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In the Netherlands, rainwater becomes more and more popular as an economic and environmentally sustainable water source for splash parks, however, the associated public health risk and underlying risk factors are unknown. Since splash parks have been associated with outbreaks of infectious diseases, a quantitative microbial risk assessment was performed using Legionella pneumophila as a target pathogen to quantify the risk of infection for exposure due to inhalation and Campylobacter jejuni for ingestion. Data for L . pneumophila and C. jejuni concentrations in rainfall generated surface runoff from streets were extracted from literature. Data for exposure were obtained by observing 604 people at splash parks, of whom 259 were children. Exposure volumes were estimated using data from literature to determine the volume of exposure through inhalation at 0.394 μL/min (95% CI-range 0.0446–1.27 μL/min), hand-to-mouth contact at 22.6 μL/min, (95% CI-range 2.02 –81.0 μL/min), ingestion of water droplets at 94.4 μL/min (95% CI-range 5.1–279 μL/min) and ingestion of mouthfuls of water at 21.5·10 3 μL/min (95% CI-range 1.17 ·10 3 –67.0·10 3 μL/min). The corresponding risk of infection for the mean exposure duration of 3.5 min was 9.3·10 −5 (95% CI-range 0–2.4·10 −4 ) for inhalation of L. pneumophila and 3.6·10 −2 (95% CI-range 0–5.3·10 −1 ) for ingestion of C. jejuni . This study provided a methodology to quantify exposure volumes using observations on site. We estimated that using rainwater as source water for splash parks may pose a health risk, however, further detailed quantitative microbial analysis is required to confirm this finding. Furthermore we give insight into the effect of water quality standards, which may limit infection risks from exposure at splash parks.

Flooding and heavy rainfall have been associated with waterborne infectious disease outbreaks, however, it is unclear to which extent they pose a risk for public health. Here, risks of infection from exposure to urban floodwater were assessed using quantitative microbial risk assessment (QMRA). To that aim, urban floodwaters were sampled in the Netherlands during 23 events in 2011 and 2012. The water contained Campylobacter jejuni (prevalence 61%, range 14-10(3) MPN/l), Giardia spp. (35%, 0.1-142 cysts/l), Cryptosporidium (30%, 0.1-9.8 oocysts/l), noroviruses (29%, 10(2)-10(4) pdu/l) and enteroviruses (35%, 10(3)-10(4) pdu/l). Exposure data collected by questionnaire, revealed that children swallowed 1.7 ml (mean, 95% Confidence Interval 0-4.6 ml) per exposure event and adults swallowed 0.016 ml (mean, 95% CI 0-0.068 ml) due to hand-mouth contact. The mean risk of infection per event for children, who were exposed to floodwater originating from combined sewers, storm sewers and rainfall generated surface runoff was 33%, 23% and 3.5%, respectively, and for adults it was 3.9%, 0.58% and 0.039%. The annual risk of infection was calculated to compare flooding from different urban drainage systems. An exposure frequency of once every 10 years to flooding originating from combined sewers resulted in an annual risk of infection of 8%, which was equal to the risk of infection of flooding originating from rainfall generated surface runoff 2.3 times per year. However, these annual infection risks will increase with a higher frequency of urban flooding due to heavy rainfall as foreseen in climate change projections.