Are Florida Beaches Safe? Health Department Doesn’t Know

By Ron Castle

FORT Myers, Florida, March 10, 2004 (ENS) - On January 23, 2004, environmental documentary film maker Gary Burris of Goodland, Florida was shooting video at the northern end of Fort Myers Beach to continue reporting on his documentary “Deep Trouble: The Gulf in Peril.” Burris sat down in wet sand near the waterline and his pants became soaked with sea water.

“Two days later I got this itching tingling sensation on my right buttock,” Burris said, describing how that “itch” erupted into a little bump resembling a boil. Burris tried treating it himself with an antibiotic cream but several days later with no improvement, he decided to take sulfa pills from an old prescription.

Within days, the infected spot had grown to the size of a walnut and the following morning it was nearly as big as a grapefruit. Burris, who felt incredibly sick, was sent by his doctor to the Naples Community Hospital emergency room, where he was diagnosed with a staph infection and immediately put on intravenous antibiotics.

The hospital found the bacteria involved in Burris’ infection - methicillin-resistant staphylococcus aureus or MRSA - were resistant to 14 of the 16 antibiotics they tested.

“I feel quite sure I got this infection from the water at Fort Myers Beach,” Burris said.

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Beach on Sanibel Island adjacent to Fort Myers Beach (Photo courtesy SFWMD)
Burris, a former Gulf fisherman who turned environmental activist when pollution in the Gulf caused fisheries to decline starting over 25 years ago, said, “The water in the Gulf is so polluted now there is no telling what’s in it. Pollution is killing coral in the Keys. Sea turtles are sick. Manatees are sick. This is the sickest I have ever been.”

While there is no direct link as yet, MRSA infections involving beach activities and commercial fishing have become increasingly common in Florida. From 2001 to 2003 numerous Florida ocean-related infections were reported by the Associated Press, the "Naples Daily News," the "Miami Herald" and the "Daytona News Journal" in Volusia County, which cited more than 10 cases of beach and fishing boat related MRSA in 2003.

The Volusia County Health Department "EPI-GRAM Special Edition" newsletter picked up on the news, stating in October, 2003, “The occurrence of MRSA infections is on the rise in Florida and nationwide. In response to this increase, the Florida Department of Health investigates potential outbreaks of MRSA infections and provides education to the public and healthcare community.”

Still, after all the alleged investigations, one question remains unanswered: whether MRSA is actually present in Florida sea water.

Howard Rodenburg, M.D., director of the Volusia County Department of Health, when asked about the investigation into the fishermen’s and beach goers' MRSA infections in 2003 stated, “I don’t perceive they are getting infections from contact with the ocean. I think the bacteria are colonizing within the human community on fishing boats,” he said, explaining that MRSA is ubiquitous, with 20 to 30 percent of the population housing the bacteria on their skin or in their mucous membranes. “Fishermen in general have poor hygiene in a close quartered environment.”

However, Alan Tice, M.D., an infectious disease specialist with the University of Hawaii, believes the answer might lie elsewhere.

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Haunama Bay beach on the Hawaiian island of Oahu is popular with residents and visitors alike. (Photo by Richard Mieremet courtesy NOAA)
“I think ocean water is definitely a potential source of MRSA.” Tice said. “We have found in Hawaii as many as 100 MRSA colonies per liter of sea water. We think it is human activity related. When people are on the beach, rates rise in the daytime and are lower at night.”

When asked about testing sea water as part of the investigation, Rodenburg said, “Even if MRSA is in sea water, it may be that way naturally. We did not do any sea water testing.”

Lindsay Hodges, press secretary for the Florida Department of Health Office of Communications said, “MRSA is not a reportable infection in Florida. It is very unlikely MRSA infections are coming from sea water.”

“We have not done any sea water testing. We can’t go out and test the whole Atlantic Ocean.” Hodges said.

When asked if testing Florida waters for MRSA would be a good idea, Hodges replied, “I don’t know, you will have to talk to the scientists about that.”

Some researchers believe the Florida Department of Health is not doing enough to contribute to understanding the MRSA link to sea water. “In the past, the Florida Department of Health has not acted in the best interests of protecting public health in Florida." said Dr. Ritchie Shoemaker, a Maryland medical doctor and environmental disease expert who has investigated numerous environmentally related illness problems in Florida.

“They have shown little interest in investigating environmentally related diseases,” Shoemaker said.

Dr. Shoemaker cited personal examples where he was involved in a red tide related neurotoxin investigation in Duvall County in 2003 and dinoflagellate related human illness on the St. Lucie River, where he believes the Florida Department of Health did not make a worthwhile effort to learn more about these events.

“It is known that MRSA can survive in water temperatures ranging from 59 to 113 degrees Fahrenheit,” Shoemaker said.

Other health departments have shown greater interest in adding to the body of knowledge about MRSA in sea water. In Hawaii, there is ongoing study regarding MRSA in sea water, according to Dr. Tice. Tests were started almost a decade ago when outrigger canoe paddlers and surfers frequently contracted MRSA infections.

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Staphylococcus aureus under a microscope. The methicillin-resistant Staphylococcus aureus (MRSA) strains are a problem in that there are no oral antibiotics to treat them that are known to be effective. (Photo courtesy University of Missouri)
Based on research by Dr. Roger Fujioka with the Hawaii Department of Health, who has found MRSA bacteria in sea water particularly where people congregate at beaches, it was discovered that MRSA can survive in sea water anywhere from hours to days.

Tice said, “We have been working with Dr. Fujioka to determine what level of staph bacteria in sea water is a marker for what is safe for human health.” Tice went on to say that this is an important key to preventing potential epidemic outbreaks.

The Florida Department of Health cites the lack of such a marker as reason for not testing for MRSA. Yet, every Florida coastal county already tests beach water for other bacteria that put human health at risk as part of the statewide Healthy Beaches Program.

Tice explained, “Sunlight exposure kills MRSA. But these bacteria can cluster together and form a biofilm, like a protective cover. Beach sand could provide a place for biofilm clustered bacteria to perpetuate.”

Both Dr. Tice and Dr. Shoemaker noted that MRSA bacteria have become biofilm formers to protect themselves from the environment and that MRSA bacteria are colonizing. Colonies of these single cell organisms start acting like interactive multi-cell organisms. The biofilm, a shield that protects the bacteria from environmental exposure, may allow MRSA to live longer in sea water.

The biofilm contains toxins that can cause hemolysis or a breakdown of red blood cells in humans. The biofilm seems to feed on the iron in human red blood cells. This appears to make these infections much more aggressive in humans, according to Shoemaker.

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Prisoner at Limestone Correctional Facility in Alabama displays a staph infection. (Photo by Robin Nelson courtesy SCHR)
“The rates of MRSA infection are increasing everywhere and the infections are getting harder to treat.” Tice said. “MRSA outbreaks or infections outside of health care facilities like the ones we have had in Hawaii are usually related to a skin injury like a scratch or scrape or cut. The infection gets its start there.”

Robert South, M.D., an epidemiologist with the Lee County Health Department in Fort Myers, dismisses Burris’s infection and other reports of MRSA from Fort Myers Beach. “We don’t have any problems here that I know of," he said. "We don’t hear about MRSA often.”

Lack of mandatory reporting and lack of sea water testing in Florida may be the reason. MRSA infections other than those acquired within a hospital or other health care facility are required to be reported to departments of health in only five states. Florida is not one of these states.

Jackie DiPietre with the Office of Communications of the Florida Department of Health advises, “The department is constantly undergoing reporting rules revisions and mandatory reporting of MRSA may be considered in the current round of discussions.”

DiPietre said that testing of sea water for MRSA does not appear likely soon.

But Burris, who has spent more than $4,000 on antibiotics and does not have health insurance, believes testing and reporting should already be happening.

On Monday he said, “It looks like my infection is coming back. I am going to see the doctor again today.”

{Ron Castle is an editor and producer with Public Eyes TV. Dara Colwell, freelance environmental journalist in New York City, contributed to this report.}