Health officials are heralding a new report that analyzes a widespread Utah RWI outbreak as offering key lessons to avoid future incidents.
“Compared to the rest of the country Utah residents have a good knowledge of healthy swimming.” said epidemiologist Michele Hlavsa, chief of the Centers for Disease Control’s Healthy Swimming Program. She helped author the report about a major 2007 cryptosporidium outbreak in Utah.
“I hope that other states take this report and start thinking about developing their own healthy swimming campaigns to get information out their residents,” she added.
The Utah outbreak included approximately 5,700 related cases state wide. To prevent a repeat, health officials went on the offensive in 2008. They collaborated with pool operators and community partners to establish fecal incident-response protocols and install secondary or supplemental disinfection systems at 75 treated recreational water venues. They also launched a multimedia public information campaign.
It appears the campaign worked. In a telephone survey of adult Utah residents conducted between July and September 2008, 96.1 percent of 499 respondents correctly indicated that ‘it is not OK to swim if you have diarrhea.” Similarly, in 2009, a separate national mail survey of 4,556 adults found that 100 percent of those from Utah correctly indicated that ‘not swimming while ill with diarrhea protects others from recreational water illnesses (RWIs).” That’s compared with only 78.4 percent of residents of other states. Additionally, 96.4 percent of Utah residents correctly identified “not swallowing water you swim in” as a healthy swimming behavior, compared with 85.7percent of residents of other states. And 85.8 percent of Utah residents correctly indicated that “chlorine does not kill germs instantly,” compared with 65.9 percent of residents of other states.
However, a smaller percentage of Utah residents than residents of other states identified “making sure that pools are treated” as a healthy swimming behavior (49.3 percent versus 86.0 percent). That may be because “when we tell people about crypto we tell them that it’s extremely chlorine tolerant, so we might have inadvertently taught them that … chlorine is not as important as it is,” Hlavsa said.
Overall, Teresa Gray was very pleased with the results of the analysis. She was instrumental in putting the pieces of the Utah campaign together. “I think the number one take away message is that you have to have everyone working together,” said Gray, bureau manager for Water Quality and Hazardous Waste, Salt Lake Valley Health Department.
That message has hit home in Northern Kentucky, where officials faced an outbreak of more than 250 cases last year.
“[The report] made me feel validated, like we’re on the right track,” said Dr. Lynne Saddler, district director of health, Northern Kentucky Health Department. “I felt like the report adds to the growing body of evidence on what works in preventing these crypto outbreaks.”
However, Hlavsa noted a few caveats to the data. “We weren’t able to measure healthy swimming knowledge before the campaign,” she said. “And just because they know what healthy swimming is doesn’t mean they’re actually doing it.”