MINNESOTA DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH
Summer 2008
Volume 2, Issue 3
PWDU Quarterly Update
Partnership and Workforce Development Unit
The Recreational Water Issue
ABOUT THIS ISSUE:
Our work demands that we consider water in the contexts of
handwashing, foodborne illness
and outbreaks, restaurant and food
cleanliness, our response to
flooding and planning for other
emergencies … and all the myriad
other ways that water, lack of it, too
much of it, and water quality affect
our working and personal lives.
Consulting on, preparing for, and
responding to the new pool legislation has been a major item on the
Minnesota Department of Health
agenda for many months.
Now, we in Environmental Health
Services, and staff in all the other
pool regulatory programs are working with pool owners to ensure that
we all do what we must to comply
with the Abigail Taylor Pool
Safety Act, and to prevent further
injuries and deaths from unsafe
pool conditions.
This issue focuses on the new pool
safety act. It also includes articles
on Cryptosporidiosis, beach closure, EHS-Net water-related activities, and other recreational water
issues of concern or interest to our
environmental health community.
Abigail Taylor Pool Safety Act
The Abigail Taylor Pool Safety Act
was signed by Governor Pawlenty
on May 16, 2008.
information more quickly and easily,
the department has created an
online survey at:
This new pool safety act, requiring
licensure and inspection of all
public pools in the state, expands
the definition of public pools to
include those pools and spas
connected with apartment buildings,
homeowners’ associations, and
townhomes, (some) fitness centers
and more.
http://www.health.state.mn.us/divs/eh/
pools/forms.html.
The act was named in honor of
six-year-old Abigail Taylor, who
died as a result of injuries from a
wading pool drain accident in 2007.
The new law also requires pool
owners to make immediate and
future changes to public pools to
ensure the safety of pool users
(see the “Important Dates” article
on the next page for more information on the required changes).
One of these requirements asks
public pool owners to provide
information to the Minnesota
Department of Health (MDH) by
July 1, 2008 about their pools and
the drain covers in their pools, in
order to renew or receive a license
to operate. The drain covers must
meet industry standards, be
properly installed, and must not be
broken or loose.
To help pool owners provide this
Pool owners who do not have
internet access, or who would prefer
to complete a paper version of the
survey may call the MDH St. Cloud
District Office at: 320-223-7300 to
request a paper version of the
survey, or to seek assistance with
completing the survey.
In This Issue
Overview-Abigail Taylor Act
1
Important Pool Dates
2
Pool Questions and Answers
3
Pool Licensing and Plan Review
4-5
Beach Testing, and Advisories
6
EHS-Net Water Activities
MDH Swim Safe Press Release
7
Crypto Graphics
8
Bug of the Quarter: Crypto
9
CDC Pool Guidance / Germ
City / Six Pleas for Swimming
10
EHKMP Update
11
PWDU Staff Contact Information
Page 2
PWDU Quarterly Update
Pool Act Dates To Remember
IMPORTANT DATES RELATED
TO THE ABIGAIL TAYLOR POOL
SAFETY ACT
January 1, 2008: Swim ponds in
existence prior to this date are not
considered public pools and are
therefore exempt from Minnesota
Rules, chapter 4717.
However, they must still certify to
the commissioner annually (and by
July 1, 2008) that drain covers—
except for unblockable drains—
have been stamped by the manufacturer that they are in compliance
with ASME/ANSI standards and
that all covers, grates and mounting
rings have been inspected to
ensure they have been properly
installed and are not broken or
loose. AND they must meet the
requirements for dual drains, gravity
systems or unblockable drains.
May 17, 2008: Public pool operators are required to conduct daily
(or every day the pool is open for
use) physical inspections of the
drain covers/grates. These physical
inspections must be documented
on the pool log. If the cover is
loose, broken, or missing, the pool
must be closed immediately.
May 17, 2008: All public pools in
Minnesota are subject to licensure
and inspection.
June 1, 2008: All drain covers and
grates in public pools must be
installed with screws that meet the
manufacturer’s specifications.
July 1, 2008: And annually thereafter, all public pool owners must
certify to the commissioner that all
outlets, except for unblockable
drains, are equipped with covers
that have been stamped by the
manufacturer that they are in
compliance with ASME/ANSI
standards, AND that all covers,
grates and mounting rings have
been inspected to ensure they have
been properly installed and are not
broken or loose. This includes
owners of swim ponds.
Owners who do not submit the
survey will not be issued a renewal
license until the information is
submitted.
January 1, 2009: All public pool
construction plans submitted for
review must be certified by an
engineer registered in the state of
Minnesota.
January 1, 2009: All public pools
constructed after this date: each
pump must be connected to at least
two suction outlets, connected in
parallel with suction cover outlets
that meet current ASME/ANSI
standards (unless the pool is
constructed with a gravity outlet or
drain).
January 1, 2009: All public pools
four feet deep and less must have
an unblockable drain, OR at least
two suction outlets, connected in
parallel with covers that meet
current ASME/ANSI standards, OR
have a gravity outlet/drain.
January 2, 2009: Public pools four
feet deep or less that have not
made the necessary modifications
will be subject to closure.
January 15, 2009: MDH must
report to the Legislature: the
number of licensed pools in the
state, the type of ownership of
licensed pools, the type of drains in
licensed pools, the number of pools
that require modification to meet the
act, the estimated economic impact
and costs of meeting the act.
December 15, 2010: By this date,
MDH must have convened a group
of stakeholders to address the
exception for swim ponds and
made recommendations to the
Legislature.
January 1, 2011: All public pools
greater than four feet deep must
have an unblockable drain, OR at
least two suction outlets, connected
in parallel with covers that meet
current ASME/ANSI standards, OR
have a gravity outlet/drain, or
another system approved by the
commissioner that is equally
effective or better than the systems
listed in this paragraph.
January 2, 2011: Public pools
greater than four feet deep that
have not made the necessary
modifications will be subject to
closure.
June 30, 2011: The swim pond exception expires.
NOTE:
MDH has
received
numerous calls
regarding these
dates. It has been
helpful to point out that changes
prior to January 1, 2009 pertain to
existing equipment. Specifically,
existing drain covers, grates and
mounting rings were required to
be properly installed and
inspected by June 1, 2008. New
equipment and necessary
reconstruction must be in place by
January 1, 2009 for pools less than
4 feet deep, and by January 1, 2011
for deeper pools.
Page 3
PWDU Quarterly Update
Questions and Answers Regarding the New Pool Law
Question: Is there an MDH position on pools that do not provide
the proper response by July 1? Is
closure mandatory?
ANSWER: No, closure is not
mandatory. Our goal is to gain
compliance. We will not close pools
because the form wasn’t submitted
by July 1, 2008. However, previously unlicensed pools that do not
submit the survey will not receive a
license, and currently licensed
pools that do not submit the survey
will not have their licensed renewed
in 2009 until they complete the
survey.
Question: The Act says that by
June 1, 2008 all drain covers and
grates must be installed with
screws that meet the manufacturer’s specifications. Will pools
be closed on June 2, 2008 if they
don’t have screws meeting the
manufacturer’s specs?
ANSWER: Yes. If upon routine inspection, pools are found to have
improper screws, the pool must be
closed until the proper screws or a
new cover/mounting ring are installed according to manufacturer’s
specifications..
Question: If on January 2, 2009, I
find a pool four feet deep or less
without an acceptable drain
system, do I have to close the
pool immediately?
ANSWER: Yes
Question: Will pools require plan
review if they need to cut in a
second drain? If yes, what
should we do if we inspect a pool
and find that they’ve made
changes without plan review?
ANSWER: Yes, pools will need plan
review for drain modifications (Note:
replacing the drain cover and
mounting ring ONLY do not require
plan review). Plan review fees are
$400 per pool. If pools are found to
have made modifications (i.e.,
added a second drain) without obtaining plan review first, enforcement will be handled on a case-bycase basis.
Question: Can the operators drill
new holes in the existing mounting ring and attach a new
approved cover to the existing
ring?
ANSWER: Covers must be installed
according to the manufacturer’s
requirement - the only way to know
if you can drill new holes is to check
the manufacturer’s specifications.
Question: What actions are required by pool owners, in order
to meet the July 1, 2008 deadline? Are pool owners required to
have drain covers installed which
meet the ASME/ANSI standard,
or simply complete the MDH
survey?
ANSWER: Pool operators are
required to have properly installed
drain covers that meet the
ASME/ANSI standard, and they
must complete the survey by July 1,
2008. Pools have always been
required to have properly installed
drain covers meeting the ASME/
ANSI standard. The new law simply
clarifies this requirement. Proper
installation is done by installing the
cover according to the manufacturer’s requirements. Enforcement or
penalties for not completing the
survey on time will be assessed only
after attempts at reasonable and
voluntary compliance have failed.
Question: Owners of seasonal
pools are requesting that they be
allowed to wait until the end of
their operating season (fall) to
comply.
ANSWER: All public pools in
Minnesota must comply with the
Abigail Taylor Pool Safety Act,
including compliance dates stated in
the act. Enforcement for pools that
fail to comply will be handled on a
case-by-case basis.
Question: Do therapy pools need
to be licensed and meet the
requirements of the Act?
ANSWER: Yes. MDH and local
jurisdictions should license and
inspect therapy pools to ensure they
are meeting the provisions in
Chapter 4717 and the Abigail Taylor
Pool Safety Act.
Question: Youth Camps are currently exempt from paying fees for
FBL – will they now need to pay
licensing fees for their pools?
ANSWER: Yes. In addition to
licensing fees, they will also be
required to pay plan review fees if
plans are submitted.
For more information, see:
http://www.health.state.mn.us/divs/eh/
pools/index.html
Page 4
PWDU Quarterly Update
Licensing and Plan Review for Pools
By Mike Nordos, PWDU Staff
Is your pool a pool and does it
need to be licensed?
This has been a hot topic lately.
Minnesota Rules, Chapter 4717
define a pool as, “any structure,
chamber, or tank containing an
artificial body of water for swimming, diving, relaxation, or
recreational use including special
purpose pools and wading
pools.”
All public pools in Minnesota
must be licensed beginning
January 1, 2009. This is a new
requirement of the Abigail Taylor
Pool Safety Act. Previously, only
public pools associated with another licensed facility, such as
lodging or food establishments,
were required to be licensed.
Is your pool public or private?
Most of us think of a private pool
as the pool in our backyard, and
in most cases this is accurate. A
more detailed description of a
private pool, as found in Minnesota Rule, would be a pool that is
connected with a single-family
residence or owner-occupied
duplex. It must be located on
private property, and be under
the control of the homeowner.
The use of the pool must be
limited to family members or the
family's invited guests.
A pool that is associated in any
way with a business is not a
private pool. If a pool meets the
requirements of a private pool,
the State does not require it to
be licensed. However, a local
authority may have additional
requirements for pool construction, inspection, and operation.
Local city building officials may
also regulate the construction of
a "Private Residential Pool."
A public pool is any pool, other
than a private residential pool,
intended to be used collectively
by numerous people, and operated by any person, whether the
person be an owner, lessee,
operator, or concessionaire, and
regardless of whether a fee for
use is charged.
Public pools include, but are not
limited to pools operated in a
park, school, licensed child care
facility, group home, motel,
camp, resort, apartment building,
club, condominium, hotel, manufactured home park, or political
subdivision.
All public pools in Minnesota are
required to be licensed on a
yearly basis.
approved by the commissioner.
Once a plan is approved, no modifications or alterations affecting
the safety and sanitation features
of the public pool can be made
without prior approval.
Since the passage of the Abigail
Taylor Pool Safety Act, many pool
operators have asked whether the
addition of a second drain would
require a plan. The answer is,
“Yes.”
Cutting in a second drain or
making any major changes to the
plumbing does require approval
from the commissioner. Some
other examples of alterations that
would require plan review and
pre-approval are:
•
Addition of Second Main Drain
•
•
•
Filter Replacement
•
Fiberglass Spa Pool Shell Replacement. Considered a new
pool; existing equipment may
be re-used, if code compliant.
•
Addition of Slides or Play Features
•
Re-Piping of Recirculation
System
•
PVC Repair Coating of Failed
Pool Shells
•
Disinfection System Change.
Plan Review is required;
however inspections are not
usually required provided that
When is plan review required?
The construction of any public
pool requires submittal and
approval of plans and specifications. The Minnesota Department
of Health provides plan review
and construction inspection for
all public pools within the state.
No public pool can be constructed, installed, or materially
altered until complete plans and
specifications are submitted and
Gutter System Replacement
Concrete Pool Shell: remove
and replace, or filling in the
deep end. This is considered a
new pool; existing equipment
can be re-used, if it is codecompliant.
Page 5
PWDU Quarterly Update
Pool Plan Review, continued
water quality standards are
met.
Does all pool work require plan
review?
Not all work performed on a pool
requires plan review. General maintenance, as long as work is done
within code requirements, does not
need to be approved.
Replacing a non-approved drain
cover with an approved cover or
installing a main drain antientrapment cover plate over the
main drain does not require prior
approval.
A vacuum limits switch does not
meet the safety requirements of the
new pool legislation. However if an
operator wishes to install such a
system as an extra safety precaution, no prior approval is required.
Some pool operators have been
asking MDH and local staff if they
would meet the new safety requirements by installing a grate over the
top of the main drain. Though it appears that this would meet the requirements of the new legislation it
may create other safety risks and is
not being recommended at this
time.
Examples of maintenance work that
does not require plan review are:
•
Painting of pool shell: Must be
white or light- colored, no logos
or patterns allowed.
•
Fencing repair or replacement:
Check local ordinances, and
see:
www.revisor.leg.state.mn.us/
arule/4717/1550.html.
•
Pump or motor replacement.
Must meet the National Sanitation Foundation’s NSF-50
requirements. See: www.nsf.org
for more information.
•
Pool heater replacement:
May require local mechanical
permitting.
•
Ventilation System replacement
or upgrade
•
Lighting System replacement or
upgrade: See:
www.revisor.leg.state.mn.us/
arule/4717/3450.html
•
•
•
Piping Leak Repair
Skimmer Replacement
Filter Sand Replacement: Filter
Sand must meet the requirements of: Minnesota Rules,
Chapter 4717.2850. The use of
other filter media is prohibited.
Are there any requirements for
abandoning a pool?
The Minnesota Department of
Health does not have any regulations or guidelines on pool abandonment. If a pool owner wishes to
permanently close a pool they need
to check with their local health and
building officials.
[For more info, see: http://
www.health.state.mn.us/divs/eh/
pools/index.html]
The following materials must
be included with a pool plan
review submittal to MDH:
Site Plan – A scaled drawing
showing facility and deck
dimensions, fencing, access,
security, showers, and mechanical room locations.
Pool Plan – Pool volume,
surface area, and design flow
rate. Scaled drawings showing
top and profile views, including
dimensions and all equipment
such as skimmers, gutters,
inlets, drains, lights, diving
boards, slides, ladders, steps,
and handrails.
Recirculation Plan – Must
show all pipe sizing, valves,
flow meters, equipment
connections, and pool fill
method.
Deck and Mechanical Room
Plan – Must show drains,
sumps, deck slopes, air gaps,
and backflow prevention
devices.
Equipment Specifications –
Make, model number, maximum capacity, and NSF-50
approval of all pumps, filters,
and disinfection feeders. Safety
equipment,
signs, vacuums,
and water
quality test kit.
Page 6
PWDU Quarterly Update
Beaches: Testing, Advisories, Advice
BEACH TESTING
Few of Minnesota’s beaches are
monitored regularly. State law does
not require regular testing of swimming beaches; however some
jurisdictions choose to do so.
The largest Minnesota program is
the Minnesota Pollution Control
Agency (MPCA) Lake Superior
Beach Monitoring Program
currently monitoring 40 Lake
Superior beaches. MPCA maintains
a “Beaches” website with links to
each of the Lake Superior beaches.
Listed on the page for each beach
are: water quality and temperature;
the most recent sampling data; the
agency doing the sampling; a local
forecast; beach amenities; and a
link to historical data.
The website, found at:
www.mnbeaches.org, also has links
to other Minnesota beach monitoring program websites—most in the
metro area. MPCA plans eventually
to include all beach advisories and
closures on the Beaches website.
for determining advisories. The proposed state standards for recreational waters are 1260 CFU/100 mL
and 126 CFU/100 mL, respectively.
MPCA and MDH advice for use
of beaches that are not
monitored regularly:
•
Avoid swimming the day after
a heavy rain. When wind disturbs the water, illnesscausing bacteria can be
flushed out of the sediment.
Rain may also wash goose
poop (and other fecal matter)
from the beach into the water,
or may result in storm drain
discharge (also potentially
chemical or feces-laden) into
the water.
•
Avoid swimming where storm
drains enter the water.
•
Avoid beaches where pets,
geese, and other wildlife; and
other sources of feces
abound.
•
Do your part by keeping
poopy diapers and poopy
bottoms out of the water.
•
Avoid areas where you see
significant amounts of trash,
or other signs of pollution
(e.g., oil slicks) in the water.
•
Look for a beach with bathrooms and handwashing
resources … and use them.
•
If you think your beach water
is contaminated, contact your
local health or environmental
protection officials.
•
If you think you’ve become ill
from swimming in recreational
water, contact your physician.
In some cases, local authorities
may decide to close beaches rather
than post advisories when
monitoring reveals pathogens in the
water that exceed allowable limits.
Sample materials, designed to
assist with beach closure, can be
found on the MDH website at:
www.health.state.mn.us/divs/eh/
beaches/closure.html
SAMPLING METHODOLOGY
In addition to the usual sampling
concerns (e.g., storage, handling,
and transportation), beach samples
must be taken at the same depth
for all sampling events, to ensure
consistent and comparable results.
ADVISORY and CLOSURE
A University of Wisconsin study
confirmed that E. coli concentrations were significantly different
(p<0.05), when water from different
depths was compared. Lower concentrations of E. coli were found, as
sampling depth increased.
For the Lake Superior Monitoring
Program, MPCA or local Health
Department staff will post “Water
Contact Not Recommended”
advisories when tests do not meet
current standards.
MPCA Lake Superior samples are
taken at a depth of six to 12 inches,
in water that is knee deep. One reason for this choice of location is to
collect samples where children are
likely to ingest the water.
Standards are different for the Lake
Superior Beach Monitoring Program
than the proposed state E. coli
standards. The Lake Superior
program uses 235 CFU per 100 mL
single sample,
and 126 CFU
per 100 mL 5
sample geometric mean
Heidi Bauman, MPCA director of
the Lake Superior program points
out that, "Between sampling, the
incubation period, and then counting the colonies on these filters, it's
a good 24-30 hours before we get
actual numbers. Of course that
means that things could totally
change by the time we post an
advisory."
Crypto Information:
Minnesota Department of Health:
http://www.health.state.mn.us/divs/idepc/
diseases/cryptosporidiosis/index.html
Centers for Disease Control
(CDC):http://www.cdc.gov/crypto/
Page 7
PWDU Quarterly Update
EHS-Net Recreational Water Activities
Trisha McDonald, MDH
The Environmental Health Specialists Network, or EHS-Net, is a collaboration of environmental health
specialists, epidemiologists, and
laboratorians whose mission is to
improve environmental health.
Minnesota has been involved in
EHS-Net Food since its beginning
in 2000. In 2007, the EHS-Net program expanded in Minnesota to
identify and prevent environmental
factors contributing to waterborne
illness and disease outbreaks.
EHS-Net Water includes members
from CDC, EPA, California, Georgia, Minnesota, New York, and Tennessee.
EHS-Net Water activities in Minnesota involve both drinking and recreational water. Several activities
are currently underway to identify
environmental factors that contribute to waterborne illness due to
drinking of recreational water.
As part of EHS-Net Water activities,
an extensive environmental health
outbreak investigation survey is
completed on each pool implicated
in an outbreak. The survey includes
information on the physical description of the pool, water flow and
treatment, associated physical facilities, facility management, recent
developments at the facility, a field
assessment of the chemical levels,
and a review of pool policies.
The information gathered from the
survey not only helps with assessing anything that may have contributed to the individual outbreak, but
it also will be used in a future study
that will look at overall contributing
factors in waterborne outbreaks.
To report a suspected waterborne
illness, please call the Foodborne
and Waterborne Illness Hotline at:
1-877-366-3455.
For more information about the
EHS-Net Water program, contact
Trisha McDonald at 651-201-5639
or see the CDC EHS-Net Web page
at: http://www.cdc.gov/nceh/ehs/
EHSNet/default.htm.
July 1, 2008 MDH Press Release - Swim Safety
Health officials remind Minnesotans to practice healthy swimming behaviors this summer
Awareness of illnesses and healthy
swimming behaviors play an important role in stopping the spread of
illnesses through recreational water,
according to the Minnesota Department of Health.
“Germs on and in swimmers’
bodies end up in the water and can
make other people sick,” said Dr.
Kirk Smith, foodborne disease supervisor for MDH. “Even healthy
swimmers can get sick from
recreational water illnesses, but the
young, elderly, pregnant women,
and people with weakened immune
systems are especially at risk.”
Specific actions you can take to promote healthy swimming include:
•
If you have been ill with diarrhea
in the past two weeks, do not go
swimming.
•
Do not allow children who have
been ill with diarrhea or vomiting
in the past two weeks to go
swimming.
•
Avoid swallowing water or getting water in your mouth.
•
Shower before swimming.
•
Wash your hands after using the
toilet or changing diapers.
•
Take children on bathroom
breaks or change diapers often.
•
Change
children’s
diapers in
a bathroom, not at poolside or
beachside.
From 2000 to 2007, 17 swimming
pool outbreaks and 12 beach outbreaks were identified in Minnesota.
The parasite Cryptosporidium, one
of the most common waterborne
disease agents, is a chlorineresistant parasite that can survive
and be transmitted even in a
properly maintained pool. In 2007, a
record number of 302 cases of
Cryptosporidium were reported to
MDH. Three swimming pool-related
outbreaks of cryptosporidiosis
occurred in 2007.
Page 8
PWDU Quarterly Update
Cases of Cryptosporidium by Month of Specimen Collection
December
November
October
September
August
July
June
May
February
March
April
2004
2005
2006
2007
January
Number of Cases
80
70
60
50
40
30
20
10
0
Month of Specimen Collection
Kittson
2007 Cases of
Cryptosporidium
(n = 302)
Roseau
Lake
of the
Woods
Koochiching
Marshall
2
Beltrami
Cook
Clear
Water
Red Lake
2
St. Louis
1
Pennington
Polk
Lak
e
Itasca
8
3
Mahnomen
Norman
Hubbard
1
1
Becker
Clay
Cass
1
3
5
Aitkin
Wadena
Crow Wing
Carlton
Ottertail
Wilkin
7
10
8
Grant
1-4
Pine
Todd
Mille
Lacs
3
Douglas
Morrison
1
Kanabec
5-9
5
7
>10
Benton
Stevens
Traverse
Pope
2
9
Swift
4
Stearns
2
3
Big Stone
4
Meeker
7
3
6
1
Lyon
1
7
Brown
5
Rock
1
Le
Sueur
11
8
10
Scott
Dakota
7
Nicollet
4
WashingRam- ton
sey
32
2
Redwood
Rice
Goodhue
15
2
18
2
Pipestone
Hennepin
Carver
2
Sibley
Lincoln
3
5
McLeod
3
Anoka
Wright
Renville
Yellow Medicine
Chisago
1
Kandiyohi
Chippewa
Lac Qui Parle
Isanti
Sherburne
Murray
Cottonwood
Watonwan
Nobles
Jackson
Martin
Blue Earth
Wabasha
Olmsted
Waseca
Faribault
Steele
Freeborn
1
2
Dodge
12
Winona
17
Fillmore
Mower
10
Houston
9
3
This and other posters from:
http://www.cdc.gov/healthyswimming/posters.htm
Page 9
PWDU Quarterly Update
Quarterly Bug Report - Cryptosporidium
About Cryptosporidiosis
Cryptosporidiosis (“Crypto”) is
a diarrheal disease caused by
the protozoan parasite
Cryptosporidium spp.
During the past two decades,
Crypto has become recognized
as one of the most common
causes of waterborne diseases
in humans in the United States.
Symptoms include: watery
diarrhea, vomiting, stomach
cramps, loss of appetite, weight
loss, and a slight fever.
In persons with normal immune
systems, symptoms usually last
about two weeks. The symptoms may appear in cycles during which you may seem to get
better for a few days, then feel
worse, before the illness ends.
For persons with compromised
immune systems, some cancers,
or recent organ transplants, the
infection may persist indefinitely, and symptoms may be
more severe.
Cryptosporidium can live in the
intestines of humans and animals and is passed in the stool
of an infected person or animal.
Millions of Crypto organisms
(oocysts) can be released in the
bowel movement of an infected
human or animal. Infection
occurs after accidental ingestion
of the oocysts.
Crypto may be found in soil,
food, water, or surfaces that
have been contaminated with
the feces of infected humans or
animals.
CRYPTO STATS—2007
During 2007, 302 confirmed cases
of cryptosporidiosis (5.8 per
100,000) were reported. This is the
highest number of cases ever
reported in Minnesota, and is 75%
higher than the median number of
cases reported annually from 1996
to 2006 (See chart, page 8).
The median age of case-patients in
2007 was 20 years (range, one
month to 101 years). Children 10
years of age or younger accounted
for 37% of cases. Sixty-seven percent of cases occurred during July
through October of 2007.
The incidence of cryptosporidiosis
in the Southwestern, South Central,
Southeastern, and West Central
districts (16.0, 14.6, 14.0, and 10.1
cases per 100,000, respectively)
was significantly higher than the
statewide incidence. Only 67 (22%)
reported cases occurred among
residents of the metropolitan area
(2.4 per 100,000).
Forty-eight (16%) case-patients
required hospitalization, for a median of three days (range, 1 to 20
days). Three case-patients with
cryptosporidiosis died; all had underlying health conditions. Two
cases were known to be HIVinfected.
Five outbreaks of cryptosporidiosis
were identified in 2007, accounting
for 21 laboratory-confirmed cases.
An outbreak in a child daycare setting accounted for two laboratoryconfirmed cases. Three recreational
waterborne outbreaks occurred,
including 20 cases (five laboratoryconfirmed) associated with a membership club swimming pool, 60
cases (three laboratory-confirmed)
associated with a hotel water park,
and 33 cases (nine laboratoryconfirmed) associated with a membership swimming pool. One foodborne outbreak with two laboratoryconfirmed cases was associated
with an event at a private home.
CRYPTO PREVENTION
MDH advice for minimizing the risk
of crypto infection includes:
•
Wash hands often and well (in
all the usual situations with emphasis on people with diarrhea).
•
Wash raw fruits and vegetables
before eating.
•
Avoid ingestion of recreational
water.
•
Avoid using ice, drinking water,
and eating uncooked foods in
countries where the water supply might be unsafe.
•
Avoid drinking untreated water
from shallow wells, lakes, rivers, springs, ponds, and
streams.
•
When drinking potentially contaminated water cannot be
avoided, water should be
treated by bringing water to a
rolling boil for at least one minute or using a filter that has an
absolute pore size of at least
one micron or one that has
been NSF-rated for "cyst removal."
•
Be careful when dealing with
animals; always wash hands
after contact with animals, their
feces, and their environments.
•
Avoid fecal exposure, especially during sexual intercourse
(also helpful in preventing
Giardia and other parasites).
Page 10
PWDU Quarterly
PWDU Update
Quarterly Update
Odd and Ends - From Us and Our Friends
CHANGES to CDC GUIDANCE on
FECAL ACCIDENTS in POOLS
(reprinted from April issue)
The Centers for Disease Control
issued an alert on February 1, 2008
regarding changes to the guidance
for responding to fecal accidents in
swimming pools.
Based on new data, Cryptosporidium was found to be more resistant
than previously thought to chlorine
disinfection when the pH was raised
to 7.5. As a result of these findings,
new guidance for diarrheal events
says to:
“Raise the free chlorine concentration to 20 ppm (mg/L); maintain the
water’s pH between 7.2 and 7.5;
and temperature at about 77F. The
chlorine and pH should remain at
these levels for at least 12.75 hours
(changed from 8.0 hours previously)
to achieve the CT inactivation
value** of 15,300.”
**[The CT inactivation value is the
concentration (C) of free chlorine in
ppm multiplied by time (T) in minutes (CT value = C x T ).]
These new guidelines, and information for pool managers who wish to
use a lower chlorine concentration
or inactivation time, are posted on
the Healthy Swimming website at:
http://www.cdc.gov/healthyswim
ming/pdf/Fecal_Accident_Respon
se_Recommendations_for_Pool_
Staff.pdf.
Also note that CDC has posted updated recreational water illness prevention materials on the healthy
swim website (above) as part of this
year’s Health Promotion Toolkit.
VOLUNTEERS NEEDED for
GERM CITY at the STATE FAIR
The MDH/Minnesota Food Safety
Partnership Germ City handwashing ‘experience’ will be sharing
the Minnesota Dept. of Agriculture space at the Minnesota State
Fair from August 21 through
Labor Day, September 1.
We hope to recruit volunteers to
help fill three, four-hour shifts
each day of the fair. (That’s 144
shifts.) MDH will provide a ticket
for the Fair, a Germ City tee-shirt
and abundant thanks for all who
volunteer.
We will notify all our partners
soon of the web address where a
volunteer sign-up sheet will be
found on the
MDH website.
Please join us at
the Fair!
SIX “PLEAs” THAT PROMOTE
HEALTHY SWIMMING:
Three “PLEAs” for all swimmers
•
Please don't swim when you
have diarrhea . . . this is especially important for kids in diapers. You can spread the germs
into the water and make other
people sick.
•
Please don't swallow the pool
water. In fact, try your best to
avoid even having water get in
your mouth.
•
Please practice good hygiene.
Take a shower before swimming and wash your hands after
using the toilets and changing
diapers. Germs on your body
end up in the water.
Three “PLEAs for parents with
young children. Follow these to
protect your child and others from
getting sick:
•
Please take your kids for bathroom breaks or check diapers
often. Waiting to hear “I have to
go” may mean that it's to late.
•
Please change diapers in a
bathroom and not at poolside.
Germs can spread to surfaces
and objects in and around the
pool and spread illness.
•
Please wash your child thoroughly (especially their rear
end) with soap and water
before swimming. We all have
invisible amounts of fecal
matter on our bottoms that end
up in the pool. (Reprinted cour-
PLEASE NOTE:
MDH EMAIL CHANGING
Now we get to be like all the other
state agencies!
MDH email addresses will no
longer include the word, “health.”
instead of
[email protected],
contact us now at
MEHA
[email protected].
tesy of the CDC.)
Minnesota Department of Health
DIVISION OF ENVIRONMENTAL HEALTH
Orville L. Freeman Building
625 North Robert Street
Saint Paul, Minnesota 55155
http://www.health.state.mn.us/foodsafety
EHKPM Update
Regarding the Environmental Health Knowledge
Management Project (EHKMP)
As was noted in the Winter 2008 PWDU Quarterly Update,
efforts have been underway to share information about the
EHKMP Action Plan: Part 1 – Food Program (the Action
Plan), and to encourage stakeholders and partners across
the state to become involved in the implementation of the
recommendations and action steps contained in the Action
Plan.
One of the short-term action steps for harmonizing food
program data sharing initiatives that is included in the
Action Plan pertains to a Memorandum of Understanding
(MOU) concerning the sharing of food safety data.
To implement this action step, the EHKMP Steering
Committee developed a Food Safety Data Sharing MOU
that endorses the EHKMP Food Program Data Dictionaries contained in the Action Plan and implements the use
of the dictionaries whenever practicable so that future
data sharing efforts will be streamlined.
Initially, the EHKMP Steering Committee was going to
only seek signatures on the MOU from MDH and
agencies with delegated agreements. However, they
came to realize that inviting all agencies, regardless of
their delegation status, to learn more about the EHKMP
and to sign the MOU concerning the endorsement of food
safety data sharing would result in a more consistent,
statewide approach to improving data sharing, and would
demonstrate that collectively, we recognize the value of
food safety data sharing across agencies.
We are pleased to report that as of June 18, 2008, there
are now fifty-six (56) Food Safety Data Sharing
Memorandums of Understanding that have been jointly
signed by MDH and local agency partners; of this total,
twenty-six (26) are with agencies that have a food
program delegation agreement, and thirty (30) are with
agencies without delegation for food.
To learn more about the EHKMP Action Plan, see:
http://www.health.state.mn.us/divs/eh/local/knowproj/
actionplans/food/index.html.
PWDU Staff Contact Information
April Bogard
Supervisor, Partnership and Workforce Development Unit
[email protected]
651-201-5076, 612-296-8118
Deborah Durkin
Food Safety Partnership, Food Safety Center, UPDATE,
Manual development, food safety education
[email protected]
651-201-4509, 651-295-5392
Tony Georgeson
Rapid inspection software development, maintenance, and
training
[email protected]
218-332-5167, 218-770-2119
Steve Klemm
Swimming pool construction, plan review, and inspections
[email protected]
651-201-4503, 651-238-7737
Lynne Markus
Web content, emergency response, factsheet development
[email protected]
651-201-4498
Angela McGovern
Administrative support
[email protected]
651-201-4506
Michael Nordos
Training, Evaluation Workgroup, program evaluation
[email protected]
651-201-4511, 651-775-6234
Cathy Odinot
Training, Manual development, program evaluation,
Consulting Team
[email protected]
651-201-4843, 651-373-7381