Between 1997 and 2022, splash pad-related outbreaks were reported in 23 states and Puerto Rico, resulting in 10,611 cases of illness, 152 hospitalizations, and 99 emergency department visits. No fatalities were reported, but the data underscores a significant public health concern, particularly for young children who frequently use these venues.1
The primary culprit in these outbreaks is Cryptosporidium, which caused 67% of the incidents. This parasite, which is resistant to chlorine, accounts for 91% of reported cases and 81% of hospitalizations. Two additional outbreaks were linked to norovirus, leading to many emergency department visits.1
Public health experts emphasize the need for effective prevention strategies, including proper water treatment, public education, and improved facility management. According to study author, Hannah Lawinger, MPH, epidemiologist from the CDC, “Public health messaging should target splash pad users and their caregivers by promoting safe user behaviors such as staying away from splash pads when sick with diarrhea, not sitting or standing on top of water jets, and not ingesting splash pad water.”
What Is Cryptosporidiosis?
Cryptosporidiosis is caused by the parasite Cryptosporidium and leads to watery diarrhea, and spreads through contact with contaminated water, food, soil, or surfaces. The infection typically develops 2 to 10 days after exposure, with symptoms lasting 1 to 2 weeks, though some people may show no symptoms. Healthy individuals usually recover without treatment. Preventative measures include good hygiene, particularly handwashing after using the toilet, changing diapers, and before eating or preparing food.2
Symptoms of cryptosporidiosis commonly include prolonged, watery diarrhea, along with stomach cramps, nausea, vomiting, fever, weight loss, and dehydration. While symptoms usually last 1–3 weeks in healthy individuals, they can persist up to 30 days, and people with weakened immune systems may experience more severe or prolonged symptoms, including chronic illness and nutrient absorption problems. Reinfection typically results in milder symptoms due to the development of antibodies.3
Facility Design and Operation
Regarding the role of facility design and operational practices, Lawinger added, “While there is no definitive data showing that adopting the CDC’s Model Aquatic Health Code (MAHC) has directly led to a reduction in splash pad outbreaks, we believe the MAHC recommendations targeting facility design and operational practices could play a large role in reducing these types of outbreaks. The MAHC recommends the use of secondary treatments in splash pads, such as UV or ozone, to help reduce Cryptosporidium. It is also recommended to maintain certain free chlorine and pH levels, monitoring these levels every 2-4 hours with proper testing. These recommendations help splash pad operators detect problems quickly with disinfection systems and limit the spread of germs.”
What You Need To Know
Between 1997 and 2022, 60 waterborne disease outbreaks linked to splash pads resulted in over 10,000 cases of illness, with Cryptosporidium as the primary cause.
Splash pads face unique challenges in water treatment, as Cryptosporidium is resistant to chlorine, requiring additional measures like UV or ozone disinfection.
Public health experts urge better user education on safe practices and improved facility protocols to reduce the risk of waterborne illness at splash pads.
Lawinger further explains that while operational practices can help reduce outbreaks, preventing infections caused by Cryptosporidium remains a significant challenge. “The easiest and most effective way to prevent these types of infections is for caregivers and young children to stay away from splash pads and other aquatic venues when sick with diarrhea until two weeks after symptoms have stopped,” she said. “For splash pads, it may be more efficient to completely drain the water if contaminated with Cryptosporidium, clean all accessible surfaces, replace filters if needed, and refill with clean water.”
The CDC’s findings underscore the importance of continued efforts to improve safety protocols and educate the public about proper splash pad behavior. While splash pads provide valuable recreational opportunities for children, their management must prioritize hygiene and water treatment to minimize the risks of waterborne diseases. Public health officials, aquatics professionals, and caregivers must work together to ensure these venues remain safe for all users.
References
1. Lawinger H, Khan A, Lysen C, et al. Waterborne Disease Outbreaks Associated with Splash Pads — United States, 1997–2022. MMWR Surveill Summ 2024;73(No. SS-8):1–15. DOI: http://dx.doi.org/10.15585/mmwr.ss7308a1
2. About Crypto Infections. CDC. Updated June 5, 2024. Accessed December 5, 2024.
