Alert after Legionnaires’ disease case in baby

Following the determination of a case of neonatal Legionnaires Disease Public Health England have issued a press release explaining the situation. I have commented for the Science Media Centre and that appears at the bottom of the piece.

For immediate release:
Tuesday 17 June, 2014

 PHE advises temporary suspension of heated home birthing pools filled in advance of labour in home settings

 Public Health England (PHE) and NHS England have temporarily advised against the home use of birthing pools with built-in heaters and recirculation pumps, potentially filled up to two weeks in advance of the birth. This follows a single case of Legionnaires’ disease identified in a baby born in this specific type of birthing pool at home. The baby is currently receiving intensive care treatment in hospital. Samples taken from the heated birthing pool used have confirmed the presence of Legionella bacteria, which cause Legionnaires’ disease. Tests are ongoing to establish if it is the same strain which infected the baby. This is the first reported case of Legionnaires’ disease linked to a birthing pool in England, although there have been two cases reported internationally some years ago.

 NHS England has today issued a Patient Safety Alert rapidly notifying the healthcare system – and specifically midwives – to the possible risks associated with the use of these heated birthing pools at home. The alert recommends that heated birthing pools, filled in advance of labour and where the temperature is maintained by use of a heater and pump, are not used for labour or birth. In the meantime, a full risk assessment into their use is being carried out.

 The majority of birthing pools used at home are filled from domestic hot water systems at the time of labour – these birthing pools do not pose the same risk and are excluded from this alert. There are no concerns about these types of pools as long as pumps are used solely to empty the pool and not for recirculation of warm water.

 Professor Nick Phin, PHE’s head of Legionnaires’ disease, said: “This is an extremely unusual situation, which we are taking very seriously. As a precaution, we advise that heated birthing pools, filled in advance of labour and where the temperature is then maintained by use of a heater and pump, are not used in the home setting, while we investigate further and until definitive advice on disinfection and safety is available. “We do not have concerns about purchased or hired pools that are filled from domestic hot water supplies at the onset of labour, provided that any pumps are used solely for pool emptying. “PHE and relevant local authorities are investigating the infection control measures required for this type of birthing pool and local authorities will be working with the small number of companies who supply these heated birthing pools for use at home.”

 Louise Silverton, director for midwifery at the Royal College of Midwives, said: “Women planning birth at home using a traditional pool that is filled when the woman is in labour or using a fixed pool in an NHS unit are not affected by this alert and should not be concerned. Birthing pools in hospitals are subject to stringent infection control procedures and monitoring. Home birthing pools filled during labour come with disposable liners and are only in place for a relatively short time period, reducing opportunity for bacterial growth.

 “Any women with concerns about using home birthing pools should contact their midwife or local maternity unit.”

 Legionnaires’ disease is extremely rare in childhood, with only one case in children aged 0-9 years reported in England between1990-2011.The infection does not spread from person-to-person – people become infected with the bacteria through inhalation of contaminated water droplets.

Prof Mark Fielder, Professor of Medical Microbiology at Kingston University and Hon General Secretary of the Society for Applied Microbiology.

The recent report of a baby being treated in intensive care following the diagnosis of Legionnaries Disease is an unfortunate and very rare occurrence. The case has been reported by Public Health England they have already advised against a specific type of birthing pool with built in heaters and recirculation pumps. The specific type of pool implicated can be filled in advance of labour and the temperature is maintained by the heater and pump. Birthing pools that are filled from domestic hot water systems at the time of labour do not appear to possess the same risk factors and are not included under the current exclusion. This single case does represent a rare occurrence indeed this is the first case reported in England, there were two other cases reported internationally in past years. The infection is caused by a bacteria called Legionella pneumophilia which can be found commonly in water sources and at low levels it is harmless. The organism can be controlled effectively if the water is cooled to below 20oC or heated to above 60oC. This type of treatment coupled with general good hygiene in terms of keeping water free of impurities will help to keep the organism under control.