This chapter presents a modified framework for assessing the credibility of association of illness with recreational water exposures and presents information on waterborne disease surveillance systems. Evidence for severity is outlined and an index of severity is described to help public health professionals better prioritize and manage diseases with potentially severe outcomes related to recreational water exposures. 3.1 SOURCES OF AVAILABLE EVIDENCE Evidence for this review is taken from two main sources: published scientific literature (case reports and epidemiological studies) accessed through databases such as MEDLINE; and available data reported to national surveillance centres. The majority of cases of illnesses associated with recreational waters are reported from the United States and the United Kingdom (the latter since 1992
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