Shigella Outbreak: New Hampshire, Take a Good Look at Kentucky

Children who are not potty trained are no longer allowed in public pools in four Kentucky counties.  In addition, swimmers who have had diarrhea must not venture into pools for two weeks after diarrhea has subsided.  The Northern Kentucky Health Department set new restrictions for all public pools in response to a recent Shigella outbreak (see news video).  The outbreak demonstrates the importance of reducing the risk of fecal contamination of swimming pool water by using all available resources, including pool inspections, to address swimmer hygiene and appropriate disinfection.

The health department’s response to the outbreak has been appropriately aggressive, including arming environmental inspectors with waterborne disease prevention messages.  In contrast, a similar outbreak in a state such as New Hampshire, which is currently entertaining the notion of eliminating pool inspections to save state dollars, could be much worse.

According to the Centers for Disease Control and Prevention (CDC) website, Shigella is a group of bacteria that can cause diarrhea (often bloody), fever and stomach cramps within a day or two of exposure.  The bacterial infection that results from exposure to this organism, shigellosis, is spread via contact with the stool of an infected person through contaminated hands, food and water.  It is especially common in toddler childcare environments.

Swimming pools in Kentucky likely became contaminated when swimmers with shigellosis shed fecal matter into the water, which uninfected swimmers inadvertently ingested.  In a June 2 press release, District Director of Health, Lynne M. Saddler, MD, MPH, said, “…the bacteria spread easily through water— infection can occur between the time a person with Shigella has an accident in a pool and the bacteria is killed by the chemicals in the pool water. Shigella can be spread after the symptoms end, so people who have had diarrhea recently should not swim, even if they feel better and the diarrhea has ended….Even if children are in plastic diaper pants or diapers designed for use in water, commonly called swimmies, you can’t guarantee that fecal matter will not escape into the pool water.”  Since April of this year, the number of shigellosis cases in Boone, Campbell, Grant and Kenton Counties in Kentucky are more than triple the annual average.

The operators of 350 pools have been given information and educational materials, including instructions to pool operators on the proper response (e.g., “hyperchlorinating” the swimming pool) to fecal accidents.  Tips from the CDC and the health department include a warning to swimmers to: avoid swallowing pool or water playground water; shower before swimming; wash hands after using the toilet and changing diapers; take children on frequent bathroom breaks; and change diapers in bathrooms, not poolside.

CDC’s website notes the past two decades have brought a substantial increase in the number of recreational water illness outbreaks associated with swimming.  New Hampshire, take a good look at Kentucky for evidence that de-funding pool inspections is simply penny wise and pound foolish for public health.

Chris Wiant, M.P.H., Ph.D., is president and CEO of the Caring for Colorado Foundation. He is also chair of the Water Quality & Health Council.