Abstract and Introduction
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 [aORMI] = 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."†
On June 18, 2021, the Kansas Department of Health and Environment (KDHE) notified CDC of three cases of shigellosis associated with visiting the wildlife park. Because splash pads are not typically regulated, and thus not inspected, the capacity to identify factors contributing to outbreaks associated with such venues is also limited. KDHE and Sedgwick County Health Department (SCHD) consulted with CDC on the outbreak investigation, which included a case-control study that identified 21 shigellosis cases in respondents who visited the wildlife park on June 11 and six norovirus infection cases in respondents who visited the park 1 week later, on June 18.
Morbidity and Mortality Weekly Report. 2022;71(31):981-987. © 2022 Centers for Disease Control and Prevention (CDC)