Waterborne disease outbreaks at 60 splash pads nationwide since 1997 led to 123 hospitalizations, CDC report says

During a 25-year period ending in 2022, public health officials in 23 states — including New York — and Puerto Rico reported 60 "splash pad" associated outbreaks due to waterborne disease, the Centers for Disease Control and Prevention reported last week.

"These 60 outbreaks resulted in 10,611 cases, 152 hospitalizations, 99 emergency department visits, and no reported deaths," the agency said in its Morbidity and Mortality Weekly Report dated Dec. 5.

The CDC defined splash pads, also known as "water playgrounds," as "recreational interactive water venues that spray or jet water on users. Splash pads are intended for children aged <5 years and designed so that water typically does not collect in areas accessible to users, thereby minimizing the risk for drowning. Splash pads were first found to be associated with waterborne disease outbreaks in 1997," the agency said in its report.

The agency's study covered the years 1997 to 2022, and noted that the number of outbreaks reported might be an undercount because of underreporting or misclassification, or the long incubation period of one of the pathogens, for instance. Public health officials have been voluntarily providing the CDC with information about waterborne outbreaks since 1971, the agency said.

Long Island has several water spray parks, some of which are sponsored by municipalities. In an emailed statement to Newsday, Suffolk County Health Commissioner Dr. Gregson Pigott said: “We advise parents to be aware that there is a risk of transmitting cryptosporidiosis at splash pads. To minimize risk, keep children home when they are ill, change diapers or use bathrooms often, and train children not to swallow water in pools or splash pads."

In 52 of the 60 outbreaks — the vast majority of which occurred between May and August — laboratory testing confirmed the presence of a waterborne pathogen, the CDC said. The pathogen that was most present was Cryptosporidium, which the CDC said caused 40 — or 67% — outbreaks "that resulted in 9,622 (91%) reported cases, 123 (81%) hospitalizations, and 21 (21%) emergency department visits."

The agency said Cryptosporidium was most resistant to chlorine, a common chemical disinfectant used in water venues. "However, maintaining an adequate free chlorine concentration can be especially difficult in splash pads because spraying or jetting the water aerosolizes free chlorine, which decreases its concentration," the CDC report said.

Dr. Mundeep Kainth, a pediatric infectious disease specialist at Northwell Health's Cohen Children’s Medical Center in New Hyde Park, said, "The reason that children often end up hospitalized in general is from dehydration" from parasite outbreaks. "They are smaller humans and can’t stay as hydrated as easily as adults can when suffering from diarrhea."

She added that Cryptosporidium "causes a lot of fluid losses. It becomes a very big problem because these children have to be hospitalized because the medications that are used aren’t really shown to effectively change how long you’re sick for if you have a healthy immune system. A typical child using a splash pad, really the only cure is time or an IV fluid. This does increase hospitalization rates, especially in the summer time."

The CDC said the splash-pad outbreaks were often the result of maintenance issues, such as failures with disinfection systems. The agency also cited "person-related contributing factors" when Cryptosporidium was involved. 

Among the CDC's recommendations: "Prevention of waterborne disease outbreaks at splash pads requires changes in user behavior; recreational venue code updates; and improved venue design, construction, operation, and management of facilities. Recommended user behaviors in splash pads and other recreational water venues include not getting in the water if ill with diarrhea until two weeks after it has stopped, not swallowing the water, taking young children on bathroom breaks or checking diapers or swim diapers every hour, and, if needed, changing them away from the water."

Kainth echoed the CDC recommendations, adding the two-week time frame from entering the water was critical. "Make sure the child doesn't have diarrhea symptoms for two weeks" prior to going to a water park. "We shed parasites or these viruses even after symptoms improve. So you need to wait a good solid two weeks," she said.

She added that washing one's hands was very important. "We seemed to have forgotten to do that again in the last couple of years."

By Olivia Winslow

olivia.winslow@newsday.com@newsollie