Bacteriological threats in water sports: Challenges and Health Risks in the Lead - Up to Major Sporting Events
DOI:
https://doi.org/10.12775/QS.2025.40.59304Keywords
microbiological threats, water sports, water quality, sporting events, preventionAbstract
Introduction: Water quality is a critical issue affecting human health, with contamination by pathogens leading to various diseases. Pathogens in water, often transmitted through the fecal-oral route, pose significant risks, causing gastrointestinal diseases and bacterial diarrhea. The World Health Organization (WHO) has set water quality standards for recreational use, and sports events like triathlons and the Olympics may involve waterborne infection risks. Additionally, athletes in water sports face health risks from physical exertion and environmental conditions, including exercise-induced bronchoconstriction, hypothermia, hyperthermia and swimming-induced pulmonary edema. Understanding these risks and implementing preventive measures are crucial for ensuring the safety and health of athletes and participants in water-based sports events.
Purpose of the work: The purpose of this study is to review the impact and risks of pathogenic microorganisms found in water on the health and physical performance of athletes. Special attention is given to the organization of water sports competitions in the context of microbiological threats.
Materials and methods: A comprehensive analysis of research articles available on PubMed, Google Scholar, Web of Science, Embase, and Scopus was conducted using search terms related to: "water sports", "microbiological hazards", "water pathogens", "water quality", "athletes" and "prevention."
Results: Microbiological threats included in water expose participants in major sporting events to potential infection that can cause various health issues. To reduce these risks, water quality standards must be monitored, and actions should be taken when limits are exceeded. Event organizers must prioritize athlete safety, considering factors like weather and water quality, and involve public health authorities in decision-making. If health risks are identified, rescheduling or changing the event location should be considered.
References
Pandey PK, Kass PH, Soupir ML, Biswas S, Singh VP. Contamination of water resources by pathogenic bacteria. AMB Express. 2014 Jun 28;4:51. doi: 10.1186/s13568-014-0051-x. PMID: 25006540; PMCID: PMC4077002.
Cabral JP. Water microbiology. Bacterial pathogens and water. Int J Environ Res Public Health. 2010 Oct;7(10):3657-703. doi: 10.3390/ijerph7103657. Epub 2010 Oct 15. PMID: 21139855; PMCID: PMC2996186.
Medema GJ, Payment P, Dufour A, Robertson W, Waite M, Hunter P, Kirby R, Anderson Y. Assessing Microbial Safety of Drinking Water Improving Approaches and Method. WHO & OECD, IWA Publishing; London, UK: 2003. Safe drinking water: an ongoing challenge; pp. 11–45.
Reischer G. H., Haider J. M., Sommer R., Stadler H., Keiblinger K. M., Hornek R. W., Zerobin W., Mach R. L., Farnleitner A. H. (2008). Quantitative microbial faecal source tracking with sampling guided by hydrological catchment dynamics. Environ Microbiol 10, 2598–2608. doi: 10.1111/j.1462-2920.2008.01682.x
Fewtrell L, Kay D. Recreational Water and Infection: A Review of Recent Findings. Curr Environ Health Rep. 2015 Mar;2(1):85-94. doi: 10.1007/s40572-014-0036-6. PMID: 25821715; PMCID: PMC4371824.
Adhikary, R.K., Mahfuj, M.SE., Starrs, D. et al. Risk of Human Illness from Recreational Exposure to Microbial Pathogens in Freshwater Bodies: A Systematic Review. Expo Health 14, 325–343 (2022).
Yan X, Fang Y, Li Y, Jia Z, Zhang B. Risks, Epidemics, and Prevention Measures of Infectious Diseases in Major Sports Events: Scoping Review. JMIR Public Health Surveill. 2022 Dec 2;8(12):e40042. doi: 10.2196/40042. PMID: 36459401; PMCID: PMC9758642.
Chamberlain, Matthew MD; Marshall, Ashley N. ATC; Keeler, Steven MD. Open Water Swimming: Medical and Water Quality Considerations. Current Sports Medicine Reports 18(4):p 121-128, April 2019. | DOI: 10.1249/JSR.0000000000000582
Delamare H, Septfons A, Alfandari S, Mailles A. Freshwater sports and infectious diseases: A narrative review. Infect Dis Now. 2024 Jun;54(4S):104883. doi: 10.1016/j.idnow.2024.104883. Epub 2024 Jun 6. PMID: 38849257.
Lopes, F.A.; Leite, A.C. Water Quality for Triathlon and Open Water Swimming Competitions in Brazilian Freshwaters. Limnol. Rev. 2021, 21, 169-179. https://doi.org/10.2478/limre-2021-0016
Pandey PK, Kass PH, Soupir ML, Biswas S, Singh VP. Contamination of water resources by pathogenic bacteria. AMB Express. 2014 Jun 28;4:51. doi: 10.1186/s13568-014-0051-x. PMID: 25006540; PMCID: PMC4077002.
Arnone RD, Walling JP. Waterborne pathogens in urban watersheds. J Water Health. 2007;4(1):149–162. doi: 10.2166/wh.2006.001.
Weiskel PK, Howes BL, Heufelder GR. Coliform contamination of a coastal embayment: Sources and transport pathways. Environ Sci Technol. 1996;4(6):1872–1881.
Li P, Karunanidhi D, Subramani T, Srinivasamoorthy K. Sources and Consequences of Groundwater Contamination. Arch Environ Contam Toxicol. 2021 Jan;80(1):1-10. doi: 10.1007/s00244-020-00805-z. Epub 2021 Jan 2. PMID: 33386943; PMCID: PMC7778406.
Kay D, Edwards AC, Ferrier RC, Francis C, Kay C, Rushby L, Watkins J, McDonald AT, Wyer M, Crowther J, Wilkinson J. Catchment microbial dynamics: the emergence of a research agenda. Prog Phys Geogr. 2007;4(1):59–76.
Ferguson C, Husman AMD, Altavilla N, Deere D, Ashbolt N. Fate and transport of surface water pathogens in watersheds. Crit Rev Environ Sci Technol. 2003;4(3):299–361
Kay D, Crowther J, Stampleton CM, Wyer MD, Fewtrell L, Anthony S, Bradford M, Edwards A, Francis CA, Hopkins M, Kay C, McDonald AT, Watkins J, Wilkinson J. Faecal indicator organism concentrations and catchment export coefficients in the UK. Water Res. 2008;4:2649–2661. doi: 10.1016/j.watres.2008.01.017
Cui Q, Huang Y, Wang H, Fang T. Diversity and abundance of bacterial pathogens in urban rivers impacted by domestic sewage. Environ Pollut. 2019 Jun;249:24-35. doi: 10.1016/j.envpol.201129.02.094. Epub 2019 Mar 1. PMID: 30877966.
Fewtrell L, Kay D. Recreational Water and Infection: A Review of Recent Findings. Curr Environ Health Rep. 2015 Mar;2(1):85-94. doi: 10.1007/s40572-014-0036-6. PMID: 25821715; PMCID: PMC4371824.
Jang J, Hur HG, Sadowsky MJ, Byappanahalli MN, Yan T, Ishii S. Environmental Escherichia coli: ecology and public health implications-a review. J Appl Microbiol. 2017 Sep;123(3):570-581. doi: 10.1111/jam.13468. Epub 2017 Jul 3. PMID: 28383815
Holcomb DA, Stewart JR. Microbial Indicators of Fecal Pollution: Recent Progress and Challenges in Assessing Water Quality. Curr Environ Health Rep. 2020 Sep;7(3):311-324. doi: 10.1007/s40572-020-00278-1. PMID: 32542574; PMCID: PMC7458903.
USEPA (1986) Ambient Water Quality Criteria for Bacteria. Washington, DC: USEPA.
Edberg, S.C., Rice, E.W., Karlin, R.J. and Allen, M.J. (2000) Escherichia coli: the best biological drinking water indicator for public health protection. J Appl Microbiol 88, 106S–116S.
Cabral JP. Water microbiology. Bacterial pathogens and water. Int J Environ Res Public Health. 2010 Oct;7(10):3657-703. doi: 10.3390/ijerph7103657. Epub 2010 Oct 15. PMID: 21139855; PMCID: PMC2996186.
Jung AV, Le Cann P, Roig B, Thomas O, Baurès E, Thomas MF. Microbial contamination detection in water resources: interest of current optical methods, trends and needs in the context of climate change. Int J Environ Res Public Health. 2014 Apr 17;11(4):4292-310. doi: 10.3390/ijerph110404292. PMID: 24747537; PMCID: PMC4025003.
Ryan U, Hill K, Deere D. Review of generic screening level assumptions for quantitative microbial risk assessment (QMRA) for estimating public health risks from Australian drinking water sources contaminated with Cryptosporidium by recreational activities. Water Res. 2022 Jul 15;220:118659. doi: 10.1016/j.watres.2022.118659. Epub 2022 May 24. PMID: 35635918.
Factsheet on quality water parameters, EPA 841F21007F, July 2021, https://www.epa.gov/awma/e-coli-parameter-factsheet (Access: 04.03.2025)
Directive 2006/7/EC of the European Parliament and of the Council of 15 February 2006 concerning the management of bathing water quality and repealing Directive 76/160/EEC https://eur-lex.europa.eu/eli/dir/2006/7/oj (Access: 04.03.2025)
Migliorini, S. (2020). Oświadczenie ITU Triathlon Water Quality Statement. W: Migliorini, S. (red.) Triathlon Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-22357-1_24
Tlougan BE, Podjasek JO, Adams BB. Aquatic sports dermatoses: part 1. In the water: freshwater dermatoses. Int J Dermatol. 2010 Aug;49(8):874-85. doi: 10.1111/j.1365-4632.2010.04536.x. PMID: 21128915.
Sridhar SC, Deo SC. Marine and Other Aquatic Dermatoses. Indian J Dermatol. 2017 Jan-Feb;62(1):66-78. doi: 10.4103/0019-5154.198052. PMID: 28216728; PMCID: PMC5286756.
Haddad V Jr, Lupi O, Lonza JP, Tyring SK. Tropical dermatology: marine and aquatic dermatology. J Am Acad Dermatol. 2009 Nov;61(5):733-50; quiz 751-2. doi: 10.1016/j.jaad.2009.01.046. PMID: 19836641.
Tlougan BE, Podjasek JO, Adams BB. Aquatic sports dematoses. Part 2 - in the water: saltwater dermatoses. Int J Dermatol. 2010 Sep;49(9):994-1002. doi: 10.1111/j.1365-4632.2010.04476.x. PMID: 20883263.
Pujalte GGA, Costa LMC, Clapp AD, Presutti RJ, Sluzevich JC. More Than Skin Deep: Dermatologic Conditions in Athletes. Sports Health. 2023 Jan-Feb;15(1):74-85. doi: 10.1177/19417381211065026. Epub 2022 Jan 17. PMID: 35034516; PMCID: PMC9808835.
Pecci M, Comeau D, Chawla V. Skin conditions in the athlete. Am J Sports Med. 2009 Feb;37(2):406-18. doi: 10.1177/0363546508325663. Epub 2008 Nov 6. PMID: 18988923.
Delamare H, Septfons A, Alfandari S, Mailles A. Freshwater sports and infectious diseases: A narrative review. Infect Dis Now. 2024 Jun;54(4S):104883. doi: 10.1016/j.idnow.2024.104883. Epub 2024 Jun 6. PMID: 38849257.
Harder-Lauridsen NM, Kuhn KG, Erichsen AC, Mølbak K, Ethelberg S. Gastrointestinal illness among triathletes swimming in non-polluted versus polluted seawater affected by heavy rainfall, Denmark, 2010-2011. PLoS One. 2013 Nov 7;8(11):e78371. doi: 10.1371/journal.pone.0078371. PMID: 24244306; PMCID: PMC3820603.
Parkkali S, Joosten R, Fanoy E, Pijnacker R, VAN Beek J, Brandwagt D, VAN Pelt W. Outbreak of diarrhoea among participants of a triathlon and a duathlon on 12 July 2015 in Utrecht, the Netherlands. Epidemiol Infect. 2017 Jul;145(10):2176-2184. doi: 10.1017/S0950268817001017. Epub 2017 May 17. PMID: 28511732; PMCID: PMC9203431.
van Asperen IA, Medema G, Borgdorff MW, Sprenger MJ, Havelaar AH. Risk of gastroenteritis among triathletes in relation to faecal pollution of fresh waters. Int J Epidemiol. 1998 Apr;27(2):309-15. doi: 10.1093/ije/27.2.309. PMID: 9602415.
Mena KD, Gerba CP. Risk assessment of Pseudomonas aeruginosa in water. Rev Environ Contam Toxicol. 2009;201:71-115. doi: 10.1007/978-1-4419-0032-6_3. PMID: 19484589.
Guida M, Di Onofrio V, Gallè F, Gesuele R, Valeriani F, Liguori R, Romano Spica V, Liguori G. Pseudomonas aeruginosa in Swimming Pool Water: Evidences and Perspectives for a New Control Strategy. Int J Environ Res Public Health. 2016 Sep 15;13(9):919. doi: 10.3390/ijerph13090919. PMID: 27649225; PMCID: PMC5036752.
Rice SA, van den Akker B, Pomati F, Roser D. A risk assessment of Pseudomonas aeruginosa in swimming pools: a review. J Water Health. 2012 Jun;10(2):181-96. doi: 10.2166/wh.2012.020. PMID: 22717744.
Brockmann S, Piechotowski I, Bock-Hensley O, Winter C, Oehme R, Zimmermann S, Hartelt K, Luge E, Nöckler K, Schneider T, Stark K, Jansen A. Outbreak of leptospirosis among triathlon participants in Germany, 2006. BMC Infect Dis. 2010 Apr 10;10:91. doi: 10.1186/1471-2334-10-91. PMID: 20380736; PMCID: PMC2858141.
Walker MD. Leptospirosis: the possible risk to those participating in water-based sports and activities. Br J Gen Pract. 2018 Aug;68(673):394-395. doi: 10.3399/bjgp18X698285. PMID: 30049778; PMCID: PMC6058646.
Hall V, Taye A, Walsh B, Maguire H, Dave J, Wright A, Anderson C, Crook P. A large outbreak of gastrointestinal illness at an open-water swimming event in the River Thames, London. Epidemiol Infect. 2017 Apr;145(6):1246-1255. doi: 10.1017/S0950268816003393. Epub 2017 Feb 6. PMID: 28162113; PMCID: PMC9507846.
Sesa G, Borry P, Loland S, Camporesi S. Olympic Glory Vs. Athlete Safety: Ethical Lessons From the Seine Water Quality Controversy. Public Health Rev. 2024 Nov 19;45:1608075. doi: 10.3389/phrs.2024.1608075. PMID: 39628964; PMCID: PMC11611586.
World Triathlon Medical Committee. World Triathlon Water Quality Statement (2019).
Hintaran AD, Kliffen SJ, Lodder W, Pijnacker R, Brandwagt D, van der Bij AK, Siedenburg E, Sonder GJB, Fanoy EB, Joosten RE. Infection risks of city canal swimming events in the Netherlands in 2016. PLoS One. 2018 Jul 27;13(7):e0200616. doi: 10.1371/journal.pone.0200616. PMID: 30052633; PMCID: PMC6063404.
Joosten R, Sonder G, Parkkali S, Brandwagt D, Fanoy E, Mughini-Gras L, Lodder W, Ruland E, Siedenburg E, Kliffen S, van Pelt W. Risk factors for gastroenteritis associated with canal swimming in two cities in the Netherlands during the summer of 2015: A prospective study. PLoS One. 2017 Apr 3;12(4):e0174732. doi: 10.1371/journal.pone.0174732. PMID: 28369101; PMCID: PMC5378355.
Guillois Y, Bourhy P, Ayral F, Pivette M, Decors A, Aranda Grau JH, Champenois B, Malhère C, Combes B, Richomme C, Le Guyader M, King LA, Septfons A. An outbreak of leptospirosis among kayakers in Brittany, North-West France, 2016. Euro Surveill. 2018 Nov;23(48):1700848.doi: 10.2807/1560-7917.ES.2018.23.48.1700848. PMID: 30621819; PMCID: PMC6280422.
Morgan J, Bornstein SL, Karpati AM, Bruce M, Bolin CA, Austin CC, Woods CW, Lingappa J, Langkop C, Davis B, Graham DR, Proctor M, Ashford DA, Bajani M, Bragg SL, Shutt K, Perkins BA, Tappero JW; Leptospirosis Working Group. Outbreak of leptospirosis among triathlon participants and community residents in Springfield, Illinois, 1998. Clin Infect Dis. 2002 Jun 15;34(12):1593-9. doi: 10.1086/340615. Epub 2002 May 24. PMID: 12032894.
Schreiber PW, Aceto L, Korach R, Marreros N, Ryser-Degiorgis MP, Günthard HF. Cluster of Leptospirosis Acquired Through River Surfing in Switzerland. Open Forum Infect Dis. 2015 Jul 7;2(3):ofv102. doi: 10.1093/ofid/ofv102. PMID: 26269796; PMCID: PMC4531225.
Pagès F, Larrieu S, Simoes J, Lenabat P, Kurtkowiak B, Guernier V, Le Minter G, Lagadec E, Gomard Y, Michault A, Jaffar-Bandjee MC, Dellagi K, Picardeau M, Tortosa P, Filleul L. Investigation of a leptospirosis outbreak in triathlon participants, Réunion Island, 2013. Epidemiol Infect. 2016 Feb;144(3):661-9. doi: 10.1017/S0950268815001740. Epub 2015 Jul 27. PMID: 26211921.
Radl C, Müller M, Revilla-Fernandez S, Karner-Zuser S, de Martin A, Schauer U, Karner F, Stanek G, Balcke P, Hallas A, Frank H, Fürnschlief A, Erhart F, Allerberger F. Outbreak of leptospirosis among triathlon participants in Langau, Austria, 2010. Wien Klin Wochenschr. 2011 Dec;123(23-24):751-5. doi: 10.1007/s00508-011-0100-2. Epub 2011 Nov 24. PMID: 22105111.
Dallam GM, Jonas S, Miller TK. Medical considerations in triathlon competition: recommendations for triathlon organisers, competitors and coaches. Sports Med. 2005;35(2):143-61. doi: 10.2165/00007256-200535020-00004. PMID: 15707378.
Mougin L, Bougault V, Racinais S, Mountjoy ML, Stephenson B, Carter S, James LJ, Mears SA, Taylor L. Environmental challenges facing athletes, stakeholders and spectators at Paris 2024 Olympic and Paralympic Games: an evidence-based review of mitigation strategies and recommendations. Br J Sports Med. 2024 Jul 25;58(15):870-881. doi: 10.1136/bjsports-2024-108281. PMID: 38955507.
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