Recreational water quality guidelines protect the public from health risks associated with water recreation by helping to prevent unacceptable concentrations of pathogenic organisms in ambient water. However, illness risk is associated with both the concentration of pathogens in the water and the degree of contact with those pathogens. Different recreational activities can result in different levels of contact with ambient water containing water-borne pathogens. We conducted a systematic literature review and meta-analysis to evaluate risks of illness associated with different recreational activities and different levels of contact to ambient surface waters. We screened 8,618 potentially relevant studies for quantitative measures of risk using inclusion/exclusion criteria established in advance. We categorized recreational activities as swimming, sports-related contact, minimal contact, and sand contact. We combined relative risks using a random effects meta-analysis for adverse health outcome categories representing gastrointestinal illness, respiratory illness, skin, eye, ear, nose, throat, and cold/flu illness. We identified 92 studies meeting our inclusion criteria. Pooled risk estimates indicate significant elevation of gastrointestinal illness with the recreational activity categories swimming (2.19, 95% CI: 1.82, 2.63) and sports-related contact (2.69, 95% CI: 1.04, 6.92), and nonsignificant elevation of gastrointestinal illness with minimal contact (1.27, 95% CI: 0.74, 2.16). We also found a significant elevation of respiratory illness with swimming (1.78, 95% CI: 1.38, 2.29) and sports-related contact (1.49, 95% CI: 1.00, 2.24), and no elevation of respiratory illness with minimal contact (0.90, 95% CI: 0.71, 1.14). This study suggests that exposures associated with different types of recreational activities are important characteristics of the exposure pathway when assessing illness risk associated with recreation in ambient surface waters.

中文翻译：

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评估与娱乐活动期间暴露于周围地表水相关的健康风险：系统评价和荟萃分析。

娱乐用水质量指南有助于防止环境水中病原微生物浓度达到不可接受的水平，从而保护公众免受与水上娱乐相关的健康风险。然而，疾病风险与水中病原体的浓度以及与这些病原体的接触程度有关。不同的娱乐活动可能会导致与含有水传播病原体的环境水的不同程度的接触。我们进行了系统的文献综述和荟萃分析，以评估与不同娱乐活动和与周围地表水的不同接触程度相关的疾病风险。我们使用预先制定的纳入/排除标准筛选了 8,618 项潜在相关研究，以定量评估风险。我们将休闲活动分类为游泳、与运动相关的接触、最小接触和沙子接触。我们使用随机效应荟萃分析对代表胃肠道疾病、呼吸系统疾病、皮肤、眼睛、耳朵、鼻子、喉咙和感冒/流感疾病的不良健康结果类别组合相对风险。我们确定了 92 项符合我们纳入标准的研究。汇总风险估计表明，休闲活动类别游泳（2.19，95% CI：1.82，2.63）和运动相关接触（2.69，95% CI：1.04，6.92）胃肠道疾病显着升高，而胃肠道疾病则无显着升高最小接触（1.27，95% CI：0.74，2.16）。我们还发现游泳（1.78，95% CI：1.38，2.29）和运动相关的接触（1.49，95% CI：1.00，2.24）会显着增加呼吸道疾病的发生率，最小程度的接触不会加重呼吸道疾病（0.90，95% CI：0.71，1.14）。这项研究表明，在评估与周围地表水域娱乐相关的疾病风险时，与不同类型娱乐活动相关的暴露是暴露途径的重要特征。