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Two of the most serious dangers resulting from improper water treatment of pools, spas and cooling towers are E. coli which can be ingested from contaminated pool water and Pseudomonas (Legionnaires' disease) which can be inhaled from contaminated air near spas or cooling towers . Both of these can lead to serious illnesses and fatalities.

E. coli

What is E.coli ?

E. coli is a common bacterium that lives in the digestive tracts of humans and animals. The strain that sickened children in a White Water Recreation Park near Atlanta, Georgia is E. coli 0157:H7 is highly toxic, causing bloody diarrhea and severe cramps.

E. coli 0157:H7 is also the strain that killed three children and sickened hundreds in Western Washington in 1993.

Another, less dangerous strain of E. coli bacteria was blamed for an outbreak of the disease nicknamed "travelers diarrhea" in the Chicago area. Some 4,500 people fell ill after eating deli food over the June 6 weekend, the largest documented outbreak in the United States involving the relatively rare bacterium.

26 children confirmed with E. coli O157:H7

Date: 07/17/98

Georgia public health officials have confirmed two more cases of E. coli O157:H7 in children who attended White Water Recreation Park. One child from Texas and one from Georgia (Cherokee County) were at the park on June 18, 1998. Neither child is hospitalized.

The two new cases were being followed by Public Health, but laboratory tests were not final until this week. A case previously reported from Forsyth County has now been removed from the list following further lab testing that did not confirm E. coli. Seventeen cases have been confirmed in Georgia and nine from out of state, bringing the total number to 26.

Cases are tied to exposure at White Water during June 11, 12, 17 and 18th. Possible explanations for the multiple days of exposure include four fecal accidents at the park and/or two fecal accidents with high concentrations of bacteria at the park on the 11th and 17th with some residual contamination on the following days, June 12 and 18th.

Though Public Health is continuing to investigate a few more potential cases, none are children who were at the park after June 18th. “We have no evidence of any exposures other than the ones we've been tracking from June 11-18," says Paul Blake, M.D., epidemiologist for the Georgia Department of Human Resources (DHR). If your child was at White Water during that time and has not shown symptoms, there is no cause for concern. The incubation period of one to nine days is over.”

DHR Public Health Director Kathleen E. Toomey, M.D., M.P.H., reminds parents not to take a sick child to a public pool. "Although proper chlorination greatly reduces the risk of infection, even the best chlorination system cannot totally protect against a high concentration of bacteria," she says.

Dirty Public Pool Spreads Deadly E.coli
To Six Small Children

By June Preston (Reuters)

A contaminated paddling pool at a suburban Atlanta water park was blamed Tuesday for an outbreak of E.coli infection that has hospitalized at least eight young children in three states. “It appears it was transmitted through contaminated water,” Georgia Public Health Director Kathleen Toomey told a news conference.  A child may have been infected and had an accident in the pool.”

Toomey said the outbreak was traced to a recreation park in Marietta, Georgia, 15 miles (24 km) north of Atlanta. Four of the hospitalized children suffered kidney failure, and two remained in critical condition Tuesday. Toomey said five children hospitalized in Georgia were at the park on June 11 or 12, 1998 as were two children from Tennessee and one from South Carolina also diagnosed with E.coli infection. A sixth Georgia case appeared unrelated. She said all of the E.coli cases tied to the park were among children 6 years old or younger.

One of the children who suffered kidney failure was 3-year-old Brody Weiss, the son of Atlanta Braves shortstop Walt Weiss. He was in serious condition Tuesday at Scottish Rite Children's Hospital and was being treated with dialysis, a respirator and blood transfusions.

Weiss said his son initially appeared to have some kind of bug “but blood started showing up in his bowel movements and by Thursday he was just passing pure blood from his bowels.” E.coli bacteria are killed by chlorine, and Toomey said experts believed the pool may not have received adequate chlorine treatment.  

She said an incontinent youngster could have spread E.coli bacteria in the pool. “It is important to tell your child not to go to the bathroom in a pool,” Toomey said. “And more important, if your child has a diarrheal condition, do not take them to a water park.”

A confirmed fatality

A little girl named Michele died as a result of exposure to E. coli at the recreation park in Marietta, Georgia.  In response, the Georgia legislature is considering a bill to be called "Michele's Law" strengthening the regulations pertaining to public pools, spas and waterparks.

Pseudomonas

What is Legionnaires' disease?

Legionnaires' disease is a type of pneumonia that is caused by Legionella, a bacterium found primarily in warm water environments. Both the disease and the bacterium were discovered following an outbreak traced to a 1976 American Legion convention in Philadelphia. Pontiac fever, a flu-like illness, is also caused by Legionella organisms (legionellae), but is not as serious as Legionnaires' disease. Most people who get Pontiac fever recover within five days, without having to be hospitalized.

What are the symptoms of Legionnaires' disease?

Legionnaires' disease develops within 2 to 10 days after exposure to legionellae. Initial symptoms may include loss of energy, headache, nausea, aching muscles, high fever (often exceeding 104°F), and chest pains. Later, many bodily systems as well as the mind may be affected. The disease eventually will cause death if the body’s high fever and antibodies cannot defeat it. Victims who survive may suffer permanent physical or mental impairment.

Is Legionnaires' disease common?

Legionnaires’ is not rare. It is perceived as rare only because most cases are never detected, and not all detected cases are reported to public health authorities. Because underdiagnosis and under-reporting make incidence of the disease difficult to estimate, figures have varied widely. The (U.S.) Centers for Disease Control and Prevention (CDC), Atlanta, has estimated that the disease infects 10,000 to 15,000 persons annually in the United States, but others have estimated as many as 100,000 annual U.S. cases.

Where Are Legionella Bacteria Found?

The bacteria are found normally in many places in the environment. A common source is water. Outbreaks have been related to contaminated air-conditioning cooling towers, NOT window air conditioners. The bacteria also have been found in hot and cold water taps, showers, whirlpool baths, creeks, ponds and wet soil.

Recent outbreaks

Flower show, 233 cases, 22 deaths, The Netherlands, Mar. 1999

Updated 27 April 1999: Dutch health authorities have confirmed that 233 people who visited a large flower show near Amsterdam became ill and 22 died. Seemingly healthy people are among the victims. Laboratory tests have confirmed Legionnaires' disease in 106 cases and 15 of the deaths. Legionnaires' is the probable cause of 48 cases and 2 deaths. Legionnaires' could not be identified in the other 79 cases and 5 deaths. The public health laboratory found legionellae in a whirlpool spa that was on display at the show. The strain of legionellae found in the whirlpool was identical to that found in patients. Source: news media and NL health ministry.

1994 New York Cruise Ship

An outbreak of Legionnaires disease among cruise ship passengers that occurred in April 1994, but went unrecognized until july 1994. 50 passengers with Legionnaires' disease (16 confirmed, 34 probable) were identified from nine cruise embarking between April 30 and July 9 1994. Exposure to whirlpool spas was strongly associated with the disease.

(Jernigan DB, The Lancet 1996 347; Febuary 24 494-499)

1994 2 Deaths in Hot Tubs, Queensland, Australia

Legionella pneumophila is the cause of Legionnaires' disease, and Pontiac fever, an influenza-like condition without pneumonia. We present a case of Pontiac fever after exposure to a hot tub contaminated with L pneumophila. A 37 y/o wf presented to the office with acute onset of sore throat, fever, headache, and myalgia. Patient was hospitalized 3 days later because of worsening shortness of air. Chest x-ray was normal. Patient was treated with 2 days of IV erythromycin and was discharged home on oral erythromycin. Her Legionella IFA was 1:16,384. Two days later, she developed chest tightness, pleuritic chest pain, and increasing shortness of air but did not have any cough or sputum production. She was re-hospitalized with a diagnosis of Pontiac fever and treated with IV erythromycin plus oral rifampin. A repeat chest x-ray remained normal. After a detailed epidemiologic history was obtained, it was noted that she became ill after using a hot tub, which her two children also used and they themselves developed a self limited illness. Water from the hot tub was positive for L pneumophila by DFA, culture, and PCR. Patient improved gradually with therapy and was discharged home. This report emphasizes the importance of a complete epidemiologic history in the diagnosis of respiratory infections. It also demonstrates that aquatic environment can be contaminated with Legionella and serve as a source of infection.

Division of Infectious Diseases, University of Louisville, School of Medicine, KY, USA.

1996 Virginia.  Whirlpool Spa Display .

This report describes the preliminary findings of an ongoing investigation by the Virginia Department of Health (VDH) and CDC of a recent outbreak of Legionnaires' disease in Virginia, which implicated a whirlpool spa display at a retail store as the source of infection.

On October 15, 1996, a district health department in southwestern Virginia contacted the Office of Epidemiology, VDH, about a hospital (hospital A) report that 15 patients had been admitted during October 12–13 with unexplained pneumonia.

Four of these case-patients and one of the controls reported only “walking by” the spa. No other activity, including drinking from the store’s water fountains or visiting the 14 other locations in the community, was associated with illness. Whirlpool Spas Drained Samples were collected and cultured for the presence of Legionella from water sources in the home-improvement center, including a whirlpool spa basin, spa filters, a greenhouse sprinkler system, a decorative fish pond and fountain, potable water fountains, urinals, and hot and cold water taps in the store’s restrooms. In addition to these potential sources, a second whirlpool spa had been sold, drained on October 9, and removed from the store floor on October 11.

1989 Vermont Spas

Three cases of Legionnaires' Disease reported to the New York Health Department in September 1989, All three cases were members of a 20-man golf team that had stayed at the Vermont resort hotel.  The resort health club had two whirlpool spas, only one was in use, and was used by the three cases , 3 days prior to the illness.  The whirlpool spa was identified as the most probable source of exposure at the resort.

NOTE:  The State of Vermont has since passed a law requiring automated ORP control in all commercial, public and semi-public spas.

More Information on Legionnaires' Disease

For more detailed information on the above cases, go to the site of  HC Information Resources.