Derivation of numerical values for the World Health Organization guidelines for recreational waters

In April 2001, draft 'Guidelines' for safe recreational water environments were developed at a World Health Organization (WHO) expert consultation. Later the same month, these were presented and discussed at the 'Green Week' in Brussels alongside the on-going revision of the European Union Bathing Water Directive 76/160/EEC. The WHO Guidelines cover general aspects of recreational water management as well as define water quality criteria for various hazards. For faecal pollution, these include faecal indicator organism concentrations and an assessment of vulnerability to faecal contamination. Central to the approach set out in the WHO Guidelines are: (i) the concept of beach profiling to produce a 'sanitary inspection category' which implies a priori hazard assessment as a core management tool and (ii) the prediction of poor water quality to assist in real time risk assessment and public health protection. These management approaches reflect a harmonized approach towards the assessment and management of risk for water-related infectious disease being applied by WHO. Numerical microbiological criteria for intestinal enterococci are proposed in the new Guidelines. These were developed using a novel approach to disease burden assessment, which has been applied to both recreational waters and urban air quality. This paper explains the scientific rationale and mathematical basis of the new approach, which is not presented in the WHO Guidelines for recreational waters.