Studies have increasingly found significant relationships between respiratory illness risk and a bacterial indicator. This has been shown in recent studies in at least four different countries, but it may not be a new phenomenon:
- Hong Kong (Cheung et al 1990)
- England (Balarajan et al 1989; Fewtrell et al 1992; Fleisher, Kay, Salmon et al 1996)
- Australia (Corbett et al 1993)
- New Zealand (McBride, Salmond et al 1998).
The aetiological agent(s) for this are unclear, although it is generally recognised that a number of bacterial and viral pathogens that cause respiratory illness (e.g. members of the enterovirus and adenovirus group, and certain species of the genus Klebsiella) are shed in faecal matter. Infection is generally acquired by inhalation of aerosols containing these infectious particles (Horwitz 1990; Melnick 1990; Tyler & Fields 1990; Grimont et al 1992), and the potential for transmission of viral pathogens via wave-generated aerosols has been demonstrated (Baylor et al 1977).
Contact with contaminated recreational water has been shown to pose a number of possible health risks. These illnesses, symptoms and pathogens are listed in Table G1, along with the relevant references.
A number of New Zealand cases of campylobacteriosis from the ingestion of contaminated drinking water have been demonstrated (Briesman 1987; Stehr-Green et al 1991; Ikram et al 1994; Eberhart-Phillips et al 1997), as has also been shown for giardiasis (Fraser & Cooke 1991). With respect to respiratory symptoms, inhalation of aerosols has been indicated as a possible transmission route (Baylor et al 1977; Tyler & Fields 1990). See also Note G(i).
|Campylobacteriosis – acute diarrhoea with risk of dehydration lasting about five days, but may be longer. Usually with fever, headaches and nausea in the first stages. Abdominal pain can be sufficiently severe for patients to be hospitalised with suspected appendicitis.||Campylobacter jejuni||Koenraad et al. 1997|
|Cryptosporidiosis – acute diarrhoea. Symptoms may wax and wane but duration in healthy persons is usually less than 20 days with spontaneous complete recovery. May be fatal in immunocompromised patients.||Cryptosporidium parvum||Sorvillo et al. 1992|
|Ear infection – otitis externa, skin infection of the outer ear and otitis media, inner ear infection with exudate and earache.||Not identified (usually Pseudomonas aeruginosa, Streptococcus, and Staphylococcus)||Robson & Leung 1990|
|Enterovirus-like illness – vomiting, diarrhoea, and abdominal pain.||Enteroviruses (type not identified)||D'Alessio et al. 1981|
|Hepatitis A – long incubation with symptoms developing gradually. Symptoms include loss of appetite, malaise, fever and vomiting followed by jaundice.||Hepatitis A virus||Bryan et al. 1974|
|Norwalk gastrointestinal illness – usually sudden onset with vomiting, diarrhoea and abdominal pain. Vomiting frequently appears without warning and may be projectile and uncontrollable, while diarrhoea may be explosive.||Small round structured viruses (SRSVs), including Norwalk virus||Barron et al. 1982|
|Respiratory illness – cold and flu-like symptoms. May be associated with fever.||Adeno virus and others not identified||McBride, Salmond et al. 1998; Corbett et al. 1993; Fattal et al. 1986|
|Shigellosis – diarrhoea that may vary from relatively mild to violent, with abdominal pains and fevers.||Shigella sonnei||Rosenberg et al. 1976|
|Swimmer’s ear – otitis externa, infection of the outer ear.||Not identified (usually Pseudemonas aeruginosa)||Calderon & Mood 1982|
|Typhoid and Paratyphoid (enteric) – fever||Salmonella typhi and Salmonella paratyphi||PHLS 1959|
Environmental performance indicators are designed for use in state of the environment monitoring programmes. They help us to:
- systematically report on the state of New Zealand’s environmental assets
- systematically measure the performance of its environmental policies and legislation
- better prioritise policy and improve environmental decision making.
Over time, the information produced by State of the Environment reporting can:
- contribute to raising the level of knowledge about the state of New Zealand’s environment
- increase our ability to report on environmental health and trends
- provide the tools for effective evaluation of policy
- provide the information base for more informed policy and management decisions.
This document serves as a monitoring protocol two state of the environment performance indicators developed by the Ministry under the Environmental Performance Indicators (EPI) Programme. Please note that beaches refer to both freshwater and marine recreational areas, so each of the following indicators would be reported for marine and freshwater beaches:
- the percentage of monitored beaches in each beach grade
- the percentage of the season beaches or coastal areas were suitable for bathing or shellfish gathering.
The Pressure-State-Response (PSR) model was used to measure environmental performance of management responses to develop environmental performance indicators. The PSR model asks three important questions:
- What are the pressures on the environment?
- What is the state of the environment?
- What is being done to manage changes in pressures or state?
Pressure indicators answer the first question by measuring the stresses from human activities (and natural variations) that cause environmental change. State indicators answer the second question by measuring actual changes or trends in the physical or biological state of the environment. Response indicators answer the third question by monitoring the effectiveness of policies or actions taken by people to reduce, prevent or mitigate undesirable change in the state of the environment.
The indicators on which these guidelines are based; percentage of monitored beaches in each beach grade, and percentage of the season beaches or coastal areas were suitable for contact recreation or shellfish gathering, are state indicators that provide general information on the public health risk presented by recreational waters. Pressure indicators would measure the surrounding land use and discharges to water to assist identification of potential causes of changes in water quality. Response indicators would identify management or policy changes at the regional or national level (for example infrastructural improvements, land use management policies, national environmental standards) to manage issues for recreational waters.
Implementation of integrated pressure, state and response monitoring provides a measure of the entire system in question and supports detection of policy gaps or opportunities for management improvements.
The purpose of the Microbiological Water Quality Guidelines for Marine and Freshwater Recreational Areas is to help control the public health risk from microbiological contamination in recreational waters, and to provide a framework for monitoring and reporting on the general health of beaches. Integrating the needs of both state of the environment and public health monitoring may present some challenges, but it is achievable.
Microbiological information is generated more intensively to keep stock of short-term variation that can affect the public health risk of water quality. This monitoring takes place on a weekly basis, although at times follow-up monitoring is required to identify the permanence of an identified guideline exceedance.
The purpose of state of the environment monitoring is to collect sufficient data to produce information on the general health of the environment. This information can then be used to measure how well our management practices, policies and laws are working, and whether environmental outcomes are being achieved. The beach grades generated through the combination of the catchment assessment and microbiological assessment provide state of the environment information to the public on the general condition of the recreational area with respect to public health risk. The microbiological information collected to assess the public health risk at the beach on a weekly basis is aggregated over five years to generate the Microbiological Assessment Category used in the beach grading process.
Councils may monitor microbiological water quality for objectives other than public health reporting (e.g. land-use pressure, trends). Merging monitoring programmes can result in significant cost savings, though there are some issues to be aware of.
The following considerations should be made when merging programmes other than for public health reporting:
- Can the sampling requirements of both programmes be satisfied?
- Will the sampling locations be appropriate for both programmes?
See Box 4 for an example of merging programmes.
Box 4: Issues with integrating programmes
Council A’s existing microbiological monitoring programme has been specifically designed to monitor the effects of agricultural land-use. The sampling conditions (wet, dry) and the locations of those sites are important to determine trends over time and space. The monitoring requirements to meet these objectives are:
- monitoring sites that are representative of the catchment
- avoiding monitoring during or after storm events, to avoid skewing trends
- monthly sampling.
However, the public health programme as outlined in the Microbiological Water Quality Guidelines for Marine and Freshwater Recreational Areas has been designed for the protection and reporting of public health risk. This requires:
- monitoring at beaches that are used for contact recreation
- sampling at locations and times that most closely represents public exposure (this may include sampling during rainfall events)
- weekly sampling.
When the council attempted to satisfy the monitoring requirements of both programmes, it quickly became clear that there would be difficulties merging the two without the objective of one or both of the programmes being compromised.
Merging or adapting an existing state of the environment monitoring programme to report on public health risk requires careful design to ensure the objectives of both programmes are successfully achieved. The following solutions are suggested where monitoring objectives conflict.
- Separate monitoring programmes: this is not the most efficient solution, but the clearest way to preserve the integrity of both monitoring programmes.
- Integrate the programmes: design a joint programme taking advantage of overlaps, recognising the specific sampling requirements of each programme. This approach is more complex and may involve tagging data considered unsuitable to the differing objectives.
- Economise sampling efforts: use the catchment assessment and frequency of use to prioritise beaches that require weekly sampling for public health risk evaluation. These beaches will form the focus for meeting the public health objectives of the guidelines. The land-use pressure objectives could then be met by a less stringent sampling regime while maintaining important trend information.
As part of determining a sensible and pragmatic approach to recommending an assignment of roles and responsibilities, the Ministry for the Environment investigated a number of scenarios operating around the country.
Scenario One: Integrated approach
- The regional council undertakes all beach monitoring in an area.
- When the alert level is exceeded, the territorial local authority carries out additional monitoring. Additional sampling is funded by the Medical Officer of Health.
- A sanitary survey is carried out when in alert mode II.
- When the action level is exceeded the territorial local authority carries out additional monitoring. Additional sampling is funded by the Medical Officer of Health.
- Investigation of nuisance is carried out by the territorial local authority.
- When in action mode, public notification is undertaken by the Medical Officer of Health (includes signage).
Scenario Two: Medical Officer of Health lead
- The Medical Officer of Health brings the regional council and territorial local authorities in the region together before the beginning of the bathing season to ascertain the degree of monitoring programmed for the region. The Medical Officer of Health is kept informed of the status of beaches throughout the entire season.
- The territorial local authority carries out all monitoring in each district.
- When the alert level is exceeded the territorial local authority undertakes a degree of investigation (additional sampling is rarely carried out).
- When the action level is exceeded signs are put up at beaches (sometimes permanent around some discharge points) and a public communications strategy is implemented.
- An investigation into the cause of nuisance is carried out.
- The regional council is kept informed throughout the season.
Scenario Three: Single agency
- The territorial local authority carries out monitoring.
- The public are not alerted when action levels are exceeded, although an investigation is carried out to find the cause of the problem and abate nuisance.
- The Medical Officer of Health is available to provide advice to the territorial local authority on whether to inform the public.
Scenario Four: Regional lead
- The regional council carries out all monitoring.
- Territorial local authorities remain informed of water quality in their district through regional councils.
- The Medical Officer of Health is informed by regional councils when the action level is exceeded, and provides advice on the public health significance.
- Regional councils take additional samples and investigate when the action level is exceeded.
- The Medical Officer of Health informs the public when the action level is exceeded.
Scenario Five: Double check
- The regional council monitors beaches for state of the environment reporting.
- The territorial local authorities monitor beaches for public health purposes.
- The Medical Officer of Health provides advice on a sampling strategy and the public health significance of sampling results.
- The territorial local authorities carry out additional sampling and investigation when alert levels are exceeded.
- Territorial local authorities inform the public when action levels are exceeded and investigate the nuisance.
The recommendations made by the Ministry for the Environment and the Ministry of Health are supported by legislation as follows.
The regional council undertakes surveillance and alert-level monitoring (including resource consent monitoring).
Section 35 of the Resource Management Act, 1991 requires regional councils to undertake monitoring to carry out their functions under the RMA effectively. Section 35(2) requires regional councils to undertake “state of the environment” monitoring.
Under the RMA, regional councils have functions in relation to the coastal marine area, including coastal waters, which are linked to the purpose of the RMA. The aspects of the purpose of the RMA (Part II) that are relevant to coastal waters/marine bathing and, in particular, the public health aspects of beach water quality are:
- section 5 – sustainable management incorporates health and safety, safeguarding the life-supporting capacity of water and avoiding, remedying or mitigating any adverse effects of activities on the environment
- section 6 – the preservation of the natural character of the coastal environment, including the coastal marine area and the maintenance and enhancement of public access to and along the coastal marine area are matters of national importance
- section 7 – the maintenance and enhancement of amenity values and the quality of the environment are matters to which particular regard must be had by decision makers under the RMA.
Section 30 of the RMA ascribes functions to regional councils for the purpose of giving effect to the RMA, including:
- control of land use for the purpose of maintaining and enhancing the quality of coastal water
- in respect of the coastal marine area, the control of discharges of contaminants into water and discharges of water into water
- the general, control of discharges of contaminants into water and discharges of water into water.
Policy 5.1.1 of the New Zealand Coastal Policy Statement directs regional councils that:
Rules should be made as soon as possible with the object of enhancing water quality in the coastal environment where that is desirable to assist in achieving the purpose of the Act, and in particular where there is a high public interest in, or use of the water.
In summary, it is consistent with the RMA to require regional councils to undertake surveillance monitoring and alert-level monitoring of marine bathing waters. Arguably, the RMA requires regional councils to go further than this and undertake stepped-up nuisance monitoring, where necessary.
There is no provision in the Health Act for the Medical Officer of Health to audit the monitoring carried out by regional councils. However, the recommendation that the Medical Officer of Health be satisfied with the manner in which the monitoring is carried out is to protect public health and safety. It also helps to ensure that the guidelines will be consistently applied around the country.
If alert or action levels are reached the regional council informs the Medical Officer of Health and the territorial authority. The Medical Officer of Health ensures the territorial authority is informed.
Section 35(2) of the RMA requires regional councils to “take appropriate action (having regard to the methods available to it under the RMA) where this is shown to be necessary”. This is linked to state of the environment monitoring requirements. Appropriate action may include informing the Medical Officer of Health and territorial authority.
Once the Medical Officer of Health is aware that alert or action levels have been exceeded, it is consistent with the Health Act that he or she ensure that the territorial authority is informed. Under the Health Act, the Director-General of Health (and his or her officers) has an overriding duty to improve, promote and protect public health. The Medical Officers of Health and Health Protection Officers under the Director-General of Health have supervisory/ auditing roles in relation to public nuisances. While there is specific legislative authority for the Medical Officer of Health to direct territorial authorities, there is currently no such authority for him or her to direct regional councils.
The territorial authority informs the public, where necessary. The Medical Officer of Health ensures the public are informed.
Territorial authorities have a duty to improve, promote and protect public health within their districts under section 23 of the Health Act. This extends to specific powers and duties:
If satisfied that any nuisance, or any condition likely to be injurious to health or offensive, exists in the district, the territorial authority is to cause all proper steps to be taken to secure the abatement of the nuisance or the removal of the condition.
“All proper steps” arguably includes informing the public. Also, as outlined above, the Medical Officer of Health has an auditing role under the Health Act, and it is consistent with this that he or she ensures that the public is informed.
Section 57 of the RMA provides for a New Zealand Coastal Policy Statement (NZCPS), which is mandatory. By virtue of sections 55 and 57, local authorities must take such action as is necessary to implement the NZCPS. Policy 5.1.7 of the NZCPS states:
Provision should be made to ensure that the public is adequately warned when the degradation of water in the coastal environment has rendered the water unsafe for swimming, shellfish gathering or other activities.
Consequently, the NZCPS directs local authorities to make provision to warn the public.
Regional councils have functions to ensure that integrated management of the natural and physical resources of a region is achieved, and provision could be achieved by ensuring that territorial authorities will carry out this function.
If the action level is reached, in the first instance the territorial authority will undertake nuisance monitoring and cause all proper steps to be taken to abate or remove the nuisance. On occasion it may be more appropriate for the regional council to undertake this duty. The Medical Officer of Health will provide advice and ensure that the territorial local authorities and/or regional councils take proper steps.
The Health Act requires territorial authorities to undertake nuisance monitoring in relation to their districts pursuant to section 23:
To cause inspection of its district to be regularly made for the purpose of ascertaining if any nuisances, or any conditions likely to be injurious to health or offensive, exist in the district.
‘District’ is not defined in the Health Act, and arguably the coastal marine area is not within a territorial authority’s district because of the definition of ‘district’ in the RMA. However, this definition does not expressly apply to the Health Act. Further, the source of the nuisance is likely to be within the territorial authority’s district (i.e. the land, as defined in the RMA), and it is appropriate that the territorial authority locate the source of the nuisance.
The RMA requirements for regional councils to monitor may extend to nuisance monitoring. For example, where the cause of the nuisance is found to be a consented activity or an activity controlled by the regional council rather than the territorial local authority, then responsibility for continued monitoring and abatement rests with the regional council. Other situations where it may be more appropriate for the regional council to carry out nuisance monitoring include when it has been agreed by all agencies involved before the beginning of the bathing season, and where the territorial local authority is too small to cope with increased monitoring. The Medical Officer of Health may need to assist the territorial local authorities and regional councils in determining the most appropriate agency to investigate and monitor the nuisance.
A legal opinion sought by the Ministry for the Environment found that the two major pieces of legislation concerned (the RMA and Health Act) did not explicitly define responsibilities for beach water-quality monitoring and reporting. However, the proposed framework is consistent with current legislation.
The Annapolis Protocol combines a monitoring scheme of microbiological testing with broader data collection on sources and transmission of pollution. It involves both an environmental hazard assessment and a microbiological water-quality assessment.
Councils and health authorities have been consulted on the concept and implementation of a risk-based approach and guideline values for recreational waters. The Annapolis Protocol framework as detailed in the guidelines has been adapted to suit New Zealand conditions after trial at 30 New Zealand recreational beaches and consideration by a Marine Bathing Working Group established for the purpose. The same approach has been applied to the guidelines for freshwater recreational use, following consideration and trial by the Freshwater Guidelines Advisory Group.
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