This publication gives a comprehensive review and analysis of potential diseases associated with recreational water activities in marine, freshwater, spas/whirlpools and swimming pools, drawing on information on the ecology and health aspects of a variety of pathogens. Issues discussed include: the factors related to infection and disease severity, susceptible sub-populations, the credibility of association with recreational water use, a severity rating system for prioritising public health protection measures, and pathogen summaries. It will be useful to all those concerned with recreational water quality, including environmental and public health professionals, local authorities and user groups.

Use of coastal, estuarine and freshwater recreational environments has significant benefits for health and well-being, including rest, relaxation, exercise, cultural and religious practices, and aesthetic pleasure, while also providing substantial local, regional and national economic benefits. These guidelines focus on water quality management for coastal and freshwater environments to protect public health. The guidelines: 1. describe the current state of knowledge about the possible adverse health impacts of various forms of water pollution; and2. set out recommendations for setting national health-based targets, conducting surveillance and risk assessments, putting in place systems to monitor and control risks, and providing timely advice to users on water safety.These guidelines are aimed at national and local authorities, and other entities with an obligation to exercise due diligence relating to the safety of recreational water sites. They may be implemented in conjunction with other measures for water safety (such as drowning prevention and sun exposure) and measures for environmental protection of recreational water use sites.

As the human population grows-tripling in the past century while, simultaneously, quadrupling its demand for water-Earth's finite freshwater supplies are increasingly strained, and also increasingly contaminated by domestic, agricultural, and industrial wastes. Today, approximately one-third of the world's population lives in areas with scarce water resources. Nearly one billion people currently lack access to an adequate water supply, and more than twice as many lack access to basic sanitation services. It is projected that by 2025 water scarcity will affect nearly two-thirds of all people on the planet. Recognizing that water availability, water quality, and sanitation are fundamental issues underlying infectious disease emergence and spread, the Institute of Medicine held a two-day public workshop, summarized in this volume. Through invited presentations and discussions, participants explored global and local connections between water, sanitation, and health; the spectrum of water-related disease transmission processes as they inform intervention design; lessons learned from water-related disease outbreaks; vulnerabilities in water and sanitation infrastructure in both industrialized and developing countries; and opportunities to improve water and sanitation infrastructure so as to reduce the risk of water-related infectious disease.

Cyanobacterial toxins are among the hazardous substances most widely found in water. They occur naturally, but concentrations hazardous to human health are usually due to human activity. Therefore, to protect human health, managing lakes, reservoirs and rivers to prevent cyanobacterial blooms is critical. This second edition of Toxic Cyanobacteria in Water presents the current state of knowledge on the occurrence of cyanobacteria and cyanotoxins as well as their impacts on health through water-related exposure pathways, chiefly drinking-water and recreational activity. It provides scientific and technical background information to support hazard identification, assessment and prioritisation of the risks posed by cyanotoxins, and it outlines approaches for their management at each step of the water-use system. It sets out key practical considerations for developing management strategies, implementing efficient measures and designing monitoring programmes. This enables stakeholders to evaluate whether there is a health risk from toxic cyanobacteria and to mitigate it with appropriate measures. This book is intended for those working on toxic cyanobacteria with a specific focus on public health protection. It intends to empower professionals from different disciplines to communicate and cooperate for sustainable management of toxic cyanobacteria, including public health workers, ecologists, academics, and catchment and waterbody managers. Ingrid Chorus headed the department for Drinking-Water and Swimming-Pool Hygiene at the German Environment Agency. Martin Welker is a limnologist and microbiologist, currently with bioMérieux in Lyon, France.

Legionnaires' disease, a pneumonia caused by the Legionella bacterium, is the leading cause of reported waterborne disease outbreaks in the United States. Legionella occur naturally in water from many different environmental sources, but grow rapidly in the warm, stagnant conditions that can be found in engineered water systems such as cooling towers, building plumbing, and hot tubs. Humans are primarily exposed to Legionella through inhalation of contaminated aerosols into the respiratory system. Legionnaires' disease can be fatal, with between 3 and 33 percent of Legionella infections leading to death, and studies show the incidence of Legionnaires' disease in the United States increased five-fold from 2000 to 2017. Management of Legionella in Water Systems reviews the state of science on Legionella contamination of water systems, specifically the ecology and diagnosis. This report explores the process of transmission via water systems, quantification, prevention and control, and policy and training issues that affect the incidence of Legionnaires' disease. It also analyzes existing knowledge gaps and recommends research priorities moving forward.

Recent and forecasted advances in microbiology, molecular biology, and analytical chemistry have made it timely to reassess the current paradigm of relying predominantly or exclusively on traditional bacterial indicators for all types of waterborne pathogens. Nonetheless, indicator approaches will still be required for the foreseeable future because it is not practical or feasible to monitor for the complete spectrum of microorganisms that may occur in water, and many known pathogens are difficult to detect directly and reliably in water samples. This comprehensive report recommends the development and use of a "tool box" approach by the U.S Environmental Protection Agency and others for assessing microbial water quality in which available indicator organisms (and/or pathogens in some cases) and detection method(s) are matched to the requirements of a particular application. The report further recommends the use of a phased, three-level monitoring framework to support the selection of indicators and indicator approaches.Â

In the early 1980s, two water-supply systems on the Marine Corps Base Camp Lejeune in North Carolina were found to be contaminated with the industrial solvents trichloroethylene (TCE) and perchloroethylene (PCE). The water systems were supplied by the Tarawa Terrace and Hadnot Point watertreatment plants, which served enlisted-family housing, barracks for unmarried service personnel, base administrative offices, schools, and recreational areas. The Hadnot Point water system also served the base hospital and an industrial area and supplied water to housing on the Holcomb Boulevard water system (full-time until 1972 and periodically thereafter). This book examines what is known about the contamination of the water supplies at Camp Lejeune and whether the contamination can be linked to any adverse health outcomes in former residents and workers at the base.