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This paper presents a preliminary attempt at obtaining an order-of-magnitude estimate of the global burden of disease (GBD) of human infectious diseases associated with swimming/bathing in coastal waters polluted by wastewater, and eating raw or lightly steamed filter-feeding shellfish harvested from such waters. Such diseases will be termed thalassogenic--caused by the sea. Until recently these human health effects have been viewed primarily as local phenomena, not generally included in the world agenda of marine scientists dealing with global marine pollution problems. The massive global scale of the problem can be visualized when one considers that the wastewater and human body wastes of a significant portion of the world's population who reside along the coastline or in the vicinity of the sea are discharged daily, directly or indirectly, into the marine coastal waters, much of it with little or no treatment. Every cubic metre of raw domestic wastewater discharged into the sea can carry millions of infectious doses of pathogenic microorganisms. It is estimated that globally, foreign and local tourists together spend some 2 billion man-days annually at coastal recreational resorts and many are often exposed there to coastal waters polluted by wastewater. Annually some 800 million meals of potentially contaminated filter-feeding shellfish/bivalves and other sea foods, harvested in polluted waters are consumed, much of it raw or lightly steamed. A number of scientific studies have shown that swimmers swallow significant amounts of polluted seawater and can become ill with gastrointestinal and respiratory diseases from the pathogens they ingest. Based on risk assessments from the World Health Organization (WHO) and academic research sources the present study has made an estimate that globally, each year, there are in excess of 120 million cases of gastrointestinal disease and in excess of 50 million cases of more severe respiratory diseases caused by swimming and bathing in wastewater-polluted coastal waters. Filter-feeding shellfish/bivalves, which are often harvested from wastewater-polluted areas of the sea, can effectively filter out and concentrate the microbial pathogens in the seawater. It can be roughly estimated that annually there are some 4 million cases of infectious hepatitis A and E (HAV/HEV), with some 40 thousand deaths and 40 thousand cases of long-term disability, mainly chronic liver damage, from consuming raw or lightly steamed filter-feeding shellfish/molluscs harvested globally from polluted coastal waters. The total global health impact of the thalassogenic diseases--human infectious diseases associated with pathogenic microorganisms from land-based wastewater pollution of the seas--is estimated to be about 3 million 'disability-adjusted life years' (DALY)/year, with an estimated economic loss of some 12 billion dollars per year. Due to the preliminary nature of the estimates in this study it is appropriate to assume that all of the above figures are no more than first approximations and that the true figures may be 50% higher or lower. Nevertheless, it is the author's belief that this study indicates that wastewater pollution of the sea results in a multi-billion dollar per year health burden and that preventing wastewater pollution of the sea is worthy of inclusion on the global agenda of marine pollution prevention and control.

Estimating the global burden of thalassogenic diseases: human infectious diseases caused by wastewater pollution of the marine environment