UK - A Health Protection Agency study has highlighted serious problems with spa pools being a cause of Legionnaires? disease because they are not managed or maintained properly. The study raises the question of whether routine legionella testing should be included within new Health and Safety Executive and HPA guidelines.

This research carried out in collaboration with local authority environmental health officers will be presented to delegates on the second day of the Agency?s scientific conference at Warwick University. The year long study, surveyed over 100 spa pools, commonly referred to as jacuzzis. Out of 88 premises, 23 spa pools were found to contain legionella bacteria. Sixteen of these had passed current accepted levels for routine microbiological parameters.

Speaking at the Agency?s annual conference, Dr Susanne Surman-Lee, who led the research said, ?In every spa pool related outbreak that we have investigated the pool had not been managed or designed according to guidelines or had poorly trained staff. In addition, at present, testing for legionella is not mandatory for spa pools.

?Because spa pools are increasing in popularity we need greater recognition and understanding of the risks associated with their use and misuse. They have the potential to cause infection because the water systems become contaminated with bacteria and the high temperatures of the water make considerable demands upon the disinfection and filtration systems making it easy for the bacteria to develop and spread if not adequately maintained. The jets from spa pools then produce aerosols containing legionella which can then be inhaled and cause illness.\"

?It?s been assumed that if the pool water is satisfactory for routine microbiological checks then growth and spread of legionella would also be under control. But we discovered that the legionella bacterium, may be present in high numbers in both privately owned and public facilities even when routine microbiological and safety checks appear satisfactory.?

During 2003, there were 27 cases of Legionnaires? disease in England where spa pools were identified as the source of infection, with 3 deaths. So far this year there has been only one case of Legionnaires? reported to be associated with a spa pool.

The HPA has published spa pool guidelines since 1994 and a new joint document with the Health and Safety Executive is being produced which will update advice on risks and legislation associated with spa pools.

Notes to Editors:

1. The Health Protection Agency?s Annual Conference takes place at Warwick University from 13th to 15th September. Further information can be found at the conference website at

2. Journalists are invited to attend the conference; to book your place please call the Colindale press office on 0208 327 6647/7097.

3. Legionnaires\' disease is pneumonia, caused by the bacterium Legionella pneumophila. The majority of cases are reported as single (isolated) cases but outbreaks can occur, currently around 300 cases are reported annually. All ages can be affected but it mainly affects people over 50 years of age, and generally men more than women.

4. The early symptoms of legionnaires? disease include a \'flu-like\' illness with muscle aches, tiredness, headaches, dry cough and fever. Sometimes diarrhoea occurs and confusion may develop. Deaths occur in 10-15% of the general population and may be higher in some groups of patients.

5. The incubation period ranges from 2 to 10 days, sometimes up to 14 days. In rare cases some people may develop symptoms as late as three weeks after exposure.

6. Legionella infection can be treated with antibiotics and person-to-person spread does not occur.

7. Legionellae are widely distributed in the environment. They have been found in spa pools, hot and cold water systems, and water in cooling towers.

Health Protection Agency, UK