ADVANCEMENT OF THE PRACTICE
DIRECT FROM CDC ENVIRONMENTAL HEALTH SERVICES
Here Come the Surf Venues and Artificial Swimming Lagoons
Michele C. Hlavsa, MPH, RN
Joseph P. Laco, MSEH, REHS/ RS, CPO
injury associated with surf venues is inher- ently dierent from that associated with other aquatic venues, a change request proposing inclusion of text specific to surf venues was submitted for the fourth edition of the 2023 MAHC. It was not, however, approved. With multiple surf venues being planned before the release of the fifth edition of the MAHC, the Council for the Model Aquatic Health Code (CMAHC), a key CDC MAHC partner, reconvened its surf venue ad hoc committee in August 2022. The ad hoc com- mittee is made up of public health ocials and representatives from across the surf venue sector. Committee members have been categorizing each recommendation in the MAHC as “properly addresses surf venues,” “is not applicable,” or “needs revision to properly address surf venues.” The commit- tee is focusing on the recommendations in the “needs revision” category. Based on these discussions, CDC has been drafting interim guidance and the commit- tee will then develop and submit a change request that proposes inclusion of text spe- cific to surf venues for the fifth edition of the MAHC. To prevent injuries, discussion top- ics have included revising: 1) MAHC recom- mendations for slip-resistant finish where waves break in less than 3 ft of water, 2) depth marker recommendations for where water depths change substantially, and 3) lighting recommendations given that light basin color and shallow water combined can cause glare. Artificial swimming lagoons (ASLs) are being similarly addressed with support from the CMAHC artificial swimming lagoon ad hoc committee. ASLs are novel, large-format (up to hundreds of millions of gallons of
Editor’s Note: The National Environmental Health Association strives to provide up-to-date and relevant information on environmental health and to build partnerships in the profession. In pursuit of these goals, we feature this column on environmental health services from the Centers for Disease Control and Prevention (CDC) in every issue of the Journal . In these columns, authors from CDC’s Water, Food, and Environmental Health Services Branch, as well as guest authors, will share tools, resources, and guidance for environmental health practitioners. The conclusions in these columns are those of the author(s) and do not necessarily represent the ocial position of CDC. Michele Hlavsa leads healthy swimming activities at the National Center for Emerging and Zoonotic Infectious Diseases within CDC. CDR Joseph Laco serves as an environmental health ocer at the National Center for Environmental Health within CDC.
I n September 2018, the Centers for Dis- ease Control and Prevention (CDC) and state and local public health partners in Texas investigated a fatal case of Naegleria fowleri infection likely associated with a surf venue (Miko et al., 2023). Investigators found that the surf venue water was not recirculat- ed or filtered, and water quality testing and treatment were not documented. N. fowleri can infect people when water containing the amoeba enters the nose and then travels up the olfactory nerve and into the brain. Once in the brain, trophozoites (the infective life stage) destroy brain tissue, causing primary amoebic meningoencephalitis (PAM). While PAM rarely occurs, it is over 97% fatal. N. fowleri can be found in untreated recre- ational water venues (e.g., lakes, rivers, hot springs), particularly in the sediment at the
bottom. During 1962–2021, of the 154 known cases of PAM in the U.S., 85 (55%) were associ- ated with such venues and 7 (5%) with aquatic venues (e.g., pools, splash pads, surf venues). Linking an aquatic venue, or a venue with treated (e.g., filtered and chlorinated) water, to a PAM case is a red flag for inadequate water treatment in that aquatic venue. Surf venues are novel, large format aquatic venues dedicated to surfing on a surfboard— or other similar surfing and wave riding devices—and have equipment and a floor shaped to generate traveling and surfable waves that mimic those in oceans. The CDC Model Aquatic Health Code (MAHC) pro- vides guidance to help prevent public aquatic venue-associated illness and injury through venue design, construction, operation, and management. Because the risk of illness and
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Volume 85 • Number 9
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