Caribbean Environment Programme
United Nations Environment Programme
Second CEPPOL Seminar on Monitoring and Control of Sanitary
Quality of Bathing and Shellfish-Growing Marine Waters in the
Wider Caribbean
Kingston, Jamaica, 9-13 August 1993
CEP Technical Report No. 23
1993
Note: The designations employed and the presentation of the material in this document do not imply the expression
of any opinion whatsoever on the part of UNEP concerning the legal status of any State, Territory, city or area, or
its authorities, or concerning the delimitation of their frontiers or boundaries.
For bibliographic purposes the printed version of this document may be cited as:
IOC/UNEP: Second CEPPOL Seminar on Monitoring and Control of Sanitary Quality of
Bathing and Shellfish-Growing Marine Waters in the Wider Caribbean. Kingston, Jamaica, 9-13
August 1993. CEP Technical Report No. 23. UNEP Caribbean Environment Programme,
Kingston, 1993.
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1
CEP Technical Report No. 23
SECOND CEPPOL SEMINAR ON
MONITORING AND CONTROL OF
SANITARY QUALITY OF BATHING
AND SHELLFISH-GROWING MARINE WATERS
IN THE WIDER CARIBBEAN
Kingston, Jamaica, 9-13 August 1993
REPORT OF THE MEETING
Introduction
1.
Among the components of the CEPPOL Programme, Activity 4.4.3 "Monitoring and Control
of the Sanitary Quality of Bathing and Shellfish Growing Waters", represents an important
effort for the development of a monitoring and research programme that will ensure the
sanitary quality of these waters and the development and enforcement of adequate quality
criteria and control measures. To this end, and as a preliminary activity within the
programme, this seminar was convened in Kingston, Jamaica, 9-13 August 1993, at the
Regional Co-ordinating Unit of the Caribbean Environment Programme.
2.
The main objectives of the Seminar were:
(i)
To discuss the progress made in the implementation of the pilot studies sponsored by
this activity leading to the development of suitable environmental quality criteria for
the region;
(ii)
To examine and provide comments regarding the monitoring programmes on the
sanitary quality of bathing and shellfish growing waters actually being conducted in
the Wider Caribbean region;
(iii)
To formulate detailed recommendations for the prioritization of future studies geared
to complete the objectives of the activity; and,
(iv)
To discuss measures required to improve the control of microbial contamination by
micro-organisms of waters and to diminish the public health risk from such
contamination.
3.
Seminar participants were selected by the CEPPOL Coordinator and were invited to attend
as experts in their personal capacity. In selecting the participants, the RCU was guided by
the experience of the participants to the subject matter of the Seminar. A list of the
participants is provided in Annex I of this report.
Agenda Item 1: Opening of the meeting
4.
The meeting was opened on Monday, August 9 1993 at 10:00 a.m., at the Conference Room
of the United Nations Law of the Sea Office in Kingston by Mr. Richard Meganck,
Coordinator of the Caribbean Environment Programme. Mr. Meganck welcomed the
participants and highlighted the main aspects and importance of the CEPPOL Programme
for the region. In particular, he emphasized the relevance of the subject matter for the Wider
Caribbean as it affects the natural environment, the economic activities and the health and
well-being of the population. He recognized that without the appropriate regional co-
operation between countries and international organizations, it would be impossible to
achieve the objectives of CEPPOL. He then encouraged the participants to consider this
type of co-operation during the deliberations of the meeting. Moreover, Mr. Meganck
emphasized the need to consider the socio-economic and policy implications resulting from
the decisions adopted by the Seminar.
Agenda Item 2: Administrative Arrangements
Agenda Item 2.1: Adoption of Agenda
5.
The meeting adopted the agenda (IOC/UNEP-WG. 12/1) with minor modifications, which is
attached as Annex II to this report. The list of documents (IOC/UNEP-WG. 12/3) is
appended as Annex III to this report.
Agenda Item 2.2: Election of Officers
6.
The meeting unanimously elected the following officers:
Chairman:
Mr.
Enrique
Mandelli
IOC
Consultant
Rapporteur:
Mr.
Gary
Toranzos
Associate
Professor
University
of
Puerto
Rico
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CEP Technical Report No. 23
Agenda Item 3: Present State of Development of Activity 4.4.3
7.
The CEPPOL Coordinator presented the document "Summary of the Implementation of
CEPPOL Activity 4.4.3 - Monitoring and Control of the Sanitary Quality of Bathing and
Shellfish Growing Waters", for the period April 1991 through August 1993
(UNEP(OCA)/CAR WG.12/6).
8.
Activity 4.4.3 was initiated with a Seminar on "Monitoring and Control of Sanitary Quality
of Bathing and Shellfish-Growing Marine Waters in the Wider Caribbean", convened in
Kingston, 8-12 April 1991. The participants in the Seminar, a total of fourteen (14), were
selected by the CEPPOL Coordinator and invited to attend as experts in their personal
capacity. Among the invited experts were representatives of CEPIS/PAHO and the
MEDPOL Programme of UNEP'S Mediterranean Action Plan.
9.
The report of the Seminar together with a Circular Letter (CAR 16/1991) inviting the
submission of study proposals was sent to the CEPPOL focal points of all States and
Territories participating in the CEP during August 1991. The Circular Letter indicated that
the proposals should concentrate on the Seminar's recommendations as previously described.
10.
As a result of this request, the RCU received the following proposals:
-
"Indicadores Sanitarios de la Calidad de las Aguas del Mar Caribe: Relaciones y
Tasas de Mortalidad", Instituto Costarricense de Acueductos y Alcantarillados (A y
A), Costa Rica;
-
"Coliphages and H2S Strips as Alternate Indicators of the Microbiological Quality of
Tropical Coastal Waters", Department of Biology, University of Puerto Rico;
-
"Pilot Prospective Epidemiological Study in Trinidad and Tobago", Institute of
Marine Affairs (IMA), Trinidad and Tobago;
-
"A Comparative Assessment of Selected Bacterial Indicators of Faecal
Contamination for Application in Sanitary Water Quality Monitoring Programmes in
the Caribbean", (CEHI), St. Lucia and,
-
"Microbiological Indicators of Pollution in Bathing Waters in the U.S. Virgin
Islands", Eastern Caribbean Centre, University of the Virgin Islands.
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Second CEPPOL Seminar on Sanitary Quality ...
11.
Four (4) of the above-mentioned pilot studies were approved in 1992. It is important to
indicate that the CEPPOL assistance to the IMA for the epidemiological study was an
additional support to project TRI/87/003/A001, financed by UNDP and the Government of
Trinidad and Tobago. The proposal presented by the Eastern Caribbean Centre was not
approved due to limited funds available at the time the proposal was received.
12.
The funds allocated in 1992 to the above-noted proposals totalled US$41,000 - (US$32,000
from Activity 4.4.3 and US$9,000 from Activity 4.4.6). At the time of writing this
document, the pilot studies proposed by A y A, Costa Rica and the Department of Biology of
Puerto Rico were completed.
13.
During 1993, three (3) additional proposals were received by the CEPPOL Coordinator,
namely:
-
"Pilot Study to Assess the Status of Microbiological Pollution of Shellfish and
Shellfish Growing Waters in Trinidad", Institute of Marine Affairs (IMA);
-
"Monitoring of the Sanitary Quality of Shellfish- Growing Waters in Jamaica",
University of the West Indies (UWI), Jamaica and,
- Vibrio cholerae Bacteriophages and their possible use to Monitor Waters for the
presence of Enterotoxic Vibrios", University of Puerto Rico (UPR).
14.
The above proposals were approved by the RCU Coordinator and funds made available for a
total of US$22,000.
15.
In addition, the CEPPOL Programme prepared a questionnaire on the "Monitoring of the
Microbiological Quality of Coastal Marine Waters in the Wider Caribbean Region (Annex I)
that was distributed to the CEPPOL focal points. Approximately 50% of the states and
territories of the Wider Caribbean completed the questionnaires. In this regard, some of the
countries provided information collected by more than one agency. Most of the countries
used faecal coliforms as indicator organisms. The frequency of sampling varied from
occasional sampling to very strict schedules such as those observed by the Overseas
Departments of France.
16.
During 1993, the CEPPOL Programme received a document from CEHI/PAHO entitled
"Assessment of Operational Status of Waste Water Treatment Plants in the Caribbean",
covering mainly CARICOM Countries . The preparation of the above document was
discussed during the First Seminar of Activity 4.4.3.
17.
Concerning the future of Activity 4.4.3, the Sixth Intergovernmental Meeting of the
Contracting Parties to the Convention for the Protection and Development of the Marine
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CEP Technical Report No. 23
Environment of the Wider Caribbean Region which was held in Kingston, 16-18 November
1992, approved a preliminary budget of US$45,000 for the 1994-1995 biennium.
Agenda Item 4: PAHO/WHO Activities on Health-related Aspects of Marine Pollution
by Micro-organisms in the Wider Caribbean
18.
Mr. Henry Salas of PAHO/CEPIS initiated his presentation by identifying PAHO/CEPIS's
role as a technical centre of the Panamerican Health Organization.
19.
Microbiological criteria and/or standards for primary contact recreation and shellfish
harvesting waters presently in use in Colombia, Cuba, Ecuador, Mexico, Puerto Rico and
Venezuela were presented. The above criteria and/or standards for recreational use were
primarily based on the US/EPA (pre 1986) and California, USA criterion to assess the merits
of the present indicators, which are presently used. It was pointed
out that modifications were made by various countries with respect to the percent of samples
which should not contain more than a specified level of indicator organisms, for example, in
Puerto Rico 20% of the samples should not exceed 400 faecal coliforms/100 ml, while in
Venezuela 0% of the samples should have more than 400 faecal coliforms/100 ml.
On the other hand, Brazil promulgated a water quality standard for primary contact
recreation stating that 80% of samples should be less than 1000 faecal coliforms/100 ml.,
based on attainability and not epidemiological studies. Peru subsequently followed suit
adopting the Brazilian standard.
20.
A log-normal distribution comparison showed that the EEC mandatory guideline of 95% of
the samples should be less than 2000 faecal coliforms/100 ml. is actually more restrictive
than the EPA geometric mean guideline (pre-1986) of 200 faecal coliform/100 ml. in that the
95 percentile for this mean would be greater, (Kay et al, 1992). This fact, notwithstanding, it
is recognized that the EPA exceedence criteria (10% of the samples not more than 400 faecal
coliforms/100 ml.) would be the controlling factor. As such, care through rigorous statistical
evaluations should be taken in selecting percent exceedance levels in that these are normally
the controlling criteria and can significantly alter the engineering design and costs of
adequate disposal systems necessary to comply with the standards. To support this point,
cost curves for submarine outfalls were presented and typical values for outfall installation
varied from US$5,000 per metre (diameter = 2m) to US$400 per metre (diameter = 0.25m)
using high density polyethylene (HDPE) plastic; the latter case applicable to small
communities. Submarine outfall length would be inversely proportional to the standard
adopted.
21.
Sewage disposal alternatives and present practices in Latin America and the Caribbean were
briefly discussed. At present, there are around 80 outfalls with lengths of 500 meters or
greater primarily distributed as follows: Venezuela (39), Puerto Rico (14), Brazil (13) and
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Second CEPPOL Seminar on Sanitary Quality ...
Mexico (9). Outside of Puerto Rico, only one other outfall of more than 500 meters exists in
the Caribbean. The reader is referred to the CEP Technical Report No. 9 of 1991 of a
previous CEPPOL Seminar on Monitoring and Control of Sanitary Quality of Bathing and
Shellfish-Growing Waters in which this subject is discussed in more detail.
22.
The results of an epidemiological "Cabelli Style" study conducted in the bathing waters of
the state of Sao Paulo, Brazil 1991 were presented. The results were presented at the
previous CEPPOL meeting in 1991 (Report No. 9) and unfortunately, the study has yet to be
published. It was noted that this was the only epidemiological research on this subject
matter conducted in Latin America and its comparison
to the Trinidad & Tobago study would be interesting. Mr. Salas again stressed that further
epidemiological research was needed in tropical waters.
23.
With regard to shellfish-harvesting water, the Latin American countries already mentioned
have adopted the internationally accepted microbiological criterion of 70 total coliforms/100
ml., using a median MPN, with no more than 10% of the values exceeding 230 total
coliforms/100 ml. or the faecal coliform equivalent of 14 and 43 faecal coliforms/100 ml.
respectively. The only exception is Peru which has a standard of 80% less than 10 faecal
coliforms/100 ml. and 100% less than 100 faecal coliforms/100 ml. for shellfish harvesting
waters.
24.
The problems encountered (Ahmed, F. E. 1991) with current faecal coliform indicators in
growing waters and the guideline for oyster meat (230 MPN faecal coliforms/100 g.) are the
following:
1.
Non-Escherichia coli faecal coliforms and even non-sewage related bacteria may
predominate in the faecal population analyzed by APHA (1985) methods. For
example, a Louisiana oyster study showed that in warm months, Klebsiella
pneumoniae isolates of environmental origin accounted for 86% of the non-E. coli
faecal coliforms and often outnumbered E. coli 1000 to 1. This was confirmed in
Gulf of Mexico studies.
2.
The faecal coliform indicator for water does not include the presence of non-sewage
related naturally occurring aquatic bacterial pathogens, such as Vibrionaceae.
3.
The faecal coliform indicator does not correlate with the presence of human enteric
viruses considered to be causative agents of illness.
25.
Processing and distribution aspects were discussed and the National Shellfish Sanitation
Programme guidelines for monitoring interstate shellfish shipments presented. It was
emphasized through examples that quality deterioration of shellfish could be handling abuse
during transport of foodstuffs characteristic of developing countries.
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CEP Technical Report No. 23
26.
The presentation ended with discussion regarding the cholera outbreak in Peru in 1991 and
the measures taken. Basically, the community educational programmes assisted in
controlling the outbreak. The basic sanitation situation has essentially remained unchanged
in Peru. It was noted that there were minimal risks of cholera due to swimming in water
contaminated with Vibrio cholerae because of the high infectious dose.
27.
The Seminar was very interested in the epidemiological study conducted in Brazil following
the Cabelli methodology. In the above-mentioned study, a correlation was observed
between levels of enterococcus and health risks, but no correlation was observed with faecal
coliform levels. The data obtained in this study seemed to indicate a higher incidence of
overt disease than in the study conducted by Cabelli in the USA. The Seminar concluded
that this maybe due to the percentage of pathogen excreters in the population. Mr. Dufour
suggested a more detailed look at the data collected in the Brazil study (still unpublished),
since this was not possible with the Cabelli USA study.
28.
Mr. Dufour also discussed a French study on people exposed to unpolluted and polluted
beach waters. These researchers compared the upper confidence limit of the mean illness rate
of non-swimmers versus the lower confidence limit of the slope of the swimming-associated
illness rate, water quality relationship. They suggested that the point at which the confidence
limit lines intersected was the point above which statistically significant gastro-intestinal
illness occurred. Mr. Dufour suggested that this statistical evaluation approach might be
considered for analyzing data from the Trinidad recreational water quality studies.
Agenda Item 5: Review of Indicator Organisms for Bathing and Shellfish-Growing
Waters and Health Studies from Non-point Sources
29. Mr. Alfred P. Dufour, Director of Microbiological Research Division of the
USEPA/EMSL/CIN summarized the work being conducted by this organization for the
development of microbiological water quality criteria for recreational and shellfish-growing
waters.
30.
In this regard, EPA is supporting a study in Hawaii which is examining the effectiveness of
currently recommended indicator bacteria in tropical waters. Investigators in Puerto Rico,
Hawaii and Hong Kong have suggested that these indicator bacteria may have extra-enteric
sources that preclude their use as indicators of water quality. Alternate indicators will be
examined to determine if they can be used in place of E. coli or enterococci.
31.
Enterococci - A single step, 24 hour procedure has been developed to replace the 2-step
procedure, 48 hour test for enterococci. Indoxyl-B-D-glucoside was incorporated into the
mE medium. The hydrolysis of this chromogenic substrate results in a blue colour in
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Second CEPPOL Seminar on Sanitary Quality ...
colonies of enterococci. This modified method will be approved by the EPA after
completion of inter-laboratory evaluation studies.
32.
E. coli - The two-step mTEC procedure has been modified by the addition of indoxyl-B-D-
glucoside to the medium. Blue E. coli colonies result from the hydrolysis of this substrate.
The substrate is highly specific for E. coli.
33.
The derivation of the 35 enterococci per 100 ml guideline was reviewed. A simple ratio
formula was presented to show how EPA arrived at the 35 number.
34.
Data from multiple freshwater studies were presented to show that statistically significant
correlations between two indicator bacteria could not be used to imply that each indicator
would show a strong correlation with health effects in swimmers.
35.
The current guidelines for water quality were reviewed and it was pointed out that because
of the wording of the guideline, surface waters must be of a much higher quality than
implied by the current upper limit of the indicator bacteria. For instance, if the geometric
mean of 5 samples is not to exceed 35 enterococci per 100 ml, then the true geometric mean
density of enterococci must be about 1 enterococcus per 100 ml.
36.
Relative risks for gastro-intestinal and respiratory illness in swimmers were compared to
enterococci densities in five (5) separate trials relating swimmers' illness to water quality. A
significant correlation was found between indicator density and relative risk associated with
gastro-enteritis. Relative
risk associated with respiratory illness was not correlated with indicator densities, implying
that gastro-enteritis is pollution related and respiratory disease is not. Skin, ear and eye
infections, were similarly not correlated with water quality indicators.
37.
A large scale study of the relationship between gastro-intestinal illness associated with the
consumption of raw shellfish and the quality of the water from which the shellfish were
harvested is currently being supported by funds from the U.S. National Marine Fisheries
Service. This study, entitled "The National Indicator Study (NIS)", is being conducted in
three (3) phases. The first phase covered the development of new methods for detecting and
enumerating indicators and pathogens in water and shellfish meats, the preparation of a
manual of available methods and the preparation of literature review covering all aspects of
shellfish microbiology.
38.
The second phase of the NIS will address the development of protocols for examining
candidate sites from which to obtain shellfish for a feeding study, the development of an
epidemiology study design and the identification of a contractor to carry out the feeding
studies.
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CEP Technical Report No. 23
39.
The third and last phase of the NIS will include feeding studies wherein participants will be
exposed, i.e., fed, shellfish obtained from harvesting waters contaminated by point sources
and non-point sources of pollution, and shellfish obtained from uncontaminated waters.
Three (3) types of shellfish will be used: the eastern hardshell clam, the western hardshell
clam and oysters.
40.
Shellfish digestion - A procedure has been developed for producing filterable digests of
oysters. The procedure involves homogenation, enzyme digestion and pre-filtration. The
digested shellfish meat can be filtered through a 0.45 micron pore size membrane for
subsequent placement on selective media for various indicators.
41.
The study of non-point sources of pollution, with respect to infectious agents, is more
meaningful if addressed in terms of the potential health risks associated with exposure to
human faecal contamination versus exposure to animal faecal contamination. A study
conducted by Yale University examined the relationship between the quality of water
contaminated only by animals and gastro-intestinal illness in swimmers.
42.
High densities of faecal indicator bacteria were not associated with illnesses in swimmers,
indicating that the risk of illness from exposure to animal faecal contamination must be
lower than that due to exposure to point source contamination (human). Illnesses in
swimmers were shown to be associated with swimmer density and Staphyloccus aureus
densities.
43.
After Mr. Dufour's presentation, the discussion centered on how the indicator numbers were
chosen to establish guidelines i.e. <200 FC/100 ml . In the case of selecting new emerging
indicators, Mr. Dufour cautioned that the emerging indicators may not indicate all health
risks. Concerning the selection of health risks to be included in studies related to primary
contact with recreational waters, we must keep in mind that for enteric illnesses we can do
something to prevent them by controlling the sources of contamination. However, other
infections may be caused by resident microorganisms. Mr. Salas pointed out that taking into
account the socio-economic conditions of developing countries, enteric illnesses risk
associated with primary contact recreation are relatively insignificant when compared to
infant mortality.
44.
Considering coliphages as emerging indicators for the Caribbean, Mr. Dufour mentioned that
they may be an alternative for the Caribbean as determined in a pilot study which is being
supported by the EPA in Hawaii. However, a large study in the Caribbean should be able to
determine if coliphages could in fact be used as indicators. Moreover, Mr. Dufour
emphasized the importance of determining human versus animal faecal contamination.
Several studies are being carried out using coproantibodies (sIgA) to differentiate between
these two (2) sources. However, the need for simple and facile techniques should continue
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to be research goals.
Agenda Item 6: Presentation of the Progress Reports of the Pilot Studies Under
Implementation
Agenda Item 6.1: Relationships and Decay Rates of Indicators in Micro-organisms of
Coastal Marine Waters of the Costa Rican Caribbean Sea
45.
Mr. Darner Mora, Head of the Laboratory at the Institute of Aqueducts and Sewerage, Costa
Rica, reported the final results of the above-mentioned pilot study. In order to fulfill the
objectives of the study, eight (8) points of sampling were selected along the beach of
"Ciudad Limón" - four (4) sampling points were located in the contaminated area and the
rest in areas with reduced faecal contamination.
46.
The collection of water and sediment samples was carried out in 1992 at monthly intervals.
Levels of the following microbiological indicators were assessed: Escherichia coli, faecal
coliforms: Staphylococcus aureus, Streptococcus faecalis, enterococcus, Pseudomonas
aeruginosa and Candida albicans.
47.
Additionally, the declination rates (T90) were determined in five (5) of the above indicators.
It was observed that a high linear correlation (r>0.5) existed between different pairs of
indicators both in sediment and water. The relationship between faecal coliforms and faecal
streptococcus demonstrated that the pollution observed in the waters of the beach comes
from domestic discharges. For all the indicators, it was observed that the T90 under light
conditions was shorter than those obtained under dark conditions. The longest T90 of all
the organisms tested under light conditions was observed with Candida albicans. E. coli
exhibited the longest under dark conditions.
48.
According to the previous results, Mr. Mora concluded that faecal coliforms and E. coli
appear to be the most adequate indicators for the evaluation of contamination of faecal origin
in tropical waters.
49.
The discussion generated by Mr. Mora's paper referred to the need to consider the
examination, if possible, of opportunistic pathogens (e.g. Candida albicans). The importance
of strict control of the time elapsed between the collection of samples and the time of
analysis to a maximum of 6 hours at the appropriate temperature. Concerning the observed
differences between T90 of indicator microorganisms obtained under light and dark
conditions, he stressed the need for more T90 studies; however, it was the opinion of the
Seminar that T90 values obtained during the light period may provide information about
these microbes as indicators of faecal pollution for possible health risk.
Agenda Item 6.2 : A Pilot Prospective Epidemiological Study to Assess the Health
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CEP Technical Report No. 23
Risks Associated with Bathing in Recreational Waters of Trinidad
50.
Mrs. Christine Bullock-Ramsumair, Research Officer of the Microbiology Section of the
Institute of Marine Affairs (IMA), provided information on the progress of the above-
mentioned study.
51.
In 1992, during the month of April in the dry season and July and August in the wet season,
an epidemiological study was conducted in Trinidad to assess the health risks associated
with sea bathing and to provide data to CEPPOL to assist in the development of
environmental quality criteria for the Caribbean region.
52.
There were six (6) survey areas in the study and these were located at four (4) beaches
selected from a pre-pilot study. On each Sunday during the study period, water samples
were collected, water parameters such as temperature, salinity, dissolved oxygen, pH and
turbidity were measured and interviews were conducted at each survey area. Three (3) days
after the initial beach interviews, follow-up interviews were conducted by telephone. Water
samples were analyzed to assess the levels of water quality indicators: total coliforms, faecal
coliforms, Escherichia coli and enterococci in the bathing water.
53.
To date, the statistical analysis of the data obtained during this study has not been completed.
Some information, however, has been obtained on the water parameters measured and on
the bathing water quality at the survey areas during the study period. Crude symptom rates
per 1000 persons have also been calculated from the questionnaire data.
54.
Water temperature, pH and dissolved oxygen content did not vary considerably over the
study period. However, a higher
degree of variation was noted among salinity and turbidity values obtained during this
period. With respect to the four (4) microbiological water quality indicators, levels obtained
during the wet season were usually higher than in the dry season. Bacterial water quality
indicator levels were notably higher on survey days in the wet season when there was heavy
rainfall and increased river discharge rates.
55.
A total of 10,204 beach interviews were conducted and 8,542 telephone follow-up
interviews were completed. Only 8,369 of
the completed telephone follow-up interviews, however, yielded usable data. The response
rate was, therefore, 82 percent. Approximately 88 percent of the study participants were
swimmers and 12 percent were non-swimmers. During the dry season, the wet season and
for the overall study period, symptom rates were significantly higher for swimmers than for
non-swimmers. Indeed in this study, 9 percent of the swimmers and only 4 percent of the
non-swimmers became ill.
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56.
Generally, symptom rates for respiratory illnesses, gastrointestinal illnesses, highly credible
gastrointestinal illnesses, eye infections, ear infections, skin infections and allergies were
higher among swimmers than non-swimmers over the study period. Among swimmers,
symptom rates were highest for respiratory illnesses followed by gastrointestinal illnesses.
Respiratory illness represented about 47 percent of the overall illness incidence among
swimmers. Over the study period, for all age groups, morbidity rates were higher among
swimmers than non-swimmers. Among swimmers, morbidity rates were highest for study
participants in the 16 to 20 age group. In addition, symptom rates for swimmers were higher
among participants under 20 years than for those over 20 years.
57.
Concerning the epidemiological study conducted the IMA, the data obtained in this study
showed that there was a definite difference in health risks between the swimmer versus the
non-swimmer groups.
58.
The discussion was centered on the need to increase the size of non-swimmer control groups
in future epidemiological studies. In addition, it was proposed that there should be an effort
to correlate levels of indicators to health risks. Mrs. Bullock-Ramsumair replied that this is
being looked at. The feeling of the seminar was that future studies should include emerging
indicators as well as traditional ones.
Agenda Item 7: Special Presentations on Subjects Related to the Objectives of
CEPPOL Activity 4.4.3
Agenda Item 7.1: Sanitary Quality of Water Sediments and Oysters from Coastal
Lagoons in Tabasco and Campeche, Mexico
59.
Mr. Jorge Romero from the (ICM Y L) of the University of Mexico described the work he
conducted in the above-mentioned area. The work involved the determination of total and
faecal coliforms in water, sediment and oysters. The results of the study indicated a heavy
microbiological contamination beyond the accepted standards based on USEPA 1986
criteria. Consequently, the presence of pathogenic bacteria (Salmonella spp and Vibrio spp),
and levels of heterotrophic bacteria and oil degrading bacteria were also determined.
60.
The bacteria were isolated, purified and identified through biochemical tests. The isolated
strains were exposed
to antibiotics (Ampicillin, Kanamycin and Nalidixic Acid) and to HgCl2 solutions in media
containing NaCl at different concentrations. During the bioassay samples were allocated and
DNA extracted to determine the presence of plasmids.
61.
A correlation between the resistance to the above-mentioned agents and the presence of
plasmids was determined.
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CEP Technical Report No. 23
Agenda Item 7.2: Report on the Consultation on Microbiological Quality of Coastal
Recreational Waters (WHO/EURO Joint Project, MEDPOL Phase II) June 9-12 1993
Athens, Greece
62.
Mrs. Christine Bullock-Ramsumair also prepared a brief on the MEDPOL Meeting
convened in Athens, Greece. Under the framework of the Long-term Programme of
Pollution Monitoring and Research in the Mediterranean Sea (MEDPOL Phase II), this
consultation was convened to undertake recommendations proposed at a previous
consultation in 1991 on "Health risks from bathing in marine waters".
63.
The main objectives of the consultation were as follows:
1.
To expand the WHO guidelines for prospective microbiological/epidemiological
studies on the correlation between natural recreational water quality and effects on
health to include complimentary designs such as the Randomized Controlled Clinical
study design.
2.
To expand the scope of the above-mentioned guidelines by the inclusion of protocols
for studies concerning specific recreational water activities other than bathing and,
3.
To review the results of recent microbiological/ epidemiological studies and to re-
evaluate the scientific evidence for the recommendation of recreational water and
beach quality criteria and standards.
64.
The activities during the consultation included presentations by several participants who
conducted epidemiological studies using two types of study designs.
65. The Cabelli type protocol was adopted during the previous consultation in 1991.
Presentations were made by participants who had conducted studies using this protocol in
Mediterranean countries and in temperate and tropical conditions climates.
66.
A draft protocol for Randomized Controlled Clinical trials was reviewed for adoption as an
alternative or complementary design for the Cabelli type protocol. In addition, there was
a presentation on a study which was conducted in the United Kingdom using this type of
study design.
67.
In relation to a review of draft protocols for studies covering specific recreational water
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Second CEPPOL Seminar on Sanitary Quality ...
activities other than bathing, it was indicated that recreational activities such as surfing and
diving (including wind surfing and scuba diving) incur greater relative risks of reporting all
classes of symptoms than swimming. There was also a presentation on research conducted
in the United Kingdom on the health effects associated with of white-water canoeing.
68.
From discussions during the consultation, it was recommended that the following factors be
considered when conducting future epidemiological studies of this type:
1)
It is generally considered that gastrointestinal symptomatic illness in bathers, related
to water quality, are of viral origin and it would not be inconsistent to find that
relative attack rates for such symptoms are related to counts of viral indicator, for
example, enterovirus or possibly male-specific bacteriophage.
2)
The microbiological quality of wetted beach sand and sediments are important
parameters in determining the environmental quality of bathing areas and should be
an integral part of epidemiological-microbiological studies correlating recreational
water quality with health effects.
69.
The Seminar questioned the applicability of the Randomized Control Clinical Study. Mrs.
Bullock-Ramsumair considered two (2) factors: it may be too expensive and labour
intensive, and in addition, there may be too many pathogens not considered as risk factors,
which may influence the results from the clinical analysis. Mrs. Bullock-Ramsumair also
mentioned that because of ethical considerations only subjects 18 years old and above were
surveyed, and therefore, a possible bias could be introduced.
Agenda Item 7.3: Coliphages as Alternate Indicators of the Microbiological Quality of
Tropical Coastal Water
70.
Mr. Gary Toranzos, Associate Professor of the Department of Biology of the University of
Puerto Rico, provided information on the results of the above-mentioned pilot study. Data
from a project financed by UNEP and currently being carried out was also presented.
71.
A one year study was conducted in Puerto Rico at different beaches impacted and non-
impacted by sewage. Coliphages were detected only from sewage-contaminated waters,
(fresh as well as marine). In all cases, high concentrations of faecal coliforms and
enterococci were detected but there seemed to be
no correlation regarding the presence of point source pollution. The coliphage host strain
used, permitted the detection of somatic and male specific coliphages. It was concluded that
coliphages seem to be a good indicator of faecal contamination, therefore, any monitoring of
waters should include coliphage detection. However, if results from one study are to be
compared with another, they should use the same bacterial host and use standardized
techniques. In conclusion, coliphages seem to be an excellent alternate indicator of faecal
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CEP Technical Report No. 23
contamination.
72.
Regarding the second project, it was determined that the techniques used to detect Vibrio spp
in the environment are susceptible to interference by background microbiota. The culture
medium (TCBS) is easily overgrown and the detection of the target organisms is extremely
difficult.
73.
We have modified the TCBS by adding a buffer and different concentrations of salt. These
modifications have reduced the interference caused by the background biota and allows for
an easier detection of the target Vibrio spp.
74.
The seminar generally agreed with the conclusions drawn from the project, however, it was
felt that other countries in the
region have expressed their interest in evaluating coliphages as possible indicators of faecal
pollution. Discussion was centered on the modification of the TCBS and the possibility of
using this medium to detect Vibrio cholerae 01 as well as Vibrio parahaemolyticus in the
environment. Some use of molecular techniques conjointly with the modified media was
discussed.
Agenda Item 7.4: Sanitary Quality of Water in Bays and Coastal Zones in Cuba
75.
Mrs. Hortensia Mancebo, Research Officer of CIMAB in Cuba, provided information on the
abovementioned subject.
76.
During the past 15 years the results obtained from different bays and coastal zones in Cuba
indicate that there is faecal pollution in certain areas. The indicators most commonly used in
these studies were: total coliforms, faecal coliforms, faecal streptococci and Clostridium
perfringens.
77.
Coastal pollution is the result of poor domestic wastewater treatment systems and inadequate
disposal practices. The environmental impact of these wastewaters discharged into coastal
waters is minimal because of dispersion and dilution.
78.
Generally, there is no evidence of pollution problems at Cuban recreational bathing beaches
because they are not situated
near sites of sewerage effluent discharges.
Agenda Item 8: Recommendations
79.
The Seminar proceeded with the recommendations according to the following:
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Second CEPPOL Seminar on Sanitary Quality ...
a)
Types
of
indicators
recommended
for
the region and justification (bacteria,
fungi, virus)
b)
Types of methodology according to the indicator
c)
Guidelines, standards or criteria
d)
Treatment
systems
e)
Monitoring programmes which need to be implemented in order to achieve
or maintain the Water Quality of Bathing and Shellfish-Growing Activities
80.
With reference to the type of indicators to be recommended, the Seminar felt that there is
insufficient evidence to change the current standards in use. However, it is recommended
that the enterococci group should be included in routine sampling because there is evidence
indicating that is a good indicator of recreational water quality.
81.
The Seminar also recommended the continuation of studies on male specific and somatic
coliphages and Clostridium spp as indicators of faecal contamination in bathing and
shellfish-growing areas within the region, taking into account the following:
i)
Their persistence in the tropical environment;
ii)
identification
of
their
sources
(faecal material, sewage effluents, run-off,
etc.); and
iii)
their occurrence (their presence in polluted recreational and shellfish
harvesting areas).
82.
The Seminar encouraged the continuation of microbiological/epidemiological studies, taking
into consideration traditional as well as newly emerging indicators of faecal contamination
(more specifically coliphages and Clostridium spp).
83.
These studies should use as a base the newly completed study in Trinidad and Tobago. The
Seminar suggested that Cuba, Costa Rica, Jamaica, and Puerto Rico have suitable facilities
and locations for conducting these studies.
84.
In reference to the microbiological analyses of shellfish tissue, the Seminar recommended
that new techniques for the preparation of the samples (such as enzyme digestion methods)
as well as the above-mentioned emerging indicators should be included in the two pilot
studies which are being implemented in Jamaica, Trinidad and Tobago and Puerto Rico.
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CEP Technical Report No. 23
Agenda Item 8.1: Types of Methodologies
85.
Taking into account that the methods used for the detection of emerging indicators
(coliphages and enterococci) were successfully evaluated in at least one country it is
recommended that this emerging methodology be evaluated by laboratories in other
countries of the region.
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Second CEPPOL Seminar on Sanitary Quality ...
Agenda Item 8.2: Guidelines/Standards Criteria
86.
The Seminar felt that there is not enough information at present to recommend any new
guidelines.
Agenda Item 8.3: Treatment and Disposal Systems
87.
Although this topic was thoroughly discussed, it is the consensus of the Seminar that the
topic of sewage disposal and treatment is beyond the scope of this Seminar. Consequently,
is recommended that a workshop be convened to discuss treatment and disposal systems
during the 1994-1995 biennium.
Agenda Item 8.4: Monitoring Programmes
88.
The Seminar recommends strongly that monitoring programmes be started or continued by
the countries of the region. Monitoring programmes will benefit the economy of the region
based on the following rationale:
a)
The economy of a great number of countries in the region is based on tourism
as a source of income. Consequently, an unacceptable microbiological
quality of recreational water may adversely affect the tourism industry;
b)
many of the Wider Caribbean countries may have increased access to the
international market in the future for the commercialization of shellfish; and,
c)
based on previous experiences within the region (e.g. Costa Rica) long-term
microbiological monitoring of coastal waters has provided the baseline data
necessary for the negotiation of loans (e.g. IDB, World Bank, etc.) to finance
appropriate sewage disposal systems.
89.
The Seminar recommended that a protocol be prepared as a guide for monitoring practices in
3 phases:
a)
Preparation of a preliminary questionnaire which will be used to identify
appropriate authorities to whom communications would be addressed;
b)
preparation of a questionnaire to elicit information about the needs and
problems relative to monitoring practices;
c)
use the responses from the above survey to prepare a guidance document that
addresses water quality monitoring issues in the region.
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CEP Technical Report No. 23
Agenda Item 8.5: Additional Recommendations in Priority Order for Actions to be
Implemented during the 1994-1995 Biennium
90.
To determine if traditional indicators of faecal pollution multiply in the tropical terrestrial or
aquatic ecosystems
1)
To determine if traditional indicators of faecal contamination have sources
other than the enteric tract of warm blooded animals.
2)
To
show
if
E. coli is capable of multiplying under environmental conditions
using traditional cultural and molecular techniques.
91.
To sponsor a cooperative programme among the states and territories of the Wider
Caribbean to evaluate traditional and emerging methods for measuring faecal contamination
in coastal waters
.
The objective of this effort is to conduct inter-laboratory studies to define the
accuracy, specificity and reliability of microbiological
methods used to measure the quality of tropical coastal waters
92.
To conduct a follow-up microbiological/epidemiological study in Trinidad and Tobago using
indicators appropriate for tropical climates
1)
To develop indicators that can be used to reliably assess the risk to human
population, and
2)
to develop a relationship between the quality of recreational water and health
effects in swimmer population.
93.
To demonstrate the effectiveness of alternative technologies for on-site treatment of
domestic sewage in coastal areas of the Wider Caribbean
1)
To identify the most effective tropical plant species for constructing artificial
wetlands for on-site sewage treatment and,
2)
to demonstrate the use of artificial wetlands to improve the quality of
wastewater normally discharged into shellfish-harvesting waters.
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Second CEPPOL Seminar on Sanitary Quality ...
94.
To conduct a workshop/seminar to define treatment and disposal practices applicable to
coastal areas in the Wider Caribbean
1)
The objectives are to discuss the benefits and problems of various options for
disposal of sewage in tropical environments and to define research needs for
the Wider Caribbean and,
2)
prepare a report summarizing the findings of the workshop/seminar.
95.
To determine the occurrence and abundance of Vibrio spp in coastal waters of the Wider
Caribbean
1)
To determine seasonal variations and,
2)
to determine the importance of eutrophication on Vibrio spp. in the tropical
marine/estuarine environment.
96.
To educate citizens in coastal areas of the Wider Caribbean on the potential health risks and
economic impacts of improper disposal of domestic sewage to recreational and shellfish
growing waters
. The objective is to encourage citizens to voice their concern regarding the
treatment of domestic wastes before disposal in coastal areas.
Agenda Item 8.6: Suggested Activities
96.
Prepare leaflets in the languages of the Wider Caribbean region for distribution during
community gathering, festivals, etc.
97.
For children preparation of colouring/workbooks for distribution in elementary schools,
guides for high school teachers, and
98.
Prepare slide presentation/script or video for use at community gathering, service club
meetings, etc.
Agenda Item 9: Other Matters
99.
No other matters were brought to the floor for discussion.
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CEP Technical Report No. 23
Agenda Item 10: Adoption of the Report
100. The Chairman presented the report of the Seminar to the meeting including it
recommendations and requested that the participants adopt the report with its amendments, if
required. The report was adopted with amendments.
Agenda Item 11: Closure of the Meeting
101. The meeting was closed on Friday, 13 August 1993, at 7:00 p.m. by Mr. Orjan Mohlund,
Officer-in-Charge, in the absence of Mr. Richard Meganck, Coordinator, UNEP-CAR/RCU,
who was on mission overseas. Mr. Mohlund presented the closing remarks and thanked all
the participants for their valuable contributions, co-operation and interest in the Seminar.
The Chairman thanked UNEP and the CEPPOL Secretariat on behalf of the participants, for
a well organized and interesting meeting and the RCU staff for their support and kindness
during their stay in Jamaica.
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Second CEPPOL Seminar on Sanitary Quality ...
ANNEXES
Page
23
CEP Technical Report No. 23
ANNEX
I
LIST OF PARTICIPANTS
Lemuel BRADY
Acting Sanitary Engineer
PAHO
60 Knutsford Boulevard
Kingston 5
Jamaica W.I.
Tel: (809) 926-1990/2
Fax: (809) 929-1182
Christine BULLOCK-RAMSUMAIR
Research Officer/Microbiologist
Institute of Marine Affairs (IMA)
Hilltop Lane, Chaguaramas
P.O. Box 3160, Carenage
Trinidad and Tobago
Tel: (809) 634-4291/4
Fax: (809) 634-4433
Al DUFOUR
Director, Microbiology Research Division
USEPA/EMSL/CIN
26 West Martin Luther King Drive
Cincinnati, Ohio 45268
U.S.A.
Tel: (513) 569-7218
Fax: (513) 569-7170
Fred KOPFLER
Chief Scientist
Gulf of Mexico Programme
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Second CEPPOL Seminar on Sanitary Quality ...
U.S./EPA
Building 1103, Room 202
Stennis Space Center MS. 39529
U.S.A
Tel: (601) 688-3726, Ext. 2712
Fax: (601) 688-2709
Hortensia MANCEBO
CIMAB/ITT
Apartado 17029, CP 11700
Habana 17
Cuba
Tel: (53-7) 624-387
Darner MORA ALVARADO
Jefe, Laboratorio Central de A y A
Instituto Costarricense de Acueductos y Alcantarillados
450m Norte de la Iglesia de Tres Rios
La Union, Cartago
Costa Rica
Tel: (506) 79-51-18/79-59-73
Fax: (506) 795-973
Jorge ROMERO JARERO
Instituto de Ciencias del Mar y Limnologia (ICM y L)
Universidad Nacional Autonoma de Mexico (UNAM)
Ciudad Universitario Delegación
Coyocán C.P. 04150
Mexico
Tel: (52-5) 622-58-21
Fax: (52-5) 616-04-78
Henry SALAS
Coordinator, Environmental Risks Unit
CEPIS/PAHO
Casilla Postal 4337
Lima 100, Peru
Tel: (511-4) 37-1077
Fax: (511-4) 37-8289
L. Don STREETE
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CEP Technical Report No. 23
Senior Director
National Resources Conservation Authority
(NRCA)
191 Old Hope Road
Kingston 6, Jamaica W. I.
Tel: (809) 927-1552
Fax: (809) 923-5070
Gary TORANZOS
Associate Professor
Department of Biology
University of Puerto Rico
Box 23360
Rio Piedras, Puerto Rico 00931-3360
U.S.A.
Tel: (809) 751-5708
Fax: (809) 764-3875
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Second CEPPOL Seminar on Sanitary Quality ...
SECRETARIAT
Richard MEGANCK
Coordinator
UNEP-CAR/RCU
14-20 Port Royal Street
Kingston
Jamaica W.I.
Tel: (809) 92-29276/9
Fax: (809) 92-29292
Raul MEDEROS BAEZ
CEPPOL Coordinator
UNEP-CAR/RCU
14-20 Port Royal Street
Kingston, Jamaica
Tel: (809) 92-29267/9
Fax: (809) 92-29292
Alessandra VANZELLA-KHOURI
Programme Officer
UNEP-CAR/RCU
14-20 Port Royal Street
Kingston, Jamaica
Tel: (809) 92-29267/9
Fax: (809) 92-29267/9
Enrique MANDELLI
IOC Consultant for CEPPOL
c/o UNEP-CAR/RCU
14-20 Port Royal Street
Kingston, Jamaica
Tel: (809) 92-29267/9
Fax: (809) 92-29292
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CEP Technical Report No. 23
ANNEX
II
AGENDA
1.
Opening of the meeting
2. Administrative
arrangement
2.1
Adoption of agenda
2.2
Election of officers
3.
Present state of development of CEPPOL Activity 4.4.3 CEPPOL
4.
PAHO/WHO activities on health related aspects of marine pollution by micro-organisms in
the Wider Caribbean
5.
Presentation by the representative of USEPA Office of Research and Development
6.
Presentation of the progress reports of the pilot studies under implementation
6.1
Relationships and Decay Rates of Indicators in Micro-organisms of Coastal Marine
Waters of the Costa Rican Caribbean Sea
6.2
A Pilot Perspective Epidemiological Study to Assess the Health Risks Associated
with Bathing in Recreational Waters of Trinidad
7.
Special presentations on subjects related to the objectives of Activity 4.4.3
7.1
Sanitary Quality of Water Sediments and Oysters from Coastal Lagoons in Tabasco
and Campeche, Mexico
7.2
Report on the consultation on Microbiological Quality of Coastal Recreational
Waters (WHO/EURO Joint Project, MEDPOL Phase II), June 9-12 1993, Athens,
Greece
7.3
Coliphages as Alternate Indicators of the Microbiological Quality of Tropical
Coastal Water
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Second CEPPOL Seminar on Sanitary Quality ...
7.4
Sanitary Quality of Water in Bays and Coastal Zones in Cuba
8. Recommendations
8.1
Types of Methodologies
8.2
Guidelines/Standards
Criteria
8.3
Treatment and Disposal Systems
8.4
Monitoring
Programmes
8.5
Additional Recommendations in Priority Order for Actions to be Implemented
during the 1994-1995 Biennium
8.6
Suggested
Activities
9. Other
Matters
10.
Adoption of the Report
11.
Closure of the Meeting
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CEP Technical Report No. 23
ANNEX
III
LIST OF DOCUMENTS
Working Documents
UNEP(OCA)/CAR WG.12/1
Agenda and Timetable
UNEP(OCA)/CAR WG.12/2
Annotated Agenda
UNEP(OCA)/CAR WG.12/3
List of Documents
UNEP(OCA)/CAR WG.12/4
List of Participants
UNEP(OCA)/CAR WG.12/5
Report of the Meeting
UNEP(OCA)/CAR WG.12/6
Present state of development of Activity 4.4.3
NOAA, 1993
The National Indicator Study, prepared by The
Interstate Shellfish Sanitation Conference for
the National Oceanic and Atmospheric
Administration, 1 July 1993
Reference Documents
1.
EEC,
1976
Council
Directive
of
8
December
1975
concerning the quality of bathing water
(76/160 EEC). Official Journal of the
European Communities No. L31/1 - 4
2.
WHO,
1977
Health
criteria
and
epidemiological
studies
related to coastal water pollution, Athens, 1 -
4 March 1977 (English only)
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Second CEPPOL Seminar on Sanitary Quality ...
3.
UNEP/WHO/IAEA, 1985
The determination of total coliforms in sea
water by the multiple test tube (MPN)
method. Reference Methods for Marine
Pollution Studies No. 21 (draft), UNEP 1985
4.
UNEP/WHO/IAEA, 1985
The determination of faecal coliforms in sea
water by the multiple test tube (MPN)
method. Reference Methods for Marine
Pollution Studies No. 22 (draft), UNEP 1985
5.
UNEP/WHO/IAEA,
1985
The
determination of faecal streptococci in
sea water by the multiple test tube (MPN)
method. Reference Methods for Marine
Pollution Studies No. 23 (draft), UNEP 1985
6.
WHO, 1990
Health risks associated with pollution of
coastal bathing waters, WHO Geneva, Vol
43, No. 3, 1990
7.
UNEP/WHO/IAEA,
1986
The
determination
of
Staphylococcus aureus
in sea water and sewage by the membrane
filtration culture method. Reference Methods
for Marine Pollution Studies No. 28 (draft),
UNEP 1986
8.
UNEP/WHO/IAEA,
1986
The
determination
of
Pseudomonas
auruginosa in sea water and sewage by the
membrane filtration culture method.
Reference Methods for Marine Pollution
Studies No. 29 (draft), UNEP 1986
9.
UNEP/WHO/IAEA,
1986
Isolation/enumeration
of
Salmonellae from
sea water and sewage. Reference Methods for
Marine Pollution Studies No. 30 (draft),
UNEP 1986
10. UNEP/WHO/IAEA, 1988
Guidelines for monitoring the quality of
coastal recreational and shellfish growing
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CEP Technical Report No. 23
areas. Reference Methods for Marine
Pollution Studies No. 1, Rev. 1, UNEP 1988
11. UNEP/WHO/IAEA, 1989
Statistical methods for the evaluation of
results from monitoring the quality of coastal
recreational and shellfish growing waters.
Reference Methods for Marine Pollution
Studies No. 55 (draft), UNEP 1989
12.
IOC/UNEP,
1990
Environmental
Quality
Criteria
of
Coastal
Areas in the Wider Caribbean Region - A
Compilation. IOC/UNEP-WQC-I/4, 1990
13.
IOC/UNEP,
1991
CEPPOL
Regional
Workshop
on
Coastal
Water Quality Criteria and Effluent
Guidelines for the Wider Caribbean region.
San Juan, Puerto Rico, 5 - 15 November 1990
14. IOC/UNEP,
1991
Report on the CEPPOL Seminar on
Monitoring and Control of Sanitary Quality of
Bathing and Shellfish-Growing Marine
Waters in the Wider Caribbean, Kingston,
Jamaica 8-12 April 1991. CEP Technical
Report No. 9, UNEP Caribbean Environment
Programme, Kingston 1991
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Second CEPPOL Seminar on Sanitary Quality ...
SECOND CEPPOL SEMINAR ON
MONITORING AND CONTROL OF
SANITARY QUALITY OF BATHING
AND SHELLFISH-GROWING MARINE WATERS
IN THE WIDER CARIBBEAN
Kingston, Jamaica, 9-13 August 1993
REPORT OF THE MEETING
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33