CDC REVIEW ARTICLE. Edited by: Larry K. Pickering, MD. Reducing Illness Transmission From Disinfected Recreational Water Venues
|
|
- Lee Perry
- 6 years ago
- Views:
Transcription
1 CDC REVIEW ARTICLE Edited by: Larry K. Pickering, MD Editor s Note: Outbreaks of recreational water-related illnesses have shown an increasing trend over the past 10 years. Strategies for prevention and control include recruiting health care professionals to educate their patient populations about healthy swimming habits. This article highlights important issues and directions the medical community can implement to reduce recreational water-related infectious diseases. Reducing Illness Transmission From Disinfected Recreational Water Venues Swimming, Diarrhea and the Emergence of a New Public Health Concern Mei Lin Castor, MD, and Michael J. Beach, PhD* Abstract: Recreational water-related illnesses are associated with swimming in contaminated water venues. The transmission of diarrheal illness in disinfected settings is influenced by several factors which include: chlorine resistance in waterborne pathogens; poor facility maintenance of disinfectant levels; and lack of healthy swimming habits. Health care providers can help to disseminate healthy swimming messages to their patients and help to prevent and control this emerging public health concern. Key Words: recreational water illnesses, swimming, Cryptosporidium, swimming pools, education, shiga toxinproducing Escherichia coli, Giardia, Escherichia coli O157:H7 (Pediatr Infect Dis J 2004;23: ) Water, both drinking and recreational, is a well-documented transmission vehicle for infectious diseases throughout the world. 1 Recreational water-related illnesses refer to the spectrum of illnesses associated with swimming in contaminated recreational water venues such as swimming pools, hot tubs, lakes, rivers and the ocean. Recreational water-related illnesses include diarrhea and skin, ear, eye, neurologic, respiratory and wound infections Some of the consequences of these waterborne infections are serious and life-threatening, particularly in the young, the elderly, the pregnant and the immunosuppressed The complex nature of recreational water-related illness transmission requires that a multifaceted approach be integrated into any proposed prevention plan. This should include participation of the health care community in implementing educational and behavioral modification strategies. This review focuses on the occurrence of diarrheal illness transmitted through exposure to disinfected or treated swimming venues. In this article, we discuss: (1) the biologic, environmental and behavioral factors contributing to recreational waterrelated illnesses in the United States; (2) surveillance data documenting increasing occurrence of diarrheal illness associated with recreational water use; (3) swimming pool inspection data revealing pool maintenance inadequacies; (4) investigations demonstrating the impact of recreational water-related illnesses on the swimming public; and (5) proposed guidelines highlighting the critical role that health care providers can play in prevention of diarrheal illness. Accepted for publication June 14, From the *Division of Parasitic Diseases, National Center for Infectious Diseases, and the Preventive Medicine Residency Program, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA Reprints not available. Copyright 2004 by Lippincott Williams & Wilkins ISSN: /04/ DOI: /01.inf BIOLOGIC, ENVIRONMENTAL AND BEHAVIORAL FACTORS CONTRIBUTING TO TRANSMISSION OF RECREATIONAL WATER-RELATED ILLNESSES Waterborne pathogens present unique challenges for aquatics venues. Pathogen characteristics such as environmental stability of pathogens, high concentrations of organ- 866 The Pediatric Infectious Disease Journal Volume 23, Number 9, September 2004
2 The Pediatric Infectious Disease Journal Volume 23, Number 9, September 2004 Recreational Water-Related Illnesses isms, and low infectious doses are important factors in potential for transmission. In disinfected aquatics venues, chlorination is the main barrier to infectious disease transmission. The parasites Cryptosporidium spp. and Giardia spp. and the noroviruses (Norwalk-like viruses) have varying degrees of chlorine resistance Cryptosporidium oocysts can survive for days at chlorine concentrations typically found in swimming venues making traditional pool chlorination ineffective as a barrier to Cryptosporidium transmission. Although most fecal orally transmitted bacteria, such as Escherichia coli O157:H7, are chlorine-susceptible, outbreaks caused by this pathogen have occurred in treated recreational water facilities because of poor maintenance of disinfectant concentrations Cryptosporidium and Giardia have low infectious doses ( 132 oocysts and 10 cysts, respectively) and high excretion concentrations (up to 10 6 oocysts or cysts per g of stool); a single fecal accident can be all that is necessary to contaminate a water park containing millions of gallons of water In these settings, swallowing only a few mouthfuls of contaminated water is sufficient for disease transmission. In addition, Cryptosporidium and Giardia are often shed at low concentrations for weeks after cessation of diarrhea. 23,26 This facilitates disease transmission not only from swimmers who have diarrheal illness but also from people who are recovering from illness. Diarrheal illness and fecal contamination of swimming venues are common in the United States. Approximately 11% of the U.S. population have had diarrhea in the prior month, indicating that there is at least 1 diarrheal episode/person/ year. 27 In addition, 2% of the population were reported to be fecally incontinent in a Wisconsin community survey; 70% of this fecally incontinent population were younger than 65 years of age. 28 The high proportion of diarrheal illness in the population and the increase in reported outbreaks make it likely that persons ill with diarrhea commonly are visiting swimming venues. The communal nature and shared water aspects of swimming facilitates transmission of waterborne pathogens having fecal-oral spread. High usage during peak swim season including heavy use of swimming pools by diapered and toddler age children contributes to the possibility of fecal contamination in these settings. Fecal accidents are common events, sometimes occurring daily in the same venue. 29 Even in the absence of fecal accidents, a lack of showering before entering swimming pools may contribute to contamination from swimmers bodies. An average of 0.14 g of feces is present on the perianal surface of persons; in children, the amount may be up to 10 g/child. 30 Exposure to recreational water venues is extremely high in the United States. As the second most popular exercise activity in the United States, 61 million persons older than 7 years swim at least 6 times per year. Fifty-seven percent of children in the United States 7 17 years of age swim at least 6 times per year. At a minimum, 368 million annual person-visits occur at U.S. swimming venues. 31 These biologic, environmental and behavioral factors contribute to the emergence of recreational water-related illnesses, particularly in disinfected aquatic venues. Understanding these contributing factors is critical to the development and implementation of effective recreational waterrelated illness prevention and control measures. SURVEILLANCE FINDINGS Surveillance for recreational water-related illness outbreaks of gastrointestinal tract illness has documented a statistically significant increase in the number of reported outbreaks during the past 2 decades (Fig. 1). 32 This trend is primarily driven by a steady increase in outbreaks associated with disinfected swimming venues versus outbreaks occurring in fresh water venues such as lakes and rivers (Fig. 2). 32 Pathogens contributing to these outbreaks vary depending on the type of swimming venue (Fig. 3), and surveillance data have revealed the importance of pathogens such as Cryptosporidium and shiga toxin-producing E. coli In fresh water venues, E. coli O157:H7 and Shigella spp. account for most outbreaks where a pathogen is identified. In treated water venues, Cryptosporidium accounts for 66% of reported outbreaks of diarrheal illness in the United States This may be in large part because of the extreme chlorine resistance exhibited by the parasite, which renders pool chlorination an ineffective barrier to transmission. National surveillance data for Cryptosporidium and Giardia also demonstrate a marked seasonality with peaks for transmission occurring during the summer months This coincides with the annual swim season and further supports findings that recreational water plays a key role in transmission of these parasites. As illustrated in Figure 3, pathogens such as E. coli O157:H7 and Shigella cause 12% of reported outbreaks in FIGURE 1. Recreational water-related illness outbreaks of gastroenteritis: United States, Total number of outbreaks, Lippincott Williams & Wilkins 867
3 Castor and Beach The Pediatric Infectious Disease Journal Volume 23, Number 9, September 2004 FIGURE 2. Recreational water-related illness outbreaks of gastroenteritis: United States, Total number of outbreaks, 134. indicates disinfected venues;, freshwater venues. disinfected venues. These outbreaks underscore the importance of proper pool maintenance because these chlorinesusceptible pathogens would have been susceptible to typical disinfection procedures had they been implemented properly. Assurance of adequate pool maintenance is complicated by a lack of federal regulation and oversight that has resulted in varied state and local regulations, enforcement and compliance throughout the country. In U.S. surveillance data from 22,000 swimming pool inspections performed during the summer of 2002, 54% of inspections had 1 or more violations (range, 1 12 violations). Eight percent of inspections resulted in immediate pool closure, reinforcing the need for increased efforts to assure a higher standard of pool operation throughout the country. 39 OUTBREAK CASE STUDIES Two outbreak investigations illustrate how chlorine resistance of waterborne pathogens and inadequate pool maintenance contribute to the occurrence of recreational water-related illness outbreaks. The first was a cryptosporidiosis outbreak in Nebraska in The outbreak was detected initially when the state surveillance system noted an increase in the number of cryptosporidiosis cases reported compared with the same period in previous years. The investigation documented 200 cases of diarrhea caused by Cryptosporidium confirmed by clinical evaluation and/or laboratory tests. All infections were associated with the use of 2 swimming pools. Water samples from both pools were positive for Cryptosporidium oocysts. Control measures consisted of closure and hyperchlorination of both pools. Hyperchlorination protocols to inactivate Cryptosporidium typically require chlorine concentrations that exceed acceptable swimming levels, making pool closure necessary. Despite these control measures, the outbreak expanded to include additional community pools. The initial closure of the 2 implicated pools had resulted in the use of other community pools by ill swimmers. Interviews revealed that 18% of ill persons continued swimming despite being symptomatic and that 32% swam during illness or during the 2 weeks after illness when transmission could still occur. This outbreak highlights: (1) that even properly maintained swimming pools can spread illness when chlorine-resistant pathogens are involved; and (2) how behaviors, such as swimming when ill with diarrhea, can initiate or contribute to the occurrence and amplification of enteric illness outbreaks in a community. Extensive education about healthy swimming habits may have reduced further amplification of this outbreak. The second outbreak occurred in a recreational water park in Georgia in A child-care center coordinator reported several children ill with bloody diarrhea including one hospitalized with hemolytic-uremic syndrome secondary to E. coli O157:H7 infection. The investigation documented 26 persons with E. coli O157:H7 infections; 7 were hospitalized and 1 death occurred. All ill persons had visited the Georgia water park and played in one particular kiddie pool. The suspect kiddie pool had a low disinfectant level that was believed to have contributed to the outbreak. This out- FIGURE 3. Pathogens identified in recreational water-related illness outbreaks of gastroenteritis (gastro): United States, Disinfected venues, n 53; the Other category includes Campylobacter, norovirus and Salmonella. Freshwater venues, n Lippincott Williams & Wilkins
4 The Pediatric Infectious Disease Journal Volume 23, Number 9, September 2004 Recreational Water-Related Illnesses break highlights: (1) the role of poor facility maintenance in promoting outbreaks; (2) the need for education of pool operators about the transmission risk of recreation waterrelated illnesses from poor facility maintenance; and (3) how behaviors, such as swimming when ill with diarrhea, can contribute to the occurrence of recreational water-related illness outbreaks. PREVENTION AND CONTROL STRATEGIES: THE ROLE OF THE HEALTH CARE COMMUNITY Any prevention and control strategy must address several issues: technologic challenges related to adequate disinfection procedures; management and maintenance lapses; training deficiencies; and the general public s lack of awareness concerning healthy swimming habits. Because of this, prevention strategies must incorporate a multidisciplinary approach that targets the general public, aquatics facilities staff, public health practitioners and health care providers. Prevention measures should include critical components such as the redesign of aquatics facilities and increased governmental oversight of swimming pool maintenance and aquatics staff training, and education of the general public about healthy swimming habits. As part of an effort to understand what the public thinks about swimming and disease transmission, the Centers for Disease Control and Prevention conducted a series of focus discussion groups with parents of young swimmers. Findings revealed that parents lacked awareness of the potential for disease transmission in swimming pools. They did not equate swimming in chlorinated pools with communal bathing or water sharing. They believed that chlorination killed organisms instantaneously and rendered the water sterile. Finally they were not aware of the existence of chlorine-resistant pathogens. Parents were open to learning and changing their swimming behaviors and suggested multiple avenues for recreational water-related illness education such as the media, schools, child-care centers and aquatics centers. However, they preferred to receive education about recreational water-related illnesses from a trusted source such as a pediatrician or other health care provider. 42 Multiple challenges face health care providers in educating patients about recreational water-related illnesses. These include several myths that should be dispelled: (1) chlorine kills all organisms instantaneously and leaves pool water sterile; (2) it is acceptable to swim when ill with diarrhea; and (3) it is safe to swallow pool water. As demonstrated by the outbreak in Nebraska, even a well-maintained pool is only as safe as the health of the swimmers who use it. Healthy swimming messages need to be disseminated to the general public, especially patients with diarrhea and parents of diapered and toddler age children. In addition, groups at risk for serious complications from enteric infections such as the young, the elderly, the pregnant and the immunosuppressed should receive targeted health education messages. Health care providers can play a key role by providing anticipatory guidance and/or health education materials to parents of ill children and patients. This information can influence and guide behaviors. These simple and practical messages (also posted at include the following: (1) don t swim when you have diarrhea; (2) don t swallow pool water; (3) shower with soap and water before swimming; (4) wash your hands with soap and water after using a toilet or after changing diapers; (5) take your children on bathroom breaks or check diapers often; (5) change diapers in a bathroom and not at poolside; and (6) wash your child thoroughly with soap and water before swimming. It may also be judicious to recommend that patients ill with infectious diarrhea refrain from swimming for 2 weeks after cessation of diarrhea, particularly if they are infected with Cryptosporidium or Giardia, which may be excreted for several weeks after symptoms resolve. These prevention measures also should be reinforced with patients using recreational water when traveling domestically and/or internationally. By educating themselves and their patients about recreational water-related illnesses and healthy swimming behaviors, health care providers can have a significant impact on the morbidity and mortality associated with recreational water-related illnesses and can contribute to the prevention of this emerging public health concern. ACKNOWLEDGMENTS We thank Dr. Larry Pickering for the support he has given the Healthy Swimming Project. REFERENCES 1. Pruss A, Kay D, Fewtrell L, Bartram J. Estimating the burden of disease from water, sanitation, and hygiene at a global level. Environ Health Perspect. 2002;110: Pruss A. Review of epidemiological studies on health effects from exposure to recreational water. Int. J Epidemiol. 1998;27: McAnulty JM, Fleming DW, Gonzalez A. A community-wide outbreak of cryptosporidiosis associated with swimming at a wave pool. JAMA. 1994;272: Cabelli VJ, Dufour AP, McCabe LJ, et al. Swimming-associated gastroenteritis and water quality. Am J Epidemiol. 1982;115: Jones F, Bartlett CL. Infections associated with whirlpools and spas. Soc Appl Bacteriol Symp Ser. 1985;14:61S 66S. 6. Calderon R, Mood E, Dufour A. Health effects of swimmers and nonpoint sources of contaminated water. Int J Environ Health Res. 1991;1: Caldwell GG, Lindsey NJ, Wulff H, et al. Epidemic of adenovirus type 7 acute conjunctivitis in swimmers. Am J Epidemiol. 1974;99: Visvesvara G, Stehr-Green J. Epidemiology of free-living ameba infections. J Protozool. 1990;37:26S 33S. 9. Khoor A, Leslie KO, Tazelaar HD, et al. Diffuse pulmonary disease caused by nontuberculous mycobacteria in immunocompetent people (hot tub lung). Am J Clin Pathol. 2001;115: Mangione EJ, Remis RS, Tait KA, et al. An outbreak of Pontiac fever 2004 Lippincott Williams & Wilkins 869
5 Castor and Beach The Pediatric Infectious Disease Journal Volume 23, Number 9, September 2004 related to whirlpool use, Michigan JAMA. 1985;253: Hollyoak V, Allison D, Summers J. Pseudomonas aeruginosa wound infection associated with a nursing home s whirlpool bath. Commun Dis Rep CDR Rev. 1995;5:R100 R Frisby HR, Addiss DG, Reiser WJ, et al. Clinical and epidemiologic features of a massive waterborne outbreak of cryptosporidiosis in persons with HIV infection. J Acquir Immune Defic Syndr Hum Retrovirol. 1997;16: Guerrant R. Cryptosporidiosis: an emerging, highly infectious threat. Emerg Infect Dis. 1997;3: Hoxie NJ, Davis JP, Vergeront JM, et al. Cryptosporidiosis-associated mortality following a massive waterborne outbreak in Milwaukee, Wisconsin. Am J Public Health. 1997;87: Korich D, Mead J, Madore M, et al. Effects of ozone, chlorine dioxide, chlorine, and monochloramine on Cryptosporidium parvum oocyst viability. Appl Environ Microbiol. 1990;56: Chauret C, Nolan K, Chen P, et al. Aging of Cryptosporidium parvum oocysts in river water and their susceptibility to disinfection by chlorine and monochloramine. Can J Microbiol. 1998;44: Jarroll EJ. Effect of disinfectants on Giardia cysts. Crit Rev Environ Control. 1988;18: Keswick B, Satterwhite T, Johnson P, et al. Inactivation of Norwalk virus in drinking water by chlorine. Appl Environ Microbiol. 1985;50: Rice E, Clark R, Johnson C. Chlorine inactivation of Escherichia coli 0157:H7. Emerg Infect Dis. 1999;5: Friedman M, Roels T, Koehler J, et al. Escherichia coli 0157:H7 outbreak associated with an improperly chlorinated swimming pool. Clin Infect Dis. 1999;29: Hildebrand JM, Maguire HC, Holliman RE, et al. An outbreak of Escherichia coli O157 infection linked to paddling pools. Commun Dis Rep CDR Rev. 1996;6:R33 R DuPont H, Chappell C, Sterling C, et al. The infectivity of Cryptosporidium parvum in healthy volunteers. N Engl J Med. 1995;332: Rendtorff R. The experimental transmission of human intestinal protozoan parasites, II: Giardia lamblia cysts given in capsules. Am J Hyg. 1954;59: Goodgame RW, Genta RM, White AC, et al. Intensity of infection in AIDS-associated cryptosporidiosis. J Infect Dis. 1993;167: Danciger M, Lopez M. Numbers of Giardia in the feces of infected children. Am J Trop Med Hyg. 1975;24: Stehr-Green J, McCaig L, Remsen H, et al. Shedding of oocysts in immunocompetent individuals infected with Cryptosporidium. Am J Trop Med Hyg. 1987;36: Mead P, Slutsker L, Dietz V, et al. Food-related illness and death in the United States. Emerg Infect Dis. 1999;5: Nelson R, Norton N, Cautley E, et al. Community-based prevalence of anal incontinence. JAMA. 1995;274: CDC. Prevalence of parasites in fecal material from chlorinated swimming pools: United States, MMWR. 2001;50: Gerba CP. Assessment of enteric pathogen shedding by bathers during recreational activity and its impact on water quality. Quant Microbiol. 2000;2: United States Bureau of the Census. Statistical abstract of the United States. 115th ed. Washington, DC: US Bureau of the Census; Lee SH, Levy DA, Craun GF, et al. Surveillance for waterborne-disease outbreaks: United States, MMWR Surveill Summ. 2002;51: Barwick RS, Levy DA, Beach MJ, et al. Surveillance for waterbornedisease outbreaks, United States, MMWR Surveill Summ. 2000;49: Levy DA, Bens MS, Craun GF, et al. Surveillance for waterborne disease outbreaks: United States, MMWR Surveill Summ. 1998;47: Kramer MH, Herwaldt BL, Craun GF, et al. Surveillance for waterborne disease outbreaks: United States, MMWR Surveill Summ. 1996;45: Moore AC, Herwaldt BL, Craun GF, et al. Surveillance for waterborne disease outbreaks: United States, MMWR Surveill Summ. 1993;42: Dietz V, Roberts JM. National surveillance for infection with Cryptosporidium parvum, : what have we learned? Public Health Rep. 2000;115: Furness BW, Beach MJ, Roberts JM. Giardiasis surveillance, United States, MMWR Surveill Summ. 2000;49(SS-7): CDC. Surveillance data from swimming pool inspections: selected states and counties, United States, May-September June 6, MMWR. 2003;52: CDC. Protracted outbreaks of cryptosporidiosis associated with swimming pool use: Ohio and Nebraska, MMWR. 2001;50: Gilbert L, Blake P. Outbreak of Escherichia coli 0157:H7 infections associated with a water park. Georgia Epidemiol Rep. 1998;14: Macro International. Cryptosporidium and waterparks: an opportunity for disease prevention. Internal report to CDC, Lippincott Williams & Wilkins
Healthy Swimming: Prevention of Recreational Water Illnesses (RWIs)
Healthy Swimming: Prevention of Recreational Water Illnesses (RWIs) Q u e s t i o n s a n d A n s w e r s f o r A q u a t i c s F a c i l i t y S t a f f The following information about recreational water
More informationThe use of risk management as best practice to reduce outbreaks of recreational water illnesses in disinfected swimming facilities and spas
The use of risk management as best practice to reduce outbreaks of recreational water illnesses in disinfected swimming facilities and spas Roy Vore, Ph.D., NSPF I, CPO Vore & Associates, LLC Email: Roy.D.Vore@gmail.com
More informationCryptosporidium Incident Response
WWA Response Plan Cryptosporidium Incident Response Summary Cryptosporidium ( crypto ) is a diarrheal illness caused by a microscopic parasite that lives in the intestines of humans & animals. For a number
More informationCRYPTO FACT SHEET FOR POOL OPERATORS
CRYPTO FACT SHEET FOR POOL OPERATORS Crypto Basics Cryptosporidiosis is a diarrheal disease caused by microscopic parasites, Cryptosporidium, that can live in the intestine of humans and animals and is
More informationWhat s in the Water? What s in the Air?
What s in the Water? What s in the Air? Michele C. Hlavsa, RN, MPH Water and Environment Activity Team Division of Parasitic Diseases Centers for Disease Control & Prevention Swimming is fun and a great
More informationRecreational Water Illness Michele Hlavsa, RN, MPH Epidemiologist/Healthy Swimming OutbreakNet Conference Atlanta, GA August 30, 2012
Recreational Water Illness Michele Hlavsa, RN, MPH Epidemiologist/Healthy Swimming OutbreakNet Conference Atlanta, GA August 30, 2012 Healthy Swimming Program National Center for Emerging and Zoonotic
More information2016 Crypto Outbreak & Response. Adam Holbrook, RS, REHS, NSPFI Sarah Badenhop, RS, NSPFI
2016 Crypto Outbreak & Response Adam Holbrook, RS, REHS, NSPFI Sarah Badenhop, RS, NSPFI Outline Cryptosporidium and Cpryptosoridosis How to Kill Crypto in Your Pool Crypto Outbreak in Central Ohio Public
More informationTreated Recreational Water Associated Outbreaks of Cryptosporidiosis. Outline. Info for environmental health specialists. Why CDC is focusing on RWIs?
Treated Recreational Water Associated Outbreaks of Cryptosporidiosis Charles Otto & Michele Hlavsa Healthy Swimming Program Centers for Disease Control & Prevention Outline Info for environmental health
More informationCrypto Outbreak Collection
Crypto Outbreak Collection Below are educational materials and prevention strategies a facility can implement to minimize the spread of a crypto outbreak. Save or print the documents relevant to you. FACTSHEETS:
More informationLearning Objectives. Recreational Water Illnesses. Section One Regulations and Responsibilities
Recreational Water Illnesses Louis Sam Fruia, M.Ed., CPO-I, AFO-I, WSI, LGI, ASCA Fellow, LvIV Coach and SwimAmerica Director Brownsville Independent School District, Brownsville, TX bisdnatman@bisd.us
More informationFECAL/VOMITUS INCIDENT RESPONSE IN RECREATIONAL WATER FACILITIES
Health, Seniors and Active Living Active Living, Indigenous Relations, Population and Public Health FECAL/VOMITUS INCIDENT RESPONSE IN RECREATIONAL WATER FACILITIES Closures for fecal/vomitus incidents
More informationLicking County Health Department 675 Price Rd., Newark OH (740)
For Pool Staff 12 Steps for Prevention of Recreational Water Illnesses (RWIs) Licking County Health Department 675 Price Rd., Newark OH 43055 (740) 349-6535 www.lickingcohealth.org Twelve steps for reducing
More informationOutbreaks Caused by Giardia and Cryptosporidium Associated with Swimming Pools
Outbreaks Caused by Giardia and Cryptosporidium Associated with Swimming Pools Charles P. Gerba, Ph.D., Professor Department of Soil, Water, and Environmental Science University of Arizona Peter Gerba
More informationModel Aquatic Health Code Network Webinar. Cyanuric Acid and the Fecal, Vomit, and Blood Response
Model Aquatic Health Code Network Webinar Cyanuric Acid and the Fecal, Vomit, and Blood Response Tuesday, September 19 th Thank you for your interest and attendance! Please use your computer speakers to
More informationHealthy Swimming. For Aquatics Staff: Twelve Steps for Prevention of Recreational Water Illnesses (RWIs) Healthy Swimming
Healthy Swimming For Aquatics Staff: Twelve Steps for Prevention of Recreational Water Illnesses (RWIs) Healthy Swimming Prevention Planning Facility Design Disinfection Water Quality Communication Education
More informationFor Aquatics Staff: Twelve Steps for Prevention of Recreational Water Illnesses (RWIs) Prevention Planning FACILITY DESIGN.
Healthy Swimming For Aquatics Staff: Twelve Steps for Prevention of Recreational Water Illnesses (RWIs) Healthy Swimming Prevention Planning FACILITY DESIGN Disinfection Water Quality Communication Education
More informationModel Aquatic Health Code Network May Webinar
Model Aquatic Health Code Network May Webinar Cryptosporidium in Public Swimming Venues: Recommendations for Reducing Crypto Risk in Swimming Pools" Thank you for your interest and attendance! Please use
More informationHealth risks posed by unregulated Water Park Installations in NSW
Health risks posed by unregulated Water Park Installations in NSW Okay who can help me identify a swimming pool? So why the confusion? Awkwardly in NSW we have two Acts that have two definitions
More informationCompliance with Best-Practice Water-Sanitation Policies by Pool Organizations
International Journal of Aquatic Research and Education Volume 1 Number 3 Article 4 8-1-2007 Compliance with Best-Practice Water-Sanitation Policies by Pool Organizations Paola Paez Iowa State University,
More informationPolicy Statement: Model Aquatic Health Code
Policy Statement: Model Aquatic Health Code Americans swim hundreds of millions of times in pools, oceans, lakes, rivers, hot tubs, and spas every year and most people have a safe and healthy time enjoying
More informationWelcome to the Model Aquatic Health Code Network Webinar
Welcome to the Model Aquatic Health Code Network Webinar Cyanuric Acid: It s Not Just About Crypto Featured Presenter: Richard Falk, CYA Ad-Hoc Committee Member of the CMAHC Tuesday, January 30 th, 2018
More informationWELCOME NEW FOOD/POOL SAFETY TEAM
POOL NEWSLETTER APRIL 2014 WELCOME NEW FOOD/POOL SAFETY TEAM Happy Spring! Your new Food Safety Team is Jim Zimny, (Program Manager), Paul Giuntoli, Ross Lytle, Patty Olsen, Dayna Hernandez, Niels Nicolaisen,
More informationA Comparison of Recreational Water Illness Awareness and Frequency of Swimming
A Comparison of Recreational Water Illness Awareness and Frequency of Swimming Elden Chan 1, Martin MacLeod 2 1 Lead Author, B. Tech Student, School of Health Sciences, British Columbia Institute of Technology,
More informationEvidence Review: Water Quality (Recreational Water)
Evidence Review: Water Quality (Recreational Water) Population Health and Wellness BC Ministry of Health April 2007 This paper is a review of the scientific evidence for this core program. Core program
More informationDisinfection in Communal Bathtubs Ronald George
Disinfection in Communal Bathtubs Ronald George Ron has over 17 years experience in the Aquatics Industry. He has worked closely with national and state health organizations in developing or improving
More informationNH Dept. of Environmental Services Public Pool and Spa Program
NH Dept. of Environmental Services Public Pool and Spa Program Tonight s Topics Operational Requirements Circulation System Testing Requirements Water Balance Water Clarity Automated Controllers Salt Chlorine
More informationSWIMMING POOL OPERATION AND MAINTENACE GUIDE
SWIMMING POOL OPERATION AND MAINTENACE GUIDE There have been changes to the operation and maintaining of the swimming pools as set forth by DHEC. All AMCS properties that have a pool/s must be under these
More informationJuly 2018 Issue 26, Vol. 1. Hand, Foot, and Mouth Disease. Nursing Talk. Healthy and Safe Swimming
Newsletter July 2018 Issue 26, Vol. 1 Nursing Talk Skills Fair 2018 Healthy and Safe Swimming This disease is common in young children. It causes fever, mouth sores, and a rash. Wash your hands often to
More informationCHAPTER 3 MICROBIOLOGICAL HAZARDS
CHAPTER 3 MICROBIOLOGICAL HAZARDS The risk of illness or infection associated with swimming pools, spas and similar recreational-water environments has been linked to faecal contamination of the water.
More informationPUBLIC POOL MANUAL FOR OPERATORS
PUBLIC POOL MANUAL FOR OPERATORS Tel: 705-647-4305 Toll free: 1-866-747-4305 www.timiskaminghu.com Adapted and Reprinted With the Permission of the Wellington-Dufferin-Guelph Public Health Unit. Table
More informationCRYPTOSPORIDIOSIS OUTBREAK EDUCATION AND ACTION PLAN A MODEL DOCUMENT DEVELOPED BY COMMUNITIES IN JOHNSON COUNTY, KANSAS AND THE SURROUNDING AREA
CRYPTOSPORIDIOSIS OUTBREAK EDUCATION AND ACTION PLAN A MODEL DOCUMENT DEVELOPED BY COMMUNITIES IN JOHNSON COUNTY, KANSAS AND THE SURROUNDING AREA Spring 2012 Table of Contents Definition... 3 Symptoms..3
More informationAssociation Between Swimming Pool Operator Certification and Reduced Pool Chemistry Violations Nebraska,
Association Between Swimming Pool Operator Certification and Reduced Pool Chemistry Violations Nebraska, 2005 2006 Bryan F. Buss, DVM, MPH, DACVPM Nebraska Department of Health and Human Services OWCD,
More informationPublic Recreational Bathing
DENVILLE DIVISION OF HEALTH 1 St. Mary s Place Information Denville, NJ 07834 (973) 625 8300, Ext. 260 Public Recreational Bathing Definitions: Public Recreational Bathing Place: Any bathing beach, hot
More informationMichele Hlavsa, RN, MPH. Epidemiologist/Chief, Healthy Swimming. EH2O Recreational Waters Virtual Conference January 18 19, 2017
Network for Aquatic Facility Inspection Surveillance Data on Immediate Closures and Violations: Unlocking the Potential Power of Aquatic Inspection Data Michele Hlavsa, RN, MPH Epidemiologist/Chief, Healthy
More informationINFORMATION NOTE No 353: MICROBIOLOGICAL TESTING
INFORMATION NOTE No 353: MICROBIOLOGICAL TESTING First issued: January 2007 Updated: June 2010 ABOUT ISRM This is one of a series of Information Notes produced by the Institute of Sport and Recreation
More informationModel Aquatic Health Code
Model Aquatic Health Code American Society of Law, Medicine & Ethics Network for Public Health Law Public Health Law Association Public Health Law Research Program The legal information and assistance
More informationImplementation of a Drowning Surveillance System for Ohio Public Pools
Implementation of a Drowning Surveillance System for Ohio Public Pools Amanda M. Zabala, MPH CDC/CSTE Applied Epidemiology Fellow Waterborne Ohio Department of Health Bureau of Environmental Health & Radiation
More informationIntroducing Aquatic Inspector A CDC ipad App to Streamline Pool Inspections
Introducing Aquatic Inspector A CDC ipad App to Streamline Pool Inspections Presented by: CDR Jasen Kunz, MPH CDC Model Aquatic Health Code Team Sarah Pomerantz, MPH CommunicateHealth Jocelyn Cozzo CommunicateHealth
More informationThe Tungland News TUNGLAND FLAGSTAFF S ANNUAL PICNIC FUN, FOOD, AND FRIENDSHIP!
The Tungland News TUNGLAND FLAGSTAFF S ANNUAL PICNIC FUN, FOOD, AND FRIENDSHIP! When the clients, staff, families, and friends of Tungland s Flagstaff area gathered recently at Ft. Tuthill County Park
More informationANNUAL SUMMARY OF INFECTIOUS DISEASES OHIO 2014
OHIO DEPARTMENT OF HEALTH ANNUAL SUMMARY OF INFECTIOUS DISEASES OHIO 2014 REPORTED INCIDENCE OF SELECTED NOTIFIABLE DISEASES PREPARED AND DISTRIBUTED BY: BUREAU OF INFECTIOUS DISEASES TABLE OF CONTENTS
More informationRecreational Water Illness
Recreational Water Illness [The following information was obtained from the Centers for Disease Control and Prevention at http://www.cdc.gov/healthywater/swimming/rwi/index.html] Recreational water illnesses
More informationPUBLIC SPA MANUAL FOR OPERATORS
PUBLIC SPA MANUAL FOR OPERATORS Tel: 705-647-4305 Toll free: 1-866-747-4305 www.timiskaminghu.com Adapted and Reprinted With the Permission of the Wellington-Dufferin-Guelph Public Health Unit. Table of
More informationNon-Residential: Any swimming pool or spa that is not used at a single-family residence.
SECTION 1: INTRODUCTION TO POOL AND SPA SAFETY Purpose Protect the public from possible safety and health hazards Establish minimum operating and construction standards for swimming pools and spas Provide
More informationBacteriological Quality Assessment of swimming pools in the Osu- Labadi Area, Accra
Bacteriological Quality Assessment of swimming pools in the Osu- Labadi Area, Accra George Osei-Adjei 1*, Simon Kwabena Sarpong 2, Emmanuel Laryea 1, Emmanuel Tagoe 1 1. Accra Polytechnic, School of Applied
More informationZachary D. McCormic, MPH Infectious Disease Epidemiologist New Hampshire Department of Health and Human Services InFORM 2017 November 8, 2017
Zachary D. McCormic, MPH Infectious Disease Epidemiologist New Hampshire Department of Health and Human Services InFORM 2017 November 8, 2017 Diarrheal disease caused by the parasite Cryptosporidium 1
More informationSwimming Pool/ Spa Safety Plan
Swimming Pool/ Spa Safety Plan Name of Facility: Facility Address: City/State/Zip: A. Organization and Management 1.) Outline the Chain of Command for your facility below: 2.) Pool Job Duties and Descriptions
More informationOzone Technology for Commercial Pools. presented by. DEL Ozone
Ozone Technology for Commercial Pools presented by DEL Ozone Ozone History 1840 Identified by German Scientists 1906 Ozone Drinking Water Purification Plant in Nice, France 1937 Commercial Pool Installs
More informationAdvances in the application of Ultraviolet light for swimming pool disinfection.
Advances in the application of Ultraviolet light for swimming pool disinfection. Tony Leigh, atg UV Technology Introduction Ultra violet (UV) light has gained rapid prominence as an effective disinfection
More informationPool Standards 2014 (Amended 2017)
Pool Standards 2014 (Amended 2017) How Did We Get Here? Continued Challenge: Respond to New Evidence Provincial Aquatic Committee (AHS) Two anti-entrapment workshops Meetings with Industry: Anti-entrapment
More informationThe Effect of Cyanuric Acid on Disinfection
The Effect of Cyanuric Acid on Disinfection Conclusions Cyanuric acid (CYA) is a useful tool for stabilizing chlorine residuals and reducing chlorine degradation from UV radiation in sunlight. The greatest
More informationWaterborne Illnesses and
Waterborne Illnesses and Outbreak Presentation Investigation Title Spring Seminars June 10-12, 2014 Sarah E. Koske, D.V.M, M.P.H. CDC/CSTE Applied Epidemiology Fellow - Waterborne Diseases Wisconsin Department
More informationSandy Palmatter Office: Cell: Steven Sipes Office: Cell:
Calvin College Swimming Pool Contingency and Emergency Action Plan Prepared by: Date: Approved by: Aquatics Director & EHS 2/18/19 Revision 9 Date: CEHS 4/27/2007 1.0 PURPOSE Michigan s Public Health Code,
More informationWhat s in the water The importance of bather hygiene and cleanliness. Luke Griffiths STA s Technical Manager for Pool Plant
What s in the water The importance of bather hygiene and cleanliness Luke Griffiths STA s Technical Manager for Pool Plant Types of Commercial Pool and Recreational Water Systems Types of Commercial Pool
More informationDeterminants of Bacterial Contamination in Pools, Spas, and Wading Pools: Should Chlorine Standards Be Revised?
International Journal of Aquatic Research and Education Volume 4 Number 1 Article 5 2-1-2010 Determinants of Bacterial Contamination in Pools, Spas, and Wading Pools: Should Chlorine Standards Be Revised?
More informationGeneral Policies July Hydrotherapy Pool Policy
Hydrotherapy Pool Policy HYDROTHERAPY POOL POLICY Contra-indications to a User with the advice of a Doctor, the School Nurse and/or Physiotherapist: Infectious skin disease Infectious upper respiratory
More informationPhysical activity has a number of benefits
Health Policy Brief September 2018 Walking Among California Adults Susan H. Babey, Joelle Wolstein, and Allison L. Diamant SUMMARY: This policy brief describes two types of walking among California adults:
More informationRisk of spread after introduction of the virus in to wild boar population
Available tools for the prevention and control of diseases in wildlife, with focus on ASF in wild boar in infected country: hunting biosecurity and wild boar carcass disposal Marius Masiulis FAO international
More informationWhy Pool Operator Training for Medical Fitness Professionals September 2011 By Thomas M. Lachocki, Ph.D.
Why Pool Operator Training for Medical Fitness Professionals September 2011 By Thomas M. Lachocki, Ph.D. Whether you are working with clients in the water who are wounded warriors, athletes recovering
More informationNova Scotia Operational Guidelines for Aquatic Facilities
Nova Scotia Operational Guidelines for Aquatic Facilities Reducing Risk and Promoting Healthy Recreational Water Experiences 2014 Nova Scotia Operational Guidelines for Aquatic Facilities Reducing Risk
More informationReducing Disease Risks Caused by Pathogens Associated with Columbia
Reducing Disease Risks Caused by Pathogens Associated with Columbia River Hatcheries Jerri Bartholomew Department of Microbiology Oregon State University, Corvallis, OR Pathogen Transmission and Hatchery
More informationResearch Update: Enhancing Filtration to Maximize Cryptosporidium Removal James Amburgey, Ph.D.
Research Update: Enhancing Filtration to Maximize Cryptosporidium Removal James Amburgey, Ph.D. Dr. James Amburgey is an Assistant Professor in the Department of Civil and Environmental Engineering at
More informationLegionnaires disease
Legionnaires disease A guide for employers Health and Safety What is this leaflet about? Legionnaires disease A guide for employers This short and simple guide is written to help you, as an employer, understand
More informationSNOHOMISH HEALTH DISTRICT SANITARY CODE WATER RECREATION FACILITIES
CHAPTER 7 WATER RECREATION FACILITIES 7.1 Rules and Regulations of the State Board of Health for Water Recreation Facilities, WAC 246-260 (For a copy of this booklet please call the Food & Living Environment
More informationAlberta Health. Pool Standards July 2014 (Amended January 2018)
Alberta Health Pool Standards July 2014 (Amended January 2018) Government of Alberta Department Alberta Health Title Author Authority Public Health and Compliance Section 66(4) of the Public Health Act,
More informationBeta Study Report. Results of Nosocomial Infection Study In Whirlpool Bathing
Beta Study Report Results of Nosocomial Infection Study In Whirlpool Bathing Germicidal Ultraviolet Light Purifying Technology vs. Traditional Chemical Disinfecting Introduction Apollo Corporation has
More informationSchistosomiasis / Bilharzia
Schistosomiasis / Bilharzia An update for registered healthcare practitioners April 2017 Aims of resource:- To raise awareness of Schistosomiasis/Bilharzia infection with registered healthcare practitioners
More informationPUBLIC SPA MANUAL FOR OPERATORS
PUBLIC SPA MANUAL FOR OPERATORS Revised July 2014 Table of Contents Introduction... 3 Role of the Public Health Inspector... 4 Role of the Operator... 4 Designation of Trained Operator... 5 Requirement
More informationA Retrospective Case Study Implicating Foster Calves in a Calf Diarrhea Epidemic
A Retrospective Case Study Implicating Foster Calves in a Calf Diarrhea Epidemic William B. Epperson 1 Department of Veterinary Science BEEF 2003 02 Introduction Calf diarrhea (scours) is the most common
More informationFrom the Health Clinic. Mrs. Maureen Earner
From the Health Clinic Mrs. Maureen Earner (mearner@stambroseschool.org) Water Safety Pools, lakes, ponds, and beaches mean summer fun and cool relief from hot weather. But water also can be dangerous
More informationCITY COUNCIL AGENDA MEMORANDUM
CITY COUNCIL AGENDA MEMORANDUM City and County of Broomfield, Colorado To: From: Prepared by: Mayor and City Council Charles Ozaki, City and County Manager Jim Becklenberg, Assistant City and County Manager
More informationAn Assessment of Data Related to Inspections of Risk Factors for Public Swimming Pools
Georgia Southern University Digital Commons@Georgia Southern Environmental Health Sciences Faculty Publications Department of Environmental Health Sciences 12-15-2016 An Assessment of Data Related to Inspections
More informationIntroduction. Legal Duties. Risk Assessment
All Hampstead Hill School Policies are always to be read and considered in conjunction with Equal Opportunities, Race Equality and Inclusion Policies. This Policy of Hampstead Hill School applies to all
More informationCopyright Recreational Water Illness and Aquatic Facility Related Events Associated with Swimming Pool Chemicals. Outline
Recreational Water Illness and Aquatic Facility Related Events Associated with Swimming Pool Chemicals Michele Hlavsa, RN, MPH Healthy Swimming Division of Parasitic Diseases Centers for Disease Control
More informationInfection is caused by breathing in small droplets of water contaminated by the bacteria. The disease cannot be passed from one person to another.
DCH05 - Legionella Policy and Procedure Page: 1 of 6 Purpose Scope Policy Protect staff and patients from the risks from legionella. Service Provider and Registered Manager. What is Legionnaires disease?
More informationTools to Enhance Laboratory Biosafety and Biosecurity Performing Risk Assessments
Tools to Enhance Laboratory Biosafety and Biosecurity Performing Risk Assessments Selection of Safety Practices Biosecurity in the Laboratory Safety Orientation and Training Biosafety Competencies Audits,
More informationCounty of Santa Clara Emergency Medical Services System
County of Santa Clara Emergency Medical Services System Policy # 700-S01 Ebola Virus Prevention and Control EBOLA VIRUS PREVENTION AND CONTROL Effective: October 30, 2014 Replaces: October 8, 2014 (Version
More informationSocial Media Hashtag: #PoolRocksNOLA
Social Media Hashtag: #PoolRocksNOLA Exhibit Hall Hours Wednesday 10:00 am - 5:00 pm Thursday 10:00 am - 5:00 pm Friday 10:00 am - 2:00 pm APSP Pavilion Show Floor Highlights Casual Furniture Marketplace
More informationLegionella, Pseudomonas and general pathogen control in water systems
Legionella, Pseudomonas and general pathogen control in water systems Dr Tom Makin Makin & Makin Consultancy Ltd info@makinandmakin.co.uk Formerly, Directorate Manager Department of Medical Microbiology
More informationThe Surfer Health Study
The Surfer Health Study Surfrider Foundation collaborated with scientists at Southern California Coastal Water Research Project (SCCWRP); University of California, Berkeley, School of Public Health; and
More informationThe World s Largest Inflatable Water Slide A Public Health Nightmare. Presenters: Megan Savill - EH Team Leader Michelle Speek - Senior EHO
The World s Largest Inflatable Water Slide A Public Health Nightmare Presenters: Megan Savill - EH Team Leader Michelle Speek - Senior EHO Cessnock LGA is located in the Hunter Valley, approx. 2hrs (120km)
More informationIDENTIFYING AND ADDRESSING THE PUBLIC HEALTH RISKS OF SPLASH PARKS
AUGUST 2017 IDENTIFYING AND ADDRESSING THE PUBLIC HEALTH RISKS OF SPLASH PARKS KEY MESSAGES Photo by: Cpl. William Jackson (Public Domain) Playing with a watergun at the Combat Center s Splash Park, MCAGCC
More informationAdvanced Chemistry and Its Impact on Disinfection
Advanced Chemistry and Its Impact on Disinfection National Environmental Health Association s EH2O Recreational Water Virtual Conference 18-19 January 2016 Roy D. Vore, Ph.D., NSPF I, CPO Certification,
More informationWelcome to the Salmon City Pool Pool Opens Monday, June 5th, 2017
Pool Hours Welcome to the Salmon City Pool Pool Opens Monday, June 5th, 2017 Summer Season: June 5 th - August 19 th Monday Tuesday Wednesday Thursday Friday Saturday 7:00-9:00 am 12:00-1:00 pm 9:15-12:00
More informationPerformance Validation of UV Reactors for Recreational Water O. Karl Scheible, Ernest (Chip) Blatchley III, PhD, PE, BCEE & Chengyue Shen, PhD
Performance Validation of UV Reactors for Recreational Water O. Karl Scheible, Ernest (Chip) Blatchley III, PhD, PE, BCEE & Chengyue Shen, PhD Mr. Scheible has over 30 years experience in the development,
More informationAmoeba Response Protocol. Safe Drinking Water which has the Trust of Consumers
Amoeba Response Protocol Safe Drinking Water which has the Trust of Consumers Environmental Health Directorate December 2010 Contents 1.0 Background...2 2.0 Mode of Transmission...2 3.0 Protocol for Drinking
More informationFLOODING & PUBLIC HEALTH IMPACT. Paul R Hunter The Norwich Medical School University of East Anglia
FLOODING & PUBLIC HEALTH IMPACT Paul R Hunter The Norwich Medical School University of East Anglia DIRECT IMPACTS ON HEALTH Pre-onset phase Injuries Onset phase Death by drowning Injuries Post-onset phase
More informationHAVUZ, ÇOCUK ve DEZENFEKSÝYON. Ek-2 : Pool Standards, 2006 for the Swimming Pool, Wading Pool and Water Spray Park Regulations
Ek-2 : Pool Standards, 2006 for the Swimming Pool, Wading Pool and Water Spray Park Regulations I. Definitions and Interpretation The following terms are defined in the Swimming Pool, Wading Pool and Water
More informationPlug and Play: Using MAHC now! A Risk Factor Study as an example of putting the MAHC into play.
Model Aquatic Health Code Network July Webinar Plug and Play: Using MAHC now! A Risk Factor Study as an example of putting the MAHC into play. Thank you for your interest and attendance! Please use your
More informationEngineering Notice. Introduction
Introduction Water quality of swimming pools is essential! Regulatory provisions set the conditions for their use. The attraction and comfort of water, as well as basin and pool surroundings, impact upon
More informationAdvanced Chemistry and Its Impact on Disinfection Roy Vore, Ph.D.
Advanced Chemistry and Its Impact on Disinfection Roy Vore, Ph.D. Dr. Vore is a technology manager at BioLab, Inc. His work focuses on the control of microbial growth in recreational water and aqueous
More informationTitle: A swimming pool-associated outbreak of pharyngoconjunctival fever caused by human adenovirus type 4 in Beijing, China
Accepted Manuscript Title: A swimming pool-associated outbreak of pharyngoconjunctival fever caused by human adenovirus type 4 in Beijing, China Authors: Jie Li, Xiaoyan Lu, Yamin Sun, Changying Lin, Feng
More informationInteractions Between Wild and Farmed Salmonids in Southern British Columbia: Pathogen Transfer
Interactions Between Wild and Farmed Salmonids in Southern British Columbia: Pathogen Transfer Stewart Johnson, Michael Foreman, Kyle Garver Brent Hargreaves, Simon R.M. Jones and Chrys Neville PICES AGM
More informationSt Peters CE Primary POOL SAFETY OPERATING PROCEDURE (PSOP)
St Peters CE Primary POOL SAFETY OPERATING PROCEDURE (PSOP) January 2013 DETAILS OF THE POOL The pool is an outdoor pool measuring 16.5 metres by 6 metres. The depth of the water is 0.75m in the shallow
More informationRide-On Mower Injuries in Children
Committee on Accident and Poison Prevention Ride-on mowers or lawn tractors are common lawn and field mowing vehicles used in the United States. An estimated 7.65 million such mowers are in operation annually.
More informationFITNESS AND RECREATION
General Facility Policies: All rules regarding health, safety, and sanitation of this facility must be observed or use of the swim complex will be denied. Lifeguards must be on duty prior to entering the
More informationHamilton Public Health Services 2014 Beach Monitoring Report
Public Health Services Health Protection Division 110 King Street West, 2nd Floor, Hamilton, ON L8P 4S6 Phone: (905) 546-2424, ext. 3570 Fax: (905) 546-2787 Hamilton Public Health Services 2014 Beach Monitoring
More informationDPW Environmental and Natural Resources. The Compliance Branch presented material on composting, storm water pollution and careers in the science
June 2015 Volume 3, Issue 6 DPW Environmental and Natural Resources Fort Gordon, Ga. Earth Day Events DPW Environmental and Natural Resources Division celebrated Earth Day April 22 at Wilkerson Lake (pond).
More informationSchistosomiasis. World Health Day 2014 SMALL BITE: Fact sheet. Key facts
Fact sheet Key facts is an acute and chronic disease caused by parasitic worms. At least 249 million people required preventive treatment for schistosomiasis in 2012. The number of people reported to have
More information5/13/ National Drowning Prevention Symposium, Pittsburgh, April Linda Quan Monday Plenary Presentation 1
Drowning in Open Water Recreational settings Linda Quan, MD Seattle Children s Hospital Professor, Pediatrics University of Washington School of Medicine, Seattle, WA 1 Open Water Drowning Who drowns in
More informationWATER DISINFECTION METHODS Advantages and Disadvantages. MS. ELAINE M. LAVISTE Head, Water Quality Division Dasmariñas Water District
WATER DISINFECTION METHODS Advantages and Disadvantages MS. ELAINE M. LAVISTE Head, Water Quality Division Dasmariñas Water District OBJECTIVES: Define and give examples of different methods of disinfection
More information