King Sarah, Exley Josephine, Winpenny Eleanor, Alves Lottie, Henham Marie-Louise, Larkin Jody
Rand Health Q. 2015 Mar 20;4(4):5.
The European Bathing Directive (2006/7/EC) stipulates water quality standards for recreational bathing waters based on specified limits of faecal indicator organisms (FIOs). Presence of FIOs above the limits is considered to be indicative of poor water quality and to present a risk to bathers' health. The European Bathing Directive (2006) is to be reviewed in 2020. We conducted a rapid evidence assessment on recreational bathing waters and gastrointestinal illness (GI) to identify the extent of the literature published since the previous review period in 2003 and to determine whether there is any new evidence which may indicate that a revision to the Directive would be justified. Overall, 21 papers (from 16 studies), including two RCTs, met the inclusion criteria; 12 were conducted in marine waters and four were conducted in freshwater. Considerable heterogeneity existed between study protocols and the majority had significant methodological limitations, including self-selection and misclassification biases. Moreover, there was limited variation in water quality among studies, providing a limited evidence base on which to assess the classification standards. Overall, there appears to be a consistent significant relationship between faecal indicator organisms and GI in freshwater, but not marine water studies. Given the apparent lack of relationship between GI and water quality, it is unclear whether the boundaries of the Bathing Waters Directive are supported by studies published in the post-2003 period. We suggest that more epidemiological evidence is needed to disprove or confirm the original work that was used to derive these boundaries for marine waters.
《欧洲沐浴指令》（2006/7/EC）根据粪便指示生物（FIOs）的特定限值规定了休闲沐浴用水的水质标准。FIOs超过限值被认为表明水质较差，并对沐浴者健康构成风险。《欧洲沐浴指令》（2006年）将于2020年进行审查。我们对休闲沐浴用水和胃肠道疾病（GI）进行了快速证据评估，以确定自上一个审查期（2003年）以来发表的文献范围，并确定是否有任何新证据表明该指令需要修订。总体而言，21篇论文（来自16项研究），包括两项随机对照试验，符合纳入标准；12项在海水中进行，4项在淡水中进行。研究方案之间存在相当大的异质性，大多数研究存在重大方法学局限性，包括自我选择和错误分类偏差。此外，各研究之间水质变化有限，为评估分类标准提供的证据基础有限。总体而言，在淡水研究中，粪便指示生物与胃肠道疾病之间似乎存在一致的显著关系，但在海水研究中并非如此。鉴于胃肠道疾病与水质之间明显缺乏关联，尚不清楚2003年后发表的研究是否支持《沐浴用水指令》的界限。我们建议需要更多的流行病学证据来反驳或证实用于确定这些海水界限的原始研究。
