Recent Legionnaires’ Disease Outbreaks
Sydney, Australia • April 2016
An outbreak in Sydney — not associated with the nine cases and one death in March — has affected a total of five people since mid-April. The two most recent cases were reported May 10th. The first three individuals who were reported ill are still in the hospital, including a woman in her 30’s who is in critical condition and a man in his 50’s in intensive care. Investigators have focused on cooling towers, requiring disinfection of any in which Legionella is found.
Sydney, Australia • March 2016
Investigators are still searching for the Legionella source responsible for nine cases of Legionnaires’ disease identified near the city center of Sydney this month. Some of the cases were hospitalized and one has died.
New England • February 2016
Person-to-person transmission of Legionella was reported for the first time in February 2016. Researchers concluded that a 48-year-old man was exposed to Legionella when working around cooling towers in 2014 and then transmitted Legionella via coughing to his mother while she was caring for him. The mother died on December 1, 2014 and her son about a month later, on January 7th. The Legionella strain found in both the mother and son matched the strain found in the son’s workplace. The New England Journal of Medicine article is available at http://www.nejm.org/doi/full/10.1056/NEJMc1505356.
Spain • January 2016
More than 230 cases of Legionnaires’ disease were reported in December and early January near the Spanish town of Manzanares. Several people were hospitalized, three of whom died. Health officials did not confirm a source but suspected an ornamental fountain based on initial test results.
United Kingdom • January 2016
In January, a hotel operator in the UK was fined 54,000 British Pounds for inadequate maintenance of a whirlpool spa implicated in 18 confirmed cases of Pontiac fever in 2011. Officials reported that the hot tub was not properly drained, cleaned, or disinfected in the two months prior to the outbreak.
Flint, Michigan • November 2015
Michigan health officials said 10 fatal cases of Legionnaires’ disease, among 88 cases total, occurred in the Flint area between June 2014 and November 2015. Some have questioned whether Flint’s lead contamination and Legionnaires’ outbreak were associated with switching its water source from Lake Huron (by way of the Detroit water system) to the Flint River from April 2014 to October 2015. A Virginia Tech research team indicated, based on Legionella testing, that large building plumbing systems were also a factor in the outbreak. Health officials recently warned residents that the risk of Legionnaires’ disease will likely increase during the warmer months.
France • September 2015
Between mid-August and early September, 8 cases of Legionnaires’ disease were reported among persons who had been in the city center of Montpellier. As of September 10th, 1 patient had died, 2 were still hospitalized, and 5 had recovered.
NYC Morris Park, Bronx • September 2015
13 cases of Legionnaires’ disease and 1 death were reported in September among people in the Morris Park neighborhood in the Bronx. A confirmed source for the outbreak has not been reported. Morris Park is about 6 miles (10 km) northeast of the South Bronx neighborhood where an unrelated Legionnaires’ outbreak involving 120 cases and 12 deaths occurred in July.
Portugal • September 2015
16 cases of Legionnaires’ disease were reported in Porto (Oporto) between late July and early September. Five individuals were hospitalized. A confirmed water source link was not reported but six cooling towers were shut down and a hotel was temporarily closed based on the investigation.
Quebec, Canada • August 2015
Legionnaires’ disease was confirmed in 18 individuals in late August, 2 of whom have died. Authorities suspected the source of the outbreak was a cooling tower in the town of Berthierville.
San Quentin State Prison, California • August 2015
Approximately 30 suspected cases of Legionnaires’ disease were reported among inmates at San Quentin State Prison in late August. Prison officials tried to control the outbreak by “turning off the water” and bringing in portable toilets. Information in news reports was insufficient to conclude the number of confirmed cases or the source of contamination.
Veterans nursing home in Quincy, IL • August 2015
54 cases of Legionnaires’ disease and 12 deaths have been reported among residents of a veterans long-term care facility in Quincy, IL since August. Information about the epidemiology or source of the outbreak was not reported.
New York City • July 2015
More than 120 people in the South Bronx contracted Legionnaires’ disease between early July and early August, 12 of whom died. Health officials ordered the disinfection of cooling towers and since have established regulations for ongoing Legionella control measures. A hotel cooling tower was implicated in the outbreak.
Lacey, Washington • July 2015
A motel in Lacey, Washington voluntarily closed for a few days in July after three confirmed cases and one suspected case of Legionnaires’ disease were reported in guests who had stayed there. Thurston County health officials contacted recent guests of the motel, warning them to see a physician for any Legionnaires’ symptoms. They also collected water samples and recommended that the motel implement temporary water treatment procedures (which it completed prior to reopening), continue water sampling, and assess its water systems.
Christchurch, New Zealand • May 2015
Health officials said at least four of six cases of Legionnaires’ disease reported in Christchurch in April and May were linked to a cooling tower in the suburb of Hillsborough. The cases occurred in four women and two men from 49 to 79 years of age. All six were hospitalized but have been discharged. Businesses in the industrial area were urged to sample and treat their cooling towers.
New York City • May 2015
On May 13th, the New York City Department of Health and Mental Hygiene issued an alert because of an increase in Legionnaires’ disease cases in Queens. The alert is posted at http://www.webwire.com/ViewPressRel.asp?aId=197777.
Orlando, FL • April 2015
Notifications are going out to thousands of guests who stayed at a hotel in Altamonte Springs, Florida since last September, urging them to see a doctor for any pneumonia-like symptoms. Three cases of Legionnaire’s disease have occurred among people who stayed at the hotel over the last few months. The most recent case was in April. The health department is investigating the hotel’s water systems.
Boldon, UK • April 2015
Two cooling towers at an auto parts factory in Boldon were blamed for five cases of Legionnaires’ disease, four which occurred in workers at the factory and the other in a nearby resident. The first case occurred in October and the other four since April. The factory plans to replace all of its cooling towers with closed systems.
Valencia, Spain • March 2015
Valencia Department of Health reported a sixth case of Legionnaires’ disease among persons who had frequented a sports stadium in Benidorm. Four of the six were hospitalized. The source of the outbreak was not reported.
New York City • January 2015
In January the New York City Department of Health investigated 12 cases of Legionnaires’ disease diagnosed among Bronx residents since December, eight of whom live in the same residential complex. Cooling towers identified as a suspected source were disinfected by the operators.
Retirement Home in Spain • November 2014
Eight cases of Legionnaires’ disease were reported among residents of a retirement home in the northwest region of Spain in November. All eight were hospitalized but no deaths were reported. Around the same time, at least three cases of Legionnaires’ were reported at another nursing home about 21 kilometers away.
Rhode Island Hospital • November 2014
Two patients at Rhode Island Hospital were diagnosed with Legionnaires’ disease in November. Details about the number of days the case patients had been in the hospital and their exposure to water were not reported. In response to the cases, the hospital provided bottled water for drinking and performed “superheating and flushing” of the plumbing system in at least one building.
Major Outbreak in Portugal • November 2014
As of 13 November, the case count in an outbreak of Legionnaires’ disease near Lisbon had risen to 311, with 7 deaths, according to Portuguese health officials. The World Health Organization has called the outbreak a “major public health emergency.” Evidence of a possible source has not been reported but officials suspect the cooling towers at a fertilizer plant.
Four Retirement Home Residents in Lugo, Spain • November 2014
Four residents of the same retirement home in Lugo, Spain were diagnosed with Legionnaires’ disease in earlier November. All four were hospitalized. The Department of Health disinfected the building’s plumbing system.
Eight Legionnaires’ Cases in Alcoy, Spain • October-November 2014
Eight cases of Legionnaires’ disease were reported in the city of Alcoy over a 10-day period in late October and early November. As of November 3rd, six persons who required hospitalization had been discharged and the other four were recovering well. Health officials are attempting to identify the source of Legionella that caused the infections. Alcoy is located in the eastern part of Spain.
North Carolina Health Facility • September 2014
In late September, the North Carolina Department of Health and Human Services reported that Legionnaires’ disease had been diagnosed in two patients of a 327-bed facility for intellectual and developmental disabilities. The second case was identified after the first case prompted increased patient surveillance. The facility suspended admissions and restricted visitation while investigating and remediating the water systems. As of September 26th, one patient had recovered and the other was still receiving treatment.
Eight Deaths in Spain • September 2014
More than 40 cases of Legionnaires’ disease were identified in September in the Spanish towns of Sabadell and Ripollet, located only about 10 kilometers (6 miles) apart, near Barcelona. Eight of the patients have died. Health officials, believing the cases are part of two separate outbreaks, said the source of the Ripollet outbreak has not been established but the source of the Sabadell outbreak is likely a particular company’s cooling tower. According to news reports, if the cooling tower is confirmed to be the source of the Sabadell outbreak and is not in compliance with every cleaning and maintenance regulation, the company could be fined up to 600,000 Euros (US$751,000). No new cases have been identified since late September.
North Carolina Nursing Home • August-September 2014
Legionnaires’ disease has been reported in three residents of a nursing home in Hoke County, North Carolina. The first case was diagnosed on August 28th and the other two after all the residents were tested for Legionella.
Cooling Towers Investigated in German Outbreak • August-September 2014
Cooling towers at a power plant, research center, and metalworking and plastics plants are under investigation as possible sources of 60 suspected and 23 confirmed cases of Legionnaires’ disease identified in the German town of Juelich in August and September. Two of the patients have died.
Three Guests of a Hotel in California • August 2014
Three people who had stayed at a hotel in Ukiah, CA were hospitalized with Legionnaires’ disease in early August. County health officials suspected the hotel’s water systems were the source.
Four Cases in Grimsby, UK • July 2014
Four people diagnosed with Legionnaires’ disease in late July had all been in the area around Freeman Street in Grimsby in the days before onset of illness. As of early August news reports, no common source had been identified and all four patients were recovering.
Travelers to a Softball Tournament in Alabama • July 2014
The Alabama Department of Public Health launched an outbreak investigation after receiving phone calls about illness in several children and adults who had traveled to a softball tournament in early to mid July. Among the group of 40 who traveled to the event, 16 reported symptoms of fever, cough, nausea, diarrhea, or vomiting, three of whom tested positive for Legionella and were hospitalized. The state health department said a hotel in Elmore County was the common link among the three who tested positive for Legionella.
Veterans Health Facility Near Orlando • July 2014
Three veterans receiving care at a new VA health facility in Lake Nona, Florida were diagnosed with Legionnaires’ disease in July. One has since died.
Hotel in Ocean City, Maryland • Summer 2014
Legionnaires’ disease has been reported among hotel guests in Ocean City, Maryland yet again, this time in two people who stayed at the same hotel this summer. Both guests recovered after seeking treatment elsewhere in Maryland.
Three North Carolina Nursing Homes • June-July 2014
Since mid June, Legionnaires’ disease has been reported at three nursing homes in North Carolina, two in Wilson County and one in Forsyth County. Five residents and three visitors of a nursing home in Wilson County were diagnosed with the disease and have recovered. Three additional cases were linked to another nursing home in Wilson County, at a state-operated facility. Six cases of Legionnaires’ disease were identified among residents of a nursing home in Forsyth County, all of whom have recovered. No new cases have been reported in Wilson County homes since July 10th or in Forsyth County home since July 24th.
Baby Contracts Legionnaires’ Disease During Birth in Pool • June 2014
Public Health England has advised against the use of home birthing pools. It issued a temporary warning in June after a case of Legionnaires’ disease was identified in a baby born in a home pool and confirmed the advice earlier this month after investigating the pools and finding unsatisfactory risk control procedures. The alert pertains only to birthing pools with heaters and circulation as opposed to pools that are filled from the home’s hot water system and do not incorporate heaters or circulation pumps. The full press release is at https://www.gov.uk/government/news/public-health-england-advice-on-home-birthing-pools.
Eight Cases at an Alabama Hospital • May 2014
Two patients in the hematology/oncology unit of an Alabama hospital died In late May after laboratory tests confirmed a Legionella infection. Six other patients in the same unit tested positive for Legionella. After the cases were identified, the hospital installed filters on showers and faucets, flushed superheated water through the hot water piping in part of the hospital, and asked patients to temporarily wear masks when flushing the toilet. The news articles did not state the hospital’s longer term plan, if any, for controlling Legionella.
Melbourne, Australia • April-May 2014
Two men and a woman were hospitalized with Legionnaires’ disease after spending time in the same area of Melbourne late April and early May. Health officials have focused their investigation on cooling towers in the area.
Senior Living Facility in Florida • April 2014
On April 18th, the Duval County Health Department in Jacksonville, Florida issued a health advisory after Legionnaires’ disease was identified in three residents of an elder care facility. Health officials collected water samples from the facility’s water systems. Source: First Coast News
Indianapolis Hospital • January 2014
An Indianapolis (USA) hospital restricted patient showers and baths and provided bottled water for drinking after two patients contracted Legionnaires’ disease. Both patients have died. Legionella was found in the hospital plumbing water after the cases were identified. The hospital implemented procedures to temporarily disinfect its plumbing system. Source: indystar.com