Pages: 63-74
Authors: Zsófia Barna, Judit K Horváth, Mihály Kádár, Ilona F Paluska, Anita Szax, Tamás Pándics and Márta Vargha

Three clusters (eight cases including two deaths in total) of spa pool related travel associated Legionnaires’ disease cases were identified in Hungary between 2010 and 2012. The aetiological agent was L. pneumophila sg 1 in all three clusters. Clinical strains were available from cluster 1 and 2. In cluster 1, the spa pool water was negative for legionellae, but L. pneumophila 1 was isolated from the sand filter. In the other two clusters high Legionella counts were detected in the pool water (1,700 and 1,500,000 CFU/L, respectively). The domestic water distribution system was negative in all three hotels. In all three clusters, the residual disinfectant level was low or not recorded at the estimated time of infection, on-site measurements were not carried out properly, and records were incomplete. In clusters 2 and 3, the pool design was not suitable for community use and in the latter pool management practices did not meet the minimum standards. These results strongly support that the source of infection with high probability was the hotel spa pool. The pools were shut down, disinfected and refurbished where necessary and re-opened under strong supervision of the local health authority after negative results. The findings of the investigations served as a basis for the development of legislation on environmental Legionella risk assessment and risk management, covering spa pools among other settings.

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Dokumentum neve	sorrend	Dátum
Barna - Spa		2021-10-08