Outbreaks Associated with Treated Recreational Water - United States, 2015-2019.

Outbreaks associated with treated recreational water can be caused by pathogens or chemicals in aquatic venues such as pools, hot tubs, water playgrounds, or other artificially constructed structures that are intended for recreational or therapeutic purposes. For the pseriod 2015-2019, public health officials from 36 states and the District of Columbia (DC) voluntarily reported 208 outbreaks associated with treated recreational water. Almost all (199; 96%) of the outbreaks were associated with public (nonbackyard) pools, hot tubs, or water playgrounds. These outbreaks resulted in at least 3,646 cases of illness, 286 hospitalizations, and 13 deaths. Among the 155 (75%) outbreaks with a confirmed infectious etiology, 76 (49%) were caused by Cryptosporidium (which causes cryptosporidiosis, a gastrointestinal illness) and 65 (42%) by Legionella (which causes Legionnaires' disease, a severe pneumonia, and Pontiac fever, a milder illness with flu-like symptoms). Cryptosporidium accounted for 2,492 (84%) of 2,953 cases resulting from the 155 outbreaks with a confirmed etiology. All 13 deaths occurred in persons affected by a Legionnaires' disease outbreak. Among the 208 outbreaks, 71 (34%) were associated with a hotel (i.e., hotel, motel, lodge, or inn) or a resort, and 107 (51%) started during June-August. Implementing recommendations in CDC's Model Aquatic Health Code (MAHC) (1) can help prevent outbreaks associated with treated recreational water in public aquatic venues.

Evaluation of the occurrence of pathogenic free-living amoeba and bacteria in 20 public indoor swimming pool facilities.

Recently, indoor swimming pool activities have increased to promote health-enhancing physical activities, which require establishing suitable protocols for disinfection and water quality control. Normally, the assessment of the microbial quality of the water in the pools only considers the presence of different bacteria. However, other less frequent but more resistant pathogens, such as free-living amoebas (FLA), are not contemplated in both existing recommendation and research activities. FLA represent a relevant human health risk, not only due to their pathogenicity but also due to the ability to act as vehicles of other pathogens, such as bacteria. Therefore, this work aimed to study the physicochemical characteristics and the occurrence of potentially pathogenic FLA and bacteria in water samples from 20 public indoor swimming facilities in Northern Portugal. Our results showed that some swimming pools presented levels of pH, free chlorine, and conductivity out of the recommended limits. Pathogenic FLA species were detected in two of the facilities under study, where we also report the presence of both, FLA and pathogenic bacteria. Our findings evidence the need to assess the occurrence of FLA and their existence in the same environmental niche as pathogenic bacteria in swimming pool facilities worldwide and to establish recommendations to safeguard the health of the users.

The prevention of child drowning: the causal factors and social determinants impacting fatalities in portable pools.

ISSUE ADDRESSED: There is a scarcity of research into portable pool drowning and its prevention. This total population study examines fatal drowning among children under five in portable pools in Australia. METHODS: All child drowning deaths in portable pools for the period 1 July 2002 to 30 June 2018 were identified. A portable pool was defined as any structure used for swimming and wading which, when emptied, can be moved. RESULTS: Twenty-three children (aged 0-17 years) drowned in portable pools. The drowning rate for children less than 5 years of age was 0.09 per 100 000 population. The peak age of death was 12-23 months (RR = 2.99; CI: 1.09-8.23), with the majority (n = 20 deaths) aged 16-31 months. Ninety per cent followed a fall into water. None were supervised. Children commonly resided in areas classified as socially and economically disadvantaged (85%; n = 17). Drowning rates in very remote areas were 15 times greater (RR = 15.41; CI: 0.03-7579.65) than city children. Eleven (55%) drowning deaths occurred in pools with a depth >300 mm, of which 10 (91%) were known to be unfenced. CONCLUSIONS: Social determinants impact child drowning in portables pools, which can occur quickly and in just 150 mm of water. Active supervision and a regulation-compliant barrier are effective prevention stratagems, factors which were absent from the deaths in this study. SO WHAT?: Portable pool drowning disproportionately impacts those aged 16-31 months who reside in very remote areas and areas classified as having high socio-economic disadvantage. Education for these groups on fencing and supervision of children must be provided.

Hot weather and risk of drowning in children: Opportunity for prevention.

The link between outdoor temperature and risk of drowning in children is poorly understood. The objective of this study was to determine the association between elevated temperature and the chance of drowning in children and adolescents. We used a case-crossover study design to assess 807 fatal and nonfatal drowning-related hospitalisations among children aged 0 to 19 years in Quebec, Canada between 1989 and 2015. The primary exposure measure was maximum temperature the day of drowning. We estimated odds ratios and 95% confidence intervals (CI) for the association of temperature with drowning by age group (<2, 2-4, 5-9, 10-19 years), adjusted for precipitation, relative humidity, and holidays. Elevated temperature was associated with greater odds of drowning. Compared with 15 °C, a temperature of 30 °C was associated with 6 times the chance of drowning between 0 and 19 years of age (95% CI 4.40-8.16). The association was not modified by characteristics such as age or location of drowning. Relative to 15 °C, a temperature of 30 °C was associated with 3.75 times the odds of drowning in pools (95% CI 1.85-7.63) and 12.44 times the odds of drowning in other bodies of water (95% CI 3.53-43.81). Associations persisted even after implementation of a policy to restrict access to private pools in 2010. These findings suggest that hot weather is strongly associated with the risk of drowning in children aged 0 to 19 years. Interventions to prevent drowning in children should be enhanced during hot days, and not only around pools.

Assessment, control, and prevention of microbiological and chemical hazards in seasonal swimming pools of the Versilia district (Tuscany, central Italy).

Although in Europe the quality of swimming pools (SPs) is dictated by regulations, microbiological and chemical hazards are described in the literature. Environmental bacteria or toxic disinfection by-product (DBP) compounds may indeed be recovered in waters even after disinfection. We evaluated the water quality from 26 outdoor seasonal SPs of the Versilia district, according to requirements of Regional Decree 54R/2015. In spring 2017, supply and reinstatement waters were collected after shock hyperchlorination (10 mg/L) while in summertime, a second sampling of waters before entering the pools, as well as in the pools, was performed after SPs were open to the public. In all samples, microbiological and chemical parameters were determined as defined by Directive 98/83/EC and the Italian Health Ministry. Microbiological data were within suggested limits. The first chemical analyses showed that in 35% of the feeding-pool seawater samples, the halogenated organic compounds were higher than the maximum permissible concentrations (30 µg/L). Pool waters were then dechlorinated and re-treated with hydrogen peroxide (10 mg/L) to ensure the abatement of DBPs (from 164 ± 107 to 0.9 ± 0.8 µg/L; p = 0.002). Results highlighted the need of self-controlled procedures for the SPs waters to prevent waterborne diseases and suggested hydrogen peroxide as the most appropriate disinfection method.

Swimming Pool Electrical Injuries: Steps Toward Prevention.

OBJECTIVE: Electrical injuries in swimming pools are an important pediatric public health concern. We sought to (1) improve our understanding of the clinical presentation and outcomes following and (2) describe the epidemiology of swimming pool electrical injuries in the United States. METHODS: We reviewed 4 cases of pediatric (<18 y old) electrical injury from a single, urban level 1 pediatric trauma center. We also queried the National Electronic Injury Surveillance System (NEISS) for emergency department visits due to electrical injury associated with swimming pools, occurring between 1991 and 2013. RESULTS: Overall, 566 cases were reported, with a mean (SD) age of 9.2 (4.1) years. Patients were mostly treated and released from the emergency department (91.8%), whereas 8.2% were hospitalized. When stated, injuries occurred most frequently at home (57.0%), followed by public (23.9%) and sports facilities (19.1%). Electrical outlets or receptacles (39.8%) were most commonly implicated, followed by electrical system doors (18.2%), electric wiring systems (17.0%), thermostats (16.3%), hair dryers (4.6%), and radios (4.1%). Pediatric cases represented 48.4% of swimming pool-related electrical injuries reported to NEISS. CONCLUSIONS: Electrical injuries occurring in and around swimming pools remain an important source of morbidity and mortality. Although NEISS monitors sentinel events, current efforts at preventing such cases are less than adequate. All electrical outlets near swimming pools should be properly wired with ground fault circuit interrupter devices. Possible approaches to increasing safe electrical device installation are through strengthening public awareness and education of the potential for injury, as well as changes to current inspection regulations.

The impact of free access to swimming pools on children's participation in swimming. A comparative regression discontinuity study.

OBJECTIVE: Investigating the extent to which providing children with free swimming access during school holidays increased participation in swimming and whether this effect differed according to the socioeconomic deprivation of the neighbourhoods in which children lived. SETTING: A highly disadvantaged local authority (LA) in North West England. INTERVENTION: Provision of children with free swimming during the summer holidays. OUTCOME MEASURES: Number of children swimming, and the number of swims, per 100 population in 2014. DESIGN: Comparative regression discontinuity investigating the extent to which participation rates amongst children aged 5-15 were greater in the intervention LA compared to a similar control LA. We estimated the differential effect of the intervention across five groups, defined by quintiles of area deprivation. RESULTS: Free swimming during the summer holidays was associated with an additional 6% of children swimming (95% CI: 4-9%) and an additional 33 swims per 100 children per year (95% CI: 21-44). The effects were greatest in areas with intermediate levels of deprivation (quintiles 3 and 4) within this deprived LA. CONCLUSION: Providing free facilities for children in disadvantaged areas is likely to increase swimming participation and may help reduce inequalities in physical activity.

Understanding the full burden of drowning: a retrospective, cross-sectional analysis of fatal and non-fatal drowning in Australia.

OBJECTIVES: The epidemiology of fatal drowning is increasingly understood. By contrast, there is relatively little population-level research on non-fatal drowning. This study compares data on fatal and non-fatal drowning in Australia, identifying differences in outcomes to guide identification of the best practice in minimising the lethality of exposure to drowning. DESIGN: A subset of data on fatal unintentional drowning from the Royal Life Saving National Fatal Drowning Database was compared on a like-for-like basis to data on hospital separations sourced from the Australian Institute of Health and Welfare's National Hospital Morbidity Database for the 13-year period 1 July 2002 to 30 June 2015. A restrictive definition was applied to the fatal drowning data to estimate the effect of the more narrow inclusion criteria for the non-fatal data (International Classification of Diseases (ICD) codes W65-74 and first reported cause only). Incidence and ratios of fatal to non-fatal drowning with univariate and Χ2 analysis are reported and used to calculate case-fatality rates. SETTING: Australia, 1 July 2002 to 30 June 2015. PARTICIPANTS: Unintentional fatal drowning cases and cases of non-fatal drowning resulting in hospital separation. RESULTS: 2272 fatalities and 6158 hospital separations occurred during the study period, a ratio of 1:2.71. Children 0-4 years (1:7.63) and swimming pools (1:4.35) recorded high fatal to non-fatal ratios, whereas drownings among people aged 65-74 years (1:0.92), 75+ years (1:0.87) and incidents in natural waterways (1:0.94) were more likely to be fatal. CONCLUSIONS: This study highlights the extent of the drowning burden when non-fatal incidents are considered, although coding limitations remain. Documenting the full burden of drowning is vital to ensuring that the issue is fully understood and its prevention adequately resourced. Further research examining the severity of non-fatal drowning cases requiring hospitalisation and tracking outcomes of those discharged will provide a more complete picture.

Validation of Questionnaire Methods to Quantify Recreational Water Ingestion.

Swimming pool water ingestion volumes are necessary for assessing infection risk from swimming. Pool water ingestion volumes can be estimated by questionnaire or measuring a chemical tracer in swimmer urine. Questionnaires are often preferred to the chemical tracer method because surveys are less time consuming, but no research exists validating questionnaires accurately quantify pool water ingestion volumes. The objective of this study was to explore if questionnaires are a reliable tool for collecting pool water ingestion volumes. A questionnaire was issued at four pool sites in Tucson, Arizona to 46 swimmers who also submitted a urine sample for analyzing cyanuric acid, a chemical tracer. Perceived ingestion volumes reported on the questionnaire were compared with pool water ingestion volumes, quantified by analyzing cyanuric acid in swimmer urine. Swimmers were asked if they swallowed (1) no water or only a few drops, (2) one to two mouthfuls, (3) three to five mouthfuls, or (4) six to eight mouthfuls. One mouthful is the equivalent of 27 mL of water. The majority (81%) of swimmers ingested <27 mL of pool water but reported ingesting >27 mL ("one mouthful") on the questionnaire. More than half (52%) of swimmers overestimated their ingestion volume. These findings suggest swimmers are over-estimating pool water ingestion because they perceive one mouthful is <27 mL. The questionnaire did not reliably collect pool water ingestion volumes and should be improved for future exposure assessment studies. Images of the ingestion volume categories should be included on the questionnaire to help swimmers visualize the response options.

Faecal contamination in public pools in Barcelona province: Cryptosporidium spp. and bacterial indicators.

A study was conducted of the occurrence of Cryptosporidium in indoor heated public swimming pools and of three bacterial indicators (Escherichia coli, faecal enterococci and Clostridium perfringens) on pool surrounds. Although all examined pools adhered strictly to the Spanish regulations, the influence of several parameters related to water conditions, pool structure, users and location on the presence of protozoa and bacteria was analysed. Cryptosporidium was detected in 18.8% of pools in 60% of the five towns studied. The maximum concentration was 13 oocysts/L in one swimming pool and one Jacuzzi. The bacterial indicators' prevalence on pool surrounds was higher than 50%, being present in all of the towns. Plastic surfaces presented the lowest bacterial prevalence, whereas painted surfaces were 100% positive. No differences were observed for pool surrounds with autonomous or disabled users. Risk of cryptosporidiosis in pool vessels indicated that concentrations over 1 oocyst/10 L enhance the risk of infection, even in one exposure. Guidelines for managing faecal accidents and public information on the importance of good hygiene behaviours in and around swimming pools are recommended to limit oocysts' presence.

Aqua walking as an alternative exercise modality during cardiac rehabilitation for coronary artery disease in older patients with lower extremity osteoarthritis.

BACKGROUND: The purpose of this study was to examine the effects of aqua walking (AW) on coronary artery disease (CAD) and cardiorespiratory fitness in older adults with osteoarthritis in the lower extremity and compare it with that of traditional over-ground walking. METHODS: Sixty consecutive eligible patients who had undergone percutaneous coronary intervention for CAD with limited ambulation due to lower extremity osteoarthritis were recruited. They were randomly assigned to the AW program group, treadmill/track walking (TW) program group, or non-exercise control group (CON). Assessments were performed before and after 24 weeks of medically supervised exercise training. RESULTS: Significant differences were observed in the change in %body fat (TW: -2.7%, AW: -2.8%, CON: -0.4%), total cholesterol level (TW: -23.6 mg/dL, AW: -27.2 mg/dL, CON: 15.8 mg/dL), resting heart rate (TW: -6.3 bpm, AW: -6.9 bpm, CON: 1.3 bpm), and cardiorespiratory fitness expressed as VO2 peak (TW: 2.3 mL/kg·min-1, AW: 2.0 mL/kg·min-1, CON: -2.5 mL/kg·min-1) over 24 weeks among the groups. However, no significant differences in the change in these measures were found between the TW and AW groups. CONCLUSION: AW appears to be a feasible alternative exercise modality to over-ground walking for cardiac rehabilitation and can be recommended for older adults with CAD and osteoarthritis.

Bladder Cancer and Water Disinfection By-product Exposures through Multiple Routes: A Population-Based Case-Control Study (New England, USA).

BACKGROUND: Ingestion of disinfection byproducts has been associated with bladder cancer in multiple studies. Although associations with other routes of exposure have been suggested, epidemiologic evidence is limited. OBJECTIVES: We evaluated the relationship between bladder cancer and total, chlorinated, and brominated trihalomethanes (THMs) through various exposure routes. METHODS: In a population-based case­control study in New England (n=(1,213) cases; n=(1,418) controls), we estimated lifetime exposure to THMs from ingestion, showering/bathing, and hours of swimming pool use. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) using unconditional logistic regression adjusted for confounders. RESULTS: Adjusted ORs for bladder cancer comparing participants with exposure above the 95th percentile with those in the lowest quartile of exposure (based on the distribution in controls) were statistically significant for average daily intake mg/d of total THMs [OR=1.53 (95% CI: 1.01, 2.32), p-trend=0.16] and brominated THMs [OR=1.98 (95% CI: 1.19, 3.29), p-trend=0.03]. For cumulative intake mg, the OR at the 95th percentile of total THMs was 1.45 (95% CI: 0.95, 2.2), p-trend=0.13; the ORs at the 95th percentile for chlorinated and brominated THMs were 1.77 (95% CI: 1.05, 2,.99), p-trend=0.07 and 1.78 (95% CI: 1.05, 3.00), p-trend=0.02, respectively. The OR in the highest category of showering/bathing for brominated THMs was 1.43 (95% CI: 0.80, 2.42), p-trend=0.10. We found no evidence of an association for bladder cancer and hours of swimming pool use. CONCLUSIONS: We observed a modest association between ingestion of water with higher THMs (>95th percentile vs.<25th percentile) and bladder cancer. Brominated THMs have been a particular concern based on toxicologic evidence, and our suggestive findings for multiple metrics require further study in a population with higher levels of these exposures. Data from this population do not support an association between swimming pool use and bladder cancer. https://doi.org/10.1289/EHP89.

Indoor swimming pool environments and self-reported irritative and respiratory symptoms among lifeguards.

A web survey was conducted among 870 lifeguards (current and former) to assess the relationship between exposure to indoor swimming pool environments and respiratory health. Associations between respiratory symptoms and asthma with varying lengths of occupational exposure were assessed by multiple logistic regression. Lifeguards exposed more than 500 hours in the previous 12 months experienced more cough (adjustedOR = 2.54, IC95 % = 1.51-4.25), throat (aOR = 2.47, IC95 % = 1.44-4.24) and eye irritation (aOR = 4.34, IC95 % = 2.52-7.50) during this period than non-exposed lifeguards. Upper and lower respiratory symptoms while on duty were related to duration of lifetime exposure (> 500 days vs. ≤ 50 days: Upper aOR = 5.84, IC95 % = 3.60-9.50; Lower aOR = 2.53, IC95 % = 1.58-4.06). Physician-diagnosed asthma was high among lifeguards (23 %). Highly exposed asthmatic lifeguards (> 500 hours) over the previous 12 months had a significantly higher risk (aOR = 3.74, IC95 % = 1.39-10.02) of suffering from asthma attack(s) than non-exposed asthmatic subjects. Exposure to indoor swimming pool environments is related to respiratory symptoms among lifeguards.

Injured coliforms in swimming pools : How big a threat?

BACKGROUND: A swimming pool is an important leisure facility, but it can harbor injured cells creating potential health hazards. Disinfection of swimming pools can cause bacterial injury, when cells are exposed to a suboptimal concentration of disinfectants. Possible pathogenic bacteria can enter into an injured state, for example, Escherichia coli, Klebsiella spp, and Enterococcus faecalis. Injured bacteria can retain their pathogenicity and virulence and they may recover causing diseases. AIM: To assess the presence of injured coliforms in swimming pools based on differential plating media. MATERIALS AND METHODS: This study compared the difference in recovery of coliforms between two differential media, one designed for recovery of injured coliforms (HiCrome ECC selective agar and the other is CHROMagar ECC). A total of 120 samples were collected from 10 semi-public swimming pools with sporadic distribution around Alexandria, Egypt, and included in this study. Five pools were used for swim training, 4 were used for both training and recreational swimming and one was used for children only. RESULTS: The recovery medium (HiCrome ECC selective agar) detected 1.47 and 2.54 times total coliforms and E. coli, respectively, as CHROMagar ECC. The compliance of samples per fresh water swimming pool Egyptian standard in total coliforms and E. coli fell from 54.10% when examined by CHROMagar ECC medium to 35% by HiCrome ECC selective medium. CONCLUSION: The current findings may not be universal to all swimming pools but may be applicable to ones where the physicochemical properties of their water induce coliform injury. Results suggest that the use of media that detect injured yet viable coliforms will give a more sensitive and representative guidance about the quality of examined water and will assist in the treatment and decontamination of swimming pools.

Epidemiology of fatal and non-fatal drowning patients attended by paramedics in Victoria, Australia.

Drowning is a major cause of injury and death worldwide. This study aims to expand the evidence in fatal and non-fatal drowning. A retrospective study was conducted to investigate fatal and non-fatal drowning incidents attended by ambulance paramedics in Victoria (Australia) from 2007 to 2012. A total of 509 drowning incidents were identified, 339 (66.6%) were non-fatal, with 170 (33.4%) resulting in death. Children aged 0-4 years had the highest crude drowning rate (7.95 per 100,000 persons). Non-fatal incidents were more likely to be witnessed by a bystander when compared with fatal incidents (43.7% vs. 20.0%, p < 0.001). Spatial analysis indicated that 35 (43.8%) local government areas (LGAs) were considered at 'excess risk' of a drowning event occurring. This study is the first to apply spatial analysis to determine relative risk ratios for fatal and non-fatal drowning. These findings will enable geographically targeted and age-specific drowning prevention activities.

Pseudomonas aeruginosa in Swimming Pool Water: Evidences and Perspectives for a New Control Strategy.

Pseudomonas aeruginosa is frequently isolated in swimming pool settings. Nine recreational and rehabilitative swimming pools were monitored according to the local legislation. The presence of P. aeruginosa was correlated to chlorine concentration. The ability of the isolates to form a biofilm on plastic materials was also investigated. In 59.5% of the samples, microbial contamination exceeded the threshold values. P. aeruginosa was isolated in 50.8% of these samples. The presence of P. aeruginosa was not correlated with free or total chlorine amount (R² < 0.1). All the isolates were moderate- to strong-forming biofilm (Optical Density O.D.570 range 0.7-1.2). To control biofilm formation and P. aeruginosa colonization, Quantum FreeBioEnergy© (QFBE, FreeBioEnergy, Brisighella, Italy), has been applied with encouraging preliminary results. It is a new, promising control strategy based on the change of an electromagnetic field which is responsible for the proliferation of some microorganisms involved in biofilm formation, such as P. aeruginosa.

Occurrence and health risk assessment of halogenated disinfection byproducts in indoor swimming pool water.

Swimming pool disinfection byproducts (DBPs) have become a concern in many countries all over the world. In this study, the concentrations of several categories of DBPs, including trihalomethanes (THMs), haloacetic acids (HAAs), haloacetonitriles (HANs), haloketones (HKs) and trichloronitromethane (TCNM), in 13 public indoor swimming pools in Nanjing, China were determined, the correlations between DBPs and water quality parameters as well as between different DBP categories were evaluated, and the health risks of the DBPs to human were examined. The results indicate that the DBP levels in the swimming pools in Nanjing were relatively high, with HAAs as the most dominant category, followed by THMs, HANs, HKs and TCNM sequentially. Bromochloroacetic acid (BCAA), trichloromethane (TCM), dichloroacetonitrile (DCAN), and 1,1,1-trichloropropanone (1,1,1-TCP) were the most dominant species among HAAs, THMs, HANs, and HKs, respectively. For all the different categories of DBPs, the concentrations in the pool disinfected with ozonation/chlorination were lower than those in the pool disinfected with chlorination. The DBP levels were generally not affected by the number of swimmers and the DBP levels on different dates were relatively stable. Besides, the chlorine residual seemed to be a critical concern in most of the swimming pools in this study. Moreover, there were some correlations between DBPs and water quality parameters as well as between different DBP categories. It is to be noted that the predicted cancer and health risks of the DBPs in these swimming pools were generally higher than the regulatory limits by USEPA, and thus DBPs in these swimming pools should be concerned.

Drowning in Pretoria, South Africa: A 10-year review.

Drowning is classified as the 3rd leading cause of accidental deaths worldwide and is deemed to be a preventable cause of death. Bodies retrieved from a water medium pose several challenges to the forensic pathologist with the diagnosis of drowning being primarily one of exclusion. The aim of this study was to do a retrospective descriptive case audit of bodies retrieved from water and immersion related deaths, which were investigated at the Pretoria Medico-Legal Laboratory (PMLL) over a 10 year period (January 2002 through December 2011). A total of 346 cases were identified for inclusion into this study. In 6% (20) of these cases, the death was not related to drowning; in 14% (48) no clear cause of death could be ascertained and in 278 cases (80%) the cause of death was considered to have been due to drowning. Infants (under 1 year, of age) constituted 41 (15%) of the cases; toddlers (aged 1-2 years) comprised 52 (19%) cases; children (aged 2-13 years) 49 (18%) cases; adolescents (aged 13-18 years) comprised 10 (3%) cases; adults (above 18, years) made up 126 (45%) of the cases. The majority of the drownings, occurred in swimming pools [125 cases (38%)]. In infants 23 (56%) of, drownings occurred in swimming pools followed by buckets [7 cases (17%)]. Sixty-nine per cent of toddler drownings (36 cases) occurred in swimming, pools. In the adult population, 40 (32%) of cases occurred in pools and 35 cases (28%) in rivers. Positive blood alcohol results were recorded in 48, (42%) out of 113 cases where the test was requested, 40 (35%) of these, cases higher than 0.05 g per 100 ml. This study suggests that many drowning deaths in Pretoria may be preventable by introducing greater public awareness of the risks and instituting relatively simple, protective measures.

Occurrence and daily variability of pharmaceuticals and personal care products in swimming pools.

The aim of this research was to investigate the presence and daily variability of pharmaceuticals and personal care products (PPCPs) in public swimming pools. Various types of public swimming pool water were analysed, taken from freshwater indoor swimming pools, outdoor swimming pools, spa pools and seawater swimming pools. Swimming pool water samples were analysed for 30 PPCPs using solid phase extraction (SPE) followed by isotope dilution liquid chromatography tandem mass spectrometry (LC-MS/MS). All PPCPs were below quantification limits in seawater pools. However, caffeine was detected in 12 chlorinated swimming pools at concentrations up to 1540 ng/L and ibuprofen was observed in 7 chlorinated pools at concentrations up to 83 ng/L. Caffeine and ibuprofen concentrations were below quantification limits in all fill water samples, eliminating this as their source in swimming pools. High variations in caffeine concentrations monitored throughout the day roughly reflect bather loads in swimming pools. Future monitoring of these compounds may assist in evaluating what portion of organic matter measured in swimming pools may come from human excretions.