Fecal fountains: CDC warns of diarrhea outbreaks linked to poo splashes

Enlarge / A 2-year-old child enjoys the water jet at a wading pool in Los Angeles on June 20, 2022.

In the record-breaking heat of this summer, a jet of crisp, cool water sounds like delicious bliss. Each drop delivers fast relief as it crackles on your face, quenching your sizzling skin.

But if you find such a euphoric respite at a kiddie pool, that soothing spray could quickly turn into sickening spit, as drips and drips can be doused in diarrheal pathogens. Each crackle can deliver a splash of infectious germs that, if accidentally ingested, could turn you into a veritable fecal fountain within days.

At least that’s the warning from the Centers for Disease Control and Prevention. This week, the agency released a report describing two gastrointestinal outbreaks linked to a single recreational wading pool in Kansas. The two outbreaks, which occurred within days of each other in June 2021, involved two different pathogens –shigella bacteria and norovirus – and collectively sickened at least 27 people. While certain circumstances are specific to this particular wading pool in Kansas, the outbreaks highlight the common risk of these facilities, which are often unregulated.

starchy fun

Wading pools — popular water spots that can involve interactive fountains, water features, and jets — typically don’t include areas with standing water. And for that reason, “splatters do not always meet the local, state, territorial, or tribal definition of an ‘aquatic place,'” and may be exempt from public health codes, the CDC notes on its website. “That means they’re not always regulated and not always required to disinfect the water with germ-killing chemicals.”

In other words, the water squirting out of those attractive jets could have been filtered through a poopy swim diaper rather than a proper sanitation system. This is not just a horrifying hypothetical but a revolting reality. The CDC has counted a number of these outbreaks over the years and listed the risks for more. The most obvious is that young children generally have poor hygiene and toilet skills and enjoy sitting and standing on jets, which, as the CDC bluntly warns, “can flush the poo from your ass”. Small children are also more likely to have this water in their mouths, thus completing the fecal-oral route in record time.

The authors of the new report, by CDC and Kansas health officials, referenced a 2010 study that documented children’s splash behavior and found “kids wearing diapers, sitting on squirts of water and placing the open mouth in the water”.

Additionally, the squirts and sprays themselves pose a risk because when the water becomes aerosolized, it depletes the concentration of free chlorine, making it more difficult to consistently maintain the concentration needed to prevent the spread of disease.

Aquatic diversity

If all that wasn’t nauseating enough, the report on the two Kansas outbreaks notes that the wading pool involved was at a wildlife park where people visited animal exhibits, including lemurs, before entering the grounds. water jets. One of the outbreaks, which occurred on June 11, involved the spread of shigella bacteria that causes 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 teenagers between the ages of 1 and 15, was not linked to touching or feeding the lemurs, outbreak investigators have found. Instead, illnesses were associated with playing in the paddling pool and having water in your mouth. Three sick children had to be hospitalized, and they luckily recovered.

A week later, on June 18, another epidemic broke out, this time with a norovirus. Investigators have identified six cases in this outbreak, affecting people between the ages of 1 and 38. All sick people played in the paddling pool and all reported having water in their mouths.

But that was not all. In the days between the two outbreaks, investigators identified more cases of acute gastrointestinal illness among people who visited the park, but they lacked lab data to link them directly to either of them. identified epidemics. With additional cases identified on June 19, investigators listed 63 gastrointestinal illnesses and the wading pool was closed on June 19.

Rethinking regulation

When local health officials investigated how the splash works, they found some concerning features that could explain the outbreaks, including:

The water remained in the collection tank (where water flows after spraying users and before being filtered, disinfected and re-sprayed) overnight instead of being continuously recirculated, filtered and chlorinated. The splash pad did not have an automated controller to measure and help maintain the concentration of free chlorine needed to prevent transmission of pathogens. In addition, none of the staff had documentation showing that they had completed standardized operator training.

CDC testing found gastrointestinal bacteria in three of the seven pumps used to supply water to the splash pad features.

After the paddling pool closed on June 19, the animal park responded to the findings of the health investigator, adding continuous circulation, filtering, disinfection; the addition of an automated chlorine controller and the training of its personnel. The paddling pool reopened on July 24 and no further illnesses in the paddling pool have been identified.

“As the use of splashes increases, the exemption of splashes from regulation under public health codes should be reconsidered,” the report authors concluded.

For now, however, simple messages can also help prevent splashing from splashing, such as signs telling splashers and caregivers: “Do not swim if you have diarrhea”, “Do not stand or don’t sit on top of the jets” and “Don’t swallow the water.”

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