Diseases

Diarrheal IllnessesSwallowing water that has been contaminated with feces containing germs can cause diarrheal illness.Swimmers share the water -- and the germs in it -- with every person who enters the pool. On average, people have about 0.14 grams of feces on their bottoms which, when rinsed off, can contaminate recreational water. In addition, when someone is ill with diarrhea, their stool can contain millions of germs. This means that just one person with diarrhea can easily contaminate the water in a large pool or water park. Swallowing even a small amount of recreational water that has been contaminated with feces containing germs can make you sick. Remember, chlorine does not kill germs instantly, and some germs, such as Cryptosporidium (or "Crypto"), are extremely chlorine tolerant.In addition, lakes, rivers, and the ocean can be contaminated with germs from sewage spills, animal waste, and water runoff following rainfall. Some common germs can also live for long periods of time in salt water.Other RWIsMany other RWIs (skin, ear, eye, respiratory, neurologic, wound, and other infections) are caused by germs that live naturally in the environment (for example, in water and soil). If disinfectant levels in pools or hot tubs are not maintained at the appropriate levels, these germs can multiply and cause illness when swimmers breathe in mists or aerosols of or have contact with the contaminated water.

Steps for Healthy SwimmingHere are a few easy and effective healthy swimming steps all swimmers can take each time we swim to help protect ourselves, our families, and our friends from recreational water illnesses (RWIs):Keep the pee, poop, sweat, and dirt out of the water!

• Stay out of the water if you have diarrhea.
• Shower before you get in the water.
• Don't pee or poop in the water.
• Don't swallow the water.

Every hour -- everyone out!

• Take kids on bathroom breaks.
• Check diapers, and change them in a bathroom or diaper-changing area-not poolside-to keep germs away from the pool.
• Reapply sunscreen.
• Drink plenty of fluids.

Check the free chlorine level and pH before getting into the water.

• Pools: Proper free chlorine level (1-3 mg/L or parts per million [ppm]) and pH (7.2-7.8) maximize germ-killing power.
• Hot tubs/spas: Proper disinfectant level (chlorine [2-4 parts per million or ppm] or bromine [4-6 ppm] and pH [7.2-7.8]) maximize germ-killing power.
• Most superstores, hardware stores, and pool-supply stores sell pool test strips.

Recreational water illnesses (RWIs) are caused by germs spread by swallowing, breathing in mists or aerosols of, or having contact with contaminated water in swimming pools, hot tubs, water parks, water play areas, interactive fountains, lakes, rivers, or oceans. RWIs can also be caused by chemicals in the water or chemicals that evaporate from the water and cause indoor air quality problems. RWIs can be a wide variety of infections, including gastrointestinal, skin, ear, respiratory, eye, neurologic and wound infections. The most commonly reported RWI is diarrhea. Diarrheal illnesses can be caused by germs such as Crypto (short for Cryptosporidium), Giardia, Shigella, norovirus and E. coli O157:H7.

RWIs are caused by germs spread through contaminated water in swimming pools, water parks, water play areas, hot tubs, decorative water fountains, oceans, lakes, and rivers.Swimming Pools, Water Parks, Water Play AreasThe most common RWI is diarrhea. Swallowing water that has been contaminated with feces containing germs can cause diarrheal illness.Swimmers share the water -- and the germs in it -- with every person who enters the pool. On average, people have about 0.14 grams of feces on their bottoms which, when rinsed off, can contaminate recreational water. In addition, when someone is ill with diarrhea, their stool can contain millions of germs. This means that just one person with diarrhea can easily contaminate the water in a large pool or water park. People may not realize that although there is no standing water in interactive fountains/water play areas, the spray water will rinse any contaminants (for example, diarrhea, vomit, and dirt) down into the water holding area and be sprayed again. In other words, the water is recycled through the system.Swallowing even a small amount of recreational water that has been contaminated with feces containing germs can make you sick.To ensure that most germs are killed, check chlorine or other disinfectant levels and pH regularly as part of good pool operation.Hot TubsSkin infections like "hot tub rash" are a common RWI spread through hot tubs and spas. Respiratory illnesses are also associated with the use of improperly maintained hot tubs.The high water temperatures in most hot tubs make it hard to maintain the disinfectant levels needed to kill germs. That's why it's important to check disinfectant levels in hot tubs even more regularly than in swimming pools.The germs that cause "hot tub rash" can also be spread in pools that do not have proper disinfectant levels and in natural bodies of water such as oceans, lakes, or rivers.Decorative Water FountainsNot all decorative fountains are chlorinated or filtered. Therefore, when people, especially diaper-aged children, play in the water, they can contaminate the water with fecal matter. Swallowing this contaminated water can then cause diarrheal illness.Oceans, Lakes, and RiversOceans, lakes, and rivers can be contaminated with germs from sewage spills, animal waste, water runoff following rainfall, fecal incidents, and germs rinsed off the bottoms of swimmers. It is important to avoid swallowing the water because natural recreational water is not disinfected. Avoid swimming after rainfalls or in areas identified as unsafe by health departments. Contact your state or local health department for water testing results in your area or go to EPA's beach site.

Children, pregnant women, and people with weakened immune systems (for example, people living with AIDS, individuals who have received an organ transplant, or people receiving certain types of chemotherapy) can suffer from more severe illness if infected. People with weakened immune systems should be aware that recreational water might be contaminated with human or animal feces containing Crypto (short for Cryptosporidium). Crypto can cause a life-threatening infection in persons with weakened immune systems.People with a weakened immune system should consult their health care provider before participating in activities that place them at risk for illness.

Chlorine (in swimming pools and hot tubs) kills the germs that cause recreational water illnesses (RWIs), but the time it takes to kill each germ varies.In pools and hot tubs with the correct pH and disinfectant levels, chlorine will kill most germs that cause RWIs in less than an hour. However, chlorine takes longer to kill some germs, such as Crypto (short for Cryptosporidium). Crypto can survive for days even in a properly disinfected pool. This is why it is so important for swimmers to keep germs out of the water in the first place.To protect yourself, your family, and other swimmers from RWIs, it is essential to learn and practice healthy swimming behaviors.