Association of gastrointestinal illness and recreational water exposure at an inland U.S. beach

Recent epidemiology studies examining U.S. recreational water exposure and illness relationships have focused primarily on coastal and Great Lakes beaches. Human-made lakes in the U.S. have received little attention in epidemiology studies despite contributing to more waterborne disease epidemics annually than coastal U.S. waters. In a comprehensive beach cohort study, we examined relationships between water quality indicators and reported adverse health outcomes among users of a beach at an inland U.S. lake. Human health data was collected over 26 swimming days during the 2009 swimming season in conjunction with water quality measurements. Adverse health outcomes were reported 8-9 days post-exposure via a phone survey. Wading, playing or swimming in the water was observed to be a significant risk factor for GI illness (adjusted odds ratio (AOR) of 3.2; CI 1.1, 9.0). Among water users, Escherichia coli density was significantly associated with elevated GI illness risk where the highest E. coli quartile was associated with an AOR of 7.0 (CI 1.5, 32). GI illness associations are consistent with previous freshwater epidemiology studies. Our findings are unique in that our observations of positive associations with GI illness risk are based upon a single daily E. coli measurement. Lastly, this study focused on an understudied issue, illness risk at inland reservoirs. Our results support the usefulness of E. coli as a health-relevant indicator of water quality for this inland U.S. beach.