Splash Pads and Waterborne Disease Outbreaks: A 25-Year Perspective Introduction

Are Splash Pads safe?

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Many parents take their children to splash pads to beat summer boredom. These interactive water venues, primarily designed for children under 5 years old (although kids and adults of all ages love them), provide a refreshing way to enjoy the summer heat while minimizing drowning risks. However, while these recreational facilities help alleviate drowning accidents, they have been linked to waterborne disease outbreaks since 1997.

Splash pads, or water playgrounds, spray or jet water on users. Water can be recirculated or passed once through plumbing, and in recirculating pads, water is filtered and disinfected before reuse. On the other hand, in single-pass pads, water circulates once before draining, usually into a sewer system.

A new CDC report examines 25 years of data, shedding light on the prevalence, causes, and prevention strategies for illnesses associated with splash pads, which first appeared in the 1990s. Between 1997 and 2022, 60 waterborne disease outbreaks were reported across 23 states and Puerto Rico, resulting in thousands of cases, numerous hospitalizations, and emergency department visits. Understanding the risks and implementing preventive measures is critical for parents and guardians to ensure the safe enjoyment of these popular attractions.

Key Findings from the Report

The CDC Waterborne Disease and Outbreak Surveillance System (WBDOSS) has monitored waterborne illnesses since 1971. The latest report provides a detailed analysis of outbreaks linked to splash pads between 1997 and 2022, highlighting several concerning trends:

“The outbreak etiology of waterborne disease was laboratory confirmed for 52 (87%) of the 60 outbreaks,” the authors detailed. “Cryptosporidium caused 40 (67%) outbreaks (including one that also was caused by Giardia species and another also caused by Shigella species) that resulted in 9,622 (91%) reported cases, 123 (81%) hospitalizations, and 21 (21%) emergency department visits.”

Scope and Impact

Over the 25 years between 1997 and 2022, 60 waterborne disease outbreaks associated with splash pads were reported. These outbreaks resulted in a total of 10,611 cases of waterborne illnesses. Among those affected, 152 individuals required hospitalization, and 99 emergency department visits were reported. Fortunately, no deaths were linked to these outbreaks, highlighting the importance of early intervention and prevention strategies.

Primary Pathogens Identified

Most of these outbreaks were caused by Cryptosporidium, a chlorine-tolerant parasite responsible for 67% of confirmed outbreaks. This pathogen accounted for 91% of the cases and 81% of hospitalizations, underscoring its significant role in splash pad–associated illnesses.

In addition, norovirus, though less prevalent, was suspected in 2 outbreaks that caused 73% of the reported emergency department visits.

Transmission Risks

Waterborne pathogens such as Cryptosporidium and norovirus are primarily transmitted through ingesting water contaminated by feces from infected individuals. Although chlorine is commonly used to sanitize splash pad water, Cryptosporidium’s high resistance to chlorine presents a significant challenge. This highlights the need for additional preventative measures and advanced water treatment technologies to mitigate these risks effectively.

Challenges in Preventing Splash Pad–Associated Outbreaks

Several factors contribute to the spread of waterborne illnesses in splash pads:

1. Pathogen Resistance: Cryptosporidium's high tolerance to chlorine allows it to thrive in recreational water settings.
2. User Behaviors: Behaviors such as children swallowing water, improper diaper use, and insufficient hygiene before entering splash pads significantly increase contamination risks.
3. Operational and Design Limitations: Improperly designed splash pads or maintenance lapses can compromise water quality, increasing the likelihood of pathogen transmission.

The findings emphasize the need for enhanced public health strategies and operational standards for splash pads to mitigate waterborne disease risks. One key recommendation is promoting hygiene practices. Public health officials and splash pad operators should prioritize educating parents and caregivers about proper hygiene behaviors, such as ensuring children shower before using splash pads, practicing proper diapering techniques, and discouraging water ingestion during play.

Another essential measure is implementing the Model Aquatic Health Code (MAHC) guidelines. Adopting the CDC’s MAHC recommendations can help improve splash pad construction, operation, and management practices. These guidelines address crucial aspects such as water circulation, filtration, disinfection, and maintenance, all of which contribute to minimizing contamination risks.

Improving water treatment methods is also vital to combat chlorine-tolerant pathogens like Cryptosporidium. Splash pad operators should consider integrating secondary disinfection technologies such as ultraviolet (UV) light or ozone systems, which can provide additional protection against these resilient pathogens.

Lastly, enhancing surveillance and reporting systems is crucial. Strengthening the monitoring of waterborne diseases associated with splash pads can yield valuable insights into outbreak patterns, help identify areas of vulnerability, and guide the development of more effective prevention strategies. Improved surveillance and data collection will empower public health professionals to respond to emerging risks more effectively.

Prevention Strategies for Splash Pad Users

Parents and caregivers are crucial in reducing the risk of waterborne illnesses. Recommended practices include:

• Ensuring children shower before and after entering the splash pad.
• Avoid using splash pads when experiencing diarrhea or other symptoms of gastrointestinal illness.
• Encourage frequent bathroom breaks for young children and ensure proper diaper changes are done well away from the splash pad area.
• Discouraging children from swallowing water during play.

Future Directions

As splash pads continue to grow in popularity, collaborative efforts between public health practitioners, the aquatics sector, and local communities are essential to reducing the burden of waterborne diseases. Investments in education, infrastructure, and technology will be critical in mitigating the risks associated with recreational water venues. The CDC’s comprehensive analysis is a valuable resource for shaping policies and practices prioritizing health and safety in public recreational spaces.

Conclusion

While splash pads offer safe, fun, and accessible recreational opportunities for children, the risks of waterborne disease outbreaks cannot be ignored. The CDC’s 25-year analysis underscores the importance of vigilance, proper maintenance, and adherence to health guidelines to prevent the spread of pathogens like Cryptosporidium and norovirus. Public health officials and splash pad operators can ensure these facilities remain safe and enjoyable for all ages by adopting proactive measures and fostering community awareness.