ArticlePloS one2022
Health risks to children from exposure to fecally-contaminated recreational water.
Article in PloS one, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 12 papers, 2 of them syntheses that pooled it.
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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
12 citing papers in PubMed, 2 syntheses or guidelines pooled it, 32 citations in OpenAlex.
- Is detection of enteropathogens and human or animal faecal markers in the environment associated with subsequent child enteric infections and growth: an individual participant data meta-analysis.The Lancet. Global health · 2024Pooled it
- Have genetic targets for faecal pollution diagnostics and source tracking revolutionized water quality analysis yet?FEMS microbiology reviews · 2023Pooled it
- Water contamination and cytogenetic effects in fish from coastal lagoons of southern Brazil.Environmental monitoring and assessment · 2026Article
- A Review of the Human Health Risks from Microbial Hazards in Recreational Beach Sand.International journal of environmental research and public health · 2025Review
- Assessing fecal pollution source in a Northern Michigan Lake using qPCR and a community-based monitoring framework.PloS one · 2025Article
- Canadian beach cohort study: protocol of a prospective study to assess the burden of recreational water illness.BMC public health · 2024Article
- Climate change and public health in California: A structured review of exposures, vulnerable populations, and adaptation measures.Proceedings of the National Academy of Sciences of the United States of America · 2024Review
- Article
- Fecal Impairment Framework, A New Conceptual Framework for Assessing Fecal Contamination in Recreational Waters.Environmental management · 2024Article
- Scenario-based assessment of fecal pathogen sources affecting bathing water quality: novel treatment options to reduce norovirus andFrontiers in microbiology · 2024Article
- Correction: Health risks to children from exposure to fecally-contaminated recreational water.PloS one · 2024Article
- Recreational water exposures and illness outcomes at a freshwater beach in Toronto, Canada: A prospective cohort pilot study.PloS one · 2023Article
Corrections and comments
- Erratum issued
Authors and funding
7 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundChildren may be at higher risk for swimming-associated illness following exposure to fecally-contaminated recreational waters. We analyzed a pooled data set of over 80,000 beachgoers from 13 beach sites across the United States to compare risks associated with the fecal indicator bacteria Enterococcus spp. (measured by colony forming units, CFU and quantitative polymerase chain reaction cell equivalents, qPCR CE) for different age groups across different exposures, sites and health endpoints.
methodsSites were categorized according to the predominant type of fecal contamination (human or non-human). Swimming exposures of varying intensity were considered according to degree of contact and time spent in the water. Health endpoints included gastrointestinal and respiratory symptoms and skin rashes. Logistic regression models were used to analyze the risk of illness as a function of fecal contamination in water as measured by Enterococcus spp. among the exposed groups. Non-swimmers (those who did not enter the water) were excluded from the models to reduce bias and facilitate comparison across groups.
resultsGastrointestinal symptoms were the most sensitive health endpoint and strongest associations were observed with Enterococcus qPCR CE at sites impacted by human fecal contamination. Under several exposure scenarios, associations between illness and Enterococcus spp. levels were significantly higher among children compared to adolescents and adults. Respiratory symptoms were also associated with Enterococcus spp. exposures among young children at sites affected by human fecal sources, although small sample sizes resulted in imprecise estimates for these associations.
conclusionUnder many exposure scenarios, children were at higher risk of illness associated with exposure to fecal contamination as measured by the indicator bacteria Enterococcus spp. The source of fecal contamination and the intensity of swimming exposure were also important factors affecting the association between Enterococcus spp. and swimming-associated illness.
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