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WHO launches first-ever international guidelines on creating safe places to swim and bathe

Today, the World Health Organization (WHO) is launching the world's first-ever international guidelines on how to create safe places to swim and bathe. The guidelines aim to protect people from the risks associated with swimming pools, spas and other recreational bathing areas.

Globally, swimming, bathing and spas are becoming more popular. However, as more people use water for recreation, poor design, maintenance, management and use of these areas increase the risk of spinal injuries, disease and even death. Accumulating evidence and experience shows that many of these accidents and much of this disease can be prevented through simple measures.

WHO's new guidelines give state-of-the-art information on how to ensure swimming pools, spas and other recreational bathing areas are safe. The Guidelines for Safe Recreational Water Environments: Swimming Pools and Similar Environments include both specific values for contaminants and a set of recommended best practices to support safe management and use of recreational waters, pools and spas and prevent unnecessary disease and injury. They address a wide range of hazards, including the improper use of recreational facilities and how improvement could prevent drowning and injury; risks from poor water quality; the contamination of facilities such as pools and hot-tubs; and air quality in indoors bathing facilities.

The Guidelines point towards simple, achievable measures that have been shown to be effective in protecting health. These include: effective supervision by lifeguards, which can mitigate or prevent a range of health problems; better water quality and ventilation management, which can control exposure to toxic chemicals; and improving the way children's 'accidental faecal releases', and the outbreaks of disease which they can cause, are dealt with.

"We are seeing an ever-greater use of rivers, lakes, pools, spas and other bathing facilities, worldwide and year-round, in both developing and developed countries. While in principle this is a positive development from the health perspective, unfortunately the benefits are tempered by rising rates of death, injury and disease associated with their use," said Dr Maria Neira, Director of WHO's Department of Public Health and the Environment. "So much of this disease, disability and death is preventable. These Guidelines are part of WHO's efforts to save lives and prevent injury and disease."

"The purpose of facilities such as swimming pools and spas is to provide access for people with all abilities to enjoy their chosen aquatic pursuit, whether fitness, fun or friendship, in a healthy and safe manner. The launch of these Guidelines will help to better manage and protect the people who use them. Lifesavers worldwide applaud the World Health Organization in taking this initiative," said Alan Whelpton, President of the International Life Saving Federation.

Some of the major infectious risks for users of substandard recreational waters include gastroenteritis outbreaks associated with the presence of, for example, Cryptosporidium or E.coli, and non-gastroenteritis outbreaks associated with the presence of, for example, Legionella spp1 in pools, spas and whirlpools.

A recent outbreak of pool-related illness due to Cryptosporidium (which is found in human faeces) in the United States in 2005, for example, is reported to have affected at least 1800 people and caused the closure of an entire amusement park.

"This is a welcome and timely initiative from WHO," added Mr Joth Singh, Director of the Caribbean Environmental Health Institute. "For regions like ours which now depend on tourism year-round, and where seasonal demand can vary significantly from Christmas and summer peaks to winter and hurricane-season troughs, we will have access to the best practice on how to manage our pools and other tourist facilities most efficiently and safely."

Under normal circumstances, outbreaks of legionellosis are relatively small in comparison, but they can often be more dangerous than those caused by other microbiological agents. Several studies have isolated Legionella spp. from spa waters: in a study in Portugal, for example, 288 Legionella isolates from 14 sites were identified. France, Japan and Spain have also reported the presence of Legionella spp bacteria in natural spas. The large number of positive samples indicates a potential risk to users of thermal waters, especially those people that are undergoing inhalation treatment with thermal water, or those using hot tubs, natural spas or taking a shower.

More than 60 experts from 20 countries contributed to these Guidelines. The Guidelines are intended for a variety of different stakeholders with interests in ensuring the safety of pools and similar recreational water environments: national and local authorities; facility owners, operators and designers (public, semi-public and domestic facilities); special interest groups; public health professionals; scientists and researchers.

These Guidelines complement Volume I of the same series - Guidelines for safe recreational water environments (coastal and freshwaters) - and also relate to the WHO publication entitled Water Recreation and Disease, Plausibility of Associated Infections: Acute Effects, Sequelae and Mortality.

For more information contact:

Mr Gregory Hartl
Communications Adviser, Sustainable Development and Healthy Environments
WHO/Geneva
Telephone: +41 22 791 4458
Mobile phone: +41) 79 203 6715
E-mail: hartlg@who.int

Journalists may also contact:

WHO Regional Advisors for Water and Sanitation:

African Region: Dr Ahmed Nejjar, Environmental Health Officer, WHO/AFRO, Brazzaville, Tel: + 47 241 39271; Email: nejjars@afro.who.int

Eastern Mediterranean Region: Dr Houssain Abouzaid, Coordinator, EGY, Tel: +20 2 670 2362; Email: azaidh@emro.who.int

European Region: Mr Roger Aertgeerts, Regional Advisor, Water and Sanitation, Tel: +39 06 487 7528; Email: rae@ecr.euro.who.int

South-East Region: Mr Han Heijnen, Sanitary Engineer; Tel: +91 11 2337 4418; Email: hanheijnen@gmail.com Western Pacific Region: Mr Terry Thompson; Tel: +63 2 528 9890; Email: thompsont@wpro.who.int

Americas Region: Mr Henry Salas, Regional Advisor on Water Resources for Public Health, Tel: +51 1 437 7019; Email: hsalas@paho.org

List of national technical experts who can be contacted for interviews:

EUROPE
Germany: Christiane Höller, Bavarian Health & Food Safety Authority (Department of Hygiene), Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Sachgebiet Hygiene; Veterinärstrasse 2, 85764 Oberschliessheim, Germany, Tel: +49 (89) 31 560 236, Email: christiane.hoeller@lgl.bayern.de

Greece: Athena Mavridou, National School of Public Health, Microbiology Dept, 196 Alexanda Ave, 11521 Athens, Greece, Tel: +30 (1) 644 4260, Email: amavrid@asph.ariadnet.gr

Spain: Maria Jose Figueras, Universitat Rovira i Virgili, Facultat de Medecina i Ciencies de la Salut, Unitat de Microbiologia y Microbiologia, Sant Llorenc 21, 43201 Reus, Spain; Tel: +34 (9) 77 75 9321, Email: mariajose.figueras@urv.net

Sweden: Thor-Axel Stenström, Swedish Institute for Infectious Disease Control, WHO Collaborating Centre for Legionellea Infections, Swedish Ins. for Infectious Disease Control,Lundagatan 2,S-105 21 Stockholm, Tel: +46 (8) 457 2469, Email thor-axel.stenstrom@smi.ki.se

United Kingdom: Brian Guthrie, Pool Water Treatment Advisory Group, Field House, Thrandeston near Diss, Norfolk IP21 4BU, UK,Tel: +44 (1379) 783 678, Email: guthrie@pwtag.org

ASIA
Australia: Norman Farmer, Education Committee, International Life Saving Federation, PO Box 7305 Karingal Centre Victoria 3199, Australia, Tel: +61 (0)3 9785 9368, Fax: +61 (0)3 9785 9384 Email: nfarmer@bigpond.net.au

Australia: Paul Stevensen, Stevensen & Associates Pty Ltd, 7/33 Ryde Road, Pymble, NSW 2073, PO Box 1047, Pymble Business Centre, NSW 2073, Australia, Tel::+61(02) 9880 2822, Fax::+61(02) 9880 2833, Email: engineers@stevenson.net

Japan: Takuro Endo, National Institite of Infectious Diseases, Ministry Of Health and Welfare; 1-23-1 Toyama, Shinjuku-ku, Tokyo 162 8640, Japan, Tel: +81 (3) 52 85 1111 x 2371, Email: tendo@nih.go.jp

CARIBBEAN
Vincent Sweeney, Caribbean Environmental Health Institute, P.O. Box 1111; Castries, St. Lucia. Tel: +1 (758) 453 2931, Email: vsweeney@cehi.org.lc

AFRICA
South Africa: Willie Grabow - Emeritus Professor, Department of Microbiology, University of Pretoria, 10 Kamdeboo, Bakkielaan; 0041 The Willows, Pretoria, South Africa, T/F : (+2712) 807-2351; Email wgrabow@icon.co.za

Kenya: Charles Mbogo, International Centre of Insect Physiology and Ecology, PO Box 30772, Nairobi, Kenya, Telephone: 254-2-861680, Fax: 254-2-860110.

SOUTH ASIA
Singapore: Pranav Joshi, Ops Intelligence and Analysis (Hygiene), Environmental Health Department, The National Environment Agency, Environment Building, 40 Scotts Road # 21-00, Singapore 228231, Tel:(65) 67319139, Fax:65) 67345787 or (65) 67319749; Email: Pranav_JOSHI@nea.gov.sg

NORTH AMERICA
US: Chris Brewster, President - Americas Region, International Life Saving Fed, 3850 Sequoia Street, San Diego, CA 92109-6518, USA, Tel: +1 (858) 581 1221; Email: brewster@lifesaver1.com

US: Joe Cotruvo, Joseph Cotruvo Associates/NSF International Collaborating Centre; 5015 46th St., N.W., Washington, D.C. 20016, USA, Tel: +1 (202) 362 3076; Email: joseph.cotruvo@verizon.net

US: Christine Branche, National Center for Injury Prevention and Control; Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, 4770 Buford Highway, NE, Mailstop, K-63, Atlanta, Georgia 30341-3724 USA, Tel: +1 (770) 488 4652. E-mail: cbranche@cdc.gov


1 Legionella spp. are heterotrophic bacteria found in a wide range of water environments and can proliferate at temperatures above 25 ºC. They can grow in poorly maintained hot tubs and associated equipment. Legionella spp. can also multiply on filter materials, such as granulated activated carbon. However, exposure to Legionella is preventable through the implementation of basic management measures. Legionellosis is transmitted through aerosols which contain the bacteria and can cause Legionellosis (a serious disease that affects mostly people over 50) and a milder flu-like Pontiac fever, which is often mistaken for flu.

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