Here's What You Need to Know About Waterborne Infections

Now that it's summer, many of us are spending more time in water than we have been over the past nine months.

There's nothing more refreshing than diving into a pool, jumping into a lake or running into the ocean on a hot day.

For some of us, there's a certain childlike charm to cooling off this way. It brings back happy memories from when we lived carefree lives as kids.

Things are quite different these days. Even bodies of water are affected. I'm talking about waterborne infections that can put a big damper on the enjoyment of splashing and swimming with family and friends.

Hot Tubs & Pools the Biggest Culprits

Lakes, rivers, streams, creeks and oceans can all carry waterborne infections. But do you know what's even worse? Public hot tubs and pools.

Officials from the Centers for Disease Control and Prevention (CDC) tell us that public hot tubs are the single most germ-infested waters we encounter. Public pools aren't far behind.

Between 2015 and 2019, a study showed that Legionella found in public hot tubs and Cryptosporidium found in public pools were the two main culprits.

They caused significantly more waterborne infections than outbreaks associated with recreational waters.

Cryptosporidium, Legionella & More

This information was reported in the 2021 Morbidity and Mortality Weekly Report. Here's how the report read, in part: 

"Among the 155 (75%) outbreaks with a confirmed infectious etiology, 76 (49%) were caused by Cryptosporidium (which causes… a gastrointestinal illness).

"And 65 (42%) (were caused) by Legionella (which causes Legionnaires' disease, a severe pneumonia, and Pontiac fever, a milder illness with flu-like symptoms)." 

During that four-year span, 208 outbreaks associated with treated recreational waters were voluntarily reported by 36 states and the District of Columbia through the National Outbreak Reporting System.

Heat Breaks Down Chlorine

Almost all those outbreaks occurred in pools, hot tubs and water playgrounds. They resulted in 3,646 cases of illness, 286 hospitalizations and 13 deaths.

And among those outbreaks, 34% were associated with hotels or resorts, with 70% being associated with hot tubs.

Why are hot tubs such a breeding ground for waterborne infections? Part of the answer is in the name – hot. The heat makes chlorine break down more quickly than it otherwise would.

Certain bacterial pathogens, such as Legionella, flourish in hot water. And the hot tub's jets aerosolize the water. Which makes chlorine less effective. In addition, the jets often splash water with its germs into the noses and mouths of the occupants.

Hot Tub Folliculitis?

Another germ is Pseudomonas, also known as hot tub Folliculitis. It causes an itchy rash in the form of scattered red bumps. 

They erupt underneath swimsuits when the hot tub water is not properly maintained and that water stays on the skin for a long time.

Yet another possible cause of waterborne infections from hot tubs in hotels is negligence. The person responsible for maintenance is usually tasked with many other jobs. It becomes less of a priority than it should.

As far as pool and water playground infections are concerned, it won't surprise you to learn that 92% of those outbreaks from 2015 to 2019 occurred during the months of June through August. 

Combating Waterborne Infections

What is being done about waterborne infections? For one, some hot tub workers are using bromine instead of chlorine. That's because it's more heat-stable.

Cryptosporidium has been known to survive in chlorinated water for over a week. Due to the parasites' outer shell.

Some other infectious waterborne pathogens can also be chlorine-resistant. Including Norovirus and Giardia. The former is a virus that can cause vomiting and diarrhea. The latter is a parasite responsible for diarrhea and stomach cramps.

In some areas of the country, they're using chlorine plus ultraviolet light, which kills chlorine-resistant microbes.

Tips for Water Lovers

Now, if you only spend time in lakes and oceans, you're safer, right? Yes, probably. But safe? Not necessarily. There are plenty of waterborne contaminants in those bodies of water as well.

The first thing you should do before entering a lake or ocean to swim is check for signs warning about waterborne pathogens.

Second, take a good look at the water. Dr. Allen Perkins is professor of family medicine at the University of South Alabama College of Medicine. He says, "The rule of thumb is, if the water looks murky, don't swim in it."    

The day after a heavy rain is a good time to skip swimming in lakes and rivers. The excess precipitation can pick up lots of contaminants before draining into those bodies of water.

And if you have a wound, make sure it is very tightly bandaged before swimming anywhere. An open wound can pick up all sorts of pathogens. Including flesh-eating bacteria called Vibrio Vulnificus.

So be careful out there this summer. There's plenty of fun to be had in the water, but you don't want to pay a steep price later.