by Cheryl-Anne Sturken | May 30, 2018
According to a new study from the Centers for Disease Control and Prevention, more than 493 disease outbreaks associated with treated recreational water linked to hot tubs/spas, pools and water playgrounds resulted in 27,000 cases and eight deaths between 2000 and 2014. The outbreaks were reported by health officials in 46 states and Puerto Rico, and many were linked to hotels.
 
Among the 363 outbreaks with a confirmed infectious origination, 212 (58 percent) were caused by Cryptosporidium, which leads to gastrointestinal illness; 57 (16 percent) by Legionella, which causes Legionnaires' disease (a severe form of pneumonia) and Pontiac fever (a milder illness with flu-like symptoms); and 47 (13 percent) by Pseudomonas, which causes folliculitis (commonly referred to as hot-tub rash) and otitis externa (swimmers' ear). At least six of the eight reported deaths occurred in persons affected by outbreaks caused by Legionella.
 
The report found that pools and hot tubs at hotels, motels, lodges and inns were the leading cause of 157 of the 493 outbreaks, and 94 percent of those 157 outbreaks were confirmed to have infectious origins: 40 were caused by Pseudomonas, 29 by Legionella and 17 by Cryptosporidium. In addition, 65 percent of the hotel-related outbreaks were associated with hot tubs/spas.
 
Approximately 20 percent of the 13,864 routine inspections of public hot tubs and spas conducted in 16 jurisdictions in 2013 identified improper disinfectant concentrations being used at treated water facilities, according to the CDC's report. Legionella is typically transmitted when someone inhales aerosolized water droplets, which are produced by hot tub/spa jets containing the bacterium. Pseudomonas are transmitted when skin comes in contact with contaminated water. Multiple factors contribute to Legionella and Pseudomonas growth in hot tubs/spas, including an inadequate concentration of disinfectant; incorrect water temperatures, which facilitate pathogen amplification and make it difficult to maintain adequate disinfectant concentration; water aeration, which depletes halogens; and the presence of biofilm and sediment on wet surfaces.
The report urges the public to check the inspection scores of public recreational water venues, and to conduct your own mini-inspection before getting into the water by measuring the bromine or free-chlorine level and pH using test strips that can be purchased at pool supply, hardware and big-box stores.
 
The CDC also said potential hot tub/spa users should know whether they are at an increased risk for Legionnaires' disease, so they can choose to avoid using them. Most healthy people exposed to Legionella do not get sick; those with an increased risk of getting sick are:
 
• People age 50 or older;
• Current or former smokers;
• People with a chronic lung disease (like chronic obstructive pulmonary disease or emphysema);
• People with weak immune systems or who take drugs that weaken the immune system (such as those taken after a transplant operation or chemotherapy);
• People with cancer, and
• People with underlying illnesses such as diabetes, kidney failure or liver failure.