Report: Swimming-Related Disease Outbreaks Linked to Hotel Pools

Healthcare professionals can play an important role in educating patients regarding healthy swim habits, and disease outbreak prevention strategies.

A recent CDC report demonstrates that many swimming-related disease outbreaks occur at hotel pools or hot tubs.1,2Healthcare professionals can play an important role in educating patients regarding healthy swim habits, and outbreak prevention strategies.

There have been 493 outbreaks associated with treated recreational water during 2000-2014, which caused at least 27,219 illnesses, and 8 deaths.2Outbreaks associated with pools and hot tubs are determined when similar illnesses occur in 2 or more individuals linked to the same location and time of exposure to pathogens or chemicals. Hotels were found to be the leading setting, associated with 157 (32%) of the outbreaks. About 50% of the outbreaks occurred June-August, the peak swimming season.2

The most common infectious cause (58%) of the outbreaks in pools, hot tubs, and water playgrounds wasCryptosporidium, which causes gastrointestinal adverse effects including diarrhea.2Cryptosporidiumsymptoms usually occur around 7 days after becoming infected, and generally include the following:

  • Watery diarrhea
  • Stomach pain
  • Dehydration
  • Nausea
  • Vomiting
  • Fever
  • Weight loss

Educate patients to manage the diarrhea by drinking plenty of fluids to prevent dehydration. Oral rehydration solutions, such as Pedialyte® for infants and children, and Gatorade for adults, should be used to replenish electrolytes lost through diarrhea. Alinia (nitazoxanide) is FDA approved for the treatment of diarrhea caused byCryptosporidium.3Individuals with severe dehydration may need to be hospitalized and receive intravenous fluids.

Prevention is key to reduce the risk of pool-related outbreaks. Healthcare professionals can encourage parents to follow prevention strategies that include not swimming with diarrhea, checking teh pool inspection scores, and avoid swallowing water.1

Additional prevention strategies, and more information about cryptosporidiumoutbreaks can be found


  1. Centers for Disease Control and Prevention. 1 in 3 swimming-related disease outbreaks occur at Accessed May 18, 2018.
  2. Hlavsa MC, Cikesh BL, Roberts VA, et al. Outbreaks Associated with Treated Recreational Water-United States, 2000-2014.MMWR Morb Mortal Wkly Rep2018;67:547-551.DOI:
  3. Centers for Disease Control and Prevention. Parasites-Cryptosporidium. Accessed May 18, 2018.

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