Recreational water illness prevention, 2008.

fessionals and practitioners. R ecreational water illnesses (RWIs) are an increasing public health problem, but local and state health departments can use existing tools and innovative pro­ cedures to control them in the recreational water venues in their areas. Effective RWI prevention requires sound environmental health interventions, education for the pub­ lic and industry, effective team approaches to outbreaks, and additional research into is­ sues such as disinfection effectiveness and air quality in indoor pool areas. An estimated 7.4 million swimming pools are in public or residential use in the United States. Every year, more than 360 million visits are recorded for recreational water venues (e.g., swimming pools, spas, lakes, oceans), mak­ ing swimming the second most popular recre­ ational activity in the United States—and the most popular activity for children. This use of recreational water, however, is associated with public health consequences such as drowning, injuries, and spread of infectious diseases. Public health jurisdictions need a mul­ tifaceted prevention and response plan to prevent Cryptosporidium in recreational ven­ ues. The spread of diarrheal RWIs is facili­ tated by poor pool maintenance, low pub­ lic awareness of RWIs, and the emergence of chlorine-resistant pathogens such as Cryptosporidium. In fact, an average of five Cryptosporidium outbreaks were reported in 1995–2004. In 2006, 22 outbreaks were re­ ported; preliminary data for 2007 indicate at least 29 outbreaks reported. National reporting of RWIs to Centers for Disease Control and Prevention (CDC) is poor. Environmental health programs have the responsibility to ensure that these RWI outbreak reports are submitted through state epidemiologists to the CDC RWI sur­ veillance system. A complete toolkit for out­ break reporting, response, and investigation is available online at the Healthy Swimming Web site (www.cdc.gov/healthyswimming/ outbreak.htm). The toolkit includes an en­ vironmental health systems approach out­ break investigation report, sample letters, questionnaires, and forms to use for reports. In 2008, RWI reporting will move ahead with a new CDC online reporting system that will be linked to foodborne and other waterborne disease reports. Using inspection reports as a surveillance or indicator tool in our RWI prevention ef­ forts is a good way to track important trends both nationally and locally. In 2003, CDC En­ vironmental Health Services Branch (EHSB), in collaboration with CDC Division of Para­ sitic Diseases (DPD) and six state and local environmental health programs, examined critical violations that were listed in the 2002 inspection reports of more than 5,000 spas and 22,000 swimming pools. Study results were reported in two Morbidity and Mortal­ ity Weekly Report (MMWR) issues available at www.cdc.gov/nceh/ehs/Topics/recreation­ alwater.htm. An expanded 2007 aquatic in­ spection report study is under way, and it is not too late to participate. Contact the corre­ sponding author if your program wants to be a part of this study. Results from the 2002 studies showed that collecting, organizing, and analyzing