Sand pathogens and their Sand pathogens and their indicators on coastal and inland indicators on coastal and inland

designated beachesdesignated beaches

João Brandão João Brandão

(Project manager)(Project manager)

A centennial public health institute (1899-2009)A State Laboratory (R&D, reference, health observatory)Committed to Public Health gainsNational bioterrorism and outbreak surveillance

institution

What is INSAWhat is INSA

• 22 years of activity

•Increase from 37 to 220 awarded beaches since 1987 till today

•Currently 40% of designated beaches of all of Portugal (550) are currently awarded

•Program runs on a voluntary basis financed mainly by municipalities but also by private sponsors

Blue Flag PortugalBlue Flag Portugal

1989 - Mycology group of INSA look into fungi in sand (joint study with Portuguese National Directorate of Health).

For 10 years, several beach sands were screened for fungi, following different approaches.

PastPast

Pityriasis versicolorPityriasis versicolorby by Malassezia furfurMalassezia furfur

Examples of fungal infections “easily” passed Examples of fungal infections “easily” passed on to non-immunocompromised individuals on to non-immunocompromised individuals

by sandby sand

• “From a recreational viewpoint, sand beaches are sought after. Especially in higher latitudes, a significant percentage of time is spent on the beach itself rather than in the water.”

•“A number of genera and species that may be encountered through contact with sand are potential pathogens. Accordingly concerns has been expressed that beach sand may act as reservoir of vectors of infection.”

World Health Organization, 2003, in World Health Organization, 2003, in “Guidelines for safe recreational “Guidelines for safe recreational

water environments”, p118.water environments”, p118.

Population with increased risk without specific Population with increased risk without specific disordersdisorders

Children

Elderly

Pregnant women

Actual beach on the south coast of Actual beach on the south coast of Lisbon during a misty day in the Lisbon during a misty day in the

SummerSummer

Where do you find most people (Please don’t try and find Wally!)

•Risk Assessment

•Surrounding environment – identification of possible pollution sources

•Tighter limits and overview of a sequence of results

•Adjusted limits and parameters for fresh and sea bathing waters

New European Bathing Water Directive New European Bathing Water Directive (2006/7/EC)(2006/7/EC)

““Microbiologic Quality of Coastal Beach Microbiologic Quality of Coastal Beach Sands”Sands”

2000-2002: by invitation of the Portuguese Blue Flag a project with several institutions took place, aiming to structure beach sand quality

parameters and associated methods

Portuguese Blue Flag Association, The National Institute of

Health Dr. Ricardo Jorge (INSA), The General Directorate of

Health (DGS), The Environmental Institute (IA), The Water

Institute (INAG), The City Hall of Cascais, The City Hall of

Viana do Castelo

210 sand samples

105 water samples

210 sand samples

105 water samples

3 beaches per region:

1 Beach awarded with the Blue Flag

1 Beach with no direct human interference

1 Beach with documented poor water quality

3 beaches per region:

1 Beach awarded with the Blue Flag

1 Beach with no direct human interference

1 Beach with documented poor water quality

5 Regions – Bimonthly sampling during 13 months

5 Regions – Bimonthly sampling during 13 months

Dry Sand

Wet Sand

Water front

Sterile sampling bag and glovesSterile sampling bag and gloves

Transport in cold and analysis within 24 hours of sampling

• Yeasts - Faecal contamination indicators (genuses Candida, Cryptococcus, Saccharomyces and Rhodotorula),

• Alergogenic and (potential) pathogens (genuses Aspergillus, Fusarium, Scopulariopsis, Scedosporium, Chrysosporium, Scytalidium, Histoplasma, Coccidioides, Exophiala, Fonsecae, Phialophora, and other moulds of clinical significance (the later when present as dominating species in significant counts (> 500 cfu/g)).

• Dermatophytes - Indicators of animal presence, including humans (genuses Microsporum, Epidermophyton and Trichophyton)

Mycological parameters for sand quality Mycological parameters for sand quality assessmentassessment

Bacterial parameters for sand quality Bacterial parameters for sand quality assessmentassessment

• Coliform bacteria

• Escherichia coli

• Intestinal enterococci

Bacteriologic Parameters (chosen from the original):MRV**

1. Total coliforms 100 cfu/g2. E. coli 20 cfu/g3. Enterococci 20 cfu/g

Mycologic Parameters:MRV**

1. Yeasts 60 cfu/g2. Potential pathogenic moulds (filamentous fungi) 85 cfu/g3. Dermatophytes 15 cfu/g

*Acredited by ISO 17025 (certificate L4025)**Maximum Recommended Value

Values of the parameters for sand quality Values of the parameters for sand quality assessment*assessment*

Sand quality organizationSand quality organization

Municipalities

Transport of samples

Laboratories

2006 – 66 beaches

2007 – 72 beaches

2008 – 90 beaches

Continental Portugal: Continental Portugal: sand monitorization during 2006-2008sand monitorization during 2006-2008

Participation in the blue flag sand Participation in the blue flag sand monitoring program of 2008monitoring program of 2008

Amostra 1

Amostra 2

Amostra 3

33%

17%

43%

17%

13%

27%

7% 10%

3%0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Região Algarve - 30 Praias

>VMA %

>VMR %

>NVMR %

Amostra 1

Amostra 2

Amostra 3

49%

23%23%

37%

23%

20%20%

3% 6%0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Região Algarve - 35 Praias

>VMA %

>VMR %

>NVMR %

The beaches were monitored for the first time in 2006. Since then, the beach managers were instructed on how to control contaminant levels and the result is the dramatic reduction of contaminant levels from the first sampling (pre-bathing

season) to the following two (within bathing season)

Algarve 2006 x 2008Algarve 2006 x 2008

Factors that positively influence the Factors that positively influence the quality of beach sandquality of beach sand

•GarbageGarbage - - Frequent removal of litter and garbage from sand and neighbouring Frequent removal of litter and garbage from sand and neighbouring areas;areas;

•Garbage recipientsGarbage recipients - Number of garbage recipients appropriate for the length Number of garbage recipients appropriate for the length of the beach;of the beach;

•Sand treatmentSand treatment - based on experience of one region with weekly iodine - based on experience of one region with weekly iodine spraying;spraying;

•SurroundingsSurroundings - Identification and treatment of neighbouring contaminated areas - Identification and treatment of neighbouring contaminated areas

Factors that negatively influence the Factors that negatively influence the quality of beach sandquality of beach sand

•Over-use of beachOver-use of beach

•Admission of petsAdmission of pets

•Accumulation of garbage Accumulation of garbage

•Abandonment of remains from fishingAbandonment of remains from fishing

•Rodents and prowling animalsRodents and prowling animals

CurrentlyCurrently•We currently provide this service to the community and the demand has been growing every year (currently over 100/bathing season, including blue flag program)

•The Blue Flag is contemplating insertion of the sand quality within the awarding criteria

•We’re extending internationally in order to gather information and compare experiences on other climates and regions, namely within Europe, America and Mediterranean coasts.

•We’re going molecular detection in Portugal to try and set up high put-through and low cost of sand analysis

2008-2010 - Molecular approach 2008-2010 - Molecular approach

and Pathogensand Pathogens

•Other countries are participating on a consortium basis, with local funding, namely UK, Hong Kong and Spain

•Specific pathogens and molecular means of identification of those and of the current indicators are under study

•Details on pathogens will be handed out at the end of the workshop

List of technical people currently List of technical people currently involved in sand analysisinvolved in sand analysis

Mycology Laboratory (INSA) :

Laura Rosado (head of the lab)Cristina VeríssimoRaquel SabinoJoão BrandãoCelia AlvesHelena Parada

Water Microbiology Laboratory (INSA):

Leonor Falcão (head of the lab)Manuela BarrosoCecília SilvaRaquel Rodrigues

Microbiology Laboratory (Portuguese Environmental Agency):

Isabel Moura (head of the lab)Maria Ana CunhaBela WergiskowskiCarmen RosadoGraça Noronha

Questions?Questions?

Image of a beach in AlgarveImage of a beach in Algarve