Fecal fountains: CDC warns of diarrhea outbreaks linked to poop splatter

A 2-year-old enjoys the jet of water in a splash pad in Los Angeles on June 20, 2022.
enlarge / A 2-year-old enjoys the jet of water in a splash pad in Los Angeles on June 20, 2022.

In this summer’s record heat, a splash of fresh, cool water sounds like delicious bliss. Each drop offers solid relief as it patters on your face, quenching your blistering skin.

But when you find such a euphoric reprieve at a kiddie pool, that calming spray can quickly turn into a nauseating spit, as the drops and drops can be doused with diarrheal pathogens. Any chatter can spawn a spate of infectious germs that, if accidentally ingested, can turn you into a veritable fecal fountain in the following days.

At least that’s the warning from the Centers for Disease Control and Prevention. This week, the agency released a report outlining two gastrointestinal outbreaks linked to a single recreational splash pad in Kansas. The two outbreaks, which occurred several days apart in June 2021, involved two different pathogens:shigella bacteria and norovirus – and collectively made at least 27 people sick. While some conditions are specific to that particular splash pad in Kansas, the outbreaks highlight the general risk of such facilities, which are often unregulated.

Feculent Pleasure

Splash pads — the popular water spots with interactive fountains, water sprinklers, and jets — usually don’t contain areas of standing water. And therefore, “splashpads do not always meet the local, state, territorial or tribal definition of an ‘aquatic location'” and may be exempt from public health codes, the CDC notes on its website. “This means they are not always regulated, nor are they always required to disinfect the water with germicidal chemicals.”

In other words, the water spouting from those tantalizing jets could have been filtered through a poopy swim diaper rather than a proper plumbing system. This is not just a horrifying hypothetical but a horrific reality. The CDC has counted several such outbreaks over the years and listed the risks for more. The most obvious is that small children generally have poor hygiene and toileting skills and enjoy sitting and standing on jets, which – as the CDC warns bluntly – “can flush the poop off your butt.” Small children are also most likely to get that water in their mouths, completing the fecal-oral route in record time.

The authors of the new report, written by CDC and Kansas health officials, referenced a 2010 study that documented the behavior of children with splash pads and found that “children wore diapers, sat on water jets, and kept their open mouths in the water. “

In addition, the jets and sprays themselves pose a risk because when the water is atomized, it depletes the free chlorine concentration, making it more difficult to consistently maintain the concentration needed to prevent the spread of disease.

Aquatic Diversity

As if all that wasn’t sickening enough, the report on the two Kansas outbreaks notes that the splash pad in question was in a wildlife park where people visited exhibits of animals, including lemurs, before entering the water mist. One of the outbreaks, which occurred on June 11, involved the spread of shigella bacteria that cause a diarrheal disease called shigellosis.

Non-human primates, such as lemurs, are the only known animal reservoir of shigella. But the outbreak, which sickened at least 21 children and teens ages 1 to 15, was not linked to touching or feeding the lemurs, outbreak researchers found. Instead, illnesses were associated with playing in the splash pad and getting splash pad water in the mouth. Three sick children had to be hospitalized and have thankfully recovered.

A week later, on June 18, another outbreak broke out, this time with norovirus. Researchers identified six cases in this outbreak, which affected people between the ages of 1 and 38. All the sick people played in the splash pad and they all reported getting water in their mouths.

But that wasn’t all. In the days between the two outbreaks, researchers identified more cases of acute gastrointestinal illness in people visiting the park, but they had no lab data to link them directly to any of the identified outbreaks. With additional cases identified on June 19, the researchers counted 63 gastrointestinal illnesses and the splash pad was closed on June 19.

Rethinking regulations

When local health officials examined the operation of the splash pads, they found some pertinent features that could explain the outbreaks, including:

Water was left overnight in the collection tank (into which the water drains after user spraying and before being filtered, disinfected and sprayed again) instead of being continuously recirculated, filtered and chlorinated. The splash pad did not have an automated controller to measure and help maintain the free chlorine concentration needed to prevent pathogen transmission. In addition, no staff member had documentation proving that he had undergone standardized operator training.

CDC tests found gastrointestinal bacteria in three of the seven pumps used to feed water into the splash pad functions.

After the splash pad closed on June 19, the wildlife park responded to the health researcher’s findings and added continuous circulating, filtering, and disinfecting; adding an automated chlorine controller and training the staff. The splash pad reopened on July 24 and no additional splash pad diseases have been identified.

“As splash pad use increases, exempting splash pads from regulation under public health codes should be reconsidered,” the report’s authors concluded.

For now, however, simple coverage can also help prevent splashy outbreaks, such as signs that splash and tell health care providers, “Do not enter the water if you are sick with diarrhea”, “Do not stand or sit over the jets” and “Do not swallow the water.” .”

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