Swimming pools, hot tubs, water parks, splash pads, lakes, rivers, and oceans are all potential sources of water recreation-associated illness. Illnesses spread through exposure to recreational water can cause diarrhea, vomiting, skin rashes, skin irritations, and respiratory illnesses.
If you think you have a recreational water illness that needs medical attention, contact your health care provider. Report any suspected recreational water illnesses to your local health department. If you can't reach them, contact the Washington State Department of Health at 206-418-5500.
Stomach and Intestinal Illness
Several recreational water-associated illnesses are infections that cause diarrhea, vomiting, or both. These infections can be spread when the feces (poop) of an infected person or animal gets into the water and is then swallowed by another person.
To avoid getting an infection that can cause diarrhea or vomiting from exposure to recreational water:
- Avoid swallowing water when you participate in water recreation.
- Do not swim or wade in areas that are closed because of poor water quality.
To avoid spreading an infection that can cause diarrhea or vomiting while participating in recreational water activities:
- Never participate in recreational water activities when you have diarrhea or vomiting.
- Shower with soap and water before participating in water recreation activities.
- Always put babies and children who are not toilet-trained in a tight-fitting swim diaper before allowing them to swim, wade, or play in the water, and check the diaper every hour.
- Take babies and children on frequent bathroom breaks.
- Change swim diapers (and regular diapers worn by children who aren’t getting in the water) away from water recreation areas.
Cryptosporidiosis (“Crypto” Infection)
Cryptosporidium (or “Crypto”) is a parasite that is one of the most common causes of water recreation-associated infections in the United States. It can be found in the feces (poop) of infected animals (especially cattle) and people. The most common symptom is watery diarrhea, which begins about 7 days after exposure. Crypto is highly resistant to chlorine disinfection and can survive in a pool for as long as 10 days. If you are diagnosed with crypto, don’t go back in the water until 2 weeks after diarrhea has ended. Learn more about Cryptosporidium.
Giardiasis (Giardia Infection)
Giardia parasites are found in the feces (poop) of infected people and animals. Symptoms begin about 7 to 10 days after exposure and include diarrhea, stomach cramps, bloating, gas, fatigue, and weight loss. Learn more about Giardia.
Shigellosis (Shigella Infection)
Shigella bacteria can be found in the feces (poop) of infected people. Shigellosis symptoms include severe diarrhea (which may be bloody), fever, and stomach cramps that usually start 1 to 2 days after being exposed. People diagnosed with shigellosis should avoid water recreation activities for 2 weeks after the diarrhea has ended. Learn more about Shigellosis.
Shiga Toxin-producing E. coli Infection (STEC)
Shiga toxin-producing E. coli (STEC) is a bacteria found in the feces (poop) of animals (especially cattle) and infected people. Symptoms begin 1 to 8 days after being exposed and include diarrhea (which may be bloody) and severe abdominal cramps. STEC infection can cause serious complications that can damage the kidneys and other organs. Learn more about E. coli.
Norovirus Infection
Norovirus is found in the feces (poop) of infected humans. It is extremely contagious. Symptoms usually begin 24 to 48 hours after being exposed and include diarrhea, vomiting, body aches, abdominal cramps, fever, and headache. Chlorine disinfection helps kill this virus in pools, but norovirus is a common cause of recreational water-associated infection at lakes. Learn more about Norovirus.
Skin Rashes and Irritations
Hot Tub Rash - Pseudomonas folliculitis
Pseudomonas folliculitis, or hot tub rash, is an infection caused by bacteria called Pseudomonas aeruginosa. It appears as an itchy, bumpy rash and sometimes pus-filled blisters. The rash starts a few hours to a few days after exposure and is usually more severe in areas covered by the bathing suit. Most people recover without treatment in 5 to 10 days. Properly maintaining hot tubs and pools helps eliminate the bacteria that cause this rash. Removing your swimsuit and showering with soap and water, especially after using a hot tub, can prevent the infection. Learn more about Hot Tub Rash, CDC.
Swimmer's itch - Cercarial dermatitis
Swimmer's itch is a rash caused by an allergic reaction to parasites that infect birds and mammals. The parasites come from infected snails that live in lakes, ponds, and oceans. People are not suitable hosts for the parasite's life cycle, so after burrowing into a swimmer's skin, the parasite dies. The human body responds with an allergic reaction. The rash looks like small red pimples, which may develop into blisters. To prevent swimmer’s itch, shower and dry off with a towel immediately after leaving the water. Don’t swim or wade in areas known to have a swimmer’s itch problem. Learn more about Swimmer's Itch, CDC.
Swimmer's Ear - Otitis externa
Swimmer's ear is an infection of the outer ear canal and can affect anyone but is most common in children. Symptoms usually start a few days after swimming and include ear pain, itchiness, redness, swelling, and pus draining from the infected ear. It can be treated with antibiotic ear drops. Swimmer's ear is caused when water stays in the ear canal for long periods of time, allowing germs to grow and infect the skin. When swimming, try to keep ears dry. If water gets in your ear, tilt your head with your ear facing down and gently pull your earlobe in different directions to help the water drain out. Learn more about Swimmer's Ear, CDC.
Cyanotoxin-producing Cyanobacteria (Harmful Algal Blooms)
Cyanobacteria, sometimes called “blue-green algae,” are microscopic organisms that can grow rapidly and create “blooms” in lakes, rivers, and ponds. The blooms look like spilled paint or grass clippings on the water surface. When a cyanobacteria bloom produces cyanotoxin, it is called a “harmful algal bloom.” People exposed to the water can experience skin, eye, or ear irritation. Swallowing water from water with a harmful algal bloom can cause stomach cramps, vomiting, diarrhea, sore throat, fever, headache, muscle and joint pain, or nerve and liver damage. Avoid swimming in bodies of water that have a visible algae bloom unless the water has been tested for cyanotoxins. Obey warning signs that say cyanotoxin has been found in the water, even if the water looks clear. Don't let pets drink from or swim in water with algal blooms. Dogs are especially sensitive to the effects of cyanotoxin, and reports of dog deaths due to harmful algal blooms are reported most years in Washington State. Learn more about Cyanobacteria.
Chemical Sensitivity
Some people can experience allergic reactions, such as skin redness and itching, to chemicals used in pools. The reactions commonly occur within an hour or two of being in the water. It's also possible that improper use of chemicals or a chemical release at a pool could expose people to skin or respiratory irritants.
Sun Exposure
Prevent sun burns and skin cancer by choosing five protection options: seeking shade, covering up, getting a hat, wearing sunglasses, and rubbing on sunscreen. Learn more about Sunscreens and Sun Safety.
Respiratory Illness
Legionellosis (Legionnaires’ Diseases)
Legionnaire’s disease is a serious life-threatening pneumonia caused by Legionella bacteria. Symptoms include high fever, chills, and a cough that begins 2 to 10 days after exposure. People get legionella when they breathe in water mist or vapor (small droplets of water in the air) contaminated with Legionella bacteria. Hot tubs can be a source of Legionella bacteria when they are not adequately maintained. Learn more about Legionnaires’ Disease.
Mycobacterium avium and Endotoxins
Water vapor or steam contaminated with bacteria or bacterial fragments can be breathed in causing an allergic reaction and inflammation in the lungs. This condition, called "hypersensitivity pneumonitis," is rare, but has been associated with spas or indoor pools that have water features that produce vapors or mists. Water sitting in pipes that isn't continuously disinfected can become a source of bacterial fragments. Proper maintenance of pools and spas helps eliminate these germs.
In the Swim of Things Video
More Resources
Water Recreation - Beach swimming advisories, staying safe in pools and open water, and regulated water recreation facility resources.
Content Source: Water Recreation Program, Office of Communicable Disease Epidemiology