Cruise Ship Hot Tubs: Investigating Links to Recent Outbreaks on Two Vessels

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Many passengers enjoying their time in private hot tubs on luxury cruise ships never anticipated that their serene escape could harbor a serious risk – a potentially fatal respiratory illness linked directly to the warm waters.

However, a recent investigation by the Centers for Disease Control and Prevention (CDC) has identified these private retreats as the cause of a recent outbreak of a condition known as Legionnaires’ disease on two major cruise vessels that remain unnamed.

This serious pneumonia, resulting from the bacteria Legionella pneumophila, was reported in 12 passengers who sailed on the two cruise ships during the period from November 2022 to July 2024.

“Epidemiological, environmental, and laboratory data indicate that hot tubs on private balconies were likely the source of exposure during two outbreaks of Legionnaires’ disease among passengers aboard a cruise ship,” according to the CDC.

The CDC first identified concerns on “Cruise Ship A,” where five passengers displayed symptoms following a voyage in November 2022. Over the subsequent months, more cases emerged, ultimately affecting eight passengers by April 2024.

In response to this situation and upon the CDC’s recommendation, the cruise ship performed thorough water testing at various locations around the vessel, including hot tubs, drinking water systems, and shared spaces. 

Legionella bacteria were found in six out of ten private balcony hot tubs, with some samples revealing alarmingly high levels of the bacteria.

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Upon further examination, it was discovered that “Cruise Ship B” also faced similar issues, with cases of Legionnaires’ disease surfacing in January, February, and May of 2024. Laboratory analyses validated that the bacterium was present in every private hot tub examined, with several samples showing dangerously elevated levels.

The Centers for Disease Control and Prevention (CDC) reports that Legionnaires’ disease predominantly affects men and older adults. On Cruise Ship A, all passengers were from the United States, and most were male, with an average age exceeding 63.

All passengers had utilized public and private hot tubs during their trip, with 63 percent of guests from the first ship confirming they had accessed the spa facilities.

Seventy-five percent of individuals on Cruise Ship A needed hospitalization, whereas all passengers from Cruise Ship B were hospitalized. Thankfully, all passengers made a full recovery.

While the Centers for Disease Control and Prevention (CDC) did not disclose the names of the cruise ships, both Norwegian Cruise Line and Celebrity Cruises confirmed instances of Legionnaires’ disease on board Norwegian Prima and Celebrity Ascent, respectively, aligning with the timeline of the CDC’s investigation.

The CDC’s inquiry revealed that contamination was discovered in hot tubs located on the balconies of private suites, which are the most luxurious and costly accommodations available on cruise ships. However, hot tubs can also be found on open decks near swimming pools and within cruise ship spas.

Public hot tubs generally follow strict cleaning protocols, including ongoing disinfectant application and pH level monitoring via automated systems to ensure safe operating conditions. Furthermore, children who are not toilet trained are not permitted in hot tubs.

Following recent outbreaks linked to private hot tubs, the CDC has released updated guidance for cruise ships, advocating for enhanced maintenance protocols that exceed the existing weekly chlorination guidelines.

Specifically, the CDC urges cruise operators to adopt continuous disinfectant dosing and pH monitoring for private hot tubs, aligning them with the standards already established for public hot tubs.

In situations where continuous dosing is not practical, the CDC recommends conducting a thorough shock-chlorination of hot tubs after each guest’s use to reduce the risk of contamination.

The agency also suggests completely draining and disinfecting hot tubs after every use rather than keeping them filled between guests. Additionally, it highlights the importance of removing and cleaning heating elements and filtration systems, which can harbor bacteria.

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