Heated birthing pools as a source of Legionnaires' disease.
In June 2014 Public Health England confirmed a case of Legionnaires' disease (LD) in a neonate following birth at home in a hired birthing pool incorporating a heater and a recirculation pump which had been filled in advance of labour. The case triggered a public health investigation and a microbiological survey of an additional ten heated birthing pools hired or recently hired to the general public across England. The birthing pool used by the parent of the confirmed case was identified as the source of the neonate's infection following detection of Legionella pneumophila ST48 in both patient and environmental samples. Legionella species were detected by quantitative polymerase chain reaction but not culture in a further three pools together with other opportunistic pathogens identified by culture and matrix-assisted laser desorption ionization-time of flight (MALDI-ToF) mass spectrometry. A Patient Safety Alert from NHS England and Public Health England was issued stating that heated birthing pools filled in advance of labour should not be used for home births. This recommendation remains in place. This investigation in conjunction with other recent reports has highlighted a lack of awareness regarding the microbiological safety of heated birthing pools and their potential to be a source of LD and other opportunistic infections. Furthermore, the investigation raised important considerations with regards to microbiological sampling and testing in such incidents. Public health authorities and clinicians should consider LD in the differential diagnosis of severe respiratory infection in neonates within 14 days of a water birth.
National Infection Service,Public Health England,UK.
S L
SL
Collins
National Infection Service,Public Health England,UK.
B
B
Afshar
National Infection Service,Public Health England,UK.
J T
JT
Walker
National Infection Service,Public Health England,UK.
H
H
Aird
National Infection Service,Public Health England,UK.
F
F
Naik
National Infection Service,Public Health England,UK.
F
http://orcid.org/0000-0002-0482-0175
F
Parry-Ford
National Infection Service,Public Health England,UK.
N
N
Phin
National Infection Service,Public Health England,UK.
T G
TG
Harrison
National Infection Service,Public Health England,UK.
V J
VJ
Chalker
Environmental Health Officer.
S
S
Sorrell
Health Protection Team,Public Health England,UK.
T
T
Cresswell
D016550:Birthing Centers; D003937:Diagnosis, Differential; D004739:England; D006358:Hot Temperature; D006801:Humans; D006875:Hydrotherapy / Q000009:adverse effects*; D007231:Infant, Newborn; D016952:Legionella pneumophila / Q000145:classification / Q000302:isolation & purification / Q000502:physiology*; D007877:Legionnaires' Disease / Q000175:diagnosis* / Q000382:microbiology / Q000635:transmission; D014871:Water Microbiology
Laboratory tests; Legionella; Legionnaires' disease; opportunist infections; water (quality)