Legionnaires’ Disease Outbreaks 2002-2004

Iowa City Hospital, 2 Cases, December 2004 Nearly three months after two Legionnaires’ cases were confirmed, a hospital in Iowa is still providing patients with bottled water for drinking and filtered water for showering until Legionella can be eradicated from its water system. Hospital officials said that the first patient contracted the disease in December from a showerhead, and has recovered. The second patient, whose case of Legionnaires’ was confirmed in January, died, but hospital officials could not confirm that the death was caused by Legionnaires’. Source: Iowa City Press-Citizen

NJ Apartment Building, 2 Cases, October 2004 Two elderly residents of a high-rise apartment building in northern New Jersey were diagnosed with Legionnaires’ disease in recent months, an elderly man in June and a 78-year-old woman with lung cancer in late October, 2004. Both residents have recovered. In November, health officials shut off the water to the building after finding Legionella in a water heater. The 1,000 or so residents used bottled water until the systems were disinfected. Source: The New York Times

Redditch, UK, 3 Cases, 2 Deaths, September 2004 As of mid September health officials had not found the source of contamination that has caused three cases of Legionnaires’ disease in Redditch. Two women, aged 62 and 67 years, have died. The third case, a man in his 50s, was hospitalized but is now recovering at home. Of 69 samples collected, five tested positive, but not with the strains found in the people who became ill. Results of further tests are pending. Source: news media.

Sweden, 14 Cases, 1 Death, August 2004 Between 10 August and 6 September, Legionnaires’ disease was confirmed in 14 people who either live in or had visited the city of Lidköping, in southern Sweden. One patient, an elderly man, has died. The patients range from 36 to 83 years of age. Only three of them were immunocompromised. Twelve of the infections were diagnosed by urinary antigen, and two by culture. The epidemiological investigation ruled out several potential sources of infection, including whirlpools, private humidifiers, and hot water systems in the patients’ homes. All of the patients spent time within a small area of the city. Samples from cooling towers in two locations have shown high numbers (>300 cfu/ml) of Legionella pneumophila serogroup 1. These cooling towers have now been shut down for cleaning. A source of contamination has not been implicated, but typing of all Legionella isolates will be undertaken to check for a connection between the cooling towers and the patients. Source: Eurosurveillance Weekly.

Barcelona, Spain, 20 Cases, August 2004 Health authorities in the northeastern Spanish region of Catalonia blamed four cooling towers for an outbreak of Legionnaire’s disease in Barcelona that affected 20 men and 7 women in August. Those who contracted the disease ranged from 45 to 83 years of age. As of 19 August, 15 of the 27 people were still in hospital but their conditions were generally satisfactory, according to health authorities. Source: news media.

Cleveland Service Garage, 3 Cases, July 2004 Three workers at a large city service garage in Cleveland contracted Legionnaires’ disease; one case occurred about 11 months ago and the other two more recently. The garage houses dump trucks and street sweepers. Two of eight water samples tested positive for Legionella. The positive samples were collected from the shower in the employees’ lounge and the truck wash system. The garage was closed pending further investigation.

NJ Nursing Home, 2 Cases, 1 Death, July 2004 Two cases of Legionnaires’ disease were reported in early July in Paterson, New Jersey. Both were residents of the same senior housing center. One of the cases, an 82-year-old man, died 8 July. The other, a 76-year-old woman, was recovering in the hospital as of 14 July. After finding legionellae in the hot water, Paterson Housing Authority officials shut off the system and prepared to disinfect it. Source: New Jersey Star-Ledger  

Austrian Campsite, 3 Cases, 1 Death, June 2004 In July three laboratory confirmed (by urinary antigen) cases of Legionnaires’ disease were reported to Austrian health authorities. All three cases had stayed at a campsite in Klagenfurt. Patient 1, a 57-year-old Austrian man, became ill on 30 May. He was admitted to hospital with severe pneumonia and transferred to the intensive care unit on 6 June. He died on 4 July. Patient 2, a 71-year-old German man, became ill on 20 June and was admitted to the hospital on 29 June. He has recovered. The third case, a 53-year-old man from the Netherlands, stayed at the campsite from 27 to 29 June and became ill 5 July. He also has recovered. Health authorities believe that the campsite was the likely source of infection. High levels of Legionella pneumophila serogroup 1 were found in samples collected from the water systems on 22 June, just prior to thermal disinfection. A second disinfection, utilizing chlorine, was carried out on 28 June. Legionella bacteria were found in samples collected after the first disinfection procedure, but all samples collected after the second procedure tested negative. Evaluation of the shower facilities revealed that further remedial measures were required. Source: Eurosurveillance Weekly.

Zaragoza, Spain, 27 Cases, 7 Deaths, June 2004 This outbreak involved at least 27 confirmed and 3 probable cases of the Legionnaires’ disease, including 7 deaths. The patients who died were aged 87, 84, 83, 75, 64, 45, and 24 years. The reason for the high death rate is uncertain, except that some of the patients were elderly and in poor health. The outbreak has been blamed on two cooling towers at a general hospital because tests confirmed that both towers were contaminated with the same subtype of Legionella pneumophila serogroup 1 that was found in four of the patients. The cooling tower was disinfected and the water treatment program was revised. The outbreak was declared over by the middle of July.

Australia, 4 cases, June 2004 Three women, ages 64, 66, and 78, and a 69-year-old man, were admitted to the hospital with symptoms of Legionnaires’ disease in the northern Victorian town of Cobram earlier this month. A Department of Human Services spokesman said the most recent diagnosis was probably linked to the earlier three. Health officials are investigating cooling towers in the Cobram region. Source: AAP

Austria, 3 Cases Possibly Linked to Whirlpool Display, March 2004 Legionnaires’ disease was confirmed by urinary antigen in three men, between 42 and 65 years of age, who attended a trade show in Austria from 5 to 7 March 2004. All three were hospitalized. The 65-year-old patient developed multiorgan failure and required mechanical ventilation and haemodialysis for 11 days, but was reported in stable condition earlier this month. The three men had visited a whirlpool display at the exhibition at approximately the same time. No additional cases have been detected since 31 March. The Austrian Agency for Health and Food Safety is investigating. Source: Eurosurveillance Weekly 

Italian Hospital, Five Cases, Three Deaths, Jan-March 2004 Five cases of Legionnaires’ disease occurred in a hospital in Matera, Italy, during the first quarter of this year. All five patients were elderly or HIV-infected; three have died. The report stated that the hospital plumbing system has been disinfected, but nothing was mentioned about a risk assessment or ongoing water treatment.

Oklahoma City, Pontiac fever, March 2004 Oklahoma State health officials have confirmed that Legionella is the cause of a cluster of respiratory illnesses, likely Pontiac fever, contracted by several persons visiting Oklahoma City last week for a basketball tournament. Of the 240 teams participating in the tournament, only two, one from Houston and one from Indiana, have reported respiratory illnesses among players or family members. At least 13 have tested positive for Legionella. Health officials are collecting environmental samples at the hotel where the Houston and Indiana teams were guests. Source: news media

Maryland Hotel Guests, Feb. 2004 Four people who stayed at an Ocean City, Maryland hotel in the last five months have been diagnosed with Legionnaires disease, according to county health officials. Although initial tests of the hotel water system were negative for Legionella, the health department has found no other link among the four people besides their hotel stays. All got sick within about a week of staying at the hotel. More water testing is under way. Source: AP

Cyprus Hotel, Jan. 2004 Two British men between 50 and 59 years of age contracted Legionnaires’ disease after staying in a hotel in northern Cyprus from 21 December 2003 to 3 January 2004. One has died. A case of Legionnaires disease in August 2003 was associated with this same hotel. The European Surveillance Scheme for Travel Associated Legionnaires’ Disease (EWGLINET) is handling the environmental investigation and control measures at the hotel.

France’s worst outbreak: 85 cases, 13 deaths, Jan. 2004 France’s worst outbreak of Legionnaires’ disease has infected 85 people and killed 13, most of whom resided in or visited an area to the east of the town of Lens, in the northern part of the country. On 4 January the French government shut down a petrochemical factory after tests revealed that the strain of Legionella found in the plant’s cooling tower matched the strain found in at least 14 of the victims. [However, the data reported appears insufficient to implicate a source in this outbreak.]

Hereford, UK, 28 cases, 2 deaths, Nov. 2003 Cooling towers at a cider plant in the west of England, in Hereford, are being blamed for 28 cases of Legionnaires’ disease that occurred in October and November. Two persons have died, a man in his 70s and a woman in her 50s. Health experts confirmed that the Legionella strain found in patients matched the strain found in samples collected from a cooling tower at the site. Source: news media

5 Cases, 1 Death Among Cruise Passengers, August 2003 On 26 August German health authorities reported five cases of Legionnaires’ disease among people who traveled on a cruise ship from 6-23 August 2003. One of them, a 69-year-old German man, has died. LD was confirmed by urinary antigen in three of the patients and was suspected in the other two. The ship visited Iceland, Greenland, and northern parts of Great Britain and then returned to Germany. The source of contamination has not been identified. Sources: Reuters; Eurosurveillance Weekly, 28 August 2003

France, 30 Cases, 3 Deaths, August 2003 Health authorities have reported 30 cases of Legionnaires’ disease and 3 deaths in the southern French city of Montpellier. The last case was reported on 10 August. Investigators have found legionellae in several cooling towers in the center of Montpellier but have not identified the precise source of the outbreak. Disinfection measures have been implemented. Source: WHO

Valencia, Spain, 25 Cases, 1 death, June 2003 In two or more separate outbreaks occurring in May and June in Valencia, 25 cases of legionellosis have been identified, one of which resulted in death. The first was a community outbreak in Alcoy and nearby areas. The second outbreak was associated with the oncology unit and adjacent rehabilitation area of a hospital; seven cases were identified, four patients and three visitors. One of the patients died. Investigators quickly traced the infections to the hospital’s hot water system, blaming two showers as the particular source of contamination. The health department reported that the hospital collected environmental samples, hyperchlorinated the domestic water system, disinfected the rehabilitation pool, and began distributing higher water temperatures to faucets and showers. Source: ABC.es

New Zealand Police Building, 9 Cases, June 2003 Nine police staff that worked in the same building in Auckland contracted Legionnaires’ disease. The building was to be closed for two months, requiring that about 200 staff be moved to other buildings. Source: Independent Newspapers Limited

Spain Spa, 4 Cases, May 2003 Spanish health authorities believe that four recent cases of LD were associated with a spa that provides water-based treatments. All four cases were hospitalized and are recovering. An environmental investigation was conducted but a source of contamination was not confirmed. Source: Diario de Avisos

UK Hotel, 19 cases, February 2003 19 cases of Legionnaires disease, including two deaths, have been blamed a resort hotel near Chard (UK). Health officials suspect the hotel’s whirlpool spa is the source of contamination but have not reported a confirmed link. The showers and spa bath at the hotel leisure center were closed on 27 February 2003 but allowed to reopen on 31 March after officials were satisfied that the remedial work had been carried out. Source: BBC News

Israeli Hotel, 3 cases, January 2003 Legionnaires’ Disease was suspected in three people hospitalized with severe pneumonia after staying at the same hotel in Eilat, Israel. The Health Ministry ordered the hotel closed for two days while a team conducted tests. Two separate investigations found the first two people diagnosed stayed at the hotel in late December and both were in rooms with whirlpool spas. Source: Haaretz English Editions

Spain, 7 Cases, October 2002 On 17 October 2002, Reuters reported that Spanish health authorities were investigating an outbreak of Legionnaires’ disease that killed one man and hospitalized six others. Five of the victims were in the same hospital and came from the same district of Madrid.

Melbourne, 3 Cases, Oct. 2002; Legal Action Considered Three men, aged 54, 61 and 81, were hospitalized with Legionnaires’ disease in Melbourne. One was still in intensive care as of 1 November. Health officials tested and disinfected all cooling towers at 13 sites in the suspected area. Legal action is being considered against the owner of an industrial site with an unregistered tower. Victorian law requires registration of every cooling tower. Source: Melbourne Herald Sun

5 Travel-Related Cases, 1 Death, Sept. 2002 Legionnaires’ disease was confirmed in five British people who all stayed at the same hotel in Belgium within the ten days preceding illness. One of the cases was confirmed by culture and the other four by urinary antigen; L. pneumophila serogroup 1 was the cause of all five. The five individuals were traveling in three separate groups. A 63-year-old man, who became ill on 7 September 2002 and has died, had been traveling with a group of ten people, two of whom had reported respiratory symptoms but were negative for Legionella. Three cases occurred in a man and two women who were part of a group of 46 people on a coach tour to Austria. They became ill between 21 and 24 September; all three were hospitalized. The fifth case occurred in a 65-year-old woman who was with 40 British tourists on another Austrian tour; she became ill 28 September and was hospitalized in France. All five patients had stayed only one night at the hotel in Belgium. Belgium health inspectors have investigated the hotel, collected water samples, and implemented control measures. The hotel remains open. Source: Eurosurveillance Weekly, 3 October 2002. Reported by Carol Joseph, EWGLI surveillance scheme project coordinator, Public Health Laboratory Service Communicable Disease Surveillance Centre, London, England

Melbourne, 2 Deaths, Sept. 2002 Two men, ages 51 and 83, contracted Legionnaires disease in Melbourne and have died. As of 12 September, a 72-year-old woman with Legionnaires’, also from Melbourne, was still in the hospital. Health authorities suspect all three got the disease after visiting the same area in Brunswick. One of the men lived in the Brunswick area and the other, a truck driver, had made deliveries there. The woman works in the area. Health officials are investigating. Source: The Age

Stavanger, Norway, 3 Cases, Sept. 2002 On 5-6 September 2002, Legionella infection was confirmed in a 49-year-old Sandnes man and a 55-year-old Stavanger man. The only common factor identified is that both make a 15-kilometer commute to work daily between Sandnes and Stavanger. Both were hospitalized in Rogaland and have recovered. A third case, a 62-year-old Stavanger woman, was identified on 7 September. News of the three cases worried Stavanger residents because an outbreak involving 28 cases and 7 deaths occurred there during the summer of 2001. Source: Aftenposten

Essex (UK), 2 Cases, Sept. 2002 As of 25 September 2002, two men with Legionnaires’ disease were in critical condition in an Essex (UK) hospital. Laboratory tests confirmed the presence of Legionella. The Essex Health Authority is investigating both cases to identify potential links. Source: BBC

Waterloo, Canada, 3 Cases Sept. 2002 On 10 September 2002, it was reported that two construction workers, ages 34 and 47, were in critical condition after contracting Legionnaires’ disease a week prior. The men were on respirators and their lungs had shut down. One of the men was experiencing additional organ failure. As of 28 September, one was still in intensive care; the other’s condition was upgraded to stable. Both had been doing renovations to the roof of a hospital in the Waterloo area. A 44-year-old female patient at the same hospital was diagnosed with the disease on 7 September. At the time she had been in the hospital four days with an unrelated ailment; she may have contracted Legionnaires’ before she came to the hospital. In the week of 23 September, two more workers at the hospital construction site were diagnosed with pneumonia and hospitalized. Urinary antigen tests were negative for Legionella pneumophila serogroup 1; the results of blood and sputum tests have not yet been reported.   Source: The Record

Sandwell, UK: 8 Cases, 1 Death, August 2002 Three women, all in their 50s and all from the Sandwell area, were admitted to the hospital 16 August. Five other cases were subsequently identified, including two women in their 40s and 50s, a 63-year-old man, and a man in his 30s. The eighth case, a man in his 50s, died 25 August. Epidemiologic information led officials to focus their investigation in the Oldbury and Smethwick areas, but a specific source has not been reported. Sources: BBC, The Scotsman, Reuters.

Mataró, Spain: 124 Cases, 2 Deaths; August 2002 As of 26 August, a total of 124 cases have been reported in the Spanish town of Mataró, near Barcelona. The first cases were reported mid-August. News reports stated that the outbreak is being blamed on the air conditioner of a public building, but details of the investigation were not given. A 49-year-old man and an 83-year-old woman have died. Source: The Daily Telegraph (Australia).

Vermont State Office Complex; 16 cases; July-August 2002 16 cases of Legionnaires’ disease have been reported in Waterbury, Vermont (USA). The first case was reported in late July in a former inmate at the state women’s prison located in a 39-building state office complex. Five state employees and two other inmates were also infected. More than 1,500 people live and work at the complex. All but one of the victims were out of the hospital by 14 August. The complex has not been closed. Health officials think cooling towers are the source and that disinfecting the towers will be effective. Source: Associated Press.

Britain’s Worst Outbreak: 131 Cases, 4 Deaths; July 2002 Legionnaires’ disease has been confirmed in 131 people who had been in or around the center of Barrow-in-Furness, Cumbria in July. Nearly 330 others received hospital treatment for Legionnaires’-like symptoms. Four have died; an 88-year-old man and three women aged 54, 56, and 76. The death toll may actually be five. A mother of four in her 50s, who contracted Legionnaires’ in early August and was discharged from the hospital after an apparent recovery, died at her home about two weeks later. But a hospital official said her death could not be definitely related to the Legionella infection. Investigators said that the source was “beyond all reasonable doubt” the air conditioning plant at the town’s arts and civic centre. Legionella bacteria were found in the cooling water. Source: various news media.

Japan Hot Spring; 252 Suspected Cases; 6 Deaths; July 2002 As of 19 August, 252 suspected cases of Legionnaires’ have been identified among individuals who visited a new hot spring resort in southern Japan. Six have died. The first two deaths were a woman in her 60s and a man in his 70s. The woman went to the hot spring on 7 July, was admitted to a hospital with respiratory problems on 14 July, and died 22 July. The man bathed at the hot spring on 4 July, was admitted to a hospital on 9 July, and died 15 July. After opening 1 July, the resort received about 1,000 visitors daily until authorities shut it down 24 July following reports of disease. Sources: The Associated Press; The Daily Yomiuri.

Youth Hostel in Greece; 7 Pneumonia Cases, 1 LD Death; June 2002 Late June, health officials in Greece linked the death of a 22-year-old man to Legionnaires’ disease. The authorities were alerted to the outbreak after seven children from a youth hostel contracted pneumonia and experienced other Legionnaires’ symptoms. Health officials found Legionella in the water supply. Two of the water tanks were found to be rusty and unclean and were promptly replaced.   The children were treated and sent home. The last published report indicated that officials were awaiting blood sample test results to determine if there is a definite connection between the illnesses and the hostel. Source: Hellenic Resources Network, 6 July 2002.

Massachusetts Nursing Home; 4 Cases; June 2002 Four cases of Legionnaires’ disease that occurred at a Massachusetts nursing home in June are being blamed on the building’s hot water system. One of the cases occurred in an employee; the other three were in residents. Six environmental samples were collected after the cases were identified. Four of six tested positive for Legionella, three from showers and one from a whirlpool bath. The incoming water supply tested negative. The nursing home attempted to decontaminate the system via hot water flush.

Los Angeles Hospital; 9 Cases, 2 Deaths; Spring 2002 In March, two cases of Legionnaires’ disease apparently contracted at a 408-bed hospital in Los Angeles were reported to county health officials. Water samples that were subsequently collected tested negative. Two months later two more cases were reported, one of which resulted in the death of a 67-year-old man. Samples were again collected, this time showing Legionella bacteria. The hospital attempted to decontaminate the plumbing system by heat shock. Then, on 25 May, a 55-year-old man who entered the hospital with heart problems contracted Legionnaires’. He died 15 June. The hospital’s chief of staff contended that the patients had underlying illnesses, so Legionnaires’ disease may not have been the primary cause of death. All nine of the patients were over 50 and had heart problems. Eight of the nine spent time on the same floor of the hospital before becoming ill. Sources: LA Times; Reuters; Associated Press.

Philadelphia Nursing Home, 10 cases, 2 deaths, June 2002 Nine residents and one employee of a suburban Philadelphia nursing home have been diagnosed with Legionnaires’ disease since June 10th. Two have died, a 75-year-old man and a 102-year-old woman.

8 Cases, 1 Death, Spain, May 2002 Eight cases of community-acquired Legionnaires’ disease have been identified in the Barcelona area. One of the eight, an 87-year-old man, has died. The regional health department was to investigate the cause. Source: Independent Newspapers (UK) Limited.

Melbourne, 4 cases, April 2002 Four men who visited central Melbourne sometime between late March and mid April have been diagnosed with Legionnaires’ disease. The ages of the men are 29, 51, 58, and 85. At least two of the men have been discharged from the hospital, but the last news report indicated that the other two are still undergoing treatment. Cooling towers at 31 sites in the suspect area have been inspected, tested, and disinfected. Health authorities are awaiting water test results. Sources: Australian Broadcasting Corporation and news.com.au.

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