The Perspective

Swimming in It

Swimming, a popular summer pastime in our arid climate, can pose a host of health hazards. Drowning and near drowning are the risks that usually come to mind, but man-made and natural bodies of water can serve as breeding grounds for an array of germs.

And contrary to popular belief, chlorine and the chemicals added to pools, spas, water parks and features do not kill all germs instantly. Many pathogens have grown resistant to chemicals and some that were never known to cause human illness, can now make you sick. It can take anywhere from a few minutes to days for the appropriate chemicals to do their job and disinfect a pool or spa.

Recreational Water Illnesses

The diseases caused by these germs are known as recreational water illnesses (RWIs). You can catch them 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.

Illnesses associated with RWIs vary, and range from gastrointestinal, skin, ear, respiratory, eye, neurologic to wound infections. However, the most commonly reported RWI is diarrhea, which is usually a symptom of an illness caused by germs such as Crypto (short of Cryptosporidium), Giardia, Shigella, norovirus, or E. coli O157:H7.

Over the past two decades infections have been on the rise and swimmers should learn the basic facts about RWIs to protect themselves and their family every time they swim or take part in recreational activities in water. Crypto, for example, can stay alive for days even in a well-maintained pool, and has become the leading cause of pool-related outbreaks of diarrheal illnesses. According to the Centers for Disease Control and Prevention from 2004 to 2008, reported Crypto cases increased over 200 percent (from 3,411 cases in 2004 to 10,500 cases in 2008).

Unlike Crypto, most germs are not tolerant to chlorine. Keeping chemical levels at the recommended levels is essential to maintaining a healthy pool. To this end, the Southern Nevada Health District inspects the more than 4,700 permitted public swimming pools and spas in Clark County to ensure they are properly maintained and comply with state regulations. The regulatory and inspection process helps to assure the public health of residents and visitors is protected as they enjoy both man-made and natural water features in our community.

Recreational water illnesses include:

Stomach and Intestinal Illness

Gastrointestinal illnesses affect a person's stomach and intestines, and can cause diarrhea, nausea, or vomiting. The following gastrointestinal illnesses are associated with recreational water activities.

Cryptosporidium (Crypto)
Crypto is one of the most common causes of water recreation diarrhea illness in the United States. The germ is found in people's stool.

Giardia is another common cause of diarrhea and is found in infected people's stool.

Shigella causes severe diarrhea, which is often bloody, and is spread when an infected person with diarrhea swims or plays in areas such as beaches or inadequately disinfected pools.

E. coli O157:H7
People become infected with E. coli by swallowing lake water while swimming. Symptoms include severe diarrhea and bloody stool.

Norovirus is very contagious and can spread through an infected person's stool or vomit.

Skin Irritations

Skin rashes, boils, allergic reactions to chemicals, and skin damage from the sun can occur while enjoying water recreation activities.

Hot Tub Rash - Pseudomonas dermatitis/Folliculitis
Hot Tub Rash or dermatitis is an infection that causes an itchy bumpy rash on the skin.

Swimmer's Itch - Cercarial dermatitis
Swimmer's itch is a rash caused by an allergic reaction to parasites that typically infect some birds and mammals.

Swimmer's Ear - Otitis externa
Swimmer's ear is an infection of the outer ear canal and can affect anyone, but is most common in children.

Cyanobacteria - Blue-green Algae
Cyanobacteria, or blue-green algae, are found in lakes, rivers, ponds, and seawater. Sometimes cyanobacteria are toxic and people experience skin, eye, or ear irritation with contact.

Chemical Sensitivity
Some people experience allergic reactions, such as skin redness and itching, to chemicals used in pools.

Respiratory Illness

Some water recreation illnesses affect a person's breathing causing cold or flu-like symptoms, shortness of breath, cough, or a serious infection in the windpipe or lungs.

Legionnaires' disease is a serious infection that creates life-threatening pneumonia. A less serious form of the infection is Pontiac fever, which has the same early symptoms of Legionnaires' disease (body pain and weakness, headache, fever, chills, and cough).

Mycobacterium avium and endotoxins
When inhaled, water vapor or steam contaminated with bacteria or bacterial fragments can cause an allergic reaction and inflammation in the lungs.

The Southern Nevada Health District promotes healthy behaviors in and around water. For more information, visit the Healthy Swimming Behaviors webpage. If you encounter symptoms associated with an RWI, contact your health care provider.

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