Legionnaires’ Disease Outbreaks 2009-2010
Bali tourists, 14 cases, Aug.-Dec. 2010 Fourteen tourists who visited Bali between August and December contracted Legionnaires’ disease. Nearly all of the first 10 confirmed cases required treatment in an ICU. Their ages ranged from 41 to 82 years. Another person, considered a possible case of LD, died in Bali from pneumonia. Health officials identified a hotel as the source of the infections.
Madrid, 46 cases and 5 deaths, Nov. 2010 Health officials in Madrid are still investigating an outbreak of Legionnaires’ disease that has affected 46 people since late October. As of November 13th, five had died, seven were still in the hospital, 30 had been discharged, and four had not required hospitalization. Investigators have inspected at least 736 cooling towers, 12 of which were ordered closed.
Wales largest outbreak, Sept. 2010 As of September 23, officials from the Health and Safety Executive (HSE), Public Health Wales (PHW), and eight South Wales localities had not been able to pinpoint the source of Legionella that caused 22 cases of Legionnaires’ disease. Two people have died, a 64-year old woman and a 74-year old man. Having identified no single building visited by all the people who became ill, the investigators are focusing on cooling towers.
Slovenia nursing home, 4 cases, Aug. 2010 Between August 8 and 28, 2010, a total of 15 of the 234 residents showed symptoms of Legionnaires’ disease. Cases ranged in age from 37 to 80 years (average was 55 years). The full report is at http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19672.
Bali vacationers, 2 cases, Aug. 2010 Two Australians who traveled independently to Bali contracted Legionnaires’ disease in August. Both stayed at the same hotel, with overlapping trips between July 29 and August 8.
Maryland assisted living facility, 2 cases, Aug. 2010 Two residents of a Maryland (USA) assisted living facility contracted Legionnaire’s disease. Both were hospitalized and recovered. The facility implemented water restrictions on September 2 per the county health department’s recommendation. Source: Washington Post.
US military base in Michigan, 6 cases, August 2010 Legionnaires’ disease has been identified in six civilians who worked at or had visited an Air National Guard base in Michigan. The first three cases were diagnosed in late July. The sixth case was diagnosed on August 4th. Workers were moved out of the buildings believed to have been associated with the cases until the water was disinfected and tested, according to Army health command leaders. In July, A bacterial outbreak at the same base sickened more than 30 people. Source: news media.
Whirlpool spa in France, 3 cases, 1 death, May 2010 French investigators identified a public whirlpool spa as the most probable source of three LD cases that were confirmed in May. The first case involved a woman in her early 70s who used a sauna located in the room with the whirlpool spa in late April, but did not use the spa. She developed LD symptoms three days later, was hospitalized, and survived after antibiotic treatment. Another woman visited the spa six days after the first case did and was in the room with the whirlpool. She was diagnosed by urinary antigen and died just a few days later despite intensive antibiotic treatment. She was in her early 50s. The third case, a man in his early 30s, visited the spa 17 days after Case 1 did. He used the whirlpool spa and was diagnosed with LD and hospitalized. He recovered after antibiotic treatment. Case 1 had an underlying chronic disease, Case 2 was a smoker, but Case 3 had no risk factors. The whirlpool spa was closed by health authorities three days after notification of the second case. Legionella (150,000 cfu/l Lp1) was found in samples collected from the spa at that time. The Lp1 strains found in the water and in the patients were indistinguishable by monoclonal antibody subtyping, sequence-based typing, and PFGE. Source: Campese C, Roche D, Clément C, Fierobe F, Jarraud S, de Waelle P, Perrin H, Che D. Cluster of Legionnaires´ disease associated with a public whirlpool spa, France, April – May 2010. Euro Surveill. 2010;15(26):pii=19602. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19602.
Water wall, 8 cases, March 2010 In March, health officials blamed a water wall at a hospital in Wisconsin for eight cases of Legionnaires’ disease. The hospital turned off the water wall with no plans to restart it.
Germany’s largest outbreak, Dec. 2009 Around the end of 2009, approximately 65 German residents ranging from 27 to 96 years of age contracted Legionnaires’ disease, five of whom died. Nearly all of them lived or worked in Ulm or Neu-Ulm, in southwest Germany. The investigators suspected a cooling tower was the source of contamination even though the outbreak occurred in winter.
Hospital in UK, Dec. 2009 Two patients at a hospital in Essex contracted Legionnaires’ disease. The hospital reported that water test results indicated it was the probable source. As of the 8 January report, both patients had responded to antibiotics but one was still in a critical condition. Source: BBC News
Retirement community in Illinois, Fall 2009, 2 Deaths Three confirmed and seven suspected cases of Legionnaires’ disease occurred among residents of a retirement community in the Chicago area. Two have died. The first case died in September; the subsequent cases were identified in November. A rain forest, water fall, and spa located in the atrium of the facility were shut down by investigators. Source: Daily Herald
Hotel in Miami, Fall 2009, 3 cases Three guests of a hotel in Miami contracted Legionnaires’ and one died. A European man left on a cruise after staying at the hotel in late September but was rushed back to a hospital where he died. A second man contracted LD while at the hotel in late November. Health officials did not recognize the outbreak until December when a third case occurred in a woman who visited the hotel. Source: Miami Herald
Senior apartment complex in Baltimore, Oct. 2009, 6 cases Six elderly residents contracted Legionnaires’ disease, one of whom died. The outbreak was investigated in October. Source: Baltimore Sun
Hong Kong, 2 Cases, July 2009 Two confirmed cases of Legionnaires’ disease occurred in two Hong Kong men ages 62 and 54. The source of contamination was not identified in the news report. Source: media-newswire.com
Alcoy, Spain, 11 cases, Summer 2009 Eleven people contracted Legionnaires’ disease in Alcoy this summer, one of whom has died. Investigators believed that spring water used in the road resurfacing machinery was the source of contamination. [Details of the investigation, and the bases for implicating the spring water, were not given in the news report.]
Meat plant pressure washer, UK, 2 cases A meat processing plant in the UK was fined 25,000 british pounds because 2 of its 50 workers contracted Legionnaires’ disease and were hospitalized. The firm had to pay an additional £20,000 after pleading guilty to failing to protect its employees from Legionella in the plumbing system. Investigators concluded that Legionella bacteria were transmitted from a pressure washer used for cleaning the plant. The pressure washer was supplied with hot water that became stagnant on weekends. Both men survived, but one of them missed a significant period of work. Source: lep.co.uk/news
LD cases among fans at world handball championships, Croatia, Feb. 2009 Four Norwegians, one Danish, one Swede, one Croat, and about twelve Serbians who attended the World Handball Championships in Croatia contracted Legionnaires’ disease last month. Preliminary epidemiologic evidence indicated that the source of the illness was probably in the sports halls rather than in the hotels where the fans were staying. None of the players became ill with the disease.
Hospital, Atlanta (USA), 4 Cases, Jan. 2009 A State of Georgia epidemiologist said that four patients diagnosed with Legionnaires’ disease in January appear to have contracted the disease during their stay at Atlanta’s largest hospital. The hospital reported that all four patients were responding well to antibiotics. Legionella was found in water samples collected from rooms on the hospital floors where the four patients had stayed. The hospital closed those floors until water samples tested negative for Legionella following chlorination procedures.
Hotel in Dubai, 3 cases, 1 death, Jan. 2009 A 69-year-old British broadcaster died on 29 January after contracting Legionnaires’ disease. The man stayed at a 5-star hotel in Dubai in mid-January and returned to the UK on 20 January. Two other guests of the same hotel contracted the disease and recovered.