Re: BEACHNET==> High Sensitivity of Children to Swimming-AssociatedGI-Illness: Results Using a Rapid

["Keith Linn" <LinnK@neorsd.org>]

Note that, according to Figures 1 and 2 of the article,
swimming-associated GI illness equals -0.0091816 + log 10 Enterococcus
QPCR CE x 0.0213998 for all subjects and equals -0.04821 + log 10
Enterococcus QPCR CE x 0.0486077 for children aged ten years or
younger.

At the existing EPA criteria*s acceptable freshwater
swimming-associated illness rate of eight cases per thousand swimmers,
Enterococcus QPCR CE is 6 per 100 mL for all subjects but is 14 per 100
mL for children aged ten years or younger, suggesting that, at
Enterococcus levels below the existing EPA criteria, the article*s
conclusion that *children at 10 years or younger were at greater risk
for GI illness* does not apply.

This is supported by Table 6, which includes an adjusted cumulative
incidence ratio that is lower for children than for all subjects when
Enterococcus levels are below 33 CFU/100 mL. 

Regardless, I would be interested in the insights of others on the
feasibility of consistently attaining Enterococcus levels of 6 per 100
mL and lower at beaches.


Keith J. Linn, Environmental Specialist
Water Quality & Industrial Surveillance
Northeast Ohio Regional Sewer District
4747 East 49th Street
Cuyahoga Heights, Ohio 44125-1011
Phone: (216) 641-6000, ext. 2202
Fax: (216) 641-8118
LinnK@neorsd.org


>>> "Shannon Briggs" <briggss4@michigan.gov> 4/21/2008 1:31 PM >>>
Please note that this article will be published in May, 2008.
The abstract is included below and available online now at 
http://www.epidem.com/pt/re/epidemiology/abstract.00001648-200805000-00008.htm;jsessionid=LMKT7bWwBQ6CJdRyV1mhWdZWlrntyxvxRwbN92qnTTZnQlvZwb3k!-859253161!181195629!8091!-1


Epidemiology. May, 2008
High Sensitivity of Children to Swimming-Associated Gastrointestinal
Illness: Results Using a Rapid Assay of Recreational Water Quality.
Wade TJ, Calderon RL, Brenner KP, Sams E, Beach M, Haugland R, Wymer L,
Dufour AP.

>From the US Environmental Protection Agency, National Health and
Environmental Effects Research Laboratory, Chapel Hill, NC; US
Environmental Protection Agency, National Exposure Research Laboratory,
Cincinnati, Ohio; and Centers for Disease Control and Prevention,
Atlanta, GA.

BACKGROUND: Culture-based methods of monitoring fecal pollution in
recreational waters require 24 to 48 hours to obtain results. This delay
leads to potentially inaccurate management decisions regarding beach
safety. We evaluated the quantitative polymerase chain reaction (QPCR)
as a faster method to assess recreational water quality and predict
swimming-associated illnesses. 
METHODS: We enrolled visitors at 4 freshwater Great Lakes beaches, and
contacted them 10 to 12 days later to ask about health symptoms
experienced since the visit. Water at the beaches was polluted by point
sources that carried treated sewage. We tested water samples daily for
Enterococcus using QPCR and membrane filtration (EPA Method 1600). 
RESULTS: We completed 21,015 interviews and tested 1359 water samples.
Enterococcus QPCR cell equivalents (CEs) were positively associated with
swimming-associated gastrointestinal (GI) illness (adjusted odds ratio
per 1 log10 QPCR CE =1.26; 95% confidence interval = 1.06-1.51). The
association between GI illness and QPCR CE was stronger among children
aged 10 years and below (1.69; 1.24-2.30). Nonenteric illnesses were not
consistently associated with Enterococcus QPCR CE exposure, although
rash and earache occurred more frequently among swimmers. Enterococcus
QPCR CE exposure was more strongly associated with GI illness than
Enterococcus measured by membrane filtration. 
CONCLUSIONS: Measurement of the indicator bacteria Enterococci in
recreational water using a rapid QPCR method predicted
swimming-associated GI illness at freshwater beaches polluted by sewage
discharge. Children at 10 years or younger were at greater risk for GI
illness following exposure.


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