Community Outbreak of Legionellosis Associated With an Indoor Hot Tub, New Hampshire, 2018

Abstract

Legionellosis is an infection acquired through inhalation of aerosolized water droplets containing Legionella bacteria. In August 2018, public health officials in New Hampshire launched an investigation into a legionellosis outbreak. They identified 49 illnesses likely associated with the outbreak and implicated an improperly maintained hot tub at a hotel. The same strain of Legionella pneumophila serogroup 1 was found in both the hot tub and in samples from two patients with Legionnaires' disease. The indoor hot tub vented to the outdoors, which is how some patients with confirmed legionellosis likely acquired the infection despite not entering the hotel during the incubation period. This outbreak is notable for 1) likely illness acquisition through the exterior vent of the hot tub room and 2) use of whole genome sequencing to link environmental and patient specimens. Collaboration among public health and environmental officials, laboratorians, and building managers was essential to determining the source of the outbreak and preventing further illness.

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Speaker / Author:
Elizabeth R. Daly, MPH, DrPH, New Hampshire Department of Health and Human Services
Elizabeth A. Talbot, MD, New Hampshire Department of Health and Human Services, Geisel School of Medicine at Dartmouth
Jessica C. Smith, MPH and Troy Ritter, MPH, PhD, REHS, DAAS, Centers for Disease Control and Prevention
Zachary D. McCormic, MPH, New Hampshire Department of Health and Human Services
Katherine Fay, MD; Brian H. Raphael, PhD; & Natalia A. Kozak-Muiznieks, PhD, Centers for Disease Control and Prevention
Kara J. Levinson, MPH, PhD, New Hampshire Department of Health and Human Services, Centers for Disease Control and Prev
Christine L. Bean, MBA, PhD, MT(ASCP), New Hampshire Department of Health and Human Services
R. Tim Wilson, New Hampshire Department of Environmental Services
Darlene Morse, MSN, MEd, CIC, RN and Andria Scacheri, RN, New Hampshire Department of Health and Human Services
Justin Linxweiler, MS, RN and Benjamin P. Chan, MPH, MD, New Hampshire Department of Health and Human Services
Month Year:
June 2022
Volume#:
84.10
Page #:
16-24
Publication Month:
June 2022
Subtopic:
Pathogens and Outbreaks