Summer Swimming: Why Cryptosporidium is not your friend

July 23, 1:43 PMHealth Care ExaminerDoctor Lissa

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One of the best ways to keep cool during the hottest days of summer is to go for a swim.  For many of us, that means in public pools or water parks.  Fun as this is, you should be aware that  waterborne diseases can ruin your vacation. 

Most people assume that a well-maintained swimming pool is germ-free, that chlorine kills all germs instantly.  Even at the country club. This is not true.  Even the best-maintained pools with adequate chlorine levels  can transmit waterborne diseases.  Gasp!  I know.  I'm not trying to ruin the summer for you, but I do want you to be aware and take precautions so you won't get sick. 

So what's the danger.  Well there are several, but the first and possibly most dangerous is Cryptosporidium.  It has been directly linked to outbreaks of GI illnesses from swimming pools and water parks.  It is the most difficult to avoid and treat.

Facts about Cryptosporidium:

• A nasty protozoan parasite that can withstand chlorine disinfection for nearly 11 days.  The mode of transmission is fecal to oral. 
• It is found in 65% to 97% of surface water and 24% of treated water.  Conventional pool filters do not trap this parasite. 
• Swallowing as few as 10 oocysts can cause infection.  Infected people can pass as many as 1 trillion oocysts with each bowel movement, so 10 is not hard if you swallow the pool water.
• The incubation period is 7-10 days after oocyte injestion and the illness lasts from several days to up to a month.
• Relapse occurs in about 40% of all cases but people can shed oocytes several months after recovery. 
• Symptoms are profuse watery diarrhea, abdominal cramps, nausea, vomiting, dehydration, and anorexia.
• There is no reliable treatment-just maintain fluid intake and of course, seek medical attention for supportive care.
• Nitazoxanide is a broad-spectrum antiparasitic drug and is approved by the FDA.  It can be helpful for some.

Ok, now that you're scared silly.  What can you do about this?  Well, there are a couple of things that will make your swim more enjoyable.

• First, next time you swim, take a look at the number of people in the pool.  A large number of bathers increases the likelihood that you will become infected.
• Check out the number of toddlers and children in diapers swimming in the pool.  With Cryptosporidium, a single fecal accident can contaminate the entire pool, so small children are a special concern.
• Children who play in water parks with interactive water features, such as fountains, shallow pools, vertical pressure jets and overhead sprays may be at greater risk than children who use traditional pools.  This is because water is usually collected in an underground holding tank and recirculated back up through the waterspouts.  If the underground tanks are not well designed with high level-filtration and water sanitizing systems, the water is at high risk for contamination.
• If you have small children in diapers, change them frequently and clean their skin thoroughly.  Do not change them at poolside but take them to the bathroom and dispose of the diaper there.
• Wash your children thoroughly with soap and water before swimming.
• Take a shower before entering a pool and wash your hands after using the toilet or chaniging diapers.
• Don't swallow water in pools, spas, or interactive fountains.
• If you have diarrhea, wait 2 weeks after it resolves to enter pools, spas, fountains, lakes, rivers or the ocean.

In summer 2002, the CDC reported that inspections of over 22,000 pools found that 54% had at least one health violation.  Most were in wading pools, therapy pools and hotel/motel pools.  The problem is that currently there is no federal oversight and no national standards for pool or water park design, construction, or maintenance.  So you need to be alert and educate your friends, family and co-workers.  Swimming is healthy and fun.  Just be mindful that public pools and water parks should be considered communal bathing sites and exercise caution.

Additional Resources: www.cdc.gov/crypto/

health.utah.gov/uthealthnews/2007/20070828-SwimRestrictions.htm

www.dallasnews.com/sharedcontent/dws/dn/latestnews/stories/072408dnmetinfection.8470e55b.html