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Another Fatality – Legionella accidently introduced at birth

 The details surrounding the unfortunate death of a 19 day old infant in January 2014 from Legionella infection have recently been released, and they indicate another instance of the possible dangers of Legionella, once again, possibly involving home birthing pools.

After a healthy pregnancy, the baby was delivered via uncomplicated, spontaneous vaginal birth in a recreational-grade, jetted, soft-sided collapsible tub with the assistance of a certified professional midwife. The tub was delivered to the home two weeks prior by a licensed midwifery center and was filled with the home’s well water. Enzyme-based spa purifying drops were added. These drops did not contain chlorine, nor did the home’s water supply undergo any additional filtration or disinfection. The water was circulated at 37C (98.6F) until two days prior to birth. At that time, the tub was emptied, refilled with well water and circulated at 37C (98.6F) until delivery.

At six days old, the infant was admitted to the hospital for loose stool, cyanosis and respiratory failure. With these symptoms, and the knowledge of a home water birth, clinicians suspected legionellosis. Urine and tracheal aspirate test results confirmed L. pneumophilia serogroup 1 on the fourth day of hospitalization. On day 19, the infant died.

By the time that legionellosis was confirmed, the home birthing tub was drained, disinfected and stored at the midwifery center and was unable to be sampled. Although no environmental sampling of the home’s water supply detected the presence of Legionella, investigators identified several items which lead to believing the home birthing tub was the likely primary culprit and source of infection, including:

  1. The center used a recreational jetted tub that was not approved for medical equipment. The internal tubing can be difficult to disinfect.
  2. Water treatment inside the tub included a non-FDA approved additive.
  3. Non-disinfected water was circulating at 37C (98.6F) for an extended period of time, which is an ideal temperature for the proliferation of Legionella and other species of bacteria.

Birthing pools themselves are not necessarily the issue; rather it is the cleaning and maintenance of any type of water reservoir, especially those used for Legionella susceptible populations. For instance, birthing pools in hospitals, unlike home birthing pools, are subject to stringent infection control procedures and monitoring.  Expectant mothers who choose home vs. hospital water birth options should understand the risks as well as cleaning and maintenance procedures and discuss them with their doctor.

Legionellosis, also known as Legionnaires’ disease and the milder version of Pontiac Fever, first came to light in 1976 when a previously unknown illness killed 34 people and sickened another 200 following an American Legion convention in Philadelphia.  The source was traced to the cooling towers of the hotel’s air conditioning system, and the bacterium was thus named for the convention attendees. However, the bacteria can be found in many environments, both natural and man-made.

For more information on Legionella infections and resources for preventing, identifying, or treating Legionella contamination in your building’s water supply, contact us at solutions@cogencyteam.com.

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