Legionellosis incidents associated with spa pools, England, 2002-2018.

Abstract Background Spa pools (SPs) pose risks of Legionella infection for users and bystanders. Methods We searched the National Enhanced Legionella Surveillance System for reported SP-associated legionellosis incidents in England between 2002 and 2018 involving at least two cases. Results For seven legionellosis SP-associated incidents, six were in commercial settings such as hotels. The median number of cases per outbreak was four (range 2–115). Conclusion SP-associated legionellosis incidents were mainly located in commercial settings with a wider range of cases than those recognised in previous publications, reinforcing the need for effective environmental controls for SPs in a range of settings.