Trial reportEnvironmental health perspectives2006
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.
Trial report in Environmental health perspectives, 2006. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 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
33 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Evaluating health risks associated with exposure to ambient surface waters during recreational activities: A systematic review and meta-analysis.Water research · 2020Pooled it
- Occurrence of coliphage in raw wastewater and in ambient water: A meta-analysis.Water research · 2019Pooled it
- Sources of human infection by Salmonella enterica serotype Javiana: A systematic review.PloS one · 2019Pooled it
- Interventions to improve water quality for preventing diarrhoea.The Cochrane database of systematic reviews · 2015Pooled it
- Machine Learning, Generalization, and Transfer Learning for Predicting the Exceedance of Fecal Indicator Bacteria Thresholds at Beaches.Environmental science & technology · 2025Article
- 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
- Cultured and molecular measures of fecal indicator microbes in Gulf of Mexico recreational waters.The Science of the total environment · 2025Article
- Population structure and pathogen interaction of Escherichia coli in freshwater: Implications of land-use for water quality and public health in Aotearoa New Zealand.Environmental microbiology reports · 2024Article
- Spatio-Temporal Variation in the Exceedance of Enterococci in Lake Burley Griffin: An Analysis of 16 Years' Recreational Water Quality Monitoring Data.International journal of environmental research and public health · 2024Article
- How suitable is freshwater sponge Ephydatia fluviatilis (Linnaeus, 1759) for time-integrated biomonitoring of microbial water quality?Access microbiology · 2024Article
- Microbial bowel infections-induced biochemical and biological abnormalities and their effects on young Egyptian swimmers.Scientific reports · 2023Article
- The Effect of Protozoa Indigenous to Lakewater and Wastewater on Decay of Fecal Indicator Bacteria and Coliphage.Pathogens (Basel, Switzerland) · 2023Article
- Bathing Water Quality Monitoring Practices in Europe and the United States.International journal of environmental research and public health · 2021Review
- Variable fecal source prioritization in recreational waters routinely monitored with viral and bacterial general indicators.Water research · 2021Article
- Modeling the photoinactivation and transport of somatic and F-specific coliphages at a Great Lakes beach.Journal of environmental quality · 2020Article
- Searching variables to assess recreational water quality: the presence of infectious human enterovirus and its correlation with the main variables of water pollution by multivariate statistical approach in Córdoba, Argentina.Environmental science and pollution research international · 2019Article
- Exposure to Human-Associated Chemical Markers of Fecal Contamination and Self-Reported Illness among Swimmers at Recreational Beaches.Environmental science & technology · 2018Article
- An outbreak of Norovirus infections associated with recreational lake water in Western Finland, 2014.Epidemiology and infection · 2018Article
- Estimate of incidence and cost of recreational waterborne illness on United States surface waters.Environmental health : a global access science source · 2018Article
- Coliphages and Gastrointestinal Illness in Recreational Waters: Pooled Analysis of Six Coastal Beach Cohorts.Epidemiology (Cambridge, Mass.) · 2017Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
We performed epidemiologic studies at public freshwater bathing sites in Germany to provide a better scientific basis for the definition of recreational water quality standards. A total of 2,196 participants were recruited from the local population and randomized into bathers and nonbathers. Bathers were exposed for 10 min and had to immerse their head at least three times. Water samples for microbiological analysis were collected at 20-min intervals. Unbiased concentration-response effects with no-observed-adverse-effect levels (NOAELs) were demonstrated for three different definitions of gastroenteritis and four fecal indicator organisms. Relative risks for bathing in waters with levels above NOAELs compared with nonbathing ranged from 1.8 (95% CI, 1.2-2.6) to 4.6 (95% CI, 2.1-10.1), depending on the definition of gastroenteritis. The effect of swallowing water provided additional evidence for true dose-response relationships. Based on the NOAELs, the following guide values for water quality are suggested: 100 Escherichia coli, 25 intestinal enterococci, 10 somatic coliphages, or 10 Clostridium perfringens per 100 mL. Recreational water quality standards are intended to protect the health of those consumers who are not already immune or resistant to pathogens that may be associated with indicator organisms. In contrast to current World Health Organization recommendations, we concluded that standards should be based on rates of compliance with NOAELs rather than on attributable risks determined above NOAELs, because these risks depend mainly on the unpredictable susceptibility of the cohorts. Although in theory there is no threshold in real concentration-response relationships, we demonstrated that a NOAEL approach would be a more robust and practical solution to the complex problem of setting standards.
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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.