indicator for ear, respiratory and total illness, and should be used in complementary to E. coli. Beach water quality objectives for both E. coli and staphylococci have been proposed. A 4-tier classification system (rather than a single acceptability criterion) based on swimming-associated health risks has been developed for the beaches of Hong Kong. Information on the bacterial water quality and health risk levels of individual beaches is reported to the public both annually and fortnightly, so that beach-goers can choose where to go for swimming based on health effects data.

No abstract