Can You Get Legionnaires’ Disease From Your Hot Tub?

The answer, unfortunately, is YES. The families of four dead from Legionnaires’ disease and 141 infected people can blame a hot tub display at the Mountain State Fair in North Carolina, according to state health officials. Legionella pneumophilia, the bacteria that lives in pooled water and infects those who inhale water droplets containing the bacteria, causes flu-like symptoms that progress into pneumonia.

Early information gathered by local health departments and a Henderson County, N.C. doctor indicated that most of those infected reported attending the State Fair, which ran from Sept. 6-15 at the Western North Carolina Agricultural Center (WNC Ag Center) in Fletcher, NC.   Almost 70% of the people infected had to go to the hospital — a total of 94 people, according to a statement from the North Carolina Department of Health and Human Services.

Health department officials tested a broad range of water sources from the WNC Ag Center and found multiple positives for Legionella from different water sources around the building. The center is undergoing an industrial cleaning designed to disinfect any remaining reservoirs of Legionella, the health department states.

“Legionella organisms can be found in many types of water systems,” says George Schiffman, MD, FCCP. “However, the bacteria reproduce to high numbers in warm, stagnant water (95 F-115 F), such as that which is found in certain plumbing systems and hot-water tanks, cooling towers, and evaporative condensers of large air-conditioning systems, and hot tubs. Cases of legionellosis have been identified throughout the United States and in several other countries. The disease likely occurs worldwide.”

Legionnaires’ disease and Pontiac fever, a milder form of the illness caused by the same bacteria, cause fever, chills, and cough. At its worst, Legionnaires’ disease can cause severe pneumonia and respiratory failure.  Patients with Legionnaires’ disease usually develop a fever, chills, and a cough. The cough may either be dry or produce sputum. Some patients with Legionnaires’ disease also have muscle aches, headache, tiredness, loss of appetite, and occasionally diarrhea.  Legionnaires’ disease can cause a severe pneumonia, seriously affect breathing, even lead to respiratory failure and adult respiratory distress syndrome (ARDS), Dr. Schiffman said.  People with Pontiac fever experience a self-limiting influenza-like illness with fever, chills, headache, and muscle aches but, by definition, do not have pneumonia. Sickened individuals generally recover in two to five days without treatment.

So, what do you do about that hot tub? Well, prevention is aimed at improving the design and maintenance of cooling towers and plumbing systems. The goal is limiting the growth and aerosolization of Legionella organisms. But before you overload your hot tub with chlorine, hyperchlorination tends to be ineffective at disinfecting the water supply. However, copper-silver ionization, super heating, and monochloramine disinfection are newer methods of controlling and eliminating growth of this bacteria. So keep your hot tub HOT, keep testing the water and maintain proper chemical levels and balances, and clean the filter regularly. Ideally, a filter should be replaced every 6 months or so. Another part of regular maintenance is draining, cleaning and refilling the spa. How often you should do this depends on how much use it gets.

During outbreaks, health department investigators seek to identify the source of disease transmission and recommend appropriate prevention and control measures, such as decontamination of the water source.  Detailed guidelines for the prevention of Legionnaires’ disease both in hospitals with no identified cases (“primary prevention”) and in hospitals with reported cases (“secondary prevention”) have been published and are available in the U.S. from the Centers for Disease Control and Prevention.

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