Setting microbiological water quality standards for sea bathing--a critical evaluation.
The World Health Organization (WHO) recently produced draft guidelines for safe recreational water environments. The microbiological standards proposed in the guidelines are expected to overestimate the degree of water quality required to provide given levels of public health protection. The WHO standards were obtained by means of a risk assessment which featured a dose-response model derived from a series of randomised controlled trials. The trials have many strengths but biases and problems with statistical analysis are likely to have led to over-estimation of the risks from bathing in the dose-response model. In addition, the WHO risk assessment failed to consider the effects of uncertainty and variability in risk estimates and sensitivity to model assumptions. Improved standards could be obtained by extending the risk assessment to examine these effects and by incorporating a suitably revised dose-response model.