Splash pads reduce risk of drowning in children and stimulate outbreaks of diarrhea

September 02, 2022

4 minute read

Disclosures: The authors report no relevant financial information.

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Wading pools for children in water parks offer less risk of drowning, but inadequate sanitization and poor toileting/hygiene skills create a hub for gastrointestinal disease outbreaks, data in Morbidity and Mortality Weekly Report.

“Splash pads are popping up everywhere” Michele C. Hlavsa, MPH, an epidemiologist and head of the CDC’s healthy swimming program, told Healio. “I suspect the public doesn’t know that the water is recirculated and recycled. Sitting on jets, drinking water from jets – these are great ways to spread germs or transmit diarrhea-causing germs.

Hlavsa and her CDC colleagues participated in a case-control study that identified 21 cases of shigellosis and six cases of norovirus infection that stemmed from a wading pool at a Kansas wildlife park in June 2021.

To identify those affected, the Kansas Department of Health and Environment and the affected wildlife park issued press releases and social media posts encouraging guests who visited the park between May 28 and June 19, 2021 to complete a questionnaire including questions on gastrointestinal diseases. . Those who did not show gastrointestinal symptoms were considered controls.

Study results

There were 404 respondents and analysis of the data revealed two separate outbreaks.

Of the 72 respondents who visited the park on June 11, the illness experienced by 29% (n=21; median age, 5 years; age range, 1-15 years; 62% female) was considered shigellosis , defined as three or three softer stools felt within 24 hours with disease onset 12 to 73 hours after park visit. While wading pool play was unrelated to illness, having water in the mouth of the wading pool was associated with illness (adjusted OR for multivariate complete case = 10.2; multivariate ORa imputed = 6.4; P = 0.036).

Of the 27 respondents who visited the park on June 18, the illness experienced by 22% (n=6; median age, 5 years; age range, 1-38 years; 83% female) was considered an infection norovirus, defined as vomiting or three or more loose stools within 24 hours with onset of illness 12 to 56 hours after park visit. All six individuals received splash protection water in the mouth, which was associated with illness (multivariate ORa of complete cases = 24.1; multivariate ORa imputed = 28.6; P = 0.006).

Three of the 21 children with shigellosis were hospitalized for an average of 3 days, while one child with norovirus was hospitalized for 1 day. No deaths have been reported in either outbreak.

Water, disinfection of equipment

According to the findings, young children for whom the splash pads are intended have poor toileting and hygiene skills and are therefore more likely to contaminate water. Ingestion of water contaminated with feces of infected people transmits pathogens that cause gastrointestinal illness.

In some wading pools, the water is recirculated, with the spray water flowing into an underground reservoir. It passes through a filter and is disinfected with a germ-killing chemical, such as chlorine, before being sprayed again. However, these germs are not killed immediately.

According to Hlavsa, while most germs are inactivated and killed within minutes when chlorine is measured at 1 ppm, which is the CDC’s recommended level, others can take 10 to 15 minutes. Cryptosporidiumthe main cause of splash pad outbreaks according to Hlavsa, can survive for 7 days in a well chlorinated splash pad.

“Chlorine doesn’t kill germs instantly,” Hlavsa said.

Additionally, since wading pools generally do not have standing water, they may be exempt under public health codes because they do not meet a jurisdiction’s definition of a treated recreational water site. , like a swimming pool. The researchers recommend reconsidering this exemption.

“[Splash pads] represent a reduced risk of drowning because there is no standing water in the user’s area,” Hlavsa said, adding that the public then falls under the false assumption that paddling pools are completely safe, which which is not the case.

“It’s really about getting this message across: if you have diarrhea, don’t go to this paddling pool. And in the future, don’t drink this water,” Hlavsa said.

Raising awareness

According to the researchers, efforts to prevent gastrointestinal disease outbreaks at splash pads must target caregivers. “It’s about educating the public,” Hlavsa said.

Key points to remember include staying out of the water if diarrhea occurs, showering before entering the water, and taking children to the bathroom (or checking diapers) every hour. The CDC also recommends that caregivers remind children not to swallow water, not to defecate or urinate in water, and not to stand or sit on spray jets, which could flush the eyes. feces in the water.

Hlavsa said the CDC hopes pediatric healthcare providers will help communicate this information and recommended visiting cdc.gov/healthyswimming for additional guidance.

“To educate providers, I think often when we have diarrhea, we worry about what we ate the night before,” Hlavsa said. “We don’t think about where we went swimming, and with Cryptosporidiumwhere did we swim last week.

Going forward, Hlavsa explained that the CDC will take a multi-pronged approach to collecting additional data.

“We want to do more research and look at splash pad outbreaks as a whole — see what common things we find, where we see more opportunities to prevent those outbreaks,” Hlavsa said.

The researchers will also evaluate the CDC’s Model Aquatic Health Code, which provides guidance on how to swim safely and healthy, to see how it can be improved.

“It’s OK to use these places,” Hlavsa said. “We just have to do it in a healthy and safe way.”


Martin E. Berry