result
All outbreaks related to splash pads
From 1997 to 2022, public health authorities in 23 states and Puerto Rico (Figure 1) 60 outbreaks associated with splash pads were reported (Table 1). These 60 occurrences were associated with exposure in environments with only splash pads (n = 39) and environments with splash pads and other venues (e.g., swimming pools and hot tubs) (n = 21). I was doing it. These 60 outbreaks resulted in 10,611 cases, 152 hospitalizations, 99 emergency department visits, and no deaths reported.
The cause of waterborne disease outbreaks was laboratory confirmed in 52 of 60 outbreaks (87%) (Table 2). Cryptosporidium caused 40 (67%) outbreaks, including one giardia caused by one species and another species Staphylococcus ruber As a result, 9,622 (91%) cases were reported, with 123 (81%) hospitalized and 21 (21%) seen in the emergency department. More specifically, Cryptosporidium hominis It caused 14 (23%) outbreaks, resulting in 7,833 (74%) cases, 97 (64%) hospitalizations, and 3 (3%) emergency department visits. C. Hominis It also caused the three largest outbreaks (2,307, 2,050, and 2,000 cases). Two of these outbreaks involved the splash pad only, and the remaining outbreaks involved the splash pad and other venues. Cryptosporidium parvum It caused 4 (7%) outbreaks resulting in 9 (<1%) cases, 2 (2%) emergency department visits, and no hospitalizations. Cryptosporidium Infections with unknown species caused 17 (28%) outbreaks resulting in 1,478 (14%) cases, 21 (14%) hospitalizations, and 6 (6%) emergency department visits. I had a medical examination. multiple species Cryptosporidium 3 (5%) outbreaks resulting in 199 (2%) cases, 10 (10%) emergency department visits, and 1 (1%) hospitalization.
Staphylococcus ruber Caused 5 outbreaks (of which 1 was also caused) Cryptosporidium), Escherichia coli O157:H7 caused 3 outbreaks and each of the following caused 1 outbreak: Campylobacter jejuni, duodenal giardia (This is also the cause Cryptosporidium), Norovirus and Salmonella The serotype is Newport. These 12 (20%) occurrences resulted in 271 (3%) acute gastrointestinal illnesses, 16 (11%) hospitalizations, and 6 (6%) emergency department visits. Legionella pneumophila Each chloramine was found to cause one outbreak. Of the 99 emergency department visits reported for all splash pad-related outbreaks, 72 (73%) were due to two outbreaks suspected to be caused by norovirus.
Of the 60 outbreaks associated with splash pads, 57 (95%) were reported from May to August (Figure 2). Approximately a quarter of outbreaks (n = 17, 27%) were associated with at least one splash pad in a community or municipal setting, followed by 14 outbreaks (23) in community or municipal parks. %).Figure 3).
Outbreaks related only to splash pads
Data on outbreaks associated only with splash pads were analyzed separately to assess only splash pad-associated pathogens and contributing factors. This is because these may be different from outbreaks associated with other treated recreational facilities (e.g. swimming pools and hot tubs). Of the 60 outbreaks, 39 (65%) were related to splash pads alone, resulting in 5,384 cases, 85 emergency department visits, and 68 hospitalizations (Table 3). In 33 of 39 outbreaks (85%), the etiology of the outbreak was confirmed by laboratory. Cryptosporidium 25 of 39 outbreaks (64%) were caused by other infectious diseases giardia And another reason too Staphylococcus ruber) The results were 5,111 of 5,384 cases (95%), 9 of 85 emergency department visits (11%), and 45 of 68 hospitalizations (66%). More specifically, C. Hominis It caused 9 outbreaks (23%) resulting in 4,551 (85%) cases and 33 (49%) hospitalizations, but no emergency department visits. C. parvum It caused 4 (10%) outbreaks resulting in 9 (<1%) cases, 2 (2%) emergency department visits, and no hospitalizations. Cryptosporidium Unknown species caused 9 outbreaks (23%) resulting in 436 (8%) cases and 8 (12%) hospitalizations, but no emergency department visits. There wasn’t. multiple species Cryptosporidium One outbreak (3%) resulted in 22 (<1%) cases, 4 (5%) emergency department visits, and no hospitalizations.
Staphylococcus ruber These species have caused 4 outbreaks associated only with splash pads (1 of which also occurred with splash pads) Cryptosporidium), Escherichia coli O157:H7 caused two outbreaks, and the following pathogens each caused one outbreak: C. jejuni, G. Duodenal squirrel (This is also the cause Cryptosporidium), norovirus, Salmonella Serotype is Newport (Table 3). These 10 (26%) of the 39 occurrences included 140 (3%) of 5,384 acute gastrointestinal illnesses, 10 (15%) of 68 hospitalizations, and 3 (4%) of 85 emergency department visits. ) caused. Of the 85 emergency department visits reported solely for splash pad-related outbreaks, 72 (85%) were due to two outbreaks suspected to be caused by norovirus. Chlorine was suspected of causing 1 outbreak related to the splash pad alone, resulting in 17 outbreaks (<1%), 1 emergency department visit (1%), and no hospitalizations.
Of the 39 outbreaks involving only splash pads, 38 (97%) were reported from May to August (Figure 2). Puerto Rico reported one outbreak that began in December. Of the 39 outbreaks associated only with splash pads, 14 (36%) were associated with splash pads in community or municipal park settings, followed by 13 (33%) outbreaks in community or municipal park settings. (Figure 3).
Of the 39 outbreaks associated only with splash pads, 27 (69%) had data on contributing factors reported in NORS (Table 4). Of these 27 occurrences, a total of 70 documented/observed contributing factors were reported. Covers only outbreaks related to splash pads and caused by: Cryptosporidiumindividual-related factors (i.e., the main use of water is by diapers and young children) and facility design-related factors (i.e., no additional disinfection that would inactivate pathogens is installed) [e.g., Cryptosporidium]) were most commonly reported as documented/observed. Only on splash pads caused by bacteria or viruses, maintenance-related factors (i.e., malfunctioning, inadequate, or missing disinfectant management systems), and policy- and management-related factors (i.e., inadequate water quality monitoring). In case of related occurrences [e.g., inadequate test kit or testing frequency]) was the most frequently reported. Human-related factors (i.e., operator error) are also commonly reported as documented/observed for outbreaks due to: Cryptosporidium or by bacteria or viruses.
