Fleisher J M, Kay D, Wyer M D, Godfree A F
Center for Research into Environment and Health, University of Leeds, UK.
Int J Epidemiol. 1998 Aug;27(4):722-6. doi: 10.1093/ije/27.4.722.
During the summers of 1989-1992 we conducted four randomized intervention trials at four separate UK bathing locations judged of acceptable quality under current USEPA and EU criteria. The results showed bathers to be at increased risk of gastroenteritis, acute febrile respiratory illness (ICD-9 461-466, 480), ear and eye infections relative to non-bathers. The public health significance of these findings has been questioned based upon the unproven assumption that these illnesses are minor in nature and thus of questionable public health significance.
The severity of these illnesses or ailments in terms of duration of illness, percentage of participants seeking medical treatment, and number of days of lost normal daily activity among study participants reporting specific illnesses or ailments were assessed. In addition the attributable proportion of illness among the exposed (bathers) was calculated for each illness or ailment.
Average duration of illness ranged from approximately 4 days to approximately 8 days depending on the specific illness reported. The percentage of study participants seeking medical treatment ranged from 4.2% to 22.2% while the percentage reporting the loss of at least one day of normal daily activity ranged from 7.0% to 25.9% depending on the illness reported. The overall percentage of each illness that can be directly attributable to exposure to marine waters contaminated with domestic sewage ranged from a low of 34.5% for gastroenteritis to a high of 65.8% for ear infections.
To our knowledge, this is the first study to assess and report the severity of illnesses associated with bathing in recreational waters contaminated with domestic sewage. Illness associated with bathing in marine waters contaminated with domestic sewage can no longer be viewed as minor, and indeed can have a substantial impact on the public health.
在1989年至1992年的夏季，我们在英国四个不同的沐浴场所进行了四项随机干预试验，这些场所根据美国环境保护局（USEPA）和欧盟现行标准判断水质合格。结果显示，与非沐浴者相比，沐浴者患肠胃炎、急性发热性呼吸道疾病（国际疾病分类第九版编码461 - 466、480）、耳部和眼部感染的风险增加。基于这些疾病本质上较轻因而对公共卫生意义存疑这一未经证实的假设，这些研究结果的公共卫生意义受到了质疑。
根据疾病持续时间、寻求医疗救治的参与者百分比以及报告特定疾病或不适的研究参与者正常日常活动丧失天数，评估这些疾病或不适的严重程度。此外，还计算了每种疾病或不适在暴露人群（沐浴者）中的归因比例。
根据报告的具体疾病，疾病的平均持续时间约为4天至约8天不等。寻求医疗救治的研究参与者百分比在4.2%至22.2%之间，而报告至少丧失一天正常日常活动的百分比在7.0%至25.9%之间，具体取决于所报告的疾病。可直接归因于接触受生活污水污染的海水的每种疾病的总体百分比，从肠胃炎的低34.5%到耳部感染的高65.8%不等。
据我们所知，这是第一项评估和报告与在受生活污水污染的休闲水域沐浴相关疾病严重程度的研究。与在受生活污水污染的海水中沐浴相关的疾病不能再被视为轻微疾病，实际上可能对公众健康产生重大影响。
