Activities such as swimming, paddling, motor-boating, and fishing are relatively common on US surface waters. Water recreators have a higher rate of acute gastrointestinal illness, along with other illnesses including respiratory, ear, eye, and skin symptoms, compared to non-water recreators. The quantity and costs of such illnesses are unknown on a national scale. Recreational waterborne illness incidence and severity were estimated using data from prospective cohort studies of water recreation, reports of recreational waterborne disease outbreaks, and national water recreation statistics. Costs associated with medication use, healthcare provider visits, emergency department (ED) visits, hospitalizations, lost productivity, long-term sequelae, and mortality were aggregated. An estimated 4 billion surface water recreation events occur annually, resulting in an estimated 90 million illnesses nationwide and costs of $2.2- $3.7 billion annually (central 90% of values). Illnesses of moderate severity (visit to a health care provider or ED) were responsible for over 65% of the economic burden (central 90% of values: $1.4- $2.4 billion); severe illnesses (result in hospitalization or death) were responsible for approximately 8% of the total economic burden (central 90% of values: $108- $614 million). Recreational waterborne illnesses are associated with a substantial economic burden. These findings may be useful in cost-benefit analysis for water quality improvement and other risk reduction initiatives.

Aims: The goal of this study was to characterize enteric virus concentrations and their infectivity in a variety of limited-contact recreation and bathing waters, including Great Lakes beaches, inland lakes, rivers, and an effluent-dominated urban waterway. Additionally, we evaluated associations between point sources of human faecal pollution and enterovirus and adenovirus presence and concentrations. Methods and Results: Quantitative polymerase chain reaction (qPCR) and two cell culture lines were used to identify and quantify viruses in water samples. The presence of human adenoviruses F was strongly associated with effluent-dominated waters (odds ratio 6·1, confidence interval 2·3, 15·7), as was adenovirus concentration; though, neither enterovirus presence nor concentration was associated with an effluent source. Samples with high concentrations of qPCR targets all tested positive by cell culture on both cell lines, although qPCR target concentrations were not correlated with culture values. Conclusions: Adenovirus was strongly associated with point sources of human faecal pollution while enterovirus was not, indicating that adenovirus measured by qPCR is a better target than enterovirus for identifying wastewater discharges in recreational freshwaters. Significance and Impact of the Study: The development of monitoring for enteric human viral pathogens at recreational waters should include adenovirus testing. Further research is needed to interpret the results of qPCR testing in relationship to the presence of infectious viruses using cell culture.

A peer-reviewed open access journal published by the National Institute of Environmental Health Sciences

The United States Environmental Protection Agency has established methods for testing beach water using the rapid quantitative polymerase chain reaction (qPCR) method, as well as “beach action values” so that the results of such testing can be used to make same-day beach management decisions. Despite its numerous advantages over culture-based monitoring approaches, qPCR monitoring has yet to become widely used in the US or elsewhere. Considering qPCR results obtained on a given day as the best available measure of that day’s water quality, we evaluated the frequency of correct vs. incorrect beach management decisions that are driven by culture testing. Beaches in Chicago, USA, were monitored using E. coli culture and enterococci qPCR methods over 894 beach-days in the summers of 2015 and 2016. Agreement in beach management using the two methods, after taking into account agreement due to chance, was summarized using Cohen’s kappa statistic. No meaningful agreement (beyond that expected by chance) was observed between beach management actions driven by the two pieces of information available to beach managers on a given day: enterococci qPCR results ofsamples collected that morning and E. coli culture results of samples collected the previous day. The E. coli culture beach action value was exceeded 3.4 times more frequently than the enterococci qPCR beach action value (22.6 vs. 6.6% of beach-days). The largest evaluation of qPCR-based beach monitoring to date provides little scientific rationale for continued E. coli culture testing of beach water in our setting. The observation that the E. coli culture beach action value was exceeded three times as frequently as the enterococci qPCR beach action value suggests that, although the beach action values for bacteria using different measurement methods are thought to provide comparable information about health risk, this does not appear to be the case in all settings.