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Legionella is a Gram negative bacterium, including many species that cause legionellosis or Legionaires' disease, most notably L. pneumophilia. At least 46 species and 70 serogroups have been identified. On the side-chains of the cell wall are carried the bases for the somatic antigen specifity of these organisms. The chemical composition of these side chains both with respect to components as well as arrangement of the different sugars determines the nature of the somatic or O antigen determinants, which are such important means of serologically classifying many Gram-negative bacteria.

At least 14 different serovars of L. pneumophila have been described as well as several other species being subdivided into a number of serovars. Sera have been used both for slide agglutination studies as well as for direct detection of bacteria in tissues using fluorescent-labelled antibody. Specific antibody in patients can be determined by the indirect fluorescent antibody test. ELISA and microagglutination tests have also been successfully applied.

Legionella pneumophila is non-acid, fast non-capsulated rods, aerobic and do not hydrolyse gelatin or produce urease. They are non-fermentative. L. pneumophila is neither pigmented nor does it autofluoresce. It is oxidase- and catalase- positive, and produces beta-lactamase.

L. pneumophila is an intracellular pathogen. The internalisation of the bacteria is enhanced by the presence of antibody and complement. A pseudopod coils around the bacterium in this unique form of phagocytosis. Once internalised, the bacteria surround themselves by a membrane-bound phagolysosome. This becomes a vesicle, within which the bacteria multiply. They produce a 39kDa metalloprotease into culture fluids, which is cytotoxic for some cultured tissue culture cells.

 Special Note

Legionella is a bacteria not a virus, it has an incubation period now of up to 20 days.

Two recent outbreaks in France and Norway it was stated that the legionella travelled 12 and 17 Kilometres

http://members.dodo.net.au/~jamgreen/legionellose_france.index.htm

http://www.q-net.net.au/~legion/legionella_norway.htm


Unidentified illness kills four Toronto seniors

2 October 2005

Toronto

Public health officials are investigating the deaths of four people from a "typical respiratory illness" at an east-end senior's residence, but say the outbreak is not SARS.

The four victims were residents at the Seven Oaks Home for the Aged in the city's east end, said Dr. Barbara Yaffe, Toronto Public Health's director of communicable disease control.

"We know from the testing that's been done so far that this is not influenza, we know this is not SARS, we know this is not avian influenza," said Dr. Allison McGeer, infectious disease consultant at Toronto's Mount Sinai Hospital.

"There are many other viruses it could be ... and the Ontario Public Health lab is working very hard on identifying which one of those viruses it might be."

The unidentified illness has affected 68 residents and five employees at facility.

Three of the victims died at the home while the fourth died in hospital, she said.

Dr. Yaffe said all of the four victims had severe pre-existing medical conditions. Two were in their 90s, another in the late 70s, and the fourth in the 50s.

She said outbreaks are typical but this one set off alarms because of its severity.

"We get hundreds of outbreaks every year, however in this situation we do have a particularly serious outbreak," Dr. Yaffe said.

She said 15 people have been admitted to hospitals in the area, but are not being quarantined.

"There is no quarantine necessary for this," Dr. Yaffe said, and emphasized that there was no threat to the greater public.

The speed with which the illness spread led Dr. McGeer to speculate whether a presence of bacteria within the home contributed to the outbreak.

Dr. Yaffe also added that while this outbreak was serious, it was not the worst in recent memory. Last year, 11 people died after an outbreak at a Cobourg, Ont., nursing home, she said.

CFTO News reported that the first signs of the most recent illness were detected Tuesday, but no residents were taken to hospital until Saturday night.

Dozens of family members were prevented from entering the home Saturday.

Emergency room staff at Centenary Hospital donned gowns and masks Saturday as a procedural precaution — a standard practice in Ontario hospitals after the SARS outbreak in 2003.
Either people haven't been following precautions that we are supposed to follow now for all people with fever or respiratory illness . . . or alternatively, somebody had brought it in from the community to the nursing home and they weren't really that sick from it," infectious disease specialist Dr. Neil Rau said.

Symptoms of the illness include fever, cough, runny nose, and malaise, Dr. McGeer said.
She said the best way for the public to prevent such outbreaks occurring is to wash their hands thoroughly and frequently.


October 3, 2005
Media Advisory - Respiratory illness update


Toronto Public Health continues to investigate the outbreak of respiratory illness at Seven Oaks Home for the Aged, Dr. David McKeown, Toronto's Medical Officer of Health, said today.

The investigation is being carried out in conjunction with the Ministry of Health and Long-Term Care, the Ontario Public Health Laboratory, the Coroner's Office and affected hospitals. The outbreak began September 25, 2005.

Dr. McKeown reported the following update:
 


October 4, 2005
Media Advisory - Respiratory illness update

The respiratory illness at Seven Oaks Home for the Aged has resulted in additional deaths among ill residents, but the outbreak remains under control, Dr. David McKeown, Toronto’s Medical Officer of Health, reported today.

Dr. McKeown provided the following update:

"Although the condition of some ill residents has worsened and unfortunately four more have died, others are improving and we are confident this outbreak is under control," said Dr. McKeown.

Dr. McKeown will hold a media briefing this afternoon.

Date: Tuesday, October 4
Time: 4 p.m.
Location: Room 502, 277 Victoria St. (corner of Dundas St. E., one block east of Yonge St.)


Date: Tue, 4 Oct 2005 13:06:00 -0400
From: Jeannette Macey <Jeannette_Macey TA phac-aspc.gc.ca & Susan Squires, (Public Health Agency of Canada) & the Ontario Ministry
of Health and Long Term Care


By way of further follow-up to the 3 Oct 2005 posting entitled "Undiagnosed respiratory deaths - Canada (ON): RFI", I am providing the following summary from the Ontario Ministry of Health and Long Term Care and the Public Health Agency of Canada.

The province of Ontario has in place ongoing surveillance for febrile respiratory illnesses in hospitals and residential institutions. The syndrome
under surveillance is referred to as febrile respiratory illness or FRI. As a result of this ongoing surveillance, outbreaks are regularly detected,
especially during the influenza/respiratory virus season, which we are now entering in Canada. The 1st outbreak of laboratory-confirmed influenza for 2005-2006 was reported in a long-term care facility (LTCF) elsewhere in the country last week, and other common respiratory viruses are circulating as well. (see Canada's weekly FluWatch surveillance report at:
<http://www.phac-aspc.gc.ca/fluwatch/index.html)>)

The important summary points re: public health significance of this outbreak are that preliminary laboratory results are negative for key respiratory
pathogens of concern (including influenza viruses, novel influenza viruses, SARS as well as other common respiratory pathogens); the attack rate and mortality rate are not out of the expected range for LTCF outbreaks, and finally the outbreak appears to be waning (no new cases in recent days). Further laboratory investigations are ongoing.

The current outbreak of FRI was identified in a Toronto nursing home on Tue 27 Sep 2005.  A FRI case is defined as a resident, staff member or visitor with sudden onset of fever with malaise and/or anorexia, with or without runny nose and congestion or cough.

To date, 67/249 (27 percent) residents and 8/290 (3 percent) staff members meet the case definition (these numbers are subject to change); 23 (34
percent) resident-cases and 1 (13 percent) staff-case have been hospitalized. 6 (9 percent) case-residents have died.  Additionally, 3 visitors have been
identified who meet the case definition; 2 of these have been hospitalized and investigated.

Cases are rapidly improving upon initiation of antibiotic therapy. Despite comprehensive preliminary testing for bacterial and viral respiratory
pathogens, no organism has yet been identified. Lung biopsy specimens from deceased cases are undergoing testing. Several prevention and control
strategies have been implemented, and the outbreak appears to be waning, with many cases now improving. There have been new cases reported since midnight 2 Oct [2005]. The risk of transmission to the general public would appear to be minimal.

In terms of the larger picture with respect to the respiratory [illness] season in Canada, we are likely to see many reports of nursing home and other
institutional outbreaks. As is often the case, a proportion of these outbreaks will not have any identifiable etiologic agent. Using increasingly
sophisticated molecular testing techniques, laboratory scientists are able to detect and identify previously unrecognizable viruses, e.g. new coronaviruses and parvoviruses etc. As a result, appropriate risk assessment is an important accompaniment to these reports, especially given the current very wide coverage of respiratory illnesses/outbreaks in the media.



Jeannette Macey
A/Head of Disease Surveillance
Immunization and Respiratory Infections Division (IRID)
Division d'immunisation et des infections respiratoires (DIIR)
Public Health Agency of Canada (PHAC)
Agence de sante publique du Canada (ASPC)
Building #6, AL 0602D, Tunney's Pasture
Ottawa, Ontario K1A 0L2
<Jeannette_Macey TA phac-aspc.gc.ca>


Respiratory illness update

    TORONTO, October. 4 
The respiratory illness at Seven Oaks Home for the Aged has resulted in additional deaths among ill residents, but the
outbreak remains under control, Dr. David McKeown, Toronto's Medical Officer of Health, reported today.

    Dr. McKeown provided the following update:

    -  Since yesterday there have been four additional deaths,for a total of ten in the outbreak.

    -  The outbreak has so far affected a total of 70 residents,12 employees and two visitors at Seven Oaks.

    -  40 residents from Seven Oaks have been admitted to hospital.

    -  The majority of cases are improving but some have worsened as the illness takes its course.

    -  Testing continues to determine the cause of the illness.

    -  Hospitals and their emergency rooms are operating normally.

    "Although the condition of some ill residents has worsened and unfortunately four more have died, others are improving and we are confident
this outbreak is under control," said Dr. McKeown.   

October 5, 2005
Media Advisory - Respiratory illness update

The respiratory illness at Seven Oaks Home for the Aged has resulted in six additional deaths among ill residents, Dr. David McKeown, Toronto’s Medical Officer of Health, reported today.

“The six new deaths are not new cases. All of these elderly individuals had been previously identified as cases and had underlying medical conditions,” Dr. McKeown said. “There have been no new reported cases in the last 24 hours.”

Dr. McKeown provided the following update:

"We are working with staff at the home and the Ministry of Health and Long-Term Care to ensure appropriate measures continue to be in place to control the outbreak," Dr. McKeown said.
 


Mystery illness kills 4 more seniors

October 5, 2005

TORONTO

Four more residents of a nursing home for elderly people have died of an unknown respiratory illness, bringing the number fatally infected to 10, Toronto's chief medical officer said Tuesday.

Dr. David McKeown said the outbreak at the Seven Oaks Home for the Aged has affected 84 residents, employees and two visitors to the nursing home on the outskirts of Toronto.

Health officials have said they have ruled out influenza, avian flu, severe acute respiratory syndrome or SARS, and Legionnaires' disease.


Mystery virus hits Toronto: ten people dead

5 October 2005

Ten people have died from a mystery viral outbreak at a Toronto nursing home and another 40 are in hospital, public health officials said on Tuesday as they raced to contact anyone who visited the home recently.

The outbreak, an unidentified respiratory virus, has sparked memories of the SARS outbreak two years ago that killed 44 people in Canada's largest city.

But health officials said the latest outbreak, which was first detected on September 25, is under control although they warned that more deaths could be expected.

Four new deaths were added to the toll on Tuesday, all of them elderly residents at the Seven Oaks Home for the Aged. All of the dead were aged between 50 years to 95 years.

"Although the condition of some ill residents has worsened and unfortunately four more have died, others are improving and we are confident this outbreak is under control," said David McKeown, Toronto's medical health officer.

Health officials have ruled out SARS, avian flu and influenza and are awaiting lab results, reports the Reuters.


Six more seniors dead from mystery T.O. outbreak

Six more residents of a Toronto seniors' residence home are dead from a mystery respiratory illness, raising the death toll to 16.

"It's obviously something new," infectious disease specialist Dr. Neil Rau  told CTV News. "It's either a new virus, or it's a play on an old virus that's become a little more virulent to the point of causing very significant disease in elderly people."

Toronto's medical officer of health, Dr. David McKeown, said there have been no new reported cases in the last 24 hours.

Public health officials say the cause for the outbreak at the Seven Oaks Home for the Aged in the city's east end remains unknown but that they are continuing testing. However, they maintain that the situation is under control.

"I think that if in a week we can't figure this out, it's time to get some international help," Dr. Rau said.

"What we are seeing is a pretty virulent pathogen that is causing this outbreak," said Dr. Donald Low, medical director of the public health laboratories branch in the Ministry of Health, appearing on CTV Newsnet.

Low has analyzed tissue samples from one of the victims who just died. Health officials have have ruled out influenza, avian flu, SARS (severe acute respiratory syndrome) and Legionnaires' disease.

"So our task right now is to find out...what the cause is," Low said. "And that's what we are doing... literally working day and night with clinical specimens to find out what is causing this."

A total of 38 people are in hospital; 34 of them are residents, two are staff, and two are visitors to Seven Oaks.

Since the outbreak began on Sept. 25, 70 residents, 13 employees and five visitors have become ill.

"The majority of cases are improving but some have worsened as the illness takes its course," a statement released by the city's public health officials said Wednesday.

"What is reassuring, despite the fact that the number of deaths are going up is that the number of new cases per day is dropping," said Dr. Rau. "We have to watch a little longer, but it looks like that is a favourable trend."

Ontario Health Minister George Smitherman urged caution, saying there is no evidence to suggest the outbreak has spread beyond the seniors' home.

Smitherman noted Wednesday that respiratory illnesses afflicting vulnerable patients such as seniors are not uncommon.

"These are not circumstances that are new," he said. "We're struggling with circumstances like this always in the institutional environment."

Dr. Low agreed, saying such outbreaks have been around for decades.

"It is just now that we have the technology that we can actually identify them, and hopefully actually tell you what is causing them," he said.

Anxiety over the outbreak has been aggravated by fears of SARS in Toronto, a city still reeling from the effects of the respiratory illness.

In 2003, two SARS outbreaks in the Toronto area killed 44 and sickened hundreds. Worldwide, more than 8,000 people contracted the illness and 774 people died.

Meanwhile, the Greater Toronto Hotel Association has released a confidential memo to hotels in the city, urging them to be on alert that visitors and foreign media may pick up on the story and draw unwarranted comparisons to the SARS outbreak.

Among a list of bulleted recommendations, officials are warned that speaking out on the issue may make them appear "defensive."

"The only threat here is if people get carried away with hysteria (or if the outbreak escalates significantly, but there appears no reason to suspect it will)," the memo says.'

"We can inform anyone who asks that we are monitoring the situation closely. Of course we can't appear to be dismissing it out of hand.

"But the biggest threat to tourism is not a respiratory outbreak, it's a hysteria outbreak. That's what we need to contain. We certainly do not want to make any comments that refer to SARS or "last time."

Hotel officials are urged to limit any comment to the theme: "Toronto is one of the safest cities in the world, and that's as true today as ever."

The memo follows in the footsteps of increasingly intense media coverage on the outbreak.

The city's tourism and hospitality industry was hard hit by the SARS crisis after the World Health Organization put Toronto on a list of areas fighting SARS in 2003, thus driving away potential tourists leery of becoming infected


Mystery Illness Kills 16 People In Toronto

 October 5, 2005
 
TORONTO

A deadly outbreak of a respiratory illness at a Toronto nursing home for the elderly has claimed six more lives, raising the death toll to 16, health officials said Wednesday.

The cause of the outbreak at the Seven Oaks Home for the Aged remains unknown, although officials insisted the situation was under control. Thirty-eight people remained hospitalized with the illness, and officials fear many of them are too frail to fully recover. Another 88 residents, employees and visitors have been affected.

Public health officials have said it may never be possible to determine the exact type of bug responsible for the rash of illnesses, but they have ruled out influenza, avian flu, SARS and Legionnaires' disease.


Health minister urges Ontarians to get flu shot after seniors' home outbreak at 15:05 on October 5, 2005, EST.

5 October 2005

TORONTO
A deadly outbreak of a respiratory illness at a Toronto seniors' home is a grim but timely reminder that Ontario residents should get their free flu shot this year, Health Minister George Smitherman said Wednesday.

The mysterious illness at the Seven Oaks Home for the Aged has killed 10 people and affected more than 80 others, but Smitherman said he's confident the outbreak is contained and under control. Even though the cause of the outbreak is unknown, Smitherman said it highlights the need for people to take necessary precautions to stay healthy.

"It really does help to remind people that as relates to the flu, it's serious, and accordingly we really need to encourage people to take advantage of those free flu vaccines," he said, noting that not all provinces offer free flu shots to residents as Ontario does.

People should also remember that a simple act like proper handwashing can also prevent the spread of illnesses, Smitherman said.

The minister said there's no evidence to suggest the outbreak has spread beyond the Seven Oaks home, but he noted that respiratory illnesses are common among vulnerable groups of people like seniors.

"These are not circumstances that are new," he said. "We're struggling with circumstances like this always in the institutional environment."

"But I do feel that lessons have been learned from SARS have been well-applied here."

The outbreak is being carefully monitored by public health officials, Smitherman said.

"Of course we're monitoring it vigorously," he said. "I'm very confident that the steps that have been taken are the appropriate ones."


Date: Fri, 7 Oct 2005 09:27:16 -0400
From: Susan Squires <susan_squires1 TA phac-aspc.gc.ca>
Source:  Jeannette Macey, Susan Squires, Ottawa, Public Health Agency of  Canada, & Erika Bontovics, Toronto, Ontario Ministry of Health and Long-term
Care [edited]


Since 2 Oct 2005, no new cases of FRI (febrile respiratory illness) have been identified in connection with a respiratory outbreak in a Toronto nursing home. A FRI case is defined as a resident, staff member or visitor with sudden onset of fever with malaise and/or anorexia, with or without runny nose and congestion or cough.

In total, 93 cases, including 16 deaths, have been identified to-date.  The case breakdown is as follows:  70 residents, 16 staff and 7 visitors.  All deaths have occurred in residents of the nursing home.  Cases are rapidly improving upon initiation of antibiotic therapy.

Autopsy specimens were received from 7 patients through the coroner's office and tested by the Central Public Health Laboratory in Toronto.  All were tested for _Legionella pneumophila_ by DFA and culture. To-date specimens from 3 deceased patients are positive for _L. pneumophila_.  Culture results on the other 4 deceased patients are pending.
 


A masked health care worker greets an unidentified women who came to the front doors of Seven Oaks Home for the Aged.

As a result of this ongoing surveillance, outbreaks are regularly detected, especially during the influenza/respiratory season, which we are now entering in Canada.  The 1st outbreak of laboratory-confirmed influenza for the 2005-2006 season was reported in a long-term care facility (LTCF) elsewhere in the country last week, and other common respiratory viruses are circulating as well. 
(see Canada's weekly FluWatch surveillance report at: <http://www.phac-aspc.gc.ca/fluwatch/index.html> )

In terms of the larger picture with respect to the respiratory [illness] season in Canada, we are likely to see many reports of respiratory outbreaks in nursing

homes and other institutions.  As is often the case, a proportion of these outbreaks may not have any identifiable etiologic agent.  Using increasingly sophisticated molecular testing techniques, laboratory scientists
are able to detect and identify previously unrecognizable pathogens, e.g. new coronaviruses and parvoviruses etc.  As a result, appropriate risk assessment is an important accompaniment to these reports, especially given the current wide media coverage of respiratory illnesses/outbreaks.

Toronto Public Health News Release:

http://wx.toronto.ca/inter/it/newsrel.nsf/bbe889573b1b4bc585256a9d00589271/63b4e996664a64d18525709200753944?OpenDocument

Susan Squires
Senior Epidemiologist
Immunization and Respiratory Infections Division (IRID)
Division d'immunisation et des infections respiratoires (DIIR)
Public Health Agency of Canada (PHAC)
Agence de santa publique du Canada (ASPC)
Building #6, AL 0602D, Tunney's Pasture
Ottawa, Ontario  Canada K1A 0L2
susan_squires1 TA phac-aspc.gc.ca

[ProMED-mail would like to thank Dr. Squires and the Public Health Agency of Canada for sending this update on the outbreak in Toronto.  The last paragraph is a very accurate and astute assessment of the situation most departments of health in the northern hemisphere are facing at this time of year and moving forward.

With the current concerns regarding when and where the next influenza pandemic will arise (and in the shadow of the SARS epidemic in 2002/2003), and on public health preparedness to both identify the onset of the pandemic early as well as to develop and implement control measures rapidly, there is a heightened focus of the media on coverage of outbreaks of febrile respiratory illness.  This current outbreak came to the attention of the media because it was "different" from the majority of febrile respiratory illness outbreaks in long-term care facilities, and in fact, the etiologic agent turned out to be _Legionella pneumophila_.


October 6, 2005
Statement by Dr. David McKeown, Medical Officer of Health
Announcement re: Respiratory Outbreak at Seven Oaks Nursing Home


Laboratory testing on autopsy specimens from three residents of Seven Oaks Home for the Aged were reported this afternoon as positive for Legionella pneumophila, the bacterium that causes Legionnaires Disease. This indicates that the cause of the current outbreak is likely Legionnaires Disease.

Legionnaires Disease is a form of pneumonia caused by bacteria formed naturally in the environment, usually in water. The bacteria grow best in warm water such as hot water tanks, large plumbing systems and air conditioning systems. People get Legionnaires Disease when they breath in air contaminated by droplets of water containing the bacteria. Legionnaires Disease is not transmitted from person to person. Most cases can be successfully treated with antibiotics, although older people with underlying health conditions are more likely to become seriously ill and die.

The Legionnaires Disease at Seven Oaks is confined to the nursing home. Because Legionnaires Disease is not transmitted from person to person, there is no risk to the general community.

There have been no new cases of infection for the past two days and it appears that transmission of the illness has subsided. There have been no further deaths.

Further testing will be carried out to confirm these findings. In the meantime Toronto Public Health is taking immediate action to protect the health of residents and staff.
 


The disease that has killed 16 people at a Toronto nursing home has been identified. The current outbreak at the nursing home is likely Legionnaires' Disease, officials said Thu [6 Oct 2005].

3 of the 16 people who died at the 7 Oaks Home for the Aged tested positive for the pneumonia-type illness, Dr. David McKeown, Toronto's medical health officer, told a press conference on Thursday.

Dr. McKeown said there have been no new deaths since Wednesday and it appears that the cases have been waning.

The bacteria that cause the illness are found in water, the health officials said. Legionellosis is not an airborne disease, they said.

Toronto Mayor David Miller emphasized that the city's general population has never been at risk because of the outbreak.

"In identifying the source we are now able to move effectively to address it."All 16 people who died of the respiratory illness that surfaced on 25 Sep [2005] were elderly, and frail from other medical problems. The latest victims were 3 men, who were 75, 84 and 89, and 3 women, who were 85, 92 and 96. In all, 70 residents were affected, along with 13 staff members and 5 visitors.

The name "Legionnaires' disease" came from an illness that swept through a convention in 1976 in Philadelphia. That convention was held by the American Legion of Pennsylvania. Eventually, the bacterium responsible for the disease was isolated and [called] "_Legionella pneumophila_."
Since the until-now mystery illness appeared, officials have taken pains to emphasize that it is in no way comparable to the severe acute respiratory syndrome [SARS] in 2003 that killed 44 people in the city.

On Thursday, Ontario Premier Dalton McGuinty issued a word of caution against those tempted to compare the death of the residents with the outbreak of SARS.
Mr. McGuinty insisted that medical experts have concluded that the [bacterium] was contained and that it posed no threat of spreading.

The Premier insisted that there was nothing unusual about the recent outbreak which was not "dissimilar to what happens from time to time" in long term care homes.


October 7, 2005
Legionnaires' disease investigation continues


Toronto Public Health continues to investigate the Legionnaires' disease outbreak at Seven Oaks Home for the Aged, Dr. David McKeown, Medical Officer of Health, said today.

Results of the environmental investigation are not expected until late next week. Investigators are examining possible sources and samples are being sent to the Ontario Public Health Laboratory.

There have been no new cases of the disease since Tuesday. There has been one additional death, for a total of 17.

A total of 70 residents, 18 staff and nine visitors have been affected by the disease. There are 35 residents, two staff and five visitors being treated in hospital.

Most of those affected are improving and some have been discharged from hospital.

The home remains closed to new admissions and most visitors. The home's ventilation system remains shut down.

Bottled water is being brought in for both the home and the adjacent Seven Oaks Child Care Centre while the onsite water system is shut down for investigation.

Toronto's drinking water remains safe for residents.


 PRESS RELEASE

 

THE RESPIRATORY ILLNESS IN TORONTO HAS BEEN IDENTIFIED: IT CAN BE CURED

 Situation in Toronto now under control

  The Canadian Embassy in Italy notifies that on October 6, 2005, the Health Authorities of the Province of Ontario have identified the respiratory disease as legionaires disease that struck several guests of the Seven Oaks seniors residence in Toronto.

 Moreover, we hereby communicate that:

                     Legionaires disease is a form of pneumonia of bacterial form, not viral, that can be cured by taking antibiotics.

                      Preliminary research results exclude any connection of the illness to SARS or Bird flu.

                      Legionaires disease is not transmitted from human-to-human but comes from direct contact with aircondition systems containing contaminated water.

                     In the past two days there have been no new cases. 

Casualties were limited exclusively to the senior’s residence and there is no risk of contagion among the population. Therefore, please note that there is no danger to travel to Canada. According to the World Health Organisation, other countries have no reason to be concerned.


La legionela causa el brote mortal de Toronto 

8th October 2005

La bacteria de la legionela fue la causante de la muerte de 16 personas mayores durante las últimas dos semanas en una residencia en Toronto (Canadá), según confirmaron ayer las autoridades médicas de esa ciudad. "Las pruebas de laboratorio realizadas en las autopsias de tres residentes resultaron positivas con la bacteria Legionella pneumophila", afirmó ayer el jefe médico de Toronto, David McKeown.

Las autoridades habían afirmado en los últimos días desconocer la causa de la enfermedad respiratoria, aunque habían descartado el Síndrome Respiratorio Agudo y Grave (SRAG) y la gripe aviar.

Hasta la noche de ayer, seguían hospitalizadas 38 de las 88 personas afectadas, entre las que se encuentran residentes, trabajadores y visitantes de la residencia.

El brote de legionela en Toronto es vigilado por la Organización Mundial de la Salud (OMS), a pesar de que las autoridades de la provincia han seńalado que este tipo de infecciones "son normales en residencias de ancianos y ya está controlado".


Canadá: La legionella es la posible causa de la muerte de 16 ancianos en Toronto

7 October 2005

Las autoridades médicas de Toronto han seńalado este viernes que creen que la legionella es la causante de la muerte de 16 personas que vivían en una residencia de ancianos de la ciudad.

"Las pruebas de laboratorio realizadas en las autopsias de tres residentes de la residencia Seven Oaks han resultado positivas con la bacteria que causa la enfermedad del 'legionario'", ha afirmado David McKeown, jefe médico de Toronto.

El sanitario ha ańadido que "esto indica que la causa del actual brote en la residencia de ancianos es probablemente la enfermedad de la legionella".

Desde el pasado 25 de septiembre, más de 70 residentes de Seven Oaks, 13 trabajadores de la institución y varios visitantes han contraído una infección respiratoria que ha causado la muerte, hasta el momento, de 16 personas.

Esta información contradice a los responsables médicos de la ciudad y de la provincia de Ontario que habían concluido que la enfermedad no estaba causada por la gripe aviar, el virus de la gripe o la legionella.
 


La légionellose ŕ l'origine de 16 décčs ŕ Toronto
Vendredi 7 octobre 2005

Les autorités médicales de Toronto ont annoncé jeudi en fin de journée que la mystérieuse infection respiratoire ayant coűté la vie ŕ 16 personnes âgées d'un foyer de Toronto était en fait la maladie du légionnaire ou légionellose.

"Les analyses de laboratoire effectuées ŕ partir des autopsies de trois résidents de la maison "Seven Oaks Home for the Aged" sont positives en ce qui concerne la "legionella pneumophila", la bactérie qui cause la maladie du légionnaire", a déclaré le chef du service de santé de Toronto, le Dr David McKeown.

"Parce que la maladie du légionnaire ne se transmet pas de personne en personne, la population ne court aucun risque", a-t-il rassuré en précisant "qu'aucun nouveau cas d'infection au cours des trois derniers jours" n'a été répertorié et "qu'il n'y a eu aucun nouveau décčs" depuis mercredi.

Trente-huit personnes étaient toujours hospitalisées jeudi, selon les responsables des services de la santé publique de Toronto.

Au total, 70 résidents, 13 employés et cinq visiteurs du "Seven Oaks Home for the Aged" ont été contaminés depuis la découverte du virus le 25 septembre.

"Ces résultats sont préliminaires. Nous allons continuons d'effectuer des recherches dans d'autres directions, mais nous pensons bien avoir affaire avec la maladie du légionnaire", a indiqué Donald Low, membre du laboratoire de santé publique de l'Ontario.

La "maladie du légionnaire" est une infection respiratoire provoquée par une bactérie hydrophile, qui se développe dans les systčmes de climatisation ou les douches mal désinfectées et touche particuličrement les personnes âgées. Ses symptômes ressemblent ŕ ceux de la grippe: nausées, fičvre et perte d'appétit.

Le foyer "Seven Oaks", qui héberge habituellement 249 personnes, ne sera pas fermé, le systčme de climatisation a été débranché, de l'eau en bouteille de męme que des antibiotiques préventifs ont été distribués aux résidents et au personnel de l'établissement, a précisé M. Low en ajoutant que la source de la bactérie n'est pas encore connue.

"Il n'y a pas et il n'y a jamais eu de menace pour le grand public ŕ Toronto", a affirmé le maire de la ville, David Miller.

"Nous avons bénéficié des leçons tirées du passé", a-t-il poursuivi dans une référence ŕ la crise du SRAS (syndrome respiratoire aigu sévčre), qui avait fait 44 morts en 2003 dans le centre financier du Canada.

Vendredi, les autorités avaient fait part des quatre premiers décčs dus au mystérieux virus respiratoire. Le nombre est ensuite passé ŕ six dimanche, dix mardi et 16 mercredi.

Cette épidémie rappelait de pénibles souvenirs aux cinq millions d'habitants de la métropole économique du Canada, oů la pneumonie atypique avait tué 44 personnes en 2003 et provoqué un grave ralentissement économique.

"Il ne s'agit pas du SRAS", avait cependant déclaré mercredi ŕ la presse un haut responsable de la santé, le Dr David McKeown.

"L'épidémie étant confinée aux résidents, aux employés et aux personnes associées de prčs ŕ cette institution, il n'y a donc pas de risque pour la santé publique", a-t-il insisté.

Les six personnes dont la mort a été annoncée mercredi luttaient déjŕ depuis quelques jours contre la bactérie et avaient également d'autres problčmes de santé, a précisé le Dr McKeown dans un communiqué. Ces personnes, trois hommes et trois femmes, étaient âgées entre 75 et 96 ans.

Les autorités avaient noté mercredi qu'aucun nouveau cas d'infection n'avait été signalé dans les 24 derničres heures.

Jeudi, trente-quatre personnes âgées, deux employés et deux visiteurs étaient toujours traités en isolement dans des hôpitaux de Toronto.

L'état de santé de la majorité de ces personnes s'améliore, mais se dégrade pour certains, avaient indiqué mercredi le Dr McKeown sans précision.

"Nous sommes maintenant confiants de pouvoir contrôler l'épidémie", avait-il déclaré, en soulignant que le nombre de nouveaux cas signalés n'avait cessé de diminuer depuis le 29 septembre, signe, selon lui, que la maladie régresse.


Decedute 16 persone in una casa di riposo a Toronto, 38 in ospedale
Canada: il virus «misterioso» č la legionella

In realtŕ č un batterio responsabile del morbo del legionario, č conosciuto ed č trattabile con antibiotici

TORONTO - Le autoritŕ sanitarie canadesi tirano un sospiro di sollievo: il virus misterioso che ha ucciso sedici persone in una casa di riposo (e altre 38 restano ricoverate in ospedale) č quasi certamente la legionella: quindi non un virus ma un batterio. Perciň qualcosa di conosciuto, anche se molto pericoloso in quanto provoca il mortale «morbo del legionario». Lo ha comunicato il dottor David McKeown, responsabile sanitario di Toronto. Due analisi su tessuti prelevati da persone decedute hanno dato questo risultato e una terza l'ha confermato. Analisi precedenti, effettuate sulle urine di persone che avevano contratto il morbo, non avevano, perň, dato risultati positivi. Ulteriori accertamenti sono in corso.

Č UN BATTERIO - Fra i sintomi del morbo del legionario vi sono febbre, brividi, stanchezza, mal di testa, dolori muscolari e perdita d'appetito. A Toronto si verificano in media quattro-dieci casi all'anno di morbo del legionario. Si tratta di una malattia di natura batterica e, dunque, trattabile con gli antibiotici. La malattia non si trasmette da persona a persona e quindi le minacce di epidemia sono rientrate. Nel corso di una conferenza stampa delle autoritŕ sanitarie di Toronto č stato comunicato che nelle ultime 24 ore non si sono registrati nuovi decessi né si sono manifestati nuovi casi, anche se molti anziani ricoverati sono in gravi condizioni. Non č chiaro come il morbo abbia attaccato la casa di riposo ma, come hanno ricordato i sanitari, il batterio vive molto bene nell'acqua. Spesso sono stati contaminati gli impianti di aria condizionata.
 
07 ottobre 2005

Friday 2005-10-07, Nepszabadsag (Hungarian)

A "legionárius betegség" okozta a rejtélyes járványt Kanadában

Több napi vizsgálatok után a kanadai egészségügyi hatóságok kiderítették, hogy legionárius megbetegedés végzett egy torontói nyugdíjasotthon 16 lakójával - közölték csütörtökön a kanadai nagyváros illetékesei.

A kór a múlt hét végén ütötte fel a fejét, és a szakemberek laboratóriumi vizsgálatok sorozatával sem tudták kideríteni azt, hogy milyen vírus okozza a Seven Oaks Home for the Aged nevű  intézetben a lakók, az ápolók és a látogatók megbetegedését, illetve az élemedett korúak halálát. Kizártnak tartották azonban, hogy madárinfluenza vagy atípusos tüdőgyulladás lenne a járvány oka, sőt idesorolták a legionárius megbetegedést is.

Az egyik legutóbbi teszt azonban kimutatta a legionella pneumophila vírust. Így bizonyossá vált, hogy mégiscsak a legionárius megbetegedés okozta a járványt, amely egyébként csak a  nyugdíjasotthonra korlátozódott.

Ezt a betegséget, tudományos nevén: legionellózist egy philadelphiai szállodában 1976-ban amerikai legionáriusok által rendezett nagygyűlés kapcsán ismerték fel. A 4400 résztvevő közül 182-en tüdőgyulladás tüneteivel megbetegedtek, és 29-en meg is haltak. Mint később megállapították: a gyilkos vírus a légkondicionáló páradúsítójából került a levegőbe.

A fertőzés emberről emberre nem terjed, így már nem kell tartani attól, hogy a napokig rejtélyesnek bizonyult kór egy tömeges méretű járvány kitörésének veszélyét jelentheti.


Dřr av mystisk sykdom i Canada

En mystisk sykdom i Canadas střrste by Toronto har tatt fire nye liv.

Onsdag 05.10.2005,

Totalt er 10 mennesker dřde av den mystiske sykdommen.

Mens man fortsatt leter etter ĺrsaken til dřdsfallene, sier helsemyndighetene at det kan bli svćrt vanskelig ĺ finne ut av den eksakte typen virus elle bakterie som er ansvarlig for sykdommen.

 De har imidlertid utelukket influensa, fugleinfluensa, SARS og legionella. Flere obduksjoner har blitt gjort, men de har ikke gitt svar.

Sykdomsutbruddet startet forrige uke pĺ et pleiehjem, og 84 mennesker har hittil blitt smittet.

Flesteparten av de smittede er beboere, men ogsĺ flere pleiere og to besřkende er blitt syke. 40 mennesker er blitt innlagt pĺ sykehus, ifřlge Torontos helsesjef, Dr. David McKeown.


Toronto, 08 ottobre 2005 - 09:00

CANADA: MORBO LEGIONARIO, SALE A 17 BILANCIO DEI MORTI

E' salito a 17 il bilancio delle morti alla casadi cura per anziani Seven Oaks di Toronto. Gli inquirenti continuano a indagare sui decessi, la cui causa, apparsa misteriosa per giorni, e' stata identificata nel morbo del legionario, una malattia causata dalla Legionella, un gruppo di oltre 40 batteri che, a causa della sua forte resistenza agli antibiotici, puo' dare luogo a forme di polmonite molto gravi e addirittura letali. La malattia prende il nome dal raduno a Fidadelfia dell'American Legion nel 1976, quando si manifesto' per la prima volta, e si trasmette facilmente attraverso il sistema di aerazione. Alla Seven Oacks non sono stati registrati altri casi tra i 70 pazienti, i 12 membri del personale e le altre due persone che hanno visitato il centro, anche se 42 persone rimangono sotto osservazione medica.


Legionnaires' nursing-home outbreak claims 17th victim

8th October 2005

A deadly outbreak of legionnaires' disease has claimed its 17th victim at an east-end nursing home, but health officials insist the outbreak is contained and that it is very unlikely new cases will arise.

Yesterday, David McKeown, Toronto's Medical Officer of Health, confirmed that an 89-year-old woman who had been a resident at Seven Oaks Home for the Aged in Scarborough has succumbed to legionnaires' disease.

The illness is a rare form of pneumonia that can only be contracted by inhaling water droplets contaminated by legionella bacteria and can't be spread from person to person.

The death toll from the outbreak stands at 17, with 70 residents, 18 staff members, and nine visitors having been affected

A deadly outbreak of legionnaires' disease has claimed its 17th victim at an east-end nursing home, but health officials insist the outbreak is contained and that it is very unlikely new cases will arise.

Yesterday, David McKeown, Toronto's Medical Officer of Health, confirmed that an 89-year-old woman who had been a resident at Seven Oaks Home for the Aged in Scarborough has succumbed to legionnaires' disease.

The illness is a rare form of pneumonia that can only be contracted by inhaling water droplets contaminated by legionella bacteria and can't be spread from person to person.

The death toll from the outbreak stands at 17, with 70 residents, 18 staff members, and nine visitors having been affected

Health officials repeated yesterday that the outbreak is nearing an end, with no new cases identified since Tuesday.

"There are no new cases, and that suggests this is a one-time event that is now finished," said Allison McGeer, an infectious disease consultant at Mount Sinai Hospital.

Dr. McGeer said that Toronto usually sees between three and 10 cases of legionnaires' disease each year.

Officials added that investigators will work through the weekend to locate the source of the bacteria that caused the outbreak. Water and environmental samples were taken from the Seven Oaks facility yesterday for testing.

Results of that investigation, which began on Thursday, are not expected until late next week.

"We're very carefully monitoring it and looking for sources all around the building," said Barbara Yaffe, Director of Communicable Disease Control. "But it's very unlikely that [the disease] will pop up sporadically somewhere else to this extent."

In total, 35 residents, two staff members, and five visitors are recovering in hospital. Numerous other residents with less-severe symptoms are recovering at the nursing home.

Most of them have been treated with antibiotics, health officials said.

Dr. McGeer played down any concern that the disease might somehow spread from affected patients to hospital workers and other members of the public.

"[It] is not an issue for anybody else living in Toronto or any other health-care institutions, and it's not a communicable disease," she said.

"So we don't have to worry about transmission to staff or to other residents or within the community."

On Thursday, 10 days after the first patient began suffering symptoms, autopsy results revealed that three of the deaths at the home were likely the result of legionnaires' disease, which originates from bacteria that colonizes in warm, stagnant water.

The disease spreads when droplets of water bearing the bacteria are transmitted by wind or an air current, then inhaled. Symptoms include coughing and fever, and the illness does the most harm to elderly people, especially those with pre-existing respiratory conditions.

"This looks like what we call a point-source outbreak, a single event that aerosolized large concentrations.

"And the reason you see a distribution of cases is because the incubation period is variable from person to person," Dr. McGeer said.

"It could have come from something distant to the facility, it could have happened within the facility -- there's a fairly large number of possibilities where the bacteria might have come from."

One possibility being investigated is that the bacteria somehow made its way into the ventilation system of the Seven Oaks home.

As a precaution, the home's ventilation and water system have been shut down while inspectors try to find the source of the bacteria.

Bottled water is being brought in for both the home and the adjacent Seven Oaks Child Care Centre and the home remains closed to new admissions and most visitors, Dr. McKeown said.

"I want to emphasize this is purely a local precaution and that Toronto's drinking water remains entirely safe for residents in the city," he said.


Legionnaires' investigation continues

October 11, 2005

Dr. David McKeown, Medical Officer of Health, said today that Toronto Public Health continues to investigate the Legionnaires' disease outbreak at Seven Oaks Home for the Aged.

Dr. McKeown provided the following update:

  • The Home's water supply has been flushed and is safe to use. It was returned to service on Monday evening.
  • The Home's air exhaust system has been inspected and returned to service.
  • The Home's air intake system is still being examined and remains shut down.
  • Environmental investigation of both the interior and exterior of the Home continues and test results are expected at the end of this week.
  • There have been no new deaths since Friday, October 7.
  • There have been no new cases with onset of illness after Wednesday, October 5.
  • A total of 71 residents, 23 staff and 14 visitors have been affected by the disease.
  • Most of those affected continue to improve.
  • The Home remains closed to new admissions and most visitors.

Media Advisory - Legionnaires' Disease update

13 October 2005

Dr. David McKeown, Toronto's Medical Officer of Health, reported late yesterday that testing by the Ontario Public Health Laboratory has identified two additional cases of Legionnaires' Disease in the vicinity of Seven Oaks Home for the Aged.

The two cases occurred during the height of the outbreak two weeks ago and both appear to have been exposed to the disease outside the Home. The individuals live or work in the immediate vicinity of Seven Oaks.

The investigation for a possible source of the illness continues. There is no evidence of any continuing risk of exposure to Legionnaires' Disease.

There have been no new cases with onset of illness since October 5 and no deaths since October 7.


Two new cases of legionnaires' disease in Toronto

14 October 2005

Health officials are investigating two new cases of legionnaires' disease they believe are linked to the deadly outbreak that killed 17 people at a Toronto nursing home.

Late Wednesday, Toronto's Department of Public Health confirmed that they have identified two people with legionnaire's disease.

According to Toronto's medical officer of health, the two sick individuals never visited the Seven Oaks Home for the Aged, but fell ill at the peak of the deadly outbreak that was centred there.

"They have never been inside the (Seven Oaks) home," Dr. David McKeown told CTV News. "Because of the timing we think they have the same source -- our investigation is focused on trying to locate that source."

Even though the new cases suggest the disease was not confined to the east end nursing home, McKeown was emphatic there is no cause for alarm.

"I think we're dealing with the same source and the same outbreak. So I'm not concerned that we're dealing with an ongoing risk."

Nevertheless, the city's top doctor says officials have to take every case related to the deadly outbreak very seriously.

"This has been a very challenging outbreak with 17 deaths, we take the situation very seriously. Our investigation is continuing to try to get to the root."

The outbreak at Seven Oaks began in late September and sickened 71 residents, 23 employees and 14 visitors to the nursing home.

There have been no new deaths since Friday, but the home remains closed to new admissions and most visitors.


Why did test fail to detect disease?

Ontario's health lab was warned five years ago that the test they were using for detecting legionnaires' was flawed, says an American expert on the disease.

"We stumbled onto the fact that it wasn't very good, and we told them," Dr. Victor Yu told the Star last night. Yu, of the University of Pittsburgh, was a visiting professor at an Ontario medical school at the time.

The urine test used in Canada did not detect the disease in patients from a Scarborough nursing home two weeks ago. Seventeen died from the outbreak.

"The test failed us," admitted Dr. Donald Low, medical director of the Ontario Public Health Laboratories, in an interview yesterday.

"We've got to find out why did it fail."

Reached last night, Low could not confirm Yu's assertion because he only started with the lab in July.
The urine test was developed in Canada and had worked successfully up until the second week of September, Low said.

"We'll find out what went wrong, but we don't think it was anything done procedurally," he said. "It could be this is a strange subgroup of legionella bacteria and this test might not be detecting it."

Toronto officials began testing 40 urine samples for legionnaires' on Saturday, Oct. 1, the day after the outbreak began at the Seven Oaks Home for the Aged, but every one came back negative, Low said.

"That was worrisome. Legionnaires' is a difficult diagnosis to make."

Then lung, kidney and heart tissue from autopsies on five of the 17 who died were sent for testing and positive results for legionnaires' came back days later, said Ontario's Deputy Chief Coroner Dr. Jim Cairns. Once those came back positive, they started to look at why they were positive and the other tests were negative, he said.

"When we took the specimens — and those (in the lung) are the best specimens — it was not thought at the time we were taking them to find legionnaires' disease," he said.

Low said he is confident that no patients suffered or died because of the time lag, because they were all put on antibiotics used to treat legionnaires', and other things.

"It didn't interfere with the management of the patients, but it (not knowing) did interfere," he said. "If we had had an answer on Saturday, it would have put the public's mind at rest as well as the international press."

After the positive results for legionnaires' came back, Low began trying to get a newer, more sensitive Binax test, which is not approved yet in Canada.

Twenty-two kits were shipped here from Calgary Laboratory Services last Saturday but because of the Thanksgiving holiday, there was a shipping delay and they arrived Tuesday, he said.

They revealed that two more patients had legionnaires', neither of whom had ever been in Seven Oaks, but lived or worked within a few minutes' walking distance of it.

Low also contacted a number of his colleagues in the U.S. for help in locating more of the Binax tests.

The Binax company specializes in rapid test kits that identify respiratory infections; in the late 1990s, its NOW Legionella Urinary Antigen Test was cleared by the U.S. FDA.

Low has managed to get 100 more kits shipped from the Mayo Clinic and Johns Hopkins University.

"We'll test all the people who fit the case definition in the nursing home and beyond that," Low said.

Public health officials are collecting cultures from water and soil to try to find the cause but it could take up to 10 days to get the results, he said. In past outbreaks, legionella has been linked to mist machines in grocery stores, water filters and cooling towers. In one case, the infection occurred a kilometre from the original site.

But Low said he's confident the problem that caused the outbreak has come and gone because no new cases have been detected in the past six days, which "suggests a point source outbreak and a large number of people were exposed to the pathogen. We got a burst of legionnaires' into the environment and then it went away."

The pattern indicates "a single short-term event sometime between Sept. 18 and 24," a source said, "and whatever produced the concentration of legionella bacteria was probably gone before the first case appeared on the 25th. The risk to anyone was actually over before the illness started."

Public health officials aren't surprised two cases popped up later because they were "anticipating that the problem was in some way airborne," the source said. "While very obviously the highest concentrations were at Seven Oaks, it would be surprising if a few people in the immediate vicinity were not affected," the source said. "These two are the only two identified so far with pneumonia, and people have been looking quite intensively."

Finding the two cases doesn't fundamentally change the list of potential sources people are looking at, the source said. There is still a "small residual risk" of more illness but they "won't know for sure until the investigation is over," the source said.

"So far, everything suggests the problem is gone, but it isn't for sure for a while."

The Binax test has yet to be approved in this country, said Nathalie Lalonde, spokesperson for Health Canada. In order for approval to be fast-tracked, the U.S. company has to submit a priority review request to Health Canada, she said, "and that has not been done."

 

Yu compared the Binax and Canadian legionnaires' tests, saying "this particular case was the Lexus versus a Camry, I think. Or a Corolla."

Dr Yu's Home Page

Ontario warned years ago, expert says

October 14, 2005

TORONTO -- Ontario's provincial health laboratory was warned more than five years ago the in-house test it developed to detect legionnaires' disease wasn't sensitive enough, the U.S. expert who issued the caution said yesterday.

True to Dr. Victor Yu's warning, the same test failed to detect legionella pneumophila as the source of the outbreak at the Seven Oaks nursing home that has claimed 17 lives in Toronto.

After the lab detected the bacteria in lung tissue taken during autopsies from some of the victims of the outbreak, a commercially available test confirmed the outbreak was indeed legionnaires' disease.

Yu, a legionnaires' expert at the University of Pittsburgh, said he warned the lab a number of years ago its test wasn't accurate enough.

At the time, Yu was at an Ontario medical school as a visiting professor. He diagnosed a patient as suffering from legionnaires' but was told the provincial lab had run its test and ruled out the disease.


Ontario Government Announces Independent Review Of Legionnaires' Disease Outbreak

    Dr. David Walker To Lead Review Of Outbreak
TORONTO, 17 October 2005 
An independent review of the legionnaires' disease outbreak in Toronto will be conducted by Dr. David Walker, Minister of
Health and Long-Term Care George Smitherman announced today.

"The legionnaires' disease outbreak was a tragedy that affected some of our most vulnerable citizens," Smitherman said. "I believe that Toronto Public
Health has done a good job in managing this outbreak. We now need to look closely at what worked and what improvements need to be made, and apply any
new lessons quickly."

    Dr. David Walker is currently the Dean, Faculty of Health Sciences at Queen's University. Dr. Walker chaired the expert panel on SARS and Infectious
Disease Control. This experience makes him a suitable candidate to evaluate actions taken during this outbreak, assess whether or not relevant lessons
learned from SARS were applied, and identify what can be learned from this experience in order to manage and respond to future outbreaks.
    
"I am pleased that someone of Dr. Walker's stature has agreed to take on this very important task," said Dr. Sheela Basrur, Ontario's Chief Medical
Officer of Health. "His experience with SARS will be invaluable."
   
 Dr. Walker's review will examine response times, processes, communication and co-ordination between the various organizations that were involved in the
management of the outbreak. These organizations include the Ministry of Health and Long-Term Care, the Ministry of Community Safety and Correctional
Services, Toronto Public Health, Toronto Emergency Medical Services, Seven Oaks Home for the Aged, and area hospitals.
    
Dr. Walker will begin his review immediately, with the final report presented to the public and the minister before the end of the year.

Cooling tower source of Legionnaires' outbreak
21 October 2005
Dr. David McKeown, Toronto's Medical Officer of Health, announced today that the source of the Legionnaires' Disease outbreak at Seven Oaks Home for the Aged has been identified as the 
air conditioning cooling tower on the roof of the Home.

Dr. David McKeown, Toronto's Medical Officer of Health, announced today that the source of the Legionnaires' Disease outbreak at Seven Oaks Home for the Aged has been identified as the 
air conditioning cooling tower on the roof of the Home.

"The source was confirmed earlier today by the Ontario Public Health Laboratory based on environmental samples collected by Toronto Public Health investigators," Dr. McKeown said. "
The cooling tower has been turned off since October 6, 2005, the day we learned that Legionnaires' was the cause of the outbreak. There is no risk to the public from this source since that time." 

Lab tests showed that the cooling tower contained the same legionella bacterium found in samples taken from residents. An air intake is located near the cooling tower. Droplets containing the
 bacterium were spread through the Home by the air handling system. The disease then affected a vulnerable population of elderly residents as well as staff and visitors.

A total of 20 residents have died and 127 people have become ill from Legionnaires' Disease

Source of legionnaires' disease outbreak found; 3 more deaths 
October 21 2005

The cooling towers of the airconditioning system of the Seven Oaks nursing home in Scarborough was the source of the legionella bacteria that have now killed 20 people, public health authorities said Friday.

"We feel confident that this is the source of the outbreak," said Dr. Donald Low, director of Ontario's public health laboratory.

Three people have died in recent days and eight people are still being treated for the disease. Low says they are improving.

Since September, the bacteria have infected more than a hundred people with legionnaires' disease.

All the people who died, and most of those who became infected, lived at the Seven Oaks Home for the Aged. The others either worked at the seniors home or had visited the facility recently. Four lived nearby.

The fact that people outside the building were infected led investigators to the facility's rooftop air conditioners.

Toronto's Medical Officer of Health Dr. David McKeown says the tower has been shut down since Oct. 6 and there is no current risk to the public.

The province has ordered an independent review of the outbreak.


Toronto outbreak kills 3 more

21 October 2005

TORONTO

Three more people have died from an outbreak of legionnaires' disease that investigators confirmed Friday originated in the cooling tower of a Toronto nursing home.

Toronto health officials said droplets were distributed into the air by the cooling system on the roof of the Seven Oaks Home for the Aged in the city's east end and then sucked into the ventilation system's air intake. "The bacteria causing the disease was spread through a very vulnerable population of elderly residents with tragic results," Dr. David McKeown, Toronto's medical officer of health, told a news conference.

"From what we know at this point, there's no evidence that the cooling tower was not properly maintained."

The latest three people to die were all elderly residents of the home with a median age of 90 and pre-existing health conditions, officials said.

Health officials ordered the cooling tower shut down Oct. 6 when the disease was detected, and McKeown said there's been no risk to the public since that time.

"This outbreak stands as one of the most significant events on record involving legionnaires' disease and we will be very diligent in reviewing our work and identifying important lessons learned."

A separate, independent review of the outbreak is also being conducted by Dr. David Walker, who also chaired an expert panel on Toronto's deadly SARS outbreak two years ago.

Walker will evaluate the city's response to the latest outbreak and determine whether lessons learned from the 2003 SARS outbreak were applied.

So far, 20 people - all of whom were elderly with underlying health conditions - have died as a result of the outbreak, which began late last month. The investigation is continuing, but there's no evidence the building's cooling tower was not properly maintained.

All told, there have been 127 cases of legionnaires' disease, including 67 residents, 30 staff and 26 visitors.

Another four people who live or work in close proximity to Seven Oaks Home for the Aged have also contracted the disease, likely infected by droplets that escaped the building through the cooling tower.

 


Lawsuit Launched in Toronto's Legionnaires' Outbreak
Oct, 25 2005

TORONTO
A lawsuit is being launched following the deadly outbreak of Legionnaires' disease in Toronto.

The suit alleges officials were negligent in their efforts to find the source of the outbreak at the Seven Oaks Home for the Aged where 21 people have died.

The suit names the nursing home, the city and the province.

H o t z      L a w y e r s  

Seven Oaks and Community Lawsuit


Toronto: la climatisation ŕ l'origine de la légionellose
21 October 2005
Une tour de conditionnement de l'air sur le toit du centre pour personnes âgées Seven Oaks, ŕ Scarborough, est ŕ l'origine de la flambée de la maladie du légionnaire, 
une infection respiratoire, ŕ la fin septembre.
C'est ce qu'a affirmé le bureau de santé publique de Toronto, qui a fait part des résultats de son enquęte, vendredi, aprčs plus d'une semaine d'analyses

Les autorités ont ordonné l'arręt du systčme de climatisation du centre le 6 octobre dernier, au moment oů l'on apprenait que la maladie du légionnaire était ŕ l'origine du décčs de plusieurs pensionnaires. Il n'y a donc plus de risque de propagation de la maladie par cette source, a précisé le responsable des services de santé de Toronto, le Dr David McKeown, dans un communiqué.

La bactérie a fait 20 morts ŕ la résidence Seven Oaks, selon le dernier bilan. Plus de 120 patients, visiteurs et membres du personnels ont aussi été contaminés.

La bactérie ŕ l'origine de la maladie du légionnaire, ou légionellose, se développe dans les systčmes qui produisent de la vapeur d'eau. Les systčmes de climatisation ou les douches mal désinfectées sont des endroits particuličrement propices.

 


FULL REPORT


December 05, 2005

Download Now


Report of the Expert Panel on the Legionnaires’ Disease Outbreak in the City of Toronto
September/October 2005

41 pages | 1085 kb | PDF format

 


Email     Denis     legion@q-net.net.au