Recreational exposure to polluted open water and infection: a systematic review and meta-analysis protocol

Jones, Matt Lloyd; Frances Leonard, Anne Clare; Bethel, Alison; Lamb, Emma; Gaze, William H.; Taylor, Tim; Singer, Andrew C. ORCID: https://orcid.org/0000-0003-4705-6063; Ukoumunne, Obioha C.; Garside, Ruth. 2025 Recreational exposure to polluted open water and infection: a systematic review and meta-analysis protocol. Environment International, 109371. 10.1016/j.envint.2025.109371

Before downloading, please read NORA policies.

[thumbnail of 1-s2.0-S0160412025001229-main.pdf]

Preview

Text
1-s2.0-S0160412025001229-main.pdf - Accepted Version
Available under License Creative Commons Attribution Non-commercial No Derivatives 4.0.
Download (1MB) | Preview

Official URL: https://doi.org/10.1016/j.envint.2025.109371

Abstract/Summary

•Background: Open water recreation (e.g. swimming, surfing) is growing in popularity alongside concerns about contracting infections as a result of wastewater (including sewage) and runoff pollution in seas, rivers, lakes, and other bodies of open water. Previous systematic reviews have found evidence for a positive association between exposure to open water and infection. However, these syntheses focus on comparisons of recreational water users and non-recreational water users, and make concessions on key stages of the systematic review process. This limits their ability to summarise the evidence for an effect of exposure to pollution, specifically. •Methods: We present a peer-reviewed protocol for a systematic review and meta-analysis of exposure to wastewater and runoff pollution and infection in recreational open water users in the Global North. Eligible studies must contain at least two groups of recreational water users known or suspected to have been exposed to distinct levels of pollution, with some estimate of cases of infection in each group. These studies will be obtained via searches of bibliographic databases (MEDLINE, Web of Science Core Collection, Environment Complete, and Global Health), grey literature sources, and supplementary search methods. Risk of bias in these studies will be assessed using Cochrane’s ROBINS-E and RoB 2 tools. Studies’ results will be qualitatively and quantitatively synthesised, following and reporting to contemporary standards and guidelines (e.g. PRISMA, SWiM). The results of the review will be summarised with a GRADE certainty assessment of the evidence for different types of infections, presented in a Summary of Findings table.

Item Type:	Publication - Article
Digital Object Identifier (DOI):	10.1016/j.envint.2025.109371
UKCEH and CEH Sections/Science Areas:	Environmental Pressures and Responses (2025-)
ISSN:	0160-4120
Additional Information. Not used in RCUK Gateway to Research.:	Open Access paper - full text available via Official URL link.
Additional Keywords:	recreational water, water quality, pollution, infection, systematic review, meta-analysis
NORA Subject Terms:	Health Hydrology Data and Information
Related URLs:	Dataset
Date made live:	24 Mar 2025 16:10 +0 (UTC)
URI:	https://nora.nerc.ac.uk/id/eprint/539142

Item Type:

Publication - Article

Digital Object Identifier (DOI):

10.1016/j.envint.2025.109371

UKCEH and CEH Sections/Science Areas:

Environmental Pressures and Responses (2025-)

ISSN:

0160-4120

Additional Information. Not used in RCUK Gateway to Research.:

Open Access paper - full text available via Official URL link.

Additional Keywords:

recreational water, water quality, pollution, infection, systematic review, meta-analysis