Family Forum / Parenting / Mothers / June 2005

Check the palms of their hands and soles of feet. If you see tiny blisters,
this is generally an indicator of Coxsackie. Were they playing in a pool?
Coxsackie is often spread thru a pool - that's why you see it a lot in the
summer and not so often in the winter.  Hope the littles feel well soon.
Teri

9 chances out of 10 it's from a "swim-diaper".

The swim-diapers DO NOT hold back all of
the fecal matter.

Google the effectiveness of  swim-diapers.

A mouthful won't kill you...

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http://healthlink.mcw.edu/article/959984740.html

Doesn't the chlorine in the pool, hot tub, and spa kill all the germs?
No. Chlorine does a good job of killing most germs, but it does not
sterilize the water. A few germs can survive normal pool, hot tub, and spa
levels of chlorine for several hours to days. Chlorine must be maintained at
proper levels to kill most germs. The high water temperature of hot tubs and
spas may cause chlorine to evaporate faster. As a result, chlorine levels in
hot tubs and spas need to be checked more regularly than in swimming pools.
Remember: even if you can smell the chlorine odor the water is not germ
free.

Skin infections are the most common infections spread through hot tubs and
spas

Can I get diarrhea from playing and wading in ornamental water fountains?
Yes, if you swallow the water. Several diarrheal disease outbreaks have been
associated with playing in ornamental water fountains. Not all ornamental
water fountains are chlorinated and filtered. When people, especially
diaper-aged children, play in or soak themselves with the water jets, they
can contaminate the water.

What is my chance of getting diarrhea when I go swimming?
We don't really know. If public pools are properly maintained and
chlorinated, the risk is thought to be low. However, over the past 10 years,
over 150 outbreaks have been reported, involving small community pools,
large waterparks, hot tubs, spas, lakes, and rivers.

Many outbreaks go unnoticed because people do not consider the pool water as
a possible source of illness. It may take up to several weeks for some germs
to cause symptoms of illness. The longer the time period between swimming
and development of illness, the less likely people are to associate their
illness with swimming activity. As a result, the number of actual outbreaks
is probably greater than those currently reported.

Do swim diapers or swim pants prevent fecal matter from entering the water?
Using rubber pants, swim pants, or swim diapers has been suggested as a way
to reduce fecal contamination of recreational water by infants and toddlers.
These diapers may prevent formed stool from getting into the water, but they
have not been tested to determine how well they contain stool after it
becomes wet or how well they contain diarrhea. Swim diapers are most likely
NOT able to prevent diarrhea (which may indicate ongoing illness) from
leaking into the pool. Even though the diapers may reduce the release of
formed stool, they are not leakproof. Change your child often and make
frequent trips to the toilet.

http://www.lifesaving.com/issues/articles/16cyptosporidium.html

Cryptosporidium
Information for Swimming Pool Operators

Provided by the Centers for Disease Control and Prevention

This information is being provided to inform those who manage and operate
pools, waterparks, and other venues about the risks of cryptosporidiosis and
ways to help prevent it.

Cryptosporidium parvum (also known as "Crypto") is a parasite excreted in
the feces of infected humans, cattle, and other mammals. The infectious form
of the parasite (the "oocyst") is too small to be seen without a microscope
and is highly resistant to the levels of chlorine normally found in swimming
pools. Infection with Cryptosporidium, known as cryptosporidiosis, often
causes a profuse and watery diarrhea that is frequently accompanied by
abdominal cramping. Fatigue, fever, loss of appetite, nausea, and vomiting
are other signs and symptoms of crypto, which begin an average of about 7
days after oocysts are swallowed. A person with a normal, healthy immune
system can expect symptoms to last for 2 weeks or less. People with weakened
immune systems (those with HIV/AIDS, on cancer chemotherapy, or those
receiving organ transplants) will have cryptosporidiosis for a longer period
of time, and it could become life-threatening. Small children and pregnant
women with cryptosporidiosis can quickly become severely dehydrated.

The infection occurs after accidental swallowing of Cryptosporidium oocysts
in contaminated pool water, by drinking contaminated tap water, eating or
drinking contaminated food products, or through direct contact with feces.
Since 1988, health departments have documented more than 10 outbreaks of
crypto at both waterparks and swimming pools in the U.S., resulting in
thousands of people becoming ill after swallowing contaminated pool water.
It is believed that these reported outbreaks are only the tip of the
iceberg, and that outbreaks will be more frequently recognized in the coming
years as health care providers increase their testing of patients for Crypto
infection.

The number of Cryptosporidium oocysts needed to cause infection is probably
very low; as few as 2 - 10 oocysts have been shown to cause illness in
animals. At the height of infection a person is very contagious and may pass
millions of infectious oocysts per day in his or her stool, enough to
contaminate a large waterpark. Cryptosporidium oocysts appear in the stool
of infected persons at the onset of symptoms and can continue to be excreted
in the stool for several weeks after the symptoms resolve. Outside the body,
oocysts may remain infectious for 2 - 6 months in a moist environment. The
ability of Crypto to infect the body is probably the same for everyone.
However, the severity of disease differs and may be greater in children,
pregnant women, and those whose immune systems are compromised.

Cryptosporidium is highly resistant to halogen (chlorine/bromine)
disinfection. This is a concern in pools where the primary protection
against disease transmission is halogen disinfection. Cryptosporidium
oocysts, because they are microscopic, may pass through many types of pool
sand filters and most cartridge filters. A diatomaceous earth filter can
capture most of the oocysts. However, even with an effective filter it may
take as long as 2 1/2 days to remove most of the oocysts from a pool. More
studies need to be undertaken before the effectiveness of nonhalogen liquid
sanitizers and other methods of disinfection on Cryptosporidium are known.
Additionally, new filter media and flocculents have not been studied to
determine their effectiveness in removing Crypto oocysts.

Once a pool is contaminated (for example, through a fecal accident or by
rinsing a diaper in the pool), it can remain a source of infection for pool
users for prolonged periods of time because of Cryptosporidium's resistance
to halogens and the difficulty of removing oocysts by filtration. Pool
operators can reduce the risk of initial contamination by using common sense
operating practices.

The Centers for Disease Control and Prevention recommends the following:

1. Prepare a plan. In the even that you get calls about crypto, how would
you answer questions and complaints? To whom would you refer these
individuals? How would you manage press inquiries in the event of an
outbreak?

2. Prepare and implement a written fecal accident policy for your pool.
Teach this policy to all relevant employees. Be sure that employees enforce
your policy. Instruct lifeguards and other personnel to monitor the pool
area for fecal accidents and behavior that can put others at risk.

3. Unfortunately, fecal accidents that are caused by Cryptosporidium
infection are likely to be in the form of watery diarrhea, and therefore
will probably not be seen or reported. It is therefore important to:

   * Train staff to report illnesses they experience to the management and
not to swim if ill with diarrhea or abdominal cramps.

   * Develop a policy for pool usage by diaper-aged and toddler children.
These children are at high risk for having fecal accidents in the pool. The
best situation is one where there is a separate pool for diaper-aged
children that has a separate water circulation and filtration system. In
such a situation, diaper-aged children should only be allowed in the pool
specifically designated for them. Older children, adolescents, and adults
should not be allowed in that pool unless they are caring for a diaper-aged
child. After using the "kiddie" pool, patrons should rinse off before
entering the pool designated for older individuals. If a separate "kiddie"
pool is not possible, strong consideration should be given to excluding
diaper-aged children from the pool. The use of rubber pants or "swim
diapers" have been suggested as a way to reduce fecal contamination by
infants and toddlers, but these methods have not been tested to determine
their ability to contain Cryptosporidium.

   * Provide signage in a conspicuous location before pool entry. The sign
might state:

     1. "If you have or have had diarrhea in the past 2 weeks, please do
not use the pool."

     2. "Shower your child and yourself before entering the pool."
(Showering is very important as thousands of oocysts may reside on the
surfaces near the anus after a bowel movement. The oocysts can contaminate
the pool upon contact with the water. A policy of mandatory showers before
swimming and enforcement of the policy can reduce the risk of remaining,
unnoticeable fecal material being washed into the pool. Showering should
include the thorough use of soap and warm water, focusing on the surfaces
near the anus. A quick rinsing over a swimsuit with cold water will probably
not do much good. Facilities should always have hot water available in
bathroom and shower facilities).

     3. Maintain the recirculation and filtration equipment to provide
maximum filtration. Many pools are periodically overused, and the average
bather loads exceeded. These pools may need filtration equipment that
exceeds required minimums just to maintain normal water quality during peak
periods of use. If normal minimums are exceeded, install anti vortex drain
covers (with no top openings and automatic cut-off valves) to avoid injuries
to small children.

     4. Maintain the chemical feed equipment and chemicals at optimal
levels. This includes maintaining the disinfectant levels; optimal pH (7.2 -
7.8); alkalinity (80 - 120 ppm); calcium hardness (200 - 400 ppm), and total
dissolved solids (below 2500mg/liter). Lack of proper pH can greatly affect
disinfection effectiveness in chlorinated pools. Be sure to obtain water
samples for chemical and pH testing from the poolside, not the central
filter bay or pumphouse. Although crypto is chlorine resistant, maintaining
proper equipment and chemical levels will reduce the risk of illnesses from
most other fecally transmitted pathogens. Consider scheduling pool usage by
incontinent persons (e.g. infant swim classes) later in the day to allow for
filtration systems to run overnight before heavy usage by other patrons.

     5. Provide training on the prevention of diseases and injuries for all
persons responsible for the maintenance and operation of the swimming pool.
Include in this training information regarding Cryptosporidium.

     6. Provide safe and easily accessed diaper-changing areas and
discourage diaper-changing at poolside. Inspect your facility often.

     7. Use club or organization newsletters to remind patrons:

   * Toddlers should wear close fitting swimsuits or underwear in order to
better contain solid or semi-solid stool.

   * Do not use the pool if you or your child has had diarrhea in the
previous 2 weeks.

   * Do not change your child's diaper at poolside.

   * Do not rinse diaper-aged children in the pool before, during, or after
diaper changes.

   * Assist young children in making frequent visits to the bathroom to
minimize accidents.

   * Do not rinse hands in the pool following a trip to the bathroom or
changing a child's diaper. Wash hands correctly by using soap and warm water
and thoroughly cleaning all hand surfaces.

   * Notify the pool management if you or a family member develops a
gastrointestinal illness that you think may have been related to a visit to
the swimming pool.

Following these recommendations may help reduce the risk of Cryptosporidium
contamination of your pool.

Lifesaving Resources Inc. - www.lifesaving.com - (603) 827-4139