Vibrio Infections & other Recreational Water Illnesses

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Vibrio infections, E.coli - shiga toxin, Shigellosis, and Cryptosporidiosis are all Recreational Water Illnesses (RWIs). RWIs are caused by germs or chemicals found in water bodies such as swimming pools, hot tubs, lakes, rivers, estuaries and oceans. It is important to understand how to prevent these illnesses and enjoy water activities safely.

What are Recreational Water Illnesses (RWIs)?

RWIs are infections that can be contracted by swallowing, breathing in, or having contact with contaminated water. The most common types of RWIs include gastrointestinal illnesses, skin infections, respiratory infections, and ear infections. These illnesses can be caused by various pathogens, including bacteria, viruses, and parasites.

Safety Tips for Preventing RWIs:

1. Don't swim if you're sick. If you have diarrhea or any other contagious illness, avoid swimming or entering any recreational water facilities. This will help prevent the contamination of water and the spread of germs.

2. Don’t swim if you have a compromised immune system or open wounds. People with weakened immune systems should consult their healthcare provider before participating in recreational water activities, such as swimming. Open wounds such as cuts, scrapes, and recent tattoos can leave you more susceptible to illness. If you have a wound, including from a recent surgery, piercing, or tattoo, stay out of salt or brackish water, if possible. This includes wading at the beach. Cover your wounds with a waterproof bandage if it could come into contact with salt water, brackish water, or raw or undercooked seafood and its juices. Promptly tend to any wounds, cuts or abrasions you get while in or near the water. Thoroughly wash the wound with clean, drinkable water and soap.

3. Shower before swimming. Take a quick shower with soap and water before entering the water. This helps remove any germs or contaminants on your body, reducing the risk of spreading them into the water.

4. Don't swallow the water. Avoid swallowing water while swimming or participating in water activities. Ingesting even a small amount of contaminated water can lead to illness.

5. Use proper hygiene practices. Wash your hands thoroughly with soap and water after using the restroom or changing diapers. This is crucial in preventing the spread of germs to others and reducing the risk of contamination.

6. Change diapers in designated areas. If you have young children who wear diapers, change them in designated diaper-changing areas and not near the water. Dispose of diapers properly to prevent contamination.

7. Keep water clean. If you own a pool or hot tub, maintain proper water chemistry and filtration systems. Regularly test the water and ensure it meets the recommended standards. Follow the manufacturer's instructions for cleaning and maintaining your pool or hot tub.

8. Avoid swimming in high risk areas or situations. Heavy rainfalls can wash contaminants into recreational water bodies, increasing the risk of RWIs. Wait at least 24-48 hours after heavy rainfall before swimming to allow the water to clear. Avoid swimming near ocean outfalls at all times. Marine or ocean outfalls discharge wastewater, stormwater, and other potentially contaminated waters to the sea.

9. Stay informed. Check for any local advisories or warnings regarding water quality before swimming or participating in water activities. Stay updated on any closures or restrictions in your area. Further information regarding advisories may be obtained from North Carolina Department of Environmental Quality (NCDEQ) by visiting their NC Recreational Water Quality Swimming Advisory Map or signing up to receive NCDEQ press releases on their Water Quality Swimming Advisories page.

10. Teach children about water safety. Educate children about the importance of not swallowing water, using proper hygiene practices, and following safety rules while swimming or playing in water.

11. Report any water quality concerns. If you notice any issues with water quality or suspect an outbreak of RWIs, report it to the appropriate authorities, such as North Carolina Department of Environmental Quality, your local health department and/or pool operators.

12. Seek medical care if you become ill. If you get cut while in the sound or ocean, seek a doctor's care if you become ill, a rash or swelling develops around the wound, or it appears infected.

Remember, by following these safety tips, you can reduce the risk of contracting RWIs and ensure a safe and enjoyable experience in recreational water environments.

Stay informed, stay safe, and enjoy your time in the water responsibly!

Types of Recreational Water Illnesses

Stomach and Intestinal Illness

Gastrointestinal illnesses affect a person's stomach and intestines, and can cause diarrhea, nausea, or vomiting. The following gastrointestinal illnesses have been associated with recreational water activities:

Cryptosporidium (Crypto)

Crypto has become one of the most common causes of water recreation diarrhea illness in the United States. The germ is found in people's stool. It's highly resistant to chlorine disinfection and can survive in a pool for as long as ten days. Swallowing contaminated water is how people are often infected. To help stop the spread of Crypto, people with diarrhea shouldn't go swimming. Learn more at Crypto, CDC.

Giardia

Giardia is another common cause of diarrhea and is found in infected people's stool. It can take about 45 minutes for this germ to be killed by chlorine disinfection in pools. You shouldn't swim if you have diarrhea and you should always avoid swallowing water while swimming. Learn more at Giardia, CDC.

Shigella

Shigella causes severe diarrhea, which is often bloody. It can be spread if an infected person with diarrhea swims or plays in areas such as beaches or inadequately disinfected pools. Having hand washing stations with soap near swimming areas helps keep the water from becoming contaminated. Daycare centers shouldn't provide water play areas. Learn more at Shigellosis, CDC.

E. coli O157:H7

People have gotten an E. coli infection by swallowing lake water while swimming. Symptoms are similar to Shigella and include severe diarrhea and bloody stool. This infection can also be life-threatening and cause permanent damage to the kidneys. Swimming in inadequately disinfected pools or contaminated beaches are potential sources of infection. Learn more at E. coli, CDC.

Norovirus

Noroviruses are very contagious and can spread through an infected person's stool or vomit. The illness often begins suddenly and usually includes nausea, vomiting, diarrhea, and stomach cramps. Chlorine disinfection helps kill this virus in pools, but lakes and beaches can be contaminated. Avoid swallowing water while swimming to help prevent infection. Learn more at Norovirus, CDC.

Skin Irritations

Skin rashes, boils, allergic reactions to chemicals, and skin damage from the sun can occur when enjoying water recreation activities.

Vibrio - Vibrio Species Causing Vibriosis

Vibrio bacteria naturally live in certain coastal waters and are present in higher concentrations between May and October when water temperatures are warmer. About a dozen Vibrio species can cause human illness, known as vibriosis. The most common species causing human illness in the United States are Vibrio parahaemolyticus, Vibrio vulnificus, and Vibrio alginolyticus. Most people become infected by eating raw or undercooked shellfish, particularly oysters. Certain Vibrio species can also cause a skin infection when an open wound is exposed to salt water or brackish water. Brackish water is a mixture of fresh and salt water. It is often found where rivers meet the sea. Learn more at Vibrio Species Causing Vibriosis, CDC.

Hot Tub Rash - Pseudomonas dermatitis / Folliculitis

Hot Tub Rash or dermatitis is an infection that causes an itchy bumpy rash on the skin. The rash usually occurs within days of swimming in poorly maintained hot tubs or spas but can also be spread by swimming in a contaminated pool or lake. Properly maintaining hot tubs and pools helps eliminate the germ that causes this rash. Learn more at Hot Tub Rash, CDC.

Swimmer's Itch - Cercarial dermatitis

Swimmer's itch is a rash caused by an allergic reaction to parasites that typically infect some birds and mammals. The parasites come from infected snails which live in lakes, ponds, and oceans. People are not suitable hosts for the parasite's life cycle, so after burrowing into a swimmer's skin, the parasite soon dies. Reduce your risk by not swimming in areas known to have a swimmer's itch problem or where snails are commonly found. Shower or towel dry immediately after leaving the water. More tips on reducing the risk and treating swimmer's itch are at Swimmer's Itch, CDC.

Swimmer's Ear - Otitis externa

Swimmer's ear is an infection of the outer ear canal and can affect anyone but is most common in children. Symptoms usually start a few days after swimming and include ear pain, itchiness, redness, swelling, and pus draining from the infected ear. It can be treated with antibiotic ear drops. Swimmer's ear is caused when water stays in the ear canal for long periods of time, allowing germs to grow and infect the skin. When swimming, try to keep your ears dry. If water gets in your ear, tilt your head with your ear facing down and gently pull your earlobe in different directions to help the water drain out. Learn more at Swimmer's Ear, CDC.

Cyanobacteria - Blue-green Algae

Cyanobacteria, also called harmful algal blooms or blue-green algae, are found in lakes, rivers, ponds, and seawater. Sometimes cyanobacteria is toxic and people can experience skin, eye, or ear irritation with contact. If toxic cyanobacteria is swallowed, it can cause stomach cramps, vomiting, diarrhea, sore throat, fever, headache, muscle and joint pain, or nerve and liver damage. Avoid swimming in or having contact with algal blooms. Don't let pets drink or swim in waters with algal blooms. Learn more about Blue-Green Algae.

Chemical Sensitivity

Some people can experience allergic reactions, such as skin redness and itching, to chemicals used in pools. The reactions commonly occur within an hour or two of being in the water. It's also possible that improper use of chemicals or a chemical release at a pool could expose people to skin or respiratory irritants.

Sun Exposure

Prevent sunburns and skin cancer by choosing five protection options: seeking shade, covering up, getting a hat, wearing sunglasses, and applying sunscreen. Learn more at Skin Cancer, CDC.

Respiratory Illness

Skin rashes, boils, allergic reactions to chemicals, and skin damage from the sun can occur when enjoying water recreation activities.

Legionellosis

Legionnaire disease is a serious infection that creates life threatening pneumonia. Another less serious form of the infection is Pontiac fever, which has the same early symptoms of Legionnaire disease (body pain and weakness, headache, fever, chills, and cough) but isn't associated with pneumonia or death. The germ that causes the disease can be found in streams, ponds or in man-made structures such as fountains or spas. People are typically infected by breathing in contaminated water vapor or steam. Proper maintenance of pools and spas helps eliminate this germ. Learn more at Legionellosis, CDC.

Mycobacterium avium & endotoxins

Water vapor or steam contaminated with bacteria or bacterial fragments can be breathed in, causing an allergic reaction and inflammation in the lungs. This condition, called "hypersensitivity pneumonitis," is rare, but has been associated with spas or indoor pools that have water features that produce vapors or mists. Water sitting in pipes that isn't continuously disinfected can become a source of bacterial fragments. Proper maintenance of pools and spas helps eliminate these germs.