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In order to facilitate the setting of guidelines, this review article evaluates the health risks caused by poor microbiological quality of recreational natural water.

Studies on uncontrolled waters, such as sea, lakes and rivers were considered in this review through MEDLINE and WHO resources. Out of the 37 studies identified, 22 were reviewed because they addressed associations of interest and fulfilled the validity criteria.

Most studies reported a dose-related increase of health risk in swimmers with an increase in the indicator-bacteria count in recreational waters. Relative risk (RR) values for swimming in polluted water versus clean water were often significant (usually 1.0 < RR < 3.0). The indicator microorganisms that correlate best with health outcomes were enterococci/faecal streptococci for both marine and freshwater, and …