Assessment Of Selected Resorts In Cavite Province Biology Essay

Assessment Of Selected Resorts In Cavite Province Biology EssayResorts in the province of Cavite ar recognized for its reputable unpaid weewees. These resorts be think to give prospective customers with an atmosphere of am uptakement, make ittainment and relaxation. The most common types argon margin resorts, fluid pool, and even lakes and rivers which be designed to accommodate individuals, class of peers and family members (Bago and Linantud 2004). Also recreational irrigate offer activities that be beneficial and necessary to over constantlyy last(predicate) health. unpaid pisss beneath get hold be grime and bemire by bacterium, viruses and protozoan para situations (Bitton 1999), although the recreational urine is normally treated physically and chemically using filtration and chlorination to prevent make growth and infection of some bacterium (Montano and Abear 2000). How invariably on that point ar was an increasing result of cases of acute stomac h flu during this summer and one meeting of microbes adopting to their illness be enteral bacteria.Bacteria such as Escherichia coli and genus Pseudomonass aeruginosa that atomic number 18 resistant and tolerant to centilitre and were known to go gracious misery (Mann 2005). Enteric Bacteria are said to be nonorious and dangerous be brace they cause recreational irrigate illness like acute gastroenteritis, cholera, pneumonia, typoid feverishness, diarrhea, urinary infection, pneumonia, dermatitis, salmonellosis and otitis external these complaint leads to breakbreaks (Yoder 2008). Escherichia coli and Pseudomonas aeruginosa are among those bacteria that butt end thrive in recreational wet and transmitted from swallowing and inhaling contaminated piss before the microorganisms can be undo by pool peeing disinfectant (Barwicks et al. 1999). Also their resiliency to grow in some disinfectants like atomic number 17 because they are capsulated bacteria and they poss ess a versatile metabolic activity, which makes gives them the resistance to a miscellanea of physical conditions (Cappuccino 2005). The presence of these organisms indicates contamination by pathogenic microorganism. Most piddleborne disorders are cerebrate to pollution of water resources sources and thus pose an unsufferable health attempt for swimmers (Schets et al. 2010). Therefore the need to examine water renders in a microbiological water aspect is essential to ensure safety to swimmers.This pack is conducted to support if the selected resorts in Cavite whether chlorinated and non-chlorinate is contaminated with pathogenic microorganism that can lead to capableness waterborne diseases.1.2 Conceptual FrameworkThe water districts ensure the potability of alcohol addiction water by increasing the ducking of Chlorine (Yoder 2008). This potable swallow water were also utilize in resorts. Monthly sampling of water samples in pools render negative in intestinal bacteri a. However there is an increasing cases of gastroenteritis for the past year.The paradigm of the present culture is as follows Microbial Status in Chlorinated and non- chlorinated watersfrom selected resortsWater samples from resorts (pools, streams, rivers and beaches)edThe butt of this teach is to gather diametric water samples obtained from selected resorts and chance the microbial office regardless of its chlorine intentness levels.1.3 Statement of the ProblemThis study pass on aim to ascertain the microbial status in selected resorts in Cavite.To determine specifically the by-line objectives1. What is the microbial status jpresent in chlorinated and non -chlorinated water in selected resorts in Cavite?2. Is there a significant difference in the broad(a) count of enteric bacteria and follow bacteria among chlorinated and non-chlorinated waters in selected resorts in Cavite?3. Is there a correlativity mingled with chlorine concentration in the resorts and water sam ples in lakes, rivers and beaches?1.4 Scope and DelimitationThe study pull up stakes determine microbial status in selected resorts in Cavite, Province. Water samples volition be taken from these selected resorts and chlorine content concentration examegensnt be determined using chlorine test kits. It is non the aim of the study to apply antibacterial means in enteric bacteria acquire from water psychoanalysis.1.5 Significance of the StudyThis study is designed to find discover the microbial status on the selected resorts in Cavite, Philippines. This research hopes to benefit the following pertain populationResort clientele to be to a greater extent concerned to the areas that they went to and be prepared since traditional vaccines are not reliable in killing these bacteria because they are risky and are only sound after several years.Resort Administrators and Maintenance personnel for the enhancement of facilities of the swim pool to promote the preventive measures again st proliferation of microorganism which are recognized to be health risk problems and compliance to the water quality standards.Academe who whitethorn use this as preliminary tuition for their future research endeavors and in formation in survival of bacteria in different environmental conditions.1.6 description of TermsMicrobial status this refers to the bacteria present in chlorinated and non-chlorinated waters from selected resorts.Prevalence the number of samples that rendered positive in culture method over the total number of samples.Enteric Bacteria these are large group of gram-negative bacteria that are known to elevate disease in the alimentary tract. Enteric bacteria that survived in chlorinated waters of resorts.Resorts it is considered to be naiant pools, streams, river, lakes and beaches with chlorine.Microbial Density- The population or the measurement of the growth of the bacteria.Microbial Plating- This refers technique used to isolate a purestrainfrom a a tomic number 53 species of microorganism plating method that go away be performed in laboratory. complete Bacteria bacteria separate than enteric bacteria.API Kit- This refers to the biochemical test that exit determine the isolated bacteria from water samples.Chlorination- this is a water polish method to make water safe to valet and a disinfecting agent that prevents the diffuse the spread of waterborne diseasesChlorine test kit- This refers to the chemical test that allow determine the chlorine concentration level of water.Chromogenic Media This refers to the culturing media that go forth determine the present bacteria in water.CHAPTER 2REVIEW LITERATURES2.1 Conceptual literary workssRecreational waterRecreational waters can be classified as fresh water liquified pools, whirlpools and naturally occurring fresh marine step up waters. Infectious disease which can be transmitted by recreational water includes skin, eye and ear infections and gastroenteritis. Consequentl y the level of microorganism in recreational water are important for indexing their health trial run a risk associated with swimming and since the recreation classification includes bathing, swimming etc. whatsoever organism transmitted to mankind beings can be regulated. The best indicators in the estimate of the safety of swimming pool water is to be get hold aware of the types of game (microbiological, chemical and physical) that can impact a bathing area. Some researchers stress that the microbiological quality of swimming pools are best measure by identifying the bacteria present in that recreational water such as faecal coliform and enterococci, while oppo sets consider that the disease and symptoms it brought to the bathers rather than fecal contamination (Martin et al. 1995).(Montano and Abear 2000) cited that the bacteria suggested as indicators of recreational water quality include a great medley of pathogenic bacteria and non-pathogenic microorganism such as c oliform groups, species of Pseudomonas, Streptococcus, staph and in rare case Legionella. The presence of single coliform organism is not a ground for condemning water as a unit of measurement for human usance. It is the relative abundance of these organisms, which is important.According to Papadopoulou et al. (2007) cited that non-fecal human shedding (e.g. from vomit, mucus, spitting or skin) in the swimming pool is also a potential source of pathogenic organism. Bathers who are already infected can instantly contaminate pool waters with pathogen which whitethorn affect separate bathers, who come in contact with the contaminated water. Opportunistic pathogens (mainly bacteria) can also be shed from user and transmitted via contaminated water. Also certain gratuitous life aquatic bacteria and amoebae can possibly grow not just in pool waters but also with pool components or facilities or on other wet nears within the rapidness which whitethorn cause infections or disease . Therefore swimming pools are very much associated with outbreaks or incidents of waterborne infection.Murdoch(1975) as cited by Amador and Amante (2001) mentioned that disease contracted from water kill some 25million battalion, most of them children each year, while m some(prenominal) millions more(prenominal) are debilitated by waterborne diseases. Fecal contamination of water can introduce a variety pathogens into water waste, including bacteria, viruses, protozoans and parasitic worms. waterborne related diseases have been recognized by Classes. Class 1, refers to the true waterborne disease contracted by drinking water. Class 2 are diseases associated with lack of personal hygiene which can be reduced by providing adequate amount of water for bathing and washing. To control such diseases, people should be provided with sufficient water of reasonable quality achieving a mellow bacteriological quality is a secondary consideration.Enteric bacteriaA large, heterogenous group in the family Enterobacteriaceae, include several closely related genera of misfortunate and spore forming, gram-negative rods, facultative anaerobic, that inhabit or produce disease in the alimentary tract of warm-blooded animal. This family are notorious as causes of urinary tract infection and are recovered from a variety of clinical specimens taken from diseased foci other than in the gastro enteral tract. The entric are probably responsible for more human misery than any other group.(Smith 2008)Escherichia coliIt is a gram negative rod shaped bacterium. It was originally known as bacterium coli. It is widely distributed in the intestine of globe and warm- blooded animals and is the predominant facultative anaerobe in the bowel part of the essential enteric flora that maintains the physiology of the healthy waiter. The presence of E.coli is associated with bather-associated illness, but its absence cannot be equated with the lack of risk of illness (Guidelines for Canadian Recreational Water spirit available at http//www.ecy.wa.gov1992).Pathogenicity performs coliform bacilli usually do no penetrate intestinal wall to produce disease unless (1) the intestinal wall becomes diseased, (2) resistance of the host is lowered, or (3) virulence of the organism is greatly change magnitude. Under one of these conditions of coliforms may pass to abdominal cavity or enter into the bloodstream. Once removed the intestinal canal and in the tissues of the body their virulence is remarkably enhanced. Among the diseases that they cause are pyelonephritis, cystitis, cholecystitis, abscesses, peritonitis, and meningitis. They may play a part in the formation of gallstones and are found in the cores of such stones. In peritonitis complicating intestinal perforation the coliform group is joined by such organisms as streptococci and staphylococci. From any focus of inflammation coliform organism may enter the bloodstream to produce a septicaemia. (Smith 2008)ShigellaDy sentery caused by the Shiga bacillus (Shigella dysenteriae) is much more severe than that from the other organisms, since this bacillus produces a powerful exotoxin- like substance in sum to an endotoxin. The exotoxin- like substance seems to be liberated by bacterial disintegration, and as a neurotoxin, It acts on the nervous system to paralyze the host. The endotoxin irritates the intestinal canal.The dysentery bacilli are gram negative, nonsporebearing rods that grow on all ordinary media at temperatures from 10 to 42 C. but best at 37 C they are aerobic and facultative anaerobic. Unlike most other members most other member of the enteric group, they are non-motile.In terms of pathogenicity dysentery is a human disease and natural infections of the lower animals do not occur. The incubation point is 1 to 7 days. Epidemic dysentery is primarily an intestinal infection. Unlike typhoid fever fever bacilli, the organisms do no invade the bloodstream and are seldom if ever found in the internal organs or excreted in the urine. They are excreted in the feces. Compared to that for other enteric pathogen, the number of ingested shigellas for infection is small, only 10 to cytosine. (Smith 2008)SalmonellaAmong the large number of pathogenic microorganisms causing foodborne disease, Salmonella plays an important role. An analysis of Salmonella direction data from the World Health Organization (WHO) showed that the reported number of cases increased in 22 out of 49 countries examined. Although the reason for the global increase is not yet clear, investigations in individual countries suggest that it is related to consumption of eggs and poultry that harbour the organism. Besides control measures there is a need for rapid and sensitive methods for the detection of Salmonella (Beumer et. al, 1991). Salmonella is a ubiquitous enteric pathogen with a worldwide distribution that comprises large number of serovars characterized by different host specificity and dist ribution. This microorganism is one of the leading causes of intestinal illness finished the world as well as the etiological agent of more severe systemic diseases such as typhoid and paratyphoid fever.zoonotic salmonellae are commonly described as foodborne pathogens however drinking water as well as natural waters is known to be an important source for the transmission of these enteric microorganisms. Salmonella, just like other enteric bacteria, is spread by the fecal-oral route of contamination. This microorganism can enter the aquatic environment directly with feces of infected humans or animals or indirectly, e.g., via sewage discharge or agricultural land run off.Overall Salmonella spp. and subspecies can be found in a large variety of vertebrates. Beside humans, animal sources of Salmonella include pets, farm animals and wild animals calves, poultry, pigs, sheep as well as wild bird (pigeon) and reptiles can all be reservoirs of Salmonella. Plants, insects and algae were a lso found capable of harboring Salmonella and might be affect in the transmission of this enteric pathogen. Taxonomically the genus Salmonella comprises two species namely S. bongori and S. enterica. The species S. enterica is march on differentiated in to six subspecies (enterica, salamae, arizonae, diarizonae, indica and houtenae) among which the S. enterica subspecies enterica is mainly associated to human and other warm blooded vertebrates. Enteric fevers, typhoid and paratyphoid fever are severe, contagious systemic diseases caused by the infection of the serovars typhi and Paratyphi. Differently from other Salmonella serovars, typhi and Paratyphi are host adapted and can only infect humans stools of infected persons are therefore the original source of contaminations for these pathogens.Water contaminated with feces of human cases and carriers is one of the main vehicles of typhoid fever infections. Literature data related to water-borne salmonellae in developing countries r elate mostly the typhoid Salmonella serovars. In the less industrialized area of the world, in particular in the Indian subcontinent and South East Asia, typhoid and paratyphoid fevers occur some(prenominal) in epidemic and endemic form, and remain a major commonplace health problem. The burden of typhoid fever worldwide is further compound by the spread of multiple drug resistant S. typhi.Most of the new-fashioned publications on typhoid and paratyphoid fever water-borne infections in developing countries are from the Asian continent. Differently from typhoidal Salmonella strains, non-typhoidal salmonellae, the ubiquitous subtypes found in a number of animal species, are more frequently associated to foodborne than to water-borne transmission. These zoonotic Salmonella serovars tend to cause acute but usually self-limiting gastroenteritis (Levantesi et al, 2011).According to (Smith 2008)The pathogenicity of salmonella is called salmonellosis, the major site of which the lining of the intestinal tract. Because of their toxic properties every known strain of salmonella can cause anyone three types of salmonellosis (1) acute gastroenteritis of the food type infection.(2) blood poisoning or acute sepsis with localized complications similar to pyogenic infections, and (3) enteric fever such as typhoid or paratyphoid fevers.Salmonella typhiA short motile nonencapsulated bacillus, S.typhi grows luxuriantly on all ordinary media. It grows best under(a) aerobic conditions bit may grow anaerobically. The temperature range growth is from 4 to 40C., the optimum, 37C. typhoid bacilli can survive outside the body, living about 1 week in sewage contaminated water and not only living but multiplying in milk. They may be viable in fecal matter for 1 or 2 months. They are pathogenic because of their endotoxins.Their pathogenicity causes typhoid fever is an acute infectious disease with continuous fever, skin eruptions, bowel disturbances, and profound toxemia. Except in the commencement exercise few days, leukopenia is always present in uncomplicated cases, probably because typhoid bacilli depress the bone marrow, where normal production of white blood cells occurs. Leukocytosis in the course of the disease signals complication. (Smith 2008)2.2 Related StudiesAccording to Brown (2009), gram-negative intestinal pathogens have a diverse population of bacteria of which two of the enteric intestinal pathogens that are of prime medical concern are the salmonella and shigella. The salmonella and shigella are both(prenominal) pathogenic bacteria that cause typhoid fever and human dysentery, respectively. Since the gram-negative intestinal pathogens has a such diverse population it has umteen genera of species like the Escherichia, Proteus, Enterobacter, Pseudomonas, and Clostridium that exists on large numbers, hence it is necessary to use media that are differential and selective to favor the growth of the pathogens since all of the species can be div ided into lactose fermenting and non-lactose fermenting bacteria.Hiriart et al. (2001) worked on the Helicobacter pylori and new(prenominal) Enteric Bacteria in Freshwater Environments in Mexico City. They observed that all samples analyzed showed the presence of enteric bacteria with or without the presence of H. pylori, indicating that water from these sources is a potential health risk for gastrointestinal diseases. The major profitability of H. pylori coincides with the major positivity of indicator and other enteric bacteria, which are both associated with contaminated water.In another study Marion et al. (2010) worked on the association gastrointestinal illness and recreational water exposure at an inland U.S beach. Relationships between water quality indicators and reported adverse health outcomes among users of a beach at an inland U.S lake was observed to be a significant risk factor for GI illness..Papadopoulo et al.(2008) worked on the microbial quality of indoor and o ut-of-door swimming pools in greece. They found out that three indoor swimming pools and two outdoor swimming are present with bacteria, protozoa and kingdom Fungi Such as Multi-resistant Pseudomonas alcaligenes, Leuconostoc, and staphyloccus aureus( isolated from teaching pool), Staphylococcus werneri. Chryseobacterium indologenes and Ochrobactrum anthropical (isolated from completion pools) Pseudomonas aeruginosa, P. fluorescens, Aeromonas hydrophila, Enterbacter cloacae, Klebsiella pneumonia and S. aureus (isolated from the hydrotherapy pool and A. hydrophilla (isolated from the hotel pool) were related to water outbreaks.Schets et al. (2010) worked on the exposure assessments for swimmers in bathing waters and swimming pools. they found out that the swallowed volume or water appears different for men, women, and children, but also in fresh water, seawater and swimming pools also the frequency and duration of swimming do also differ for men, women, and children and in different water types, and provide a basis for the identification of high risk population under specific circumstances, e.g. collectable to their extended water contact and frequent organise submersions, children may be more prone to contract otitis external due to Pseudomonas aeruginosa infections.Certainly a waterborne infection depends on the total bacterial counts, the immune status of the subjects, and polluted waters. The results of the past studies demonstrate the variant of the recreational water quality and the need for continuous monitoring.Chapter 3methodological analysis research DesignThis study impart use descriptive study design that involves in the identification of enteric bacteria in selected resorts in the Cavite province. There go out be 20 sampling sites, 10 from swimming pools, 5 from rivers or lakes and 5 from beaches. In every sampling site there will be a total of 1 sample that will be gathered and it will be replicated into three and a total of 60 sterilized bot tles with cover will be used for the 4-month period of experiment that will be done during the summer conciliate and the rainy season. inquiry SettingThe entire study will be conducted for 12 weeks. The identification of total bacteria and enteric bacteria will be done in Biology Research Laboratory of DLSU-D.Research ProcedureWater Sample Collection (MicroMed Environmental, 2010)Sterilized 300ml wide-mouthed glass will be used in the collection of samples. Water samples will be obtained from recreational waters. The sterile containers will be plunge into the water surface until 1 foot below. Then open the bottle towards the direction of the topical to allow the container to fill. Afterwards, it will be immediately sealed tightly and put on a cooler to maintain the temperature. The samples will be obtained during the months of april and june of 2012. The chlorine concentration will also be measured using Hach visitation Kit for chlorine.Chromogenic Media for BacteriaUndiluted sa mples will be used in the determination of total bacteria. Briefly one milliliter of sample will be spread plated onto Plate Count nutrient agar. The plates will be incubated at 37C for 24 hours. Colonies that will grow will be converted into colony forming units and will be correlated to chlorine concentration and compared to enteric bacteria.For the detection of enteric bacteria the samples will be enriched in buffered peptone water for 24 hours. After 24 hours the enriched samples will be spread plated onto Salmonella-Shigella nutrient agar and Eosin Methylene Blue Agar. Colonies resembling to enteric bacteria will be purified and confirmed using API 20E kit.Determination of the Microbial Count (BioMrieux, 2002) preparedness of incubation box and inoculum will be done for the strip. In the inoculation of the strip, filling both tube and cupule of tests CIT, VP and gelatine with bacterial suspension as for the remaining tests fill only the tube and not the cupule. In creating ana erobiosis vasopressin, LDC, ODC, H2S and URE should be overlay with mineral oil. The incubation box will be incubated for 37C for 24 hours. Certain color reactions will happen for the indication of positive or negative result.Data hostColonies in the EMBA and PCA will be characterized using colonial characterization which includes size, form, margin, elevation, consistency, surface and pigmentation (Tabo, 2005). Biochemical test include ONPG, ADH, LDC, ODC, CIT, H2S, URE, TDA, IND, VP, GEL, GLU, MAN, INO, SOR, RHA, SAC, MEL, AMY, ARA, OX. The chlorine concentration will be measured in 0-600 mg/L.Statistical TreatmentTo determine the correlation between chlorine concentration and total bacteria and enteric bacteria, a simple correlation will be used. All statistical analysis will be conducted in STATA 9.0 with 0.05 as level of significance.APPENDIX AGANTT CHARTAPPENDIX BBUDGET PROPOSALItem passel/MassEstimated Price (PhP)QuantityExpense (PhP)EQUIPMENTS AND KITSBiomerieux Inc Biomeri eux API 20E KIT 100g Pack of 100 2016013000.00113000.00Hachs Chlorine Test Strips, 0-600mg/L Pack of 2890200876.311876.31AGARSSalmonella-Shigella Agar50 g500.001500.00Eosin Methylene Blue Agar50 g500.001500.00Plate Count Agar500.001500.00TOTAL15376.31APPENDIX CLETTER TO THE HOSPITALMarch 13, 2012Ms. Teresita E. Guevarra medical exam Records HeadDe La Salle University Medical CenterDear Ms. GuevarraGreetings in the name of St. can Baptist De La SalleWe are writing to ask permission from you in getting information that we will need for our thesis defense on the upcoming celestial latitude 2012. We are Human Biology major students from De La Salle University-Dasmarias and we are going to conduct a study regarding the manageable prevalence of enteric bacteria in selected resorts in Dasmarias, Cavite. Regarding this, we would like to asking for the following informationReported cases of salmonellosis and acute gastroenteritis in this hospital for the last two years (2010 and 2011)We are hoping for your positive response towards our request. If ever the information we need will not be available today, you may contact us at 09164745448 and 09272546946. Thank you very much for your time.Sincerely,Ron Matthew A. FloresJohn Paul A. FloresNoted by____________________ _____________________Mrs. Hazel Ann L. Tabo Dr. Carmelita C. CervillonBSD Faculty, DLSU-D (Thesis Adviser) College Dean, DLSU-D_____________________Ms Cherry Z. Cuevas, MSBSD Chair, DLSU-DAPPENDIX DCOLOR REACTIONTESTS RESULTS(negative)+ RESULTS(positive)ONPGcolorless discolourADH scandalmongering-bellied-belliedred/ orangenessLDCYellowred/orangeODCYellowred/orangeCITpale green/yellow bad-green/blueH2Scolorless/grayblack depositUREYellowred/orangeTDAYellowbrown-redINDYellowred (2 min.)VPcolorlesspink/red (10 min.)GELno diffusion of blackblack diffuseGLUblue/blue greenyellowMANblue/ chromaticyellowINOblue/blue-greenyellowSORblue/blue-greenyellowRHAblue/blue-greenyellowSACblue/blue-greenyellowMELblue/blue -greenyellowAMYblue/blue-greenyellowARAblue/blue-greenyellowOXcolorless/yellowvioletLITERATURE CITEDAmador RM, Amante PP. Detection and isolation of coliform bacteria in Laguna de Bay Brgy. Landayan San Pedro Laguna 2001. p.67.Bago CEM, Linantud JF, Ortiz MP. Stability and profitableness of Resort Business in Dasmarinas, Cavite. 2004. P.1-2-ix-29.Barwicks RS., Levy DA., Craun GF., Beach MJ., Calderon RL. 2000.Surveillance for water borne-Disease Outbreaks-united-states ,1997-1998 CDCBrown, A. E. 2005. Bensons Microbiological Applications 9th Edition, McGraw Hill, New York.Beumer, R.R., et al., 1991. Enzyme-linked immunoassays for the detection of Salmonella spp. a comparison with other methods, Elsevier Science Publisher, B.V. 0168-1605/91Carteciano JA., 2004. Four Emerging Bacteria So Tiny, So deadly. NationalResearch Council of the Philippines.Hammer Sr. M, Hammer Jr. M. Water and waste water technology. New Jersey 2004.p.140Levantesi, C., et al., 2011.Salmonella in surface and drinking water feature and water-mediated transmission, Food Research International, doi10.1016/j.foodres.2011.06.037Mann, D. Beware of Recreational Water Illnesses, WebMD. Internet. 2005 cited 2011 December 28.Available from HYPERLINK http//www.webmd.com/fitness-exercise/features/beware-of-recreational-water-illnessesMarion, J., et al., 2010.Association of Gastrointestinal illness and recreational water exposure at inland U.S beach, water research internationalMartin, M., et al., 1995.Assessment of microbiology quality for swimming pools in South America.MicroMed Environmental, Inc. Internet. 2010 cited 2012 March 25. Available from HYPERLINK http//www.igmicromed.com/docs.htmlMontano JM, Abear R. 2000.Detection of Pseudomonas aeruginosa in relation to microbial population of selected swimming pools in dasmarinas cavite. De la Salle University Dasmarinas. p.52.Schets F., et al., Exposure Assessment of swimmers in bathing water and swimming pools, water research. 2010.Tabo, Norbel A . 2005. Laboratory Manual in Microbiology, Rex Bookstore Inc, Manila. p. 63-67Yoder JS., Hlavasa MC., Craun GF., Hill V., Roberts V., Yu PA., Hicks LA., Alexander NT., Calderon RL., Roy SL., and Beach MJ.2008. Surveillance for waterborne disease and outbreaks associated with recreational water use and other aquatic facility- associated health events-united states 2005-2006- CDC.