A Review of the Human Health Risks from Microbial Hazards in Recreational Beach Sand.

At many recreational beaches, the health of visitors is protected through water quality monitoring programmes. However, visitors may also be exposed to microbiological pathogens in sand via ingestion, inhalation and skin contact. Microbiological pathogens that can cause human illness may be naturally found in beach sands, or introduced with people, animals or water entering the beach. The World Health Organization has recommended that recreational water safety plans consider microbial pathogens in beach sand. This review shows that a range of faecal and non-faecal pathogens can be detected in beach sand, but difficulty in determining whether exposure occurred via the sand or water means that there is insufficient evidence to link their presence with adverse human health effects. Proactively integrating beach sand testing into recreational water safety programmes will generate data to assess the impact of risk management activities. The use of faecal indicator bacteria to indicate elevated risk from faeces should be a priority where there are potential sources of contamination. This should be complemented with sanitary surveys and analyses that elucidate faecal contamination sources. The inclusion of non-faecal pathogens into monitoring programmes needs further, locally relevant justification through evidence from epidemiological studies and human health risk assessment.