Pathogens and risk factors associated with freshwater-exposure outbreaks: A systematic review

Julii Brainard; Grace Bernard; Ben W Rowland; Theodora Commandeur; Edward K. Lam; Vasilia Thompson; Isabel C. Swindells; Nicola Love; Roberto Vivancos; Valerie Decraene; K. Marie McIntyre; Gavin Stewart; Paul R. Hunter

Pathogens and risk factors associated with freshwater-exposure outbreaks: A systematic review

Julii Brainard
, Grace Bernard
, Ben W Rowland
, Theodora Commandeur
, Edward K. Lam
, Vasilia Thompson
, Isabel C. Swindells
, Nicola Love
, Roberto Vivancos
, Valerie Decraene
, K. Marie McIntyre
, Gavin Stewart
, Paul R. Hunter

Research output: Contribution to conference › Poster

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Abstract

Context: There is widespread concern about microbiological hazards in freshwater bodies, especially when accessed for recreational bathing.
Research Objective : Identify and characterise disease outbreaks linked to contact with outdoor freshwater bodies, using scientific reports, grey literature and government datasets.

Design: Systematic review with descriptive summary and frequency counts. Focus on gastrointestinal (GI) illness in humans.

Results: 406 unique outbreaks documented in 80 sources.

Pathogens: Viruses, bacteria or protozoa. Six pathogens (on chart) were linked to 71% of the 406 outbreaks.The most consistent risk factor evidence was: Risk of GI illness was often higher after facial contact with lake/river water, especially if water entered the mouth.

Information gaps : Most potential risk factors for GI illness were only considered in a single study, and there was often missing information about whether commonly collected attributes such as age or gender could be associated with risk of illness.

Original language	English
Publication status	Published - 8 Sept 2026

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Cite this

@conference{13123294e634484ca080a396c87aa4a8,

title = "Pathogens and risk factors associated with freshwater-exposure outbreaks: A systematic review",

abstract = "Context: There is widespread concern about microbiological hazards in freshwater bodies, especially when accessed for recreational bathing. Research Objective : Identify and characterise disease outbreaks linked to contact with outdoor freshwater bodies, using scientific reports, grey literature and government datasets. Design: Systematic review with descriptive summary and frequency counts. Focus on gastrointestinal (GI) illness in humans. Results: 406 unique outbreaks documented in 80 sources. Pathogens: Viruses, bacteria or protozoa. Six pathogens (on chart) were linked to 71\% of the 406 outbreaks.The most consistent risk factor evidence was: Risk of GI illness was often higher after facial contact with lake/river water, especially if water entered the mouth. Information gaps : Most potential risk factors for GI illness were only considered in a single study, and there was often missing information about whether commonly collected attributes such as age or gender could be associated with risk of illness.",

author = "Julii Brainard and Grace Bernard and Rowland, \{Ben W\} and Theodora Commandeur and Lam, \{Edward K.\} and Vasilia Thompson and Swindells, \{Isabel C.\} and Nicola Love and Roberto Vivancos and Valerie Decraene and McIntyre, \{K. Marie\} and Gavin Stewart and Hunter, \{Paul R.\}",

year = "2026",

month = sep,

day = "8",

language = "English",

}

TY - CONF

T1 - Pathogens and risk factors associated with freshwater-exposure outbreaks: A systematic review

AU - Brainard, Julii

AU - Bernard, Grace

AU - Rowland, Ben W

AU - Commandeur, Theodora

AU - Lam, Edward K.

AU - Thompson, Vasilia

AU - Swindells, Isabel C.

AU - Love, Nicola

AU - Vivancos, Roberto

AU - Decraene, Valerie

AU - McIntyre, K. Marie

AU - Stewart, Gavin

AU - Hunter, Paul R.

PY - 2026/9/8

Y1 - 2026/9/8

N2 - Context: There is widespread concern about microbiological hazards in freshwater bodies, especially when accessed for recreational bathing. Research Objective : Identify and characterise disease outbreaks linked to contact with outdoor freshwater bodies, using scientific reports, grey literature and government datasets. Design: Systematic review with descriptive summary and frequency counts. Focus on gastrointestinal (GI) illness in humans. Results: 406 unique outbreaks documented in 80 sources. Pathogens: Viruses, bacteria or protozoa. Six pathogens (on chart) were linked to 71% of the 406 outbreaks.The most consistent risk factor evidence was: Risk of GI illness was often higher after facial contact with lake/river water, especially if water entered the mouth. Information gaps : Most potential risk factors for GI illness were only considered in a single study, and there was often missing information about whether commonly collected attributes such as age or gender could be associated with risk of illness.

AB - Context: There is widespread concern about microbiological hazards in freshwater bodies, especially when accessed for recreational bathing. Research Objective : Identify and characterise disease outbreaks linked to contact with outdoor freshwater bodies, using scientific reports, grey literature and government datasets. Design: Systematic review with descriptive summary and frequency counts. Focus on gastrointestinal (GI) illness in humans. Results: 406 unique outbreaks documented in 80 sources. Pathogens: Viruses, bacteria or protozoa. Six pathogens (on chart) were linked to 71% of the 406 outbreaks.The most consistent risk factor evidence was: Risk of GI illness was often higher after facial contact with lake/river water, especially if water entered the mouth. Information gaps : Most potential risk factors for GI illness were only considered in a single study, and there was often missing information about whether commonly collected attributes such as age or gender could be associated with risk of illness.

M3 - Poster

ER -