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Heated birthing pools as a source of Legionnaires' disease

  • S. L. COLLINS (a1), B. AFSHAR (a1), J. T. WALKER (a1), H. AIRD (a1), F. NAIK (a1), F. PARRY-FORD (a1), N. PHIN (a1), T. G. HARRISON (a1), V. J. CHALKER (a1), S. SORRELL (a2) and T. CRESSWELL (a3)...

Summary

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.

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Copyright

Corresponding author

* Author for correspondence: Dr S. L. Collins, Biosafety Investigation Unit, Public Health England, Porton Down, Salisbury, UK. (Email: Samuel.collins@phe.gov.uk)

References

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1. Bartram, J, et al. Legionella and the Prevention of Legionellosis. Geneva: World Health Organisation, 2007.
2. ECDC. Legionnaire's diease in Europe. Annual reports 2009–2012 (http://ecdc.europa.eu/en/healthtopics/legionnaires_disease/Pages/publications.aspx). European Centre for Disease Prevention and Control.
3. Anon. National findings from the 2013 survey of women's experiences of maternity care, 2013.
4. Anon. Immersion in water for labour and birth. The Royal College of Midwives Evidence Based Guidelines for Midwifery-Led Care in Labour 2012. 2012.
5. Franzin, L, et al. Legionella pneumophila pneumonia in a newborn after water birth: a new mode of transmission. Clinical Infectious Diseases 2001; 33: e103104.
6. Schrijver, D. Legionnaires' disease in a newborn after an underwater birth [in Dutch]. Vlaams Infectieziektebulletin 2002; 1: 89.
7. Fritschel, E, et al. Fatal legionellosis after water birth, Texas, USA, 2014. Emerging Infectious Diseases 2015; 21: 130132.
8. Nagai, T, et al. Neonatal sudden death due to Legionella pneumonia associated with water birth in a domestic spa bath. Journal of Clinical Microbiology 2003; 41: 22272229.
9. Phin, N, et al. Case of Legionnaires disease in a neonate following a home birth in a heated birthing pool, England, June 2014. Eurosurveillance 2014; 19(29).
10. Ratzow, S, et al. Addition of neuA, the gene encoding N-acylneuraminate cytidylyl transferase, increases the discriminatory ability of the consensus sequence-based scheme for typing Legionella pneumophila serogroup 1 strains. Journal of Clinical Microbiology 2007; 45: 19651968.
11. Collins, S, et al. Real-time PCR to supplement gold-standard culture-based detection of Legionella in environmental samples. Journal of Applied Microbiology 2015. doi:10.1111/jam.12911.
12. Mentasti, M, et al. Design and validation of a qPCR assay for accurate detection and initial serogrouping of Legionella pneumophila in clinical specimens by the ESCMID Study Group for Legionella Infections (ESGLI). European Journal of Clinical Microbiology & Infectious Diseases 2015; 7: 13871393.
13. ESCMID Study Group for Legionella Infections. Sequence-Based Typing (SBT) Database for Legionella pneumophila (http://bioinformatics.phe.org.uk/legionella/legionella_sbt/php/sbt_homepage.php). Accessed July 2015.
14. Issack, MI, Neetoo, Y. An outbreak of Elizabethkingia meningoseptica neonatal meningitis in Mauritius. Journal of Infection in Developing Countries 2011; 5: 834839.
15. NHS England. Patient Safety Alert NHS/PSA/D/2014/011 (http://www.england.nhs.uk/wp-content/uploads/2014/06/psa-legionella-birth-pool.pdf). Accessed July 2015.
16. Aydin, B, et al. A case of newborn with community acquired pneumonia caused by Cupriavidus pauculus. Tuberkuloz ve Toraks 2012; 60: 160162.
17. Issaoui, S, et al. Neonatal infection with Stenotrophomonas maltophilia (2 case studies) [in French]. Archives de Pediatrie 2012; 19: 404407.
18. Pestourie, N, et al. Outbreak of AmpC beta-lactamase-hyper-producing Enterobacter cloacae in a neonatal intensive care unit in a French teaching hospital. American Journal of Infection Control 2014; 42: 456458.
19. Turel, O, et al. Bacteremia due to Achromobacter xylosoxidans in neonates: clinical features and outcome. Brazilian Journal of Infectious Diseases 2013; 17: 450454.
20. Wareham, D. Sepsis in a newborn due to Pseudomonas aeruginosa from a contaminated tub bath. New England Journal of Medicine 2001; 345: 16441645.
21. Coetzee, N, et al. An outbreak of Legionnaires' disease associated with a display spa pool in retail premises, Stoke-on-Trent, United Kingdom, July 2012. Eurosurveillance 2012; 17(37).
22. Mentasti, M, et al. Application of Legionella pneumophila-specific quantitative real-time PCR combined with direct amplification and sequence-based typing in the diagnosis and epidemiological investigation of Legionnaires' disease. European Journal of Clinical Microbiology & Infectious Diseases 2012; 31: 20172028.
23. Shih, HY, Lin, YE. Caution on interpretation of legionella results obtained using real-time PCR for environmental water samples. Applied and Environmental Microbiology 2006; 72: 6859.
24. Teare, L, Millership, S. Legionella pneumophila serogroup 1 in a birthing pool. Journal of Hospital Infection 2012; 82: 5860.
25. Yiallouros, PK, et al. First outbreak of nosocomial Legionella infection in term neonates caused by a cold mist ultrasonic humidifier. Clinical Infectious Diseases 2013; 57: 4856

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