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On August 12, 2002, the Stephenson County Health Department (SCHD) notified the Illinois Department of Public Health Rockford Regional Division of Environmental Health of reports of illness among family members from four families who stayed at a hotel in Freeport August 9 through 11, 2002. Thirty-one of 36 individuals reported high fever, headache, and muscle aches. Based on preliminary findings, exposure to the swimming pool, spa, and the swimming pool/spa enclosure were found to be common among the ill guests. The hotel voluntarily closed the swimming and spa facilities pending further investigation by SCHD, the Department’s regional environmental health staff and the Rapid Response Team.

On August 14, 2002, Department staff initiated an environmental investigation of the hotel. Several 100 ml water samples were taken, including spa filter backwash water taken prior to superchlorination. Further samples taken included spa water, pool water, and water from the drinking fountain. Samples were submitted to the Illinois Department of Agriculture and to the Centers for Disease Control and Prevention (CDC) to be analyzed for the presence of Legionella bacteria.

Daily log records for spa water bromine and pH levels and approximate number of bathers were reviewed for August 9 - 11. Bromine levels were 3.5 and pH levels were between 7.4 - 7.5. The approximate number of spa bathers was estimated to be 95 – 115 persons. The spa was superchlorinated during this inspection to approximately 50 ppm of chlorine and recirculated. The spa filter was backwashed. The spa was drained, thoroughly cleaned, and then refilled prior to reopening, August 14. On August 26, 2002, resamples of the spa filter backwash water were obtained and cultured.

The Department was notified on August 30, 2002 by the Illinois Department of Agriculture that the initial

samples taken of the spa filter backwash water on August 14, 2002 were positive for Legionella dumoffii. Samples submitted to the CDC were positive for L. micdadei and L. maceachernii. On September 3, 2002, the hotel was advised that the results of the resampled cultures were again positive for Legionella dumoffii and the spa was voluntarily closed pending additional disinfection procedures. Superchlorination was performed and duplicate resamples were obtained on September 25, 2002 and sent to the Illinois Department of Agriculture. These duplicate resamples tested negative for Legionella species. Hotel Guest Investigation The Rapid Response Team developed a questionnaire for active case ascertainment for a retrospective cohort study of hotel guests and visitors who stayed at the hotel from August 9, the first date of hotel stay for index cases, through August 15, the date of completion of the initial environmental survey.

A case was defined as:

Any guest of the hotel who stayed or visited the hotel (or employee who worked at the hotel) from August 8 until the 15, 2002, who reported any of the following symptoms within two weeks of hotel stay: fever or headache with muscle aches.

The total number of guests during the study period was 380 from 23 states, Canada and Belgium. Public health officials from the states and Canada (officials from Belgium could not be contacted) were recruited via conference calls to administer the questionnaire to hotel guests within their jurisdiction by telephone or mail. SCHD administered the questionnaire to hotel employees. A differential diagnosis information sheet was distributed to public health officials and disseminated to care providers in communities who treated ill hotel guests. The information sheet provided instructions for performing diagnostic lab tests including nasopharyngeal swabs for adenovirus, influenza, coxsackie virus, and parainfluenza virus, sputum cultures, Legionella urinary antigen tests, and serology assays for acute and convalescent sera for Legionella.

 
 
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