Hepatitis Transmission and Swimming Pools
For millions of overheated Americans, the perfect summer activity involves a swimming pool. According to U.S. census data, swimming ranks as the second most popular exercise activity in the country. In the age of seemingly mysterious illnesses infecting every age, sex, race and income bracket, sharing the same body-enveloping fluid as strangers can initiate fear of communal waters. Whether in the backyard, local recreation center, fitness club, neighborhood pool or vacation hotel, swimming is a healthy pursuit deserving of an equally healthy, water-filled basin.
As one of the most prevalent infectious disease categories today, a growing number of people are concerned about exposing themselves to a hepatitis virus by swimming in a pool. However, there is only one hepatitis-related danger to swimming in a pool, and infection is preventable.
Although approximately 10 percent of people infected with a hepatitis virus are unsure of how they contracted it, scientists do know which bodily fluids can transmit the different strains of hepatitis illnesses. While there are three prevalent hepatitis viruses, only one has the potential to contaminate a maintained pool.
- Hepatitis A – Since this virus is primarily transmitted via fecal matter, this is the hepatitis strain that could become a problem in a swimming pool.
- Hepatitis B – Transmitting this strain of hepatitis is not a concern for swimmers because it involves blood-to-blood contact.
- Hepatitis C – Transmitting this strain of hepatitis is not a concern for swimmers because it involves blood-to-blood contact.
A self-limiting viral infection of the liver, hepatitis A typically does not cause chronic disease. While hepatitis A causes liver inflammation, most people’s livers can fully recover without any long-term damage. However, people already afflicted with chronic liver disease are more susceptible to serious illness as a result of hepatitis A infection. Since this disease is caused by a virus, it does not respond to antibiotics.
The most common symptoms of hepatitis A include:
- Nausea, vomiting, diarrhea
- Low-grade fever and loss of appetite
- Jaundice and dark urine
- Liver pain
Transmitted primarily by the fecal-oral route, hepatitis A infection can occur by swallowing pool water containing feces. Additionally, hepatitis A is a potential problem when large numbers of people congregate and where overcrowding and inadequate sanitation exist. Because hepatitis A is easily spread by raw sewage, it can become a danger in the recreational swimming environment when:
- a person accidentally has a bowel movement in the pool
- sewage systems become overburdened from heavy rainfall or flooding and infects swimming waters.
Once someone has hepatitis A, lifelong immunity is established preventing re-infection with this disease. For those who have never contracted this virus, the hepatitis A vaccination provides immunity.
In addition to getting vaccinated for hepatitis A, there are ways to minimize swimming pool risks. Proper chlorination to kill waterborne germs, good sanitation practices and suitable personal hygiene in and around the swimming area can make the difference between a healthy and unhealthy swimming experience. According to CDC epidemiologist Dr. Michael Beach, “It’s crucial that public health professionals, pool operators and the general swimming public work in partnership to increase everyone’s chances for healthy swimming experiences.”
- Disinfecting – Water filtration is not an effective means of removing contamination from a pool in a timely manner. The ability to kill pathogens in the water is based on the contact time a pathogen has with a disinfectant and the concentration of the disinfectant. While a majority of systems rely on chlorine, there are a few disinfectant alternatives. Considered to be moderately chlorine-resistant, experts approximate it takes chlorine at least 16 minutes to kill hepatitis A in pools that do not use stabilizers such as cyanuric acid. Additionally, all pools should maintain a stringent policy for water disinfection in case any fecal matter is detected.
- Evaluate the Pool – Before diving in, first evaluate the pool’s hygiene. The water should appear clean and clear, with painted stripes on the bottom clearly visible. The pool walls should feel smooth, not sticky or slippery. Listen for pump and filtration system noise to confirm the pool equipment is working. Lastly, smell the pool. Contrary to popular belief, a well-chlorinated pool has little odor. A heavy chemical odor is typically due to chloramines, not chlorine. The well-known strong chlorine odor means that unhealthy chloramines have formed in the water, created from the mix of chlorine and contaminants. Chloramines are not as effective in disinfecting swimming pool water.
- Don’t Swallow – Since hepatitis A is spread through the fecal-oral route, infection typically involves swallowing contaminated pool water. Teach children and train yourself not to swallow pool water – and even avoid getting it in your mouth.
As swimming continues its popularity as a preferred summer activity, people can take control of their health by being a hepatitis A prevention advocate. Make sure your swim spot is well maintained. Inform pool personnel about any concerns you have. Especially important for people already living with some other form of liver disease, refrain from getting pool water in your mouth. In addition, make sure you are protected with the hepatitis A vaccine in case you are exposed. By being educated about the potential for hepatitis A infection in a swimming pool, you can avoid being affected by this liver illness.
www.cdc.gov, Chlorine Disinfection Time Table, Centers for Disease Control and Prevention, 2007.
www.cdc.gov, Pool User Information, Centers for Disease Control and Prevention, 2007.
www.ehagroup.com, Diseases Acquired via Recreational Bathing (Public Swimming Pools), EHA Consulting Group, Inc., 2007.
www.havuz.org, Waterborne Pool Illnesses, Larry Katz, 2007.
www.healthstate.mn.us, Public Swimming Pools, Minnesota Department of Public Health, 2007.
www.healthypools.org, What You Think You Know and What You Should Know About Healthy Pools, U.S. Centers for Disease Control and Prevention, the National Consumers League, the Water Quality and Health Council, the Chlorine Chemistry Council and the National Spa & Pool Institute, 2007.
www.medicalnewstoday.com, Make a splash for public health this summer – Swimming pool health, MediLexicon International Ltd., 2007.
www.pponline.co.uk, A quick look at the medical hazards of swimming in pools, P2P Publishing Ltd., 2007.
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