Web-based investigation of water associated illness in marine bathers

Internet-based methods of disease investigation have proven useful for drinking water and foodborne illness but have not been applied to recreational water illness (RWI) in marine bathers. We analyzed responses to a web-based survey posted by Surfrider Foundation over the period 1996-2005. Subjects (n=1895) were recruited by self-selection via website visitation. Complaints were screened to meet inclusion criteria (n=1190). Demographic characteristics of respondents were assessed as well as the types and severity of their symptoms. Geographic information systems (GIS) were used to examine spatial patterns in survey data. Illness complaints were commonly received in summer from heavily used California beaches. A strong correlation was observed between water quality impairment and the number of illness complaints in coastal counties (r=0.96, p<0.01). Respondents most commonly complained of gastrointestinal symptoms, infections of the sinuses and other upper respiratory ailments. Certain severe symptoms, such as high fevers, severe vomiting and/or diarrhea, seizures, swollen glands, and infections that did not heal properly were also reported. Approximately one-third of respondents sought the care of a physician for their symptoms; however, less than 1% reported being hospitalized. Our findings concerning the nature of the described symptoms as well as the observed seasonal and spatial patterns in the data are consistent with previously published findings of RWI in ocean bathers exposed to sewage and urban runoff. This method of rapid RWI data collection over the web could easily be adopted by health agencies for coordinated disease surveillance.