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CDC Reports Rare Cases of Legionella Infections in Infants After Water Birth

JUN 16, 2017 | EINAV KEET
In both cases, the infants were successfully treated for the Legionella infections with 10-day courses of azithromycin. The first infant remained in the hospital for more than 2 months due to congenital heart disease.
The MMWR report notes that the number of Legionnaire’s disease cases in Arizona has increased in recent years, and more than doubled from 2011 to 2015, when the state had 93 reported cases. Arizona’s Department of Health Services reported 76 cases of Legionellosis in 2016 and 39 cases have been reported for January 2017 through May 2017.
“This increase in cases is most likely due to improved clinical and public health awareness, two factors that can greatly impact reporting of Legionnaires’ disease,” explains Otto Schwake, PhD, a Virginia Tech researcher and Editorial Advisory Board member for Contagion®. Dr. Schwake also noted that Legionellosis has been on the rise across the country. “That being said, socially driven behaviors can lead to novel transmission routes of water-borne disease, such as was seen with neti pot usage and naegleriasis. Perhaps more relevant is the advent of certain technologies, namely water recycling and ‘green’ buildings, which could have negative side effects on the microbiology of our drinking water.”
Dr. Schwake noted that healthy infants tend to be at low risk for Legionellosis, even when experiencing the same exposure routes as adults. Such cases during water birth are uncommon; however, notable cases have occurred in recent years in the United Kingdom and Texas.
“For the recent Arizona cases, we have 1 example of a water birth conducted with many obvious safety risks, namely filling a rented Jacuzzi with warm tap water allowed to stagnate for a week,” noted Dr. Schwake. “However, in the other case, a new disposable birthing tub was disinfected and filled immediately prior to the birth using a new hose. Other than using tap water without additional disinfection, such as boiling, no obvious safety issues seemed to be present in this latter case, suggesting that further research may be prudent to examine this form of transmission.”
In response to the 2 cases, the Arizona Department of Health Services and the MCDPH teamed up with Texas health officials, infection prevention specialists, and licensed midwives to develop a set of guidelines for water-immersion birth safety. The new guidelines note the benefits of water birth and detail the possible risks, and provide recommendations on birthing-pool safety and water disinfection.
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