Following cerebrating ceremony in 20 June 2002, for the completion of Hiuga Sun-Park Hot Spring Bath “Ofunade-no-Yu” facilitie Msi, yazaki Prefecture, Kyushu Island, 200 neighbors were invited each day to experience bathing on 20 and 21 June. The Bath “Ofunade-no-Yu” officially opened on 1 July 2002. On 18 July, H iuga Health Center was informed that 3 suspected Legionella pneumonia patients in a hospitala nd allo f them have bathing history of “Ofunade-no-Yu”. Health Center officers notified Hiuga City, the main proprietor of the Bath business, that on-site inspection on sanitary managementswill be done next day and requested the City to keep the bath facilitieass they are. On 19 July, Health Center officers collected bath water from seven places and recommended voluntaryclosing of “Ofunade-no-Yu” business. Because of various reasons, Hiuga City did not accept the recommendation and continued business up to 23 July. Because Legionellap neumophila serogroup 1 strainsf rom 4 patients's puta and several bath water specimens were determined geneticallys imilar by Pulsed Field Gel Electrophoresis of Sfi I-cut DNA, “Ofunede-no-Yu” was regarded as the source of infectiono f thiso utbreak. On 24 July, “Ofunade-no-Yu” accepted the Command to prohibit the business.Among 19, 773 persons who took the bath during the period from 20 June to 23 July, 295 became ill, a nd 7 died. Among them, 34 were definitelyd iagnosed as Legionella pneumonia due to L. pneumophila SG 1, by either one or two tests of positives putum culture, Legionella-specific urinary antigen, and significanrt ise of serum antibody titera gainst L. pneumophila SG 1.
In addition to the 8 items shown by Miyazaki-Prefecture Investigation Committee as the cause of infection, Hiuga City Investigation Committee pointed out following3 items: 1) Insufficienktn owledge and understanding of stuffs on Legionella and legionellosis;2) Residual water in tubing system aftert rialr uns might lead multiplicatioonf legionellae in it; and 3) Inadequate disinfectioann d washing for whole circulations ystem prior the experience bathing.
The Hiuga City Committee directed 24 measures to improve the sanitary condition of the facility including following 5 items. 1) Fix the manual for maintenance and management of the bath. 2) Keep sufficienotv erflow of bath water. 3) Put disinfectiono f filteris nto practice.4) Precise measurement and controlo f the residualc hlorinec oncentration in bath water. 5) Replacement of filtratinmga terial from crushed porous ceramic into natural sand.