CDC MMWR Report - 2017 Legionella Outbreak Associated with Memphis Hotel Hot Tub

In the January 19th MMWR release, an investigative report into a 2017 Legionella outbreak associated with a hotel hot tub and pool.  While the outbreak came to light because of a few cases, many more were found through old-fashioned investigative work rather than sample analysis.

Initially 3 cases were identified, and this led them to the hot tub.  Through proceeding to survey past guest, 92 cases were identified, including nine laboratory-confirmed (urinary antigen positive) cases, 19 probable (self-reported pneumonia) cases, and 64 suspected (self-reported fever and ≥1 compatible symptom*) cases.  Of these, 70 had required medical care, and 16 people were hospitalized and there was one reported death.

Not the way to meet up with Elvis after going into a Memphis hotel hot tub, or any hotel water for that matter.  But how do you know?  In this case, "environmental health specialists conducted an assessment of the hotel aquatics facility and identified improper water treatment monitoring and low chlorine residuals (0 ppm; acceptable range = 1–3 ppm)."  "Laboratory testing of the aquatics facility water samples identified three Legionella polymerase chain reaction–positive samples from the pool, pool sand filter, and hot tub sand filter, and isolated Legionella pneumophila serogroup 1 from the hot tub sand filter."   Something to be said about that smell of chlorine when poolside.

CDC MMWR
https://www.cdc.gov/mmwr/volumes/67/wr/mm6702a5.htm?s_cid=mm6702a5_e
Notes from the Field: Legionellosis Outbreak Associated with a Hotel Aquatics Facility — Tennessee, 2017

Public pools and E. coli - an MMWR report

With summer fast approaching, it is great when we come upon a report on microbiological safety as it related to a fun summer-related activity. There is this gem in May 16th’s MMWR: Microbiologic Contamination of Filter Concentrates from Public Pools. Basically, they looked at pool filters from public pools and found that in more than half the samples tested, E. coli was present. Now while this was unlikely the pathogenic type of E. coli, it was certainly the type that screams – “of fecal origin”. Now I guess we all sort-of-figured this poop-particle-in-shorts thing happens, but to see it in writing… The authors go on to suggest that people consider taking pre-swimming showers, but I guess that is not going to happen, especially considering that people look at the pool as a place to bath. But certainly, if someone has diarrhea, they need to stay out of the pool. And this might not be as easy with children who may be willing to forget their stomach is rolling in order to get into the pool on a hot summer day. So then secondly, if your public pool water is looking a little murky, it may be a good sign to keep your head above the water. Go chlorine, and as Cathy Cutter points out, pray for that dilution effect.

Microbiologic Contamination of Filter Concentrates from Public Pools as Evidence of the Need for Improved Swimmer Hygiene — Atlanta, Georgia, 2012
http://www.cdc.gov/media/mmwrnews/2013/0516.html
CDC
Division of News & Electronic Media
404-639-3286

A study of public pools found that feces are frequently introduced into pool water by swimmers. Water samples from pool filters were tested for Escherichia coli, a fecal indicator, which was detected in 93 (58 percent) of 161 samples. The tests cannot determine whether the E. coli represents risk to swimmers, but they do indicate that swimmers frequently introduced fecal material into pool water, which could lead to spreading germs to other swimmers. Swimmers can minimize fecal contamination and help keep germs out water by taking a pre-swim shower and not swimming when ill with diarrhea. Aquatics staff can kill germs in pools by maintaining disinfectant level and pH according to state and local public health standards, which are enforced by environmental health specialists (pool inspectors).