A Swimming-Associated Outbreak of Hemorrhagic Colitis Caused by Escherichia coli O157:H7 and Shigella Sonnei

We, Keene; Jm, McAnulty; Fc, Hoesly; Lp, Williams; Hedberg, Katrina; Gl, Oxman; Tj, Barrett; Ma, Ping; Dw, Fleming

doi:10.1056/nejm199409013310904

Cited by 287 publications

(175 citation statements)

References 29 publications

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“…In 1991, 21 cases of E. coli O157:H7 associated with swimming in a lake were reported in Oregon. 10 In 1995, five children in Illinois with E. coli O157:H7 infection had statistically significant exposure to lake water. 7 In these outbreaks, human contamination of lake water was postulated as the source.…”

Section: Discussionmentioning

confidence: 99%

A Cluster of Escherichia coli O157: Nonmotile Infections Associated with Recreational Exposure to Lake Water

Feldman

Mohle-Boetani²,

Ward³

et al. 2002

Public Health Reports

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SYNOPSISObjectives. To identify cases and determine risk factors for an outbreak of Escherichia coli (E. coli) O157:nonmotile (NM) infections in children attending a summer day care program in California.Methods. The authors conducted a retrospective cohort study; the cohort comprised first and second graders who attended the day care program during the last week in August 1999. Shiga toxin testing and molecular subtyping using pulsed-field gel electrophoresis were performed on isolates. Lake water, lake bottom sediment samples, and waterfowl feces from the lake environs were cultured for E. coli O157.Results. Three cases of Shiga toxin-producing E. coli O157:NM infections with matching pulsed-field gel electrophoresis patterns and four probable cases were found. Children who swallowed more than a mouthful of water had a higher attack rate than those who swallowed less than a mouthful or none at all (43% vs. 10%, relative risk = 4.43, 95% confidence interval 1.12, 17.50).Conclusions. E. coli O157:NM infections were associated with swallowing water from a freshwater lake. Potential sources of contamination include feces from humans, cattle, or deer. This outbreak illustrates the value in screening patients with diarrhea for E. coli O157, submitting isolates to public health laboratories, and using molecular techniques to identify related cases. Outbreaks associated with contaminated freshwater could be averted by prevention and early detection of contamination.

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Section: Discussionmentioning

confidence: 99%

A Cluster of Escherichia coli O157: Nonmotile Infections Associated with Recreational Exposure to Lake Water

Feldman

Mohle-Boetani²,

Ward³

et al. 2002

Public Health Reports

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“…Though not more than 100 bacteria is enough for infection [25], water-related dysentery outbreaks more recently are rather rare in the developed countries. Infrequent outbreaks are reported from the USA, but most of them are caused by contaminated natural bathing waters sometimes in combination with other enteric pathogens [26]. Shigelloses linked to treated recreational venues have been reported in 7 occasions to the WBDOSS in the period of time chosen for analysis.…”

Section: Bacteriamentioning

confidence: 99%

The risk of contracting infectious diseases in public swimming pools. A review

Barna

Kádár

2012

Annali Dell'Istituto Superiore Di Sanità

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Summary.A review of pathogenic microorganisms presenting risk of infection in pool based artificial recreational water venues is extracted from the available scientific literature. The microorganisms are grouped both according to their way of spread and their survival and growth strategies and their characteristics relevant for the pool and spa based recreation are discussed. In order to put the proposed risks on a solid basis, among others a ten year excerpt of the waterborne disease statistics of the Centers for Disease Control and Prevention (CDC) is used throughout the article.Key words: man-made water recreational environment, risk of infection, waterborne disease outbreaks, swimming pool, hot tub.Riassunto (Il rischio di contrarre malattie infettive nelle piscine pubbliche. Una rassegna). Viene presentata una sintesi della letteratura scientifica disponibile sui microorganismi patogeni potenzialmente infettivi, in ambienti acquatici ricreativi artificiali, come le piscine. I microorganismi sono raggruppati sia in base alle loro vie di diffusione che in base alle loro strategie di sopravvivenza e di crescita; successivamente vengono discusse le loro caratteristiche più importanti negli ambienti ricreativi considerati, piscine e terme. Per fornire adeguate e solide basi scientifiche ai tipi di rischi presentati, vengono analizzate, oltre ad altri documenti, le statistiche relative a dieci anni di osservazione di malattie legate all'acqua del Centers for Disease Control and Prevention (CDC).Parole chiave: ambienti ricreativi acquatici artificiali, rischio di infezione, epidemie di malattie legate all'acqua, piscine, vasche da idromassaggio.

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“…Some outbreaks of Shigella sonnei (human pathogen) associated with activities in recreational freshwaters have been reported. In these outbreaks, the bacteria source mostly implicated were bathers who had been attending the beaches [27][28][29]. Bathers can also carry fecal microorganisms from the sand to the water and also stir up bottom sediment, making contact between bathers and the microorganisms trapped in sediment more frequent [30].…”

Section: Urban Activitiesmentioning

confidence: 99%

Monitoring Recreational Waters: How to Integrate Environmental Determinants

Turgeon¹

2012

JEP

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Recreational waters are associated with a higher risk of disease for people engaged in activities that bring them into contact with these waters. The primary cause of contamination of recreational waters is fecal microorganisms, which may originate from various sources and involve several modulating factors, making it a complex public health and environmental issue. Monitoring recreational water quality should include two key components: Microbial water testing and monitoring environmental determinants associated with higher risks of contamination. Conducting both activities provides the foundation for a comprehensive assessment according to risk and the actual level of fecal pollution and thus could promote good management actions to ensure safe water quality. Nevertheless, monitoring of environmental determinants is rarely fully integrated in monitoring programs and is also harder to achieve, especially when water pollution is mainly associated with nonpoint sources. In order to achieve identification and monitoring of environmental determinants associated with fecal contamination of recreational waters, some specific steps should be followed and some questions must be answered. The objective of this review article is to present current knowledge on this topic and to suggest and discuss recommendations. Potential sources of contamination and factors able to modulate them should be identified and measured after the geographical area influencing fecal contamination of recreational water has been delineated. Statistical models have been developed to identify the relative importance of these environmental characteristics on fecal pollution of recreational waters but they do not allow for a full comprehension of the exact processes leading to this pollution, thus other methods should also be used to better understand these processes.

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A Swimming-Associated Outbreak of Hemorrhagic Colitis Caused by Escherichia coli O157:H7 and Shigella Sonnei

Abstract: Lake water that was fecally contaminated by bathers was the most likely vehicle for the transmission of both the E. coli O157:H7 and the S. sonnei infections. The unusually prolonged outbreak suggests both the survival of these enteric organisms in lake water and a low infectious dose.

Cited by 287 publications

References 29 publications

A Cluster of Escherichia coli O157: Nonmotile Infections Associated with Recreational Exposure to Lake Water

A Cluster of Escherichia coli O157: Nonmotile Infections Associated with Recreational Exposure to Lake Water

The risk of contracting infectious diseases in public swimming pools. A review

Monitoring Recreational Waters: How to Integrate Environmental Determinants

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