Legionnaires` disease 2001

Since July 2001, three cases of indigenously acquired legionella infection have been reported in residents of a west London health district, and one in a person who had worked in the same area. All cases are males, aged between 31 and 78 years. All the cases have been confirmed by urinary antigen test, but no isolates are available.

Two of the cases are linked to an industrial estate in the area which has several cooling towers. These are the focus of investigations by the local health authority and environmental health department, and the Health and Safety Executive with support from the PHLS Food, Water, and Environmental Laboratory and CDSC regional services.

Colleagues are asked to ensure that cases of atypical pneumonia are fully and promptly investigated to rule out legionella infection.

One case of legionnaires¡ disease and two cases of non-pneumonic legionella infection have been confirmed in an outbreak associated with a hotel in south west England.

Reports of illness indicate that there are at least a further seven unconfirmed cases with symptoms suggestive of Pontiac fever.

The case of legionnaires` disease occurred in a woman aged 84 years and the two non-pneumonic cases in men aged between 60 to 70 years.

All those affected were part of a group and stayed at the hotel at the beginning of October. Exposure to a spa bath in the leisure facilities is likely to be the source of their illness. Guests from the party experienced a relatively sudden onset of fever, myalgia, and headache within 24 to 48 hours of using the spa bath.

Ten cases were admitted to hospital either locally or on return from their holiday. All cases of Pontiac fever are thought to have recovered.

The patient with legionnaires' disease was exposed to the spa bath (although did not enter it) three to four days before the onset of symptoms. Legionellae pneumophila serogroup 1 antigen has been detected in urine from the three cases and L. pneumophila sg1 isolated in one sample of water from a shower in the hotels pool area.

All guests staying at the hotel during the first week of October have been contacted by letter and have been asked to complete a questionnaire.

A pensioner has died and two other men are recovering following an outbreak of Legionnaires' disease.

Health officials are investigating if there is a link between the men, who all lived within a mile-and-a-half of each other near Rotherham, Yorkshire.

Experts originally suspected that the dead man, aged 67, had picked up the illness during a holiday in Turkey.

A 42-year-old man was being treated at the Bassetlaw Hospital but is now recovering at home.

Dr Kevin Perrett, public health consultant for Rotherham Health Authority, said: "We now have to carry out a detective job to find out the possible source or sources for these cases

"It could be that each person contracted the illness from a separate source and that it is a coincidence."

The first man died of the illness on 10 June while the second case was diagnosed on 9 July.

Dr Perrett said: "The first man had recently been on holiday and we thought that he may have picked up the disease while abroad.

"One of the other men affected had also been on holiday abroad and the other man works in a factory which can also be a source."

Officials from Rotherham Council's environmental health department will now interview the men and their families to see if there is a common link between the cases.

Eurosurveillance Weekly has previously reported a community outbreak of legionnaires' disease in Norway, in the city of Stavanger, on the west coast of the country

(1). Twenty-six confirmed cases and two probable cases were identified in this first reported outbreak of legionellosis in Norway.

The first patient presented with symptoms on 18 July, the last on 7 September. All confirmed cases had urinary antigen detected. In addition, Legionella pneumophila serogroup 1 was cultured from nine patients. Of the 28 patients (both confirmed and probable cases), 21 were local residents in Stavanger and surrounding municipalities, and five were residents of other parts of Norway travelling through the city. In addition two foreign nationals staying in the city were diagnosed with legionnaires’ disease, a businessman and a tourist. The tourist was identified through the reporting system of the European Working Group for Legionella Infections (EWGLI, <http://www.ewgli.org/>). Seven of the 28 patients died, including one of the probable cases. The age range of the cases was from 16 to 94 years (mean age 54). The mean age of those who died was 81 years (range 43-94). Twenty-one of the patients were men.

Investigation carried out by local health authorities showed that all the patients had been in the same area in the city centre within 10 days before the onset of illness. Three of the patients had been staying in a hotel in the same area. Water samples taken from the cooling tower of this hotel subsequently showed presence of L. pneumophila serogroup 1. The air outlet of the cooling tower was situated five metres above ground level, close to a bus terminal. Nine isolates from patients and five isolates from the cooling tower were genetically compared at Statens Serum Institute in Copenhagen, Denmark, and Statens institutt for folkehelse (National Institute of Public Health, NIPH) in Oslo and showed similarities and were different from other known Norwegian legionella isolates.

The onset of symptoms of the last reported case occurred nine days after the cooling tower in the hotel was taken out of service and disinfected on 29 August (figure).

Outbreak of legionnaires’ disease in Stavanger, Norway 2001. Epidemic curve by onset of symptoms

Close cooperation between local health authorities, the local microbiological laboratory, and NIPH was essential in this successful investigation. To prevent further outbreaks, an information programme aimed at hotels, engineering consultants, and health professionals will be implemented. Current Norwegian prevention guidelines will be updated in accordance with the forthcoming European prevention guidelines produced by members of EWGLI.

The first known case of the disease discovered in Norway happened in 2001. 28 people were infected in the city of Stavanger, and seven people died. At first the authorities were puzzled as several of the victims lived all around the country, including one in Germany and another in England. After a massive hunt the source of the outbreak turned out to be the small lake of Breiavatnet, which has a fountain in the middle of it. The fountain had sprayed the bacteria into the air, in turn getting picked up by a cooling system at a Stavanger hotel close by. Only three of the infected had stayed at the hotel but it turned out the exit shaft of the cooling tower was right next to a public bus stop, explaining the other victims.

The Council of Health of the Meeting investigates three at the moment cases of pneumonía by legionella detected in three patients whom they remain entered in the Virgin Hospital Macarena of Seville.

According to the Provincial Delegation informed into Health in Seville, entered people present/display pneumonía by legionella of type communitarian, that is to say, that has contracted the disease outside hospitable scope.

According to the data of the health administration, two of patients are entered the Unit of Intensive Cares: one woman of 74 years, resident in a municipality of the province of
Seville, and whose prognosis is serious; and a man, of 50 years of age, that it evolves of favourable form, reason why is anticipated that it can to happen next to plant. The third patient is another man, of 55 years, that also evolve of favourable form.

Previously, according to the spokesmen of the Delegation explain of Health, registered another communitarian case of legionella in a woman of 38 years, that passed away the 17th of October, as a result of a failure respiratory, and that resided in the environs of one of patients at the moment entered. For this reason, the technicians of Public health, in collaboration with the local authorities, is carrying out the corresponding measures of monitoring and control in the surroundings of both people.

The health administration insists, in relation to the patients hospitalized, in which one is " isolated cases " that they do not have no relation to each other and the opportune ones are being made studies to determine which is the origin of the disease in each one of the patients, so and as establishes the protocols of performance in case of legionellosis.

The doctors of the hospitable center have maintained informed to families of the patients, as much on the made tests as on the diagnosis of pneumonía by legionella and the processing anticipated the patients.

HEALTH officials are advising Mitcham residents and workers to be on alert for signs of legionella after three men caught the disease.

The men, aged 39, 48 and 52, all either live or work in Thornton Crescent, Mitcham.

Department of Human Services yesterday sent letters to hundreds of houses and workplaces nearby to be on the lookout for symptoms.

Victorian chief health officer Dr John Catford said authorities were concerned other people might fall ill when there was a cluster of victims.

Cooling towers at three workplaces have been tested and decontaminated, with results of the tests expected to take about a week.

"We've screened and rendered safe all the relevant towers and we'll be waiting for results of the tests which, because we have to wait for this bacteria to grow, does take some days and it will be some days therefore before we can pinpoint the cause of the cluster," he said.

All the towers had been registered in compliance with Victoria's new legionella laws.

The three men had all been treated at hospital: two were discharged and the other is due to go home in the next few days.

There have been 98 cases of legionella, including seven deaths, in Victoria this year.

The Department of Health of the Catalan Government confirmed yesterday the existence of three cases of infection by legionella in Tarrasa (Barcelona) and also warned of the " suspicion " that it can have a outbreak of this disease in the city. In a notification directed to the Consistorio of the city, the Generalitat informed on the detection of the three infected people, one of who was registered whereas the other two evolve favourably, but emphasizes that these cases suppose a " suspicion of outbreak " of legionella.

According to the official notice, although the three affected people reside closely together, " the infections have not agreed in the time and one of them, for work reasons, visits different points from the regions of Barcelona ". For this reason, the Department of Health has requested to the City council of Tarrassa that facilitates information to him about the state of the cooling towers located in the South-eastern zone of the city, where reside the three people affected by the infection.

On the other hand, the Consistorio, that recently made a census of the towers, has put to disposition of the Generalitat all the information that it has and it has impelled an operative one of pursuit of the evolution of the detected cases of legionella.

They detect two suspicious cases of legionella in the Hospital Juan Ramon Jiménez de Huelva

The Council of Health of the Meeting of Andalusia has detected two cases of legionella in the Hospital Juan Ramon Jiménez de Huelva that affect two women, " middle-aged and the other greater one ", according to the accidental delegate of Health, Mountain Antonio.
The two affected women were entered in the Unit of Oncología of the hospitable center, where they stay in a state that, according to Serrano.
The direction of the Hospital has opened an investigation to verify the state of the conductions of water and air of the center, although any similar measured protocol of isolation nor of the zone has at the moment not been carried out where the cases were detected.

LINARES (JAÉN)
the direction medical of the Hospital Saint Agustín of Linares (Jaén) recognize yesterday the existence of two case suspicious of legionella in two old people in the center with pneumonia, although reject the hypothesis of that have infect in the same hospital because not be enter in the center in the last month.

The manager of the hospital, Antonio Resola, said both patients had entered the hospital from last Monday in the Unit of Care Intensive have 72 and 80 year of age, both neighbour of Linares, that find at the moment enter in state serious in the Unit of Care Intensive with a diagnosis of pneumonia communitarian or extra hospitable with suspicion of legionella " in a 99.9 percent of probability ". Both patients began to feel ill the 18th of August, reason why they decided to go to the emurgencies of San Agustín de Linares Monday, once verified that they felt worse. In this unit pneumonia was diagnosed to them extra hospitable and were entered.

The sources added that in the day the state of both people worsened yesterday, reason why entered the Unit of Intensive Cares, where they are being put under a specific processing, and bacteriological analyses were asked for to determine the causes of this ailment, including a study on legionella pneumophila. These analyses will be known in a maximum term of 72 hours. The direction of the hospital remembered that these patients were not admitted the hospital in the last months, reason why discarded that in principle they could have been infected in the hospitable enclosure. For that reason, the manager discarded that some type of risk for the rest of patients exists.
The relatives of one of the old ones who could be infected of legionella in the hospital san Agustín de Linares assured that " nobody in the hospital has informed to us into which the possibility that exists it has been able to contract legionella, to only have spoken us of pneumonia extra hospitable ".

A person died the week last as a result of " legionella pneumophilia " in the Hospital Marquess of Valdecilla of Santander, after contracting this disease outside the hospitable center.

Three patients contract legionella in the own Hospital of the Baja Fertile valley

The Hospital of the Low Fertile valley, in a has decided to superchlorinate the water

Public health affirms that the rooms have been closed, have taken environmental samples and it is going away to superchlorinate the water

The Hospital Low Fertile valley of Orihuela has communicated to the Conselleria of Health which three cases of pneumonia by legionella of nosocomial origin have been diagnosed in this center Disinfection acquired in the own center hospital and considered other like of probable, informed yesterday sources into the main directorate of Public Health. The patients are three men of 58, 74 and 69 years, first of which she has been registered, whereas the other two evolve favourably, according to the same sources. The mentioned hospital has adopted the preventive hygienic measures and has summoned to the meeting of personnel with the purpose of giving to the pertinent information on the situation and the taken decisions.

In this sense, the hospital has evacuated the affected rooms, that are in the first plant, has taken environmental samples from the same ones and has disinfected all its devices.

Also it will be made a hypercorrection of the water and ample a taking of random samples in all the hospitable center, besides to continue the active search of new cases of possible nosocomial origin.

However, during the last year the Hospital Low Fertile valley of Orihuela has adopted a series of measures of control in relation to the contamination by legionella.

Between these they appear three superchlorinate of the water systems, the disinfection of the conditioned air and the substitution of the manual system of chlorine of the water, including the cooling towers, by another automatic with frequent controls and adaptation to the necessities of the network.

Also the disassembling and meticulous disinfection of the cooling towers have been carried out, the substitution of the systems of fixed showers by systems of telephone in all the hospital, the disinfection with chlorine of the faucets of all the rooms and a monitoring epidemiologist of all the cases of pneumonias that they have been diagnosed in the hospitable center.

In addition, the hospital is coming to the installation of metallic ionisastion in cold the health water systems and warms up.

LEGIONELLA-FALLECIMIENTO TOURIST BRITISH THAT SPENT THE SUMMER IN SALOU DIES BY LEGIONELLA

A British tourist of 63 years the past passed away Friday in the Sant Hospital Joan de Reus (Tarragona) as a result of one pneumonía by legionella, according to has confirmed today the Delegation of the Department of Health of the Generalitat in Tarragona. The same sources have indicated that the deceased, that was spending days of vacations in a hotel of Salou, had pathological antecedents of isquémica cardiopathy and chronic respiratory insufficiency by silicosis.

The man entered the 11 of August in the Surgical Medical Center of Reus by acute respiratory affection and two days later Joan de Reus by agravamiento of the clinical panel with complications by her pathologies of base was transferred to the UCI of the Sant hospital.

During the past weekend the Delegation of the Department of Health in Tarragona initiated the habitual performances derived from the notification of a case of legionella.

Delegation of Health, that it investigates if the disease contracted it in Spain or it already brought it incubated, it stands out that it is an isolated case with fatal consequences, due to the antecedents of the patient, and adds that another case of legionellosis related to this episode has not communicated.

A old one the past entered 14th of July in the Hospital of Crossings of aquejado Bizkaia of legionellosis the past passed away Monday at night, according to confirmed sources of the Delegation vizcaína. The man slept habitually in the Attended Residence of Leioa, pertaining to the Leasehold Delegation of Bizkaia, accompanied by his woman.

After entering the old one in the hospitable center in the middle of the last month, the Delegation prohibited to use the water network of the Residence like preventive measure, while the conduits were examined. To the delay of the results, from the leasehold institution they discarded that the premises were an infection center.

At first, the man presented/displayed influenza symptoms, and since its state of health did not improve he was entered the 14 of July in the Hospital of Crossings. It was here where a possible panel of legionella was diagnosed to him, that, later, the test was confirmed when making to it and to give him positive.

This same week, the past Tuesday, vizcaíno of Getxo also passed away in the Hospital of Crossings a neighbor of the municipality, of 48 years, due to one neumonía caused by the bacterium legionella. After knowing the first case the week, the advisor of Health of the Government of Lakua, Gabriel Inclán, denied the existence of a outbreak of legionella in Bizkaia, although he recognized that there have been several " isolated cases ". Yesterday, the health authorities continued speaking of isolated cases.

This year 22 cases of legionella have been detected in Plowed, Bizkaia and Gipuzkoa,

A neighbor of Getxo of 48 years dies of legionella in the hospital of Crossings

A neighbor of Getxo passed away Tuesday in the hospital of Crossings of one neumonía caused by legionella. Technicians of Public Health have met with relatives and fellow workers of the victim to determine the places that month frequented in the last Miguel Angel C., and to try to locate the infectious center.
The specialists will review the conditioned air systems and the network of water conduction of the places in which it was possible to be produced I infect.

The man, who resided in a floor of Algorta next to his family, is the third person who dies of one pneumonía caused by legionella in which she goes of year in Euskadi, where all the mortal cases concentrate itself in Biscay.

The other two victims of the east disease year have been two old ones of more than eighty years, without no relation among them nor with the deceased the past Tuesday. One of the pensioners lived completely isolated in a small village.

He is habitual which the disease has a greater index of mortality between the people of more age, when having less defenseto fight the effects of the bacterium. On the contrary, Miguel Angel C. was a relatively young man and " totally healthy ", according to their fellow workers confirmed.

The statistics mainly show that every year tens of affected and several deads in the community by legionella take place, between July and November, since the heat and the humidity favour the proliferation of the bacterium in the facilities that use water. During year 2000 80 affected in the community were registered and four deaths.

The past July, Health also investigated the origin of the infection contracted by other two people in Biscay, a man who lived in a residence of old on Leioa and a foreign tourist. Nevertheless, the results of them inspection are only made public in case an outbreak exists: that more than two people they have been infected in a same installation, to the supposition already a risk for the public health.

The Cabinet the past approved Friday a real decree in which the hygienic and health criteria for the prevention and control of legionella settle down. The holders of the facilities will be the people in charge to guarantee the correct operation of the facilities able to produce the disease, between which are hydric cooling towers and other systems.

In the Basque Country 80 cases of legionella took place the last year recognized by Health of the Basque Government and four mortal victims registered themselves.
During this year the affected ones have been 27, of which three have passed away. The greater outbreak in Spain has been registered in Murcia, where already four people have passed away.

A man committed in the Hospital the Flat one of Vila-real is affected of pneumonía caused by legionella . The Conselleria of Health confirmed yesterday to the Mediterranean the existence of this case of legionella pneumophila in the province of Castellón, infected outside the hospitable center. Apparently, they indicated the sources, the man became infected in Santander during its vacations, of which it finishes returning.

The patient, boarding school days ago in the vila-realense health center, was put under diverse tests and analysis before the clinical panel that presented/displayed. Yesterday, Thursday, it was practiced him antigen tests, and its result was positive to legionella pneumophila , according to the sources.

The affected one, of which single one knows that it is 64 years old since its identification has not become public, is in the Unit of Intensive Cares.

This it is the second case of legionella in humans that is detected in Castellón, although unlike first -- a nurse that worked in the Provincial Hospital the --, center finds outside the province.

A patient is admitted the Hospital of the Coast of the Sun because of a legionellosis. The patient evolves favourably. This case is sporadic and it does not bear any relation to the factors from risk of I infect of legionella, according to showed yesterday to this newspaper the provincial delegate of Health, Jose Luis Marcos. To the patient one was diagnosed to him pneumonia in the urgencies of the Hospital of the Coast of the Sun, caused by the bacterium of legionella.

The delegate of Health indicated that the patient is stabilized and its evolution is good from the clinical point of view.

The legionellosis that that person suffers does not keep relation from any type with the channels of I infect of legionella in establishments or places public, reason why there is no possibility that it appears a outbreak.

Marks indicated that annually they take place in the province of Malaga between six and seven cases of legionellosis, of approximately the 40 that are registered in Andalusia. The delegate specified that those cases are not related either to the risk factors of contracting legionella in a public place (hospitals, hotels, commercial establishments), reason why does not exist danger of a outbreak or an epidemic.

Legionella is a bacterium that affects the respiratory system and whose manifestation usually is one pneumonia. The people who have losses the defences of the immune system are more prone to be attacked by the bacterium, commented Jose Luis Marcos.

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The first ever outbreak of legionellosis reported in Norway has beendetected in the city of Stavanger, which is on the west coast and has apopulation of 100 000. As of 29th Aug 2001, 14 cases had been reported, withthe first case on 2th July2001. All cases have had a clinical presentationcompatible with legionellosis.

A total of 13 cases have been confirmed by legionella antigen test in urineby culture of respiratorysecretions (11 men and 3 women, aged 20-94 years).

Nine of the patients are residents of Stavanger but live far apart. Theothers have visited Stavanger since mid-July.

The local health authoritiesare investigating the outbreak in collaboration with Statens institutt for folkehelse (National Institute of Public Health, NIPH) in Oslo.

Stavanger is the land base for the offshore oil industry in Norway and alsoreceives large numbers of tourists in the summer. NIPH would like toreceive immediate reports of cases who have visited Stavanger this summer.

[Byline: Preben Aavitsland (<preben.aavitsland@folkehelsa.no>), Statensinstitutt for folkehelse, Oslo, Norway]

As of 4th Sep 2001 the National Institute of Public Health (NIPH) Oslo,Norway has reported a total of 19 cases (17 confirmed by urinary antigendetection and 2 probable cases) including 2 deaths in Stavanger on the westcoast of Norway.

The first patient presented with symptoms on 26th Jul 2001, while the latestcase presented with symptoms on 1st Sep 2001. All the patients had visited alimited area of the center of Stavanger within 10 days of the onset ofsymptoms.

Local health authorities in collaboration with NIPH have identified several possible sources of legionellosis within this area, including a waterfountain situated in a park and several cooling towers. Results fromsamples taken from these possible sources are pending.
The fountain inquestion has been closed down and all cooling towers in the vicinity havebeen disinfected.

WHO encourages those who have information regarding possible cases inpersons who may have been in Stavanger during this period to contactdirectly one of the following:

Last week, Eurosurveillance Weekly reported a community outbreak of legionnaire¹s disease in Norway, in the city of Stavanger, on the west coastof the country (1). As of 4 September 2001, a total of 17 confirmed cases and two probable cases of legionellosis had been identified in thisoutbreak.
The age range of the cases is from 30 to 94 years. Sixteen of the patients are men. The first patient presented with symptoms on 26 July, the latest on1 September. All confirmed cases had urinary antigen detected.
In addition,a number of samples for cultures have been taken.
Of the 19 patients (both confirmed and probable cases), nine are local residents, 10 are residents of other municipalities in Norway, and one is a foreignbusinessman who was travelling through the city. All the patients had visited a limited area of the centre of Stavanger within 10 days of onset of symptoms. One confirmed and one probable case have died. Local health authorities in collaboration with Statens institutt for folkehelse (National Institute of Public Health, NIPH) in Oslo have identified several possible sources within that area,
including a water fountain situated in a park and several cooling towers.
Samples from these possible sources have been taken. No results are available so far. Any environmental isolate will be compared with patient isolates by genetic methods.
Measures have been taken in relation to possible sources of the outbreak.
The fountain in question has been closed down, and all cooling towers in the vicinity have been disinfected.

Reference:
1. Aavitsland P. Outbreak of legionellosis in Stavanger, Norway.
Eurosurveillance Weekly 2001; 5: 010830.

- 12/05/2001

BARCELONA

a case of legionella has been diagnosed in a prisoner of penitenciaría of Dog Brians, in Sant Esteve Sesrovires. The man, of 37 years, began to be bad and the past entered day 10 in the penitentiary hospitable pavilion of Terrassa, where legionella was diagnosed to him yesterday, the Departament of Justíce informs. The internal one (a prisoner of module 4, of ordinary fulfillment) evolves favorably, but the case has caused alarm by the fear to that an infectious outbreak in the prison takes place and can infect to more prisoners and civil employees

The direction of Dog Brians informed into the case to the representatives of the workers. Union the UGT insisted yesterday to adopt of immediate way all pertinent the health measures in these situations to avoid possible new internal or working contagios of in the penitentiary center. A spokesman of the union indicated that she did not have myself more information but than trusted that measures would be taken to avoid a outbreak.

The chief of a main directorate of Public Salut of the Generalitat, Lluís Salleras, explained that Justícia communicated yesterday to Sanitat the case - legionella of is forced declaration so that it consists in the health registries and immediately an investigation was started epidemiologist - the experts of Sanitat collaborate with the doctors of penitenciaría- to see which could have been the focus of infection of the patient. In addition, samples began to take themselves from the possible centers and the habitual measures of disinfection, environmental character and even in the showers. According to Salleras, until the moment one has not detected that other prisoners of the jail present/display symptoms of the infection. " There are indications of a no outbreak and, so far, everything aims at an isolated case ", assured.

This is the first occasion in which a case of legionella in Dog Brians is detected, although in the last months several outbreaks of this infection, caused by a bacterium have been registered in Catalonia that nests in humid places. The most common centers are the cooling towers of conditioned air systems, for that reason after the outbreak registered in autumn in the Barceloneta, that affected almost half hundred of people, it was approved a norm for the cleaning and periodic disinfection of these facilities. Legionella, ailment that is looked like an influenza, is not infected of person to person and most of the times it is cured with relative rapidity.

12 of May of 2001\

First case of legionella in a Catalan jail

BARCELONA. An internal one of the prison of Brians, in Sant Esteve Sesrovires, has been the first Catalan inmate affected by legionella. But, apparently, the panic in the prison does not have to spread. Department of Justícia of the Generalitat assured yesterday that it is a " isolated case " and completely discarded the risk of an epidemic.The doctors suspected this case five days ago, when they transferred to the internal one to the penitentiary hospital of Terrassa. The analyses confirmed yesterday that the prisoner undergoes one pneumonía caused by legionella, whose origin is not known at the moment. On the other hand, the person in charge of prisons of the UGT, Antonio Benedicto, indicated yesterday that the affected one is an inmate classified in second penitentiary degree - with right to some permissions of exit -, committed in the fourth module of the prison of Brians - of ordinary regime and is seropositivo, which him made more prone to infect itself of legionella.

The Main directorate of Prisons of the Generalitat, according to a spokesman of Justícia, already has adopted the opportune health measures to avoid that legionella propagates and becomes an epidemic. The prison authorities have discarded completely that can be produced this possibility. \

Between the adopted measures of " prophylaxis " it appears the disinfection with lye of the considered zones of risk, like for example the common showers, the communitarian washbasins or office of the dining rooms, points where the humidity is concentrated and where it thinks that the bacterium of legionella can have been incubated. On the matter, Antonio Benedicto explained that neither in the prison of Brians nor in its environs there are cooling towers, facilities in which also the bacterium is developed

Since the 7th July, incidence has declined rapidly and there have been no new cases reported since 14 July.
The epidemiological investigation and surveillance are continuing.
The most likely source of the outbreak is a cooling tower in the city centre. The cooling tower has now been disinfected.

Information received after this posting indicates that several cooling towers in the area were positive for Legionella by the polymerase chain reaction (PCR), but the organism has not been isolated thus far. Control measures have focused on all cooling towers which may be involved, as well as other potential sources.

There has been another outbreak of legionnaire's disease at European hospital Georges-Pompidou. Between 29th Jun 2001 and 9th Jul 2001,

3 new cases of the disease were diagnosed at the hospital, 2 of which have proved fatal.

After the epidemic which spread between November 2000 and January 2001, the new outbreak has brought the total number of cases in the hospital to12, including 6 fatalities.

In March [2001] it was thought that the danger was over after a series of changes were made to the hot water system. The hospital will not be closed, but a number of new measures will be put in place to combat the problem.

the epidemic of legionella untied the last week in Murcia has affected until the moment to 670 people, of whom nine remain entered in units of intensive cares with favourable evolution, informed the advisor into Health, Francisco Marquess, whom it emphasized that the episode tends to send. Marquess, who made these declarations during his visit to the services of urgencies of the Hospital Morales Meseguer of Murcia, advanced that this noon the cabinet of crisis will meet constituted in the occasion of the epidemic and integrated by people in charge of the Council of Health, the Presidency and the City council, for " adopting measures of homogenous character " in all the facilities of air

The advisor of Health and Consumption of the Region of Murcia, Francisco Marquess, showed today that, according to data of the 18,00 hours, the number of patients by legionella in Murcia already promotes to 228 confirmed cases, whereas the number of possible patients of pneumonía is of 575, " of which the 71.8 percent have been entered ".

Marquess indicated that of the 228 confirmed cases the 74.6 percent is men, and the 25.4 percent is women, to the time that indicated that " there are 12 people in the Units of Intensive Cares of the different hospitals from the Region, one of them, of 31 years, in very serious state ".

Also, the advisor today presented the facilities where the DNA tests have been positive, to the time that needed that " 14 facilities have given positive in 6 great continents, that are: the building of old the Appraised Galleries, the English Court of the Avenue of the Freedom, the Palace of San Esteban, the council of Agriculture, the council of Health, and the central offices of Cajamurcia ".

Marquess affirmed that in the samples taken in the facilities of these places " rest of DNA exist ", to the time that it asserted that " in agreement they have been arriving the results from the laboratory of these places have gone away systematically cleaning, disinfecting or stopping, and all absolute and they are totally verified, so that we can guarantee, to date of today, that no of them constitutes no risk for the public health ".

In this respect, it added that in the building of Galleries, the cooling tower, the intervention measures have been made, is to say closing, cleaning and disinfection, as well as that is open; in the conditioned air raft of the building of Galleries everything is made and also he is open; and the general depot of the same building has a hipercloración order and is closed.

On the Palace of San Esteban, it declared that " it has a closed circuit and does not exist cooling tower, reason why is impossible that it is emitting center, as much within the own Palace as outside, and one is open ". In the English Court of Great Via, in the department deposit three of the cooling tower " all the operations have been made and it is open with all the guarantees, and in the cleanliness of ladies of the third plant, a washbasin has hipercloración order, that is made but he remains closed ".

Also, Marquess indicated that in the council of Agriculture, Agua and Medio.ambiente " a purge in the cooling tower has become and all the operations are concluded, with which has opened itself ", whereas " in the central offices of Cajamurcia in Great via, in the cooling tower the operation has been made and is open ". Finally, he affirmed that " in the council of Health, in the cooling tower number one, all the operations have become and it has opened itself ".

Marquess also explained the reasons by that these data have not been facilitated before, indicating that the council of Health " at no moment desveló no name before he appeared in mass media, because the facilities can have or not the character of potentially infectante center ".

Uncontrollable " and irresponsible alarm "
In addition, according to the advisor " mentioning four facilities was assumption, in the later days, an inevitable dripping of new facilities that had been able to lodge DNA of legionella, and hubiesemos generated uncontrollable and irresponsible an alarm, and under my only responsibility those data have not been facilitated ".

Marquess stood out that the situation in the doors of emergency of the hospitals and in the services of urgency of the centers of Primary Attention of the city is of " total and absolute normality during last the 48 hours, and is the most important descente tonic ".

" Situation in hospitals is good, is taking care of patients of way suitable and has beds free in case new income take place, that are foreseeable in the next hours ", added.

They continue them inspection
As far as health them inspection, Marquess aimed that " they follow cultivated the samples that have been obtained and that are continued obtaining in the systematic hairdo that is being made, fundamentalmante, in District 1 of Murcia, as well as in the adjacent zones, although not yet we have the news ".

Thus, Marquess explained that they continue sending the samples taken to the laboratories for the fast determination from the DNA of legionella, to the time that he reiterated that this test " is not feaciente that they are centers of infection, because only determines the existence of legionella at one or another moment, without the necessity that now the bacterium is there ".

and 80 years and more, the 5.9 percent.
As far as the locality of residence of the confirmed cases of legionella, the 68 percent of the affected ones belongs to Murcia-centre,
17.7 percent to pedanías and the 14.3 percent to other municipalities of the Region.
Also, it detailed that the cases of suspicion of pneumonía per date of hospitable attendance, until the 18,00 hours of today, are the following one:

The advisor of Health also talked about to the number of discharges given until today, that ascends to 150, the time that he reiterated that " only a death by pneumonía with suspicion has taken place ". " This makes us say that foreseeable and with all the prudence, the legionellosis epidemic that has affected Murcia is in the declining phase of a form definitive, and probably absolute, although despite they will continue entering patient the hospitals and will be diagnosed of pneumonía by legionella, given the period of time of incubation that this germ causes when producing the pathology ", it asserted.

Finally, Marquess assured that the president of the Independent Community, Ramon Luis Valcárcel, " has been in all and in each one of the moments of this process, total and occupied and absolutely worried about this subject ".

The advisor of Health and Consumption of the Region of Murcia, Francisco Marquess, today showed that the number of patients by legionella in Murcia ascends to 178 cases, to the time that indicated that the number of possible patients of pneumonía is of 470.

Marquess indicated that " the number of cases no longer is going to vary significantly ", to which he added that " there are 10 people in Unit of Intensive Cares, concretely 5 in the Morales hospital Meseguer, one in the Arrixaca, 2 in the Fertile valley, and other 2 in San Carlos, all with stable prognosis and well ".

The outbreak of legionella that affects Murcia is generating the alarm between the citizens. At the moment already a person of pneumonía has died, and they remain hospitalised six more in intensive cares affected by the bacterium. Of the 253 patients, to 86 already it has been confirmed to them who have legionella. And what is worse, still the infected center has not been located.
The urgencies, meanwhile, colpasadas

The number of patients by legionella in extreme Murcia and follows. Up to 253 cases of pneumonía they have been taken care of already in the different hospitable centers from the region. 175 samples have been analysed and of them, 86 have given positive by legionellosis. Six people are entered in Units of Intensive Cares.

They are fulfilled therefore the worse prognoses, because in addition one to the affected people, a man of 65 years, passed away at dawn of yesterday. The results of the autopsy will clarify if its death could have relation with legionella, had admitted the aquejado hospital of one pneumonía.

And while, practically all the region lives to the doors of the hospitals. Some wait for the news about the state of their relatives and they complain the saturation of the centers. But the majority goes when verifying that it suffers the symptoms of the disease.

What still one looks for without rest is the center of this epidemic. All the cooling towers located in roofs of the zone have been inspected already center and they are continued taking samples from the refrigeration apparatuses. The alarm or is untied because this epidemic of legionella, in total phase of incubation, is or most virulent of the last years

The epidemic of legionella of Murcia registers one dead and 210 patients by pneumonía
The number of affected is doubled less in than 24 hours and is predicted that it continues raising

Although the analyses have still not confirmed it, everything aims at that a people of the Murcian district of Santa Maria de Gracia - the zone where it suspects that it is the infection center is the first mortal victim of the epidemic of legionella that is doing damage in the capital of the Region.
Therefore it at least assured yesterday the advisor Health, Francisco Marquess, who for the second time in less than 24 hours admitted that the Community and the City council of Murcia face a problem of public health of unpredictable consequences.
The number of affected increases as spend the hours: if Sunday there were 117 patients, to the closing of this editing they were already the 210 patients with pneumonía, of which more than 140 have admitted the hospitals, and two are in the UCI.
Antonio Ródenas, of 64 years, died Sunday in the hospital as a result of one serious pulmonary infection.

The death of a person of the center of Murcia, almost with complete certainty by the devastating effect of the bacterium, ratifies the thesis of the Council of Health on the place where the center of the epidemic resides.
Every time it seems clearer that the cooling tower by water where legionella lodges finds installed in the district of Santa Maria de Gracia or in its environs.
The patient of pneumonía that died last Friday, also in the UCI of Morales Meseguer, lived in the street Smaller Sea on the mentioned Murcian district, the same direction in which resided Antonio Ródenas.

The dripping of cases follows in increase. Throughout the day of yesterday they continued arriving at the doors of urgencies of the citizen hospitals that presented/displayed the symptoms characteristic of the legionellosis: strong headaches, dry cough, very high fever, vomits and in some cases diarrea. To last hour of last night, the Council of Health had registered a total of 210 cases of pneumonía - the majority men -, and the existence of the bacterium in 57 of than one hundred tests the more made to patients had been confirmed.

Wrapped by the heads on watch of Public Health and Epidemiology and by the mayor of Murcia, Miguel Angel Camera, the advisor of Health appeared yesterday before mass media to facilitate what takes way to become the childbirth of the day. The fatigue and the preoccupation were let notice in the faces of Francisco Marquess and Camera.

The Maxima health authority of the Region explained that, in accordance with the data received in the council throughout the dawn of Monday and during the day of yesterday, " it is possible to be affirmed that the situation is slightly better than the one of Saturday and Sunday ".

However, Marquess clarified that " the positively of the antigen with respect to legionella is being determined in more cases, which on the other hand is normal that it happens when epidemics like the present occur ". The advisor insisted on which " we are in a better situation, from the health epidemiologist and point of view ".

The percentage of people entered in hospitable centers with respect to the total of affected is almost of 80%.
The rest of patients receives processing in their addresses and they recover without problems. Most of patients with pneumonía susceptible to be caused by legionella they are bed-ridden in Morales Meseguer, which had mainly to that this hospital is the center of reference for the zone of Murcia where more cases of pneumonía are arising: Santa Maria de Gracia, goes up to around North and part of the avenue Juan Carlos I.

In spite of the important affected increase of the number of, the advisor of Health guarantees that in the hospitals there is site to take care of the alluvium of patients very well. According to Marquess, at noon of yesterday they were left 118 free beds in the health centers, that can be destined people who enter with symptoms of respiratory infections by pneumonía. Colapsada Sala of income in the door of Urgencies of the Hospital Morales Meseguer, of Murcia.

The epidemic of pneumonía caused apparently by legionella untied in Murcia from the past Friday has affected to the moment to 151 people, of whom 120 remain entered in hospitable centers, two of them in the unit of intensive cares, today informed the advisor into Health, Francisco Marquess.

The advisor confirmed, also, who this dawn has passed away a person of 65 years in a hospital of Murcia affected by pneumonía, but has needed that the same one began to be treated day 15th of June and that until they do not know themselves the results of the autopsy will not know if the death has relation with the epidemic of legionella.

The tests made to the 151 people affected by pneumonía have confirmed that in 53 cases the origin of the disease was legionella.

Marquess again requested " tranquillity to the population " because " it is not possible to be done more of those than he is being done ", and assured that " there is no collapse in the urgencies of the hospitals ", although yes great affluence of patients, and that all the centers have free beds to take care of possible new patients.

To last hour of, Marquess he explained yesterday that one was 117 patients and only 10 confirmed cases. Affected health does not discard that it can follow increased the number of, since the period of incubation is of between two and ten days, and has qualified two telephone numbers to inform to the Murcian:

The advisor indicated that, apparently, the epidemic began Friday the past and the center is located in the center of Murcia, where a numerous group of technicians, helped by a helicopter of Civil Protection, worked yesterday in the evening in the inspection of several cooling towers and public source to detect the origin.

Marquess asked the citizens who do not fall " in the alarmism " because he is working in the detection of the center and advanced that the Murcian can drink " with guarantee " water of the provision network because has been verified that is not contaminated.

The affected ones, all adults, are in their majority (60%) of the district of Santa Maria de Gracia, located in downtown, and people of North Ronda, one of the main road arteries of Murcia.

87% of the patients are men (97 people) and 13% women (20 people). Most of the patients they are mayores of 50 years, of which 10% are mayores of 80 years.
Minors of 20 years 1.5% of the cases have been only registered until the moment.
The person who remains entered in a the UCI in the Hospital of the Fertile valley is 50 years old.

The advisor indicated that 11.1% of the affected ones reside in pedanías of Murcia, and 25.7% come from other municipalities of the Region, although it emphasized that " with all probability, the contagious have taken place in the capital ". Marquess explained that from afternoon of Friday, technicians of the City council of Murcia and the Council of Health work in the collection of samples in cooling towers to locate the center.

The advisor insisted on which " there are 117 people who have pneumonía, which does not mean that all of them undergo legionellosis, but that has the pathological process, but it is not necessary to hide that there are 10 cases in which the test of the antigen has given positive, and therefore we must think that the cause of most of these pneumonía is legionella ".

Of these 117 people, 80 are hospitalised, in the Virgin hospital of the Arrixaca (28 people), the one of the Red Cross (4 people), the one of the Fertile valley (15 people), the one of the Arcs (12), the one of the Consolation of Molina (10), Morales Meseguer (44) and the one of San Carlos (3). In addition, Marquess indicated that there is a man of 50 years who is hospitalised in the Unit of Intensive Cares of the Fertile valley.

The ages of these people are outposts " fundamentally ". " a 80% of the people would have of 50 years in ahead, and of these 83% would be men and the 17 women ", clarified.
The advisor also indicated that the disease has affected fundamentally people who live in " Murcia helmet ". " 60% of the patients have their residence in Murcia helmet, and specially the technicians have determined that he is the area of Santa Maria de Gracia and all the street North Round ", he said, to the time that affirmed that " this makes suppose that in this zone it is where is the emitting center, that still it is without determining ".

Also, it indicated that a 11.1% of affected people come from pedanías, and a 25.7% come from other municipalities. " one occurs of very dispersed form, all of them have come to Murcia during the last days and we suppose that they have contracted the disease in Murcia ", it added.

The independent community has put in alert all its services, and Marquess declared that during the day samples of all the cooling towers took shelter yesterday of Murcia center, with the purpose of finding the center emitting. Thus, he added that 8 cooling towers in the palace of San Esteban have paralysed, regional seat of the government; in the leisure center Zigzag; in the English Court; and in the old building of Appraised Galleries, with the purpose of gathering samples.

In this respect, it indicated that a helicopter of Civil Protection flew over the city of Murcia " with the purpose of photographing all the cooling towers that the inspectors cannot see at first, simultaneously that other inspectors cross the streets of the city to find all the evaporators that are to the height of the street ".

Marquess explained that the legionellosis is a form of pneumonía produced by the denominated bacterium legionella, whose symptoms are high fever, between 39 and 40.5 degrees, dry cough, abdominal and sometimes diarrea pain, as well as that " I infect is exclusively by aerogenea channel, and in no case by digestive tract nor of person to person ".

The advisor emphasized that " it has been possible to determine that the potable water network of Murcia does not have absolutely any risk ". " the results have already arrived from the tests, and the total absence has been determined and absolute of legionella in the potable water ", it asserted Marquess.

I returned from a holiday in Lagana on the island of Zakynthos last week (2.7.01) where some people on my flight had been staying in an apartment where legionnaires disease had broken out. I don't have any more details than that but the company we went with was JMC and the apartments were called the Sakis Apartments.

The Danish daily Horsens Folkebladet reported Thursday that two Danish men have died after contracting Legionnaire's disease while on holiday in Turkey.

Soeren Uldum from the state Institute of Serology was quoted as saying, "Four Danish men aged between 45 and 60, have been seriously ill, two are dead, after holidays in June in Turkey when they stayed in Marmaris and Alanya."
The four Danes left for Turkey with different travel agents and stayed in two different hotels, according to the newspaper.

A health warning has been released after an outbreak of the potentially fatal Legionnaire's disease in central London.

Three people who had stayed in the Portman Square area, near Oxford Street, have contracted the disease. One of them is seriously ill.

Westminster Council was notified about the cases between 1st and 19th June, but the onset of the illness could have started earlier.
Kai Lau, a consultant for communicable disease control at Kensington, Chelsea & Westminster Health Authority said:"Anyone in the immediate vicinity of Portman Square in mid-May who has subsequently suffered from serious flu-like symptoms should contact their doctor for further advice."

The council will not say the exact location of the outbreak as there are legal considerations.

To date three confirmed cases of Legionnaires Disease have been identified, linked to the Portman Square area,

First case was notified to H&S Team at City Hall on the 1st June. Second case notified to H&S on the 12th. Third case was notified to H&S on the 19th June

1/6/01
contacts traced and arrangements made with Public Health Lab in Colindale to take samples.

2/6/01
Sampling of locations used by 1st case and stand pipes in Portman Square known to have been used by the victim.

4/06/01-05/06/01
The cooling towers in the immediate vicinity were visited and the records of maintenance procedures checked.

12/6/01
2nd case notified which triggered subsequent investigation. A formal Meeting of the Infectious Disease Incident Control Team was called by Dr Kai Lau, the Health Authority’s consultant in communicable diseases for 13th June to plan the response.

14-15.6.1:
Further stand-pipes and relevant buildings in and around Portman Square were sampled over this period. Review of records of maintenance of all cooling towers within 500m radius of Portman Square.

19/6/1:
Preliminary results received from Public Health Laboratory Service Colindale of Legionella in the domestic systems of a building in Portman Square.

20/6/1:
interim results from another Portman Square cooling tower shows substantial numbers of Legionella bacteria.

20/6/1
Prohibition Notice served on block in Portland Square requiring the towers to be closed down for cleaning and deep chlorination. The domestic hot and cold water supplies were sampled.

21/6-22/6.1
all (around 50) cooling towers within 500m of Portman Square not already sampled have been checked and appropriate action taken when the results are known.

21/6/1
Further interim results from PHLS Colindale show substantial numbers of Legionella in a sample from the first building in Portman Square. HSE and Managing Agents informed.

Health and Safety at Work etc. Act 1974 – Control of Substances Hazardous to Health regulations

Health and Safety executive provide guidance on enforcement activities of Local authorities

Section 20 gives officers power to enter, sample, interview, and take away records from premises

Westminster’s planned inspection programme is founded on a risk based approach and is carried out on a 6, 12, or 18 month cycle

- CDSC will try to notify all appropriate authorities including the Central Reporting System for Europe

An outbreak of the potentially deadly Legionnaires' disease has been traced to a hotel and a block of flats close to Oxford Street, London's busiest shopping street.

One man is seriously ill and two are in hospital after contracting the disease. The victims include two labourers and a tourist who is thought to have stayed around Portman Square in the middle of May.

Westminster Council said yesterday anyone who had suffered from serious flu-like symptoms after visiting the area should contact their GP. The first case was confirmed on June 1, the second on June 12 and the third on June 19. One of the patients is in a serious condition while the other two are said to be recuperating.

Health authorities have defended the decision not to warn the public about the legionnaire's outbreak linked to Melbourne's Alfred Hospital, despite the outbreak claiming two lives.

The outbreak began two months ago, with seven people contracting the disease, including four patients, two hospital staff, and a construction worker.

Victoria's chief health officer, John Catford, says two people have died and another is seriously ill in hospital.

He says the source of the outbreak is still unknown, despite extensive testing of cooling towers in the area.

"However, the clustering does suggest that the potential source has been in this immediate area but the testing to date indicates that the site is now safe," he said.

Dr Catford has defended the decision not to issue a warning until now, saying the link has only just been established.

"My understanding is that it was back in March and I haven't had that confirmed but it would be a huge concern to us if that is the truth that we're only being notified now," she said.

Victoria's Acting Premier and Deputy Premier John Thwaites is waiting on urgent advice about the source of the outbreak.

He says the Alfred has a full risk management strategy to ensure the water cooling towers are properly cleaned and tested for legionalla.

Mr Thwaites says legionella cannot be entirely removed from the environment.

"We've done an enormous amount.We're leading Australia in terms of legionella management.

"In this particular case our hospital system has a much stricter regime than the rest of the society.

"There has been regular legionella testing and that has not shown any indication of legionella."

Nineteen employees who work in the Borax Building have tested positive for legionella, the bacteria which causes the deadly Legionnaire` Disease.

The Borax Building houses the Los Angeles County Department of Children and Family Services. The County and the owners of the building where all 19 work have refused to take appropriate remedial action, according to a complaint filed today on behalf of 12 employees for injunctive relief and monetary damages by Quisenberry & Kabateck, LLP.

In part, the suit seeks to ``abate a public nuisance.'' It was filed on behalf of employee Wanda Cherry, all other employees at the Department's Miracle Mile headquarters, and members of the public who have entered the building. The Complaint also seeks recovery for private nuisances and personal injuries because the Borax Building is alleged to suffer from ``sick building syndrome.'' All Plaintiffs seek corrective actions from the defendants, which include the County, the building owners and the maintenance company.

``This building is making us sick,'' claimed Wanda Cherry, named plaintiff and employee with the Los Angeles Department of Children and Family Services. ``So many of us are sick all the time and it's not just affecting our work, but our lives. The building is a breeding ground for illnesses. We just want the building cleaned up. I don't think that's too much to ask for.''

The Borax Building at 3075 Wilshire Boulevard in Los Angeles is open 24 hours a day, and is used by approximately 720 county employees who oversee child abuse cases and adoptions. The building is also visited by police, social workers and children brought in on an emergency basis.

The lawsuit alleges that since the County of Los Angeles took over the Borax Building in 1998, workers and visitors have been exposed to legionella bacteria and other dangerous biological agents and containments. While 19 employees have tested positive for legionella, others have complained and been hospitalized for respiratory illnesses including pneumonia, asthma, and bronchitis -- ailments associated with Legionnaires Disease.

``When only about fifty-nine people per year in California contract Legionnaires Disease, and nineteen of them happen to work in the Borax Building, we know there is a serious problem,'' remarked Brian Kabateck, founding partner of the law firm, Quisenberry & Kabateck LLP.

Legionnaires` Disease is generally transmitted through legionella bacteria found in contaminated water supplies and is airborne though a building's plumbing, heating, ventilation and air conditioning systems. There are no documented cases of Legionnaires being transmitted person-to-person. Untreated, Legionnaires is often fatal and at least half of the documented Legionnaires cases are associated with pneumonia.

A Cal-OSHA investigation last year found sufficient evidence of this disease-causing bacteria in the building's water system to require remediation. However, the inspection stopped far short of fully examining all the potential causes of continuing illness among building employees.

This month, Cal-OSHA fined the County of Los Angeles for using nonpotable water for drinking and washing at the site. They characterized this citation as ``serious.''

``The matter in dispute is not whether the building had legionella or other forms of harmful bacteria present, like mold.

Cal-OSHA already found legionella present in the building's water supply. The problem here is that the building wasn't

remediated properly,'' stated Kabateck. ``There was no known testing of the heating and air conditioning units in the nine story building. If you just clean up the water and not the method by which the water was being distributed, people will continue to get sick.''

``Sick Building Syndrome'' is a medically recognized condition attributed to the growth of bacteria emanating from

water-damaged buildings. Typical symptoms of sick building syndrome include hypersensitivity of pneumonitas or asthma exacerbation, irritation and inflammation of the mucus membranes, respiratory tract and skin; fatigue; and/or neurocognitive dysfunction. The infections are contracted through water, air, and surface contact and most people are cured of their symptoms upon removal from the contaminated indoor structure or full remediation of the structure.

Quisenberry & Kabateck LLP is one of the largest law firms in California dedicated exclusively to representing plaintiffs and consumers. Founded in 1988, Q&K has established a national reputation for successfully and tenaciously representing plaintiffs in insurance, bad faith, insurance coverage, products liability, construction defect, catastrophic personal injury, intellectual property, toxic torts, class actions, business torts, employment, entertainment and other consumer cases throughout California. Q&K attorneys use their exceptional experience and substantive expertise in a dynamic, innovative and aggressive approach to the practice of law. It is this experience, expertise and innovation that sets Q&K apart.

The firm is based in Los Angeles, California. For more information, contact the firm's Web site at www.qklaw.com

Nineteen employees who work in the Los Angeles Borax Building have tested positive for legionella, the bacteria which causes the deadly Legionnaire's Disease.

A complaint filed on behalf of 12 employees for injunctive relief and monetary damages charges defendants with failure to take appropriate remedial action.

The suit, seeking to "abate a public nuisance," was filed on behalf of employee Wanda Cherry, all other employees at the Department's Miracle Mile headquarters, and members of the public who have entered the building. The complaint also seeks recovery for private nuisances and personal injuries because the Borax Building is alleged to suffer from "sick building syndrome."

All plaintiffs seek corrective actions from the defendants, which include the county, the building owners and the maintenance company.

The building is the home of the Los Angeles County Department of Children and Family Services, is open 24 hours a day, and is used by approximately 720 county employees who oversee child abuse cases and adoptions. The building is also visited by police, social workers and children brought in on an emergency basis.

While 19 employees have tested positive for legionella, others have complained and been hospitalized for respiratory illnesses including pneumonia, asthma, and bronchitis — ailments associated with Legionnaires` Disease.

A Cal-OSHA investigation last year found enough evidence of this disease-causing bacteria in the building's water system to require remediation. However, the inspection stopped far short of examining all the potential causes of continuing illness among building employees.

This month, Cal-OSHA fined the County of Los Angeles for using non-potable water for drinking and washing at the site. They characterized this citation as "serious."

A group of pupils and teachers were at the centre of health scare after two coach drivers contracted suspected Legionnaires' Disease during a trip to Spain.

One of the drivers, a 59-year-old man from the North Staffordshire area, died on Saturday morning, while his 36-year-old colleague is seriously ill in Leighton hospital, near Crewe, Cheshire.

Health officials have contacted "virtually all" of the 36 teenage pupils and four teachers from the Blue Coat School, in Liverpool.

The two men were taken ill during the week-long trip to the Costa Brava but it is
understood they stayed in separate accommodation to the children.

The men are thought to have first showed signs of illness on 11 April, four days into the holiday.

Health officials said the school received no reports of illness amongst the 14 and
15-year-old pupils who travelled to Spain but added that families and their doctors were being contacted as a precautionary measure.

A spokesman for NHS North West said: "Virtually all the children have now been
contacted and there is no evidence that any of them have contracted the disease. Nor do the four teachers appear to have any symptoms.

"The incubation period for Legionnaires Disease is two to 10 days and the pupils will be outside this period by the time they return to school on Wednesday.

"There is no risk of pupils having contracted the disease from the coach drivers during the trip.

"The disease can have very serious consequences for older people and for people
with other underlying health problems.

Health officials have contacted the Spanish authorities and investigations were under way to identify the source of the infection.

It particularly affects people with reduced immune defence and is fatal in up to 15% of cases.

According to this story there's little to no chance a Blenheim couple who died after contracting legionnaires disease in Oklahoma City last month contracted the disease locally.

Dr. Michael Crutcher, medical officer of health for the Oklahoma State Board of Health, was quoted as saying, "It's highly unlikely, especially if therehave been no additional cases (in Chatham-Kent) because the couple had beenhere a month before they became ill.''

Crutcher added that the incubation period for the pneumonia-like illness is seven to 10 days, he said, well within the period of their stay.

There were no other cases linked to the deaths of Jack, 76, and Marjorie Nichols 73, and the focus of the state health department's investigation wasnot a public facility, Crutcher said.

The couple had been visiting the area since mid-February and became ill in mid-March. Mr. Nichols died March 28 and Mrs. Nichols died March 31.

Red the Creu Hospital of L'Hospitalet de Llobregat it communicated yesterday to conselleria of Health the disgnóstico of three cases of legionellosis in resident people in the locality. One of the affected people have died and the other two are hospitalized, being his favorable evolution.
The Conselleria, and the council of Health of the City council of L'Hospitalet and the Hospital of the Red Cross, has initiated investigation environmental epidemiologist and to find out the possible one infection source and if one is cases related to the same one center.

Until the moment, samples have been taken from the zone where they live the patients affected and of the Hospital of the Red Cross.

The first case, a woman of 85 years with diverse pathologies previous, it initiated symptoms of neumonía 7 of April the past, with disnea and pleural vesamiento, and passed away the same day. It was had yesterday result of the culture of pleural liquid, that gave positive by legionella. This patient had had two income in the same one hospitable center by cardiac insufficiency and descompensación diabetic.

The second case, a man of 67 years, entered in the center passed 28th of March through diabetic descompensación and two days later it initiated a fever panel. The explorations of pneumonía gave negative result.

The past 7 of April, the same patient initiated a disnética alteration, by which it entered in the UCI and him pneumonía by legionellosis diagnosed one. Its evolution is favorable.

The last case is a man of 22 years without previous pathology that
Tuesday by a panel of neumonía entered the past and to which it is had to him diagnosed legionellosis. Its evolution is favorable, according to informed conselleria. According to Health informed, previously to these three cases, the Hospital of the Red Creu of L'Hospitalet had declared a apparently sporadic case, a man of 68 years who was initiate symptoms the past 18 of March and was registered the 3 of April.

This patient lives in the same street that the young person of 22 years.

Source Spanish Media 13th April 2001

The University Clinical Hospital of Zaragoza has confirmed diagnosis of three cases of neumonía by legionella in the locality zaragozana of Borja, according to informed sources into the Government of Aragón,

reason why technicians of Public Health have initiated the identification of the possible sources of I infect for the control of this bacterium.

The patients are two women of 81 and 87 years, pertaining to he calls to account of old of this municipality, and one third that do not keep relation with this welfare center. All is entered in Clinical.

The first case was notified in the morning and the others yesterday two throughout the day of today.

The technicians of Public Health of SAS will carry out in collaboration with the City council of Borja a census of the possible ones sources of I infect -- as the cooling towers -- and the taking of water samples of different points to determine the presence or not of this bacterium in the network water, and to propose in its case suitable measures of prevention more.

With regards to the residence of old, in addition to collection of samples, in afternoon was adopted a series yesterday of measures you will prevent like the exhaustive cleaning of the water tank, the installation of an automatic clorador, the substitution of

artichokes of the showers or the recommendation of not using sprinklers of irrigation in the gardens of the enclosure.

Also, the services of a company have been contracted specialized to carry out the disinfection of the circuits of cold water and warms up, by means of the hipercloración and elevation of temperature of the same one.

Legionella bacteria has been found in two Telstra buildings in the city's legal precinct, which has been linked to two recent legionella deaths.

The Department of Human Services confirmed yesterday that preliminary testing on two adjoining Telstra buildings found the bacteria in three coolings towers.

The deputy chief health officer said neither building is visited by Telstra customers or the general public.

The Human Services Department spokesman said the findings on the Telstra towers were the first results from last weekend's testing of 20 buildings in the area.

The testing was carried out as part of an investigation into the deaths from
legionnaires' disease of restaurateur Peter Black, 53, and a 43-year-old
Berwick sales manager.

Mr Black, who ran the Illia restaurant at 180 William Street, died on March15. The other man, who had visited the area, died on March5.

"Although not absolutely conclusive that the men contracted the bacteria from the same source, it appeared both had been in the vicinity of a William Street block in the city in late February," Dr Carnie said.

Preliminary testing of two adjoining Telstra buildings in the city centre has found legionella bacteria in three cooling towers.

The Deputy Chief Health Officer, Dr John Carnie, said two of the towers were at the Lonsdale Street Telephone Exchange with the third at the City West Telephone Exchange. The buildings back on to each other between Lonsdale and Little Bourke Streets.

"Preliminary tests indicate the presence of two strains of Legionella, pneumophila types 1 and 6. The levels of bacteria are not yet available," Dr Carnie said.

Dr Carnie said Telstra staff and contractors in the buildings were being made aware of the signs and symptoms of Legionnaires' Disease. Neither building is visited by Telstra customers or the public.

The towers were tested as part of an investigation into the recent deaths of two men from Legionnaires' disease.

Earlier, a cooling tower at 180 William Street tested positive for legionella. That tower was immediately dosed and decontaminated with anti-bacterial chemicals.

"We ensured that all cooling towers in a block bordered by Lonsdale, Bourke, Queen and Gresham Street and Crombie Lane were also dosed," he said.

Legionnaires' disease is a rare form of pneumonia that can be carried in droplets of water in the form of a fine spray drift emanating from cooling towers.

Early symptoms resemble those of flu, including headache, fever, chills, muscle aches and pains and generally, a dry cough followed by shortness of breath. Other systems in the body can sometimes be affected, resulting in diarrhoea and mental confusion.

There have been 30 cases reported this year and three deaths. Last year there were 247 cases, and 11 deaths and in 1999 there were 64 cases and five deaths.

Officials from the Victorian Department of Human Services are checking buildings around 180 William Street in central Melbourne after recent deaths of two men from legionnaires disease.

A 43-year-old man from Berwick died on March 5, while a 53-year- old Hawthorn man died last Thursday from the bacteria.

Victoria's acting chief health officer, John Carnie, says the probable
source of the outbreak has only recently been identified and the building's cooling tower disinfected.

"Now, if people ask us, should they stay away from work or leisure or whatever from the central business district, the answer is clearly not," he said.

"There is absolutely no reason to stay away from that area. There is no greater risk now, than at any other time. "

Officers from Victoria's Department of Human Services are continuing to check buildings in Melbourne's courts precinct after another legionella outbreak.

A 43-year-old man from Berwick died on March 5, while a 53-year-old Hawthorn man died on Thursday, from infection with the Legionella bacteria.

Three other men are recovering from the disease, which is believed to have come from the courts building.

Victoria's Acting Chief Health Officer, John Carnie, says there is no risk to the public, but he is calling on owners of near-by buildings to carry out their own tests as soon as possible.

"We are proceeding over this weekend to try and get to as many of those buildings as possible, to request the owners and managers of those buildings to get their water treatment companies in and have those towers tested and decontaminated," he said.

"There is absolutely no reason to stay away from that area. There is no greater risk now, than at any other time."

The Department of Human Services has denied it has been slow in notifying the public about the latest outbreak of legionella in Melbourne.
Mr Carnie says the source of the outbreak was only identified on Friday night.
"The reason we are telling the public now is because the connection between these cases was only made Friday night. The third case was only notified to us last evening," he said.

According to this story, emergency health teams were mobilised yesterday to test buildings across central Melbourne's legal precinct - one-and-a-half city blocks - after the death of two men from legionnaires' disease, with another three ill.

Public health officials went into action, notifying building owners and demanding they call in specialists to disinfect air-conditioning systems as a precaution against the Legionella bacteria.

The story says that the action was taken after a positive test was recorded in an air-conditioning tower of the 12-storey Douglas Menzies Chambers, on the corner of William and Little Bourke Streets - but for a different bug than the one that killed the men.

One of the dead was the owner of the building's ground-level Illia restaurant, Peter Black, 53, from Hawthorn East, who died on Thursday after falling ill on March 6.

The other man was a 43-year-old Berwick sales manager, who became ill onFebruary 28 and was treated by his GP, but died on March 5.

He had visited the William and Little Bourke Street area during the incubation period in February.

Both men were found to have Legionella in autopsies conducted by the Coroner's Office, which is now checking all deaths from pneumonia-type symptoms.

Victoria's acting chief health officer, Dr John Carnie, is urging anyone who has been near 180 William Street and is suffering respiratory symptoms to consult a doctor and request a test.

The danger period is believed to be from mid-February to the first week of March. The block affected is bounded by Queen, Lonsdale, Gresham and Bourke Streets.

Thousands of city workers are in the area daily, including almost all Melbourne's barristers and others who work in the County, Magistrates, and Supreme and Federal Courts.

Victorian Bar Council chairman Mark Derham, QC, was quoted as saying the council "believed all responsible precautions have been taken at this stage.

We have notified all our tenants of the detection of the Legionella bacteria.

The story says that although Human Services Victoria was notified of the Berwick man's death on March 7, it sprang into action only yesterday after a connection was made between all the cases.

Dr Carnie was cited as saying the air-conditioning towers at Douglas Menzies Chambers were tested on March 2, and on March13, the results showed Legionella at a rate of 1000 colony-forming units per millilitre.

But the Legionella was type 2-14, whereas the deaths and the illnesses had been caused by Legionella type 1.

However, he said circumstantial evidence of the death of the cafe owner, and the proximity of the other patients to it, and the ability of Legionella levels to go up and down, pointed to the problem being in that building.

Dr Carnie said the towers were heavily disinfected on March 13, again on March 14, then resampled by the building's owners on Friday and again by the Human Services Department yesterday.

There have been three deaths and 30 cases of legionnaires' disease in Victoria this year. Last year, there were 247 cases and 11 deaths, and, in 1999, 64 cases and five deaths.

Dr Carnie added that Victoria had the world's most stringent regime for legionella testing, with new regulations recently put in place.

A third man, 44, from Dandenong North, who delivers food, became ill on February 26. He was admitted to Dandenong Hospital on March 4 and discharged on March 14. Human Services was notified on March 9 that he had legionnaires'. The man is now recovering at home.

A related story says that the Illia restaurant was deserted yesterday. Dead leaves and a Four 'n' Twenty pie wrapper had blown into the locked doorway.

Three empty green plastic crates were stacked up outside.
A quiet street. Just what you would expect on any grey autumn Saturday. But this was no normal day.

Another story says that since last year's Legionella outbreak at the Melbourne Aquarium, legionnaires' disease has been wreaking havoc on buildings across Melbourne.

Autoworker David Hinderman died last night, the second fatality in an outbreak of Legionnaires’ disease that has crippled the Ford casting plant in Brook Park.

Hinderman, 53, a mild-mannered night-shift worker who talked of retiring to Florida, had been in intensive care at Cleveland Clinic Hospital this week.

He died of severe infection after inhaling the bacteria that is spread by mist from contaminated water.

The number of confirmed Legionnaires’ cases out of the Ford Motor Co. casting plant remained at four yesterday, as the investigation into the source and scopeof the crisis continued.

"He’s just a real good guy," Paponetti said earlier this week. "The word gentleman would fit him to a T.’"

Hinderman told Paponetti recently he was looking forward to retiring soon to Clearwater, Fla. Hinderman had bought a trailer and planned to take classes in massotherapy. He was interested in alternative therapies.

Miriam Biris, a bartender at Englebrook Inn near the plant, was saddened last night when she learned Hinderman had died.

"I used to wait on him and talk to him. He was a conversationalist," Biris said.

She recently went to her church and "lit a candle for him. I was hoping he wouldn’t die."

The county health department has asked hospitals to test all patients with pneumonia for the potentially deadly bacteria.

The Ford Legionnaires’ scare has for the time being, at least, reversed a hospital trend of not testing pneumonia patients for Legionella bacteria.

Through the 1990s, hospitals cut back on testing for the bacteria, which is thought to be responsible for about one in 20 pneumonia cases. Since newer antibiotics to treat pneumonia knock out Legionella bacteria as well, there has been little reason to bother. A diagnosis isn’t crucial if antibiotics do their job.

The lack of routine testing makes it difficult to investigate outbreaks and eradicate sources of the bacteria, said Dr. Robert Salata, chief of infectious diseases at University Hospitals.

Dr. Victor Yu, a leading Legionnaires’ researcher at the Pittburgh VA Medical Center, believes as many 100,000 Legionnaires’ cases a year are overlooked.

"Many hospitals have no [testing] capability," said Yu. He and others say testing for Legionella should be routine in pneumonia patients.

Yet a recent federal survey showed only 20 percent of hospitals routinely tested for Legionnaires’ in patients who developed pneumonia at the hospital, said Dr. Richard Besser, a Legionnaires’ expert with the Centers for Disease Control and Prevention.

"I’m concerned there’s not enough testing done in patients admitted for pneumonia," he said.

Yu, who consulted on the casting plant outbreak, said it was fortunate the first two workers landed at Southwest General Health Center in Middleburg Heights, where they were tested for Legionnaires’ after arriving with pneumonia symptoms.

The confirmed Legionnaires’ diagnosis Monday kicked off the plantinvestigation, which led to a shutdown two days later.

Plant worker Donald Tafoya died Sunday at Fairview Hospital. A co-worker, William Jenkins, remained hospitalized yesterday with Legionnaires’. No information was available on the fourth employee diagnosed with the disease.

The day after the plant closing, 52-year-old casting plant worker Artimeria Shaw learned that the hacking cough sapping her strength was an upper respiratory infection that could lead to pneumonia. Shaw expects to learn Monday what the source of her infection is.

She managed to find a silver lining underneath all the fear and confusion sweeping through Ford’s rank and file.

Shaw, of East Cleveland, worked near some of the stricken workers. She was scared and took the company’s advice to seek medical attention.

But others are panicking. One Ford worker went to the Lutheran Hospital emergency department yesterday even though he had no symptoms.

About 300 people had called a county health department Legionnaires’ hot line as of yesterday afternoon.

"There’s a possibility that the number [of stricken workers] could grow," Willie Hubbard, president of United Auto Workers Local 1250, said yesterday. "A lot of people are complaining about different symptoms."

Meanwhile, workers are expressing concerns about returning to the plant on Internet sites and over the phone lines. Some employees said they feared retaliation if they spoke publicly. Several union members said that union officials had asked them not to talk to the media.

The CDC finished taking samples from water sources at the casting plant. Workers continued disinfecting the 49-year-old plant yesterday. It is expected to reopen on Sunday at the earliest.

The precise source of the airborne bacteria won’t be known until lab results are confirmed in five to 10 days. Health officials revised the roster of suspected cases, saying there are now three other employees with pneumonia being tested for Legionnaires.’

Two workers from the Ford Motor Co. casting plant in Brook Park have been hospitalized with Legionnaires’ disease, and two others are suspected of being infected with the potentially fatal airborne bacteria.

The source of the illness was not known yesterday. The focus of the investigation is the casting plant, where 2,500 workers make vital engine parts.

Company and health officials said they would also talk to the men’s relatives,

As a precaution, Ford yesterday shut down drinking fountains, handing out bottled water, and closed its showers.

The company was also looking into whether contaminated water came into contact with a system that uses compressed air throughout the plant, said Willie Hubbard, the president of United Auto Workers Local 1250, which represents plant workers.

Ford and health officials met with workers yesterday to explain Legionnaires’ disease and answer questions.

Employees were allowed to go home, said Ford spokesman Ed Miller. He wasn’t sure how many left work.

"I’m worried," Ford worker Herschel Drake said after work yesterday. "They say people are testing the water and we will know more tomorrow. But man, I’ve got 18 more days till I retire, and now this has to happen."

County Health Commissioner Timothy Horgan said it was premature to pin the blame on the casting plant.

"If there’s a lot more cases, I’ll be able to determine that," he said. "I’m not worried about a serious outbreak yet until I see more numbers."

"I’m debating now if I want to come to work tomorrow," said Isaiah Wheeler, a welder who has 24 years with Ford. "I never drink the water here, but you’ve got to wash your hands, and now you can’t wash your hands."

"The organism lives in water faucets, in drinking fountains, in showers," said Dr. Keith Armitage, an infectious-disease specialist at University Hospitals. "It can be in the water supply of a building."

"Patients tend to be not diagnosed unless they have a severe case," said Armitage. "It is underdiagnosed and unless you look for it, you don’t find it."

The casting plant is the sole source of crucial parts for most of Ford’s engine plants in North America.

Miller declined to comment on how quickly the plant’s closing might affect Ford engine and assembly plants throughout North America.

The casting plant was opened in 1952. It manufactures different parts from a new Ford aluminum casting plant that is also part of the Brook Park complex.

The workers hospitalized were David Hinderman of Brook Park and William Jenkins, whose residence was not known. Hinderman was in intensive care at Cleveland Clinic Hospital yesterday and Jenkins was in serious condition at Southwest General Health Center in Middleburg Heights.

The men were hospitalized March 7, said Terry Allan, the director of community health services for the county health board.

Several other Ford workers said they felt ill, but it is not clear whether they have Legionnaire’s disease, said Hubbard.

Ford had two company doctors at the plant yesterday working with local health officials, said Miller. Ford management told the union Monday night about the confirmed cases, said Hubbard.

A 29-year employee, left work yesterday carrying a bottle of Aquafina water. He was irritated because morning-shift workers were not informed until 10 a.m.
"I drank a lot of water in this place this morning before they told us," McCune said.

The Ford complex also includes Engine Plant No. 2 and Engine Plant No. 1, which closed earlier this year.

Ford Motor Co. last night shut down its casting plant in Brook Park as a third case of Legionnaires’ disease was confirmed and 10 cases of pneumonia came under suspicion.

Officials believe a cooling tower at the casting plant may have been the source of the airborne bacteria, county Health Commissioner Timothy Horgan said.

The tower is a large tank of steam-producing water, which is part of the plant’s heating system.

Two subcontractors who have come down with pneumonia were working on the cooling tower, and the others may have worked near it or taken breaks in the area, Horgan said.

Horgan also said a Ford worker who died of pneumonia Friday apparently worked near the tower.

"Now we’ve got some classical exposures," Horgan said, after two days of frustration trying to pinpoint a source.
"We’ve got several people working in and around the cooling tower, which had been down for maintenance.

"They’re voluntarily closing the plant and I’m in complete agreement with that," he said.

Ford spokesman Ed Miller declined last night to speculate on the cooling tower link. He said Ford decided to close the plant based on the third diagnosis.

Miller said that at the earliest, the plant would reopen Sunday, after the company finishes taking water samples and then disinfects the facility.

"I think they did the right thing," said Calvin Lewis, 46, of Brooklyn, as he left the plant last night. "The conditions in there are not getting better. The union and company need to work together because this doesn’t make any sense. I hope [those infected] are OK. I’m not blaming Ford, but someone isn’t doing their job."

Workers who were leaving the plant encountered a few co-workers driving into the parking lot for the next shift and waved them off.

Donald Nolan, 64, of North Royalton, wasn’t concerned about potential health hazards. "I ain’t worried," he said. "I just hope I don’t get it. What’s going to be will be."

"I’ve been here for 46 years and I’ve been breathing that dust and smoke and I’m still breathing," Nolan said.

The Centers for Disease Control and Prevention will join the investigation today.

CDC experts will focus on the cooling tower, said Horgan, who appeared relieved to have a break in the case.

"This might be very good news for the investigation - not very good news for Ford," he said.

Miller said he could not speculate on the impact of the closing. The Cleveland Casting Plant supplies cast iron parts for engines across North America.

Investigators from the Cuyahoga County Health Department yesterday sifted through reports of people recently sickened with flu-like symptoms and pneumonia while officials from the federal Occupational Safety and Health Administration investigated at the plant.

Horgan said it still had not been confirmed that the airborne bacteria came from the plant.

The two Ford workers who were confirmed with Legionnaires’ Monday remained hospitalized in intensive care yesterday.

Horgan said the family of the worker who died Friday apparently had postponed cremation pending possible testing for the legionella bacteria. Miller said the hospital first told health officials the man tested negative for the legionella bacteria, but later said he was never tested.

"Now we’re back to it being a question mark. We don’t know," Miller said.

Terry Allan, chief of community health for the county health board, said he wasn’t sure whether it was still possible to get a bacteria culture from the deceased worker.

Allan said there was a fourth confirmed case of Legionnaires’ disease in Cleveland, but it doesn’t appear to be related to the others.

Legionnaires’ is not rare - six cases were confirmed inCuyahoga County last year, and Ohio has averaged 131 reported cases a year since 1994, according to the state Department of Health.

Horgan said earlier yesterday that the investigation was difficult because there were only two cases, and both men were too sick to interview about possible sources of exposure.

A spokesman at Southwest General Health Center in Middleburg Heights said last night that Ford worker William Jenkins was improving and was expected to be moved out of intensive care. David Hinderman was at the Cleveland Clinic Hospital and his condition was not released.

Miller said water samples had been taken from heating and air-conditioning units, plumbing systems and production equipment that uses water.

"We’re pleased with the action they [Ford] are taking. They are pursuing all angles," said Rob Medlock, area director for OSHA, before last night’s developments.

But there are 35 species of legionella bacteria, and of the type connected with the disease, there are 18 varieties, said Dr. Elizabeth Koch of the Ohio Department of Health.
It takes three to five days to grow cultures from samples.

"It can take awhile in a situation like this," she said. "We need something from the environment and something from a human that matched." Any water source can harbor the bacteria, including plumbing, large air-conditioning systems with cooling towers and whirlpools.

Reliable numbers of cases are difficult to ascertain because Legionnaires’ is not easily distinguished from other forms of pneumonia. Even federal agencies don’t agree on the prevalence; the CDC estimates there are 8,000 to 18,000 cases a year, while OSHA puts the number at 25,000.

Health investigators are helping Ford Motor Co. try to pinpoint a possible source of Legionnaires'
disease in a casting plant that was shut down after a third case of the illness was confirmed.
One other worker died last week, apparently of pneumonia.

"Even though the source of the disease is undetermined, we felt we had to act quickly," said Ford spokesman Ed Miller. Workers were told about 9:30 p.m. Wednesday to leave the plant in Brook Park, near Cleveland and Hopkins International Airport.

The plant, which casts engine parts, has 276 salaried and 2,224 hourly employees.
Miller did not know when the plant might open again, but he said that it probably would be closed through the weekend.

"We have a lot of territory to cover. We have a lot of water systems used in the casting process," Miller said Wednesday night. "After the sampling is complete, the plan is to begin disinfecting the plant, basically spraying to kill the bacteria. The source of contamination is not known.
We feel with three cases we have to do this." There are two engine plants and one other casting plant in the Ford complex there, but so far only one plant is closed.

Staff from the federal Centers for Disease Control and Prevention will join the investigation Thursday.
On Wednesday, a cooling tower, ice machines, shower stalls and other water holders were checked, according to Cuyahoga County Health Commissioner Timothy Horgan.
The cooling tower, part of a heating system at the Ford plant, may be a source, Horgan said.

Two subcontractors who have come down with pneumonia symptoms were working on the cooling tower, and others who became ill may have worked near it or taken breaks in the area, Horgan said.

He also said a Ford worker who died Friday, apparently of pneumonia, likely worked near the tower. He said the family of the worker who died apparently postponed cremation pending possible testing for the legionellabacteria.

"I just hope I don't get it," said Donald Nolan, another worker there. "What's going to be will be. I've been here for 46 years and I've been breathing that dust and smoke and I'm still breathing."

Ford officials said water coolers were turned off in the plant, showers were closed and bottled water was offered to employees prior to the closing.
Horgan emphasized that the disease source could be from within the plant or from another location.
Two Legionnaires' disease victims were hospitalized, at Cleveland Clinic Hospital and the Southwest General Health Center in suburban Middleburg Heights. Miller said the third person with the disease was still at home Wednesday night after previously being medically checked.
The county health agency asked regional hospitals to report any pneumonia-like cases that may be Legionnaires' victims,

Health investigators took water samples from shower stalls, drinking fountains and other
areas of a Ford Motor Co. plant Thursday to determine the source of Legionnaire's disease that has sickened three workers.

Investigators from the Centers for Disease Control and the Ohio Department of Health joined local healthofficials and federal job-safety experts who arrived at the plant earlier in the week.

The Cleveland Casting Plant, which employs 2,500 and makes engine parts, was closed at midnight Wednesday at least through the weekend after a third employee was diagnosed with the disease caused by a water-born bacteria. The plant hasn't been confirmed as the disease source.

About 100 health investigators and Ford employees moved through the sprawling plant taking samples from120 water sources. Those also included cooling towers and heating and air-conditioning units,.

It could take five to 10 days to match any bacteria found in the water with the strain of disease contracted by Ford employees. There are numerous varieties of the disease.

Miller said there was no evidence of any health risk to employees working at three adjacent Ford plants. Water samples will be taken at the other plants after the casting plant is checked.

Ford said the shutdown was not expected to impact assembly plants for at least the next several days. Thecasting plant makes engine blocks and heads and crankshafts.

The president of United Auto Workers Local 1250, said workers are concerned but not panicking. Hesaid the company and union have tried to get out as much information as possible about the disease.

Two of the stricken plant workers were still hospitalized Thursday and the third was being treated at home,

In addition to the three confirmed cases of Legionnaires' disease, 10 cases of pneumonia were beingdouble-checked.

A Ford worker who died last week of pneumonia apparently worked near a cooling tower that was a focusof the probe. The family postponed cremation pending possible testing for the legionella bacteria.

Ontario Medical officials have determined that the strange disease suffered by at least 260employees at a Ford Motor Co. engine plant Two weeks ago was caused by a mild strain of Legionnaires Disease bacteria.

Doctors said the illness resembled the so-called "Pontiac Fever" that hit about 100 Oakland County, Mich., Health Department workers in 1968. Most
Ford-Windsor workers were able to return to work late last week but blood tests are being takenfrom the plant's 1,200 employees for further investigation and monitoring of the illness. Theillness broke out the night of Aug. 17, A physician with the United Auto Workers' union health
and safety unit. Employees stricken by the disease suffered chills, fevers ranging to 104degrees,muscle aches and joint pains, Ford officials agreed to drain and steam clean the assembly systemswhere two strains of the Legionnaires Disease bacteria were identified.

Legionnaires` Disease contributed to the death of Henry Ford 11, who contracted the disease while on holiday in Europe.

An employee of The Age is in intensive care following an outbreak of legionnaires' disease in the company's building at the corner of Spencer and Lonsdale streets.

All of the 1250 staff at the building were today warned to seek urgent medical attention if they began suffering flu-like symptons after two staff were last night confirmed to have contracted the disease.

A 57-year-old woman affected by the disease is severely ill according to
a representative of the Department of Human Services who addressed staff
at 1pm today.

The department confirmed the cases last night, but assured the company an evacuation of The Age's staff from the Spencer Street building was unnecessary.

The legionella bacteria, which occurs naturally in the environment, is linked to air conditioning units.

A full cleaning and decontamination of the building's air-conditioning cooling towers was taking place today after results just received from samples taken on January 19 confirmed the presence of the disease.

According to reports the Age has complied with new laws designed to minimise the chances of airconditioning cooling towers harboring the disease.

The laws were introduced after 110 people contracted the disease and two died at the Melbourne Aquarium in May 2000.

The Age carries out regular monthly testing which includes not only full bacteria count testing but specifically tests for legionella.

Complete cleaning and disinfection of the towers are carried out every three months, the memo said.

In the address to staff the department representative said other buildings near The Age were also being tested.

He said people who walked past the building were also at minimal risk of contracting the disease.

El Ayuntamiento de Sant Cugat confirma que el origen de los casos de Legionella es una zona industrial

Sant Cugat del Vallès (Barcelona).
El Ayuntamiento de Sant Cugat del Vallès, donde aparecieron entre el 8 y el 11 de enero tres casos de neumonía por legionella, explicó hoy, aunque sin concretar la zona, que el origen de los casos detectados es un polígono industrial del municipio.
La teniente de alcalde de Servicios Personales, Mercè Conesa, informó que los tres afectados por la enfermedad ''tienen en común el origen'' y en este sentido confirmó que el Ayuntamiento, en colaboración muy directa con la conselleria de Sanidad, está realizando ''estudios epidemiológicos para detectar la fuente de infección''.

The City council of Sant Cugat confirms that the origin of the cases of Legionella is an industrial zone Sant Cugat of the Vallès (Barcelona).

The City council of Sant Cugat of the Vallès, where they appeared between the 8th. and 11th. of January three cases of pneumonía by legionella, explained today, although without making specific the zone, that the origin of the detected cases is an industrial estate of the municipality.
The lieutenant of mayor of Personal Services, Mercè Conesa, informed that the three affected by the disease ' ' have in common origen' ' and in this sense confirmed that the City council, in very direct collaboration with conselleria of Health, is making ' ' studies epidemiologists to detect the source of infección'

El Departamento de Sanidad ha detectado tres nuevos casos de legionella en el municipio barcelonés de Sant Cugat del Vallés. Según un comunicado de prensa de esta conselleria, el primer caso se notificó ayer y corresponde a una persona de 53 años que está ingresada desde el pasado día 12 de enero en el Hospital de Bellvitge.
Los otros dos casos, que han sido notificados hoy al departamento, corresponden a un hombre de 67 años que ingresó el pasado día 12 en la Mutua de Terrassa, y a un paciente de 56 años que está hospitalizado en el Clínico de Barcelona desde el día 17.
Las mismas fuentes han informado de que los tres afectados continúan hospitalizados y su evolución es favorable.

The Department of Health has detected three new cases of legionella in the Barcelonian municipality of Sant Cugat of Vallés.

According to an official notice of press of this conselleria, the first case was notified yesterday and corresponds to a person of 53 years who is entered from the past day 12 of January in the Hospital of Bellvitge.
The other two cases, that they have been notified today the department, correspond to a man of 67 years that the past entered day 12 in the Mutual one of Terrassa, and to a patient of 56 years that are hospitalized in the Clinical one of Barcelona from day 17.

The same sources have informed into which the three affected continue hospitalized and its evolution is favorable.

Three people of Sant Cugat of the Vallès in the last entered days in different hospitals from the area of Barcelona with symptoms from pneumonía by legionella, according to today informed sources into the Council into Health.
The first case, that it was notified yesterday, corresponds to a patient of 53 years who remains entered the past in the Hospital of Bellvitge (Barcelona) from 12 of January.
The other two, which today they have been put in knowledge of the Council of Health, correspond to a man of 67 years, who the past entered 12 of January in the Mútua de Terrassa (Barcelona) and to a patient of 56 years that from the past 17th January are hospitalized in the Clínic of Barcelona. According to they pointed sources of the Council of Health, the three affected, that at the moment continue hospitalized, evolve favourably. The Council of Health and the City council of Sant Cugat of the Vallès have begun the studies epidemiologists to determine the environmental cause and to make specific the possible source of infection. Until the moment, it has been possible to state that of the three affected neighbours, two work in the same company and that third lives to 500 meters of the zone that at the moment is being analyzed.
In the last hours, municipal technicians and of the Council of Health began to gather samples of the suspicious cooling towers and initiated the works of disinfection of these facilities

The Department of Health of the Generalitat of Catalonia informed yesterday into the detection of three cases of legionellosis in Sant Cugat of the Vallès (Barcelona).

Two of the three affected are used of the factory Delphi Diesel, whereas third on them it lives to 500 meters of this company. In spite of the existing relation between the different cases, the technicians of Health could not confirm yesterday if the three contagios must to the transmissions of a same center nor if the bacterial contamination left this company.

First of the three cases Thursday was notified and corresponds to a person of 53 years who is entered from the past 12th of January in the hospital of Bellvitge of Barcelona. The other two cases were notified only yesterday and correspond to a man of 67 years that also admitted the hospital of Mutual of Terrassa the 12th of January and to another person of 56 years that are admitted the Clinical hospital of Barcelona from day 17.

The technicians of the departments of Sanidad and Medio. ambiente are working from yesterday gathering samples of the other factory and cooling towers of the Delphi company of the zone. Also, already the works of disinfection of these facilities have begun.

The Department de Sanitat has detected a new case of legionella in a resident man in Sant Cugat. With this one, already they are the four people affected by the bacterium who appear in this city days in the last.

The new patient is a man of 43 years who has been admitted the hospital Mútua de Terrassa, where evolves of favorable form.
According to Sanitat, this case does not bear any relation to the other three registered in the municipal term from Sant Cugat, since it does not have labor entailment with the others and resides in Valldoreix, a moved away zone of the urban nucleus, where they reside the rest of affected. One of these was registered yesterday and the rest evolves of favourable form

Alcoy, again in alert, after registering five cases of " legionella "
The Council of Health of the Valencian Majority has confirmed that five people have been themselves affected by pneumonía by legionella from the past day 26th of May.
7th June
The last case is a woman of 68 years, who remains entered in the Local Hospital of Alcoy. Other three people are in observation in this same hospitable center and its evolution is favourable. The Association of Affected by Legionella of Alcoy has summoned the people who in some occasion suffered legionella to a meeting for the next days in the North Social Center of the city with the intention of which each one contributes data relative to its cases. The information will be sent to a Barcelonian legal cabinet, to study if it can give foot of possible demands upon presentment. The advisor of Health, Castilian Serafín, has announced that a commission of scientists and toilets specialized in the matter of legionella will move in the next hours until the alcoyana capital. The advisor has solicitd to carry far the precautions and assured that consellerias of Medio. ambiente and Sanidad will install in different points from the city around a hundred of devices and systems of detection of bacteria in the air with the intention of verifying if legionella is in the atmosphere. Total cases 5, and three probable 8th June 2001

Note this outbreak now stands at 805 cases, five deaths

Disease Outbreaks
Reported

Legionellosis in Spain - Update 1

Spain

117 people are affected by an epidemic from legionella in Murcia

8^th July 2001

Another story says that since last year's Legionella outbreak at the Melbourne Aquarium, legionnaires' disease has been wreaking havoc on buildings across Melbourne.

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Note this outbreak now stands at 805 cases, five deaths

Disease Outbreaks Reported

Legionellosis in Spain - Update 1

Spain

117 people are affected by an epidemic from legionella in Murcia

8th July 2001

Another story says that since last year's Legionella outbreak at the Melbourne Aquarium, legionnaires' disease has been wreaking havoc on buildings across Melbourne.

Disease Outbreaks
Reported

8^th July 2001