SynthesisEnvironmental health perspectives2003
Do U.S. Environmental Protection Agency water quality guidelines for recreational waters prevent gastrointestinal illness? A systematic review and meta-analysis.
Synthesis in Environmental health perspectives, 2003. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 109 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
109 citing papers in PubMed, 4 syntheses or guidelines pooled it, 449 citations in OpenAlex.
- The use of faecal indicator organisms to manage microbial health risks in recreational waterways not impacted by point sources of sewage: a systematic review of the epidemiological evidence.Journal of water and health · 2025Pooled it
- Evaluating health risks associated with exposure to ambient surface waters during recreational activities: A systematic review and meta-analysis.Water research · 2020Pooled it
- Is it safe to go back into the water? A systematic review and meta-analysis of the risk of acquiring infections from recreational exposure to seawater.International journal of epidemiology · 2018Pooled it
- Pit latrines and their impacts on groundwater quality: a systematic review.Environmental health perspectives · 2013Pooled it
- The BEACHES Study: health effects and exposures from non-point source microbial contaminants in subtropical recreational marine waters.International journal of epidemiology · 2010Trial
- A randomized controlled trial assessing infectious disease risks from bathing in fresh recreational waters in relation to the concentration of Escherichia coli, intestinal enterococci, Clostridium perfringens, and somatic coliphages.Environmental health perspectives · 2006Trial
- Turbidity and streamflow as real-time indicators of microbial risk for aquatic recreators.Environmental monitoring and assessment · 2026Article
- Assessing Recreational Safety of Urban Marine Waters: Long-Term Coliform and Enterococcus Analysis.Water environment research : a research publication of the Water Environment Federation · 2026Article
- Comparison of ESKAPE Pathogen Levels in Wastewater and Receiving Water Bodies Using Agar-Based Enumeration and Real-Time PCR.Current microbiology · 2026Article
- Microbiological safety and hygiene monitoring of coastal seawater at Northern public beaches of Mauritius and genetic characterization of human pathogenic Vibrio species.PLOS global public health · 2026Article
- Article
- Acute gastrointestinal illness burden associated with water recreation in high-income countries: A scoping review.Canadian journal of public health = Revue canadienne de sante publique · 2025Article
- Quantitative microbial risk assessment of pathogen exposure from rainwater used in high-pressure vehicle washing.Journal of water and health · 2025Article
- Cultured and molecular measures of fecal indicator microbes in Gulf of Mexico recreational waters.The Science of the total environment · 2025Article
- Article
- Canadian beach cohort study: protocol of a prospective study to assess the burden of recreational water illness.BMC public health · 2024Article
- Advancing Source Tracking: Systematic Review and Source-Specific Genome Database Curation of Fecally Shed Prokaryotes.Environmental science & technology letters · 2024Article
- Application of a microbial and pathogen source tracking toolbox to identify infrastructure problems in stormwater drainage networks: a case study.Microbiology spectrum · 2024Article
- Article
- Development of Multiplex RT qPCR Assays for Simultaneous Detection and Quantification of Faecal Indicator Bacteria in Bathing Recreational Waters.Microorganisms · 2024Article
49 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 1 institution in 1 country.
Funding
Abstract
Despite numerous studies, uncertainty remains about how water quality indicators can best be used in the regulation of recreational water. We conducted a systematic review of this topic with the goal of quantifying the association between microbial indicators of recreational water quality and gastrointestinal (GI) illness. A secondary goal was to evaluate the potential for GI illness below current guidelines. We screened 976 potentially relevant studies and from these identified 27 studies. From the latter, we determined summary relative risks for GI illness in relation to water quality indicator density. Our results support the use of enterococci in marine water at U.S. Environmental Protection Agency guideline levels. In fresh water, (Italic)Escherichia(/Italic) coli was a more consistent predictor of GI illness than are enterococci and other bacterial indicators. A log (base 10) unit increase in enterococci was associated with a 1.34 [95% confidence intervals (CI), 1.00-1.75] increase in relative risk in marine waters, and a log (base 10) unit increase in E. coli was associated with a 2.12 (95% CI, 0.925-4.85) increase in relative risk in fresh water. Indicators of viral contamination were strong predictors of GI illness in both fresh and marine environments. Significant heterogeneity was noted among the studies. In our analysis of heterogeneity, studies that used a nonswimming control group, studies that focused on children, and studies of athletic or other recreational events found elevated relative risks. Future studies should focus on the ability of new, more rapid and specific microbial methods to predict health effects, and estimating the risks of recreational water exposure among susceptible persons.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.