The cases were reported by the Centers for Disease Control (CDC) in its weekly “Notes From the Field” investigative report by Dr. Geoffrey Granseth and colleagues at the Arizona Department of Health Services.
The first case was reported to Maricopa County Department of Public Health (MCDPH) in January 2016. The baby was delivered at home by a midwife in a newly-purchased birthing tub that had been cleaned with vinegar before being filled with tap-water for the delivery.
The following day, the infant was taken to the emergency department in severe respiratory distress. The infant was diagnosed with Legionnaire’s disease and congenital heart disease and and remained hospitalized for more than 2 months. According to the CDC:
Although the tub for delivery in the first case was filled immediately before the birth, tap water is not sterile, and Legionella can grow and spread in man-made water systems, such as plumbing systems.”
The second case was reported to MCDPH in April 2016. The infant was delivered by water birth at home in a jetted Jacuzzi hot tub by another midwife, rather than a disposable birthing tub. Three days afterward, the infant developed a fever and hospitalized with sepsis, pneumonia, and Legionnaire’s disease.
Investigators discovered that the water birth took place in a rented Jacuzzi hot tub that was filled with tap-water and maintained at 98ºF in a bedroom for a week before the delivery. The temperature of the water was within the growing range of Legionella (77°F-108°F).
During the follow-up, investigators also identified a report of a baby who died of Legionnaire’s disease in Texas in 2014 after a water birth.
While the risk of Legionella infection can’t be eliminated because of the need for warm tap water to fill the tub, the risk can be reduced by running hot water through the hose for 3 minutes before filling the tub to clear the hose and pipes of stagnant water and dirt, according to the CDC.