Three Belgians who visited a fair near Antwerp have died of Legionnaires' disease and Belgian and Dutch officials are advising other visitors to seek immediate medical checks, Belgian media said on Sunday.

They said the outbreak was traced to a trade fair at Kapellen, north of the port of Antwerp close to the Dutch border. A dozen other people have been hospitalised with symptoms of the disease.

Radio and news agency reports said the Netherlands Health Ministry was advising any citizens who visited the fair to see a doctor.

An estimated 60 000 people went to the Kapellen fair between 29 Oct & 6 Nov 1999.

According to the Royal Dutch Institute for Health and the Environment, up to 28 people may have died in the Netherlands of Legionnaires' disease in 1999, the highest toll in the world since the malady -- a rare form of pneumonia transmitted by bacteria that can breed in air conditioning systems

Sun 14 Nov 1999

Three people have died in a suspected outbreak of Legionnaires' disease in the northern Belgian town of Kapellen, local news reports said Sunday.

Another 18 were hospitalized and showing symptoms of the rare pneumonia-like illness.

Doctors said tests would show Monday 15 Nov 1999 if Legionnaires' disease was definitely the cause of the deaths.

The victims were reported to have attended a trade fair in early November where bathroom fittings, including a working Jacuzzi, were displayed. That could have created the damp conditions favored by the bacteria believed to cause the illness.

Ninety-three people who met the case definition were identified. Among these 93
patients 43 could be considered as confirmed cases, 12 presumptive, and 38
possible/clinical cases. Eighty-six of the patients were visitors and seven were
exhibition staff.

The mean incubation period of the disease was nine days (range 3 to 14). Common
symptoms were malaise, headache, fever, chills, chest pain, shortness of breath, and
non-productive cough.

Eighty eight patients were admitted to hospital and five died. Four of the deaths
occurred early in the epidemic; one patient ed  month later. The average age of the
deceased patients was 64 years (range 52 to 75).

We have a serious medical problem that needs to be addressed by the leadership.
I was in Reno for the convention and the Piper reunion., so the only folks I've contacted so far are Piper sailors and a few others whose numbers I had. At the convention, Terry and his wife Ann were sick, she worse than him. Charlie also got very sick and he and Patty had to stay an extra day. I got a call earlier this week from Terry .
Their condition worsened on the way home to Nebraska, and they were admitted to St. John's Hospital in Jackson Wyoming. Both have been diagnosed with legionnaire's disease, a potentially fatal, virulent form of pneumonia.
Doctors need to know what they are looking for because special blood work is needed. Symptoms appear 2-10 days after exposure to this water vapor borne bacteria, usually found in bad HVAC systems and warm water, such as showers, jacuzzies, pools, etc.

We alerted Charlie and he was taken to the hospital. He has severe Pneumonia and awaiting results of blood cultures to identify the strain. The doctor assumes it id Legionnaire's. I began making calls today and the results are alarming. We need to alert our membership. Someone has to contact the MD member (?name) that was there to see if he had other upeer-respitory complaints and who they were.

This is an alarming rate of illness. Often this strain is underdiagnosed since people neglect to mention they'd just been at a convention of gathering. If there are shipmates or family members out there who are now sick, they need to get tested and treated right away, specifically for Legionnaire's. This is serious stuff with a high mortality rate! Don't underestimate it.

A husband and wife have been admitted to St. John's Hospital in Jackson, Wyoming. Both have been diagnosed with Legionnaire's disease, a potentially fatal, virulent form of pneumonia, probably contracted at a hotel in Reno, Nevada, during a convention of veterans of the US submarine service.

This disease is caused by water vapor borne bacteria, usually found in bad HVAC[air conditioning] systems and warm water, such as showers, jacuzzies, pools, etc.

Since Ron posted Frank's original message, there have been several more cases of Legionnaire's. *At least* 2 of them are *NON* USS Piper people.

If you have symptoms, or even think you do, *run, do not walk,* to your nearest physition and ask him/her to do a specific blood test for Legionnaire's.

This message was posted by RM663, posted on October 05, 1999 coming from 205.140.244 This message is a reply to Medical Alert for Reno Attendees posted from RM663 posted at October 03, 1999

Be aware that, since receiving a fax from Mr. Whitty (i.e., "Whitty's List") concerning the health problems & names of people who attended the Piper Reunion concurrently with the 1999 National Convention in Reno, Ms. Carol Hyde, Peppermill Corp. Risk Mgr. has been in touch with Dr. Randy Todd (and Lon Schmidt of M I Base & member of the 1999 Convention Committee).

Ms. Hyde told Lon Schmidt that Dr. Todd has been in touch with the two people on the aforementioned " Whitty's List" identified as having been "diagnosed with Legionaires." Apparently, per Ms. Hyde (who has been working closely with Dr. todd in this circumstance), Dr. Todd has determined that the two individuals apparently misunderstood exactly what the two Drs. treating them actually told them. My understanding is that at the two individuals request, they were tested for Legionaires Disease, NOT diagnosed with it.

My understanding is that Dr. Todd is continuing to contact all of the individuals on "Whitty's List" to speak personally with them and assure them that there have been NO confirmed diagnoses of Legionaires Disease in anybody attending our Convention.

Until further information is available, please give this message the widest possible dissemination to the Membership. [At least as wide a dissemination as all of the other e-mail msgs being transmitted by various individuals (you know who you are) in our Organization regarding the same subject!]

If further reassurance regarding this serious issue is desired, Dr. Todd is available to discuss the matter on 775-684-5946.

In the penal institution at Diez possibly rampant the Legionnaires` disease occurring quite rarely in our widths.
After detailed investigation of two showering departments within the mechanism, which had only been installed three months ago, experts of an institute for hygiene from Marburg determined drastically increased quantities of the disease-causing Legionella, which cause the Legionnaires disease.

Four prisoners of the JVA Diez had announced themselves within shortest time due to different disease symptoms, but in the course of the investigations with all four patients illnesses at the lung were determined. Since the Legionnaires disease, which can lead in the worst case even to death, when a type atypical pneumonia can be defined, the examining physicians came quite fast to the suspicion that with all four prisoners had Legionnaires` disease concern it koen

While two of the four patients genesen in the meantime completely to the penal institution returned, the two other patients are in the hospitals of Diez and Marburg. In the meantime all showers in JVA Diez closed, since the investigations of the two showering departments, in which the patients had washed themselves, indicated " extremely high Legionella values ", how the deputy institute conductor indicated Rainer Dittmann yesterday. Also the remaining showering departments were examined in the meantime, the results are however only expected on Friday. Up to this point in time all showers remain closed within the JVA Diez. There are not alternate places for the time being, the line of the institute considered to put in operation the old showering house again but also this building must be checked first of all for Legionella. Altogether the tendency among the prisoners is however calm.

The Legionnaires disease results from Legionella, which are everywhere in the water, how the yesterday present specialists corresponding explained. To and for itself this Legionella is harmless, only with a water temperature between 30 and 50 degrees Celsius develops before 23 years the bacteria occurred for the first time their dangerous effect. Only by the inhalation of these steams a transfer of the Legionella is possible on the human body. This development before the background, which the showering departments concerned were only taken three months ago ago in operation and technically on the newest status to be, is the more amazing.

The experts pulled to rate anyhow found still no assertion for this extremely high Legionella concentration

French authorities said they had ordered the cleaning of 23 cooling towers in two Paris districts after eight people were infected, one fatally, by Legionnaires' disease, The airborne bacterium.

In a statement, the prefect of the Ile de France, the region that includes Paris and its suburbs, said the Cooling Towers were located in the northern part of the 14th and 15th districts, in the southern part of the city.

So far there is no sign to confirm that the source of exposurel has disappeared, the statement said.

The eight cases were detected in August and September among people who lived or worked in the 14th and 15th districts.
One of the casualties was a British citizen.

The bacterium breeds in sanitary installations, such as hot-water pipes or air conditioning, and becomes airborne, mixed with fine water droplets, if these systems leak. It is not transmitted from person to person.

The prefect said Cooling Towers were being targeted for disinfection.
These are towers that expel hot water from air-conditioning systems as a cloud of fine spray.

Three cases of legionellosis, all residents of the same district of Paris (arrondissement XV), were notified to the French National Institute for Public Health Surveillance (Institut de Veille Sanitaire (InVS)) on 1 September 1999. On 27 August the European Working Group on Legionella Infections (EWGLI) notified the InVS of a British traveller who had stayed in a hotel in the same area at the beginning of August and subsequently developed legionellosis. These notifications by two independent systems suggested an outbreak in people who had visited XV district of Paris.

For the purposes of epidemiological investigation a case was defined as a person who developed pneumonia in August 1999 having resided in or visited the XVth and neighbouring districts of Paris in the ten days before onset, associated with either a positive Legionella pneumophila urinary antigen test and/or the isolation of L. pneumophila in respiratory secretions and/or a fourfold rise in specific serum antibody titre.

An active search of cases initiated through the district public health officers, the National Reference Centre, hospitals in the Paris area, and the EWGLI network identified four further cases. All cases (or their close relations) were interviewed in detail about their activities during the incubation period, using a standardised questionnaire.

All eight cases had stayed in a small area of the XVth arrondissement of Paris, near Montparnasse. One patient died (aged 42 years). Dates of onset ranged from 8 to 20 August (figure 1). Seven patients were men, aged 42 to 78 years (median 54). Seven patients were residents of France. Six cases were confirmed by the detection of urinary antigen and two by culture of L. pneumophila serogroup 1. The two isolates had indistinguishable and unique pulsed-field gel electrophoresis profiles. No specific common exposure was identified (hotel, bars, restaurant, shopping centre, etc). Exposure to the same area of the XVth arrondissement and the absence of any other potential source led us to investigate the possibility of contamination by cooling towers. Selected cooling towers to which patients may have been exposed in August have been investigated intensively by the Direction des Affaires Sanitaires et Sociales of Paris. No further cases with dates of onset since 20 August have been notified, but intensified surveillance is continuing in France and through the EWGLI network. Owners of all the cooling towers in the suspected area have been requested to disinfect their installations.

The Allegheny County Health Department has confirmed the death of a 95-year-old Monroeville woman from Legionnaires' disease.

A spokesman said the woman, died Sept. 9 at a local hospital. She was a resident of the Sunrise Assisted Living Center.
Another female resident, who is 89, is being treated for Legionnaires' disease at a local hospital.

"This is not considered an outbreak, he stated. We have had clusters before and have not recommended moving the residents. The Sunrise Assisted Living Centre is well maintained.

The spokesman said the Health Department has gathered water samples at the Sunrise home for testing but won't know the results until next week.

The Allegheny County Health Department today reported that Sunrise Assisted Living Center in Monroeville has disinfected and rid its plumbing system of legionella bacteria.

The bacteria were found in samples taken from plumbing fixtures inside the rooms of two residents diagnosed with Legionnaire's Disease last month -- a 95-year-old woman who died and an 89-year-old woman who has been released from the hospital and is now in a nursing home.

The two rooms were the only areas where legionella were found. Samples taken in other areas of the center were negative, indicating bacteria were present only in a very limited area and that other residents were not at risk of infection. No additional cases of the disease have been reported.

"Sunrise should be commended for acting quickly to disinfect its plumbing system," said County Health Director Dr. Bruce W. Dixon. "Once Legionnaire's Disease was reported, the center promptly disinfected the system and retested it to ensure that the bacteria were eliminated."

Four cases of legionnaires' disease have been treated at hospitals in south Wales.
Two people were taken to the University of Wales Hospital in Cardiff and the other cases were admitted to East Glamorgan Hospital, near Pontypridd.

Two of the patients involved have now returned home.

None of the illnesses are thought to be related and investigations are under way to determine if there is a common source.

Dr Arun Mukerjee, a consultant in communicable diseases at Bro Taf Health Authority, said no connection between the cases had been detected.

"We are doing a very wide ranging investigation to establish the source of this infection," he said.

Respiratory infections expert Dr John McFarlane, from Nottingham City Hospital, said incidents of legionnaires' disease are more common in the summer months.

Some cases can be passed off by GPs or hospitals as pneumonia without being correctly diagnosed.

Dr McFarlane said it was possible that a common source existed with the cases in south Wales, although three quarters of all recorded incidents occur sporadically without an obvious source.

Three UK tourists who stayed at the same hotel in the holiday island of Ibiza have returned home with signs of Legionnaire's disease.

The trio, all from the Menzieshall area of Dundee, are waiting for the results of blood tests to find out if they have contracted the dangerous bug.

The infection normally spreads by victims inhaling droplets of water containing the bacteria, and is often transmitted through air conditioning systems.

The tourists were staying in the resort of San Antonio, which is the most popular on the island.

They returned to Scotland on Sunday, and have been told to stay off work and remain in isolation until the test results arrive.
It is believed that a number of other people staying at their hotel have fallen ill.
But a spokesman for Tayside Health Board stressed that tourists returning from Ibiza should not panic if they experience symptoms.

He said: A lot of people do come back from holiday with flu-like symptoms, but that does no necessarily mean they have Legionnaires'.

The early symptoms of Legionnaires' disease include headaches, muscular pain, a cough and high temperatures.
A couple of days afterwards, this can develop into a dry cough and pneumonia symptoms, which can be severe enough to require the patient to be admitted to hospital.

DEVON , ENGLAND

Four children developed a folliculitis approximately 24 hours after bathing in a whirlpool spa at the home of a relative they were visiting for the weekend. Swabs were collected from each of the patients and Pseudomonas aeruginosa was isolated from two of them. Although the owners had used the pool each day they had not developed a rash. The mother only developed a mild rash. The spa pool had only been installed for ten days but had previously been on display at a garden centre for about six months. Samples collected from the pool had greater than 100000 Ps. aeruginosa per 100ml.
The isolates from the spa pool and patients were all serotype O11 and were all of the same phage type.

Federal job-safety investigators will visit a south suburban postal distribution center today after it was determined that three workers at the facility were exposed to the bacteria that causes Legionnaires' disease.
Office of Safety and Health Administration officials will investigate medical records, interview employees and conduct an inspection of the facility Blood tests determined at least three employees had been exposed to the Legionella bacterium.

Legionnaires' disease can cause chills, fever, cough,pneumonia and possibly death.

Investigators have not determined if the infected workers were exposed to the bacteria while on the job, but an industrial hygenist who was hired by the U.S. Postal Service has already removed a water cooler from the facility for testing.
The facility employs about 1,350 and more than 3.5 million pieces of mail reportedly pass through it. Health officials said that the bacteria can not be transmitted through the mail.
The Centers for Disease Control and Prevention estimate that about 15,000 people contract Legionnaires' disease nationwide. It is named after a deadly outbreak of pneumonia at an American Legion convention in Philadelphia in 1976 that was linked to the bacteria.

The staff at a Melbourne hospital are baffled after a middle-aged man contracted Legionnaires' disease while in their care. The man was admitted to In-patient Service on 22nd. December 1998. 10 days later, he was rushed to intensive care with symptoms of Legionnaires’.

Routine tests of the hospital's cooling towers on 23 December returned negative results. "While he was getting the disease, tests done on the hospital's towers were negative and the mental health unit doesn't have a tower, that's why we wonder how he got it," said the head of the hospital’s Infectious Diseases Service. We accept he acquired the infection in the environs of the hospital but exactly where is uncertain. On discovering the man's illness, the hospital re-tested its towers in late December and found positive counts in several of them.
The man is understood to be recovering in intensive care.
Source.... Herald Sun, 7 Jan 1999.

The New South Wales Health Department has confirmed two people have contracted Legionnaires disease in Sydney's west.

The department is trying to determine whether the cases are linked as the two people either live or work in the Fairfield - Yennora area.

The strain of Legionnaires in these cases is similar to the type associated with water cooled air-conditioning systems.

The department says people should see their doctor if they begin to suffer symptoms of the Legionnaires' including sudden fever, dry cough, and stomach cramps.

The detection in the General Hospital Virgen of Roci'o of Seville of two cases of legionella nosocomial between days 31 of December of last year and 5 of January has forced the direction of this sanitary center to start a plan of hyperchlornation shock for the eradication of this organism through the of the water network that supplies these facilities.
The direction of the center has showed that any risk for the health of the affected patients. of which its identity has not been facilitated - -, that already have been given of discharge, nor for the rest of the patients entered the General Hospital does not exist.
However, sources of this sanitary center today explained to theEurope Press that following the recomedations of National Commision of Public Salud in these cases, the next Friday to the 15,00 hours will activate a process of hyperchlornation in the network of water supply in the four plants of the North wing of the hospital, that is predicted that it culminates to the 09,00 hours of Saturday

La detección en el Hospital General Virgen del Rocío de Sevilla de dos casos de legionella nosocomial entre los días 31 de diciembre del año pasado y 5 de enero ha obligado a la dirección de este centro sanitario a poner en marcha un plan de choque para la erradicación de este organismo a través de la hipercloración de la red de agua que abastece estas instalaciones.

La dirección del centro ha manifestado que no existe ningún riesgo para la salud de los pacientes afectados --de los que no se ha facilitado su identidad--, que ya han sido dados de alta, ni para el resto de los enfermos ingresados en el Hospital General.

No obstante, fuentes de este centro sanitario explicaron hoy a Europa Press que siguiendo las recomedaciones de la Comisión Nacional de Salud Pública en estos casos, el próximo viernes a las 15.00 horas se activará un proceso de hipercloración en la red de abastecimiento de agua en las cuatro plantas del ala norte del hospital, que está previsto que culmine a las 09.00 horas del sábado.

The first cluster of cases of legionnaires’ disease associated with travel to Bangkok has been identified by the PHLS Communicable Disease Surveillance Centre (CDSC) and the European Working Group on Legionella Infections (EWGLI) scheme. Two of the cases came from England and the third from Scotland. All three had been on extensive but different itineraries in the Far East, but all had stayed at the same hotel in Bangkok between one and ten days before they became ill (on 10 and 19 March and 6 April). All three cases are aged 60 years or over. Two are still ill and one has recovered. Legionella pneumophila serogroup 1 has been isolated from one of the three, another case was confirmed by urinary antigen detection, and the third was diagnosed presumptively by single high antibody titre.

On Friday 16 April a cluster alert was sent to all EWGLI collaborators, the World Health Organization, the Thai Ministry of Health, and for information to a collaborator in Australia. Tour operators from the United Kingdom who use the hotel have been informed and have withdrawn their clients until further notice. We understand that investigations at the hotel are under way. CDSC is aware of two previous cases of legionnaires’ disease in people who had travelled to Bangkok – one in 1992 and one in 1994. No non-British cases are recorded on the European database.

Im März wurde bekannt, daß in drei Luxushotels der Stadt offenbar einige Gäste mit der Bakterie "Legionella pneumophila" infiziert wurden. Presseberichten zufolge war der Infektionsherd nach aufwendigen Investitionen im Wasserleitungssystem bald beseitigt. Ebenfalls im März starben vermutlich neun Menschen an der Legionärskrankheit in den Niederlanden, andere erkrankten. Allen gemeinsam war, daß sie zuvor eine Blumenschau besucht hatten. Man nimmt an, daß Legionellen sich dort in Springbrunnen eingenistet und über herumspritzendes Wasser verteilt haben.

In March it became admits that in three luxury hotels of the city some guests were obviously infected with the bacterium " Legionella pneumophila ". According to press reports the focal infection was soon eliminated after complex investments in the water pipeline system. Likewise in March probably nine humans died to the Legionaer skrankheit in the Netherlands, other gotten sick. It was common to all that they had visited a flower show before. One assumes that Legionella eingenistet themselves there in branching wells and distributed over squirting water.

An outbreak of legionnaires' disease has been identified in north east Spain among people who stayed in the natural spa resort of Cestona in the province of Guipúzcoa between 1 and 22 May 1999. The first case was diagnosed on 20 May. By 31 May 1999, two confirmed cases had been diagnosed by legionella urine antigen detection test, there were six suspected cases, and 35 people were being investigated. Local health authorities have established that 432 people were staying in the resort during the period under investigation. Six visitors were from other European Union countries, four from the United Kingdom (UK) and two from Portugal - none of these is known to have become ill. All people who may have been exposed have been identified and are being investigated for legionella infection.

The spa resort was closed on 22 May. The regional public health director of País Vasco (Basque Country) has informed all doctors and the general public. The coordinating centre of the European Working Group on Legionella Infections (EWGLI) was informed of the outbreak in order to follow up the possible British and Portuguese cases and will be notified officially when all the details of the cases have been obtained for reporting purposes. The regional surveillance unit, in collaboration with the National Centre for Epidemiology, has begun an epidemiological and environmental investigation to identify the source of the outbreak. Legionella pneumophila serogroup (sg) 1 has been recovered from water samples taken in the spa resort.

PUBLIC health experts say they will know within days if anyone has been struck by a strain of Legionnaires` Disease found at Wyre Forest Glades Leisure Centre, Kidderminster.
Health Authority and environmental health officers have been informed of the mystery outbreak and a hotline has been set up for anxious leisure centre users and their relatives. could have been in the centre’s water supply for up to a year – was found in five routine test samples of showers by Worcestershire County Council’s scientific services department. so far, said Dr Claire Constantine, consultant in communicable disease control at Worc- estershire Health Authority, and if none came to light by the end of the week none were likely to appear.
A spoksman said the building had been cleansed over the weekend by a water treatment company and another sample was taken. are expected in a week’s time when a decision will be taken on re-opening the centre. It was closed on Friday when the test results became known.
The European election vote verification and count, due to take place at the Glades, are being relocated to Stourport’s Civic Hall. finding alternative venues for sports clubs and competitions based at Forest Glades and have transferred some of their regular activities to Stourport Sports Centre. cancelled on Saturday. been temporarily using the facilities at Stourport Sports Centre and other gyms, and will be compensated for the closure, said a spokesman.

The ESRF has been informed that two users who stayed in the Guest House during recent months (one in February, the other in May) have contracted Legionnaires' Disease. This illness is caused by exposure to water aerosols polluted by a bacterium which may be present in water networks and air conditioning systems. Evidence of contamination in buildings A and B of the Guest House has been found and they have been closed to enable the water network to be cleaned by a thermal shock treatment. Given the time required for the preparation and execution of this measure, and for the subsequent verification of its effectiveness, buildings A and B will not be re-opened before the end of the ESRF's summer shutdown (i.e. mid August 1999). The new building of the guesthouse (building C) is unaffected and will remain open.

Dutch health authorities reported two cases of legionnaires’ disease being treated in hospital in the Netherlands to the Health Inspectorate of the French Community in Belgium on 17 June 1999.
Both patients had attended a reunion in southern Belgium between 4 and 6 June. A third case admitted to hospital in Belgium was reported in the next few hours.
All three had stayed in the same hotel. On 3 July, another Belgian patient with legionnaires’ disease was reported, making a total of four cases (age range 42 to 86 years) who had stayed at least one night in the hotel between 28 May and 21 June, confirmed by culture and/or urine antigen detection and/or serology. One case has died.

Preliminary enquiries made on 19 June revealed that all 3 initial cases had stayed in the same building (A) of the hotel, which was a 300 room holiday centre with two main buildings (A and B).
The hotel had hosted more than 2000 people in the past 5 weeks.
The rooms were cooled by a water-free system and two cases had never been in or near the hotel’s indoor swimming pool.
There were no whirlpools in the hotel. The only aerosol-producing source was a decorative fountain in one of the restaurants.
The hot water system of part A was separate from that of part B: it had been installed 12 years ago, had long circulating pipework favouring water stagnation and a recirculating hot water system, and the boilers had undergone no routine maintenance.

Water samples and swabs were taken from taps, showers, and boilers on 21 June. The hot water temperature ranged from 42°C (bottom of boiler) to 46°C (outlets), which would have facilitated contamination.
The system was decontaminated by hyperchlorination on 23 June (two hours at between 40-60 mg/L free residual chlorine and hot water taps were flushed for two minutes). Boilers were drained, scale deposit removed, and tanks cleaned.

On 25 June, results revealed massive contamination of the whole system with Legionella pneumophila serogroup 1 (12 out of 13 positive water samples with a concentration from 10⁴ – 10⁶/L).
Arbitrarily primed polymerase chain reaction fingerprinting (1) revealed indistinguishable patterns in strains collected from water samples and from two cases.

As the decontamination operation had been undertaken without specialised supervision, and the contamination levels were so high, it was feared the process might be incomplete. On 29 June every tap and appliance was held at 70°C temperature for five minutes to achieve thermal disinfection. Samples taken between the two processes confirmed persistently high concentrations of L. pneumophila (>10⁴) but samples obtained after thermal disinfection were negative.

All hotel guests from 15 May onwards were contacted by letter and advised to consult their general practitioner if they developed general or respiratory symptoms.
The medical community in Belgium was kept informed through medical newspapers and the incident was reported to the European Working Group on Legionella Infections (EWGLI).

In Belgium, there is currently no standard on the maximal authorised levels of Legionella spp. in water, nor on the frequency and type of control, nor decontamination norms.

Harmonisation of standards among European countries (2) would be beneficial and EWGLI is considering how this can be achieved.

References:

1.Maes, G. Wauters, M. Struelens. Evaluation of arbitrarily primed polymerase chain reaction analysis for typing Legionella pneumophila. Clinical Microbiology and Infection 1998; 4:149-54
2.Health and Safety Executive. The control of legionellosis including legionnaires’ disease. Sudbury: HSE books, 1993

Reported by Olivier Ronveaux , European Programme on Intervention Epidemiology Training, Fellow, Rijksinstituut voor de Volksgezondheid en Milieu (RIVM), the Netherlands (on temporary assignment at the Institut d’Hygiene et d’Epidemiologie, Brussels);
Sophie Quoilin; André Sasse ; Frank Van Loock ; Marc Struelens ;
A Moreau, Communauté française, Belgium

	Ol Fosse of Outhe Houffalize

The analyses prove that the bacterium Legionella was in the water pipelines of the complex «Ol Fosse of Or-the».
The testing of water carried out two weeks ago in the center of holidays «Ol Fosse of Outhe», in Houffalize, in the province of Luxembourg, revealed the presence, in pipings of medical, of the bacterium at the origin of the evil of the Legionella. According to the service of inspection of the hygiene of the French Community, the results of the analyses make it possible to establish with certainty abond with the three listed cases of Legionellose at the beginning of June. Meanwhile, a fourth case, mortal that one, was also announced.

All these people remained, at one moment or another, with «Ol Fosse of Outhe», a tourist complex able to accomodate 800 people, property of the power station of the workers of wood and building of the Christian trade union.
The service of inspection of hygiene had been prevented on June 17th. by the Dutch medical authorities that two ther compatriots, as well as a Belgian, hadcontracted the Legionellose.

The track followed by the inspectors was going to lead to the center houffalois, makes of it the holiday place of the 3 women. But, in the absence of analysis of water, that is to say the liquid vector in which the bacterium develops, no element made it possible, at this date, to point «Ol Fosse of Outhe» of the finger.
The direction of the center decided to carry out a disinfection conduits, without suspending the activity of the establishment.

Two patients with Legionnaires' disease have died in a Harford County hospital, and officials are testing to see whether the hospital's water system was contaminated with the bacteria that causes the disease.

Harford Memorial Hospital confirmed yesterday that it had had four cases of Legionnaires' disease. One person remained hospitalized, and the other has been released.

The first death at Harford Memorial occurred June 26, according to a spokeswoman for the state Department of Health and Mental Hygiene. The state was notified of the death on June 29, she said. The second death occurred Tuesday.

Once a fourth case of Legionnaires' was reported, the hospital, at the state's recommendation, flushed its water system Saturday with 150-degree water to kill any bacteria, said the medical director of Upper Chesapeake Health, the company that runs the hospital.

"We made the assumption that the bacteria was coming from the hospital, and we then undertook a super cleaning of the water systems in the hospital," Vaughn said.

Test results on water samples taken from the hospital won't be available until later this week

A third person who contracted Legionnaires' disease has died at Harford Memorial Hospital, bringing the total number of confirmed cases to five.

The person was a patient in the hospital from June 18 to June 28 before health officials discovered the bacteria, The hospital spokesman said yesterday.
The person returned to the hospital Friday and died that evening.
Test results came back Saturday confirming that the patient had the bacteria that causes Legionnaires' disease.

This person was very ill with other medical conditions,and it is believed that the Legionella helped contribute to the death.

Two other patients who contracted the disease have died.
One remains in the hospital.

It is said that a hot water tank at the hospital was the most probable source of the bacteria .The tank has been disconnected.

Source Media

Nurses at Harford Memorial Hospital are phoning about 400 people who could have been exposed to the disease as patients between May 1 and July 3, the day the hospital heated its water system to eradicate Legionella bacteria found in a hot water tank.

Five elderly people have been diagnosed as suffering from the deadly illness, characterized by flu-like symptoms. The first case was diagnosed on June 8. Three have since died at the hospital in Fallston, a town located about 30 miles northeast of Baltimore.

The latest victim was a man hospitalized from June 18 to June 28 for an unrelated illness who had to be readmitted on Friday. He died that evening, and doctors later confirmed that Legionnaires' disease contributed to his death.

The two survivors include a woman who may have contracted the disease at a nearby nursing home. One of the survivors remained hospitalized in critical but stable condition.

Authorities are refusing to identify anyone who has contracted the illness. But the hospital said about half a dozen former patients contacted by its nursing staff have been referred for tests.

A fourth patient diagnosed with Legionnaire's disease at Harford Memorial Hospital has died, but there have been no new reported cases.

A patient admitted with pneumonia on June 28 and diagnosed with Legionnaires' on July 2, died Thursday afternoon, the hospital said.

Four other people who were patients at the Havre de Grace hospital between May 1 and July 3rd were diagnosed with the disease. Two died in June and a third died on July 9.

Legionella bacteria has been found at a nursing home one day after the death of a former resident who was sent to Harford Memorial Hospital with symptoms of Legionnaires' disease.

The discovery at Citizens Care Center Friday was the first evidence that recent exposure to the Legionnaires' disease bacteria, linked to four deaths in the area, was not confined to the hospital.

State health officials have linked three of the deaths to bacteria from the hospital's hot-water system.

A nursing home spokeswoman said the nursing home flushed and heat-treated its water system July 8 and 9 after an unidentified resident in her 80s was admitted to the hospital June 28 with pneumonia and Legionnaire's disease symptoms.
The woman died at the hospital Thursday.
State health officials took more samples from the nursing home Friday to determine the extent of the infection.

No other residents have been found to have Legionnaires' disease symptoms.

Preliminary testing found bacteria in one shower head at the nursing home.
Officials are awaiting the results of further tests.

The first case came to light June 8 at Harford Memorial Hospital when an unidentified patient was diagnosed with the disease. That patient was treated and released soon after.

Another patient died June 28, prompting the state health department to begin investigating the hospital as the possible site of the infection. Two other patients died of the disease on July 6 and 9.

Bacteries legionella also made their appearance in the medical network of the Parisian airport of Roissy-Charles-to-Gaulle, in the showers and the hot water of the wash-hand basins has ete fermees in certain buildings.

" One A finds traces of legionella,et we verifions the effectiveness of the chlorines treatments in certain buildings of airport " A indicates Doctor Thierry Drumare,un doctor of work attaches has the company Airport-of-Paris

Des bacteries legionella ont egalement fait leur apparition dans le reseau sanitaire de l'aeroport parisien de Roissy-Charles-de-Gaulle,ou les douches et l'eau chaude des lavabos ont ete fermees dans certains batiments. "On a trouve des traces de legionella,et nous verifions l'efficacite des traitements chlores dans certains batiments de l'aeroport" a indique le docteur Thierry Drumare,un medecin de travail attache a la societe Aeroport-de-Paris

The Naval Academy has closed its engineering building, Rickover Hall, after discovering the bacteria that causes Legionnaires' disease in a water supply.

A routine test revealed a high concentration of legionella bacteria in the building's air conditioning cooling tower. The building was closed Wednesday and will remain closed until at least Monday. More test results are expected Friday.

Three patients at Harford Memorial Hospital in Havre de Grace died from an outbreak of the disease and another two became ill. The first case was diagnosed June 8, but patients weren't notified until July 2, after one patient died from the respiratory illness.

But state health officials said hospital officials responded correctly by reporting the outbreak and treating the water system.

Legionnaires' disease is rapidly increasing in Australia, particularly in Victoria, according to Australian Department of Health statistics.

There were 270 cases in 1998, 25% more than in any year since notification began in 1991. Victorian cases more than doubled in 1997 and 1998, jumping from 29 to 64 cases. About 10% of victims die soon after getting the disease.

So far this year [1999] there has been a further 40% rise.
By 7 July, 168 cases had been notified, more than for all of 1997. Nearly a third of all cases, more than in any other state, have been in Victoria.

A spokesman for the Department of Human Services in Victoria said the 53 Victorian victims in 1999 included two small outbreaks at the Preston Club in Bell Street, Preston, and Southcorp Packaging plant in Coburg.

Public health investigators have been unable to find a definite source in 48 cases, although more than one potential contaminated source has been found in some cases.

Nearly all cases are caused by _Legionella_ bacteria suspended in tiny droplets of water in air-conditioned air, although spas and potting mix have also been linked to the disease. These droplets can spread up to 2 km from their source.

Victoria's chief health officer, Dr Graham Rouch, says the increasing number of cases in Victoria is due to better diagnosis and more air-conditioning.

The Department of Human Services informs the public about cases only when there is an outbreak, defined as more than one case linked to a definite site.
A spokesman for the department said the public was not told of any of the 20 cases during April [1999], or about positive tests at contaminated sites because "they were unrelated''. [But] there is strong medical evidence that single cases are likely to be part of small unidentified outbreaks.

The water-treatment industry blames the rise on changed weather patterns, ineffective cleaning chemicals, and a lack of registers or surveillance of air-conditioning systems linked to poor industry compliance with cleaning regulations.
 

Two cases of Legionnaire's Disease earlier this month have been linked back to a North Coburg factory, Victoria's Chief Health Officer, Dr Graham Rouch said today.

Dr Rouch said the two cases - a woman, 59, who lives in the area, and a man, 53, who works at the factory - were now recovering from the illness.

The cases were linked to the Southcorp Packaging plant in Charles St. after water samples from cooling towers at the factory tested positive to the legionella bacteria. Further tests will be carried out on the samples to establish if that strain of bacteria caused the illnesses.

Dr Rouch said the towers were dosed with biocide on January 12, when the water samples were taken, and again at the start of this week when laboratory tests confirmed the presence of the bacteria. Thorough decontamination and cleaning should render towers safe.

He said any factory staff or local residents who develop or have recently experienced respiratory or pneumonia-like symptoms should see their local doctor and alert them to the possibility of Legionnaire's Disease in the area.

The woman was taken to hospital on January 1 after falling ill, and is now recovering.

The factory staff member fell ill on January 10 and was treated by his doctor for pneumonia. He has now recovered.

Dr Rouch said the staff member was tested for Legionnaire's Disease and returned a positive finding after Human Services Department staff asked Southcorp to check the illness records of staff who had recently been absent.

There has been another death from legionnaire's disease, the third this year in Victoria.

The Department of Human Services says a 69-year-old man died last Sunday after contracting the disease from the Preston Club in July.

He was one of two people who contracted the disease at the club, which has since been cleared of the contamination, according to the department.

SYDNEY
The NSW Health Department was cited as saying that seven people across Sydney have contracted legionnaires' disease, with one woman in a serious condition at Baulkham Hills Private Hospital after contracting the disease two weeks ago. The source of the outbreak was yet to be determined, although a Health Department spokeswoman was cited as saying that the seven people "did not appear to have visited the same building".

Infectious disease expert Jeremy McAnulty was cited as saying that an investigation of the outbreak had not revealed any common cause of infection, adding, "Legionella bacteria is found naturally in the environment and the disease is most commonly contracted by inhaling contaminated air. The disease is not spread from person to person."

Source: <http://www.repubblica.it/quotidiano/newspdocs/19990711/legio.html
Summaries by Abramo Ottolenghi <ottolenghi.1@osu.edu>

Turin:
Following an outbreak of Legionellosis that has resulted in 11 deaths and 20 infected individuals, authorities have brought criminal charges against officers of the Molinette, the largest hospital in Piedmont, including its former and current director.

[Note: it is not clear if the 11 deaths are part of the 20 cases - AO]

*** [2] Source: Deja News [in Italian] <http://www.repubblica.it/quotidiano/newspdocs/19990715/tele.html>

Milan: authorities have requisitioned documents for the purpose of investigating the extent of legionellosis in hospitals. The investigation was prompted by the death of an immunosuppressed 47 year old woman at the Instituto Europeo Oncologico who was struck while taking a shower.

[Note: that is what the report says, I think she probably acquired the infection while taking showers as has been the experience in this and other countries where the _Legionella_ was found to be present in shower heads - AO]

The San Raffaele hospital (in Don Verze) reported that since January 1998 they had 6 cases of legionellosis with 2 deaths.

In the Lombardy region there have been 25 cases of legionellosis during the first 6 months of 1999.
Two cases were found in a prison.

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MILANO
Era già accaduto all' Istituto Europeo di Oncologia e ieri è capitato all'ospedale San Raffaele: i carabinieri del Nucleo Operativo si sono presentati per procedere all'acquisizione di una serie di documenti che permettano di accertare la diffusione della legionella all'interno delle strutture ospedaliere. È stata la morte di una donna di 47 anni - avvenuta lo scorso febbraio, all'Oncologico, l'istituto diretto dal professor Umberto Veronesi - colpita da morbo del legionario contratto mentre faceva la doccia, a dare il via a questa nuova inchiesta condotta dal pubblico ministero Tiziana Siciliano. Per quella vicenda c'è una persona indagata per omicidio colposo, il direttore sanitario dell'Ieo (dall'Istituto specificano che si trattava di una paziente in condizioni immunitarie fortemente ridotte), ma l'inchiesta riguarda una serie di casi sospetti avvenuti anche al Niguarda e alla clinica San Pio X ed è stata estesa a tutte le strutture sanitarie. È stato lo stesso ospedale di Don Verzé a comunicare ieri i dati che riguardano il suo San Raffaele: dal primo gennaio '98 si sono verificati sei casi di legionella, di cui due conclusisi con la morte dei pazienti. Tutti i casi diagnosticati - ha precisato il San Raffaele - sono stati segnalati in un apposito registro presso la Asl, così come prescrive la legge. "La legionellosi - aggiunge un comunicato - è un problema di tutti gli ospedali: quelli che non ce l'hanno, in realtà non la diagnosticano". Che il morbo sia più diffuso di quanto si possa ritenere, è una realtà che emerge anche dai dati forniti dalla Regione: in Lombardia nei primi sei mesi del '99 sono stati registrati 25 casi. "Nessun allarme - ha commentato l'assessore alla Sanità, Carlo Borsani - perché si tratta di un'infezione contenuta e al di sotto della media nazionale e internazionale". L'assessore ha comunque aggiunto che "essere al di sotto della media non basta" e che la Lombardia "sta rafforzando le misure di prevenzione". La legionella è un'infezione polmonare epidemica la cui fonte di infezione è l'acqua; gli impianti idrici la portano negli acquedotti cittadini e quindi anche negli ospedali. Il meccanismo di ingresso nell'albero respiratorio è costituito dall'inalazione o dall'aspirazione di aerosol che contiene il micro-organismo e che può produrre una forma gravissima di polmonite che resiste alle penicilline. Nel carcere di Alba (Cuneo) sono stati riscontrati due casi di infezione: un uomo di 54 anni è ricoverato da un mese in ospedale ed è grave, un altro è in cura all'interno del carcere.

Legionella, arrivano le ispezioni Torino, la procura fa la mappa delle infezioni ospedaliere sui neonati. Molinette ancora sotto tiro

TORINO (m.trav.)
Sarà una settimana di fuoco, la prossima, per gli ospedali torinesi indagati dal pm Raffaele Guariniello per le infezioni da sala operatoria. Domani l'assessore regionale alla Sanità Antonio D'Ambrosio riceverà il rapporto della commissione che nei giorni scorsi ha ispezionato la "clinica dei Vip", la "Sedes Sapientiae" di via Bidone, sotto inchiesta per sette neonati contagiati da infezioni intestinali (in quattro casi sicuramente a causa del batterio clostridium difficile) nell'ultimo anno. Secondo indiscrezioni, il rapporto coinciderebbe con quello degli ispettori di Guariniello, a proposito delle gravi carenze igienico sanitarie delle sale operatorie nel reparto Ostetricia. L'assessore lascia intendere che già domani prenderà la prima decisione: la chiusura della sala operatoria più a rischio, per consentire i lavori di adeguamento alle norme di igiene e sicurezza. E martedì la commissione regionale visiterà le Molinette, l'ospedale più grande del Piemonte, nel mirino dei giudici per 11 morti e 20 contagiati da legionella pneumophila. Giovedì, poi, arriveranno gli ispettori inviati dal ministro della Sanità Rosy Bindi. E la Procura continua a lavorare senza sosta. Guariniello, negli ultimi giorni, ha iscritto sul registro degli indagati il direttore sanitario della "Sedes Sapientiae" Vittorio Caramello per lesioni colpose e ben sette dirigenti ed ex dirigenti delle Molinette (fra cui il direttore generale Luigi Odasso e il suo predecessore Mario Lombardo) per omicidio colposo plurimo e lesioni colpose. Ormai, sul suo tavolo, c'è un dossier completo su tutte le carenze igienico-sanitarie degli ospedali torinesi, dopo un anno di blitz a tappeto dei Nas, dell'Asl e dell'Agenzia regionale protezione ambiente. Il pm, sulla scorta del caso-Sedes Sapientiae, ha chiesto all'Asl e alla Regione la mappatura completa delle infezioni ospedaliere che hanno colpito i neonati in tutte le cliniche specializzate, pubbliche e private dal '97 ad oggi. Ma ha scoperto che nessuno l'ha mai tracciata: nessun controllo, nessun dato complessivo. Così ha provveduto lui, con il suo staff, che in un solo giorno di lavoro ha già scoperto una decina di casi di enteriti nosocomiali (contratte, cioè, in corsia) in vari ospedali ginecologici e infantili. Quasi tutti a causa del solito clostridium difficile, un batterio che si annida nella sporcizia.