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An
abstract of:
“Aquatics WAR
with RWIs”
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by
Louis Sam Fruia
The
Problem: Swimming is the third most popular exercise
activity in the United States, increasing the potential for
recreational water illnesses. Since 1983, the Center for Disease
Control (CDC) has published surveillance summaries entitled
“Morbidity and Mortality Weekly Reports” (MMWRs) that focus
on public health and a range of risk factors and health conditions.
Waterborne-disease outbreaks at recreational aquatic facilities
are part of that surveillance. The data shows that Class “C”
facilities are the largest health code violators. The situation
is so critical that the CDC suggests that individuals perform
their own tests before entering recreation water venues.
Reporting
Period: This study reflects outbreaks between 2001
to 2002, surveillance data for public spa and pool inspections
in the United States from May to September 2002, and a review
of the publications used in the training of aquatic professionals.
Description
of the system: A review of curricula used to educate
and certify aquatic coaches did not show that a disease transmission
course correlated to Recreation Water Illnesses (RWIs) existed.
While training in disease transmission is critical to operators,
its purpose for swimming and diving coaches is less clear.
Many health departments are unable to properly monitor and
enforce health codes due to a lack of resources so the level
of service has resulted in a difficulty to insure water quality.
Among competitive-sports certification programs, U.S. Diving
references RWIs as a hazard in their coach training program;
USA Swimming and the American Swimming Coaches Association
(ASCA) do not, resulting in those certifying groups graduating
candidates that lack critical knowledge.
Results:
The 2001-2002 MMWRs identified pathogens in 83.5% of 65 outbreaks
and confirmed that in 30 outbreak-cases involving gastroenteritis,
half involved the chlorine-resistant RWI “Crypto”, and 60%
of all outbreaks occurred in treated facilities. Twenty-seven
states were identified as the source affecting 2,536 cases.
Five states averaged more than four outbreaks, and from an
inspection of 22,131 pools and 5,209 spas, 8.3% of the pools
and 11% of the spas were recommended for immediate closure.
Of the 65 outbreaks, 7 infected 405 athletes (16% of those
infected); the source of these seven was a series of hotel/motel
pools and spas where teams stayed during competition. The
outbreaks expanded by the initial athletes infecting more
than 150 competitors at their competition because they entered
the competitive pool without showering after leaving the hotel/motel
spa and pool.
Interpretation:
While RWIs may be described or referenced in some courses,
certified candidates graduate into the field lacking knowledge
about conditions that impact the cause of infection, the method
of transmission and their prevention. The lack of governmental
standards has resulted in poor quality and unsafe pools and
spas. This lack of knowledge is clearly represented in the
CDC data. Aspiring swimming and diving coaches clearly are
not prepared to understand disease transmission because they
do not connect the possibility that infection can occur outside
of a practice or competition venue, and certainly not at the
hotel pools/spas where they are staying.
Recommended
Action: USA Swimming, U.S. Diving, and ASCA must
expand the current certification process to include a prerequisite
on disease transmission. They then must collaborate to create
a module focusing on how and why people get sick, and how
to prevent RWI infection.
Read
the complete paper PDF
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