Outbreaks of Acute Gastrointestinal Illness Associated with a Splash Pad in a Wildlife Park - Kansas, June 2021

Abstract

In June 2021, Kansas state and county public health officials identified and investigated three cases of shigellosis (a bacterial diarrheal illness caused by Shigella spp.) associated with visiting a wildlife park. The park has animal exhibits and a splash pad. Two affected persons visited animal exhibits, and all three entered the splash pad. Nonhuman primates are the only known animal reservoir of Shigella. The splash pad, which sprays water on users and is designed so that water does not collect in the user area, was closed on June 19. The state and county public health codes do not include regulations for splash pads. Thus, these venues are not typically inspected, and environmental health expertise is limited. A case-control study identified two distinct outbreaks associated with the park (a shigellosis outbreak involving 21 cases and a subsequent norovirus infection outbreak involving six cases). Shigella and norovirus can be transmitted by contaminated water; in both outbreaks, illness was associated with getting splash pad water in the mouth (multiply imputed adjusted odds ratio [aOR_MI] = 6.4, p = 0.036; and 28.6, p = 0.006, respectively). Maintaining adequate water disinfection and environmental health expertise and targeting prevention efforts to caregivers of splash pad users help prevent splash pad-associated outbreaks. Outbreak incidence might be further reduced when U.S. jurisdicitons voluntarily adopt CDC's Model Aquatic Health Code (MAHC) recommendations and through the prevention messages: "Don't get in the water if sick with diarrhea," "Don't stand or sit above the jets," and "Don't swallow the water."^†.

FIGURE 1

Cases of acute gastrointestinal illness (N = 63) among study respondents,† by wildlife park visit date — Kansas, June 2021 * A case of shigellosis was defined as diarrhea (three or more loose stools in 24 hours) with onset 12–73 hours after visiting the wildlife park on June 11 (n = 21). A case of norovirus infection was defined as vomiting or diarrhea (three or more loose stools in 24 hours) with onset 12–56 hours after visiting the wildlife park on June 18 (n = 6). A case of other acute gastrointestinal illness was defined as diarrhea (three or more loose stools in 24 hours) with onset 12–73 hours after visiting the wildlife park on June 12, 13, 14, 15, 16, 17, or 19 (n = 36). For these visit dates, no case-patients had clinical laboratory evidence supporting detection of the same pathogen. ^† One patient, who entered the splash pad on June 11 and had at least supportive laboratory evidence of Shigella detection, did not participate in the case-control study. Two patients, who entered the splash pad on June 18 and had laboratory-confirmed norovirus infection, did not participate in the case-control study.

FIGURE 2

Age distribution of shigellosis (A) and norovirus infection (B) case-patients and control study respondents, by wildlife park visit date and whether got splash pad water in the mouth— Kansas, June 2021 Abbreviation: NA = not applicable. * Shigellosis outbreak associated with park visit on June 11 and norovirus infection outbreak associated with park visit on June 18.