Legionnaires’ Disease Outbreaks 1997-1998
Madrid hospital • Nov 1998 • 3 deaths Three people died from Legionnaire’s disease in a hospital in Zaragoza in northeastern Spain – two in November and one in September. All suffering from serious illnesses that had weakened their immune system. The hospital is disinfecting the water and air conditioning systems to prevent further infection. Source: Reuters
Seattle hospital • Nov 1998 • 3 cases A Seattle hospital is working with state health officials to try to determine the source of infection of three patients who acquired Legionnaire’s disease. Two cases in July involved a man and woman in their 40s, both cancer patients. The woman died, but it is unclear whether her death stemmed from the Legionnaire’s infection, hospital officials said. The man survived. Late October, a man in his 40s, an organ transplant patient, also contracted Legionnaires’ Disease but recovered. “On the first two cases the evidence is pretty good that somewhere, somehow these individuals acquired the infection here,” state senior epidemiologist Dr. John Kobayashi said at a news conference. Despite extensive tests of water systems at the hospital, however, no source of the patients’ strain of bacteria has been found, officials said. Source: Associated Press
Thomastown, Melbourne, Australia • Oct 1998 • 16 cases Three businesses in Thomastown have been identified as possible sources of October’s Legionella outbreak involving 16 confirmed cases and another 10 suspected cases. Testing of 74 cooling towers revealed three towers carried Legionella bacteria. Victoria’s chief health officer, Dr Graham Rouch, said samples taken from eight of the 17 people infected matched the bacteria found in a cooling tower at an industrial facility. A chicken-processing company of Thomastown is also believed to be a potential source after testing proved inconclusive. The Thomastown-Reservoir outbreak is Victoria’s largest occurrence of Legionnaires Disease. Nine of the 16 confirmed victims have been discharged from hospital. Four patients remain in the hospital, one of them in intensive care. Source: Herald Sun, Victoria
Ellenville, NY, USA • Oct 1998 • 11 cases, 3 deaths Eleven Ellenville area residents were diagnosed with Legionnaires’ disease. All are among more than 30 cases of pneumonia to hit the Ellenville area since mid-September. In addition, 30 to 40 Ellenville Community Hospital workers were diagnosed with flu-like symptoms that health investigators said was Pontiac Fever, a type of legionellosis that is not as severe as Legionnaires’ Disease. Three of the Legionnaires’ victims died. Water samples from the hospital’s cooling tower tested positive for Legionella. “This is likely to be the exposure,” said Dr. Joel Acklesberg, a doctor with the federal Centers for Disease Control and Prevention. However, the hospital’s hot water system tested negative. That has led investigators to speculate exposure could have occurred as people were coming in and out of the hospital, for anything from lab tests to visiting hours. The connection to the hospital was strengthened by interviews of individuals with the illness. Seven of the eight people investigators interviewed visited Ellenville Hospital the week prior to their exposure. Source: The Times Herald Record online
Somerset, UK • Oct 1998 • 10 cases, 3 deaths An outbreak of Legionnaire’s disease in Glastonbury, Somerset, U.K. has claimed three lives. A total of 10 cases were reported. A major investigation is still under way to trace the source of the outbreak. Source: Press Association Newsfile (UK)
Plastics plant, Baltimore, USA • Oct 1998 • 3 cases, 1 death Part of a plastics plant in a Baltimore suburb was shut down after three employees contracted Legionnaires’ disease. A 51-year-old male died after several days in the hospital. The two other employees diagnosed with the disease have been discharged from the hospital and are recovering. Health officials are testing hot water and air conditioning systems and other areas to find the source of the Legionella bacteria. Source: The Associated Press
French hospital • Oct 1998 • 2 deaths Two aged patients have died and three other people became ill following an outbreak of Legionaires disease late September in a hospital in this Tarbes, France. 70 other people who had been treated in the same hospital were also prescribed antibiotic treatments as a precaution. Hot water used in treatments was thought to be the source of contamination. Source: Reuters
London • Aug 1998 • 5 cases Five men, aged 27 to 45 years, who live or work in London developed legionellosis between 2 August and 14 September 1998. All have recovered. Source: CDR WEEKLY, Volume 8 Number 41, 9 Oct 1998
Paris • July 1998 • 19 cases, 3 deaths Between 6 June and 3 July, 1998, 19 cases of legionellosis were identified among visitors to Paris. Ten of the cases were French nationals and 9 were tourists from other European countries. Three patients died. Source: The Weekly Epidemiological Record (WHO)
Victoria, Australia • June-July 1998 • 5 cases, 1 death A 73-year-old woman died from Legionnaires’ disease and four other people were identified as carrying the illness late June and early July. One of the infected women worked at the Moonee Ponds Australian Tax Office, while another was a contract worker at the city tax office, but lived in Moonee Ponds. The three other victims contracted the disease after shopping in the area. An Essendon man, 79, was battling for his life in the John Fawkner Hospital, while a 49-year-old woman at the same hospital was in a stable condition. Legionellae were found in the cooling towers of the Australian Taxation Office building in Gladstone Street and the Caseready Meats tower in Young Street. Victoria’s chief health officer Dr Graham Rouch was cited as saying that laboratory testing had shown the cluster of Legionaires’ cases in the Moonee Ponds area, in Melbourne’s north-west, was “most likely linked” to the cooling tower of Caseready Meats. Dr Rouch was further cited as saying in a statement that tests from two of the five people infected had shown the Legionella type they were carrying was the same as that identified in the meat manufacturer’s tower. Cooling towers at both Caseready Meats and the Tax Office were disinfected. Source: FSNET and The Australian News Network
Paris, France • July 1998 • 4 cases, 1 death A 32-year-old man from Blackpool, England died of Legionnaires’ disease after traveling to France for the World Cup Finals. Three other fans – two Scots and another Englishman – also fell ill with the disease after visiting France. The Department of Health reported that three of the men went to the same football match in Paris. One Scotsman in his 50s was treated in hospital at Livingston, West Lothian, but was later allowed home. The French health ministry said the victims all appeared to have passed at some point through Paris, but then attended matches in different cities. According to a Foreign Office spokesman in London, “They had been in Paris during the incubation period.” French and British health authorities were to investigate the cases to see if there was a common link. Source: BBC and ITN Online, 3 July 1998
Southwest PA, USA • June 1998 • 6 cases Excerpts from Press Release, 10 July 1998: The Pennsylvania Health Department reported six cases of community-acquired Legionnaires’ disease near the Southwestern Pennsylvania borough of North Belle Vernon, Westmoreland County. The source of the outbreak has not yet been identified; epidemiologists are testing likely sources. Each of the six cases occurred between June 15 and June 30 and required hospitalization. All but one of the patients, the one most recently infected, have been discharged.
Prague hospital • June 1998 • 8 cases, 7 deaths Eight cases of Legionnaire’s disease appeared among kidney transplants at a leading transplant center in Prague in June. Seven patients died. The outbreak was caused by L.pneumophila sg.3, revealed both from lung tissues and from hot water samples (about 1,000 cfu/ml). Subtyping of the strains linked the cases to the the hot water plumbing. Heating the water to 85 deg C and flushing all taps and outlets reduced legionellae counts signicantly, but some sites still remained positive ( 1-10 cfu/50 ml). Consequently the Tarn-Pure TP 30 was installed. In spite of all remedial measures performed, legionellae have not been completely eradicated from all sampling sites. Very low concentrations persist. The hospital is regularly monitored. The outbreak made competent health authorities put expeditiously the National Legionella Surveillance Scheme into operation service. All hospitals treating debilitated patients had to be examined for the presence of legionellae. Source : National Legionella Reference Lab Vyskov, Czech Republic
Cruise ship • June 1998 • 2 cases A woman aged 77 years and a man of 71 years, both from England, developed legionnaires’ disease after taking separate cruises to the southern Mediterranean aboard the SS Edinburgh Castle. Both cases were diagnosed serologically. Both cruises sailed from and returned to Liverpool, but their itineraries included calls at different ports. On learning of the first case, samples were obtained from the ship’s fresh water supply by Scottish port health and environmental health officers when it docked in Greenock on 21 June. An incident control team met on 24 June in Liverpool after the second case had been reported and advised the ship’s owners and the tour operator of the control measures required on the basis of information then available. Initial control measures for water treatment were carried out before the ship returned to Greenock. Legionella pneumophila serogroup 1 was cultured by the Scottish Legionella Reference Laboratory on 24 June. A separate incident control team in Scotland met on 28 June, when the ship docked in Greenock, to review the microbiological results and a proposed that a thorough supervised water treatment program should be implemented in consultation with the ship’s owners and engineers when the ship docked in Greenock. The tour operators gave passengers who disembarked in Scotland on 28 June a letter that advised them what to do if they developed symptoms of legionella infection. The ship is now subject to regular monitoring and water sampling when docked in Liverpool or Greenock. Case searching among passengers and crew will continue through public health networks in the United Kingdom. Source: Eurosurveillance Weekly, 2 July 1998. Reported by Peter Christie, Scottish Centre for Infection and Environmental Health, Glasgow and Carol Joseph, on behalf of European Working Group for Legionella Infections (EWGLI). A separate report stated that the ship was cleared by health officials on 2 July.
British Drivers • Mar. 1998 • 2 cases Two British long distance lorry [truck] drivers became ill with legionella infections on 8 and 11 March 1998. The drivers drove in separate lorries to Dover and travelled on the same ferry ship to France before meeting in northern Spain. Both took showers at a lorry park, where they slept overnight in the cabins of their lorries. Legionella pneumophila serogroup 1 was cultured from sputum of one of the cases, a 50 year old man whose illness was confirmed as Legionaires’ disease. The other case, diagnosed serologically on the basis of a single high titre and without radiological evidence of pneumonia, was 29 years of age. Regional authorities in northern Spain are conducting environmental investigations. The report indicated that the showers at the lorry park will be the focus of the investigation. Source: Eurosurveillance Weekly. Reported by Carol Joseph, European Surveillance Scheme for Travel Associated Legionnaires’ Disease, PHLS Communicable Disease Surveillance Centre
Pittsburgh office building • 5 Mar. 1998 • 3 cases Three people who worked in the same office building have contracted Legionnaire’s Disease–one in February and two last October. The downtown Pittsburgh building was just opened in 1996. Investigators tested water samples collected from the plumbing system, coffee makers, and a cooling tower but found no legionellae, according to John Schombert, chief of public drinking water and waste management for the county health department. The cases are still under investigation. Source: Associated Press
Netherlands sauna • 1998 • 6 cases, 2 deaths A sauna has been blamed for six cases of Legionnaire’s disease in the Netherlands, two of which were fatal. A female kidney transplant patient died of the disease 10 days after using the sauna. The other fatality was a 59-year-old immunosuppressed man. Dr J.W. Den Boer of the Municipal Health Service, along with other colleagues from Haarlem, reported that water from the footbath in the sauna contained the same strain of Legionella pneumophila that was found in the victims. The operators of the sauna have made changes to prevent water stagnation and are testing the water regularly. These are the first documented cases of Legionnaire’s disease associated with a sauna. Source: The Lancet, 1998;351:114
Los Angeles • December 1998 Los Angeles Health Officials investigating increase in Legionnaires’ cases Reported cases of Legionnaire’s disease in Los Angeles (USA) doubled last year’s count, according to Dr. James Haughton of the Department of Health Services, “But there may be more cases that we don’t know about,” Haughton said. Health officials are investigating the increase. Source: Los Angeles Times, 13 Dec.1997
Ann Arbor, Michigan (USA) • Dec. 1997 • 4 cases Legionnaire’s disease arises near Ann Arbor, Michigan (U.S.A.) – 5 Dec. 1997 Margo Burrage, St. Joseph Mercy Hospital spokeswoman, said that a 68-year-old woman with Legionnaires disease was in serious condition in an intensive care unit at the hospital. According to Dr. Matthew Boulton, Livingston County medical director, this case appears to have no connection with the three recent Legionnaire’s cases at Brighton High School. “She appears not to have had any contact whatsoever with the school,” he said. “We’re relatively sure we have no link.” Just weeks earlier, three Brighton High School students contracted what appeared to be Legionnaire’s. Two girls who were diagnosed with pneumonia in October tested “borderline positive” for Legionnaires disease, according Boulton. 7 of 40 water samples collected by health officials contained the same strain of Legionella found in the two girls. Tests of another student with pneumonia indicated a slightly different strain of the bacteria. Antibiotics brought quick recoveries in all three students, Boulton said. Health officials flushed the plumbing system with hot water. Locker room showers were ordered closed by school officials until the results of health department follow-up water sampling indicated safety. Source: Michigan Live Inc.
Columbus, Ohio senior center • Nov. 1997 • 2 cases Two residents of Lutheran Village, a senior center in Columbus, Ohio (USA), were hospitalized and treated for Legionnaires disease. The center, occupied by a total of 270 residents, has assisted living, private and semiprivate rooms. A woman was diagnosed with the disease on 6 Nov. 1997, which was about 10 days after moving into a room that had been closed off and unused for 18 months, according to Tom Widney, the executive director. The woman has been released from the hospital. The second victim, a man, remains hospitalized but is expected to recover. Widney said that each used the same water system, which serves about 150 rooms. The report mentioned that environmental samples were cultured, but the results were not given. Bath hoses and shower heads were sterilized in the building. Source: The Columbus Dispatch, 24 Nov. 1997
French tourists in Turkey • Sep-Oct 1997 • 13 cases, 4 deaths Three women and 14 men aged 49 to 82 developed respiratory symptoms after staying at the Hotel Festival in Istanbul at various times during September and October. Four have died, six are still in the hospital, and seven have recovered. Legionella infection has been confirmed in 13 of the victims. Legionellosis was bacteriologically confirmed in three of the four individuals who died. Clinical symptoms suggested legionellosis in the fourth fatal case but laboratory confirmation could not be obtained. No cases have been identified since 16 October, the date when the hotel was identified as the probable source of the infection. but forthcoming serological test results may indicated additional cases. A tour operator estimated that the hotel could have accommodated 3300 people between the 1 September and 22 October 1997, indicating an attack rate of approximately 1 percent. Source: Eurosurveillance Weekly, reported by Carol Joseph on behalf of the European Working Group on Legionella Infections (EWGLI). Also reported by the Centre de Référence des Legionella, Lyon, France. This report is also available in French at the Réseau National de Santé Publique
Rhine cruise • July-October 1997 • 6 cases Six cases of Legionaires in British tourists (four men, two women, aged 72 to 78 years) have been linked to a ship used for cruises on the Rhine. The cases occurred between July and October 1997. None has died. The Dutch-owned ship is being investigated by Dutch health authorities. There are no reports of illness among members of the crew. The European Working Group on Legionella (EWGLI) collaborators in Germany and the Netherlands are working closely with EWGLI’s coordinators in London to measure the extent of the outbreak and identify the source of infection. Source: Eurosurveillance Weekly, reported by Carol Joseph on behalf of the European Working Group on Legionella Infections (EWGLI)
Portugal • May-Oct. 1997 • 5 cases Five cases of Legionnaires (three men and two women aged 30 to 67 years ) have been associated with an apartment hotel in Albufeira, Portugal. No deaths have been reported. One case was reported from the Netherlands, two from Scotland, and two from England. Source: Eurosurveillance Weekly, reported by Carol Joseph on behalf of the European Working Group on Legionella Infections (EWGLI)
Chicago suburb of Woodstock • Aug. 1997 • 4 cases An outbreak of Legionnaires’ disease in the Chicago suburb of Woodstock was reported in the Chicago Sun Times, 15 August 1997. According to the Times story, four cases have been confirmed and three more are suspected. All seven live in Woodstock and range from 47 to 84 years in age. The first case was confirmed 22 July and the most recent on 1 Aug.