1998

Seven cases of Legionnaires’ Disease have been associated with a hotel in Benidorm in Spain. Five of the seven cases were men and two were women, aged between 50 and 77 years. One, a 77 year old man, is known to have died. The first case arose in August, the second in October, and the rest in December 1998. Three cases have been confirmed as due to Legionella pneumophila serogroup 1.

The hotel was closed at the beginning of January.
An epidemiological and environmental investigation, which began in December, is still in progress.

Reported by Salvador de Mateo (smateo@isciii.es) Centro Nacional de Epidemiologia, Madrid, Sebastian Crespi (screspi@ctv.es), Policlinica Miramar, Mallorca, Spain, and Carol Joseph (cjoseph@phls.nhs.uk) on behalf of the European Working Group on Legionella Infections (EWGLI)

Eurosurveillance Weekly

Public Health and Development Division, Department of Human Services, Victoria, Australia

Issued 24 December 1998

A cooling tower at a cold-storage business has been identified as a possible source of the Thomastown legionella outbreak in October, Victoria's Chief Health Officer, Dr Graham Rouch, said today.

After extensive and exhaustive testing of numerous cooling towers, three towers in the area had tested positive for the legionella pneumophila sero-group 1 bacteria.

"One tower matched the samples taken from people who contracted the illness; a second tower cannot be eliminated as a possible source because the test results were inconclusive; and the third was a different sub-type of legionella which did not match the human samples," Dr Rouch said.

Dr Rouch said detailed DNA testing of samples taken from eight of the 17 people who contracted the illness matched the legionella type found in an air conditioning cooling tower at Kats Refrigeration, a cold-storage business in Norwich Avenue, Thomastown.
 

MAP OF OUTBREAK AREA

The second premises that tested positive for the legionella bacteria is operated by La Ionica, a chicken processing company in Lipton Drive, Thomastown.

"Whilst attempting to cross-match the human samples to La Ionica samples proved inconclusive, this tower cannot be excluded as a possible source.

The tests, by the Microbiological Diagnostic Unit of Melbourne University, showed the legionella bacteria contaminating the third cooling tower was of a different sub-type.

Dr Rouch said bacterial cultures were able to be grown in the laboratory from only eight of the 17 people diagnosed as having the illness.

All 17 people who contracted legionella from the Thomastown outbreak have been notified of the test results.

Dr Rouch said samples were taken from 74 cooling towers in the area to trace the source of the outbreak.

"The majority had complied or attempted to comply with the regulations governing cooling towers. However, the Department of Human Services is considering possible action where the regulations may have been breached.

"All businesses will be re-visited again in the new year to ensure that they are in full compliance," Dr Rouch said.

All cooling towers in the area are now safe after being treated with effective biocides and those found to be positive successfully decontaminated.

The legionella bacteria occurs naturally in the environment, mainly in water and soil. It is normally in very low concentrations but can increase markedly, particularly in man-made aquatic environments with warm recirculating water, such as air conditioning cooling towers.

Evaporative air conditioning units such as those used in homes and many business premises are not a likely source of legionella infection.

Infection is acquired through breathing in very fine droplets of water which contain the bacteria, such as spray drifts which are vented off from cooling towers into the atmosphere.

There are about 20 to 40 cases per year in Victoria, and 200 cases nationally. There have been 58 cases in Victoria so far this year, resulting in seven deaths.

Thorough decontamination and cleaning of infected towers will render towers safe.

Regulations require cooling towers, warm water systems and public spas to be maintained and disinfected regularly.

4th December 1998

Legionella Bug found in Buckingham Palace.

Traces of the bacterium Legionella that causes Legionnaires' Disease have been found in the water supply at Buckingham Palace.

A Palace spokesman said engineers took a week to flush the bug out of the water system, and the Royal Family were not affected.

He said the Queen and Duke of Edinburgh continued to live in their London residence and carry out their normal duties during the scare in mid-October.

Nobody had to flee Buckingham Palace and there were no reported cases of the disease," he added.

More than 300 staff were warned to be on the alert for symptoms of the illness, which can spread through a building's water system.

Legionella was found in one section of the water supply, which was isolated so the rest of the Palace could carry on as normal.

Legionella was discovered in the water supply on 13th October after tests.

It was immediately flushed out the system.

Another sample was taken and 10 days' later the all-clear was given

Source BBC News

Three die of Legionnaires' in Spanish hospital November 26, 1998

MADRID.

Three people have died from Legionnaires' disease in a hospital in Zaragoza in northeastern Spain, state radio reported on Thursday.
Hospital officials told the radio the three people who died -- two this month and one in September -- were all suffering from serious illnesses that had weakened their immune system.

The hospital is disinfecting the water and air conditioning systems to prevent further infection. They said there were no other cases of people infected by the virus which is spread through the ventilation system or water and usually affects people with weak immune systems.

Source Media

November 1998

Three patients have died by ' legionella' in the hospital Miguel Servet de Zaragoza

The sanitary center closes the hematology plant to try to restrain the outbreak

Zaragoza

The hospital Miguel Servet de Zaragoza has had to close its plant of hematology by the death of three patients in the last weeks, due to a legionellosis bacteria At least other two people are being watched before the suspicion that they can suffer the disease.
The origin of the outbreakis in the Towns hospital, according to the analyses of its specialists The first case detected the last month of September.
The medical director of the Servet, Ricardo Canals, assured last night that already all the measures necessary have been adopted to control the bud. The three deceased, two women and a man, were people " with low defenses ", according to Canals, that also indicated that the normal thing is that those are the patients that take the bacterium to the hospital. " In this case it has not been thus and we are convinced that the outbreakis in the hospital ", admits the medical director.
The outbreakhas communicated already to the sanitary authorities, so and as they establish the sanitary protocols when it passes away more of a patient by this bacterium in an inferior period to the six months The legionella one is a bacterium that causes a serious type of pneumonia and can also damage the liver, the kidney, the brain and tracto intestinal.
The infection that it causes calls legionellosis, and the risk of against increases with the age, the tabaquismo, the respiratory diseases and certain tumors.

In September and October of 1996, a outbreakin Alcala de Henares (Madrid) affected 224 people and killed to 11 of them, almost all already serious before the infection

The hospital Miguel Servet has sent to samples to the laboratory Carlos III of Madrid, but before knowing the results it has taken measures to disinfect the water and putting under high temperatures the conditioned air conduits, that transmit the bacterium

The direction of the hospital has recommended that occurs discharges of week end, because that plan of shock can cause upheavals to the entered patients. The center is probably in one of the services of the hematology plant. " the Servet is a constructed hospital to pieces " recognizes the medical director The direction of public health of the General Diputacion of Altarable indicated yesterday: " one has become what there is to do in these cases. It is all writing, they mark the protocols to it and these have been fulfilled ". The hospital Miguel Servet is center of reference not only for Zaragoza, but also for Huesca, Youable and the Rable. It has a capacity of 1,300 beds. The hematology plant is located in one of the three buildings, the one that lodges the General Hospital The Aragonese sanitary authorities do not think that it is necessary to evacuate all the building. Part of the nervousness must to a previous outbreakof legionella that affected in the Eighties to several entered officials of the Army in the regional center of control of Zaragoza, that it had hillable during several months.

Another death in Alicante

Valencia

The most recent case of death by legionella has been registered in Alicante, where the last week the sanitary authorities ordered the closing of two training centers after the death of a professor. The educational one, a catedratica of Musica, died in September due to one pneumonia caused by legionella, which motivated an inspection in Instituto de Secundaria 8th of March, in that it gave classes After being detected the presence of the bacterium, Health ordered the closing. The order affected the mentioned center, that shares facilities with an extension of Conservatorio de Mu'sica and the School of Danza During the two days that were closed, the educative dependencies were put under a plan of disinfection shock that was centered in the cloracio'n of the water conductions.

The unions criticised the slowness of Administracio'n and the fact that this one did not inform to them

Source Media

JULY AND AUGUST 1998

Legionellosis and recent travel to Bali

Two Legionnaires' cases in Sydney
Friday 13th. November 1998

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

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

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

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

Public Health and Development Division, Department of Human Services, Victoria, Australia

Issued 6 November 1998

Follow-up testing has confirmed that three more people, receiving treatment at the Northern Hospital at Epping, have Legionnaires' Disease, Victoria's Chief Health Officer, Dr Graham Rouch said today.

There are now 16 people with confirmed Legionnaires' Disease and 10 suspected cases awaiting the results of further tests, following an outbreak in the Thomastown/Reservoir area.

Of these 16 nine have been successfully treated and are no longer in hospital, Dr Rouch said.

Water samples taken by Human Services Department officials from two cooling towers in and around an area of Thomastown north of Mahoneys Road have tested positive for legionnella.

"The Department will await results from other towers and cross-matching from samples from people who have contracted the illness to try and conclusively source the infection. However, we have served decontamination notices on both these premises to carry out further dosing and ensure their systems are free of the bacteria," Dr Rouch said.

All cooling towers in the area have already been disinfected following treatment on the weekend and at the start of this week, and Dr Rouch said this meant there would be no ongoing discharge of the bacteria into the environment while health officials waited for test results.

This is supported by the fact that the last date of onset of either a confirmed or suspect case is the first of November.

The legionella bacteria occurs naturally in the environment, mainly in water and soil. It is normally in very low concentrations but can increase markedly, particularly in man-made aquatic environments with warm recirculating water, such as air conditioning cooling towers.

Dr Rouch said legionella had been detected in natural warm-water environments, such as the hot-springs spas in New Zealand.
Evaporative air conditioning units such as those used in homes and many business premises are not a likely source of legionella infection, he said.

(SEE ARTICLE BELOW ON EVAPORATIVE AIRCONDITIONING)

The illness causes flu-like symptoms such as headache, fever, chills, muscle aches and pains, followed by respiratory problems and pneumonia developed over three or four days. Onset can be up to 10 days after the initial contact with the bacteria. Anyone concerned about developing such symptoms should see their doctor.

Infection is acquired through breathing in very fine droplets of water which contain the bacteria, such as spray drifts which are vented off from cooling towers. Thorough decontamination and cleaning of infected towers will render towers safe.

Regulations require cooling towers, warm water systems and public spas to be maintained and disinfected regularly.

Prior to the Thomastown/Reservoir outbreak, there were 36 cases of Legionnaires' Disease in Victoria, with 6 deaths.

In 1997 there were 28 cases and 5 deaths, and in 1996 there were 36 cases and 7 deaths. In 1995 there were 22 cases and one death and in 1994 there were 46 cases and 9 deaths.

Nationally there are around 200 cases reported annually to health authorities.

1989 COLORADO (LAMA)

On October 16 1989 the Colorado Health Department was notified by a local physician of an elderly patient who was hospitalized with pneumonia after attending a high school class reunion at a local hotel/motel in Lamar, Colorado on September 22-24 , After the patient reported that other members of the reunion group had also developed pneumonia, and that two had died. After futher investigation it was found that theEvaporative Airconditioning (COOLER) Units on the roof were the cause of the outbreak of Legionnaires` disease.
Twenty cases were reported with THREE deaths. Although Colorado reported 33 sporadic cases of Legionnaires disease between 1986 and 1988, this is the first recognized outbreak in Colorado.

4th. November 1998
Update

Two more people were being tested for Legionnaires' Disease in Melbourne yesterday, bringing the number of suspected and comfirmed cases in the current outbreak to 20.
The new suspects are men aged 57 and 61. One lives near the suspected source of the infection in the Melbourne suburb of Thomastown, and the other worked nearby

source
West Australian Newspaper
4th November 1998

Date: Sun, 1 Nov 1998
Source: Herald Sun, Victoria, Australia
2 Nov 1998

VICTORIA's biggest outbreak of Legionnaires' disease has struck 10 people - and health authorities fear more victims.
Late yesterday 10 people from the Thomastown-Reservoir area had tested positive to the potentially fatal illness.
And a further five people in hospital with pneumonia are suspected but not yet confirmed.
Of the positive cases, nine remain in hospital, including two men who are in a critical but stable condition in intensive care. Seven of the others are stable and one has been discharged.

The Department of Human Services believes the source is a cooling tower in an industrial estate in Thomastown, north of Mahoneys Rd. Officers have tested, disinfected or closed about 12 of more than 25 cooling towers in the area and should know the source this week.

"It's the most number of cases we've had from a Legionnaire's outbreak," Victoria's chief health officer, Dr Graham Rouch, said yesterday. "There still could be cases to be diagnosed in people incubating the disease, as the incubation period is up to 10 days."

Those infected either worked in the area north of Mahoneys Rd, or lived in residential areas just to the south, bordering on Reservoir. All patients, except one who is at St Vincent's Hospital, are in the Northern Hospital at Epping.

Melbourne, Victoria, Australia

Issued 2 November 1998

The Department of Human Services is investigating a cluster of at least 10 presumptive recent cases of Legionnaires' Disease in the Cities of Whittlesea and Darebin - centred around the junction of the suburbs of Thomastown and Reservoir.
Legionnaires' Disease is a rare form of pneumonia. Early symptoms, which resemble those of flu, include headache, fever, chills, muscle aches and pains and generally, a dry cough followed by shortness of breath.
Cases occur much more commonly in late summer and early autumn, probably as a result of warmer weather and greater use of air conditioning systems.

MELBOURNE

HEALTH authorities have warned of a new outbreak of Legionnaires' disease in Melbourne, with 10 confirmed and five suspected cases reported in the city's northern suburbs.
They have told people to stay away from the outbreak's suspected source air-conditioning cooling towers in part of the northern suburb of Thomastown. Then have been 41 cases of the disease in Victoria this year, resulting in six deaths.

A 73-year-old woman died in July after contracting Legionnaires' disease linked to two cooling towers near the Moonee Ponds shopping centre in north west Melbourne.

Legionella bacteria can breed in such towers, infecting those who breathe in the fine spray of water from the air-conditioning.
Victona's chief health officer Graham Rouch, said health department officers were disinfecting the Thomastown towers but so far they had not found the tower infected with legionella bacteria.
He recommended people with no urgent need to enter tbe area to stay away until all towers in the area were disinfected, although the department had not quarantined the area.
About 12 towers had already been examined, with about 15 towers yet to be checked, he said.
The department considered people within a 200m radius of a tower were potential candidates for infeetion, Dr Rouch said.
He warned that more cases of the disease could be diagnosed in coming days as people recognised the Flu-like symptoms as something more serious and as the 10 day incubation period of the disease expired. Signs of infection were fever, a cough and then shortness of breath developing into pneumonia. Those infected so far either worked in the industrial area north of Mahoneys Road, Thomastown, or lived in the residential area to its south.

Eight men and one woman aged between 43 to 77 have been treated for the disease at the Northern Hospital at the weekend, with one patient already sent home.
Another patient was in St Vincent's Hospital.
Two of the victims are in intensive care and the remainder are described as stable and being treated with antibiotics.
Those most at risk of contracting the disease were males over 50, heavy smokers, heavy drinkers, diabetics; people with chronic lung disease and those with impaired body defences, Dr Rouch said.

"But bealthy young people can get it and (in the past) have died from it," he said.

Friday, 30th. October 1998

Four men, aged 61, 50, 45 and 43, who live and work in the northern Melbourne suburbs of Thomastown and Reservoir have been admitted to hospital with Legionnaires' disease.
Two of the men are in intensive care.

Victoria's chief health officer Dr Graham Rouch said the four men were diagnosed earlier today by staff at the Northern Hospital in Epping. He said health officials had not yet been able to identify a common point of infection.

UPDATE
GLASTONBURY

LEGION OUTBREAK CLAIMS THIRD VICTIM
Tuesday, October 27, 1998

An outbreak of Legionnaires' Disease which left 10 people seriously ill has claimed a third life.

Health officIals said today that a 68-year-old woman from the Glastonbury area of Somerset who was struck down with the illness on September 20 has died.

A major investigation is still under way to trace the source of the outbreak.

Ten cases were confirmed and a woman from Glastonbury and a man from nearby Street have already died.

A spokesman for Somerset Health Authority confirmed that the latest victim died at Musgrove Park Hospital in Taunton.

She was admitted on September 25 and transferred to the intensive therapy unit two days later.

The other victims have all since recovered.

1998 Press Association

Recent cases of legionnaires’ disease associated with London

Recent cases of legionnaires’ disease associated with London Five men (aged 27 to 45 years) who live or work in London developed legionnaires’ disease between 2 August and 14 September 1998.

All have recovered. Four were diagnosed by urinary antigen detection and one by single high antibody titre.
No links or possible sources of infection common to them all have been identified. None had travelled abroad.
Two further possible cases reported by London laboratories last week are being investigated.
Between nought and four community acquired cases of legionnaires’ disease (that is, not associated with hospitals or travel) are reported to the PHLS Communicable Disease Surveillance Centre (CDSC) each month by laboratories throughout the Thames regions.
One of the five recent cases lives in Kent and the others in west and south London.
They all work in various parts of London.
One is known to have dismantled a cooling unit at work, another used a sauna in the same postal district as the home of one of the cases (who did not visit the sauna), and two are known to have visited the same public house. Clinicians, microbiologists, and consultants in communicable disease control are requested to ask recent cases of legionnaires’ disease whether they were in London between two and ten days before becoming ill and if so to inform the Respiratory Diseases Section at CDSC (tel 0181 200 6868 ext 4497).

CDR WEEKLY
Volume 8 Number 41..9th October 1998

Legionnaires' disease at French hospital kills two

France Oct 11

Two aged patients have died and three other people are ill following an outbreak of Legionnaires' disease late last month in a hospital in this southwest France town, health officials revealed on Sunday. A further 70 people who were treated in the same hospital recently were also prescribed antibiotic treatments as a precaution, the officials said. The virus was transmitted in the hospital by vapours rising from hot water used in treatments, the officials said. The contamination came from the water, they said.

Anyone with further information on this outbreak please email me as with the following outbreak as well in Weston-Super-Mare, this outbreal occurred at the same time as the Glastonbury outbreak in the UK

Killer disease hits victim 7

Health experts admit Legionella outbreak is not over

HOPES that an outbreak of the deadly Legionnaires' Disease in the Mendips has been contained were crushed yesterday.

Health chiefs confirmed that it has claimed a seventh victim and warned that more people could be contaminated who are yet to feel the full effects of the killer disease.

The news came only hours after Somerset Health Authority announced it had closed its investigation into the source of the outbreak and said that that all measures had been taken to eliminate any possibility of infection.

Yesterday afternoon it revealed that the latest victim of the disease, which has already claimed one life, is a 67-year-old woman from the Glastonbury area. The announcement came within hours of confirmation of a separate outbreak in Weston-super-Mare where another woman has the disease.

Martin Carter of the health authority said: "It is possible that people are developing symptoms who contracted the disease ten days ago. GPs are keeping their eyes open and hospitals continue to check people from that area. It would not surprise us if more cases came to light.

"The elderly woman from the Glastonbury area was admitted to the hospital on Tuesday 29 September. We received confirmation yesterday that she was the seventh victim of the outbreak.

"Ours and the recent outbreak in Weston-super-Mare are not connected and we are not looking for a possible link between the two."

The woman is now at Musgrove Park Hospital where she is described as being in a stable condition.

Health experts have named two sources as the most likely causes of infection ­ the Wessex Water sewage works and Imco Plastics factory, both in Glastonbury.

Dr Joyshri Sarangi, consultant for incommunicable disease control, said: "It must be stressed that although control measures have been put in place, this does not mean we can be absolutely certain either of these premises was responsible for the outbreak."

News of the latest victim came after the health authority said it had closed its investigation, giving the all clear to the two companies which had taken action to eliminate the risk of infection.

A Wells woman has already died from the bug and Mike Carroll, aged 72, of Street is in intensive care at Musgrove Park Hospital. Another victim is Andrew Parfitt, 42, of Glastonbury, who is still in hospital in a stable condition.

The Imco factory is next to the B&Q DIY store which Mr Parfitt had visited recently. The store is not a suspected source but a husband of one of its staff also suffered from the disease

Indianapolis, Indiana

18th October 1998

A DANGEROUS BACTERIA IS FOUND IN GOVERNMENT BUILDING

A dangerous bacteria is found in a local government building.

Today, at a press conference, Public Affairs Officer David Wilkinson stated that the Legionnaire bacteria was found in the finance building on East 56th Street.
Several weeks ago, a woman alleged that she contracted Legionnaires' disease from the government building.
It is still unknown if the woman did indeed contract the disease from this building.

This building is the Defense Finance and Accounting Service building, located on what used to be Fort Benjamin Harrison, Indianapolis, Indiana. (To be comfirmed)

Source Media

Update 19th October 1998

LITTLE RISK OF EXPOSURE TO DISEASE

Health officials say there is little risk of exposure to to workers at Building One at Ft. Benjamin Harrison to a deadly disease.
Officials met with employees and explained that six out of 36 water samples tested positive for the deadly Legionnaires' disease.
One employee has been diagnosed with the illness.
Further testing will be able to determine if that employee was exposed at Building One.

Fort Benjamin Harrison
Indianapolis, IN

FORT BENJAMIN HARRISON
FBH is located approximately 12 miles from downtown Indianapolis, Indiana, in Lawrence Township, Marion County, Indiana.
FBH provided support for the U.S. Army Financial and Accounting Center, the U.S. Army Administration Center, the Defense Information

Map of Indiana

May 1999

Poor hospital maintenance blamed in three deaths

ELLENVILLE, Ulster County
Inadequate maintenance and improper chemical treatments of Ellenville Community Hospital's cooling tower contributed to an outbreak of Legionnaires' disease that killed three people last fall, Officials identified the hospital's cooling tower as the likely culprit in the outbreak of the pneumonia-like disease. However, a final report issued this month by the state and Ulster County health departments pinpointed the tower as a breeding ground for the Legionella bacteria.
Authorities confirmed 21 cases of Legionnaires' disease and 22 suspected cases. Initially, authorities had confirmed 13 cases. Additionally, 70 cases of Pontiac Fever were identified among hospital workers, the report said. Pontiac Fever is a flu-like illness without the pneumonia associated with Legionnaires' disease. Legionnaires' disease is not spread by person-to-person contact or drinking contaminated water.
The final report found that maintenance of the cooling tower was "deficient." The report cited elements that made the tower, used for air conditioning, a fertile breeding ground for Legionella bacteria:

During the summer months leading up to the outbreak, maintenance staff reduced the amount of an ammonium compound used as a pesticide in the cooling tower because of a foaming problem.
The water had a pH of 6.8 in September, compared with higher levels earlier in the year.
In 1997, the cooling tower operating temperature range was raised from 75-85 degrees to 85-95 degrees. Legionella bacteria prefer warm water temperatures, above 75 degrees, and a pH of approximately 6.7, the report noted. Water samples collected from the tower tested positive for the bacteria for Legionnaires' disease.
The hospital disinfected the cooling tower, flushed the water system and regularly treated the water.
The air conditioning remains off pending final state Health Department approval of improvements the hospital has made, said the hospital's interim chief executive officer. "The investigation identified some important structural deficits involving the cooling tower,'' the report noted. It was said the report contained no surprises and that the hospital had hired engineers to correct the issues the report raised.

ELLENVILLE....... October 16th 1998

Eleven Ellenville area residents have been officially diagnosed with Legionnaires' disease.
Three of the five people who died in the recent pneumonia outbreak had the disease, health officials confirmed yesterday.
Although officials would not release the names or condition of the other eight people with Legionnaires', they said none are hospitalized. All are among more than 30 cases of pneumonia to hit the Ellenville area since mid-September.
In addition, 30 to 40 Ellenville Community Hospital workers were diagnosed with flu-like symptoms that health investigators said was Pontiac Fever, a weaker form of Legionnaires' disease, but caused by the same bacteria.
At a packed press conference in Kingston, officials zeroed in on Ellenville Community Hospital as the probable source.
Water samples from the hospital's cooling tower tested positive for Legionella, the bacteria that causes Legionnaires' disease.
"This is likely to be the exposure," said Dr. Joel Acklesberg, a doctor with the federal Centers for Disease Control and Prevention based in Albany.
The hospital's hot water system, which delivers water used for patients, tested negative.
That has led investigators to speculate exposure could have occurred as people were coming in and out of the hospital, for anything from lab tests to visiting hours.
The connection to the hospital was strengthened by interviews of individuals with the illness.
Seven of the eight people investigators were able to interview visited Ellenville Hospital the week prior to their exposure.
Officials refused to speculate whether there would be more deaths.
Stan Kondracki, an epidemiologist with the state Department of Health, explained the link to the hospital's cooling tower. "Legionnaires' is a water organism. It requires an aerosol – a spray or mist, to speak – to infect," Kondracki said.

The disease is not passed person to person, and cannot be transmitted through drinking contaminated water.
 

The investigation is still continuing, but one theory is that changes in weather may have contributed to a build up of the bacteria to dangerous levels.
The cooling system may have gone on and off depending on the changing fall weather, giving the water-borne Legionella bacteria time to multiply to dangerous levels. Legionnella thrives in warm, stagnant water.
When questioned whether health investigators moved quickly enough to protect Ellenville area residents, officials said they began Legionnaires' disease control measures in late September, even before they confirmed the disease.
Ellenville Hospital voluntarily flushed its cooling tower twice and disinfected the hot water system, which officials said was in line with federal disease control guidelines. Investigators used urine tests, blood tests, tissue cultures, water samples and individual interviews to match the bacteria in people to the bacteria found in the cooling tower, which sits atop the hospital building. DNA testing, considered as definitive a test possible, is pending. Yesterday's news, while long on history of the disease, was scant on definitive answers for some.
Health officials called it a preliminary report and more information would be coming. At least two of the victims' families have retained lawyers. "I think some will meet (this news) with frustration; others will be somewhat satisfied, but my mind goes to those with the loveones who died," said Ellenville Mayor Raymond E. Younger, one of the many politicians who attended yesterday's press conference. "How can they be satisfied?"
 

Five people in area succumb to pneumonia Five people have died in the Ellenville area pneumonia outbreak.

They have been identified as: Fawn "Bambi" Widelitz, 72, of Napanoch died Sept. 28 in Kingston Hospital.
She was admitted to Ellenville Hospital complaining of flu-like symptoms. She was sent home with a diagnosis of urinary-tract infection and a prescription for antibiotics, family members said. Widelitz returned to the hospital days later. She was diagnosed with severe pneumonia and taken byambulance to Kingston Hospital. She died a few days later. Her son, Todd, said one doctor said she was infected with the bacteria that causes Legionnaires' disease and another said they weren't sure. Todd Widelitz said he should find out today for sure.

Roy Hendricks, 63, of Accord died Sept. 30. No other details available.

Marie Playford Hendricks,
Roy Hendricks' wife, died of a heart attack, but also had pneumonia. She died Oct. 3. No other details available.

Mary Ducker, 47, died at Benedictine Hospital in Kingston after several visits to Ellenville Community Hospital. She started feeling ill Sept. 30. She died five days later, her daughter, Eva Johnson, said. Ducker had been at Ellenville Community Hospital four times in the past two months. She went to the hospital two times for her own blood work and twice for her grandchildren. Her daughter said the Legionella bacteria was found in her system.

Glen Whitaker, 44, of Ellenville, died Saturday, at Ellenville Community Hospital. He had previously been suffering from a long term illness, and was taken to the hospital by ambulance several days before he died complaining of difficulty breathing. No other details available.

ELLENVILLE – Parents waiting for a school bus were talking about Legionnaires' disease. And they all agreed that officials had not talked enough about the disease that's claimed the lives of three people and infected 11. "There were no facts.

This is the problem.

There was no alert," said Curtis Collins while he waited for his daughter's bus to arrive. Yesterday, health officials announced the Legionella bacteria growing in Ellenville Community Hospital's cooling tower was believed to be responsible for the disease.
Johnson, whose mother, Mary Ducker, 47, died at Kingston's Benedictine Hospital after several visits to Ellenville Hospital, is angry that the health department was not as forthcoming with information as it could have been. "Even if someone did panic," she said quietly as her voice trailed off. "It's my mom. You can't replace my mom." A few people in Ellenville yesterday felt the media made the issue bigger than it was, but Richard Dragon disagreed. People need to be informed, he said.

Hospital officials and Ulster County Health Department officials should have used the local access cable television channel to warn people. Collins, who was quick to point out that he approved of the health department's investigative work, said rumors were made worse by the lack of information.
Many people were scared to drink the water because they thought it may have been contaminated.

"They didn't do a good enough job of informing people," he said.

SEE

UNITED KINGDOM OUTBREAK 1985
STAFFORD GENERAL HOSPITAL

8th October 1998

Baltimore, Maryland

Three workers at a plastics production facility in a suburb of Baltimore, Maryland have contracted legionellosis, and one has died. According to Diane Dwyer, chief epidemiologist for the Maryland Department of Health and Mental Hygiene, the Department is investigating the air conditioning and all water systems at the plant but the source of Legionella organisms has not yet been identified. In the meantime, the building in which the victims worked has been closed.

In the wake of the investigation authorities have learned of nine cases of respiratory illness among plant workers including six cases of pneumonia. At the present time it is unclear whether any of these additional cases are related to the outbreak of legionellosis.

10th October 1998
Update

As health officials identified a fourth case of Legionnaires' disease yesterday among employees of a Southeast Baltimore plastics plant, Poly-Seal Corp. announced it will close the factory this morning to disinfect its water systems.

The factory's five water systems will be flushed with very hot water and high concentrations of chlorine to make certain that no Legionella pneumophila bacteria remain, said Levi Rabinowitz, a media consultant hired by Poly-Seal to speak for the company.

A third case of pneumonia was confirmed yesterday to be Legionnaires', said Dr. Diane M. Dwyer, director of epidemiology and disease control at the Maryland Department of Health and Mental Hygiene.

Medical tests are incomplete on the two remaining pneumonia victims and on several other workers who have suffered coughs, fever and other respiratory symptoms that could be caused by Legionella bacteria, she said.

Since 1993, 31 deaths in Maryland have been reported as a result of Legionnaires' disease, according to the state health department.
All of the deaths except Fisher's were isolated, often occurring among hospital patients who were weakened by other conditions.

The Poly-Seal outbreak is the first cluster of cases from a single site since 1990, health officials said.

Source Media

2nd. October 1998

UNITED KINGDOM

Legionnaires' Disease

An elderly woman has died and five other people have been taken to hospital in Somerset after being struck down with Legionnaires' Disease. Health officials have confirmed that six people aged between 32 and 76 have been admitted to hospital with the disease in the last few weeks.

Two of the patients have been sent home and the remaining three people are still in hospital in Taunton. All the six people involved are believed to come from the towns of Street and Glastonbury.

(2nd. Oct/BBC)

WOMAN DIES IN LEGIONNAIRES' DISEASE OUTBREAK
Oct. 3 1998

One woman has died and five other people have been taken ill following an outbreak of Legionnaires' disease in Glastonbury, Somerset, U.K.
It is understood tests have been conducted on air conditioning equipment at business premises in the town and results are expected next week.

No details have been released on the woman who died, but all the patients were aged between 32 and 76.

6th October 1998

The Somerset Health Authority in the U.K. was cited today as saying that they have ended their investigation into an outbreak of Legionnaires' Disease that killed an elderly woman and put five other people in hospital. [The Authority] named two Glastonbury firms - a plastics company and a Wessex Water sewage treatment plant - as the likely potential causes of the infection.

But as both companies had taken remedial action and no new cases had emerged the Authority declared itself satisfied that the potential risk of a further outbreak of the rare condition had been eradicated.

MAP OF Glastonbury

Photo

Map of Area

5th October 1998

The results of an investigation into the source of a Legionnaires' Disease outbreak in Somerset are expected on Monday.

Somerset health authority is awaiting the results of tests on the water systems of two businesses in Glastonbury.

An elderly woman from Wells has died in the outbreak and five other people have been treated in a Taunton hospital.

Two have been sent home, one woman is "critical" and a man is "poorly" in intensive care.

Another man is "comfortable" on a general ward.

None of the victims, who come from the towns of Glastonbury and Street, have been named. The health authority says there have been no new case.

However, as the incubation period for the disease is long, it warns that there could be more in the future.

Nationally, it is thought that a source of Legionnaires' Disease is traced in only 50% of cases.

Legionellosis and recent travel to Bali

The National Centre for Disease Control (Australia) has been advised of two cases (one in June and one in August) of legionellosis in persons who had recently returned from Bali. The public health authorities in Bali have been notified and investigations are continuing.
It is an important reminder of the need to ask about recent travel when trying to ascertain the source of exposure for patients diagnosed with legionella infection.
 

Friday July 10 1998

SOURCE: Pennsylvania Department of Health

Legionnaires' Disease Outbreak Reported in Southwest PA; Health Department Confirms Six Cases in Mon Valley

HARRISBURG, Pa., July 10 1998
The Pennsylvania Health Department today reported six cases of Legionnaires' disease, or legionellosis, near the Southwestern Pennsylvania borough of North Belle Vernon, Westmoreland County.

Although the source of the outbreak has not yet been identified, department epidemiologists are testing likely sources, such as large air- conditioning cooling towers and condensers, fountains and ponds, and other places where the legionella pneumophila bacteria may be found.

The Health Department also is working closely with area hospitals to notify local physicians of the outbreak and quickly identify any more cases that may occur.

Each of the six cases identified to date occurred between June 15 and June 30 and required hospitalization. All but one of the patients, the one most recently infected, have been discharged. The Monongahela Valley Hospital in Monongahela identified and treated all cases.

Initial symptoms usually are flu-like with muscle aches, exhaustion, headache and fever with dry cough, followed by high fever, commonly from 102 to 105 degrees; chills; and, possibly, diarrhea.

The disease is treated with antibiotics. Although the disease can be fatal, most people treated with appropriate antibiotics recover completely.

Health Department officials urge anyone experiencing symptoms of legionellosis, who lives in or recently visited the affected area, to seek medical attention immediately. The area includes the borough of North Belle Vernon and Rostraver Township, both in Westmoreland County, and the neighboring borough of Belle Vernon, Fayette County.

Persons with symptoms such as cough and fever, who believe they may have legionellosis but do not have a regular family doctor or may not have access to a physician, can go to any hospital or health-care facility in the area.

``This is a disease in which early treatment makes a difference in outcome,'' said the public-health physician , adding that timely identification of additional cases also could narrow the field of inquiry and help identify the source of the current outbreak sooner.

Meanwhile, Health Department staff are investigating possible sources by reviewing information about those who are ill and taking environmental water samples from likely sources.

JULY 10th. 1998
Melbourne, Victoria

Victoria`s chief health officer yesterday issued a warning about the risks of Legionnaires Disease after one women died from the disease and two others were treated in hospital.

Legionella bacteria was found in cooling towers near the Moone Ponds shopping centre and two offfice blocks

Source Media

UPDATE 20th July 1998

LEGIONELLOSIS - AUSTRALIA (VICTORIA)

OFFICIALS WARN OF LEGIONELLA SPREAD

A fifth person has been struck down in the Moonee Ponds [legionellosis] outbreak, prompting calls last night by State health officials for anyone in the area with lingering flu-like symptoms to seek urgent medical help. A spokesman also warned there could be more cases of the deadly disease, which has already killed one woman and hospitalised four others.

An Essendon man, 79, was last night battling for his life in the John Fawkner Hospital, while a woman, 49, also admitted to hospital earlier this week with the disease, was still in a stable condition.

A woman, 73, died on June 30 and two others were hospitalised early this month after contracting the disease, which infected two office building cooling towers adjacent to Puckle Street, Moonee Ponds.

The bacteria were located in the cooling towers of the Australian Taxation Office building in Gladstone Street and the Caseready Meats tower in Young Street.

One of the infected women worked at the tax office, while another was a contract worker at the city tax office, but lived in Moonee Ponds.

The three other, elderly, victims contracted the disease after shopping in the area.

The spokesman said microbiological tests from cooling towers on three other buildings in the Moonee Ponds shopping centre had not been completed.

Victoria's Chief Health Officer, Graham Rouch, called on anyone living, shopping or working in the Moonee Ponds area, with sustained flu-like symptoms, to contact a doctor. "Legionnaire's disease cuses flu-like symptoms such as headache, fever, chills, muscle aches and pains, followed by respiratory problems and pneumonia developed over three or four days," Dr Rouch said.

"Infection is acquired through breathing in very fine droplets of water which contain the bacteria.

"The incubation period for legionnaires' disease is up to 10 days and it may then take several more days for symptoms to become apparent."

Dr Rouch said the two latest victims had contracted the disease in the same outbreak, before the cooling towers had been cleaned and disinfected. But he said none of the cases had yet been positively linked to either the tax office or meat works.

Source. Media

Update 22nd. July 1998

Victoria's chief health officer Dr Graham Rouch was cited as saying today that laboratory testing had shown the cluster of Legionnaires' cases in the Moonee Ponds area, in Melbourne's north-west, was "most likely linked" to the cooling tower of Caseready Meats.

The story noted that a 73-year-old woman died and four other people were identified as carrying the illness late last month and earlier this month, leading to the closure and disinfection of the Caseready Meats tower and the Moonee Ponds Australian Tax Office (ATO) tower.

Dr Rouch was further cited as saying in a statement that tests from two of the five people infected had shown the _Legionella_ type they were carrying was the same as that identified in the meat manufacturer's tower.

MAP OF THE OUTBREAK AREA

August 1998

Legionnaires’ disease outbreak .

MELBOURNE, VICTORIA. AUSTRALIA
 

The Infectious Diseases Unit of the Human Services Department, Victoria, has received five notifications of Legionnaires’ disease, with onset of symptoms in late June and early July.
All cases either lived or worked in the same suburban area, and were due to Legionella pneumophila sero-group 1.
One death, in an elderly woman, was reported on 30 June. Investigations found two air conditioning cooling towers close to the suburban shopping district were positive for the same Legionella pneumophila sero-group. One of these towers tested positive for the same molecular sub-type as that found in sputum specimens from two of the cases, one of the cases had a different molecular sub-type, and no bacterial cultures were available from the other two cases. The towers have since been closed, disinfected and reopened, and the associated organisations have been given written recommendations on further treatment to avoid re-infection.

Although there had been 29 other cases with four deaths in Victoria for the year, earlier cases were sporadic in nature. Due to the proximity in reporting time and location, and the usual low incidence for this time of year, these recent five cases were considered to be a cluster. There are usually about 20 to 40 cases of Legionnaires’ disease per year in Victoria.

Source:
Courtesy
Australian Department of Health and Family Services

July 3rd 1998
PRAGUE

Autopsies of three who died of pneumonia following kidney transplant surgery at a leading Prague hospital have yielded evidence of Legionella bacteria. The deaths occurred during the first half of June, 1998.
A subsequent investigation found the organism in the hot water pipes of the hospital. Heating the water to 80 degrees C eliminated the bacteria in the pipes, but the hospital suspended all surgery pending resolution of the situation.

The report inicated that Czech hospitals do not routinely check for Legionella.

Source Media

Disease outbreaks reported

Date 13 August 1998

Legionellosis in Paris, France

Since early June 1998, 19 cases of legionellosis have been identified among visitors to Paris. Ten of the cases were French nationals and 9 were tourists from other European countries. All cases occurred between 6 June and 3 July. Three patients died.

Ten of the cases had visited the 9th arrondissememt (administrative area of Paris) while 7 had visited the adjacent 2nd arrondissment. Specimens from 4 patients were sent to the National Reference Centre for Legionellosis and found to be of identical type.

Investigations to identify the source of the outbreak are being carried out but no results have been obtained to date. As a precautionary measure, owners of cooling towers in the 2nd and 9th arrondissements have been ordered to clean and disinfect their installations.

No new cases have been detected since 3 July 1998. Heightened surveillance and investigations to identify the source continue.

Source... World Health Organisation 13th. August 1998

UPDATE 7th. AUGUST I998

PARIS

French health authorities were cited as saying today that four people died and 16 fell ill during the World Cup soccer championships from an outbreak of Legionnaires' disease in central Paris.

Three of the dead were French and the other a Scot, one of four Scottish tourists who came down with the infection while the World Cup was being played in France.

The National Public Health Centre and the Labour Ministry's General Health Directorate had earlier issued statements announcing three deaths. The ministry later said another case, Frenchman who died on July 31, had just been reported to it.

The centre said officials suspected the disease broke out in water-cooling tanks atop buildings in the area.

July 3, 1998

Legionnaires' disease strikes four Scots in France

French health ministry officials said Friday that four Scottish people have been struck down by Legionnaires' disease, and one has died. The officials said the cases had been discovered by a health monitoring network set up for the World Cup tournament. The cases have been identified since June 29.

One of those diagnosed with the potentially lethal infection has died, one is in the hospital in France and two others were hospitalized in Britain, they said. The three still alive were all in serious condition requiring round-the-clock care. It was not immediately known if the four had come to France for the World Cup. Scotland was knocked out in the first round of the competition. An investigation carried out with British health authorities found no link between the four cases. Ministry investigators were attempting to contact friends and family members who may have accompanied the four people to pin down where they had been before falling ill and the likely cause of the infection.

Cases of legionnaires’ disease associated with travel to France, June 1998

A Scottish resident admitted to hospital in France with legionellosis was reported to the French legionellosis surveillance system on 30 June 1998. On 1 July 1998 the European Working Group on Legionella Infection (EWGLI) surveillance network notified the Réseau National de Santé Publique (RNSP) of three cases of legionellosis among residents of the United Kingdom who had travelled to France in June. This report summarises the results of the epidemiological investigation initiated after these cases of legionellosis associated with travel to France were identified.

For this investigation a case of legionnaires’ disease was defined as an acute lower respiratory tract illness with onset of symptoms in June 1998 associated with a positive Legionella pneumophila urinary antigen test and/or the isolation of L. pneumophila in respiratory secretions. Cases were searched for in three ways: 1) by asking each of the national correspondents of the EWGLI surveillance network to notify the RNSP of any confirmed or suspected cases of legionellosis with onset in June and associated with travel to France during the 10 days before the onset of illness, 2) by asking each French District Health Department to notify immediately all confirmed and suspected cases of legionellosis with onset in June, and 3) by reviewing the database of the National Reference Centre for Legionellosis. In addition all hospitals in the region of Paris have been asked to notify cases with onset in June that they have not yet notified. All cases among European travellers to France (or their travelling companions) were interviewed about travel history by either epidemiologists of the RNSP or the EWGLI national correspondent using a standardised questionnaire.

Five confirmed cases were identified among European travellers to France. Dates of onset ranged from June 11 to June 20; all patients were men aged between 32 and 60 years (median 50 years). Four patients were from the United Kingdom (2 from Scotland and 2 from England) and one was from Denmark.
Four were confirmed by the detection of urinary antigen and one by culture. One patient was admitted to hospital in France and the others in their own countries on return from France. One patient died. Three patients were supporters of the Scottish football team playing in the World Cup. The other two had travelled to France for other reasons. They had travelled to France on dates between 5 and 27 June. All patients had been in Paris at some time during their incubation periods (1 to 10 days before onset), but no more specific common exposure was identified (mode of transportation, hotel, bars, restaurants…). One case had been to the football match between Scotland and Brazil on 10 June and two had been to the football match between Scotland and Norway in Bordeaux on 16 June.

Fourteen cases of legionellosis were notified in France in June 1998, no more than in each of the previous months.
The National Reference Centre identified no increase in the number of positive isolates in June. Among cases reported in France in June only one was a Paris resident and none of the others had travelled to Paris. Despite intensive epidemiological investigation no epidemiological link has been made between the five cases associated with travel to France in June and we have no evidence of an outbreak of legionellosis in France. Intensified surveillance is continuing in France and throughout the EWGLI network.

Reported by B. Decludt, A. Perrocheau, JC. Desenclos (desenclo@b3e.jussieu.fr) Unité Maladies Infectieuses, Réseau National de Santé Publique, Saint Maurice, France.

We thank all EWGLI correspondents, French practitioners, and French public health officers for their collaboration .

Update 25th. July 1998

Legionnaires' disease associated with Paris in June - update 1

Nine men who developed legionnaires' disease between 11 and 20 June 1998 were in Paris in the two to ten days before becoming ill. Four of the cases are from Scotland, three from England, one from Denmark, and one from Sweden. The cases have been reported to the European Surveillance Scheme for Travel Associated Legionnaires' Disease of the European Working Group for _Legionella_ Infections (EWGLI).

The Reseau National de Sante Publique (RNSP) has identified 11 cases of legionnaires' disease in residents of France who live in or travelled to the Ile de France region (Paris and surrounding districts) and became ill in June. They are not clustered by residence and are being followed up to see if they have links with the cases reported to EWGLI. Local investigations have shown that five of the EWGLI cases had stayed in a particular area of Paris. Several of the French cases who have been interviewed had travelled to the same and neighbouring areas, where cooling towers and other potential sources of infection are being checked.

Two cases were identified by culture of a respiratory specimen, one in England and one in France (a Scottish case admitted to hospital in St Etienne). Isolates from these cases are being exchanged and subtyped at the national _Legionella_ reference laboratories in Colindale and Lyons, as part of the European scheme for standardisation of typing methods for clinical isolates of _Legionella_.

The PHLS Communicable Disease Surveillance Centre (CDSC), which coordinates the European surveillance scheme on behalf of EWGLI, has received anecdotal reports of several men from the United Kingdom and elsewhere who were treated with antibiotics for severe respiratory diseases after staying in Paris during June but not tested for legionnaires' disease.

The Respiratory Diseases Section of CDSC would be grateful for information about confirmed and suspected cases of _Legionella_ infection associated with travel to Paris since the beginning of June (tel 0181 200 6868 ext 4497/4481/4014 or fax 0181 200 7868 or e-mail: respcdsc@phls.co.uk).

1/6/98
SEATTLE

Officials with the University of Washington Medical Center in Seattle say three of its patients have contracted potentially fatal Legionnaires' disease.

One of two cancer patients in their 40s who contracted the disease in July has died, but officials say they're not sure whether the disease caused her death. The other cancer patient was a man.

In addition, an organ transplant patient in his 40s contracted the disease within the past two weeks but has reportedly recovered.

Dr. Walter Stamm, who heads up the university's allergy and infectious diseases division, says Legionella bacteria was confirmed in a water-cooling tower outside the hospital, but it was a different strain from the one found in the first two patients.

The tower was reportedly being drained and cleaned. DNA testing is planned to determine whether the third case was linked to the first two.

Stam says one or two Legionnaires' cases are reported at the medical center each year. It's contracted by inhaling the Legionella bacteria, which is often found in wet environments such as hot water tanks, whirlpool spas, humidifiers and air-conditioning cooling towers.

28th June 1998

Legionella on board a cruise ship

Two holidaymakers from England developed legionnaires' disease after taking separate cruises to the southern Mediterranean aboard the SS Edinburgh Castle. The first case, a woman aged 77 years, became ill on 20 May and the second, a man of 71 years, on 3 June.
Both cases were diagnosed serologically. Both cruises sailed from and returned to Liverpool, but their itineraries included calls at different ports. The tour operators use both Liverpool and Greenock (in Scotland) as ports of sail, as a result of which two incident control teams were convened...

See Legionnaires' Disease Cruise Ships

Legionnaires' alert after five cases

Date: 28/05/98

A 75-year-old woman gardener, believed to have contracted legionnaires' disease from potting mix, remained in hospital last night following the discovery last week of five cases of the potentially fatal disease in northern Sydney and the Blue Mountains.

The Minister for Health, Dr Refshauge, said there was no common link between the five cases. The other four people are believed to have contracted the disease from unidentified air-conditioning systems.

The "avid gardener", from northern Sydney, was last night in a satisfactory condition.

The others - two northern Sydney women aged 43 and 59, a 47-year-old north Sydney man and a 58-year-old Blue Mountains man - were released from hospital after responding to antibiotics.

Legionnaires' disease can be fatal, especially for people with respiratory illnesses, weak immune systems, smokers, drinkers and the elderly.

Symptoms include fever, a dry cough, pneumonia, shortness of breath, chills, headaches and muscular aches and pains.

The four northern Sydney people live in different suburbs and had not visited any common sites such as shopping centres.

The suburbs where the disease was contracted have not been named to protect patient confidentiality, but the Northern Sydney Area Health Service covers suburbs such as Hornsby, Mona Vale, Manly, Ryde and Gladesville.

A spokesman for Dr Refshauge said the outbreak of a number of cases in a single week, which accounted for almost half of this year's legionnaires' disease notifications, appeared to be a coincidence.

He said it was generally accepted in the scientific community that a single source of contamination would result in a multiple outbreak.

The disease has an incubation period of more than one week and NSW health officials are monitoring the situation to see if other people develop symptoms that might link them to the five confirmed cases.

Legionella bacteria are found naturally in the environment and are most commonly spread by inhaling contaminated air. Legionella pneumophilia can build up in cooling towers of air-conditioning systems, spa pools or shower heads. Legionella longbeachae occurs in soil and compost.

The bacteria cannot be spread from person to person.
(I question this statement)

See Potting Mix Details

March 1998

STOCKHOLM, It was reported that the Swedish health department have tightened checks on hospital water supplies after a patient died of Legionnaires' Disease,

A Stockholm newspaper said that one person died of Legionnaires' Disease after taking a shower at the Huddinge University Hospital,

The Huddinge hospital changed parts of its plumbing,

The director general of the company which owns all the buildings rented to hospital services in the Stockholm area, said checks on running water to all of the region's hospitals would be tightened.

Legionnaires' Disease, which seems like a bad case of flu, is caused by Bacteria called Legionella pneumophila which thrives in water and particularly air conditioning systems.

Last year, 74 cases of Legionnaires' Disease were reported in Sweden, of which 15 were fatal.

Source Media

MARCH 1998
SOURCE MEDIA

Three employees at the Pittsburgh Technology Center have contracted Legionnaire`s Disease since October, but Allegheny County health officials say they have found nothing in the building itself that would cause the infection.

The office park where the three worked was once the site of a steel plant. It is located along the Monongahela River east of downtown Pittsburgh. Health officials said the city building, which opened in 1996, had been cleaned, but that they would continue to conduct tests to find the source of the infection. Investigators tested water samples, but found no trace of the disease.

Legionnaires' disease is a respiratory infection caused by the Legionella pneumophila bacteria, which can breed in hot-water systems, showers, whirlpools and air-conditioning condensers.

Legionnaires' Disease Tied To Sump Pump

For the first time, an outbreak of Legionnaires' disease has been linked to a sump pump.

In September of 1996, three people (the owner, a waitress, and a customer) who spent time at a bar in St. Louis, Missouri, developed Legionnaires' disease, a potentially fatal form of pneumonia. Dr. J.L. Kool and colleagues from the Centers for Disease Control and Prevention in Atlanta, Georgia, investigated the case and determined that a severe rainstorm had caused the sump pump in the bar's basement to work almost continuously for three days.

``It is possible that the pump produced sufficient heat during flooding to provide environmental temperatures favourable for the growth of Legionella,'' the authors write in the April 4th issue of The Lancet. The researchers suggest that sawdust and rotting wood helped spread the disease through cracks in the bar's floor after a jet of water came out a small hole in the side of the sump pump.

After the pump was disconnected, no new cases of Legionnaires' disease were linked to the bar.

``To our knowledge, this is the first time that a sump pump has been implicated as the source of an outbreak of Legionnaires' disease,'' the investigators state. They call for a better understanding of how Legionnaires' disease may develop from previously unrecognized sources.

SOURCE: The Lancet (1998;351:1030)

Note.. Though this outbreak did not occurr in 1998, I thought it would make interesting
reading, as this is the first time that Legionnaire`s Disease has been reported in a sump pump, and as far as i know this is the first public anouncement of this outbreak.

Legionnaires' Disease in long distance lorry drivers

Two long distance lorry drivers who work for the same haulage company in the north east of England became ill with legionella infections on 8 and 11 March 1998. The drivers – one of whom lives in England and the other in Scotland – drove in separate lorries to Dover and travelled on the same ferry ship to France before meeting at a lorry park cum hotel in northern Spain. Neither stayed in the hotel. Both took showers at the lorry park, where they slept overnight in the cabins of their lorries. Legionella pneumophila serogroup 1 was cultured from sputum of one of the cases, a 50 year old man whose illness was confirmed as legionnaires’ disease. The other case, diagnosed serologically on the basis of a single high titre and without radiological evidence of pneumonia, was 29 years of age. Regional authorities in northern Spain are conducting environmental investigations.

One case of legionella infection in a long distance lorry driver from England and Wales was reported in 1994 and four in 1997. These cases were drivers who had travelled through Belgium, France, Italy, the Netherlands, Spain, and Slovenia. All were said to have slept in the cabins of their lorries but took showers at lorry parks, petrol stations, or at the centres to which their goods were delivered (Public Health Laboratory Service Communicable Disease Surveillance Centre, unpublished data).

Showers are a well known source of legionella infection, and sporadic cases and outbreaks have been associated with showers in hotels (1) and camp sites in many European countries. (2). The European Surveillance Scheme for Travel Associated Legionnaires’ Disease (EWGLI) is aware of 50 cases who stayed overnight at 82 camp sites in Europe during their incubation periods since 1993 (EWGLI, unpublished data). Camp site shower rooms in particular may be subject to intermittent water supplies, variable demand, fluctuations in hot and cold water temperatures, and poor maintenance. These risk factors may also pertain to shower facilities for travellers in lorry parks or petrol stations. Use of such facilities, as well as overnight accommodation, should be considered in the assessment of people who develop legionnaires’ disease in association with travel.

References:

1.Lane CR, Joseph CA, Bartlett CLR, on behalf of the European Working Group for Legionella Infections. European surveillance of travel associated legionnaires’ disease, 1996. Eurosurveillance 1998; 3: 6-8 http://www.ceses.org/eurosurv 2.Infuso A, Hubert B, Dumas D, Reyrolle M, De Mateo S, Pelaz C. Outbreak of legionnaires’ disease in two groups of tourists staying at camp sites in France and Spain, June 1996. Eurosurveillance 1997; 2: 48-50 http://www.ceses.org/eurosurv

Reported by Carol Joseph cjoseph@phls.co.uk, European Surveillance Scheme for Travel Associated Legionnaires' Disease, PHLS Communicable Disease Surveillance Centre

Friday, March 06, 1998

In 1994, the number of cases of Legionnaires' disease in Allegheny County alone exceeded the number found in 36 states.

The explanation is not that Western Pennsylvania is a breeding ground for the disease, doctors say, but because public health officials here are highly aware of the illness when making diagnoses.

Local awareness may have been boosted again this week with reports that three workers at the Pittsburgh Technology Center in Hazelwood have contracted Legionnaires' disease since August.

About 150 people who work at the center attended a meeting with Allegheny County Health Department officials yesterday to learn more about the disease, which is a form of pneumonia.

But Health Department officials, who are conducting a second set of tests on the building's water supply, believe the three cases at the technology center do not have a common source, particularly since the first worker got sick in August, the second in October and the third last month.

"We feel that clearly the building was not the source in the first two cases," said aHealth Department spokesman.

A first test in October found the water supply at the four-story building at 2000 Technology Drive was not contaminated by the bacterium that causes the disease.

"I think we want to be sure that we can again rule out the building itself as the source (in the third case)," he said. "It could turn out that it's just a coincidence and that there is no common thread."

The county Health Department tracks the disease and usually receives reports of 25 to 30 cases each year. There were 33 cases of Legionnaires' disease in 1997 and there have been 10 cases this year.

Those numbers do not include the cases at the Pittsburgh Technology Center, Cole said, because the three individuals come from different counties -- Beaver, Westmoreland and Washington.

24 February 1998

Possible Outbreak

Heard on the news last night of two possible cases of legionnaires' cases here in the mid ohio valley.
One a 2nd grade teacher in Meigs county ohio died 2/24/98.
The other a Middle High School Teacher in Wood County, West Virginia.

Source
Personal Email

Legionnaires' Disease strikes official

30th January 1998

While a Clermont County official recovers in a local hospital from Legionnaire`s disease, national officials today will examine her workplace - municipal court - to see whether that's where she contracted the sometimes deadly respiratory illness.

It's not clear whether Deputy Municipal Court Clerk who lives inWayne Township in Clermont County, caught the disease at the courthouse in Batavia, said her boss, The clerk of courts.

Still, county officials aren't taking any chances. Doctors and officials from the county and the National Institute for Occupational Safety and Health will tour the building today and talk with employees,

The inspection comes a week after county officials learned the official had been diagnosed with Legionnaires' disease. Her husband contacted her workplace, and from there the county's General Health District, the Ohio Department of Health and the Centers for Disease Control and Prevention (CDC) in Atlanta were notified, said county Health Commissioner Janet Rickabaugh.

The female official experienced flu-like symptoms around the holidays and went downhill from there, her husband said .

''She's getting better; she's not there yet,'' he said in an interview from his wife's hospital room at Bethesda North in Montgomery.

She is entering her third week of hospitalization, he said. The disease is potentially deadly, but largely treatable. Last year more than 1,000 cases were diagnosed nationwide, according to the CDC. In 1997, 121 cases were diagnosed in Ohio, with none in Clermont and Warren counties, one in Butler County and five in Hamilton County, according to the Ohio Department of Health.

No other employees have been diagnosed with the disease, whose symptoms include pneumonia, headache and a dry cough.

A report of sauna-related Legionnaires' Disease
9th. Jan, 1998

LONDON

Six cases of Legionnaires' disease, including two deaths, have been traced to a sauna, Dutch health officials said on Friday in a letter to the Lancet medical journal. A 64-year-old man developed the disease five days after visiting the sauna in Haarlem and health records dating back to 1991 revealed that five other cases were related to the same building in the Netherlands. After taking water samples from the sauna, the Legionella pneumophila bacteria was found in a footbath.
Dr JW Den Boer of the Municipal Health Service Zuid-Kennemerland described the findings as the first documented cases of lethal sauna-associated Legionnaire's Disease. It confirmed existing knowledge of long-lasting spread of the disease due to a persistent source of infection, he added. Den Boer said the elderly patient recovered after seven weeks in hospital. No new cases of the disease have been reported since the hot water system in the sauna and footbath was changed.
It is now checked for the bacteria every three months.

Sauna Linked To Fatal Legionnaire's deaths

Researchers in the Netherlands have traced six cases of Legionnaires' disease two of them fatal to a sauna.

One of the fatalities was a women who had had a kidney transplant and died 10 days after frequenting the sauna. The other fatality was a 59-year-old man who had no history of immunosuppression. In another case, a 64-year-old man was diagnosed with Legionnaire's disease after regularly using a footbath in the sauna, Testing revealed that his disease was caused by the same Legionella pneumophila strain as found in the woman who died. The man was treated and recovered from acute pneumonia caused by L. pneumophila.
Dr J.W. Den Boer of the Municipal Health Service in Haarlem, the Netherlands, and colleagues at other sites in Haarlem, report that water from the air-perfused footbath was tested and found to contain the same strain of L. pneumophila. In light of the cases, the sauna operators changed the hot-water installation of the facility to prevent water from standing or flowing too slowly. The water also is tested regularly.

The report describes the first documented cases of lethal sauna associated Legionnaires' disease, and confirms existing knowledge of long-lasting spread of L. pneumophila due to a persistent Source of infection.

SOURCE: The Lancet (1998;351:114)

Three cases of Legionnaires' Disease in tourists who all stayed at the same hotel in Benidorm, Spain have been reported to the surveillance scheme of the European Working Group on Legionella Infections (EWGLI).
Two of the cases were British and one was Dutch.
The cases (one man and two women aged between 46 and 67 years) became ill on 20 December, 29 December 1997, and 3 January 1998. One person has died and the other two remain ill. Legionella pneumophila serogroup 1 has been diagnosed by culture from all three cases and also by urinary antigen detection from two of the cases...

The hotel has around 350 rooms and is used mainly by tour operators from Britain and northern Europe. Seven other cases of legionnaires' disease have been linked to the hotel in previous years; three in 1989, one in 1990, two in 1995, and one in 1996. The PHLS Communicable Disease Surveillance Centre (CDSC) in London reported the current outbreak to the Federation of Tour Operators and the Association of Travel Agents, who informed tour operators (1). On 16 January, all major British and Dutch tour operators agreed to withdraw their clients from the hotel until investigations and control measures have been implemented by the local health authorities in Spain.

On 20 January, an environmental investigation of the hotel was carried out by local health authorities. Samples from the hot and cold water supplies and the air conditioning system were taken for the detection of legionellas. Control measures were implemented.

EWGLI would be grateful to receive information on other cases of legionnaires’ disease that might be associated with this outbreak. Please contact Carol Joseph, EWGLI coordinator, at CDSC.

References:

1.Joseph CA, Harrison TG, Ilijic-Car D, Bartlett CLR. Legionnaires’ disease in residents of England and Wales: 1996. Comm Dis Rep CDR Rev 1997; 7: R153-9

"The Fariones Complex ( Lansarote Canary islands) has been inspected by..
Prof. Rodney cartwright, of the British Federation of Tour Operators...
Following report of 3 cases .. in persons staying at the complex since dec 97.. one swedish, german, english.
There is no proof that LD was acquired in the complex.... apart from as small recommendation... no further precautionary measures are necessary .
Prof Cartwright is of the opinion that Tour Operators can continue to use this complex normally.

The incident is now considerd closed"
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