A swimming pool can offer relief from summer heat, but swimmers should know what they are jumping into. It could be a soup of nasty parasites.
Reports of gastrointestinal illness from use of public pools and water parks have risen sharply in recent years, according to the Centers for Disease Control and Prevention. The leading culprit is a microscopic organism that lives in human feces.
Called cryptosporidium, it is a parasite transmitted in an egglike shell that can survive as long as 10 days even in chlorinated water. In 2007, the last year for which statistics are available, it was responsible for 31 recreational water outbreaks involving 3,726 people, according to the disease centers — up from 7 outbreaks and 567 people in 2004.
Health officials say the reasons are unclear. "We're not sure whether it's a true increase in incidence or an increase in reporting," said Michele C. Hlavsa, an epidemiologist with the healthy swimming program at the C.D.C.
Ms. Hlavsa noted that detection and reporting had probably improved since a treatment for the diarrheal illness — called cryptosporidiosis, or crypto for short — became available in 2002. And the recent large outbreaks, she said, have raised awareness and led to better reporting.
Officials are not recommending that people avoid public pools. "We want people to swim, but be healthy about it," said Dr. Sharon Balter, an epidemiologist with the Department of Health and Mental Hygiene in New York City, which has not had any outbreaks.
Crypto and other pool-associated illnesses are mostly caused by parasites and bacteria found in feces. The illnesses spread when people ingest contaminated water.
People should not swim or allow their children to swim when they have diarrhea, Ms. Hlavsa said. "The water you swim in is shared with everyone," she said. "So what one swimmer does has consequences for all the swimmers."
The symptoms of crypto resemble those of food poisoning. Though most cases clear up on their own, the illness can require hospitalization, particularly in small children and people with weakened immune systems.
One of the largest recent crypto outbreaks occurred in Utah in 2007. There were 2,000 confirmed cases, but that number vastly underestimates the illness's total impact, said Dr. Robert T. Rolfs, the Utah state epidemiologist.
The cases started in early summer. But slow detection and reporting delayed intervention by public health officials, who struggled to contain the illness. Multiple waves of control strategies, including temporarily barring all children 5 and younger from pools, eventually helped slow the outbreak, which subsided after the swimming season, Dr. Rolfs said.
He and other officials say swimmers can take measures to protect themselves. Water in pools should not be cloudy, tiles should not be slick and filtration machines should hum in the background. When in doubt about water quality, people should notify the pool operator and, if necessary, call the local health department, which is typically responsible for pool inspection and health code enforcement, said Ms. Hlavsa of the C.D.C.
In addition to not swimming while ill with diarrhea, health experts say people should shower before swimming and never use the pool as a toilet. Parents should wash young children before they enter the pool and take them on frequent bathroom breaks. Children in diapers require vigilant attention.
"Healthy swimming," Ms. Hlavsa said, "is no accident."
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