Outbreaks of Short-Incubation Ocular and Respiratory Illness Following Exposure to Indoor Swimming Pools

Objectives: Chlorination destroys pathogens in swimming pool water, but by-products of chlorination can cause human illness. We investigated outbreaks of ocular and respiratory symptoms associated with chlorinated indoor swimming pools at two hotels. Measurements: We interviewed registered guests an...

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Bibliographic Details
Published in:	Environmental health perspectives 2007-02, Vol.115 (2), p.267-271
Main Authors:	Anna B. Bowen, James C. Kile, Charles Otto, Kazerouni, Neely, Austin, Connie, Blount, Benjamin C., Hong-Nei Wong, Beach, Michael J., Fry, Alicia M.
Format:	Article
Language:	eng
Subjects:	Adolescent Adult Chemical hazards Child Child, Preschool Chloramines Chloramines - analysis Chloramines - toxicity Chlorine Cohort Studies Disease outbreaks Disease Outbreaks - prevention & control Diseases Environmental Exposure - prevention & control Environmental health Environmental Medicine Epidemiology Eye Diseases - epidemiology Eye Diseases - etiology Eye Diseases - prevention & control Female Hotels and motels Humans Male Medical research Medicine, Experimental Middle Aged Respiration Disorders - epidemiology Respiration Disorders - etiology Respiration Disorders - prevention & control Risk Factors Swimming Pools Ventilation systems Water Microbiology Water Pollutants, Chemical - analysis Water Pollutants, Chemical - toxicity Water samples
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Summary:	Objectives: Chlorination destroys pathogens in swimming pool water, but by-products of chlorination can cause human illness. We investigated outbreaks of ocular and respiratory symptoms associated with chlorinated indoor swimming pools at two hotels. Measurements: We interviewed registered guests and companions who stayed at hotels X and Y within 2 days of outbreak onset. We performed bivariate and stratified analyses, calculated relative risks (RR), and conducted environmental investigations of indoor pool areas. Results: Of 77 guests at hotel X, 47 (61%) completed questionnaires. Among persons exposed to the indoor pool area, 22 (71%) of 31 developed ocular symptoms [RR = 24; 95% confidence interval (CI), 1.5-370], and 14 (45%) developed respiratory symptoms (RR = 6.8; 95% CI, 1.0-47) with a median duration of 10 hr (0.25-24 hr). We interviewed 30 (39%) of 77 registered persons and 59 unregistered companions at hotel Y. Among persons exposed to the indoor pool area, 41 (59%) of 69 developed ocular symptoms (RR = 24; 95% CI, 1.5-370), and 28 (41%) developed respiratory symptoms (RR = 17; 95% CI, 1.1-260) with a median duration of 2.5 hr (2 min-14 days). Four persons sought medical care. During the outbreak, the hotel X's ventilation system malfunctioned. Appropriate water and air samples were not available for laboratory analysis. Conclusions and Relevance to Professional Practice: Indoor pool areas were associated with illness in these outbreaks. A large proportion of bathers were affected; symptoms were consistent with chloramine exposure and were sometimes severe. Improved staff training, pool maintenance, and pool area ventilation could prevent future outbreaks.
ISSN:	0091-6765 1552-9924