Pediatric Death From Rare Naegleria Fowleri Infection Linked To Arlington Splash Pad
On September 5, 2021, Tarrant County Public Health and the city of Arlington received word that a child at Cook Children’s Medical Center had been hospitalized with primary amebic meningoencephalitis, a rare and often fatal infection caused by Naegleria fowleri ameba. To protect the identity of the child, who died in hospital on September 11, no additional details are provided.
A public health study in Tarrant County identified two possible sources for the child’s exposure to water containing N. fowleri: the family home in Tarrant County or the splash pad of Don Misenhimer Park in Arlington. On Sept. 24, the Centers for Disease Control and Prevention confirmed the presence of active N. fowleri ameba on the splash pad of water samples and determined that the Arlington site was the likely source of the child’s exposure.
The risk of N. fowleri infection is very low, with only 34 reported infections in the United States between 2010 and 2019, according to the CDC. N. fowleri infects humans when water containing the ameba enters the body through the nose. This usually happens when people go swimming or diving in warm freshwater areas, such as lakes and rivers. In very rare cases, the ameba has also been found in other sources, such as insufficiently chlorinated swimming pool water or heated and contaminated tap water.
The City of Arlington closed the Don Misenhimer Park splash pad on September 5, immediately after reporting the child’s illness, and proactively closed all public splash pools for the rest of the year out of an abundance of caution. Symptoms of primary amebic meningoencephalitis usually occur within nine days of infection, according to the CDC. Other than this child, no other cases of this infection have been reported to Tarrant County Public Health.
As of Sept. 5, the city has been working with the county, the Texas Commission on Environmental Quality, the Texas Department of State Health Services, and the Centers for Disease Control and Prevention to determine if the splash pad was the source of the infection and what conditions led to the infection. ameba may exist in the treated water.
City and county officials, led by the CDC, collected a series of water samples from the splash pad and parts of the system that supply water to the facility and the surrounding area between Sept. 10 and 14. These samples were sent to the CDC for testing. On Sept. 16, the CDC said the samples collected from the Arlington splash pad were “tentatively positive” for the presence of N. fowleri ameba. Those test results were confirmed on September 24.
As part of its response plan, the City of Arlington is conducting a thorough evaluation of splash guard equipment and supplies, water quality maintenance and inspection, procedures and training to ensure safe recreational spaces for residents and visitors. All of the city’s fenders have passed their annual inspection before the start of the summer season. However, the water quality test data has shown the need for improvement, city officials said.
“We have identified gaps in our daily inspection program,” said deputy city manager Lemuel Randolph. “Those gaps meant that we were not meeting our maintenance standards for our mudguards. All fenders will remain closed until we are confident that our systems are working properly and we have confirmed a maintenance protocol consistent with city, county and state standards.”
Data from two of the four splash pads, those owned by Don Misenhimer Park and The Beacon Recreation Center, show that Parks and Recreation employees have not consistently recorded, or in some cases failed to perform, water quality tests required prior to the facilities. open every day. This includes checking for chlorine, a disinfectant used to prevent harmful organic matter.
When chlorine level readings at those locations were below minimum state standards, the inspection log did not consistently reflect what action city employees were taking to increase chlorination levels. For example, the logs did not always show how much disinfectant was manually added to the splash pad water system. The logs also did not consistently include a follow-up measurement to confirm that water chlorination levels were at acceptable levels after treatment.
In addition, a review of inspection logs found that water chlorination readings were not documented on the Don Misenhimer fender on two of the three dates the child visited the site in late August and early September. Documents show that chlorination levels were within acceptable limits two days before the child’s last visit. However, the following documented reading, which took place the day after the child’s visit, shows that the chlorination level had fallen below the minimum requirement and additional chlorine had been added to the water system.
Click here to view the City of Arlington’s 2021 inspection reports and other documents on mudguards.
The city of Arlington’s drinking water supply is unaffected and water quality continues to meet all state and federal government safety guidelines.
The Don Misenhimer Park splash guard is equipped with a backflow preventer designed to isolate the facility’s water system from the city’s water distribution system. This device has had an annual inspection in April 2021 and again on September 7, 2021. Backflow is the reversal of the flow of a substance to the safe drinking water distribution system. State law requires public water features to be equipped with some form of backflow preventer, such as the one at Don Misenhimer Park. These devices are tested every year by a qualified private company and the inspection reports are filed with the water department.
Click here to view the Don Misenhimer splash pad backflow inspection records from April and September 2021.
For more information about Naegleria fowleri, visit the Centers for Disease Control and Prevention website, https://www.cdc.gov/.
Susan Schrock, City of Arlington Communications Office, 817-459-6405, firstname.lastname@example.org
Brian Murnahan, Tarrant County Public Health Information Officer, 817-321-5306, email@example.com
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