A Study of the Proportions of Swimmers Among Well Controls and Children With Enterovirus-Like Illness Shedding or Not Shedding an Enterovirus

Abstract

CHildren between the ages of less than 1 year and 15 years who visited a pediatric clinic in Madison, Wisconsin, from June 13 through September 1, 1977, were surveyed for the frequency and location of swimming they had done in the two weeks prior to the clinic visit. The study population consisted of 679 well controls, and 296 children with enteroviral-like syndromes. Throat and rectal swab specimens were collected from 241 of the ill patients and from 27 well children. Non-polio enteroviruses were recovered from 119 ill and two well individuals. Other viruses were recovered from an additional 13 ill patients. The majority of viral-like syndromes were respiratory, with or without fever and gastrointestinal symptoms. Exclusive beach swimmers had significantly (p less than 0.0005) increased relative risk (odds ratio estimate 3.41) of enterovirus illness. The highest relative risk (10.63) of enterovirus illness occurred in children less than 4 years old who were exclusive beach swimmers. Swimming in pools exclusively carried no significantly increased risk of enterovirus illness. Children with apparent viral illnesses based on clinical findings, who had no virus isolated, did not differ from well controls in the type of swimming exposure (either beaches or pools) in the two weeks prior to their clinic visit.

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).…”

“…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.…”

“…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. Some patterns can be seen among cases reported by age (D'Alessio et al, 1981;Miyama et al, 1992;Oostvort et al, 1994), gender (Oostvort et al, 1994;Rodriguez et al, 1997), and proximity to the index case (Hawley et al, 1973;Oostvort et al, 1994;Van der Avoort et al, 1995). Typically, cases were younger children, men, or persons in close contact with index cases.…”

“…Secondary transmission reportedly occurred in coxsackievirus B5 (Hawley et al, 1973) and echovirus type 30 (Gosbell et al, 2000) outbreaks and was probably low in a set of cases with coxsackievirus A and B and/or echovirus infections (D'Alessio et al, 1981). Kee et al (1994) indicated that 26% (12 of 46) of their echovirus type 30 cases were probably secondary cases.…”

“…Other Related risk factors noted in the epidemiological literature on recreational water exposures include swimming, frequency of swimming, head immersion during swimming, and swallowing recreational water (Hawley et al, 1973;Denis et al, 1974;D'Alessio et al, 1981). It should be noted that these factors tend to be age-related behaviors and may be more common among young males.…”