A study today in Morbidity and Mortality Weekly Report that probed waterborne pathogen illnesses linked to splash pads in the United States since 1997 found that while chlorine is an important disinfecting agent, it does not eliminate Cryptosporidium, which is the most common cause of waterborne disease outbreaks associated with the playgrounds.
Splash pads are recreational spaces with fountains, sprayers, and jets that have emerged as water playgrounds for children in the past 30 years.
"Splash pads, which first appeared in the 1990s, are designed so that water typically does not collect in areas accessible to users," the authors wrote. "Although this feature minimizes the risk for drowning, splash pads have been associated with waterborne outbreaks of either infectious or chemical [source]."
Visitors are at risk of ingesting water that has been contaminated with feces at splash pads. Furthermore, because they lack standing water, some sates exempt splash pads from public health rules and regulations.
Cryptosporidium caused 90% of cases
The study included 60 waterborne disease outbreaks associated with splash pads reported from 23 states and Puerto Rico from 1997 to 2022. In total, these outbreaks included 10,611 cases, 152 hospitalizations, and 99 emergency department visits.
There were no reported deaths during the study period. Among the 60 outbreaks, 39 occurred in places with splash pads only, and 21 occurred in splash pads that included other venues, including pools or hot tubs.
Of the 10,611 cases, 9,622 cases (91%) and 123 hospitalizations (81%) were caused by Cryptosporidium, which was the pathogen associated with 40 outbreaks in the study.
The three largest outbreaks (2,307 cases, 2,050 cases, and 2,000 cases) were all caused by Cryptosporidium.
Norovirus caused most emergency visits
Norovirus, which caused two outbreaks, was associated with 72 emergency department visits (73%). Shigella caused five outbreaks (including one that was also caused by Cryptosporidium), Escherichia coli O157:H7 caused three, and the following caused one outbreak each: Campylobacter jejuni, Giardia duodenalis (Cryptosporidium also implicated), norovirus, and Salmonella serotype Newport, the authors said.
The most common barrier to infection used in splash pads is treatment with chlorine. Though chlorine is effective against many pathogens, it does not eliminate Cryptosporidium. The parasite can live longer than a week in chlorinated water, the authors said.
In order to combat Cryptosporidium outbreaks, behavior at splash pads should be the targeted intervention, including carefully monitoring children in diapers and children who frequently sit on water spouts and fountains.
Because splash pads are intended for young children, these efforts need to be oriented toward and reach caregivers of young children.
"Recommended user behaviors in splash pads and other recreational water venues include not getting in the water if ill with diarrhea until two weeks after it has stopped, not swallowing the water, taking young children on bathroom breaks or checking diapers or swim diapers every hour, and, if needed, changing them away from the water," the authors concluded. "Because splash pads are intended for young children, these efforts need to be oriented toward and reach caregivers of young children."
