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 WORLD HEALTH ORGANIZATION GENEVA 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 Preface ix 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 7.1 Exposure through dermal contact 128 7.2 Exposure through ingestion (of water or scum) 129 7.3 Exposure through inhalation 130 7.4 Identification of marine toxic algae and cyanobacteria 130 7.5 Guideline values 131 7.6 Precautionary 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 9.2 Economic 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 WTO World Tourism Organization viii GUIDELINES FOR SAFE RECREATIONAL WATER ENVIRONMENTS Preface he World Health Organization (WHO) has been concerned with health aspects Tof the management of water resources for many years and publishes various documents concerning the safety of the water environment and its importance for health. These include a number of normative “guidelines” documents, such as the Guidelines for Drinking-water Quality and the Guidelines for Safe Use of Wastewater and Excreta in Agriculture and Aquaculture. Documents of this type are intended to provide a basis for standard setting. They represent a consensus view among experts on 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 review of the available evidence. Wherever possible and appropriate, such guidelines docu- ments also describe the principal characteristics of the monitoring and assessment of the 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 hazards concerned. The Guidelines for Safe Recreational Water Environments are published in two volumes: • Volume 1: Coastal and Fresh Waters provides a review and assessment of the health hazards encountered during recreational use of coastal and freshwater environments. It includes the derivation of guideline values and explains the basis for the decision to derive or not to derive them. It addresses a wide range of types of hazard, including hazards leading to drowning and injury, water quality, exposure to heat, cold and sunlight, and dangerous aquatic organisms; and provides background information on the different types of recreational water activity (swimming, surfing, etc.) to enable informed readers to interpret the Guidelines in light of local and regional circumstances. With regard to water quality, separate chapters address faecal pollution, free-living microorganisms, freshwater algae, marine algae and chemical aspects.