NEW YORK — Several high-profile outbreaks of
cryptosporidiosis and other gastrointestinal illnesses have highlighted the
potential risks of swimming pools, and pediatricians can play a key role in
counseling parents and patients about water safety, according to a speaker here
at the 24th Annual Infectious Diseases in Children Symposium.
Michael J. Beach, PhD, associate director
for healthy water, National Center for Emerging and Zoonotic Infectious
Diseases at the CDC, said clinicians should be aware that ova and parasite
testing may not include testing for Cryptosporidium, so the test may
need to be specifically requested.
Nitazoxanide can be used to treat cryptosporidiosis in
immunocompetent children who are older than 1 year.
Beach said parents and patients should be advised to
avoid recreational water activities if they have diarrhea. Even after the
diarrhea has ceased, patients with cryptosporidiosis should avoid swimming for
an additional 2 weeks, and those patients who have an infection caused by other
waterborne pathogens should avoid the pool for an additional week. In addition,
swimmers should shower with soap and water before entering the water. All
swimmers should avoid ingesting recreational water and take frequent bathroom
breaks, and parents should change diapers often for young children.
He said these are all important measures to avoid
cryptosporidiosis outbreaks, which make up about three-quarters of all
waterborne outbreaks. He cited two high-profile outbreaks in New York and Utah.
In the summer 2005 in New York, an outbreak of
cryptosporidiosis affected a reported 4,000 people. The
results of the investigation revealed that the outbreak was related to a
communal pool with a splash pad design. In Utah in 2007, Beach said about 2,000
people had laboratory-confirmed cases of cryptosporidiosis that was associated
with 450 recreational water venues. This outbreak demonstrated the
vulnerability of the pediatric population, as most of the cases were in
children aged younger than 5 years. To quell the outbreak, children aged
younger than 5 years were banned temporarily from public pools.
Beach said other gastrointestinal illnesses, such as
Shigella, Escherichia coli and Giardia, have also been related to
outbreaks at pools.
Another common pathogen associated with swimming pools
is acute otitis externa (AOE). According to Beach, AOE is associated with about
2.4 million annual outpatient cases, and about $500 million per year of
systemic antibiotics, “so this is another pathogen pediatricians need to
keep on the radar,” he said.
It is important for pediatricians to help identify these
waterborne pathogens and report them when appropriate. Beach said the CDC is
currently developing a national consortium to “try and bring uniformity
and increase reporting performance of these illnesses.”
Disclosure: Dr. Beach reports no relevant
For more information:
- Beach MJ. Diseases from the neighborhood pool: What health care
providers, parents and swimmers need to know. Presented at: the 24th Annual
Infectious Diseases in Children Symposium; Nov. 18-20, 2011; New