Results
All Splash Pad–Associated Outbreaks
During 1997–2022, public well being officers from 23 states and Puerto Rico (Figure 1) reported 60 splash pad–related outbreaks (Table 1). These 60 outbreaks have been related to exposures in settings the place solely splash pads have been situated (n = 39) in addition to settings that included splash pads and different venues (e.g., swimming swimming pools and sizzling tubs) (n = 21). These 60 outbreaks resulted in 10,611 circumstances, 152 hospitalizations, 99 emergency division visits, and no reported deaths.
The outbreak etiology of waterborne illness was laboratory confirmed for 52 (87%) of the 60 outbreaks (Table 2). Cryptosporidium brought on 40 (67%) outbreaks (together with one which additionally was attributable to Giardia species and one other additionally attributable to Shigella species) that resulted in 9,622 (91%) reported circumstances, 123 (81%) hospitalizations, and 21 (21%) emergency division visits. More particularly, Cryptosporidium hominis brought on 14 (23%) outbreaks that resulted in 7,833 (74%) circumstances, 97 (64%) hospitalizations, and three (3%) emergency division visits. C. hominis additionally brought on the three largest outbreaks (2,307 circumstances, 2,050 circumstances, and a pair of,000 circumstances); two of those outbreaks have been related to splash pads solely and the remaining outbreak with a splash pad and different venues. Cryptosporidium parvum brought on 4 (7%) outbreaks that resulted in 9 (<1%) circumstances, two (2%) emergency division visits, and no hospitalizations. Cryptosporidium of unknown species brought on 17 (28%) outbreaks that resulted in 1,478 (14%) circumstances, 21 (14%) hospitalizations, and 6 (6%) emergency division visits. Multiple species of Cryptosporidium brought on three (5%) outbreaks that resulted in 199 (2%) circumstances, 10 (10%) emergency division visits, and one (1%) hospitalization.
Shigella brought on 5 outbreaks (together with one which was additionally attributable to Cryptosporidium), Escherichia coli O157:H7 brought on three, and the next brought on one outbreak every: Campylobacter jejuni, Giardia duodenalis (additionally attributable to Cryptosporidium), norovirus, and Salmonella serotype Newport. These 12 (20%) outbreaks resulted in 271 (3%) circumstances of acute gastrointestinal sickness, 16 (11%) hospitalizations, and 6 (6%) emergency division visits. Legionella pneumophila and chloramines have been every confirmed to trigger one outbreak. Of the 99 emergency division visits reported for all splash pad–related outbreaks, 72 (73%) resulted from two outbreaks suspected to be attributable to norovirus.
Of the 60 splash pad–related outbreaks, 57 (95%) have been reported throughout May–August (Figure 2). Approximately one fourth (n = 17; 27%) of the outbreaks have been related to a minimum of one splash pad in a neighborhood or municipality setting, adopted by 14 outbreaks (23%) in a neighborhood or municipal park (Figure 3).
Outbreaks Associated with Splash Pads Only
Data on outbreaks related to splash pads solely have been analyzed individually to guage solely these etiologic brokers and contributing components related to splash pads, as a result of these may differ from outbreaks related to different handled leisure venues (e.g., swimming swimming pools and sizzling tubs). Of the 60 outbreaks, 39 (65%) have been related to splash pads solely and resulted in 5,384 circumstances, 85 emergency division visits, and 68 hospitalizations (Table 3). An outbreak etiology was laboratory confirmed for 33 (85%) of the 39 outbreaks. Cryptosporidium brought on 25 (64%) of the 39 outbreaks (together with one which was additionally attributable to Giardia and one other additionally attributable to Shigella) that resulted in 5,111 (95%) of 5,384 circumstances, 9 (11%) of 85 emergency division visits, and 45 (66%) of 68 hospitalizations. More particularly, C. hominis brought on 9 (23%) outbreaks that resulted in 4,551 (85%) circumstances, 33 (49%) hospitalizations, and no emergency division visits. C. parvum brought on 4 (10%) outbreaks that resulted in 9 (<1%) circumstances, two (2%) emergency division visits, and no hospitalizations. Cryptosporidium of unknown species brought on 9 (23%) outbreaks that resulted in 436 (8%) circumstances, eight (12%) hospitalizations, and no emergency division visits. Multiple species of Cryptosporidium brought on one (3%) outbreak that resulted in 22 (<1%) circumstances, 4 (5%) emergency division visits, and no hospitalizations.
Shigella species brought on 4 outbreaks related to splash pads solely (together with one which additionally was attributable to Cryptosporidium), E. coli O157:H7 brought on two outbreaks, and every of the next etiologic brokers brought on one outbreak: C. jejuni, G. duodenalis (additionally attributable to Cryptosporidium), norovirus, and Salmonella serotype Newport (Table 3). These 10 (26%) of the 39 outbreaks resulted in 140 (3%) of 5,384 circumstances of acute gastrointestinal sickness, 10 (15%) of 68 hospitalizations, and three (4%) of 85 emergency division visits. Of the 85 emergency division visits reported for outbreaks related to splash pads solely, 72 (85%) resulted from two outbreaks suspected to be attributable to norovirus. Chlorine was suspected to trigger one outbreak related to splash pads solely that resulted in 17 circumstances (<1%), one emergency division go to (1%), and no hospitalizations.
Of the 39 outbreaks related to splash pads solely, 38 (97%) have been reported throughout May–August (Figure 2). Puerto Rico reported one outbreak that began in December. Of the 39 outbreaks related to splash pads solely, 14 (36%) have been related to splash pads in a neighborhood or municipal park setting, adopted by 13 outbreaks (33%) related to a splash pad in a neighborhood or municipality setting (Figure 3).
Of the 39 outbreaks related to splash pads solely, 27 (69%) had knowledge on contributing components reported in NORS (Table 4). Of these 27 outbreaks, a complete of 70 documented/noticed contributing components have been reported. For outbreaks related to splash pads solely and attributable to Cryptosporidium, a person-related contributing issue (i.e., major meant use of water is by diaper/toddler aged kids) and a facility design–associated issue (i.e., no supplemental disinfection put in that may have inactivated pathogens [e.g., Cryptosporidium]) have been mostly reported as documented/noticed. For outbreaks related to splash pads solely that have been attributable to a bacterium or virus, a maintenance-related contributing issue (i.e., disinfectant management system malfunctioning, insufficient, or missing) and a coverage and administration–associated issue (i.e., insufficient water high quality monitoring [e.g., inadequate test kit or testing frequency]) have been mostly reported. An individual-related contributing issue (i.e., operator error) additionally was generally reported as documented/noticed for outbreaks attributable to Cryptosporidium or by a bacterium or virus.
