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Sunday, July 22, 2001

Water Hazards: Hidden dangers found in depths

By DINAH VOYLES PULVER | News-Journal Environment Writer

DAYTONA BEACH — Before taking another cool dip in your favorite swimming hole to escape summer's swelter, give that refreshing water a closer look.

Dangers lie in wait there — and not just the ones with teeth, like sharks and alligators.

"It's the critters you can't see that are scary," said Dr. Richard Duma, director of infectious diseases at Halifax Medical Center.

Invisible to the naked eye, millions of bacteria, viruses and parasites in pools, springs, lakes and oceans can attack silently and leave their victims sick or, in rare instances, dead.

"Wherever there is water, there are microbes," Duma said. "A lot of people, when they get in the water, don't realize how many microbes there are and that we're often in their food chain."

In Florida last year, six disease outbreaks were reported, involving 47 people, that were either confirmed or suspected to be related to swimming pools.

Across the nation last year, more than 1,000 cases of severe nausea and diarrhea were attributed to the insidious little parasite, cryptosporidium, reported the Centers for Disease Control and Prevention. In 1997-98, more than 2,100 people got sick in 32 disease outbreaks related to recreational water.

Doctors and scientists suspect a vast number of cases — as many as three to five times more — go undiagnosed and unreported.

And each year in Florida, at least one person dies from the attack of a killer amoeba found in warm lake water.

Local doctors routinely see minor swimming-related illnesses during the summer, with ear infections being far and away the most common in adults and children. Doctors also see swimmer's itch and hot tub rash. Staying safe doesn't have to mean staying out of the water, but it does require basic precautions.

Leila Kinker didn't worry much about what was in the water when her children were small, but now the Titusville grandmother is more aware after a couple of jarring experiences last summer.

She and her husband, Charles, have camped at Blue Spring State Park in Orange City for years, bringing first their children and later their three grandsons. She always felt safe because of the tremendous flow and crystal clear water. After returning home from a trip to the park last summer, she was surprised to hear the spring run had been closed to swimmers because of high bacteria counts.

"Now we're a little more careful," she said recently, watching the boys leap into the spring run. She reminds the boys not to get water in their mouths and puts drops in their ears after every swim.

She is even more cautious about swimming pools. While letting the boys swim in a Titusville hotel pool last summer, she saw fecal matter in the water. She got the boys out of the pool and the pool was later closed.

Although sparkling pools look innocent, biologists say it's like swimming in someone's bath water.

Swimmers are more likely to use common sense and stay out of water that looks bad or feels funny, said Jack Towle, director of the Volusia County Environmental Health Laboratory. "But a lot of times it's the things you can't see or smell that can be a problem."

Do your homework

One of the best ways to tell if the water is OK for swimming is to check records at the local health department. If traveling, be aware that monitoring standards vary widely across the United States and around the world, and in some places are nonexistent.

Water quality monitoring in natural water bodies and swimming pools has improved over the years, but several new microorganisms have been discovered.

Volusia County monitors about 14 beaches, 980 swimming pools, and four springs — Blue, DeLeon, Green and Gemini — testing the water every two weeks. The Flagler County Health Department tests water at six beaches and 69 public pools. The state requires all public pools, which includes hotel pools and any pool used by the general public, to keep treatment records.

Last year, the state adopted a new testing standard, requiring monitoring for enterococcus bacteria. Found normally in the intestines of humans and animals, the presence of enterococci in the water means other more harmful organisms also may be present. Since the new rule was adopted, beach and spring closings have become routine.

When the county bought the Gemini Springs ranch in 1993, many residents couldn't wait to swim in the pool area created by the twin springs. Health department officials hesitated to issue a public bathing permit because of fluctuating bacteria levels. However, the spring met the technical requirements and the park has entertained thousands of swimmers — perhaps too many.

Since the new testing standard began last year, the park often has been closed. The high bacteria counts are attributed to a number of things, including the crowds.

The drought is the bigger complication. Paul Minshew, director of the environmental health unit of Volusia's health department, said the problem is that after heavy rains or when a lot of people are in the water, the spring isn't replacing the stagnant water with enough fresh water to keep the swimming area clean. Combine that with diaper-clad children splashing in the kiddie area and acres of surrounding current and former cattle grazing areas and the bacteria abound.

Water quality at Blue Spring has been fine since it was closed for much of September 2000. DeLeon Springs, with its megaflow of spring water, always tests well within accepted limits.

Lakes risky business

Only one freshwater lake in the county is permitted for public swimming — Lake Winona at the YMCA camp in DeLeon Springs. However, people are often seen in other lakes, swimming or zipping around on personal watercraft.

For example, although Campbell Lake in Deltona and Blue Lake in DeLand are popular, neither is a permitted bathing area. Other lakes are monitored but not as bathing areas, and tests show that several have at least occasionally high bacteria counts.

During the last 18 months, Lake Monroe and Lake Beresford have shown far higher levels of fecal coliform bacteria than would be allowed if the lakes were permitted for swimming.

The drought also makes matters worse for lakes, health officials said, because bacteria is concentrated in a more compact area. Even with recent steady rains, many lake levels remain low.

Ocean safer but...

Drought or not, the ocean still has tremendous capacity for flushing, perhaps the biggest reason the ocean remains the preferred swimming choice for many local health officials.

The beaches along Flagler and Volusia counties have had no problems with fecal coliform standards. However, 10 advisories have been issued since January because of enterococcus bacteria counts on Volusia beaches.

Beaches at Toronita Avenue on the South Peninsula and Main Street in Daytona Beach each have had three warning advisories. The cause of the contamination is unknown. As the county collects more data, Minshew hopes he'll be able to look at conditions and predict problems; for example, if warnings should be issued in certain areas after a heavy rainfall.

Pools: disease concerns

Water quality in a swimming pool can vary widely from hour to hour, making safety a bit tricky.

One person with a waterborne infectious illness, such as diarrhea, can rapidly infect a group in a pool. While chlorine kills most microbes, it could take between an hour and several days.

Volusia County has had at least three disease outbreaks in the last three years. One was in the county's interactive water park, Sun Splash, in Daytona Beach and another at an Ormond Beach time-shared resort's pool. But Minshew estimates that fewer than 5 percent of the actual outbreaks get reported and tracked to a specific cause.

Sun Splash was closed for months shortly after it opened in 1998, after guests reported diarrhea, cramps and fever after playing at the park. The symptoms were traced to two different diseases, one a bacterial infection and the other a parasite, and the cause was traced to poor water filtration. When the park reopened, children in diapers were not allowed, and no other problems have been reported.

The Ormond outbreak was traced to the cryptosporidium parasite and related to a much larger outbreak in Ohio. Cryptosporidium can cause diarrhea, stomach cramps and fever. A victim of the Ohio illness spread it to others while swimming in the pool here. Minshew said two or three other people got sick and the pool was closed. All it takes is one mouthful of contaminated water to contract cryptosporidium.

In another incident last year, several guests got sick after a private pool party, but health officials weren't able to pin down whether the guests were exposed to the germs through water or by touch or food.

One thing folks often mistakenly rely on for safety is the smell of chlorine in a pool, Towle said. But in reality, if the water has a chlorine odor, the chlorine probably isn't doing its job. The chemical usually smells more strongly when it has already attached itself to other things in the pool, such as perfumes, oils or flakes of skin.

The important test is for the amount of chlorine available to attack microorganisms. If it's already bound to something, Towle said, it can't do its job.

Public pools aren't required to let you see their chemical treatment records, but some experts say if you can't see the records, you may not want to swim.

Overcrowding is one reason public pools are sometimes closed, just to give the chemicals time to catch up with the crowd. Minshew said his department closes pools on about 10 percent of the visits each year.

Even if it means being accused of being a wet blanket, experts say it's better to stay dry if there are any doubts about water quality.

Malicious microbes

A host of nearly invisible creatures live in swimming pools, hot tubs, lakes and the surf. Exposure to some of these microscopic critters is rarely life-threatening, except to people with immune system disorders, but can make even healthy people quite ill. Here are some of the microbes and the diseases they cause:

Cryptosporidiosis: A diarrheal disease caused by a parasite that lives in human and animal intestines. The parasite can survive outside the body for a long time and resist chlorine disinfection. One mouthful of contaminated water can cause infection.

E coli: A strain of bacteria that causes severe diarrhea with bleeding and abdominal cramps. Primarily spread through uncooked meat, it can be contracted by swimming in contaminated water.

Giardiasis: A diarrheal illness caused by a parasite that lives in the intestines of people and animals. One of the most common causes of waterborne disease in the United States, it is contracted by mouth contact with feces-contaminated water.

Hepatitis A: Caused by a virus, this disease may be spread by contact with water contaminated with human feces or by people who did not wash their hands properly. Symptoms include fever, loss of appetite and nausea, although children younger than 3 may not have symptoms but can still spread the virus.

Leptospirosis: A bacterial disease that could include high fever, severe headache, chills and vomiting. Untreated, it can cause kidney or liver damage, meningitis and, in rare cases, death. Caused by exposure to water contaminated with the urine of infected animals.

Naegleria fowleri: An amoeba that causes primary amoebic meningoencephalitis, a rare disease that is almost always fatal. The amoeba, found normally in the sediment of many Florida lakes, becomes infectious at temperatures 82 to 86 degrees and higher.

Shigellosis: A bacterial disease that causes diarrhea, fever and stomach cramps and is spread by contact with fecal material.

Swimmer's itch: A skin rash caused by an allergic reaction to parasites found in birds and mammals that is spread by snails. The parasites are found in salt water and fresh water. Burning and itching symptoms may get worse with more exposure.

Viral gastroenteritis: Watery diarrhea and vomiting caused by a number of viruses, such as Norwalk virus. May be spread by swallowing water contaminated by infected individuals.

Source: Centers For Disease Control and Prevention and the Volusia County Health Department

Do's and don'ts

Wherever you swim:
—Keep your mouth closed. Try not to swallow water and avoid getting water in your mouth.
—Always wash your hands with soap and water after using the restroom or changing diapers.
—Don't swim if you have diarrhea, or for two weeks after having an intestinal illness.
—Children, the elderly and people with weakened immune systems are more likely to be affected by swimming in polluted water.
—Daytona Beach pediatrician John White recommends treating your ears after every swim, with a solution of one part white vinegar and two parts rubbing alcohol.
—Be especially alert if you are swimming and water "goes down the wrong way" and gets into your respiratory system.
—Anytime anyone gets an unexplained fever after swimming, it should be checked out by a physician, particularly if there is chest pain. Be sure to tell the doctor you've been swimming, said Dr. Richard Duma, director of infectious disease at Halifax Medical Center. "It's crucial to let them know (the patient) had swimming exposure because it can be a cardinal clue."

In the pool:
—Ask to see pool records. All public pools should have daily records on treatment and cleaning.
—Take a shower before you swim in a pool. Body fluids, skin flakes and perfumes can overload pool filters and chemicals.
—Teach children not to swallow pool water.
—Change kiddie pools daily. Empty at night and leave to dry.
—Don't swim if the water is cloudy, or you can't see the drain.

In lakes:
—Avoid swimming underwater or stirring up muck on the bottom.
—Don't swim when the water temperature gets above 82 degrees.
—Stay away from weeds.

With children:
—Don't let children swim in regular diapers. Use "swimming diapers" or plastic pants.
—Take children on bathroom breaks often.
—Do not change diapers at poolside. Germs can spread.
—Bathe children before allowing them to swim, paying particular attention to the rear end.

Sources: News-Journal research; Centers for Disease Control and Prevention.

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