A community outbreak of echovirus infection associated with an outdoor swimming pool

Abstract

Forty-six people became ill with vomiting, diarrhoea and headache within days of an outdoor swimming pool opening for the summer season in a small seaside village. During the weekend of the outbreak, 185 tickets to the pool had been sold. It was found that 34 bathers were ill, and one subject had vomited into the pool. All other cases arose after this incident. The risk of infection was greatest among those who swallowed pool water (24/28 versus 10/17, p = 0.07). Echovirus 30 was isolated from the case who vomited into the pool and from six other cases. Normal chlorine levels had not been adequate to contain the infection risk from vomitus, and, in future, pool attendants witnessing such incidents should consider closing the pool to the public and seeking advice on superchlorination.

Incorporating susceptible subpopulations in microbial risk assessment: pediatric exposures to enteroviruses in river water

“…Polioviruses, coxsackievirus A and B, and echoviruses have been found in rivers (e.g., Payment et al, 1988;Miyama et al, 1992;Tani et al, 1995), but coxsackievirus A and B and echoviruses have also been reported in lakes (D'Alessio et al, 1981) and swimming pools (Kee et al, 1994). Sources of waterborne enteroviruses suggested in the scientific literature include sewage (Oostvort et al, 1994;Van der Avoort et al, 1995), storm sewer discharge and runoff (D'Alessio et al, 1981), human activities (Payment et al, 1988;Kee et al, 1994), and diapers and sullage (Field et al, 1968).…”

“…Not all of these reports concluded that recreational water was the source of infection. There is more evidence that rules out waterborne transmission (Field et al, 1968;Hawley et al, 1973;Danes et al, 1983;Oostvort et al, 1994;Mulders et al, 1997, Rodriguez et al, 1997Gosbell et al, 2000) or is not definitive (Matsura et al, 1984;Rumke et al, 1995) than there is evidence that is suggestive (D'Alessio et al, 1981) or definitive (Kee et al, 1994) for transmission of enteroviruses through recreational water.…”

“…The symptoms included headache, fever, vomiting, abdominal cramps, diarrhea, unspecified gastrointestinal symptoms, and pharyngitis (Hawley et al, 1973;D'Alessio et al, 1981;Kee et al, 1994). Danes et al (1983) stated that there was a high incidence of enteroviral infections among children aged 5-16 years, but did not provide data for the incidence to be calculated.…”

“…Kee et al (1994) indicated that 26% (12 of 46) of their echovirus type 30 cases were probably secondary cases.…”

“…Children as a Sensitive Subpopulation Two studies provided quantitative epidemiological evidence that children are at increased risk of enteroviral illnesses following contact with recreational waters (D'Alessio et al, 1981;Kee et al, 1994). In a study of lake beach users, D'Alessio et al reported that 90% of 134 ill children under age 16 years tested positive for nonpolio enteroviruses (coxsackievirus A (34%), coxsackievirus B (22%), echoviruses (29%), untypable enteroviruses (4%), and other viruses (11%)) compared with 7% of the 27 well children (D'Alessio et al, 1981).…”