Background: Public aquatic venues (e.g., pools, hot tubs/spas, and water playgrounds) have increased in size, accommodating more bathers, and have moved indoors, making swimming, play, and relaxation in the water a year-round activity instead of one limited to the warmer months. Additionally, with design innovations, aquatic venues have advanced from being rectangular pools and changed the way bathers interact with the water and potentially waterborne pathogens. We saw the advent hot tub/spas in the early 1980s, followed by water playgrounds in the late 1990s, and floatation tanks in the early 2010s. In the late 2010s, surf pools and artificial lagoons have appeared. Public health lessons learned from the introduction of novel aquatic venues of yesterday can inform efforts to prevent illness and injury associated with novel aquatic venues of today and tomorrow.
Methods: We reviewed data from investigations of illness and injury associated with novel venues and prevention efforts of the Centers for Disease Control and Prevention (CDC), state and local public health partners, and other external partners, including the Council for the Model Aquatic Health Code (CMAHC).
Results: Public health agencies established standards for hot tubs/spas and water playgrounds after they became popular and were identified as an important source of recreational water–associated outbreaks. As floatation tanks became increasingly popular, the CMAHC convened an ad hoc committee, comprised of public health officials and aquatics sector representatives, to draft public health recommendations. Following a CMAHC membership vote approving these proposed recommendations, CDC added them to the 2018 MAHC (3rd edition). CDC is not aware of any reports of outbreaks associated with floatation tanks. CMAHC set up another ad hoc committee to address surf pools before they become popular. Themes emerged from our review, including the importance of the definition of an aquatic venue (i.e., whether a given novel venue meets the definition), collaboration between public health and aquatics sector to establish public health standards for public aquatic venues, and recognizing the uniqueness of novel venues by writing venue-specific standards as needed.
Conclusions: As exposure to water, waterborne pathogens, and safety issues at public aquatic venues evolve with the advent of novel venues, the MAHC and the CMAHC provide a roadmap to move from a reactive approach of responding to illness and injury to a proactive prevention approach.
- Identify novel aquatic venues of the last few decades
- Describe how each novel venue presents risk of illness or injury
- Discuss how the MAHC and CMAHC can help prevent associated illness and injury