1964 WASHINGTON DC

An epidemic of Legionnaires` disease occurred in July and August 1964 at the St. Elizabeth Hospital in Washington DC , at least 83 patients were involved, The illness was first thought to be Klebstella pneumoniae, it was not till a decade later that it was recognised as Legionnaires` disease, only after serologic tests were carried out on sera that had been stored at the Centre for Disease Control. Of interest is the fact that extensive soil excavationsn were being carried out on the campus of the hospital during the summer months in order to install a sprinkler system. Several risk factors were identified including sleeping by open windows and having free access to the grounds of the hospital, Thus, both temporal and geographic relations with the excavation sites were associated with increase risk,
This evidence strongly suggests airborne spread from an environmental reservoir in some way related to the excavation.
(Eickhoff Theodore C, Annals of Internal Medicine 1979 90 499-502)

1984
Waterborne Legionella bozemanii and nosocomial pneumonia in immunosuppressed patients.

From October 1983 to February 1984, five episodes of nosocomial pneumonia caused by Legionella bozemanii occurred in immunosuppressed patients at a 300-bed community hospital. Pulmonary infiltrates were predominantly patchy and present in multiple lobes and bilaterally; cavitation occurred in one patient. Patients responded promptly and completely to treatment with erythromycin and rifampin. Epidemiologic studies showed that all patients had been continuously or recently hospitalized at the same institution. Legionella bozemanii was cultured from four of the five infected patients, from tapwater in patient care areas, from the hospital's hotwater holding tank, and from soil in an area of excavation and new construction on hospital property. Chlorination and heat sterilization of the tank eliminated L. bozemanii from the water and no further cases were seen. This outbreak reaffirms that excavation and construction are risk factors for the outbreak of nosocomial legionella pneumonia and is the first description of nosocomial infection due to L. bozemanii.
(Parry MF, Stampleman L, Hutchinson JH, Folta D, Steinberg MG, Krasnogor LJAnn Intern Med 103 (2): 205-210 Aug 1985)

Role of air sampling in investigation of an outbreak of legionnaires' disease associated with exposure to aerosols from an evaporative condenser.

Epidemiologic studies have suggested that legionnaires' disease can be transmitted to susceptible hosts by contaminated aerosolized water from cooling towers and evaporative condensers; however, epidemic strains of Legionella have not been isolated by air sampling at such sites during epidemiologic investigations. An outbreak of legionnaires' disease occurred at a retirement hotel; Legionella pneumophila serogroup 1 was isolated from an evaporative condenser and from potable water. A case-control study showed that the only significant exposure risk was in area A. L. pneumophila serogroup 1 was isolated during air sampling near the evaporative condenser exhaust site, the air conditioning intake vent, and an air vent in area A, but not in shower stalls. Monoclonal antibody subtype patterns of L. pneumophila serogroup 1 isolates from patients matched those from the evaporative condenser but not from shower water. Air sampling and monoclonal antibody subtyping results support epidemiologic evidence that the evaporative condenser was the source of this outbreak.
(Breiman RF, Cozen W, Fields BS, Mastro TD, Carr SJ, Spika JS, Mascola L
Respiratory Diseases Branch, Centers for Disease Control, Atlanta, GA 30333.
J Infect Dis 161 (6): 1257-1261 Jun 1990)

1989
Barcelona

In February and March 1989 an outbreak of Legionnaires` disease developed involving 56 patients (48 males 8 females) all cases were Legionella pneumonphila serogroup 1,
7 patients died., cause of outbreak unknow.
A causative focus was not detected, it cannot be ruled out, however that the source of the outbreak was the removal
of demolition materials in the affected area on the days preceding the epidemic outbreak.
(Monforte Meed Clin (Barc) , 1989 93 521-525)

Association of Legionnaires` Disease with construction:

To describe two cases of nosocomial legionellosis and discuss the epidemiology of this infection. Potable water was collected from multiple sites. Patient and environmental isolates were characterized by the Legionella slide agglutination test and monoclonal antibody subtyping. Concordance among isolates was confirmed by pulsed-field gel electrophoresis (PFGE). SETTING: A 713-bed university-affiliated hospital.

RESULTS: There was widespread contamination of potable water with Legionella pneumophila during a period of major construction; cooling towers were without growth of Legionella. One patient's isolate was the same by PFGE as the environmental isolate collected from the water faucet in his room. Control measures included superheating water used in all patient care areas to 75 degrees C for 72 hours and flushing superheated water through faucets and showers; cleaning shower heads with a sonicator washer; and raising the hot water storage tank temperature from 43 degrees C to 52 degrees C. After these interventions, repeat environmental cultures over the next 6 months were without growth of Legionella, and no further cases of nosocomial legionnaires' disease were documented.
An association between legionnaires' disease and construction is postulated. Heightened surveillance and preventive measures may be warranted during periods of excavation on hospital grounds or when potable water supplies are otherwise shut down and later repressurized.
(Mermel LA; Josephson SL; Giorgio CH; Dempsey J; Parenteau S Address Department of Medicine, Rhode Island Hospital, Providence 02903, Infect Control Hosp Epidemiol, 1995 Feb, 16:2, 76-81)


A preliminary investigation of an outbreak of Legionnaires` Disease caused by Legionella micdadei at a building-site in the rural area of Beijing.

During the period from December 1989 to January 1990, An outbreak of upper respiratory infection (influenza-like syndrome) took place in the workers of a building-site in a rural area of Beijing. An epidemiological investigation and bacteriological examination were carried out in this area. The results showed that it was an outbreak of Legionnaires' Disease caused by Legionella micdadei (Lm). The incidence was 26.67% (24/90). This was the first report on Lm infection in China
(Wan C Institute of Epidemiology and Microbiology, Chinese Academy of Preventive Medicine.Chung Hua Liu Hsing Ping Hsueh Tsa Chih, 1990 Oct, 11:5, 274-7)

Legionnaires` disease contracted in Brussels.

One case A 71-year-old patient living in a street where major road works were taking place developed diffuse bronchopneumonia with changes in hepatic and renal biochemical tests. Since neutrophilia was moderate and all bacteriological investigations were negative, the patient was given erythromycin and was tested for antibodies directed against Legionella pneumophila. The titersof these antibodies rose from 32 to 2048 after one month. The patient was cured
(Pepersack F; Vincken W; Van Beers D; Prigogine T; Yourassowsky E Source Nouv Presse Med, 1980 Dec 6, 9:46, 3531-3)

1986
A rural outbreak of Legionnaires` Disease linked to visiting a retail store.

Between May 7 and June 7, 1986, 27 residents of a rural county in Maryland developed legionellosis, and two died. Legionella pneumophila serogroup 1 was cultured from the sputum of two patients and identified in lung tissue of a third patient by direct fluorescent antibody staining. An additional 11 patients had four-fold rises in antibody titer to L. pneumophila, and 13 had single titers greater than or equal to 1:256. To determine risk factors for disease, we performed a case-control study. Twelve of 16 case-patients reported visiting store A in the two weeks before onset of illness compared with four of 28 control-patients. A serologic survey of employees showed that employees of store A were 3.63 times more likely than control employees to have titers of antibody to L. pneumophila greater than or equal to 1:256 (95% confidence intervals 0.8, 16.7). Cultures of soil specimens, samples of water from the hot water system of store A and from stagnant ponds near store A collected five weeks after the end of the outbreak were negative for Legionella species. Store A was adjacent to a site of excavation and construction during May 1986, when the community was experiencing an extended drought. This investigation suggests that exposure to excavation and construction activity may be a risk factor for legionellosis.
(Redd SC, Lin FY, Fields BS, Biscoe J, Plikaytis BB, Powers P, Patel J, Lim BP, Joseph JM, Devadason C, et al Division of Bacterial Diseases, Centers for Disease Control, Atlanta, GA 30333 Am J Public Health 80 (4): 431-434 (Apr 1990)

LEGIONNAIRES` DISEASE TRACED TO WIS. PLANT

SEPTEMBER 1986

A fatal outbreak of Legionnaires' disease has been traced to a cooling tower at a manufacturing plant, state officials said yesterday, and the bacteria have been eliminated.

The disease has been confirmed in 17 of the 31 neighborhood residents who became ill with the pneumonia-like ailment last month.
One death has been positively linked to the disease; two others previously believed to have been linked were not related,

Six of those confirmed to have the disease remain in hospital.

The source of the outbreak was at Muth Woodstock Co., which makes auto parts and accessories. The factory is on the city's northwest side, where almost all of the victims lived.

A news conference was told the bacteria probably was blown from nearby soil and "seeded in the holding tank," then blown around the 15-square-block area near the plant by an exhaust fan.

The bacterium that causes the disease can be spread through the air from contaminated water supplies or air conditioning ducts. Most Sheboygan cases were clustered in the 15-square-block area, leading epidemiologists to believe that an air conditioner or water tower in a nearby plant had been contaminated.

One resident became ill Aug. 28 and the other Aug. 30. The others developed symptoms between Aug. 10 and Aug. 23.

An outbreak of acute fever among steam turbine condenser cleaners.

Ten of twelve men who participated in the cleaning of an electric power steam turbine condenser clogged with freshwater sponge experienced an acute febrile illness. Two similar outbreaks have been previously described, one of which has been attributed to the Legionnaires' Disease bacterium. Epidemiologic studies of this case showed a syndrome very similar to the two previously reported episodes. However, the exact etiology for this outbreak has not been identified. Environmental sampling was not initiated until after the cleaning was completed. Subsequent testing did not reveal any likely cause for the outbreak. The delayed onset of symptoms and the nature of the illness pointed to an infectious agent. In the absence of any suitable criteria for employee exposure evaluation, it is suggested that crews cleaning condensers under unusually dirty conditions, especially if eye or respiratory symptoms are reported, should be provided with respiratory protection.
(Lauderdale JF, Johnson CC. Am Ind Hyg Assoc J 44 (3): 156-160 Mar 1983)

ORANGE COUNTY
AUGUST
1987

MYSTERY ILLNESS STRIKES WORKERS AGAIN

A business man closed an electronic assembly area and called in environmental investigators Thursday after a third outbreak of mystery illnesses sent another 30 people to hospitals.

The victims complained of nausea, headaches and shortness of breath.

The Orange County Environmental Protection Department and the federal Occupational Safety and Health Administration were at the scene
Most of the factory building at the sprawling plant complex was to be closed

500 people are affected by the closing of the plant two shifts,

This incident was the second in two days and third in less than a month involving workers who assemble wire harnesses for a targeting system for the Army's helicopters.

The affected workers were taken to two hospitals, where they were treated and released within hours.

1988
CALIFORNIA
SANTA CLARA COUNTY

An outbreak of Pontiac Fever occurred among 34 of 56 people attending conferences at a hotel in Santa Clare County in 1988. Two groups had an acute febrile upper respiratory illness, with a mean attack rate of 82% and a mean incubation period of 56 hours. Legionella anisa, which has not previously been associated with outbreaks of Pontiac Fever or Legionnaires disease, was isolated from a decorative fountain in the hotel lobby. The findings raise concern about water treatment protocols foer the extent of disease that might be caused by exposure to aerols containing Legionella anisa and other Legionella species.
(Fenstersheib MD, LANCET 1990 September 1 336 (8714) 576)

1992 FLORIDA
ORLANDO

The incubation period of Legionnaires` disease in five patients was traced to attendance at conventions in a hotel in the Orlando, Florida. area between January 6 and February 2 1992. Water from the fountain was the only one from 55 environmental specimens to test positve for Legionella.
The fountain`s recirculating system had been irregulary maintained, and water in the fountain may have been heated by submersed lighting. Decorative fountains may be a potentail source of infection with Legionella pneumophila, and emphasize the need for standard maintainance and disinfection procedures.
(Hlady WG, American Journal Epidemiology 1993 138 555-562)

1982-1985
Nosocomial legionnaires` disease in a children's hospital.

Between August 1982 and December 1985, seven patients at a children's hospital developed hospital-acquired pneumonia caused by Legionella pneumophila. Demographic data included the following: mean age 12.3 years (range 9 months to 20.5 years); male/female ratio 5:2; all patients were white. Some previously identified risk factors present in our patients included high-dose corticosteroid therapy (five patients), other immunosuppressive therapy (four), and chronic lung (five) or kidney (three) disease. Symptoms and signs included rapid onset, fever, cough, pleuritic chest pain, dyspnea, abdominal pain, diarrhea, and headache. Rhinitis, myalgia, and neurologic abnormalities were not noted. Chest roentgenograms revealed single-lobe consolidation in three patients, diffuse bilateral alveolar infiltrates in three, and pleural effusion in three. All patients were treated with erythromycin; three patients also received rifampin. Tracheal intubation and mechanical ventilation were required by four patients. Six patients improved after therapy. One child died of persistent lung disease 1 month after the onset of Legionnaires` disease. L. pneumophila was isolated from potable water in the hospital. Aerosol equipment cleansed with tap water and the showers were implicated as means of exposure by patients to contaminated potable water. No new nosocomial cases were seen after immunocompromised children were prohibited from taking showers, and sterile water was used to cleanse equipment for administering aerosol medications.
(Brady MT Department of Pediatrics and Preventive Medicine, Ohio State University College of Medicine, Columbus. J Pediatr 115 (1): 46-50 Jul 1989)

Fatal nosocomial Legionnaires` Disease:

The investigation, epidemiology, and effectiveness of control procedures during an outbreak of Legionnaires' disease involving three immunosuppressed patients are described. The source of infection appeared to be a network of
fire hydrant spurs connected directly to the incoming hospital mains water supply. Removal of these hydrants considerably reduced, but failed to eliminate, contamination of water storage facilities. As an emergency control procedure the incoming mains water was chlorinated continuously. Additional modifications to improve temperature regulation and reduce stagnation also failed to eliminate the legionellae. A perspex test-rig was constructed to model the pre-existing hospital water supply and storage system. This showed that through the hydraulic mechanism known as 'temperature buoyancy', contaminated water could be efficiently and quickly exchanged between a stagnant spur pipe and its mains supply. Contamination of hospital storage tanks from such sources has not previously been considered a risk factor for Legionnaires' disease. We recommend that hospital water storage tanks are supplied by a dedicated mains pipe without spurs.
(Patterson WJ; Seal DV; Curran E; Sinclair TM; McLuckie JC Address Glasgow Royal Infirmary, Edinburgh. Source Epidemiol Infect, 1994 Jun, 112:3, 513-25)

Cross-sectional follow-up ofa flu-like respiratory illness among fberglass manufacturing employees: endotoxin exposure associated with two distinct sequelae.

Over a period of 10 years, employees in a manufacturing plant experienced sporadic flu-like episodes after work in a basement containing a recirculated washwater mist. We report a cross-sectional study to defne the flu-like illness and bioaerosol exposures.
High concentrations of Gram-negative bacteria (GNB) (> 10(7) cfulml) and endotoxin (range 34-46 micrograms/ml) were found in the water. Mist contained > 10(3) cfulm3 ofGNB, and endotoxin up to 13,900 to 27,800 ng/m3.
Few fungi and therrnotolerant Bacillus species and no Actinomycetes, Legionella species, or amoeba were found in washwater. Airborne levels of fungi were of the same species and magnitudes as outdoor samples. Subjects volunteered (n = 28) because of a history of flu-like symptorns or were randomly selected (n = 102) from workers with and without current exposure to the basement.
No acute cases were examined. Cases did not fulfil criteria for hypersensitivity pneumonitis (HP) and high levels of antibodies to water-borne antigens were not observed. However, among 20 subjects indicating a history of severe flu-like episodes (severe basement flu, SBF), diffusion capacity (DLCO) was signifcantly lower (p = 0.015) than among other workers. The prevalence of SBF was independent of smoking. Cases occurred in clusters, and SBF was more common among workers with intermittent exposure to the basement ( 19 cases} than with daily exposure (l case). These fndings suggest that SBF and associated chronically depressed DLCO resulted from toxic injury following high-level endotoxin exposure. Asthma was prevalent in the study population, particularly among employees with daily, rather than intermittent, exposure to endotoxin-containing mist (odds ratio 6.7, p = 0.02). Thus, endotoxin exposure in this study was associated with two distinct sequelae depending on the temporal pattern of exposure.

(Milton DK; Amsel J; Reed CE; Enright PL; Brown LR; Aughenbaugh GL; Morey PR Address Department of Environmental Health, Harvard School of Public Health, Boston, MA 02115, USA. Am J Ind Med, 28: 4, 1995 Oct, 469-88)

Rhode Island

Association of Legionnaires` disease with construction:

Two cases of nosocomial legionellosis and discuss the epidemiology of this infection. DESIGN: Potable water was collected from multiple sites. Patient and environmcntal isolates were characterized by the Legionella slide agglutination test and monoclonal anlibody subtyping. Concordance among isolates was conlirmed by pulsed-field get electrophoresis (PFGC). SETTlNG: A 713-bed universily-affliated hospital.
RESULTS:
There was widespread contamination of potable water with Legionella pneumophila during a period of major construction; cooling towers were without growth of Legionella. One patient's isolate was the same by PFGC as the environmental isolate collected trom thc water laucet in his room. Control measures included superheating water used in all paticnt carc areas to 75 degrecs C for 72 hours and flushing super heated water through faucets and showers; cleaning shower heads with a sonicator washer; and raising the hot water storage tank temperature from 43 degrees C to 52 degrees C. Afier these interventions, repeat environmental cultures over the next 6 months were without growth of Legionella, and no further cases of nosocomial legionnaire`s disease were documented. An association between legionnaires' disease and construction is postulated. Heightened surveillance and preventive measures may be warranted during periods of excavation on hospital grounds or when potable water supplies are otherwise shut down and later repressurized.
Mermel LA; Josephson SL; Giorgio CH; Dempsey J; Parenteau S Department of Medicine, Rhode Island Hospital, Providcnce 02903, USA. Infect Control Hosp Epidemrol, 16: 2, 1995 Feb, 76-81

In August 1996 a worker at a small plastics factory on an industrial estate in Yorkshire developed legionnaires' disease. A second case occurred in the same workforce six months later. The factory had no wet cooling system, but there were cooling towers on adjacent sites. Water from an uncovered, outdoor tank on the site was used to cool machines in the plastics factory and passed through sight glasses on its way to the machines to confirm its flow.
The glass was cracked and created a fine aerosol into the work area.
Water from this tank was positive for L. pneumophila sg 1 when tested after the second case was diagnosed. Although no clinical isolates were obtained, L. pneumophila sg 1 antigen was found in urine from one of the patients. Control measures at the factory included replacing the cracked glass, cleaning the tank, treating the water with a bactericide, and covering the tank.

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)

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 Legionnaires` 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.

IS NOT ABOUT LEGIONNAIRES` DISEASE, IT WAS AN OUTBREAK OF AN UNKNOWN DISEASE AT THE TIME.
IT CAUSED SIMILAR PANIC AMONG PEOPLE AS DID THE FIRST OUTBREAK OF LEGIONNAIRES` DISEASE IN 1976

July 26, 1993

Medicine men and MDs attack Four Corner illness

WINDOW ROCK, Ariz. - The death toll from the Hantavirus infection now stands at 23 people, including 12 Native Americans. As medical investigators and health agencies continue to work toward halting the epidemic, many people wonder when it will end.

No one knows exactly when it began, but in mid-May reports surfaced here about a "mystery flu" that had killed more than a dozen. As news of the deadly disease spread over ensuing weeks, so did fear and discrimination.

Because the mysterious illness struck down its victims quickly and appeared to be concentrated near the Navajo Nation, some press reports tagged the disease as a "Navajo Mystery Flu" and a "death bug."

Reports of racial discrimination began to pour in to tribal officials as summer camps, shop owners and restaurants turned Navajo people away due to fears that they might be carrying the disease. Tourists began cancelling reservations for summer vacations in the Southwest.

But as medical experts, epidemiologists and traditional medicine men began to sort out the clues, it became apparent that the illness had nothing to do with ethnicity.

After more than 100 of the world's best medical investigators descended on the region to conduct tests and collect specimens, a new strain of Hantavirus was identified as the culprit, says Mark Sewell, New Mexico chief epidemiologist.

The virus, named after the Han River in South Korea, where it reportedly originated, is transmitted when people breathe dust carrying remnants of infected rodents' saliva, urine or feces, according to the Centers for Disease Control in Atlanta, Ga.

Dr. C.J. Peters, chief of the Special Pathogens Branch at the CDC, says aerosols from fresh deer mouse urine may be infecting people in the Southwest. Field scientists have discovered that 23 to 30 percent of the deer mice they have tested carry the virus. Like other rodents, deer mice liberally mark their home range with urine, and people living in homes inhabited by mice are most at risk, Peters told the Albuquerque Journal.

"I want to stress that this is truly a modern medical mystery and the effort to solve this mystery has progressed very quickly over the past month," said John Hubbard, Navajo Area Indian Health Service director. Hubbard noted that in 1976, when Legionnaires disease struck the East, it took more than four months to determine the cause.

"One thing is certain - this is an equal opportunity virus that can afflict anyone regardless of race, gender or age," said Bob Howard, a spokesman for the Centers for Disease Control. "There is absolutely no scientific evidence to support the notion that Native Americans or Navajos are especially susceptible. The victims have come from many ethnic backgrounds."

The cluster of deaths was first noticed by Dr. Bruce Tempest at Gallup Indian Medical Center when several young and otherwise healthy Navajo people died within days of becoming sick with symptoms that looked like flu: fever, headache, muscle aches, eye irritation and coughing.

Unlike ordinary flu, Hantavirus resists conventional treatment in its later stages. Often it turns deadly with frightening swiftness, sometimes killing its victims within days after symptoms appear. Many of the victims succumb to Adult Respiratory Disease Syndrome, which swells the lungs, fills them with fluid and causes the victims to asphyxiate.

The two youngest victims were Navajos, a 13-year-old girl who collapsed at a graduation dance, and a 19-year-old track star who had just lost his 21-year-old fiancée to the mysterious disease. The couple left behind a five-month-old son.

The disease claimed its 18th victim on June 24, when an 84-year-old woman from south-central Colorado died in a Denver hospital from respiratory distress syndrome associated with the virus.

An elderly Navajo woman from the Monument Valley region of the sprawling 26,000-square-mile Navajo reservation became the 17th victim when she died on June 22 after being flown to University Hospital in Albuquerque, N.M. She was receiving the experimental drug ribavirin, which doctors are using to treat the illness.

Hospital officials said she was the second patient in three days to be admitted for Hantavirus treatment with ribavirin, which is also used to treat AIDS patients.

State and federal health officials say there is no evidence the virus is transmitted by humans. No family members or health workers have contracted the disease from affected patients.

While a number of similar cases were reported in Maine and northern California, Howard said health officials have discounted any connection to the Southwest cases. It appears illnesses related to the Hantavirus are confined to the Four Corners region of the nation, he said.

The virus has caused an epidemic of fear that is hitting both Native and non-native Americans' businesses in the Four Corners area.

In the scenic high desert that makes up the Navajo and Hopi reservations, the summer swarms of tourists have dwindled sharply. In June, motel managers reported business was off 20 percent to 50 percent. Park rangers say visits have dropped since the spring. Arts and crafts shop owners say sales plummeted. And in empty parking lots, Indian vendors waited for tour buses that never came.

"Tourists used to come over and talk to me, but not anymore. Some are even too scared to get out of their cars. I was hoping it would get better, but it's getting worse," said Bernice Martin, standing in front of her black pickup where tiny Navajo dolls weaving at miniature wooden looms were displayed.

"People call and ask me how close we are to the Navajo Reservation," said Nita Davis, owner of the Vogt Ranch, a bed and breakfast between Grants and Gallup, N.M. "I used to be really proud to say `only one-quarter of a mile,' because they responded, `Wow, neat.' Now, all I hear is a `thank you' and a click."

In early June, Navajo Nation President Peterson Zah told health officials that he was consulting Navajo medicine men for answers to the mysterious illness.

"Western medicine has its limits," Zah said. "We're calling on our Navajo medicine people to help us define what is causing these deaths."

Many Navajo elders and medicine people blame the loss of traditional Navajo ways for the random deaths. One elder, Nelson Dempsey of Indian Wells, Ariz., told the Navajo Times that "there is a lack of respect for the elders and the people, ceremonies are being desecrated and commercialized, and youth are increasingly involved in satanic rituals."

"It's like there is a hole in the sky and bad things are pouring through it," said Ernest Becenti, a traditional healer from Church Rock, N.M. "It's like the world has a hole in the roof, what they call the ozone layer, that we caused with satellites, rockets, jet planes, pollution and war. These things are responsible."

Donald Jackson, a medicine man from Dennehotso, Ariz., said, "Sometimes in this life, sickness comes as a punishment. Earthquakes, tidal waves, natural disasters and (things like) this disease are warnings to do right by the Earth."

Noting that many people, particularly young Navajos, have strayed from the Navajo way, he said, "People who still follow the old ways are not being harmed because they know how to pray."

Until the illnesses and deaths end, the Navajo people and other residents of the region will continue to mourn the loss of their relations and worry about their loved ones.
Many will also pray for protection using traditional ceremonies.

"I am praying to end this sickness," said Ernest Becenti. "I offer the Earth white cornmeal in the morning, yellow cornmeal at noon and black cornmeal at midnight. I am defending my people just like I did in World War II."

Lola Begay of Hardrock, Ariz., wondered how things can be made right again.

"In the Navajo way, danger of this magnitude is not supposed to affect us because the Holy People protect us. What have we done wrong to deserve this?"

1997

nvestigation of An Legionnaires' Disease Outbreak Associated with Contaminated Air-Conditioning System

Ma Xiaoyan*,Wang Yuqin, Peng Xiaoming,et al. *

Department of Epidemiology ,Beijing Municipal Center for Hygiene and Epidemic Control, Beijing 100013 Abstract

An outbreak of upper respiratory infection (influenza-like syndrom) took place among the staff members of a large office building in Beijing,June, 1997.To understand the cause of the outbreak, with a case-control study with serological antibodies detection against serogroup 1 to 14 of Legionnaires' disease bacteria (LDB) and bacteriological test and culture on samples collected from the air-conditioning system of the office building was performed. The findings showed that the attack rates of tongillitis and upper respiratory infection were 61.86% and 34.62% respectively. The relation was statistically significant between the symptoms of fever and tonsillitis in the cases (¦Ö 2=77.88,P£¼0.01). The positive rates of LDB antibodies on serogroups 9, 10, 12,14 were 45.94% in the cases of upper respiratory infection and 3/15,6/17,0/15,1/16 respectively in the four controls groups. Condensied water samples from an air-conditioning system showed that Legionella Pneumophila was positive. Evidence showed that it was an outbreak resulting from LDB serogroup 9 and 12, accompanied by upper respiratory infection related to air-conditioning system contaminated by LDB. This was the first report Lp infection associated with an air-conditioning system in China.

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