OUTBREAK OF LEGIONNAIRES' DISEASE
Follow-up after the Legionnaires’ Disease outbreak
June 9th, 2005
It was confirmed yesterday that the occurrence of legionella
bacteria in a lignin spray dryer scrubber at the Borregaard Sarpsborg plant in
Norway is the probable source of the Legionnaires’ Disease outbreak in
south-eastern Norway. The outbreak has affected 52 people in total of whom 10
have regrettably died.
“Borregaard greatly regrets what has happened and we wish to express our deep sympathy for the innocent victims of Legionnaires’ Disease and for their relatives. We are extremely upset that our company has experienced an outbreak and is probably the cause of the spread of legionella bacteria, which has resulted in such serious consequences for so many people. Our company depends on the trust and confidence of the local community, so this is also sad for everyone who works at Borregaard,” says Per Sørlie, President and CEO of Borregaard.
We are concerned about the situation of the people who have contracted Legionnaire’s Disease and their relatives. In cooperation with the authorities and other experts, we will also discuss how we can help to meet the needs of the people who have been affected.
We want to help the people who have suffered. We will give closer consideration to how this can best be done.
Borregaard has now taken a number of initiatives and measures as a result of this situation.
In this initial phase, we are focusing on ensuring that the people in the vicinity of the plant are safe. This means that we are now disinfecting the plant, checking the equipment and technical installations, and establishing the necessary monitoring system and procedures to ensure that future operations take place in a safe way. Borregaard co-operates closely with the authorities and external experts in this process.
Borregaard has similar scrubbers at production facilities in six other countries. On the basis of what we now know about the Sarpsborg plant scrubber, similar inspections are being carried out at the other installations.
June 10th, 2005
Borregaard’s plant in Sarpsborg have received permission from the Sarpsborg
health authorities to start up the scrubber that was closed down for cleaning
and disinfection after legionella were found in the installation on Monday 6
The scrubber was immediately closed down for cleaning and disinfection at the request of the health authorities as soon as it was clear that legionella bacteria had been found. Borregaard itself decided to close down and clean its other two scrubbers of the same type, even though they were not infected with the bacteria. Since 6 June, Borregaard has been working with the authorities to discover the cause of the bacterial growth and has also implemented a number of measures to make the plants as safe as possible. The new routines have been formulated in cooperation with the Health Authorities.
New routines introduced
Improved operating routines, better monitoring and control of bacterial growth, clear limits for safe operations and routines for frequent, thorough cleaning are intended to eliminate the risk of new legionella outbreaks in the company’s scrubbers.
The scrubbers are about to be started up this weekend when the disinfection process has been completed. The company will carefully monitor the start-up process and will stop it immediately if anything abnormal should occur.
Borregaard has similar scrubbers at plants in six other countries. All the scrubbers have been closed down for cleaning and inspection this week.
Compensation for the victims of the Legionnaires’ Disease outbreak
June 10th, 2005
Borregaard and its insurance company, If Skadeforsikring (If), have reviewed the liability and insurance aspects of the situation. It is now clear that If will deal with compensation claims from the bereaved and from persons who became ill due to the spread of the disease.
In If’s view, Borregaard is not to blame for the spread of Legionnaires’ Disease but, pursuant to the law, the company is nevertheless liable to pay compensation based on strict liability, and the company’s liability insurance will apply.
The insurance company has established a special personal injury team who will now begin to register cases from the bereaved and persons who have been treated or who are still being treated for Legionnaires’ Disease. If and Borreegaard will in the near future provide further information concerning measures that will make the registration process in connection with compensation as easy as possible for the people concerned.
“Borregaard is concerned about the situation of the people who have been affected by Legionnaires Disease outbreak and it is important for us that the victims receive compensation for the loss they have suffered,” says Per Sørlie, President & CEO of Borregaard.
DNA fingerprints of the legionella bacteria from patients and potential sources were compared. The DNA analysis showed that the same bacteria were found in the patients and in samples from an air scrubber at the Borregaard Sarspborg plant. Together with the results of DNA analysis, results from the population based study including information about home address and movements of patients and modelling of airflow in the area of Sarpsborg and Fredrikstad, indicated that the source of infection was found. These results were announced by the Chief Medical Officer in Sarpsborg on a press conference Wednesday June 8th 2005.
Appearance of the Legionella bacterium and its probable spread from Borregaard
8 June 2005:
The Legionella bacterium has been detected in a scrubber facility at Borregaard's site in Sarpsborg. The facility is probably the source of the epidemic of Legionnaires' Disease in the area.
Dag Arthur Aasbø, firstname.lastname@example.org
Outbreak of community-acquired legionnaires’ disease in southeast Norway, May 2005
Hans Blystad (email@example.com), Arne Broch Brantsæter and Øistein Løvoll, Nasjonalt folkehelseinstitutt (Norwegian Institute of Public Health), Oslo, Norway
The two cities are situated very close to each other with a total of 120 000 inhabitants. The area is heavily industrial and is not a particular tourist destination.
The source is still unknown. Because the outbreak is large with many cases including deaths, occurring over a wide geographical area within a short time period (Figure), cooling towers are the most likely source. All of the known 19 cooling towers in the area have been closed down, pending results of bacteriological testing and disinfection. Epidemiologists from Nasjonalt folkehelseinstitutt (Norwegian Institute of Public Health) are assisting local health authorities with the outbreak investigation. Other probable sources are also being investigated. Clinical and environmental samples are being genotyped to support other epidemiological data.
Figure. Epidemic curve of the outbreak of legionnaires’ disease in Fredrikstad-Sarpsborg, Norway, May 2005
The rate of case reporting has now diminished, and based on epidemiological data, it is probable that the source is now inactive. Local health authorities have not issued any specific restrictions regarding staying in or travel to the area.
The outbreak has stimulated public discussion about statutory regulations for cooling towers and similar installations. Following a similar outbreak in Stavanger in 2001 , all owners of cooling towers are now required to notify local health authorities of their installation and to have an adequate system of control and maintenance. Local authorities have a statutory responsibility.
Source Eurosurveillance Weekly
Anatomy of an Air Scrubber
A venturi air scrubber removes polluting particles from gas emissions by spraying a scrubber liquid directly into the emissions. The scrubber liquid surrounds the dirty particles, which are carried with the gas emissions into the separator cylinder. As the gas cycles upward through the cylinder, the liquid-covered particles drop from the gas into the contaminated liquid reservoir
An air scrubber is used to clean air or other gases of various pollutants and dust particles by mixing the polluted gas with a water mist. The dirt and pollutants are encased by the water particles and when the mixture is condensed the pollutants stay in the water while the gas rises up and can be put back into circulation.
New legislation in Norway targets prevention of legionnaires’ disease
Elmira Isakbaeva and Hans Blystad
Infectious Disease Epidemiology Department, Norwegian Institute of Public Health, Oslo, Norway
The new legislation emphasises the increased responsibility of owners and
operators in inspection and maintenance of systems with aerosol-generating
equipment. In case of failure to report, owners may be subject to penalty
including criminal offense. The role of local public health authorities will
be critical in ensuring compliance with the new regulation and monitoring is
needed to maximise awareness of this legislation.
New Norwegian legionella legislation is consistent with the European guidelines
John V Lee
Collaborator for England & Wales, European Surveillance Scheme for Travel Associated Legionnaires' Disease (EWGLINET), Health Protection Agency Centre for Infections, London, United Kingdom
Although cooling towers, evaporative condensers, hot and cold water systems and spa pools are the most common sources of outbreaks, all systems that use water that may reach temperatures conducive to the growth of legionellae should be considered as potential sources of infection, be subjected to risk assessments and have suitable control measures applied where necessary. This is the basis of the advice in the technical parts of the European Guidelines for Control and Prevention of Travel Associated Legionnaires' Disease (http://www.ewgli.org/public_info/publicinfo_europeanguideline_download.asp), which are largely based on the United Kingdom guidance. It is to be hoped that more countries improve their legislation to ensure all potential sources are considered.