A little deeper

We were delighted to read the article by Sanborn and Takaro¹ on recreational water illness among Canadian primary care patients. We believe it is important that physicians understand that the use of recreational water among the public might contribute to a substantial burden of gastrointestinal illness in warmer months.

However, for the overall burden of enteric illness in Canada, a convincing body of evidence indicates that food is the most commonly reported probable source, and also has an increased seasonal distribution in the summer.^2–4 Risks of food-borne illness are also important knowledge for primary care physicians.

The article¹ thoroughly explains risks of illness among users of untreated water sources, such as lakes and beaches. We also want to highlight that individuals using treated recreational water sources, such as pools and splash pads, might experience an even greater proportion of disease outbreaks.⁵ Physicians should also ask about these exposures among symptomatic patients, and counsel those who might be at risk.

Further, physicians can also play an important role in counseling patients about personal hygiene before entering a pool setting and avoidance of these settings if they are ill.⁶ Both of these steps are essential to maintaining personal and public health while enjoying treated or untreated recreational water this summer.

We agree that encouraging physicians to test stool samples in patients with severe symptoms will aid in proper diagnosis and treatment in a clinical setting; however, most relevant guidelines^7–9 do not recommend cultures for patients without severe or prolonged course of illness, as it is not cost-effective and does not change management.

Finally, we also wish to highlight the important role that local public health agencies play in minimizing risk of illness from recreational water exposure through routine inspection and investigation of potentially contaminated sources. We urge family physicians who suspect an infectious recreational hazard to actively contact their local public health agencies in advance of microbiological proof to mitigate the potential hazard in a timely manner through inspection.

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