Last year, an outbreak of the methicillin-resistant Staphylococcus aureus (MRSA) superbug, linked to extensive play on bouncy castles, resulted in 48 children and adolescents developing skin and soft tissue infections, with 15 requiring hospital treatment. Four children were hospitalized as a result of the outbreak.
This marks the first time a large outbreak of the antibiotic-resistant bacteria has been associated with bouncy castle activities, a mechanism previously undescribed in scientific literature. While community-acquired MRSA outbreaks are typically linked to close physical contact and crowded environments, most large outbreaks have previously occurred in settings like sporting events, prisons, and childcare facilities.
The report, published in the medical journal Eurosurveillance, indicates the outbreak occurred due to close physical contact among children and adolescents playing on three bouncy castles in a suburban area in the HSE Dublin and Midlands region. Conditions on the day were humid and warm, with parents noting the children were wet and engaged in "rough-and-tumble" play.
Most of the 48 patients had attended the event, with many spending significant time on the inflatables, including 19 who reported spending at least four hours. The first identified case was a 12-year-old boy diagnosed with MRSA folliculitis, an infection of the hair follicles, who had attended a social gathering nine days prior.
An outbreak control team was convened after doctors became aware of a cluster of 25 other children from the same event seeking treatment for unusual skin infections. The team included doctors from various HSE areas, the National MRSA Reference Laboratory, and Children's Health Ireland at Crumlin.
The event organizer assisted in identifying families present, who were then contacted and provided with risk assessments. None of the four hospitalized children experienced severe outcomes, though their average hospital stay was four days. Treatment included antibiotics, body wash, and nasal ointment, alongside advice to avoid crèches and schools until acute symptoms resolved.
The operator of the bouncy castles was instructed to clean and disinfect the equipment before reuse, and a local primary school attended by most affected children received guidance on infection prevention.
The outbreak involved 22 confirmed and 26 possible cases among children aged five to 16, with an average age of 12. Nearly three-quarters of those affected were male. Infections commonly presented as spots, redness, and blisters, primarily on the legs, followed by the abdomen and buttocks. Twelve patients also reported fever, nausea, or vomiting. Symptoms typically appeared two days after the party, though one case developed symptoms 17 days later.
Domhnall McGlacken-Byrne, one of the report's authors and from the HSE's Department of Public Health, described it as an "unusual and complex community outbreak," noting that bouncy castle play represented a "novel mechanism for an outbreak of this size." He highlighted that the specific MRSA strain had not previously been linked to an outbreak in either healthcare or community settings in Ireland and was notable for a high attack rate and a relatively short incubation period.
McGlacken-Byrne stated that no other exposure appeared as plausible as the close-contact play on the bouncy castles to explain the outbreak. While the exact source and transmission method could not be definitively determined, it is believed that one or more infected children led to onward transmission.
The report recommended that public health practitioners remain aware of the risk of community-acquired MRSA outbreaks in situations involving prolonged, close physical contact, such as play activities and contact sports. It also advised informing suppliers of inflatable play equipment about decontamination needs.
Effective control of the outbreak was attributed to prompt recognition of linked cases, early medical treatment, good communication, and strict infection control measures, as suggested by limited evidence of secondary transmission.