Pseudomonas Infection Outbreak Associated with a Hotel Swimming Pool - Maine, March 2023.

Treated recreational water venues (e.g., pools and hot tubs) located at hotels represent one third of sources of reported treated recreational water-associated outbreaks; when these outbreaks are caused by Pseudomonas aeruginosa, they predominantly occur during January-April. On March 8, 2023, the Maine Center for Disease Control and Prevention (Maine CDC) initiated an investigation in response to reports of illness among persons who had used a swimming pool at hotel A during March 4-5. A questionnaire was distributed to guests who were at hotel A during March 1-7. Among 35 guests who responded, 23 (66%) developed ear pain, rash, or pain or swelling in feet or hands within days of using the pool during March 4-5. P. aeruginosa, a chlorine-susceptible bacterium, was identified in cultures obtained from skin lesions of three patients; a difference of two single nucleotide polymorphisms was found between isolates from two patients' specimens, suggesting a common exposure. Hotel A management voluntarily closed the pool, and Maine CDC's Health Inspection Program identified multiple violations, including having no disinfectant feeder system, all of which had been identified during a previous inspection. Because chlorine had been added to the pool water after the pool was voluntary closed, environmental samples were not collected. The pool remained closed until violations were addressed. Health departments can play an important role in reducing the risk for outbreaks associated with hotel pools and hot tubs. This reduction in risk can be achieved by collaborating with operators to ensure compliance with public health codes, including maintaining chlorine concentration and otherwise vigilantly managing the pool, and by disseminating prevention messages to pool and hot tub users.

Swimming Performance in Elite Triathletes: Comparison Between Open Water and Pool Conditions.

This study aimed to compare performance, kinematic, and physiological variables between open water and pool swimming conditions in elite triathletes and to examine the associations between conditions on these variables. Fourteen elite triathletes (10 males and 4 females [23.4 ± 3.8 years]) performed two 1500-m swimming tests in open water and in a 25-m pool. Swimming speed, stroke rate (SR), length (SL) and index (SI), heart rate (HR), blood lactate concentrations [La-], and end-exercise oxygen uptake (EEV̇O2) were assessed in both conditions. Lower SL and SI and higher SR were obtained in open water compared with pool swimming (p < 0.05). Moreover, kinematic variables changed as a function of distance in both conditions (p < 0.05). No differences were found in the main physiological variables (HR, [La-], and EEV̇O2) between conditions. Respiratory exchange ratio presented lower values in open water than in pool conditions (p < 0.05), while time constant was higher in open water (p = 0.032). The fastest triathletes in open water obtained the best performance in the pool (r = 0.958; p < 0.001). All kinematic variables, HR and peak [La-] presented positive associations between conditions (r > 0.6; p < 0.05). Despite physiological invariance, triathletes and coaches should monitor specific open water training to adapt their swimming technique to the competitive environment.

Effect of exposure to disinfection by-products during swimming exercise on asthma-related immune responses.

Swimming is a widely practiced exercise in modern society, where there is a heightened interest in health. The exceptional benefits of swimming are well-known, yet the issue of water quality management inevitably arises due to its nature as an aquatic exercise. Several studies reported that chlorine disinfectants commonly used in swimming pool water disinfection could degrade into toxic disinfection by-products (DBPs) and suggested that the DBPs might induce respiratory disorders, including asthma. Conversely, there were also reports that the DBPs had no significant effects on respiratory conditions. In this study, we investigated the influence of swimming exercise and DBPs on asthma. The decomposition products had little effect on the number of T cells in various immune organs. However, swimming exercise was found to increase the cell count in proportion to the exercise duration. Nevertheless, there were no significant changes in other immune cells and the secretion of asthma-related cytokines. These findings indicate that the effects of swimming pool DBPs on respiratory conditions during swimming exercise are either negligible or absent, and instead, the immunological benefits gained through consistent swimming exercise outweigh any potential drawbacks.

Inexperienced water users can "Float to Live" in realistic open water conditions.

BACKGROUND: The RNLI "Float to Live" campaign is based on research conducted in indoor pools with experienced open water swimmers. Study 1 investigated whether the RNLI "Float to Live" guidance would enable less experienced individuals to float in realistic open water conditions. Study 2 examined the separate effects of practice and coaching on floating competence. METHODS: Study 1: Inexperienced water users conducted floats in either still, open fresh (n = 22) or open sea water (n = 13), followed by moving sea (n = 6) or fresh water (n = 5). Participants undertook three 2-min floats in still water wearing swimwear and one clothed float: 1) naïve; 2) following RNLI "Float to live" messaging; 3) individual float coaching; 4) simulated fall wearing summer clothing. In moving sea water, participants undertook two floats equivalent to Floats 3 and 4. In moving fresh water, participants undertook 3 floats: 1) naïve; 2) following "defensive floating" coaching; 3) simulated fall wearing summer clothing. Study 2: Two groups matched for skinfold thickness undertook three 2-min floats in a flume wearing swimwear. PRAC group (n = 12): 1) naïve; 2) following float practice; 3) float coaching; COACH group (n = 11) coaching followed by practice. Floating difficulty, confidence, competence, "efficiency" and perceived exertion were analysed using either a Friedman test or mixed model ANOVA. RESULTS: In both fresh water and sea water, participants' floating competence and confidence increased after viewing the RNLI messaging, it was further improved with individualised float coaching. The additional helpful instructions included: 1) "head back with ears submerged"; 2) "relax"; 3) "breathe normally"; 4) "it is OK if your legs sink"; 5) an accurate description of sculling for "active" floaters that needed it; 6) spread arms and legs for stability. The simulated fall with clothing did not impair floating competence. No difference in floating competence was seen between PRAC and COACH, though confidence may be increased sooner in COACH. CONCLUSIONS: The RNLI float advice can be applied in realistic open water settings by less experienced water users. Additional content could be included to make the messaging even more effective.

Increased number of cryptosporidiosis cases with travel history to Croatia might be related to swimming pools, Germany, 2023.

In August and September 2023, an unusually high number of cryptosporidiosis cases identified by routine German surveillance had travelled to Croatia (n = 23). Nine cases had stayed in the same camping resort and seven further cases had stayed at other camping sites within 15 km. Based on our standardised questionnaires, the most likely source of infection was swimming pools (93%). Further environmental investigations on site might reveal potential common sources of contamination that could be targeted by control measures.

Marked increase in cryptosporidiosis cases, Spain, 2023.

BackgroundBy mid-September 2023, several event notifications related to cryptosporidiosis had been identified from different regions in Spain. Therefore, a request for urgent notification of cryptosporidiosis cases to the National Surveillance Network was launched.AimWe aimed at assessing the extent of the increase in cases, the epidemiological characteristics and the transmission modes and compared to previous years.MethodsWe analysed data on case notifications, outbreak reports and genotypes focusing on June-October 2023 and compared the results to 2016-2022.ResultsIn 2023, 4,061 cryptosporidiosis cases were notified in Spain, which is an increase compared to 2016-2022. The cumulative incidence was 8.3 cases per 100,000 inhabitants in 2023, sixfold higher than the median of 1.4 cases per 100,000 inhabitants 2016-2022. Almost 80% of the cases were notified between June and October. The largest outbreaks were related to contaminated drinking water or swimming pools. Cryptosporidium hominis was the most common species in the characterised samples (115/122), and the C. hominis IfA12G1R5 subtype, previously unusual in Spain, was detected from 76 (62.3%) of the 122 characterised samples.ConclusionsA substantial increase in cryptosporidiosis cases was observed in 2023. Strengthening surveillance of Cryptosporidium is essential for prevention of cases, to better understand trends and subtypes circulating and the impact of adverse meteorological events.

Estimating airborne trichloramine levels in indoor swimming pools using the well-mixed box model.

Exposure to airborne disinfection by-products, especially trichloramine (TCA), could cause various occupational health effects in indoor swimming pools. However, TCA concentration measurements involve specialized analysis conducted in specific laboratories, which can result in significant costs and time constraints. As an alternative, modeling techniques for estimating exposures are promising in addressing these challenges. This study aims to predict airborne TCA concentrations in indoor swimming pools using a mathematical model, the well-mixed box model, found in the IHMOD tool, freely available on the American Industrial Hygiene Association website. The model's predictions are compared with TCA concentrations measured during various bather load scenarios. The research involved conducting 2-hr successive workplace measurements over 16- to 18-hr periods in four indoor swimming pools in Quebec, Canada. TCA concentrations were estimated using the well-mixed box model, assuming a homogeneous mixing of air within the swimming pool environment. A novel approach was developed to estimate the TCA generation rate from swimming pool water, incorporating the number of swimmers in the model. Average measured concentrations of TCA were 0.24, 0.26, 0.14, and 0.34 mg/m3 for swimming pools 1, 2, 3, and 4, respectively. The ratio of these measured average concentrations to their corresponding predicted values ranged from 0.51 to 1.30, 0.67 to 1.04, 0.57 to 1.14, and 0.68 to 1.49 for the respective swimming pools. In a worst-case scenario simulating the swimming pool at full capacity (maximum bathers allowed), TCA concentrations were estimated as 0.23, 0.36, 0.14, and 0.37 mg/m3 for swimming pools 1, 2, 3, and 4. Recalculated concentrations by adjusting the number of swimmers so as not to exceed the recommended occupational limit concentration of 0.35 mg/m3 gives a maximum number of swimmers of 63 and 335 instead of currently 80 and 424 for swimming pools 2 and 4, respectively. Similarly, for swimming pools 1 and 3, the maximum number of swimmers could be 173 and 398 (instead of the current 160 and 225, respectively). These results demonstrated that the model could be used to estimate and anticipate airborne TCA levels in indoor swimming pools across various scenarios.

Effects of disinfection by-products in swimming pool environments on the immunological mechanisms of respiratory diseases.

Swimming in pools is a popular and healthy recreational activity. However, potential adverse health effects from disinfection byproduct (DBP) exposure in pool water are concerning. This study evaluated how such DBP exposure affects the respiratory system. DBP exposure was simulated with an animal-specific pool environment model. Experimental animals were exposed to DBPs for a specified duration and frequency over 4 weeks. The wet and dry weights of murine lungs were measured, with no significant differences observed. There were no significant differences in interkeukin (IL)-2/4/10, and interferon-γ levels. However, IL-6 expression decreased in the experimental group. To investigate the effects of DBP exposure on immune cell response, various samples, such as bronchoalveolar lavage fluid, lymph nodes, spleen, and thymus, were collected for T-cell isolation and fluorescence-activated cell sorting. Asthma-related blood cell distribution was analyzed using a complete blood count test; no significant differences were found. Thus, DBP exposure through this model did not induce substantial lung tissue damage, major alterations in cytokine expression (besides IL-6), significant immune cell responses, or changes in asthma-associated blood cell distribution. However, considering earlier results, future studies should focus on specific types, intensity, and duration of exercise that could affect DBP exposure-related immune-inflammatory responses.

Environmental health aspects and microbial infections of the recreational water : Microbial Infections and Swimming pools.

BACKGROUND: Swimming pools are places for practicing sports, recreation, relaxation, and socialization. However, swimming pools can expose swimmers to physicochemical and microbiological risks. Accordingly, we studied the environmental health aspects and microbial infections for such recreational water aiming to disclose the possible risks they pose on swimmers. METHODS: 26 pools in Alexandria, Egypt were checked for water quality; 13 pools were checked in winter then summer, and other 13 pools were checked in summer only. Water was collected from both the top and the bottom of each pool; a total of 78 samples were collected in sterile containers. Each sample was divided into three parts; the first part was used for assessing the bacteriological quality of water. They were tested for total colony count (TCC), total coliform (TC), fecal coliform, and E. coli. The second part was used for chemical analysis. The third part was checked for parasitological study. RESULTS: Obtained data showed that only 7.7%, 78.2%, and 100% of the examined water samples have been found to fulfill the Egyptian standards for TCC, TC, and E. coli, respectively. Moreover, parasitic infection (PI) was noticed in 73.1% of the collected water samples; mainly Cyclospra and Isospora (37.2% each), followed by Cryptosporidium spp., Giradia lamblia, Microsporidia spp., and Blastocystis spp. (34.6%, 21.8%, 15.4%, and 14.1%, respectively). Acanthameba spp. was detected but at a lower rate (5.1%). The frequency of cleaning the swimming pools, flow rate, Cl2, and total dissolved solids are significantly affected PI, independently. CONCLUSION: The tested water samples don't meet Egyptian bacteriological criteria. High parasitic contamination despite high residual chlorine level mainly intestinal coccidia, G. lamblia, microsporidia, and Blastocystis spp. Thus, monitoring pool's water quality and improving the disinfection system are mandatory. Consequently, Health education regarding hygienic behaviors before and during swimming should be included in governmental programs.

Pediatric Diving-Related Injuries in Swimming Pools Presenting to US Emergency Departments: 2008-2020.

OBJECTIVES: Recreational swimming/diving is among the most common physical activities in US children and a significant cause of morbidity across the United States. This study updates the national epidemiology of diving-related injuries. METHODS: The Consumer Product Safety Commission's National Electronic Injury Surveillance System database was queried for patients aged 0 to 19 from 2008 to 2020 who presented to any of the 100 National Electronic Injury Surveillance System-participating emergency departments for a diving-related injury. Dive characteristics such as dive height, dive skill, dive direction, and dive sequence were determined from case narratives. RESULTS: A total of 1202 cases were identified for analysis corresponding to a total national estimate of 37,387 diving related injuries during the period from 2008 to 2020 and a national incidence of 3.6 injuries per 100,000 population. Males accounted for 64% of injuries. The average yearly incidences of injury in the 10 to 14 and 15 to 19 age groups were identical at 5.8 per 100,000. Contact with the diving board or platform was the most common cause of injury (34%). Diving backwards or attempting a flip or handstand dive were associated with increased odds of sustaining an injury resulting from contact with the diving board or platform (odds ratio, 16.0 and 6.9, respectively). In 2020, the incidence of diving-related injury fell to 1.6 per 100,000 population. CONCLUSIONS: Diving injuries are common in children and adolescents, especially in boys aged 10 to 19. There was a significant reduction in diving-related injury corresponding with the COVID-19 pandemic.

Catching nano: Evaluating the fate and behaviour of nano-TiO2 in swimming pools through dynamic simulation modelling.

Engineered titanium dioxide nanoparticles (nano-TiO2) in consumer products such as sunscreens widely used by swimmers in aquatic settings have raised concerns about their potential adverse impact on ecosystems and human health due to their small size and unique physicochemical properties. Therefore, this research paper aims to investigate the fate and behaviour of nano-TiO2 from sunscreens in swimming pools using System Dynamics Modelling. The study developed a dynamic simulation model that considers various factors, including weather conditions, sunscreen and pool usage behaviour, filtration efficacy, pool maintenance, water chemistry, pool chemicals, and TiO2 concentration levels, which can affect exposure levels for different scenarios. The study considered non-linear interdependent relationships, feedback structures, and temporal changes and dealt with parameter uncertainties through Monte Carlo analyses. The results reveal that the regular use of sunscreen leads to nano-TiO2 concentrations ranging from 0.001 to 0.05 mg/L within a year, reflecting seasonal and pool usage variations. The study also found that changes in the weight percentage of TiO2 in the sunscreen formulation and the filtration duration per day are the most sensitive factors affecting TiO2 concentrations. Scenario analyses exploring different nano-TiO2 removal strategies suggested that one daily turnover is necessary for sufficient removal. Regular manual pool maintenance and monthly use of a pool clarifier are recommended for enhanced and accelerated removal without substantial additional costs. The study is novel in its integrated approach, combining empirical work with dynamic simulations, resulting in a novel approach to model the environmental fate and behaviour of nano-TiO2. The study makes important methodological contributions to the field and has initiated an interdisciplinary collaboration to create more accurate models. This study is of great significance as it presents a pioneering analysis of the impact of sunscreen properties, user behaviour, and environmental stressors on the fate and behaviour of nano-TiO2 in swimming pools.

Review on the management of water quality for bio-mineral swimming pools in Western Europe.

In this review, we depict the state of the art concerning the water quality management of bio-mineral bathing pools, and compare these to traditional swimming pools. Bio-mineral pools use a combination of mechanic filtration, bio-filtration, and UV-treatment to disinfect the water. Studies in test tanks have shown that bio-filtration is effective in maintaining the water quality with regard to the treatment of organic pollution. Concerning biological risks, the bio-mineral pool relies on UV-treatment to degrade bacteria. Unlike chemical disinfectant treatments, UV disinfection does not lose its effectiveness in the event of high traffic in the pool. However, as only the water taken up by the filtration system is disinfected, it is essential that all the water in the pool is filtered. If the pool has a dead zone, its water is not disinfected and there is a risk of localized pathogen development. As the development of bio-mineral pools spreads in Europe, legislation gradually follows. The health parameters measured differ slightly from one country to another, but there are constants: the measurement of Escherichia coli, Enterococci, and Pseudomonas aeruginosa. In terms of biological swimming pools, regulatory homogeneity across Europe does not exist. From these comparisons, Austrian legislation segmenting water quality into 4 categories ranging from "excellent" to "poor" represents legislation that combines health and safety with indications of possible malfunctions. Next, a study of three real sites of bio-mineral pools is presented. It appears that whatever the type of pool, bio-mineral filtration makes it possible to achieve performances comparable to those encountered in chlorinated swimming pools concerning the risks associated with fecal contamination and external pollution. On the other hand, when frequentation is high, as is the case in small pools used for aquafitness, monitoring the risks of inter-bather contamination, as illustrated by the presence of Staphylococcus aureus, reveals a recurring problem. Knowing that this parameter is not evaluated in bathing waters in the natural environment and that numerous studies show that Staphyloccocus aureus are always detected, even on beaches, we propose the definition of three thresholds: i.e., 0 CFU/100 mL (threshold value in Wallonia) for water of excellent quality, less than 20 CFU/100 mL (threshold value in France) for water of very good quality, less than 50 CFU/100 mL (contribution of bathers by simple immersion) for good quality water, and more than 50 CFU/100 mL for poor quality water. This document could therefore be converted into a manual for operators on the use and management of bio-mineral baths.

[Lung contusion after jumping from a 10 meter tower in a swimming pool]. / Lungenkontusion nach Sprung ins Wasser.

BACKGROUND: Lung contusions often occur in the context of polytrauma, but much less frequently in sports injuries. CASE DESCRIPTION: We report on a 22-year-old patient who presented to our emergency room. On the same day he jumped from a 10 meter tower in a swimming pool and hit the surface of the water with his thorax and abdomen. He complained of pain in the right chest and hemoptysis immediately after the jump.The examination findings remained without further abnormalities.In the chest x-ray no abnormalities were found.The CT thorax with contrast medium revealed homogeneous ground-glass opacities in the middle lobe and less in the ventrobasal upper lobe on the right, consistent with the pulmonary contusion with parenchymal bleeding. In addition, there was a minimal pneumothorax border on the paracardial right side.Bronchoscopy performed on the same day showed evidence of blood in the middle lobe bronchus.The hemoptysis stopped spontaneously. On the 3rd day of the hospital stay, the patient was discharged with stable vital parameters and asymptomatic. CONCLUSION: Hemoptysis immediately after a sports chest injury may occur as a result of pulmonary contusion. In contrast to conventional chest x-rays, computed tomography is of great importance in the diagnosis of pulmonary contusion.

Disinfection byproducts in indoor swimming pool water: Detection and human lifetime health risk assessment.

Quantification of regulated and emerging disinfection byproducts (DBPs) in swimming pool water, as well as the assessment of their lifetime health risk are limited in China. In this study, the occurrence of regulated DBPs (e.g., trihalomethanes, haloacetic acids) and emerging DBPs (e.g., haloacetonitriles, haloacetaldehydes) in indoor swimming pool water and the corresponding source water at a city in Eastern China were determined. The concentrations of DBPs in swimming pool water were 1-2 orders of magnitude higher than that in source water. Lifetime cancer and non-cancer risks of DBPs stemming from swimming pool water were also estimated. Inhalation and dermal exposure were the most significant exposure routes related to swimming pool DBP cancer and non-cancer risks. For the first time, buccal and aural exposure were considered, and were proven to be important routes of DBP exposure (accounting for 17.9%-38.9% of total risk). The cancer risks of DBPs for all swimmers were higher than 10-6 of lifetime exposure risk recommended by United States Environmental Protection Agency, and the competitive adult swimmers experienced the highest cancer risk (7.82 × 10-5). These findings provide important information and perspectives for future efforts to lower the health risks associated with exposure to DBPs in swimming pool water.

Occurrence and Cytotoxicity of Aliphatic and Aromatic Halogenated Disinfection Byproducts in Indoor Swimming Pool Water and Their Incoming Tap Water.

Disinfection byproducts (DBPs) in swimming pool water are of wide concern for public health. In this study, the occurrence of five categories of aliphatic halogenated DBPs, i.e., trihalomethanes (THMs), haloacetic acids (HAAs), haloacetonitriles (HANs), halonitromethanes (HNMs), and haloketones (HKs), and six categories of aromatic halogenated DBPs, i.e., halophenols (HPs), halonitrophenols (HNPs), halohydroxy-benzaldehydes (HBALs), halohydroxybenzoic acids (HBAs), halobenzoquinones (HBQs), and haloanilines (HAs), was examined in seven indoor swimming pool water and their incoming tap water. The correlations between the DBP concentrations and water quality parameters were explored. Moreover, the cytotoxicity of the aliphatic and aromatic halogenated DBPs was tested with human hepatoma (HepG2) cells, and the concentration-cytotoxicity contributions of different DBP categories were calculated. The results demonstrate that 24 aliphatic (5 THMs, 8 HAAs, 5 HANs, 4 HNMs, and 2 HKs) and 50 aromatic halogenated DBPs (9 HPs, 8 HNPs, 9 HBALs, 8 HBAs, 11 HBQs, and 5 HAs) were present in the swimming pool water, among which 41 aromatic halogenated DBPs were detected in swimming pool water for the first time. The average concentrations of the five categories of aliphatic halogenated DBPs in the swimming pool water were in the order of HAAs > HANs > HKs > THMs > HNMs, while those in their incoming tap water were in the order of THMs > HAAs > HKs > HANs > HNMs. The average concentrations of the aromatic halogenated DBPs in the swimming pool water were significantly lower than those of the aliphatic halogenated DBPs, following the order of HBQs > HPs > HBAs > HBALs > HAs > HNPs, while those in their incoming tap water were in the order of HBALs > HBQs > HPs > HBAs > HAs > HNPs. The average concentration-cytotoxicity contributions of different DBP categories in the swimming pool water followed the order of HAAs > HANs > HNMs > HKs > HBQs > THMs > HPs > HNPs > HBAs > HBALs > HAs, with HAAs, HANs, and HNMs possessing the main concentration-cytotoxicity contributions (93.2% in total) among all DBP categories.

Determination of chloroform concentration and human exposure assessment in the swimming pool.

This cross-sectional study aimed to examine the concentration of the by-products of chlorination in the swimming pool and estimate human health risk for the swimmers of Shiraz University of Medical Sciences. In this study, the chloroform concentrations of 16 samples were measured using Gas Chromatography (GC). All the measured concentrations were less than the allowed amount announced by the World Health Organization (WHO). The results of the cancer risk (CR) and hazard index (HI) showed that the major exposure routes were found to be dermal during swimming and the 95 percentile of estimated CR and HI for the male group were 1.38 × 10-10 and 1.82 × 10-5 respectively, which is higher than the values of 5.48 × 10-10 and 2.25 × 10-5 respectively, for the women group. Sensitivity analyses indicated that the swimming exposure time (ET), and chloroform concentration were the most relevant variables in the health risk model. Therefore, knowledge about the sources of micro-pollutants in swimming pools might help promote the health methods of the pool environment.

New aspects in deriving health-based guidance values for bromate in swimming pool water.

Bromate, classified as a EU CLP 1B carcinogen, is a typical by-product of the disinfection of drinking and swimming pool water. The aim of this study was (a) to provide data on the occurrence of bromate in pool water, (b) to re-evaluate the carcinogenic MOA of bromate in the light of existing data, (c) to assess the possible exposure to bromate via swimming pool water and (d) to inform the derivation of cancer risk-related bromate concentrations in swimming pool water. Measurements from monitoring analysis of 229 samples showed bromate concentrations in seawater pools up to 34 mg/L. A comprehensive non-systematic literature search was done and the quality of the studies on genotoxicity and carcinogenicity was assessed by Klimisch criteria (Klimisch et al., Regul Toxicol Pharmacol 25:1-5, 1997) and SciRAP tool (Beronius et al., J Appl Toxicol, 38:1460-1470, 2018) respectively. Benchmark dose (BMD) modeling was performed using the modeling average mode in BMDS 3.1 and PROAST 66.40, 67 and 69 (human cancer BMDL10; EFSA 2017). For exposure assessment, data from a wide range of sources were evaluated for their reliability. Different target groups (infants/toddlers, children and adults) and exposure scenarios (recreational, sport-active swimmers, top athletes) were considered for oral, inhalation and dermal exposure. Exposure was calculated according to the frequency of swimming events and duration in water. For illustration, cancer risk-related bromate concentrations in pool water were calculated for different target groups, taking into account their exposure using the hBMDL10 and a cancer risk of 1 in 100,000. Convincing evidence was obtained from a multitude of studies that bromate induces oxidative DNA damage and acts as a clastogen in vitro and in vivo. Since statistical modeling of the available genotoxicity data is compatible with both linear as well as non-linear dose-response relationships, bromate should be conservatively considered to be a non-threshold carcinogen. BMD modeling with model averaging for renal cancer studies (Kurokawa et al., J Natl. Cancer Inst, 1983 and 1986a; DeAngelo et al., Toxicol Pathol 26:587-594, 1998) resulted in a median hBMDL10 of 0.65 mg bromate/kg body weight (bw) per day. Evaluation of different age and activity groups revealed that top athletes had the highest exposure, followed by sport-active children, sport-active adults, infants and toddlers, children and adults. The predominant route of exposure was oral (73-98%) by swallowing water, followed by the dermal route (2-27%), while the inhalation route was insignificant (< 0.5%). Accepting the same risk level for all population groups resulted in different guidance values due to the large variation in exposure. For example, for an additional risk of 1 in 100,000, the bromate concentrations would range between 0.011 for top athletes, 0.015 for sport-active children and 2.1 mg/L for adults. In conclusion, the present study shows that health risks due to bromate exposure by swimming pool water cannot be excluded and that large differences in risk exist depending on the individual swimming habits and water concentrations.

Determinants of bather hygiene in public swimming pools: a mixed-methods analysis of online discussion comments.

Swimming in public pools can expose bathers to microbiological (e.g., Cryptosporidium) and chemical (e.g., disinfection by-product) hazards, which can lead to recreational water illness. Adequate hygienic behaviours among bathers are important to reduce these risks. However, prior studies have found low compliance with pre-swim showering and avoidance of urinating in pools. We conducted a mixed-methods analysis of online discussion comments to identify key determinants of these two behaviours. We identified relevant discussion threads on Reddit, Quora, and swimming forums. Identified comments were classified as having a positive or negative sentiment towards the behaviour, and they were thematically analyzed according to the Theoretical Domains Framework (TDF). We analyzed 986 comments from 45 threads; 49.8% of comments were classified as expressing a positive sentiment towards the behaviour. Positive sentiments were more commonly expressed towards pre-swim showering compared to avoidance of urinating in pools (60.1 vs. 47.1%). Eleven themes were identified across the following eight TDF domains: beliefs about consequences (n = 362 comments), social influences (n = 298), beliefs about capabilities (n = 240), social/professional role and identity (n = 144), knowledge (n = 138), emotions (n = 137), reinforcement (n = 78), and environmental context and resources (n = 33). Results can help to inform targeted educational and outreach strategies with bathers to encourage increased adoption of hygienic behaviours.

Disinfection of therapeutic water - balancing risks against benefits: case study of Hungarian therapeutic baths on the effects of technological steps and disinfection on therapeutic waters.

Thermal therapeutic pools in most countries are operated in a manner similar to swimming pools: with water circulation, filtration and disinfection. However, in some countries, including Hungary, therapeutic pools are traditionally not treated this way, in order to preserve the therapeutic qualities of the water. However, dilution and frequent water replacement applied in these pools are often insufficient to ensure adequate microbial water quality, posing a risk of infection to the bathers. In the present case study, the impact of water treatment (including chemical disinfection by hypochlorite or hydrogen peroxide) was investigated on the therapeutic components of the water in seven Hungarian spas of various water composition. Microbial quality was improved by both disinfectants, but hypochlorite reduced the concentration of the therapeutic components sulfide, bromide, and iodide ions by 40-99%, and high levels of disinfection by-products were observed. Hydrogen peroxide only affected sulfide ion (91% reduction). Other technological steps (e.g., transport or cooling by dilution) were found to have significant impact on composition, often outweighing the effect of disinfection. The current case study demonstrated that thermal waters may be treated and disinfected with minimal loss of the therapeutic compounds, if an adequate treatment procedure is selected based on the water composition.

A procedure for removal of cyanuric acid in swimming pools using a cell-free thermostable cyanuric acid hydrolase.

Cyanuric acid (CYA) is used commercially for maintaining active chlorine to inactivate microbial and viral pathogens in swimming pools and hot tubs. Repeated CYA addition can cause a lack of available chlorine and adequate disinfection. Acceptable CYA levels can potentially be restored via cyanuric acid hydrolases (CAH), enzymes that hydrolyze CYA to biuret under mild conditions. Here we describe a previously unknown CAH enzyme from Pseudolabrys sp. Root1462 (CAH-PR), mined from public databases by bioinformatic analysis of potential CAH genes, which we show to be suitable in a cell-free form for industrial applications based upon favorable enzymatic and physical properties, combined with high-yield expression in aerobic cell culture. The kinetic parameters and modeled structure were similar to known CAH enzymes, but the new enzyme displayed a surprising thermal and storage stability. The new CAH enzyme was applied, following addition of inexpensive sodium sulfite, to hydrolyze CYA to biuret. At the desired endpoint, hypochlorite addition inactivated remaining enzyme and oxidized biuret to primarily dinitrogen and carbon dioxide gases. The mechanism of biuret oxidation with hypochlorite under conditions relevant to recreational pools is described.