THE FIRST RECORDED OUTBREAK

DATE OF CASES

Bellevue-Stratford Hotel
Historic hotel famous for The First Legionnaires outbreak in Philadelphia in 1976

The Bellevue-Stratford Hotel has stood along Broad Street in Philadelphia's Center City since the early 1900s, its French Renaissance-style architecture and grandiose stature making it a landmark. Yet the elegant 19-story building, which is listed on national and local registers of historic places, is perhaps best known outside Philadelphia as the place where a mysterious and sometimes fatal disease came to light.

The Bellevue-Stratford hosted the 58th state convention of the American Legion Department of Pennsylvania July 21-24, 1976. In the days that followed the convention, the mystery disease killed 34 participants and sickened 221, all of whom had spent time at the hotel.

It is now known that legionella bacteria lurked somewhere within the hotel. Researchers still haven't identified the exact source, according to Dr. Victor L. Yu, chief of the infectious disease section at the Pittsburgh Veterans Affairs Medical Center in Oakland.

The hotel, built from 1902-1904, closed shortly after the outbreak for rehabilitation, according to Jeff Barr, a historical research technician with the City of Philadelphia Historical Commission.

It reopened in 1979 under a new name - the Fairmont Hotel - only to revert back to the Bellevue-Stratford Hotel some years later, he said. "It went through a major renovation in the early 1990s" to include a combination retail and office space, Barr said.

Today, only the upper floors of the building offer lodging accommodations, an operation that Barr described as a "high end hotel."

Survivors of outbreak struggle with memories

By Lori Heller TRIBUNE-REVIEW

Mario Maloberti fell ill at the 1976 convention (Joe Wojcik photo)

While the country was celebrating its 200th birthday and Americans nationwide were reveling in patriotism, veterans in Pennsylvania were mourning. Members of the American Legion were surrounded by death and sickness following the group's annual state convention held in July 1976 at Philadelphia's Bellevue-Stratford Hotel.

The disease responsible for the tragic situation proved to be a mystery killer to the medical community. Without a name or face to give the malady, it took on an identity linked to those it affected most. It became Legionnaires' disease. "It didn't make it look too good for the American Legion because people didn't want to affiliate with us," Jeannette resident Mario Maloberti recalled recently.

Maloberti, 63, a member of Jeannette American Legion Post 344, was one of 221 people who contracted Legionnaires' disease while attending the convention. Thirty-four others died. "Some of our legionnaires were upset because of the name," said Hazelwood resident Dorothy Cusick, 79, who was elected president of the American Legion Auxiliary Department of Pennsylvania during the 1976 convention.

Cusick said naming the disease after her group "cast a dark cloud" over the American Legion. The name, she said, seemed to hint that only veterans could get the disease. Maloberti and Cusick were among the thousands who attended the convention and later felt the reverberating effects of the disease.

Friends and neighbors died. Others endured lengthy hospital stays. In some cases, the sick and their family members were ostracized by their communities. "I don't hold it against anybody. It's something that doesn't happen in your home town. It happens in other places, and people just don't know how to react," said Janet Maloberti, who endured public scrutiny while her husband was treated at Monsour Medical Center in Jeannette.



American Legion volunteers Dorothy Cusick (left) and Alice Cherubin remember the outbreak of Legionnaire s' disease. (J.C. Schisler photo)

"I was losing my voice because nobody would come near me," Janet Maloberti said, explaining that she was forced to shout to people who kept their distance for fear of catching Legionnaires' disease from her.

Similar experiences were shared by Cusick and her friend Alice Cherubin, both members of the American Legion Auxiliary Fort Black Unit No. 538 in Hazelwood. No members of their families were afflicted with the disease.

Cusick and Cherubin, 76, of Beechview, and their children attended the convention with their husbands. The men stayed at the Bellevue-Stratford Hotel, where researchers say the legionella bacterium lurked, while the women and children stayed at the nearby Ben Franklin Hotel. "Everything was fine. I had my whole family there," Cusick said. "The convention was a vacation for a lot of the families. After we returned home, we started hearing about people getting sick and dying."

"I started my year as president by going to funerals and visiting the sick," she continued. "When we got back home, people were treating us so rotten."

Cherubin agreed, recalling incidents in her hometown.

"When I went to stores in Beechview, everybody knew I'm with the legion," she explained. "They didn't want to touch any of my money or nothing. They thought I was contagious."

Janet Maloberti never feared catching the disease from her husband. "We didn't know what the cause of the sickness was, but after a while doctors assured me that Mario's condition was not contagious," she said.

Mario Maloberti initially thought he had the flu when he returned home from the state convention and developed a cough and high temperature. When he heard fellow legionnaires had fallen ill and some had died, he went to the hospital.

He credits the late Edward Hoak, a Manor Borough native and American Legion state adjutant at the time, with ensuring that legionnaires across the state sought medical treatment. It was Hoak, said Maloberti, who notified the Pennsylvania Department of Health and statewide media about the mystery illness.

Meanwhile, Maloberti spent nine days in the hospital. "I watched the funerals on the TV in the hospital," he said, noting that a neighbor and fellow legionnaire, Louis Byerly, died from the disease. While in the hospital, Maloberti received numerous calls from reporters.

The disease attracted national attention, and Maloberti recalls the media attention following him and other Pennsylvania legionnaires to the August 1976 national American Legion convention in Seattle, Wash. Two decades later, Maloberti doesn't dwell on the fact that he had Legionnaires' disease. Still, he wonders whether it contributed to other health problems developed through the years.

Cusick said the negative feelings concerning the name of the disease have diminished over the years. "Now I think the name is more in their memory and their honor," she said, referring to the legion members afflicted in 1976.

In 1976, Air Force veteran Ray Brennan became the first person to die
of so-called "Legionnaire's Disease" following an American Legion convention in Philadelphia.

Source: Media


Debate continues on how bacteria infect victims

Dr. Victor Yu and
Dr. Janet E. Stout examine Legionnaires' disease bacteria in a laboratory.
(Philip G. Pavely photo)

By Lori Heller
TRIBUNE-REVIEW

What began 20 years ago today as a mission of patriotism and camaraderie ended in death and mystery. Across the state, 34 people died and 221 others fell ill to a malady that quietly struck during the 58th annual state convention of the American Legion Department of Pennsylvania. The convention was held July 21-24, 1976, in Philadelphia's Bellevue-Stratford Hotel.

But it wasn't until the thousands of veterans and their families returned home that the mystery killer showed its face. American Legion officials in Pennsylvania began to receive calls from across the state. Friends had died, and many more were sick.

Nobody knew why. Was it something in the air within the Bellevue-Stratford? Could it have been the abundance of pigeon droppings outside the hotel? How about the water held in galvanized canisters throughout the convention? No one was able to identify the source, to find the link connecting those who were stricken.

Almost immediately, the pneumonia-like illness garnered the name Legionnaires' disease. It wasn't until January of the following year that the Centers for Disease Control in Atlanta, Ga., identified the bacterium responsible for the outbreak.


BAFFLING BACTERIUM

With the cause of the disease known, researchers still were baffled as to where the legionella bacterium lives and breeds.

In 1982, microbiologist Janet E. Stout at the Pittsburgh Veterans Affairs Medical Center in Pittsburgh's Oakland Section identified the bacterium's source to be water from potable water found in household spigots to puddles along the road. It is most often found in the water systems of large buildings.

Stout, employed in the medical center's special pathogens laboratory, recently said the bacterium's mode of transmission is still in question. "There is debate over how that happens," she said. "The logical question is, `How does it get from the water to the patient?'"

The Centers for Disease Control say the bacteria get into the body through the lungs either by inhalation of airborne water droplets or by aspiration of water containing legionella bacteria. Stout agrees, but says she has found enough evidence to convince her that people also can catch the disease from drinking water containing the bacteria.

Research on legionella bacteria at the VA medical center in Oakland has been under way since the late 1970s, and today scientists from all over the world visit the hospital to learn about Legionnaires' disease. For example, medical researchers who discovered the first cases of the disease in China and Turkey were trained at the center.

Twenty years after the Bellevue-Stratford outbreak, the disease has a low mortality rate with early diagnosis and proper treatment. Researchers at the VA center are working to improve both detection and treatment. To do that, they say they must educate the public and the medical community.

The disease is still being misdiagnosed as pneumonia in many cases, according to Dr. Victor L. Yu. Yu, one of the most zealous researchers of the disease nationwide, is the chief of the Oakland VA medical center's infectious disease section.

He is displeased that the public carries misperceptions about the 1976 outbreak. Some still believe the source of the bacterium to be the Bellevue-Stratford's air conditioning system when, in fact, the source has never been identified, Yu said. "It disturbs us because many of these people are physicians," Yu said. "This is one of the great modern myths."

The legionella bacterium had eluded science for years prior to 1976, according to Yu. Following the 1977 identification of the bacterium, researchers were able to link Legionnaires' disease to earlier unexplained deaths: a single fatality in 1947 and to 15 deaths in a Washington, D.C., hospital in 1965. The legionella bacterium was also responsible for causing an illness that hit 11 members of the Odd Fellows who attended a convention at the Bellevue-Stratford Hotel in 1974, Yu said.

The link was made when tests were performed on preserved lung specimens from the dead and on blood samples taken from the Odd Fellows who survived the 1974 outbreak.

He attributes the death rate resulting from the outbreak at the 1976 American Legion convention to the advanced age, poor physical condition and heavy smoking habits of many attendees. Yu stressed that most people in good health are immune to the bacteria.


OUTBREAKS CONTINUE

Since it was named 20 years ago, Legionnaires' disease is still a mystery to doctors. While they recognize the bacterium is viable in water, they have yet to determine how it infects people.

In the past 20 years, most notable outbreaks of the disease have occurred in hospitals or nursing homes - facilities with a high population of sickly people and people with impaired immune systems.

The Allegheny County Health Department, through a task force of which Yu is a member, three years ago established a set of guidelines to help health care centers prevent and control in-house outbreaks of the disease.

The department's standards were published in what amounted to the first practical guide to Legionnaires' disease available in the United States. Guidelines were created after a survey found that legionella control measures in area hospitals were non-existent or varied widely in scope and frequency, according to Guillermo Cole, the department's public information officer.

The following guidelines were issued:

Test water systems such as hot water tanks, faucets and shower heads annually, with more frequent checks in units serving transplant patients, who are more vulnerable to infection.When legionella bacteria are found, disinfect the water system if there are any current or prior cases of hospital-acquired Legionnaires' disease or if 30 percent or more of the samples are contaminated.

Disinfect using one or any combination of these techniques: Raise the chlorine content to 2 to 6 parts per million; heat water to 158 degrees and flush all outlets or heat water to 190 degrees and blend with cold water to achieve a purging temperature; apply ultraviolet radiation; or use metallic ionization.

The task force reconvened earlier this month to update the guidelines, which Yu expects to be used as national standards. "We are fortunate to have Victor Yu and a few others who are renowned on this issue worldwide" as task force members, Cole said.

AT HOME IN WATER

Yu and Stout currently are developing better ways to treat patients with the disease, Yu said. In addition, the two researchers want to identify better ways to control the bacterium in water systems.

Yu said the bacteria multiplies in water between 100 degrees and 120 degrees Fahrenheit. For that reason, the VA center keeps its water temperature at 140 degrees. In addition, the facility checks all patients for Legionnaires' disease at the time they are admitted to the hospital.

Although Stout spends a great deal of time in the laboratory, she said a portion of her work calls for her to travel across the country. She speaks publicly on the issue, especially before engineers, plumbers and the folks responsible for operations at health care centers. "They are not very knowledgeable about legionella at all," Stout said.

This year she will speak before the National Association of Plumbing Engineers in Phoenix, Ariz., and before the World Plumbing Conference in Chicago, Ill.

Stout noted that, at times, it's a tough job trying to convince professionals and the public that the water system is the source of legionella bacteria. Although the bacterium can show up in any water source, it's not often found in private residences. "It isn't, for example, in most homes," Yu stressed. "Over 90 percent won't have it."

During the 1980s, a study was undertaken by researchers at the VA medical center to determine how widespread the bacteria strain is in private homes. The research relied upon the people for whom the disease is named. "We asked the American Legion to open its doors to us," Yu said. "There would be no other group willing to listen to us."

Stout said the study called for six geographic areas of Pittsburgh to be tested. Researchers went into homes of legionnaires and retrieved water samples. In addition, urine and blood samples were taken from those living in the tested homes.

Results showed about 7 percent of the residences had legionella bacteria in the potable water supply, but no person had the disease. "What did we find? They weren't at risk," Yu said. "That was a relief for everybody."