Objectives We evaluated the severity of illness among those engaging in limited-contact water recreation such as boating, fishing, kayaking, and rowing.

Method Data were obtained from a cohort study which assessed the development of illness following water recreation. Disease severity was defined as symptom-days, the total number of days with symptoms related to gastrointestinal illness, respiratory illness, or eye, ear, and skin symptoms. Severity was evaluated in association with the degree of water exposure. Analysis included logistic regression and G-computation.

Results 11 297 participants completed the cohort study, of which 2301 developed symptoms related to gastrointestinal illness, respiratory illness, or eye, ear, or skin infection. When evaluating both ill and healthy participants who participated in water recreation, total symptom-days ranged from 0–67, and exhibited a right-skewed distribution. When dichotomized at the 90^th percentile, there was a crude relative risk (RR) of 1.47 (1.27–1.72) for those getting their face wet during water recreation, and a RR of 1.65 (1.28–2.12) for those indicating that they swallowed water during water recreation.

Conclusions Increased water exposure, resulting in getting the face wet, or swallowing water is related to increased disease severity among water recreators. Further analysis is necessary to determine if any covariates such as age, race/ethnicity, gender, or previous comorbidities modify or confound the relationship between water exposure and disease severity.