This RCT (secondary analysis of the Epibathe study) evaluated infectious disease risk from bathing in four Hungarian freshwater sites among 2,368 participants randomly assigned to either bathe for 10 minutes with ≥3 head immersions or remain on shore, with health outcomes assessed at one-week follow-up.
Higher *E. coli* concentrations were associated with increased gastrointestinal illness risk (adj. RR = 1.73; 95% CI 1.13–2.65), as were somatic coliphage concentrations (adj. RR = 1.46; 95% CI 1.04–2.04); bathing itself—independent of microbial indicators—was associated with increased skin ailment risk (adj. RR = 2.17; 95% CI 1.55–3.03).
- Low prevalence of eye, ear, and respiratory outcomes precluded reliable exposure-response estimation for those endpoints. - This is a secondary analysis of previously unpublished data, which may introduce selection or reporting constraints. - Findings are limited to four Hungarian freshwater sites, potentially limiting geographic generalizability.
In freshwater recreational settings, *E. coli* and somatic coliphage appear to be more informative indicators of gastrointestinal illness risk than enterococci—contrasting with marine water evidence—and should be prioritized in freshwater quality monitoring. Clinicians advising patients about recreational water safety should also note that bathing itself carries a skin ailment risk independent of measured microbial contamination.
Explore related topics
