A Guest Post by Dr. John Fletemeyer, Aquatic Law and Drowning Prevention Specialist,
 and Depart Smart Safety Adviser 

There has been an alarming and dramatic increase in infectious diseases from swimming pools in the United States and abroad. An article I wrote for Aquatics International titled “Overseas Swimmers Beware! An aquatics expert studies overseas pools for adherence to U.S. safety guidelines” (February, 2015) demonstrates swimming pools abroad at popular hotel chains were substandard.


The article states in part:

Around the globe

To evaluate the seriousness of the problem, I conducted a three-year investigation evaluating 86 swimming pools in seven overseas countries and territories, including the U.S. Virgin Islands, Haiti, the Bahamas, Costa Rica, Thailand, Puerto Rico and Mexico. Due to logistical problems, the sample was reduced to 42 pools while lighting standards were evaluated. Nevertheless, the sample was large enough to reach some important conclusions about lighting.

The results of this study are summarized in the chart above. Every pool that was evaluated had at least one, if not several, safety issues that would represent a significant violation in the United States. In the majority of cases, these violations, if committed in the U.S., would force a pool closure until remedied. Of the 10 criteria comprising the focus of this study, only one — the inclusion of depth markers and “No Diving” signs — had a compliance rate exceeding half, and only minimally.The remaining eight safety features had a compliance rate significantly below 50 percent.”

Most swimming pools located primarily in developing countries seldom adhere to the same safety standards required by law in the United States. Consequently, swimming pools located abroad often have significantly higher accident and drowning rates.   Even pools located in foreign lands associated with large USA based hotel chains sometimes do not adhere to USA pool safety standards!

There are two reasons for the increase in pool infections; pool chemistry is not adequately maintained by the proprietor and certain strains of bacteria and viruses have developed a resistance to chlorine.  In response to chlorine resistance, many pools in the USA rely on alternatives such as an ultraviolet sterilizing system.  Because alternative systems are costly, pools located in developing countries seldom use these.

What is Cryptosporidiosis?

One of the most serious and common infections found in pools involves a parasite called, Cryptosporidiosis (Crypto for short. More commonly known as Giardia).  The US Centers for Disease Controls says, “Cryptosporidiosis is a diarrheal disease caused by microscopic parasites, Cryptosporidium, that can live in the intestine of humans and animals and is passed in the stool of an infected person or animal. Both the disease and the parasite are commonly known as “Crypto.” The parasite is protected by an outer shell that allows it to survive outside the body for long periods of time and makes it very resistant to chlorine-based disinfectants. During the past 2 decades, Crypto has become recognized as one of the most common causes of waterborne disease (recreational water and drinking water) in humans in the United States. The parasite is found in every region of the United States and throughout the world.”

Cryptosporidiosis Symptoms

When infected with the crypto parasite from a swimming pool, a bather will show symptoms 2-10 days after exposure such as nausea, diarrhea and fever. In extreme cases, stomach cramping, pain and vomiting also affect the individual.  In very severe cases, emergency room intervention is necessary as dehydration is a serious concern.

Treatment of Cryptosporidiosis

The Centers for Disease Control is an expert resource for standards of care.  CDC’s treatment recommendation for Crypto is, “Nitazoxanide,  an FDA-approved treatment of diarrhea caused by Cryptosporidium in people with healthy immune systems and is available by prescription. Consult with your health care provider for more information. Most people who have healthy immune systems will recover without treatment. Diarrhea can be managed by drinking plenty of fluids to prevent dehydration. Young children and pregnant women may be more susceptible to dehydration. Rapid loss of fluids from diarrhea may be especially life threatening to babies. Therefore, parents should talk to their health care provider about fluid replacement therapy options for infants. Anti-diarrheal medicine may help slow down diarrhea, but a health care provider should be consulted before such medicine is taken.

People who are in poor health or who have weakened immune systems are at higher risk for more severe and more prolonged illness. The effectiveness of nitazoxanide in immunosuppressed individuals is unclear. HIV-positive individuals who suspect they have Crypto should contact their health care provider. For persons with AIDS, anti-retroviral therapy that improves immune status will also decrease or eliminate symptoms of Crypto. However, even if symptoms disappear, cryptosporidiosis is often not curable and the symptoms may return if the immune status worsens.” (Bold and underscore emphasis by Depart Smart.)

Cryptosporidiosis (Giardia) Prevention


Avoiding crypto infections from swimming pools is intuitively simple—don’t swim in pools!   However, since this recommendation will most likely NOT be followed by most, the second most effective method is not to allow swimming pool water to enter your body, such as keeping your head above water.

Other less effective recommendations include,

  • Check to see that the water is crystal clear.  If water appears cloudy or green, don’t go swimming.
  • Consider wearing goggles or a face mask, ear plugs and a bathing cap.
  • Don’t go swimming unless you are certain that the pool and its chemistry is regularly maintained.  Ask the proprietor when the pool’s chemistry was last checked.   If more than 24 hours, don’t swim in the pool.
  • Don’t swim in pools where bathers can swim in clothing—clothing is a source of water contamination.
  • Think twice about swimming in pools where bathers are not required to shower first.
  • Don’t go swimming following a major rain event.  Rain water dilutes pool chemistry.

Finally, after leaving the pool, soap thoroughly and then rinse thoroughly in fresh water.

Crypto is highly contagious you should avoid contact with feces of infected individuals. The CDC advises extra precautions during intercourse.

Thank you, Dr. Fletemeyer, Depart Smart Safety Adviser.

Sheryl Hill, Depart Smart Founder, and her team of travel and tourism safety and security specialists and volunteers have devoted the past ten years to improve travel and tourism consumer protections and provide thoughtful tools and education to empower people, especially students and families, to Depart Smart for the world with an Action Plan.  You can get your Action Plan so you know how to identify and avoid threats, get help and home at TravelHEROES.org. Make Travel Safety a priority on your next worldwide adventure.