LEGIONELLA - World Health Organization

Rare cases of Legionnaires’ disease have been associated with birthing pool use (Franzin et al., 2001),
and one where a spa pool was used as a birthing pool (Nagai et al., 2003) (see Chapter 6).
Various other types of pool are available, such as flotation tanks and small vessels used for
therapeutic use. There is no evidence to date of legionellosis associated with these but, as with
any water system, the potential for Legionella growth within such systems and for aerosol
production should be assessed, and an appropriate WSP put in place.
This chapter addresses the risk from infections caused by legionellae in recreational waters.
The risks to humans from other infectious diseases and chemicals is dealt with in the WHO
Guidelines for Safe Recreational Water Environments, Volume 2 (WHO, 2006).
8.2 Water safety plan overview
A WSP needs to be comprehensive; however, an overview of such a plan is shown in Table 8.2,
as an example of the type of information a plan might contain. As explained in Chapter 3, a
WSP is part of a framework for safe water quality that also includes health-based targets and
surveillance.
The remainder of this chapter provides information relevant to a WSP specific for natural
spas, hot tubs and swimming pools, for each of the three main areas of a WSP:
• system assessment (Section 8.3)
• monitoring (Section 8.4)
• communication and management (Section 8.5)
• surveillance (Section 8.6).
Sections 8.3–8.6 should be read in conjunction with Section 3.3 from Chapter 3.
LEGIONELLA AND THE PREVENTION OF LEGIONELLOSIS