The BEACHES Study: health effects and exposures from non-point source microbial contaminants in subtropical recreational marine waters

Fleisher, Jay M.; Fleming, Lora E.; Solo‐Gabriele, Helena M.; Kish, Jonathan; Sinigalliano, Christopher D.; Plano, Lisa R. W.; Elmir, Samir M.; Wang, John D.; Withum, Kelly; Shibata, Tomoyuki; Gidley, Maribeth L.; Abdelzaher, Amir M.; He, Guoqing; Ortega, Cristina; Zhu, Xiaofang; Wright, Mary E.; Hollenbeck, Julie; Backer, Lorraine C.

doi:10.1093/ije/dyq084

Cited by 127 publications

(118 citation statements)

References 25 publications

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“…Little was known about the relationship of enterococci and other FIB to human health in recreational waters contaminated by nonpoint sources when the regulations were promulgated (115). Recently, some studies found an association between densities of enterococci and illness rates at beaches impacted by nonpoint sources of contamination (104,304). While there was an increased incidence of gastrointestinal illness, respiratory illness, and skin illness in bathers in one study (104), the only health effect with a dose-response relationship to concentrations of indicator bacteria in both studies was skin illnesses (104,304).…”

Section: Use Of Enterococci As Fecal Indicator Bacteriamentioning

confidence: 96%

“…Recently, some studies found an association between densities of enterococci and illness rates at beaches impacted by nonpoint sources of contamination (104,304). While there was an increased incidence of gastrointestinal illness, respiratory illness, and skin illness in bathers in one study (104), the only health effect with a dose-response relationship to concentrations of indicator bacteria in both studies was skin illnesses (104,304). Furthermore, in a comparison of analytical methods, the dose-response relationship for skin illness was seen only with samples analyzed by membrane filtration (304).…”

Section: Use Of Enterococci As Fecal Indicator Bacteriamentioning

confidence: 99%

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Enterococci in the Environment

Byappanahalli

Nevers

Korajkic

et al. 2012

Microbiol Mol Biol Rev

554

383

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SUMMARYEnterococci are common, commensal members of gut communities in mammals and birds, yet they are also opportunistic pathogens that cause millions of human and animal infections annually. Because they are shed in human and animal feces, are readily culturable, and predict human health risks from exposure to polluted recreational waters, they are used as surrogates for waterborne pathogens and as fecal indicator bacteria (FIB) in research and in water quality testing throughout the world. Evidence from several decades of research demonstrates, however, that enterococci may be present in high densities in the absence of obvious fecal sources and that environmental reservoirs of these FIB are important sources and sinks, with the potential to impact water quality. This review focuses on the distribution and microbial ecology of enterococci in environmental (secondary) habitats, including the effect of environmental stressors; an outline of their known and apparent sources, sinks, and fluxes; and an overview of the use of enterococci as FIB. Finally, the significance of emerging methodologies, such as microbial source tracking (MST) and empirical predictive models, as tools in water quality monitoring is addressed. The mounting evidence for widespread extraenteric sources and reservoirs of enterococci demonstrates the versatility of the genusEnterococcusand argues for the necessity of a better understanding of their ecology in natural environments, as well as their roles as opportunistic pathogens and indicators of human pathogens.

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Section: Use Of Enterococci As Fecal Indicator Bacteriamentioning

confidence: 96%

Section: Use Of Enterococci As Fecal Indicator Bacteriamentioning

confidence: 99%

Enterococci in the Environment

Byappanahalli

Nevers

Korajkic

et al. 2012

Microbiol Mol Biol Rev

554

383

View full text Add to dashboard Cite

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“…Numerous studies have shown that beach sand may serve as a reservoir for pathogens harmful to human health and indicator microbes that can be released into surrounding waters through tidal action or run-off (Alm et al, 2003;Whitman and Nevers, 2003;Boehm and Weisberg, 2005;Beversdorf et al, 2007;Colford et al, 2007;Fleisher et al, 2010;Ge et al, 2010;Sinigalliano et al, 2010;Abdelzaher et al, 2010). Several authors have reported that both indicator bacteria and potential pathogens occur in beach sands of both freshwater and marine environments (Sanchez et al, 1986;Ghinsberg et al, 1994Ghinsberg et al, , 1995Obiri-Danso and Jones, 2000;Desmarais et al, 2002;Sato et al, 2005;Vantarakis et al, 2005;Beversdorf et al, 2007;Bonilla et al, 2007;Vogel et al, 2007;Hartz et al, 2008;Abdelzaher et al, 2010).…”

Section: Bacteriamentioning

confidence: 99%

Routine screening of harmful microorganisms in beach sands: Implications to public health

Sabino

Rodrigues

Costa

et al. 2014

Science of The Total Environment

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Beaches worldwide provide recreational opportunities to hundreds of millions of people and serve as important components of coastal economies. Beach water is often monitored for microbiological quality to detect the presence of indicators of human sewage contamination so as to prevent public health outbreaks associated with water contact. However, growing evidence suggests that beach sand can harbor microbes harmful to human health, often in concentrations greater than the beach water. Currently, there are no standards for monitoring, sampling, analyzing, or managing beach sand quality. In addition to indicator microbes, growing evidence has identified pathogenic bacteria, viruses, and fungi in a variety of beach sands worldwide. The public health threat associated with these populations through direct and indirect contact is unknown because so little research has been conducted relating to health outcomes associated with sand quality. In this manuscript, we present the consensus findings of a workshop of experts convened in Lisbon, Portugal to discuss the current state of knowledge on beach sand microbiological quality and to develop suggestions for standardizing the evaluation of sand at coastal beaches. The expert group at the "Microareias 2012" workshop recommends that 1) beach sand should be screened for a variety of pathogens harmful to human health, and sand monitoring should then be initiated alongside regular water monitoring; 2) sampling and analysis protocols should be standardized to allow proper comparisons among beach locations; and 3) further studies are needed to estimate human health risk with exposure to contaminated beach sand. Much of the manuscript is focused on research specific to Portugal, but similar results have been found elsewhere, and the findings have worldwide implications.

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“…Recent waterbody closures at Brazilian Olympic venues 4 and Waikiki beach, Hawaii 5 illustrate recreational water contamination's public health and economic reach. Several cohort studies and randomized trials have measured swimming-related health risks and risks associated with exposure to waters containing elevated fecal indicator bacteria levels, [6][7][8][9][10][11][12][13][14][15][16][17] but individual studies are usually too small to estimate the public health burden associated with water exposure with respect to missed daily activities (work, school, vacation) or medical visits and hospitalizations that result from gastroenteritis. Moreover, individual studies have not typically enrolled enough swimmers to estimate risks separately for children.…”

mentioning

confidence: 99%

Acute Gastroenteritis and Recreational Water: Highest Burden Among Young US Children

et al. 2016

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Objectives. To provide summary estimates of gastroenteritis risks and illness burden associated with recreational water exposure and determine whether children have higher risks and burden. Methods. We combined individual participant data from 13 prospective cohorts at marine and freshwater beaches throughout the United States (n = 84 411). We measured incident outcomes within 10 days of exposure: diarrhea, gastrointestinal illness, missed daily activity (work, school, vacation), and medical visits. We estimated the relationship between outcomes and 2 exposures: body immersion swimming and Enterococcus spp. fecal indicator bacteria levels in the water. We also estimated the population-attributable risk associated with these exposures. Results. Water exposure accounted for 21% of diarrhea episodes and 9% of missed daily activities but was unassociated with gastroenteritis leading to medical consultation. Children aged 0 to 4 and 5 to 10 years had the most water exposure, exhibited stronger associations between levels of water quality and illness, and accounted for the largest attributable illness burden. Conclusions. The higher gastroenteritis risk and associated burden in young children presents important new information to inform future recreational water quality guidelines designed to protect public health.

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The BEACHES Study: health effects and exposures from non-point source microbial contaminants in subtropical recreational marine waters

Cited by 127 publications

References 25 publications

Enterococci in the Environment

Enterococci in the Environment

Routine screening of harmful microorganisms in beach sands: Implications to public health

Acute Gastroenteritis and Recreational Water: Highest Burden Among Young US Children

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