Konbine Egou Debòde (CSO) nan rivyè lokal, lak, oswa plaj apre gwo lapli: Patojèn dlo egou kri, leptospiroz, ak dekontaminasyon apre imèsyon.¶

Lè yon tanpèt loraj ete, gwo lapli twopikal, oswa nèj ki fonn rapid jete plis pase 1.5 a 2.5 santimèt (0.6 a 1.0 pous) lapli pou chak èdtan sou yon vil ki pi ansyen ki sèvi ak yon Sistèm Egou Konbine (CSS), plant tretman dlo ize minisipal yo pa ka jere vag konbine dlo lari yo ak dlo egou sanitè nan kay la. Pou anpeche dlo egou anvan tout koreksyon tounen nan plizyè milye sousòl rezidansyèl yo ak nan lari vil yo, weirs sekou idwolik otomatik yo (Debòde Egou Konbine [CSO] debouche yo) louvri bò rivyè iben yo, kanal aviwon, pò, ak plaj naje, dechaje dè milyon de lit poupou moun ki pa trete, efluen lopital, ekoulman endistriyèl, ak dlo lari ki kontamine ak pipi rat dirèkteman nan vwa navigab lwazi pou 24 a 72 èdtan apre lapli a sispann. Si yon kayakè, yon rameur, yon triatlèt, yon surfe, yon pechè, yon travayè sekou inondasyon, oswa yon bèt kay yo plonje nan yon rivyè, lak, oswa plaj bò lanmè pandan oswa nan lespas 48 èdtan apre yon CSO egzeyat, yo fè fas a lèptospiroz (maladi Weil), enterotoxigenic Escherichia coli (STEC O157:H7), noroviris, epatit A, Cryptosporidium, ak Vibrio vulnificus / Aeromonas hydrophila enfeksyon nan tisi mou ki nekrotize. Rele nimewo ijans lokal ou a (911 nan Etazini ak Kanada, 112 atravè Inyon Ewopeyen an, 999 nan Wayòm Ini) atravè nou an. nimewo ijans anyè si yon moun devlope gwo lafyèv, lajònis, po wouj-vyolèt, oswa detrès respiratwa apre imèsyon dlo egou, epi konsilte gid frè ak sè nou yo sou sanitè egou fòs prensipal rupture, kri dlo egou geyser nan lari, ak fèmen valv backwater, egou prensipal debòde ak inondasyon lari, ak dlo prensipal la kraze ak bouyi dlo.

Siviv imèsyon aksidan oswa kontak lwazi ak yon Debòde Egou Konbine (CSO) oswa Debòde Egou Sanitè (SSO) plume mande pou egzekite kat pwotokòl etabli pa U.S. Ajans Pwoteksyon Anviwònman (EPA Nasyonal CSO Règleman Kontwòl), Sant pou Kontwòl ak Prevansyon Maladi (CDC), Òganizasyon Mondyal Lasante (WHO), ak Ajans Sekirite Sante UK (UKHSA): **fè respekte fenèt obligatwa 48 a 72 èdtan apre lapli "Pa naje / Pa chavire" an anba nan vil la. CSO debouche **, fè yon douch 15 minit tèt-zòtèy savon ak dlo tyèd ki te swiv pa irigasyon wo-presyon (500 mL dlo potab oswa saline esteril plis 2% Chlorhexidine oswa Povidone-Iodine) nan chak grate po, ti anpoul, oswa mòde sangsi/ensèk anvan bakteri anvayi dèrm la, woujye je ak pasaj nen yo avèk esteril. 0.9% saline san yo pa itilize dlo tiyo andedan nen an, epi mande yon evalyasyon medikal vize apre ekspoze (Doxycycline 200 mg yon sèl dòz prophylaxis leptospiroz, Tdap rapèl tetanòs, ak Hepatitis A vaksen/iminoglobulin nan lespas 14 jou) lè gen gwo risk enjèstyon oswa imèsyon blesi louvri.

Fè sa kounye a¶

1. Soti dlo a touswit si w wè oswa pran sant CSO Endikatè ekoulman yo: Plonj mawon-gri, "Fatra dlo egou" k ap flote (tivyèt mouye, aplikatè tanpon, kapòt), kim andigman/grès, oswa goelan plonje nan yon tiyo ki anba dlo. Anpil nan vil yo. CSO debouche yo plonje anba liy dlo rivyè, lak, ak plaj epi yo kòmanse dechaje nan 15 a 30 minit apre yon gwo lapli. Si yon tanpèt frape pandan w ap rame, kayak, paddle, oswa naje, oswa si minisipal ou a. CSO kat jeyografik alèt montre yon egzeyat aktif oswa resan (within the past 48 hours), soti nan dlo a imedyatman, kenbe bouch ou fèmen pou reveye espre pa frape bouch ou, epi pa rense men ou oswa figi ou nan rivyè a.
2. Egzekite "Premye 30 minit manbràn mikez ak dekontaminasyon douch la" anvan ou manje, bwè, oswa manyen figi ou. Anvan ou manyen yon boutèy dlo, goute, telefòn, oswa volan machin, dezenfekte men ou ak 60% to 70% jèl alkòl (remake ke jèl alkòl touye bakteri tankou E. coli ak Leptospira, men PA touye Norovirus oswa Cryptosporidium oosist, ou dwe lave ak friksyon ak savon). Dezabiye tout kostim mouye, gad kòlèj, vès sovtaj (PFDs), ak soulye dlo deyò oswa nan yon sache fatra plastik, douch byen ak dlo potab cho ak savon anti-bakteri pou omwen 5 a 10 minit, epi mouche nen ou epi krache soti nenpòt ki saliv olye ke vale degoute apre nen.
3. **Ire chak koupe, ti anpoul, grate, oswa mòde ensèk yo anba gwo presyon dlo k ap koule pandan 5 minit konplè, aplike povidon-yod oswa kloreksidin, epi PA JANM fèmen oswa kole yon blesi ki ekspoze nan dlo egou yo byen. shell scrapes) sèvi kòm pòtay antre dirèk pou Leptospira spirochetes, Aeromonas hydrophila, ak Vibrio vulnificus. Fwote epi lave chak poz nan po a ak savon ak dlo potab k ap koule (oswa a 500 mL boutèy saline esteril pèse pou voye yon kouran presyon), aplike 10% Povidone-Iodine (Betadine) or 2% to 4% Chlorhexidine Gluconate (Hibiclens), epi kouvri ak yon twal gaz esteril respirante (pa janm sele yon blesi dlo egou ki kontamine ak lakòl cyanoacrylate likid po oswa bann papiyon sere, ki pyèj anaerobik ak bakteri nekrotizan andedan).
4. Si dlo egou larivyè oswa plaj la te vide nan je w oswa nan bouch ou: lave je w ak esteril. 0.9% Saline pou 5 a 10 minit, epi rense bouch ou ak renmèd antiseptik san w pa vale. Pa fwote je dlo egou yo (ki moulen limon ak Adenovirus / Acanthamoeba nan korn); awoze tou de je yo ak dlo saline esteril. Swish ak krache 0.12% Chlorhexidine oswa alkòl/setylpyridinium antiseptik renmèd bouch pou 30 segonn pou diminye chaj viral ak bakteri nan mukoz oral.
5. Kontakte yon doktè oswa yon klinik swen ijan nan lespas 24 èdtan si w vale CSO Dlo oswa plonje yon blesi ouvè: Mande sou Doxycycline Pwofilaksi leptospiroz, Tdap Booster tetanòs, ak Hepatitis A Pwofilaksi apre Ekspozisyon. Anba gid klinik CDC/WHO, imèsyon dlo egou nan dlo dous ki gen gwo risk (espesyalman chavire ak enjèstyon dlo oswa ekspoze blesi ouvè nan rivyè iben ki abrite pipi rat) jistifye konsiderasyon nan sèl dòz oral. Doxycycline 200 mg pwofilaktik apre ekspoze (PEP) nan lespas 24 a 72 èdtan pou anpeche leptospiroz, yon Tdap / Td rapèl tetanòs si dènye vaksen ou te genyen plis pase 5 ane pou yon blesi sal, ak yon sèl dòz vaksen epatit A (plis IG si iminokonpwomi) nan lespas 14 jou si yo pa pran vaksen an.
6. ** Siveye drapo wouj "de-faz" yo pandan 2 a 30 jou kap vini yo: Selulit rapid (12 to 72 Hours) vs. Leptospirosis / Weil's Disease (5 to 14 Days).** Ale nan yon Depatman Ijans Lopital imedyatman epi di doktè triyaj la klèman "Mwen te plonje nan yon rivyè/plaj Debòde Egou Konbine nan [Dat]" si w devlope *(A) Anfle po wouj/vyolèt k ap gaye rapidman, gwo doulè ki pa pwopòsyon ak yon ti koupe, oswa ti anpoul ki plen san nan lespas 12 a 72 èdtan * oswa Vikwomona fasiit), OSWA (B) Gwo lafyèv, gwo doulè nan ti towo bèf/nan misk nan do, je san (conjunctival suffusion without pus), yellow eyes/skin (jaundice), dark brown urine, or coughing up blood 2 to 30 days later (Leptospirosis / Weil's disease).

Decision tree: Combined Sewer Overflow (CSO) immersion decontamination & medical triage¶

flowchart TD
    A["Person or Pet Submerged or Splashed in River, Lake, Canal, or Beach During or Within 48-72 Hours After Heavy Rain (CSO / SSO Event)"] --> B{"Immediate Step 1: Decontamination Within 30 Minutes of Exiting Water"}
    B --> C["Strip wet gear outside -> Shower 5-10 min with warm potable water & soap -> Irrigate ALL cuts/blisters with 500 mL pressurized water + Povidone-Iodine / Chlorhexidine -> Flush eyes with sterile 0.9% saline"]
    C --> D{"Did the person swallow sewage-contaminated water, submerge their head, or expose an open cut/blister/rash?"}
    D -->|"YES: Swallowed water, head immersion, or open skin wound"| E["Same-Day Medical / Urgent Care Consult (Within 24-72 hrs): 1. Tdap Tetanus Booster (if >5 yrs since last dose) 2. Discuss Doxycycline 200 mg PO x1 Leptospirosis PEP (freshwater/urban river) 3. Hepatitis A Vaccine PEP (if unvaccinated, within 14 days)"]
    D -->|"NO: Brief splash on intact skin only, promptly washed"| F["Monitor skin and temperature for 30 days; disinfect boat/gear/wetsuit with 0.1% Sodium Hypochlorite (1:50 bleach) or Quaternary Ammonium"]
    E --> G{"Monitor for Acute Clinical Red Flags Over Day 1 to Day 30"}
    F --> G
    G -->|"Hours 12 to 72: Rapidly spreading red/purple skin swelling, severe pain out of proportion to cut, or bullae"| H["EMERGENCY DEPARTMENT IMMEDIATELY: Suspect Aeromonas hydrophila (freshwater) or Vibrio vulnificus (brackish/saltwater) Necrotizing Infection -> IV Ceftriaxone/Cefepime + Doxycycline + Surgical Consult"]
    G -->|"Days 1 to 10: Explosive watery or bloody diarrhea, vomiting, abdominal cramps"| I["GI Pathogen Workup: Oral Rehydration Salts (ORS) -> Stool PCR (STEC O157:H7, Salmonella, Campylobacter, Cryptosporidium, Giardia) -> AVOID antimotility drugs (Loperamide) if bloody diarrhea/fever"]
    G -->|"Days 2 to 30: Sudden high fever, severe calf/back myalgia, red eyes (conjunctival suffusion), jaundice, dark urine, or shortness of breath"| J["EMERGENCY DEPARTMENT IMMEDIATELY: Suspect Leptospirosis / Weil's Disease -> Blood/Urine PCR + MAT Serology, Renal/Hepatic Panel -> Start Doxycycline or IV Ceftriaxone IMMEDIATELY before lab confirmation"]

Part 1: How a Combined Sewer Overflow (CSO) Works & Why the "48-to-72-Hour Post-Rain Rule" Exists¶

Over 700 municipalities in the United States (concentrated in the Northeast, Great Lakes, Midwest, and Pacific Northwest, such as New York City, Chicago, Boston, Philadelphia, Washington D.C., Seattle, Portland, St. Louis, and Indianapolis), as well as major cities across the United Kingdom (London Thames Tideway, Manchester, Glasgow), Canada (Toronto, Montreal, Vancouver), and Europe (Paris Seine, Berlin Spree), rely on 19^th- and early-20^th-century Combined Sewer Systems (CSS).

1. The Hydraulic Physics of a CSO Regulator Weir¶

• Dry Weather Flow: During dry weather, 100 percent of domestic sanitary sewage (toilets, sinks, hospitals, industrial drains) flows through a single pipe to the Wastewater Treatment Plant (WWTP).
• Wet Weather Overflow (> 0.5 to 1.0 inch / 1.3 to 2.5 cm of rain): Because street storm-drain catch basins feed into the exact same underground pipe, a heavy rainstorm increases flow volume 10- to 50-fold within 20 minutes.
• The Relief Weir: To prevent the treatment plant from flooding and stop raw sewage from exploding out of residential toilets, an underground diversion dam (regulator weir oswa tide gate) spills the excess mixed flow, consisting of raw, unscreened, unchlorinated human sewage mixed with urban street runoff, directly out of riverside or beachfront CSO outfall pipes.
• Sanitary Sewer Overflows (SSOs) in Separate Sewer Cities: Even in newer cities with separate storm and sanitary pipes, heavy rain infiltrates cracked underground sanitary mains (Inflow and Infiltration [I&I]) or knocks out electric sewage lift-station pumps, causing Sanitary Sewer Overflows (SSOs) that bubble out of manholes directly into neighborhood creeks and lakes.

2. Why Is the Water Still Dangerous 24 to 48 Hours After the Sky Clears?¶

Swimmers, triathletes, and rowers frequently make the mistake of entering a river or beach the morning after a heavy thunderstorm because the sun is shining. After a CSO discharge ends, the waterway remains heavily contaminated for 48 to 72 hours (EPA / Public Health Beach Closure Standard) for three reasons: 1. Fecal Coliform & Enterococcus Die-Off Lag: While direct ultraviolet (UV) sunlight in clear water gradually inactivates bacteria, CSO plumes are loaded with suspended silt and organic turbidity (high Nephelometric Turbidity Units [NTU]) that shields bacteria, viruses, and protozoan cysts from UV light. 2. Tidal Estuaries & Slow-Moving Lakes: In tidal rivers (like the Hudson, Potomac, Thames, or Delaware) and enclosed lakes/harbors, the incoming tide pushes the raw sewage plume upstream, sloshing the same fecal mass back and forth past boathouses and beaches for 4 to 6 tidal cycles (48 to 72 hours). 3. Bottom Sediment Resuspension: Enteric viruses (Norovirus, Adenovirus, Hepatitis A) and Cryptosporidium oocysts bind to heavy clay particles that settle into the shallow riverbed or beach sand; when waders, rowers launching shells, or dogs stir up the ankle-deep bottom sediment 2 days later, they resuspend concentrated infectious pathogens.

Part 2: The 6 High-Risk Pathogens in Raw CSO Water (Incubation, Clues & Specific Treatments)¶

When a patient develops illness after CSO or floodwater immersion, clinicians must distinguish among six distinct pathogen classes with vastly different incubation timelines and antimicrobial treatments:

Part 3: Step-by-Step Post-Immersion Decontamination Protocol (Human, Gear, and Pets)¶

1. Human Body Decontamination (The First 30 Minutes)¶

If you capsize a kayak, rowing shell, or sailboat, fall off a dock, or swim in a waterway during a CSO / SSO advisory: 1. Mouth, Nose, and Eyes First (At the Boat Dock or Car): - Spit, Do Not Swallow: Immediately spit out any water in your mouth. Rinse your mouth thoroughly with bottled potable water and spit, then swish 15 to 20 mL of antiseptic mouthwash (0.12% Chlorhexidine or Listerine / cetylpyridinium chloride) for 30 seconds and spit. - Eyes: Flush both eyes with sterile 0.9% sodium chloride eyewash pods (100 to 250 mL per eye) with your head tilted sideways so runoff does not enter the other eye. - Nose: Gently blow your nose into a disposable tissue. If thick river muck entered the nostrils, rinse ONLY with sterile 0.9% saline spray (never squirt unboiled tap water up the nose, due to Naegleria fowleri / Acanthamoeba risk). - Zòrèy ("Zòrèy Naje" Prevansyon): Panche tèt ou sou chak bò pou vide dlo rivyè ki soti nan kanal zòrèy yo, apresa bay 4 a 5 gout yon 1:1 melanj de 70% Alkòl izopropil ak vinèg blan (2% Acetic Acid) nan chak kanal zòrèy (sòf si ou gen yon tanpèn pèse oswa tib zòrèy) pou touye Pseudomonas aeruginosa ak Aeromonas. 2. Dezabiye ekipman yo nan yon sak sele epi pran yon douch savon 10 minit: - Retire rad ki mouye, kostim mouye yo, bòt, ak gan anvan van epi lwen figi w (rale gad palè gratèl mouye anba a avèk prekosyon ak je ak bouch ou byen fèmen, oswa antre nan yon douch anvan epi rense deyò chemiz la anvan ou rale l sou tèt ou). - Lave tout kò w ak cheve w ak dlo potab tyèd ak savon likid (oswa 4% Chlorhexidine Gluconate fwote chirijikal pou janm yo, men yo, ak tors) pou omwen 5 a 10 minit. 3. High-Pressure Wound Irrigation & Open-Dressing Care: - Inspect your hands (especially rower's palm blisters), shins, ankles, and feet under bright light. - Flush every cut, blister, or scrape with at least 500 mL of pressurized potable water or sterile saline (use an 18-gauge catheter tip on a 35 mL syringe or poke a pinhole in a sterile water bottle cap to generate 7 to 15 psi irrigation pressure). - Apply 10% Povidone-Iodine solution or 2% Mupirocin / Bacitracin ointment and cover with a loose, breathable sterile gauze dressing. Check the wound every 6 hours for the first 72 hours: if a red border advances outward (draw a pen line around any redness), go to the Emergency Department immediately.

2. Decontaminating Wetsuits, Life Jackets (PFDs), Kayaks, Rowing Shells, and Dogs¶

• Rowing Shells, Kayaks, Oars, and Hard Gear: Never spray down a CSO-contaminated boat with a high-pressure power washer at head height (which aerosolizes Norovirus and STEC E. coli into an inhalable mist that infects everyone in the boathouse bay). Instead, wear nitrile gloves and eye protection, wash the hull and oar handles with detergent and a low-pressure garden hose, and sponge down all grip surfaces with a 0.1% Sodium Hypochlorite (1:50 household bleach dilution: 1/3 cup [80 mL] nan 5% to 6% bleach per 1 gallon [3.8 L] of water) or an EPA List N Quaternary Ammonium disinfectant with a 10-minute wet contact time, followed by a freshwater rinse.
• Neoprene Wetsuits, Booties, and PFDs (Where Bleach Damages Fabric): Bleach degrades neoprene and weakens nylon life-jacket webbing. Soak wetsuits and PFDs in a tub of cool water mixed with a phenolic or quaternary ammonium wetsuit/gear sanitizer (such as Steramine or Revivex BCD/Wetsuit Sanitizer) for 15 minutes, rinse thoroughly, and hang in direct outdoor UV sunlight to dry completely.
• Chen ki Naje oswa Bwè CSO Dlo: Chen yo extrèmman sansib a Leptospiroz egi fatal ak Giardia / Campylobacter enterit (menm chen ki pran vaksen kont leptospiroz pa ka kouvri kont tout serovar rat iben). Mete gan ki enpèmeyab, kawoutchou ak chanpou chen an deyò ak chlorhexidine bèt kay chanpou (ki pa kite savon nan je), sèk grif yo ak vant yo, anpeche yo niche fouri mouye yo, epi rele veterinè ou imedyatman pou mande enfòmasyon sou **doxycycline oral / Amoxicillin prophylaxis soti nan **.

First aid and infectious-disease instructions on this page are for emergency guidance only and never replace medical evaluation. We recommend taking an accredited First Aid and Water Safety course from the American Red Cross, St John Ambulance, or your national Red Cross or Red Crescent society.

Nimewo ijans rejyonal yo ak pwotokòl ajans yo¶

• United States: Call 911 for any medical emergency (such as suspected Weil's disease or necrotizing wound infection). Combined Sewer Overflows (CSOs) and Sanitary Sewer Overflows (SSOs) are regulated by the U.S. Environmental Protection Agency (EPA) under the Clean Water Act (NPDES Permit Program, 1994 CSO Control Policy, ak 40 CFR 122.38 Public Notification Rule for the Great Lakes). Recreational beach water quality closures are governed by the EPA BEACH Act Recreational Water Quality Criteria (which trigger a beach advisory when Enterococci exceed a geometric mean of 35 CFU/100 mL or a Statistical Threshold Value [STV] of 130 CFU/100 mL, or E. coli exceeds a geometric mean of 126 CFU/100 mL / STV nan 410 CFU/100 mL). Report an unmapped raw sewage spill to your municipal 311 / Water Utility Emergency Line and State Department of Environmental Protection.
• Wayòm Ini: Rele 999 pou ijans medikal oswa NHS 111 for urgent post-immersion medical advice and leptospirosis/tetanus assessment (citing the UK Health Security Agency [UKHSA] / British Rowing Leptospirosis (Weil's Disease) Guidance). To report a raw sewage discharge or fish kill in a river or beach, call the Environment Agency 24-Hour Incident Hotline on 0800 80 70 60 (England), Natural Resources Wales on 0300 065 3000, SEPA on 0800 80 70 60 (Scotland), or NIEA on 0800 80 70 60 (Northern Ireland). Check live storm overflow discharges via the Rivers Trust Sewage Map or Surfers Against Sewage Safer Seas & Rivers Service.
• Canada: Call 911 for emergencies or 811 (HealthLink / Info-Santé / Health811) for 24/7 registered nurse triage after sewage water exposure. Municipal CSO reporting and recreational water closures follow Health Canada's Guidelines for Canadian Recreational Water Quality (E. coli <= 200 CFU/100 mL geometric mean, <= 400 CFU/100 mL single-sample maximum; Enterococci <= 35 CFU/100 mL geometric mean, <= 70 CFU/100 mL single sample) and Environment and Climate Change Canada (ECCC) Wastewater Systems Effluent Regulations.
• European Union: Call 112 for emergency medical care. Coastal and inland swimming waters across EU member states are regulated under the EU Bathing Water Directive (2006/7/EC) and the revised Urban Wastewater Treatment Directive (UWWTD), which mandate short-term pollution advisories during stormwater CSO events based on Intestinal Enterococci and Escherichia coli thresholds.
• Australia and New Zealand: Call 000 (Australia) or 111 (New Zealand) for emergencies. State EPA beach watch programs (such as NSW Beachwatch and EPA Victoria Yarra Watch) and New Zealand's LAWA (Land, Air, Water Aotearoa Can I Swim Here?) enforce the mandatory 48-hour post-heavy-rain "No-Swim" rule under NHMRC Guidelines for Managing Risks in Recreational Water. See our complete directory at nimewo ijans.

Kesyon yo poze souvan¶

How long after heavy rain is a river, lake, or urban beach unsafe for swimming, kayaking, or rowing due to Combined Sewer Overflows (CSOs)?¶

Public health agencies (including the U.S. EPA, UK Environment Agency, Health Canada, and state Beachwatch programs) advise staying out of urban rivers, lakes, harbors, and coastal beaches near storm or CSO outfalls for at least 48 to 72 hours after heavy rainfall ends. Even when the sun comes out the next morning, suspended silt shields fecal bacteria, Norovirus, and Cryptosporidium from UV light, and tidal currents in estuaries push raw sewage plumes upstream and downstream for 4 to 6 tidal cycles before bacterial counts return to safe levels.

What should I do immediately if I capsize or swallow water in a river during a Combined Sewer Overflow event?¶

Immediately spit out any river water without swallowing, rinse your mouth with bottled potable water, and swish and spit an antiseptic mouthwash (such as 0.12% chlorhexidine or cetylpyridinium chloride) for 30 seconds. Flush your eyes with sterile 0.9% saline, shower with warm potable water and soap for 10 minutes within 30 minutes of leaving the water, and scrub and irrigate every skin cut, scrape, or rower's blister with pressurized clean water and povidone-iodine or chlorhexidine. Contact a doctor within 24 hours to discuss a tetanus booster, Hepatitis A vaccine prophylaxis, and single-dose oral Doxycycline (200 mg) leptospirosis prophylaxis.

What are the early warning signs of Leptospirosis (Weil's Disease) after swimming or rowing in sewage-polluted freshwater?¶

Leptospirosis typically begins 5 to 14 days (range 2 to 30 days) after exposure with a sudden high fever, chills, severe headache, nausea, and two hallmark clues that distinguish it from regular influenza: intense muscle pain localized in the calves and lower back, and conjunctival suffusion (bright red, bloodshot eyes without yellow pus). If untreated, 10 to 15 percent of patients progress to Phase 2 (Weil's disease), marked by yellow jaundice, dark brown or absent urine (acute kidney failure), meningitis, and coughing up blood. Tell your emergency room doctor immediately about your river or sewage-water exposure so they can start Doxycycline or IV Ceftriaxone right away.

Why is an open cut or blister exposed to warm coastal or brackish sewage runoff an immediate emergency if it turns red and painful?¶

Warm brackish, estuarine, and coastal waters contaminated by stormwater and sewage runoff harbor Vibrio vulnificus, while freshwater sewage plumes harbor Aeromonas hydrophila. Both bacteria can invade a tiny skin scrape, oyster cut, or rowing blister and trigger necrotizing fasciitis within 12 to 48 hours. If any wound exposed to river or beach water develops rapidly spreading redness, swelling, fever, purple or blood-filled blisters (bullae), or severe pain out of proportion to the size of the cut, go to a hospital emergency department immediately for intravenous antibiotics and surgical evaluation.

Gid ki gen rapò¶

• Sanitary sewer force main rupture, raw sewage geyser in street, and backwater valve closure
• Egou prensipal debòde ak inondasyon lari
• Prensipal dlo nan tout vil la kraze ak bouyi dlo
• Do-not-drink vs. boil-water advisory: chemical or fuel contamination in tap water
• Flash inondasyon

Sous ak konsèy ofisyèl yo¶

• U.S. Environmental Protection Agency (EPA): Combined Sewer Overflows (CSO) Control Policy (59 FR 18688), NPDES Public Notification Requirements for Combined Sewer Overflows to the Great Lakes Basin (40 CFR Part 122), and Recreational Water Quality Criteria (EPA 820-F-12-058: Enterococci & E. coli Thresholds).
• Sant pou Kontwòl ak Prevansyon Maladi (CDC) & World Health Organization (WHO): Leptospirosis Clinical Guidance for Healthcare Providers (Doxycycline 200 mg Post-Exposure Prophylaxis & Weil's Disease Treatment), Vibrio vulnificus & Aeromonas Wound Management in Flood/Sewage Water, and ACIP Post-Exposure Prophylaxis Guidelines for Hepatitis A and Tetanus.
• UK Health Security Agency (UKHSA), Environment Agency (EA), & British Rowing: Leptospirosis (Weil's Disease): Clinical and Recreational Water Safety Guidance for Rowers, Paddlers, and Open-Water Swimmers, and Event Duration Monitoring (EDM) Storm Overflow Reporting Standards.
• Health Canada: Guidelines for Canadian Recreational Water Quality (4^th Edition: Microbiological Pathogens, Combined Sewer Overflow Risk Management, and 48-Hour Post-Rainfall Advisories).
• Infectious Diseases Society of America (IDSA): Clinical Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections (Aquatic Wound Infections: Aeromonas hydrophila, Vibrio vulnificus, and Mycobacterium marinum) and Infectious Diarrhea (STEC O157:H7 Antimotility Contraindications).