Legionnaires’ Disease Outbreaks 2005-2006
Thailand, 4 cases in tourists, November-December 2006 On 3 January 2007, the European Working Group for Legionella Infections (EWGLI) issued an alert to the International Federation of Tour Operators, World Health Organization, and European Centre for Disease Control (ECDC) because four individual cases of Legionnaires’ disease had been reported among tourists who had stayed at the same hotel in Phuket, Thailand since 20 November 2006. Two of the tourists are from Sweden, one from Norway, and one from Finland. Three are men, 24 to 66 years of age, and one a 51-year-old woman. None of the cases has been fatal. Some tour operators have stopped using the hotel for their guests temporarily, and all tour operators in Norway, Finland, and Sweden who used the hotel are informing the guests who stayed there since 20 November 2006. Source: Eurosurveillance Weekly
Connecticut, 2 Cases, 1 Death, October 2006 Two cases of Legionnaires disease were reported in October in West Haven. Both men were admitted into the same hospital on the same day. One of them died.
UK, 3 Cases, October 2006 On 2 November the Bexley Times reported that two staff members and a patient at a hospital in Sidcup had contracted Legionnaires’ disease. One of the staff members was still in intensive care at a London hospital at the time of the news report. A hospital spokesperson said that the other staff member was making a good recovery and the patient had been discharged from the hospital. Legionella was found in several locations in the hospital. France, 12 Cases, Sept. 2006 Twelve cases of legionellosis were identified in the small town of Lorquin in northeast France in September. None of the patients have died. The 11 patients who responded to a questionnaire reported visiting or working at a craft fair that was held in the town on 9-10 September. Although the source of the outbreak was not proven by environmental tests, investigators believe that a whirlpool spa displayed at the event was responsible. Source: Eurosurveillance Weekly, 12 October 2006
Pennsylvania Senior Citizen Center, 3 Cases, April-Sept. 2006 Three cases of Legionnaires’ disease were reported between April and September. All three were 85 years old and recovered after hospitalization.
Allegheny County, PA, 2 Cases, April, Sept. 2006 Two cases of Legionnaires disease were identified in residents of an apartment building for the elderly. The first case was reported in April and the second in September.
Paris, 26 Cases, 2 Deaths, August 2006 Local health authorities identified 26 cases of Legionnaires’ disease that occurred in southeast Paris from late July through August. The cases ranged in age from 21 to 86 years; 85 percent were men. Two have died. All patients had stayed in or visited an area near the Gare d’Austerlitz railway station. The Legionella strain isolated from six patients matched the strain found in cooling towers at one of four sites in the area. Those cooling towers were shut down on 7 September. All cooling towers in the area were disinfected. Source: Eurosurveillance Weekly, September 2006
UK, whirlpool spa, August 2006 Two confirmed cases of Legionnaires’ disease, three confirmed cases of Pontiac fever, and 113 probable cases of Pontiac fever occurred in August at a leisure club in England. There were no reports of illness among club members who did not use, or were not close to, the whirlpool spa. Legionella pneumophila serogroup 1 was found in water samples taken from the spa pool, the return flow from the massage jets, and a short supply line. No Legionella was found in samples from the swimming pool or showers.
Upstate New York nursing home, 6 Cases, August 2006 Legionnaires’ disease was confirmed in six residents, all of whom were hospitalized and recovered.
Venice, 15 Cases, July-August 2006 Fifteen confirmed cases of Legionnaires’ disease were associated with the city centre of Venice from late July through August. No deaths have occurred.
Switzerland, Pontiac fever, July 2006 In July thirty persons living in three multifamily residences in Rheinfelden contracted Pontiac fever, a flu-like illness caused by Legionella bacteria. The hot water system was the suspected source of contamination.
Netherlands, 30 cases, July 2006 Health officials implicated a cooling tower as the source of an outbreak in Amsterdam that affected 30 people, aged from 32 to 81 years, who lived or worked near it. Onset of illness occurred between June 27 and July 21. Two have died. A high concentration (5,000,000 cfu/L) was found in the cooling tower, and the strain matched that found in patients. Samples from other possible sources were negative or had different AFLP (Amplified Fragment Length Polymorphism) patterns. The cooling tower was shut down on July 11.
Spain, 139 cases, June 2006 On June 1, four confirmed cases of Legionnaires’ disease were reported in Pamplona, northern Spain. By June 8, the number of reported cases had grown to 139, all of which were diagnosed by urinary antigen tests. The patients ranged from 21 to 97 years of age. Seventy-six (55%) of the patients were hospitalized, seven of whom required intensive care. No deaths were reported. The investigators inspected cooling towers located at buildings in the neighborhood in which most of the initial cases occurred. Source: Eurosurveillance Weekly.
Spain, Hotel, 15 Cases, March-April 2006 Fifteen retirees from Spain’s Catalonia region were treated for Legionnaires’ disease following a stay in a hotel in a southern Spanish town. The retirees, all between 60 and 85 years old, had stayed in the same hotel between March 25 and April 12. Health officials collected water samples from the hotel’s water systems and an ornamental fountain. Local authorities ordered the hotel to shut down as a precaution. Source: Xinhua
NZ Beachlands Area, 2 Cases, 1 Death, March 2006 Based on water test results, investigators think that roof-collected water systems in the Beachlands area (Manukau City, Auckland, New Zealand) may be to blame for two confirmed cases of Legionnaires’ disease that occurred in March, one of which resulted in death. Test results for two other cases are pending. Beachlands households get water from roof catching systems and delivery tankers. Health officials advised the residents to empty their roof water tanks every six months, chlorinate the water once the tank was refilled, and maintain at least 60 degrees Celsius in water heaters, but some residents prefer the taste of untreated roof tank water. Source: Times newspapers, Auckland
Sydney, 10 Cases, 1 Death, February-March 2006 Ten cases of community-acquired Legionnaires’ disease were identified in Sydney, New South Wales (Australia) in late February and early March, one of which resulted in death. Officials focused their investigation on 70 cooling towers in the vicinity of a shopping center that was reported to be the common link among the cases. Source: news media
Ohio Nursing Home, 2 Cases, February 2006 Two female residents of a nursing home in Northwest Ohio were diagnosed with Legionnaires’ disease. The cases were reported to the Ottawa County Health Department on February 23. As of March 11, one of the women was still in the hospital and the other had been released. Four other residents showed symptoms but tested negative for Legionella. All 35 assisted-living residents were temporarily relocated. The facility has hired a consultant to try to pinpoint a possible source of contamination. Sources: 13abc.com; toledoblade.com
Illinois Hotel, 2 Cases, January-February 2006 The Illinois Department of Public Health ordered a hotel in Lincoln to close and clean its swimming pool and whirlpool spa after two confirmed cases of Legionnaires’ disease were identified in guests who stayed there in January and February. Both pools tested positive for Legionella. State health officials phoned more than 800 former hotel guests, advising them to see their health care provider if they had symptoms. The hotel ownership changed in mid-February. Sources: WQAD.com; pantagraph.com
Rochester, N.Y. Hospital, January-May 2006 In February, four Legionnaires’ cases occurred among patients at a hospital in Rochester, N.Y., one of whom died. All patients were given bottled water, showering was restricted, and the water system was chlorinated and considered free of Legionella based on water tests. Despite the hospital’s efforts to disinfect the water, a cancer patient tested positive for Legionnaires’ in early May, and died. A sixth patient, admitted on May 13 for an injury, contracted the disease about five days later. Because the fifth patient did not have the same Legionella strain as the first four cases, and water tests have been negative for Legionella since February, hospital officials suspect that the two recent cases may have been acquired prior to admission. Source: Rochester Democrat and Chronicle
Spain Shopping Center, 20 Cases, December 2005 Health officials believe a shopping center in Torrevieja, Spain is linked with 20 cases of Legionnaires’ disease that have been confirmed since 5 December. At least 14 of the ill persons are not from Spain. Sixteen were hospitalized. Officials suspect, but have not confirmed, that cooling towers are responsible. They also investigated ornamental fountains and irrigation systems.
Melbourne, Australia, 5 Cases, November 2005 Five cases of Legionnaires’ disease have been reported in Melbourne in the last two weeks. A common source of contamination has not been identified. All five cases are men, two aged 62, and the others 49, 64, and 72. As of early November, three were still in the hospital and two had been discharged. Sources: The Age; Herald Sun
Pennsylvania Nursing Home, 4 Cases, October-November 2005 Three elderly residents and a volunteer at a nursing home in Harleysville, Pennsylvania, were diagnosed with Legionnaires’ disease in late October and early November. The three residents, all women, have recovered. The nursing home’s potable water system was disinfected. Source: Associated Press
NYC Correctional Facility, 2 Cases, October 2005 Two Rikers Island inmates were diagnosed with Legionellosis in October. Both are men, aged 25 and 44 years. The domestic water system was chlorinated. The water was also tested, but apparently not until after the disinfection procedures were carried out. The Department of Health is monitoring the health of inmates and correction employees.
Barcelona, 19 cases, 2 deaths, October 2005 Nineteen cases of Legionnaires’ disease occurred in the Barcelona area in October. Two of the cases have died, a 44-year-old man with underlying disease, and an 81-year-old man who died three days after he was hospitalized. As of late October, several cases were still hospitalized but doing well.
Christchurch, New Zealand, 4 Cases from Potting Mix, October 2005 Four people in Christchurch, New Zealand contracted Legionnaires’ disease from potting mix and compost bags, including an elderly man who has died. Health officials do not believe that these cases are connected with the outbreak that occurred in Christchurch earlier in 2005.
Toronto Nursing Home, 127 cases, 21 deaths, September 2005 Twenty-one elderly people have died as a result of a Legionnaires’ outbreak associated with a nursing home in Toronto. In all, 127 cases have been identified, including 67 residents, 30 staff, and 26 visitors of the nursing home, and four people who live or work near it. Investigators believe that the nursing home’s cooling tower, which is located near an air intake, was the source of contamination. A $600-million class action lawsuit has been initiated, claiming the defendants were negligent in the sampling, testing, diagnoses, and evaluation of Legionella, and are liable for damages caused by the design, installation, and maintenance of the cooling tower. In light of the outbreak, the Ontario Ministry of Labour issued a bulletin on 18 October 2005 that puts employers on notice of their duty to protect workers from hazards such as Legionella. “It is the responsibility of employers to be knowledgeable about the hazards caused by Legionella bacteria and to put in place necessary precautions to protect workers.”
London, 12 cases, July-August 2005 Twelve cases of Legionnaires’ disease were associated with south east London in July and August 2005, six of which occurred between 27 and 30 August. All twelve were men, ranging from 31 to 73 years of age. None of the cases has resulted in death. Interviews have indicated potential links for groups of four or five of the cases, but investigators have not found a common area where all twelve either live, work, or have visited. Health officers have tested cooling towers, car washes, and public fountains but have not identified a source of contamination. Testing of the patients’ homes is underway. Source: Eurosurveillance Weekly
Missouri Hospital, 2 Cases, August 2005 On 3 August a hospital in Columbia, MO reported that two of its patients had contracted Legionnaires’ disease during their stay there. The hospital suspects that the patients may have become infected with Legionella while showering. One of the patients has been released; the condition of the other was not reported. Source: Columbia Daily Tribune
Zaragoza, Spain, 15 Cases, August 2005 Fifteen people have contracted Legionnaire’s disease in the northern Spanish city of Zaragoza since August 16. Twelve have been hospitalized, four of whom are in intensive care. The source of contamination has not been identified. Source: TodayOnline.com
Baltimore Hospital Patients, 5 Cases, 1 Death, July 2005 Five patients of a Baltimore hospital were diagnosed with Legionnaires’ disease during a three week period beginning 17 July. The hospital reported that two of the cases may have occurred there and the other three were acquired elsewhere. As of 18 August, one of the patients had been discharged and three remained hospitalized. The fifth patient, an elderly woman, died 25 July. Source: Catonsville Times
Pennsylvania Legionnaires Convention, 2 Cases, July 2005 Legionnaires disease was confirmed by urinary antigen in two men, 60 and 70 years old, who attended the Pennsylvania American Legion’s annual convention in July in King of Prussia, a Philadelphia suburb not far from the site of the 1976 convention outbreak. Both have recovered. Other than being from Pittsburgh, the only direct link between the two men was that they both attended the convention, but investigators have not made any conclusions. Source: Associated Press
New York City Area Hospital, 21 Cases, June 2005 A hospital in New Rochelle, NY was investigated in connection with 21 cases of Legionnaires’ disease that have occurred since June. Health officials have said that a hospital cooling tower is responsible for at least two of the 21 cases. Those who were initially infected had walked by the tower to enter the hospital. The hospital replaced the tower in July. Legionella bacteria have also been found in the hospital’s potable water, which was to be investigated further. Source: The Journal News
Rapid City, SD, 17 Cases, 1 Death, May-August 2005 An ornamental fountain in a restaurant waiting area has been implicated in the Legionnaires’ outbreak that occurred in Rapid City, South Dakota, in late May to August this year. Health officials reported that the Legionella strain found in the fountain matched the strain isolated from people who became sick. Four new cases have been identified, all linked to the fountain, bringing the total to 17. One of the cases has died and two were still in the hospital as of late October. Source: Associated Press
Christchurch, New Zealand, 19 Cases, 3 Deaths, June 2005 Since June, 19 people in Christchurch have contracted Legionnaires’ disease, three of whom have died. According to health officials, Christchurch would normally have only five or six cases of Legionnaires’ disease in a year. There was no common building or event to link the people infected, but most lived in Christchurch’s western suburbs. Health officials are focusing their investigation on cooling towers in the area. Source: The New Zealand Herald
Norfolk Postal Workers, 2 Cases, June 2005 On Wednesday of this week postal authorities found out that two employees who work the same shift at a Norfolk, Vir. facility contracted Legionnaires’ disease, one of whom has been hospitalized. The news report did not state whether the cases were confirmed by laboratory tests. Health officials are investigating. Source: WAVY-TV
Norway’s Worst Outbreak: 53 Cases, 10 Deaths, May-June 2005 Fifty-three cases of Legionnaires’ disease were confirmed in May and early June in the towns of Fredrikstad and Sarpsborg, Norway, claiming 10 lives. The youngest person who died was 69 years of age. Investigators are blaming an air washer at a chemical plant in the town of Sarpsborg. If the data support their conclusion, these will be the first reported cases associated with an air washer. Source: news media
NYC Hospital, 2 Deaths, April 2005 A hospital in New York City has reported four cases of Legionnaires’ to the health department since last month. Two of the patients have died, although the hospital has not confirmed Legionnaires’ disease as the cause. One of the patients, a 63-year-old man, checked into the hospital last month for a procedure intended to sustain his life while he waited for a transplant. On 4 April, his family members were told he had Legionnaires’ disease. He died nine days later. Although the source of contamination has not been identified, it’s interesting to note that his wife reported having used hospital tap water to fill the humidifier that was connected to his breathing mask. The New York State Department of Health is investigating the deaths. Source: The Journal News
Spain Hospital, 6 Cases, 1 Death, February 2005 Six immunocompromised patients who were admitted to an oncology center in Barcelona contracted Legionnaires’ disease in late February. The cases occurred in four men and two women ranging in age from 41 to 81. One of the patients, a 41-year-old man with advanced cancer, died on 26 February, the day after his infection was diagnosed. Source: abc.es
NSW, Australia, 9 cases, January 2005 Nine cases of Legionnaires’ were confirmed in January and early February in the New South Wales Illawarra region. Eight of the cases were in men ranging in age from 31 to 84. The other case was a 69-year-old woman. No deaths have been reported. All registered cooling towers in the city were tested and three showed elevated Legionella levels, but health officials did not expect to pinpoint the source of contamination. Source: news media
Maryland (USA) Condominiums, 3 Cases, January 2005 In late January, the Worcester County Health Department reported three cases of Legionnaire’s disease associated with a condominium tower in Ocean City. One of the individuals died. Legionella was found in several water samples collected from the building, but in none of the eight samples collected from the city water supply. Source: news media