Guidelines for safe recreational water environments

1 WORLD HEALTH ORGANIZATIONGENEVAG uidelines forsafe recreational waterenvironmentsVOLUME 1 COASTAL AND FRESH WATERSG uidelines for safe recreational water environmentsVOLUME 1: COASTAL AND FRESH WATERSWORLD HEALTH ORGANIZATION2003 WHO Library Cataloguing-in-Publication DataWorld Health for safe recreational water environments . Volume 1, Coastal and fresh beaches water quality pollution monitoring andinjuries prevention and : Coastal and fresh 92 4 154580 1(NLM classification: WA 820) World Health Organization 2003 All rights reserved. Publications of the World Health Organization can be obtained from Marketing and Dissemination, WorldHealth Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22 791 2476; fax: +41 22 791 4857; email: Requests for permission to reproduce or translate WHO publications whether for sale or for non-commercial distribution should be addressed to Publications, at the above address (fax: +41 22 791 4806.))

2 Email: designations employed and the presentation of the material in this publication do not imply the expression of any opinionwhatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area orof its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximateborder lines for which there may not yet be full mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recom-mended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omis-sions excepted, the names of proprietary products are distinguished by initial capital World Health Organization does not warrant that the information contained in this publication is complete and correctand shall not be liable for any damages incurred as a result of its by minimum graphicsTypeset in Hong KongPrinted in MaltaContentsiiiList of acronyms and abbreviationsviiPrefaceixAcknowledgement sxiiiExecutive summaryxixCHAPTER 1.

3 Of recreational water of of and to reduce risks in water recreational of the 2. DROWNING AND INJURY and head , dislocations and other minor impact , lesions and and control and 3. SUN, HEAT AND to ultraviolet to to 4. FAECAL POLLUTION AND water effects associated with faecal to risk assessment and risk faecal contamination of recreational water of recreational water 5. FREE-LIVING pathogenic assessment and control 6. MICROBIAL ASPECTS OF BEACH SAND in beach and fate of microorganisms in beach and 7. ALGAE AND CYANOBACTERIA IN COASTAL AND ESTUARINE through dermal through ingestion (of water or scum) through of marine toxic algae and 8. ALGAE AND CYANOBACTERIA IN FRESH of toxic of cyanobacterial FOR SAFE recreational water for toxicity of for toxicity of risk 9.

4 AESTHETIC debris values and 10. CHEMICAL AND PHYSICAL Exposure Hydrogen ion concentration (pH) Dissolved Chemical Guideline Approach to assessing chemical hazards in recreational References172 CHAPTER 11. DANGEROUS AQUATIC Disease In- water hazardous water s-edge hazardous Venomous Venomous References186 CHAPTER 12. MONITORING AND Design and implementation of monitoring Aspects relevant to specific Progressive implementation of monitoring and References198 CHAPTER 13. APPLICATION OF Guidelines AND MANAGEMENT OPTIONS FOR SAFE recreational water Application of recreational water safety Compliance and Control and abatement Public awareness and Public health advice and intervention (including prevention and rescue services) Operating within an integrated coastal area management References214 APPENDIX A.

5 LIFEGUARDS216 Index220viGUIDELINES FOR SAFE recreational water ENVIRONMENTSList of acronyms and abbreviationsviiAFRI acute febrile respiratory illnessAIDS acquired immune deficiency syndromeASPamnesic shellfish poisoningBCCbasal cell carcinomaCBOcommunity-based organizationCDCC enters for Disease Control and Prevention (USA)cfucolony-forming unitCOGPCode of Good PracticeCPRcardiopulmonary resuscitationDALY disability adjusted life yearDSPdiarrhetic shellfish poisoningEAPemergency action plan or procedureECEuropean CommissionGAEgranulomatous amoebic encephalitisGIgastrointestinalHACCP hazard analysis and critical control pointHAVhepatitis A virusHEVhepatitis E virusHIAhealth impact assessmentHIVhuman immunodeficiency virusIARCI nternational Agency for Research on CancerIBMintegrated basin managementICAM integrated coastal area managementID50dose of microorganisms required to infect 50% of individuals exposedILSI nternational Life Saving levelMMmalignant melanomaMOEM inistry of EnvironmentMOHM inistry of HealthMOTM inistry of TourismNGOnongovernmental

6 OrganizationNMSCnon-melanoma skin cancerNOAELno-observed-adverse-effect levelNSPneurotoxic shellfish poisoningPAMprimary amoebic meningoencephalitisPDFprobability density functionPFDpersonal flotation devicepfuplaque-forming unitPSPparalytic shellfish poisoningQAquality assuranceQMRA quantitative microbial risk assessmentSCCsquamous cell carcinomaSLRA screening-level risk assessmentSOPstandard operating procedureSPFsun protection factorTCBS thiosulfate citrate bile salts sucroseTDItolerable daily intakeUSLAU nited States Lifesaving AssociationUVultravioletUVRultraviolet radiationWHOW orld Health OrganizationWTOW orld Tourism OrganizationviiiGUIDELINES FOR SAFE recreational water ENVIRONMENTSP refaceixThe World Health Organization (WHO) has been concerned with health aspectsof the management of water resources for many years and publishes various documents concerning the safety of the water environment and its importance forhealth.

7 These include a number of normative Guidelines documents, such as theGuidelines for Drinking- water Qualityand the Guidelines for Safe Use of Wastewaterand Excreta in Agriculture and Aquaculture. Documents of this type are intended toprovide a basis for standard setting. They represent a consensus view among expertson the risk to health represented by various media and activities and on the effec-tiveness of control measures in protecting health. They are based on critical reviewof the available evidence. Wherever possible and appropriate, such Guidelines docu-ments also describe the principal characteristics of the monitoring and assessment ofthe safety of the medium under consideration as well as the principal factors affect-ing decisions to be made in developing strategies for the control of the health for Safe recreational water Environmentsare published in twovolumes: Volume 1: Coastal and Fresh Watersprovides a review and assessment of thehealth hazards encountered during recreational use of coastal and freshwaterenvironments.

8 It includes the derivation of guideline values and explains thebasis for the decision to derive or not to derive them. It addresses a wide rangeof types of hazard, including hazards leading to drowning and injury, waterquality, exposure to heat, cold and sunlight, and dangerous aquatic organisms;and provides background information on the different types of recreationalwater activity (swimming, surfing, etc.) to enable informed readers to interpretthe Guidelines in light of local and regional circumstances. With regard to waterquality, separate chapters address faecal pollution, free-living microorganisms,freshwater algae, marine algae and chemical aspects. It describes prevention andmanagement options for responding to identified hazards.

9 Volume 2: Swimming Pools, Spas and Similar recreational water Environmentsprovides a review and assessment of the health hazards associated with recre-ational waters of this type; their monitoring and assessment; and activities avail-able for their control through education of users, good design and construction,and good operation and management. It includes the derivation of guidelinesincluding guideline values and explains the basis for the decision to derive ornot to derive them. It addresses a wide range of types of hazard, including waterquality, hazards leading to drowning and injury, contamination of associatedfacilities and air addition to the above volumes of the Guidelines for Safe recreational water Envi-ronments, a practical guide entitled Monitoring Bathing Waters,1has been describes the principal characteristics of and approaches to the monitoring andassessment of coastal and freshwater recreational water environments .

10 It emphasizesthe need to utilize information of diverse types and from diverse sources in order todevelop a valid assessment; and the need to establish effective links between the infor-mation generated and interventions to control risk in both the short and long includes comprehensive practical guidance for the design, planning and imple-mentation of monitoring programmes and assessments; and a Code of Good Prac-tice for the monitoring and assessment of recreational water environments , to assistcountries in developing such codes for national use and to promote international harmonization. Material relating to toxic cyanobacteria, including that in chapters 7and 8 is based upon Toxic Cyanobacteria in water ,2which was prepared by an inter-national group of development of WHO activity on recreational or bathing water can betraced back to two expert consultations in the meetings highlightedthe breadth of possible hazards associated with recreational water use and noted thatprospective volunteer studies offered the best hope of progress in terms of estab-lishing links between water quality and bather health.