National Institute for Public Health and the Environment

Dr Sabine Dittrich(1,2), Dr Marion Koopmans (1), Dr Ana Maria de Roda Husman (1) 1 Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), The Netherlands 2 European Public Health Microbiology Training Program (EPIET/EUPHEM), European Centre for Disease Prevention and Control (ECDC), Sweden Questions and suggestions are welcome: sabine.dittrich@rivm.nl

Health risk assessment of exposure to geese droppings in recreational waters in The Netherlands
Background
Advice was sought from the RIVM by the Ministries of Agriculture and Health to assess the possible health risk from exposure to goose droppings in recreational areas in the Netherlands. A qualitative assessment of the health risk from exposure to goose droppings in recreational water was done in order to assist the MoH in further policy decisions. This approach was chosen since not enough accurate information are available for the Netherlands which would allow quantative estimations and modeling. Data on all aspects of the contamination chain (geese droppings recreational water public/swimmer) were collected and data gaps identied.

Method
Scientific literature (Pubmed) was screened for existing data on migration pattern, excreta and existing water pollution data. Literature was included after assessing the relevance of the article (abstract) in respect to the study question. Various combinations of keywords were used: Geese/goose/waterfowls/birds, droppings/feces/fecal contamination, cryptosporidium/giradia/ avian inuenza/contamination/pathogens. All relevant scientic publications before April 2009 were included. Local experts on geese in the Netherlands were questioned on Dutch migration patterns. Specific information on geese numbers, fecal contamination in the Netherlands were obtained by using Dutch keywords like keutel, ganzen, nederlands on google.

Results
Geese Droppings Recreational water Public

Geese in the Netherlands

Wintering geese (Sep-Feb): 2 million/year on agricultural land Breading geese (March-June): ~155000 / year by lakes/sea Flock sizes: 10-10000 birds Breading geese main source of concern

Pathogen (prevalence)
C. parvum (81.8 - 90%) Giardia sp. (not available) E. hellem (8.8%) Campylobacter jejuni (50.2%) Salmonella spp. (0.8%) Fecal coliform bacteria (100%) Avian inuenza Virus (1.8%; 0% highly pathogenic)

Routes of contamination
Two routes of contamination: 1) Indirect contamination by fecal runoff from agricultural land into canals/ recreational sites 2) Direct contamination by defecation into the water

Infective dose (as available)

C. parvum Giardia sp. Campylobacter jejuni 8 - 1000 cysts 10 oocysts 8*102 bacteria

Exposure of swimmers (water intake)

Children: 37 ml per swim (in pools) Adult: 16 ml per swim (in pools) (occupational diver) 5.7 ml-13 ml per dive

Fecal Burdon
Amount: ~170 fecal pellets/geese/day Dropping size: 0.42 g 25.4 g/dropping

Survival time at 15-20C in fresh water

C. parvum Giardia sp. E. hellem min. Campylobacter jejuni Avian Inuenza Virus 3 - 12 months max. 2 months 6 months 30 min. (in sunlight) 4 days

Health consequences of pathogens

Gastroenteritis Respiratory disease/Conjunctivities (AIV)

Fecal coliform bacteria 12 - 30 days

Dutch water quality

All recreational waters comply with EU regulations ( tests for fecal contamination)

SUMMARY of literature data

Large numbers of geese large fecal burden Breeding geese might be main source of contamination. Large numbers of pathogens present (data not shown) Long survival time of pathogens Fecal contamination was linked to geese by molecular source tracking

Recommendation
Large numbers of geese at a specic bathing site have the potential to be a public health threat. No such risk can be scientically proven with the data available for the Netherlands. No outbreaks of gastroenteritis have so far been linked to contaminations through geese anywhere in the world making the risk theoretical until otherwise proven. However, even if lakes with high geese numbers result in higher contamination, proof of an association is very difficult. It is recommended to monitor specic risk sites closely and perform a bathing water prole as described by the EU water directive (2006/7/EC). In addition a detailed evidence based Quantitative Microbial Risk Assessment is recommended including laboratory studies of pathogen load and survival time in Dutch climate. This would lead to a model taking run-off scenarios, varying amount of geese, meteorological data, dilution factors and temperature changes into account and could lead to a tool to help take decisions on possibly redening recreational water sites.

MISSING data to perform detailed quantitative microbial risk assessment:

091168 LIS-VIR FvdB

Detailed maps of geese numbers at specific sites no calculation using specic dilution factor possible. No data on long-lasting pathogens like Giardia sp. available for Dutch water sites. Detailed data on feces produced by geese in the Dutch delta are not available and available data are not consistent enough.

RIVM National Institute for Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, the Netherlands, www.rivm.com