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Guidelines for Safe Recreational Water Environments VOLUME 1: COASTAL and FRESH WATERS

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Guidelines for Safe Recreational Water Environments VOLUME 1: COASTAL and FRESH WATERS GUIDELINES FOR SAFE RECREA The World Health Organization’s (WHO) new Guidelines for Safe Recreational Water TI Environments describes the present state of knowledge regarding the impact of ENVIRONMENTS ONAL WATER Guidelines for recreational use of coastal and freshwater environments upon the health of users – specifically drowning and injury, exposure to cold, heat and sunlight, water quality safe recreational water (especially exposure to water contaminated by sewage, but also exposure to free- living pathogenic microorganisms in recreational water), contamination of beach sand, exposure to algae and their products, exposure to chemical and physical agents, environments and dangerous aquatic organisms. As well, control and monitoring of the hazards VOLUME 1 associated with these environments are discussed. COASTAL AND FRESH WATERS The primary aim of the Guidelines is the protection of public health. The Guidelines are intended to be used as the basis for the development of international and national approaches (including standards and regulations) to controlling the health risks from AND FRESH WATERS 1. COASTAL VOLUME hazards that may be encountered in recreational water environments, as well as providing a framework for local decision-making. The Guidelines may also be used as reference material for industries and operators preparing development projects in recreational water areas, as a checklist for understanding and assessing potential health impacts of recreational projects, and in the conduct of environmental impact and environmental health impact assessments in particular. WORLD HEALTH ORGANIZATION ISBN 92 4 154580 1 GENEVA WHO Guidelines for safe recreational water environments VOLUME 1: COASTAL AND FRESH WATERS WORLD HEALTH ORGANIZATION 2003 WHO Library Cataloguing-in-Publication Data World Health Organization. Guidelines for safe recreational water environments. Volume 1, Coastal and fresh waters. 1.Bathing beaches—standards 2.Fresh water—microbiology 3.Water quality—analysis 4.Water pollution—analysis 5.Environmental monitoring—methods 6.Wound and injuries—prevention and control 7.Drowning 8.Risk management 9.Reference values 10.Guidelines I.Title II.Title: Coastal and fresh waters. ISBN 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, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22 791 2476; fax: +41 22 791 4857; email: [email protected]). 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; email: [email protected]). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The 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 letters. The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. Designed by minimum graphics Typeset in Hong Kong Printed in Malta Contents List of acronyms and abbreviations vii Prefaceix Acknowledgements xiii Executive summary xix CHAPTER 1. INTRODUCTION 1 1.1 General considerations 2 1.2 Types of recreational water environment 3 1.3 Types of use 4 1.4 Types of user 5 1.5 Hazard and risk 5 1.6 Measures to reduce risks in water recreation 11 1.7 Managing recreational waters 12 1.8 Nature of the guidelines 16 1.9 References 19 CHAPTER 2. DROWNING AND INJURY PREVENTION 20 2.1 Drowning 20 2.2 Spinal injury 23 2.3 Brain and head injuries 26 2.4 Fractures, dislocations and other minor impact injuries 26 2.5 Cuts, lesions and punctures 26 2.6 Interventions and control measures 27 2.7 Monitoring and assessment 30 2.8 References 31 CHAPTER 3. SUN, HEAT AND COLD 36 3.1 Exposure to ultraviolet radiation 36 3.2 Exposure to cold 45 3.3 Exposure to heat 47 3.4 References 48 iii CHAPTER 4. FAECAL POLLUTION AND WATER QUALITY 51 4.1 Approach 51 4.2 Health effects associated with faecal pollution 53 4.3 Approaches to risk assessment and risk management 57 4.4 Guideline values 63 4.5 Assessing faecal contamination of recreational water environments 75 4.6 Classification of recreational water environments 83 4.7 Management action 93 4.8 References 96 CHAPTER 5. FREE-LIVING MICROORGANISMS 102 5.1 Human pathogenic Vibrio species 102 5.2 Aeromonas species 105 5.3 Free-living amoebae 106 5.4 Leptospira species 110 5.5 Guideline values 111 5.6 Risk assessment and control measures 111 5.7 References 113 CHAPTER 6. MICROBIAL ASPECTS OF BEACH SAND QUALITY 118 6.1 Microorganisms in beach sand 118 6.2 Dispersion and fate of microorganisms in beach sand 121 6.3 Guideline values 123 6.4 Research and monitoring 123 6.5 Management actions 124 6.6 References 124 CHAPTER 7. ALGAE AND CYANOBACTERIA IN COASTAL AND ESTUARINE WATERS 128 7.1Exposure through dermal contact 128 7.2Exposure through ingestion (of water or scum) 129 7.3Exposure through inhalation 130 7.4 Identification of marine toxic algae and cyanobacteria 130 7.5 Guideline values 131 7.6Precautionary measures 131 7.7 References 133 CHAPTER 8. ALGAE AND CYANOBACTERIA IN FRESH WATER 136 8.1 Occurrence of toxic cyanobacteria 137 8.2 Formation of cyanobacterial blooms 137 8.3 Cyanotoxins 138 iv GUIDELINES FOR SAFE RECREATIONAL WATER ENVIRONMENTS 8.4 Evidence for toxicity of cyanobacteria 143 8.5 Evidence for toxicity of algae 146 8.6 Health risk evaluation 147 8.7 Guideline values 149 8.8 Management options 152 8.9 References 154 CHAPTER 9. AESTHETIC ISSUES 159 9.1 Aesthetic parameters 159 9.2Economic consequences 162 9.3 Marine debris monitoring 163 9.4 Guideline values and management 165 9.5 References 166 CHAPTER 10. CHEMICAL AND PHYSICAL AGENTS 168 10.1 Exposure assessment 168 10.2 Hydrogen ion concentration (pH) 169 10.3 Dissolved oxygen 169 10.4 Chemical contaminants 169 10.5 Guideline values 170 10.6 Approach to assessing chemical hazards in recreational waters 171 10.7 References 172 CHAPTER 11. DANGEROUS AQUATIC ORGANISMS 173 11.1 Disease vectors 175 11.2 “In-water” hazardous organisms 177 11.3 “Water’s-edge” hazardous organisms 179 11.4 Venomous invertebrates 181 11.5 Venomous vertebrates 184 11.6 References 186 CHAPTER 12. MONITORING AND ASSESSMENT 189 12.1 Design and implementation of monitoring programmes 189 12.2 Aspects relevant to specific hazards 193 12.3 Progressive implementation of monitoring and assessment 196 12.4 References 198 CHAPTER 13. APPLICATION OF GUIDELINES AND MANAGEMENT OPTIONS FOR SAFE RECREATIONAL WATER USE 199 13.1 Application of guidelines 199 13.2 Recreational water safety plan 202 CONTENTS v 13.3 Compliance and enforcement 202 13.4 Control and abatement technology 204 13.5 Public awareness and information 207 13.6 Public health advice and intervention (including prevention and rescue services) 209 13.7 Operating within an integrated coastal area management framework 212 13.8 References 214 APPENDIX A. LIFEGUARDS 216 Index 220 vi GUIDELINES FOR SAFE RECREATIONAL WATER ENVIRONMENTS List of acronyms and abbreviations AFRI acute febrile respiratory illness AIDS acquired immune deficiency syndrome ASP amnesic shellfish poisoning BCC basal cell carcinoma CBO community-based organization CDC Centers for Disease Control and Prevention (USA) cfu colony-forming unit COGP Code of Good Practice CPR cardiopulmonary resuscitation DALY disability adjusted life year DSP diarrhetic shellfish poisoning EAP emergency action plan or procedure EC European Commission GAE granulomatous amoebic encephalitis GI gastrointestinal HACCP hazard analysis and critical control point HAV hepatitis A virus HEV hepatitis E virus HIA health impact assessment HIV human immunodeficiency virus IARC International Agency for Research on Cancer IBM integrated basin management ICAM integrated coastal area management ID50 dose of microorganisms required to infect 50% of individuals exposed ILS International Life Saving Federation i.p. intraperitoneal LOAEL lowest-observed-adverse-effect level MM malignant melanoma MOE Ministry of Environment MOH Ministry of Health MOT Ministry of Tourism NGO nongovernmental organization NMSC non-melanoma skin cancer NOAEL no-observed-adverse-effect level NSP neurotoxic shellfish poisoning vii PAM primary amoebic meningoencephalitis PDF probability density function PFD personal flotation device pfu plaque-forming unit PSP paralytic shellfish poisoning QA quality assurance QMRA quantitative microbial risk assessment SCC squamous cell carcinoma SLRA screening-level risk assessment SOP standard operating procedure SPF sun protection factor TCBS thiosulfate–citrate–bile salts–sucrose TDI tolerable daily intake USLA United States Lifesaving Association UV ultraviolet UVR ultraviolet radiation WHO World Health Organization WTOWorld Tourism
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