June 29, 2000 -- Running through a sprinkler on a hot summer day is a childhood rite of passage no kid should miss. But running through one of the interactive fountains spouting up at community pools and parks around the country may warrant more caution.
A new report from the CDC documents a case of an outbreak of intestinal illnesses linked to an interactive water fountain at a beachside park in Daytona, Fla., last summer. This is the type of fountain where water shoots straight up from holes in the ground. Recreational fountains of this type are becoming more common, and sometimes kids and adults even frolic in similar public fountains meant to be decorative.
The problem was noticed in Florida after reports started coming in to a local Orlando health department about sick children. A case study was started where 86 park visitors were interviewed; some of whom were people with ill family members. Just under half of the 86 people, 38 exactly, reported an illness that met the case definition of abdominal cramps or diarrhea. There were other complaints of fever, vomiting, and bloody diarrhea, symptoms brought on by two bacteria, Shigella sonnei and Cryptosporidium parvum.
The average age of the sick kids was 8 years old, with the youngest being 2, whereas most of the people who were not affected were older, around 15 years old. All 38 people said they had entered the fountain; 36 of them ingested some of the water, and others said they also had food and drinks while at the fountain.
Valerie Garrett, MD, an epidemiologist with the food-borne and diarrheal diseases branch of the CDC, describes the fountain as an "unregulated open-air facility." She says the problem was probably even worse than they documented, because it was estimated about 4,800 people had passed through that park during the period in question.
"This was down in the Dayton Beach area, so a great number of these people may have been tourists, would not have come forward, or even seen a local health care provider, but would have returned somewhere else," Garrett tells WebMD.
Upon further inspection, it was discovered that the fountain used recirculated water, which is typical. But the chlorination system to treat the water in this fountain was not monitored and was probably lacking. There was no filtering system. Add hordes of diapered and toddler-aged children, and you have a recipe for contamination.
Interactive fountains are "popping up all over because they have a very low risk of drowning, they're very popular with families of young children, children who are at increased risk for fecal accidents and at increased risk for swallowing water, so basically increased risk of both contamination and transmission," Garrett says.
Both of the bacteria in this case are transmitted by swallowing stool-contaminated water, explains Garrett, so "we think if aggressive measures are taken to adequately chlorinate and filter water, that the number of outbreaks would decrease significantly."
One of the bacteria, C. parvum, is not killed by chlorine, but filtering the water can catch it. There also is a risk no matter what because the water takes 30 minutes to recirculate, so Garrett says no fix is "instantaneous." The CDC does have some recommendations to help prevent illness.
To avoid contaminating the water:
- No adults or kids should ever enter any water attraction if they have diarrhea.
- People should bathe before entering the water area to reduce risk of contamination.
- If a child is in diapers, know that diapers do not prevent leakage of stool (even newly designed swim diapers).
- Monitor a diaper-aged child for bowel movement, remove from water, change, and clean with soap and water.
- Avoid sitting on or over water jets because this can increase risk of contaminating the water.
To stop transmission:
- Simply don't drink the water.
Garrett says this last recommendation is a huge behavior modification to teach children, at best. "It's pretty tough when you have 4-year-olds who love to play with water in their mouths and mimic the interactive fountain, which is spurting water."
Public officials eventually closed the water fountain in this case and put in new control measures that are "excellent," according to Garrett. Chlorine monitor and filtration systems were installed, a sign was posted saying don't drink the water, and kids in diapers were excluded.
That's still better than what happened in the only other case like this, when an outbreak previously occurred at an ornamental fountain of the interactive type at the Minnesota Zoo. The fountain was subsequently fenced in to keep all people away.
At a large commercial water park in Atlanta, where people are obviously welcomed, there are no standing-water kiddie pools, stringent cleanliness procedures are in place, diapered children have to wear plastic swim covers, and caregivers are asked to "encourage" their children not to drink the water, according to the park's safety guidelines.
In public, though, the problem is largely unrecognized. A spokesperson for the National Safety Council tells WebMD they have plenty of suggested guidelines for pool safety, involving physical injury, but nothing about drinking the water, and "they don't have any bulletins on this at all."
Wally James, chairman of the safety committee for the World Waterpark Association, says: "There are no standards, and there's no line of responsibility for water quality control in those things. By and large, if it's a fountain, stay away from it, don't touch it. ... If the water is not being treated and filtered, don't go near it. It's that simple."
James says "efforts to establish standards for decorative fountains and amusement rides that have water associated with them ... they've gotten no where." Efforts to get kids to keep the water out of their mouths are just as much of an upstream battle.
"Ingestion is the key for prevention," James tells WebMD. "But if a kid gets water on their hands, they're going to stick their fingers in their mouth, and [then] you're done. So the bottom line is keep them out of the water ... by and large, if it's a decorative fountain, or a theme-ing kind of attraction, best bet is to stand there and look at it and just stay out of it."