{"id":2560,"date":"2018-06-22T20:22:54","date_gmt":"2018-06-22T20:22:54","guid":{"rendered":"http:\/\/www.outbreakmuseum.com\/mobile\/?p=2560"},"modified":"2018-07-31T23:54:25","modified_gmt":"2018-07-31T23:54:25","slug":"hubbard-splash-fountain","status":"publish","type":"post","link":"https:\/\/www.outbreakmuseum.com\/mobile\/shigella\/hubbard-splash-fountain\/","title":{"rendered":"Hubbard Splash Fountain"},"content":{"rendered":"\n<table id=\"tablepress-112\" class=\"tablepress tablepress-id-112\">\n<thead>\n<tr class=\"row-1\">\n\t<th class=\"column-1\"><b>Outbreak:<\/b> Hubbard Splash Fountain<\/th>\n<\/tr>\n<\/thead>\n<tbody class=\"row-striping\">\n<tr class=\"row-2\">\n\t<td class=\"column-1\"><b>Product:<\/b> Splash Fountain in Hubbard, Oregon<\/td>\n<\/tr>\n<tr class=\"row-3\">\n\t<td class=\"column-1\"><b>Investigation Start Date:<\/b> 7\/25\/2003<\/td>\n<\/tr>\n<tr class=\"row-4\">\n\t<td class=\"column-1\"><b>Location:<\/b> Marion County, Oregon<\/td>\n<\/tr>\n<tr class=\"row-5\">\n\t<td class=\"column-1\"><b>Etiology:<\/b> <em>Shigella sonnei<\/em><\/td>\n<\/tr>\n<tr class=\"row-6\">\n\t<td class=\"column-1\"><b>Earliest known case onset date:<\/b> 7\/16\/2003<\/td>\n<\/tr>\n<tr class=\"row-7\">\n\t<td class=\"column-1\"><b>Latest case onset date:<\/b> 8\/17\/2003<\/td>\n<\/tr>\n<tr class=\"row-8\">\n\t<td class=\"column-1\"><b>Confirmed \/ Presumptive Case Counts:<\/b>  19 \/ 37<\/td>\n<\/tr>\n<tr class=\"row-9\">\n\t<td class=\"column-1\"><b>Positive Samples:<\/b> 0<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<!-- #tablepress-112 from cache -->\n<div id=\"metaslider-id-2567\" style=\"width: 100%; margin: 0 auto;\" class=\"ml-slider-3-99-0 metaslider metaslider-flex metaslider-2567 ml-slider ms-theme-default\" role=\"region\" aria-label=\"Hubbard Fount\" data-width=\"400\">\n    <div id=\"metaslider_container_2567\">\n        <div id=\"metaslider_2567\">\n            <ul class='slides'>\n                <li style=\"display: none; width: 100%;\" class=\"slide-2573 ms-image \" aria-roledescription=\"slide\" data-date=\"2018-06-22 20:19:58\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2018\/06\/Hubbard-fountain-shigellosis-22-1024x768-400x300.jpg\" height=\"300\" width=\"400\" alt=\"\" class=\"slider-2567 slide-2573 msDefaultImage\" title=\"Hubbard-fountain-shigellosis-22-1024x768\" \/><div class=\"caption-wrap\"><div class=\"caption\">Dr. William Keene at the splash fountain implicated in the 2003 shigellosis outbreak in Marion County. <\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-2571 ms-image \" aria-roledescription=\"slide\" data-date=\"2018-06-22 20:19:58\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2018\/06\/Hubbard-Fountain-revisited-63711-400x300.jpeg\" height=\"300\" width=\"400\" alt=\"\" class=\"slider-2567 slide-2571 msDefaultImage\" title=\"Hubbard-Fountain-revisited-63711\" \/><div class=\"caption-wrap\"><div class=\"caption\">The splash fountain in Hubbard, Oregon was re-engineered and an automated chlorinator was installed after the 2003 shigellosis outbreak. <\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-2572 ms-image \" aria-roledescription=\"slide\" data-date=\"2018-06-22 20:19:58\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2018\/06\/Hubbard-Fountain-revisited-65933-400x300.jpeg\" height=\"300\" width=\"400\" alt=\"\" class=\"slider-2567 slide-2572 msDefaultImage\" title=\"Hubbard-Fountain-revisited-65933\" \/><div class=\"caption-wrap\"><div class=\"caption\">The shigellosis outbreak at the splash fountain in Hubbard, Oregon underscores the necessity for standards and regulations for the design and maintenance of such fountains. <\/div><\/div><\/li>\n            <\/ul>\n        <\/div>\n        \n    <\/div>\n<\/div>\n\n<table id=\"tablepress-116\" class=\"tablepress tablepress-id-116\">\n<thead>\n<tr class=\"row-1\">\n\t<th class=\"column-1\">Outbreak Summary:<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr class=\"row-2\">\n\t<td class=\"column-1\">Investigation of an outbreak of gastrointestinal illness erupted among children in a small community in Marion County, Oregon. Investigation by epidemiologists found that the illnesses were due to the fecal bacterium <em>Shigella sonnei<\/em>, and traced to an unusual common source: a splash fountain. This outbreak underscores the risk of large and prolonged outbreaks from these fountains and the need to develop and implement environmental health standards for their design and maintenance.<br \/>\n<br \/>\n<strong>Documents<\/strong><br \/>\n<br \/>\n<ul><li>\u2022 <a href=\"http:\/\/www.outbreakmuseum.com\/mobile\/2003-103-questionnaire\/\" target=\"_blank\"><strong>Outbreak Questionnaire (MS Word)<\/strong><\/a><\/li><br \/>\n<li>\u2022 <a href=\"https:\/\/public.health.oregon.gov\/DiseasesConditions\/CommunicableDisease\/CDSummaryNewsletter\/Documents\/2004\/ohd5314.pdf\" target=\"_blank\"><strong><em>CD Summary article<\/em>: Shigellosis at the fountain of youth<\/strong><\/a><\/li><br \/>\n<li>\u2022 <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21133311\" target=\"_blank\"><strong>Shigellosis from an Interactive Fountain: Implications for Regulation (Journal of Environmental Health)<\/strong><\/a><\/li><\/ul><br \/>\n<strong>Media Coverage<\/strong><br \/>\n<ul><li>\u2022 <a href=\"http:\/\/www.outbreakmuseum.com\/wp-content\/uploads\/2016\/08\/MediaStory_Outbreak-closes-fountain.docx\" target=\"_blank\"><strong>Statesmen Journal: Outbreak closes fountain<\/strong><\/a><\/li><br \/>\n<\/ul><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<!-- #tablepress-116 from cache -->\n\n<table id=\"tablepress-117\" class=\"tablepress tablepress-id-117\">\n<thead>\n<tr class=\"row-1\">\n\t<th class=\"column-1\">Details:<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr class=\"row-2\">\n\t<td class=\"column-1\"><b>Introduction<\/b><br \/>\nOn July 25, 2003, a physician notified the Oregon Public Health Division about 5 unrelated children with diarrhea. Epidemiologists began investigating to ascertain the bacterial etiology and the means of transmission, so as to institute control measures.<br \/>\n<br \/>\n<b>Methods<\/b><br \/>\nConfirmed cases had <em>S. sonnei<\/em> infections with matching DNA patterns by pulsed-field gel electrophoresis (PFGE), with illness onset date during July\u2013August 2003. Presumptive cases had dysentery or diarrhea with fever and were epidemiologically linked to a confirmed case. Primary cases were the first ill in a household or daycare group.<br \/>\n<br \/>\nTo identify the source of the outbreak, epidemiologists conducted a case-control study, using the first seven confirmed primary cases. Interviews were conducted in English or Spanish with cases or household proxies. Respondents were asked about activities in which they had participated and places at which they had eaten during the last two weeks of July. Fifteen control children, matched to cases by telephone prefix and loosely by age (e.g., being less than 15 years old), were identified by systematic calling.<br \/>\n<br \/>\nTo estimate an attack rate, epidemiologists conducted a telephone survey of 147 children drawn at random from the rosters of two local elementary (grades K\u20135) schools. <br \/>\n<br \/>\nWater samples collected from the fountain\u2019s sump tank and surge tank, and from a nearby drinking water fountain, were assayed for fecal coliforms, <em>E. coli<\/em>, pH, and free chlorine. They were also tested for <em>Shigella<\/em> by membrane filtration and plating on <em>salmonella-shigella agar<\/em>. <em>Shigella<\/em> isolates were then speciated and subtyped by PFGE. <br \/>\n<br \/>\n<b>Results<\/b><br \/>\nInitial interviews identified no obvious common foods, but revealed that many cases had attended a festival in the city park (now known as Rivenes Park) of Hubbard, Oregon. All 7 cases but only 1 of 15 controls had played in the park\u2019s interactive fountain (matched OR undefined, P=0.001). Through case reporting and the subsequent survey, investigators identified 19 confirmed and 37 presumptive cases associated with the fountain. Primary cases were exposed during at least a 10-day period ending August 1, when the fountain was closed.<br \/>\n<br \/>\nThe fountain was a shallow basin about 8 meters in diameter with recessed spray nozzles that encouraged recreational interaction. The water drained to a central reservoir, which allowed standing water to accumulate and did not allow it to recirculate when the fountain was shut off at night. The surge tank was underground with a large device for straining out larger items like soda cans. Fresh water was supplied through a backflow device installed below ground level; the design did not provide adequate protection of the water supply from contamination.<br \/>\n<br \/>\nThe filtration system did not have influent and effluent gauges, nor was there a flow meter. Chlorine was added manually by tossing \"tri-chlor\" (trichloro-S-triazinetrione) tablets into the surge tank on an irregular basis. The ultraviolet light ozone generator was too small for the flow rate, and the bulb had never been changed.<br \/>\n<br \/>\nTwo water samples yielded fecal coliforms (940 and 370 per 100 mL, respectively) and <em>E. coli<\/em> (500 and 140 per 100 mL). Chlorine was not detectable.<br \/>\nOf the 147 local children surveyed, 51 (35%) had played in the fountain during the last two weeks of July. Of the 51, 20 (39%) subsequently developed diarrhea (compared with 3% of those who had not visited the fountain [P<0.001]). Investigators estimated that, including children from other schools, older persons, and those who may have contracted the illness from secondary person-to-person spread, >500 persons most likely contracted shigellosis in this outbreak.<br \/>\n<br \/>\n<b>Lessons learned\/historical significance<\/b><br \/>\nThis splash fountain outbreak provides two unique lessons. First, it is a reminder for epidemiologists to remain objective when investigating outbreaks and not to presume foodborne transmission when dealing with outbreaks of enteric disease. Mark Twain said, \u201cTo a man with a hammer, everything looks like a nail,\u201d but epidemiologists need to maintain a broader perspective.<br \/>\n<br \/>\nSecond, this outbreak highlights the need for public health policy that addresses risks posed by the built environment. It underscores the risk of large and prolonged outbreaks from such fountains and the need to develop and to enforce standards for their design and maintenance. In 2003, the regulations and licensure regarding splash fountains were still being developed. After the outbreak, the state health department\u2019s food, pool and lodging program visited and scrutinized the fountain and suggested that it be licensed and regulated as a public wading pool. The fountain was subsequently re-engineered and now has an automatic chlorinator.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<!-- #tablepress-117 from cache -->\n<p><a href=\"https:\/\/www.outbreakmuseum.com\/mobile\/exhibits\/\"><strong>Back to Outbreak Exhibits<\/strong><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Back to Outbreak Exhibits<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[67],"tags":[],"class_list":["post-2560","post","type-post","status-publish","format-standard","hentry","category-shigella"],"_links":{"self":[{"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/posts\/2560","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/comments?post=2560"}],"version-history":[{"count":9,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/posts\/2560\/revisions"}],"predecessor-version":[{"id":2638,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/posts\/2560\/revisions\/2638"}],"wp:attachment":[{"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/media?parent=2560"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/categories?post=2560"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/tags?post=2560"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}