Recreational exposure to polluted open water and infection: A systematic review and meta-analysis protocol
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 posi...
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| Published in | Environment international Vol. 200; p. 109371 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Netherlands
Elsevier Ltd
01.06.2025
Elsevier |
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| Abstract | 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.
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. |
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| AbstractList | 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.
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. 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.BACKGROUNDOpen 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.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.METHODSWe 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. 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. |
| ArticleNumber | 109371 |
| Author | Jones, Matt Lloyd Ukoumunne, Obioha C. Clare Leonard, Anne Frances Gaze, William H. Taylor, Tim Lamb, Emma Singer, Andrew C. Garside, Ruth Bethel, Alison |
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| Keywords | Infection meta-analysis Systematic review Pollution Recreationnal water Water quality |
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| SubjectTerms | Environmental Exposure - statistics & numerical data Humans Infection meta-analysis Meta-Analysis as Topic Pollution Recreation Recreationnal water Swimming Systematic review Systematic Reviews as Topic Wastewater Water Microbiology Water Pollution - statistics & numerical data Water quality |
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| Title | Recreational exposure to polluted open water and infection: A systematic review and meta-analysis protocol |
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