Recent Legionnaires’ Disease Outbreaks
Major Outbreak Associated with the North Carolina State Fair • September 2019
140 cases of Legionnaires’ disease have been diagnosed in connection with the North Carolina State Fair held September 6-15. Four of the victims have died. The North Carolina Department of Health and Human Services investigation indicated a hot tub display as the source of the outbreak.
13 Retirement Community Residents in Batavia, IL • September 2019
In late August to early September, 13 residents of a retirement community in Batavia, Illinois (near Chicago) were hospitalized and diagnosed with Legionnaires’ disease. The retirement community has worked with Kane County Health Department and state health officials to test and hyperchlorinate the water systems.
Six Community Cases in London • September 2019
Over about 18 days, six cases of Legionnaires’ disease were diagnosed among individuals in the same south-central London neighborhood. The Middlesex-London Health Unit (MLHU) tested cooling towers and other potential sources and found that a cooling tower in the area matched the Legionella strain found in the diagnosed individuals.
Hotel in Schaumburg, IL • August 2019
Two individuals who visited a Schaumburg, Illinois hotel in July or August have been diagnosed with Legionnaires’ disease. Both guests reportedly used the hotel pool and spa as well as water in their rooms. The hotel closed its pool and hot tub during the investigation.
Hotel in Wisconsin • August 2019
A hotel in Tomahawk, Wisconsin was shut down for testing and remediation after it was reported that over the last year, two guests had contracted Legionnaires’ disease within two weeks of their stays at the hotel. Local and state health officials investigated the hotel, and required that it implement a water management plan approved the local department.
Major Outbreak among Atlanta Hotel Guests • July 2019
Health officials estimated as many as 66 probable cases of Legionnaires’ disease were tied to an outbreak among guests or visitors of a hotel in Atlanta between June 22 and July 15. Laboratory tests confirmed Legionella in 13 of the ill persons. One has died, a 49-year-old woman who had visited the hotel for a conference. The hotel was shut down for approximately 30 days during testing and disinfection of the water systems.
Nursing Home in Connecticut • July 2019
Legionnaires’ disease was confirmed in two residents of a nursing home in Rocky Hill, CT in July, one whom has died. The state department of health worked with the facility to test and disinfect water systems. The public and residents were notified.
16 Cases in Moncton, New Brunswick • July 2019
Although 16 cases of Legionnaires’ disease reported in Moncton, New Brunswick (Canada) in recent weeks are all believed to be connected. a source was not identified. According to news media reports, public health officials stated, strangely, that there was no public benefit to knowing the source of the outbreak.
Three Employees in La Porte County, IN • July 2019
Three employees of La Porte County, IN were diagnosed with Legionnaires’ disease in July. All 3 were hospitalized and were recovering as of late August. The health commissioner reported that a cooling tower located across the street from the La Porte County office complex was the source of the outbreak. The cooling tower was disinfected twice before a negative Legionella result was reported.
Saltwater Hot Tub, UK • June 2019
14 people who visited a health spa in Bournemouth (UK) in June contracted Legionnaires’ disease, 9 of whom were hospitalized. Legionnaires’ symptoms were reported by another 39 spa visitors in whom Legionella infections were not confirmed with laboratory tests. The saltwater hot tub at the spa was closed by Public Health England pending further investigation. Note: Heller’s study found Legionella to survive in salt water with up to 3% sodium chloride (https://www.ncbi.nlm.nih.gov/pubmed/9489037).
Senior Living Facility in Missouri • May 2019
In late May, state and local health departments were investigating two cases of Legionnaires’ disease among residents of a senior living facility in Jefferson City, MO.
16 Patients of a New Hospital in Ohio • May 2019
16 cases of Legionnaires’ disease were identified among patients of a Columbus, Ohio area hospital that opened in April of this year. One of the cases, in a 75-year-old woman, has resulted in death. The Ohio Department of Health provided a list of actions for the hospital to take to prevent additional cases.
Major Outbreak in Belgium • May 2019
32 people ranging from 25 to 90 years in age were diagnosed with Legionnaires’ disease in Brussels in May. Of those infected, more than 20 were hospitalized and two have died. News reports indicated that cooling towers were the focus of an ongoing investigation.
22 Cases in Union County, NJ • May 2019
As of May 28, the CDC and local health departments had not implicated the source of a Legionnaires’ disease outbreak in Union County, NJ. Between March 8 and May 13, 22 people had been diagnosed with the disease, 5 of whom died. The only common link reported for the 22 cases was that each was a resident or recent visitor of Union County.
Hot Tub Mist Transmitted to People in Other Rooms • May 2019
17 people at a horse racetrack in West Virginia were infected with Legionella bacteria in May—10 contracted Legionnaires’ disease and 7 Pontiac fever. The investigation began in October 2018 when an employee was diagnosed with Legionnaires’ disease. The CDC, involved in the testing and investigating, implicated a locker room hot tub as the source of Legionella, concluding that some who fell ill—in addition to the jockeys who used the tub—were possibly exposed through hot tub mist that traveled to a second-floor office suite and a nearby hallway through floor cracks or the ventilation system.
Senior Living Center in New Jersey • May 2019
As of early May 2019, Legionnaires’ disease had been confirmed in 3 residents of a Newark senior living facility. The health department investigated and collected water samples to determine the Legionella source. Residents were reportedly notified.
Senior Living Center in Utah • May 2019
News outlets in Utah reported in early May that two residents of a senior living center in Taylorsville, Utah contracted Legionnaires’ disease. The county health department advised residents and staff to stop using all tap water pending an investigation. The senior home provided bottled water and shower filters until returning to normal tap water use.
Chicago, IL • April 2019
Local and state health departments inspected a Chicago hospital where two cases of Legionnaires’ disease were reported in late April. Legionella was found in the hospital’s water system. Patients and families were alerted to the risk.
Prison Inmates in Stockton, CA • March 2019
Two inmates at a correctional facility in Stockton, California were diagnosed with Legionnaires’ disease in March, and one of those inmates has died. After Legionella was found in water samples collected from the facility water systems, an additional 18 inmates who had recently shown signs of pneumonia were tested for Legionella. Prison officials provided bottled water for drinking and bathing, closed some showers and equipment, and notified inmates and employees.
Wisconsin Dells, WI • March 2019
Three individuals contracted Legionnaires’ disease within two weeks of staying at the same resort in Wisconsin. One has since died. Legionella was found in the hotel’s water system. Recent, current, and future guests were notified.
Guilderland, NY • February 2019
Two residents of an assisted living facility in Guilderland, NY were diagnosed with Legionnaires’ disease in February. One of the residents has died. After the New York State Department of Health confirmed the cases and found Legionella in the facility’s water system, the facility providing bottled water for drinking, implemented bathing water restrictions, and installed shower filters. Residents, family members, and staff were notified of the cases. The building was formerly a hotel that had been associated with Legionnaires’ disease outbreaks.
Hotel Hot Tub in Casselton, ND • February 2019
North Dakota Department of Health and Fargo Cass Public Health investigated a hotel in Casselton, ND in February after two people who had spent time at the hotel were diagnosed with Legionnaires’ disease. A third person who had visited the hotel in July 2018 had also been diagnosed with the disease. Legionella was found in the whirlpool spa. The hotel also has a water park. The health department issued a warning for anyone who spent time at the hotel between February 7 and 21.
Hotel Spa Suspected in 4 Cases; Crookston, MN • January 2019
Four people who had visited a hotel in northwestern Minnesota were diagnosed with Legionnaires’ disease late January. The hotel closed its pool and spa following the Minnesota Department of Health’s investigation.
Alexandria, MN • January 2019
Since November 2018, Legionnaires’ disease has been reported in two patients at a hospital in Alexandria, MN. The Minnesota Department of Health conducted an investigation.
Wisconsin Hospital; 14 cases; 3 Deaths • December 2018
Fourteen patients of University of Wisconsin Hospital were diagnosed with Legionnaires’ disease in December, 3 of whom have died. According to news reports, the hospital has since chlorinated its water systems and increased the flow rate during low-demand periods.
Hastings, MI • December 2018
Two patients of a Hastings, Michigan hospital were diagnosed with Legionnaires’ disease in November. One has since died. Legionella was found in the hospital water system after the diagnoses. Afterward, the hospital installed filters and implemented disinfection procedures.
St. Louis, MO • November 2018
A hotel in St. Louis closed for a few days in December to disinfect its water systems after it was reported that two recent guests had contracted Legionnaires’ disease. Legionella was found in the hotel’s domestic water system and cooling tower after the cases were reported.
McHenry, IL • November 2018
The Illinois Department of Public Health ordered a senior living facility in McHenry, Illinois to submit a Legionella remediation plan after finding the bacteria in its water. The department investigated the facility in November 2018 after three of its residents were diagnosed with Legionnaires’ disease.
2 Inmates at Rikers Island, NY • October 2018
A Rikers Island inmate hospitalized with Legionnaires’ disease on October 19 was the second confirmed inmate case within 12 months. Shower heads were cleaned and the health department collected samples for Legionella testing.
Champaign County, IL • October 2018
Six cases of Legionnaires’ disease were confirmed in Champaign County, Illinois between September 15 and mid-October, according to the Champaign-Urbana Public Health District. As of recent news reports, the investigators had not confirmed a source.
Bronx, NY • October 2018
NYC Health confirmed in October that 2 tenants of the same condominium property in the Bronx were diagnosed with Legionnaires’ disease. Health officials advised residents to take precautions and indicated Legionella testing would be conducted.
New York City (Washington Heights) • September-October 2018
A new cluster of Legionnaires’ disease cases occurred in the Washington Heights neighborhood of New York City beginning in late September, following an outbreak there in July. As of October 18, health officials had confirmed 29 cases, including the death of an individual who had underlying health conditions. The investigators tested for Legionella in 20 cooling towers.
Sioux Falls, SD • September 2018
As of late September, the local health department and the CDC were still investigating a Legionnaires’ disease outbreak involving 24 confirmed cases and one death, but had not identified a source.
405 Hospitalized in Brescia, Italy • September 2018
An outbreak of Legionnaires’ disease in Lombardy, Italy, starting in early September, led to the hospitalization of 405 people. Legionella was confirmed in 42 cases, including the death of 2 people from the town of Brescia. Lombardy officials implicated cooling towers as the source.
Sydney, Australia • September 2018
Five people were diagnosed and hospitalized with Legionnaires’ disease in Sydney, Australia, in September. The public health director of Western Sydney Local Health District cited a cooling tower on a building in Lidcombe as the source of the outbreak.
Lowell, NH • September 2018
Four cases of Legionnaires’ disease have been confirmed in Lowell, NH in early September, with reportedly no clear connection to the Hampton Beach outbreak that occurred June-August.
Nursing Home in Providence, RI • August-September 2018
The Rhode Island Department of Health confirmed 3 cases of Legionnaires’ disease at a nursing home in Providence. The condition of the patients, who were diagnosed between late August and early September, was not reported. The plumbing system, tested after the cases were diagnosed, was found to be contaminated with Legionella. Disinfection procedures were initiated and filters were installed on shower heads and faucets.
Surrey (British Columbia), Canada • August-September 2018
The Fraser Health Authority reported 7 confirmed cases of Legionnaires’ disease in a Surrey neighborhood, Guildford, in late August-early September. Decorative fountains and cooling towers at a retail store were disinfected after investigators suspected the store to be the common link. Update: 13 cases were eventually associated with this outbreak, three of which were linked to a cooling tower.
19 Cases in Hampton Beach, NH • June-August 2018
Hampton Beach, NH experienced a Legionnaires’ disease outbreak of 19 cases, including 16 hospitalizations and one death. All reported cases occurred between mid-June and late August. Two hot tub spas at two Hampton Beach resorts were cited as the most likely sources of the outbreak based on a comparison of patient Legionella strains, and closed as a precautionary measure. No new cases have been reported since their closing.
Elkhart Lake, WI • August 2018
The Wisconsin Department of Health Services confirmed 4 cases of Legionnaires’ disease among guests of the same resort in Elkhart Lake. Each of the cases were diagnosed within 2 weeks of the resort stay, 1 in March and 3 in August, 2018.
26 Cases in Bresso, Italy • July 2018
As of July 26, an outbreak of Legionnaires’ disease in Bresso, Italy, near Milan, has affected 26 people, including 3 elderly individuals who have died. Water testing and remediation is ongoing. In the first round of testing, Legionella was found in one sample from the home of a patient and in one from a public fountain. The town mayor closed 4 public fountains as a precaution. A city swimming pool and sports center were included in the second testing round, the results for which have not been reported.
27 Cases in New York City (Washington Heights) • July 2018
An outbreak of Legionnaires’ disease in the Upper Manhattan neighborhood Washington Heights sickened 27 individuals, 25 of whom were hospitalized. 1 has died. According to news reports, New York City health officials said on Tuesday, August 14, that no new cases had been diagnosed in the previous three weeks. The first cases were reported July 11. The health department suspects a cooling tower located near the neighborhood was likely the source based on a Legionella strain match between the cooling tower and 6 of the case-patients. That cooling tower had been cleaned and disinfected on July 13.
Cleveland, OH • July 2018
11 parishioners of a church in Parma, a suburb of Cleveland, were diagnosed with Legionnaires’ disease between early June and mid-July. 10 of those individuals were hospitalized and one, a 93-year-old Parma woman, has died. Legionella was not found in samples collected by the health department from the church’s cooling tower on July 23 and from the plumbing system on July 26. Health officials have not confirmed the church as the source but are not investigating other potential sources.
Pools Closed at a Retirement Community in Palm Springs, CA • July 2018
On July 4, the Riverside County (California) Department of Environmental Health closed swimming pools at a retirement community in Palm Springs after test results came back positive for Legionella. The health department had received confirmation of Legionnaires’ disease among two of the residents 12 days prior. The pools remained closed until sometime in August.
Detroit, MI • May-July 2018
3 cases of Legionnaires’ disease were reported among people on a college campus in Detroit, MI. The first case, a university employee, was confirmed in May. The university then tested 16 buildings and found Legionella in three cooling tower systems and in 3 bathrooms. Two more cases were confirmed in July, among workers on a campus construction project.
McHenry County, IL • June 2018
On July 10, the McHenry County Department of Health (MCDH) issued an announcement that Legionnaires’ disease had been diagnosed in 9 county residents between June 7 and July 1. The cases occurred among people ranging from 46 to 82 years of age and residing in various areas of the county. MCDH warned residents experiencing Legionnaires’ disease symptoms to see a doctor.
Columbus, Ohio • June 2018
Two veterans were diagnosed with Legionnaires’ disease in Columbus, OH after having both visited the primary care area of a VA ambulatory care center in Whitehall. 5 additional patients presented symptoms of the disease. The clinic disabled 26 drinking fountains, notified employees, and tested the water for Legionella.
Honolulu, HI • June 2018
Legionnaires’ disease was diagnosed in 4 patients of a Honolulu hospital in June. One of the patients has died. After the cases were reported, the hospital implemented water restrictions, had its water systems tested for Legionella, chlorinated, and began a faucet flushing program.
Laughlin, NV • March 2018
Legionnaires’ disease was confirmed in two guests who stayed at the same casino resort in Laughlin, NV. The cases occurred November of 2017 and March of this year but the hotel apparently was not notified by health officials until mid-June. At the request of the Southern Nevada Health District, the hotel provided guest information dating back to October 2017, posted a survey on its website to ask about any symptoms experienced among guests, disinfected water systems, and updated its water management plan.
Sarasota County, Florida • February 2018
Florida health officials investigated Legionnaires’ disease diagnosed in late February in approximately 13 people, all of whom had been in the spa and pool area of a single-family home community in North Port (Sarasota County). Although the investigators found Legionella in the water heater for the pool area fitness center, but not in the pool or spa, they suspected the pool or spa as the more likely source, probably because Legionella tests had not been conducted prior to disinfection.
San Antonio, TX • February 2018
A staff member at Brooke Army Medical Center in San Antonio was diagnosed with Legionnaires’ disease on February 6. Based on the Texas Department of State Health Services “Emerging and Acute Infectious Disease Guidelines” (https://www.dshs.texas.gov/foodestablishments/pdf/GuidanceDocs/The-Emerging-and-Acute-Infectious-Disease-Guidelines-2016.pdf), the case was considered part of an outbreak that affected two other staff members last summer. After identifying a water heater as the suspected source, the building in which it was located was evacuated.
Sydney, Australia • February 2018
Onset of Legionnaires’ symptoms occurred around the same time, between February 3 and 5, for three men who spent time in the Castle Hill area (near Sydney). News reports indicated that the health officials focused their investigation on cooling towers in the area.
Lisbon • January 2018
Health officials said a Lisbon hospital’s domestic water system was the most likely source of Legionella that caused infections in 9 women and 4 men in late January, 3 of whom were still in intensive care when the outbreak was reported.
Christchurch, New Zealand • November 2017
Potting mix the suspected source of 10 cases. Ten people in Christchurch, New Zealand were hospitalized with Legionnaires’ disease earlier this month. Potting mix was reported as the suspected source. In New Zealand and Australia, Legionella longbeachae in potting mix is a major source of Legionnaires’ disease, accounting for approximately half of reported cases.
Majorca, Spain • October 2017
Health officials identified a whirlpool spa at a hotel in the Balearic Islands (Majorca, Spain) as the source of Legionella that infected 19 British tourists who stayed there between mid-August and mid-October. One of the tourists, a 70-year-old man who had underlying illness, died in October.
Lisbon, Portugal • October 2017
Forty-Six Legionella infections have been diagnosed among patients of a hospital in the Lisbon area of Portugal since October 31. Four of the patients have died. Portuguese health officials suspect the source of the outbreak was the hospital’s domestic (potable) plumbing system.
Flushing, New York • October 2017
Fifteen cases of Legionnaires’ disease were identified in Flushing, NY (New York City area) in October. NYC Health investigators tested several cooling towers and ordered disinfection of the ones in which Legionella was found.
New York City • October 2017
Five residents of an assisted living facility in the Bronx (New York City) Riverdale neighborhood were diagnosed with Legionnaires’ disease last month. All five recovered without hospitalization. Little information about the investigation or response was found in news reports except that additional chemicals were added to the facility’s cooling towers.
Round Rock, TX • October 2017
Legionnaires’ disease has been confirmed in four guests and one employee of a hotel in Round Rock, Texas (near Austin). The hotel was shut down on Wednesday, October 4 for disinfection of the water systems.
Disneyland, CA • September 2017
Twelve people who spent time in Anaheim, California in September were diagnosed with Legionnaires’ disease. After Orange County health officials saw that 9 of the 12 had visited Disneyland, the park shut down and disinfected two cooling towers. Most of the 12 who contracted the disease were hospitalized. One of the three persons who did not visit Disneyland in the days before onset of infection has died. Information about the environmental and epidemiologic investigation has not been reported.
Spain • September 2017
12 cases of Legionnaires’ disease, including one death, have been reported among guests of a resort in northern Spain (Cantabria) since August. Part of the facility was closed for remediation.
England • September 2017
Public Health England closed a hotel in Burton, England (near Birmingham) after a guest was diagnosed with Legionnaires’ disease in September and Legionella bacteria was found in the hotel’s plumbing system. Another guest of the hotel was diagnosed with the disease in January. Both patients have recovered.
Maple Grove, MN • September 2017
Legionnaires’ disease was identified in two residents of an assisted living facility in Maple Grove, MN, the first in late August and another in mid-September. Minnesota health officials investigated the building water systems. The facility closed its pools and advised residents to not shower or use tap water for drinking or brushing teeth.
Valencia, Spain • August 2017
The water supply to a housing development in Valencia, Spain was chlorinated on August 16 in response to 7 cases of Legionnaires’ disease.
San Antonio, TX • August 2017
Brooke Army Medical Center in San Antonio confirmed that Legionnaires’ disease had been identified in two staff members during the last week in July and tests were pending for a third. According to an August 10 news report, 200 employees had been relocated and water testing initiated.
Seattle, WA • August 2017
Two University of Washington Medical Center patients were diagnosed with Legionnaires’ disease. One of the two, a woman in her 20s with underlying medical conditions, died on August 25. Approximately one year ago, Legionnaires’ disease was diagnosed in five patients of the same hospital building, two of whom died. The hospital said it is treating a third Legionnaires’ case it believes was contracted elsewhere.
Ohio • July 2017
An Ohio prison restricted showers, distributed bottled water, and installed filters on faucets in July after two inmates were diagnosed with Legionnaires’ disease.
Washington • July 2017
The Washington Department of Health is investigating two cases of Legionnaires’ disease diagnosed in two members of the same gym in Kennewick. The health department found no other common link between the two patients. The gym’s pool and hot tub were to be disinfected prior to reopening.
Memphis, TN • June 2017
Nine cases of Legionnaires’ disease have been identified in guests who stayed at a hotel in Memphis between May 15 and June 26. The Shelby County Health Department allowed the pools and hot tubs to be reopened after finding no Legionella in water samples collected from them following remediation.
Manhattan • June 2017
NYC Health collected samples for Legionella testing from more than 100 cooling towers in the vicinity of Lenox Hill in June in an effort to identify the source of seven cases of Legionnaires’ disease. Six persons were hospitalized. A woman in her 90s has died.
Ohio • May 2017
Five residents of a Reynoldsburg, Ohio senior apartment complex were diagnosed with Legionnaires’ disease in April and early May. Legionella was found in the building’s potable (plumbing) water system. Hyperchlorination was performed to temporarily disinfect the system.
Australia • May 2017
Two outbreaks of Legionnaires’ disease in Australia were under investigation in early May, one in Melbourne and the other in Adelaide. A total of 7 people were hospitalized. The patients ranged from 45 to 78 years of age. The investigation apparently focused on cooling towers.
California • May 2017
A community pool and spa in Orange County, California was closed on May 12 after two cases of Legionnaires’ disease were diagnosed among residents that used it. Health agency officials notified residents in the area to call their doctors if symptoms indicated a possible Legionella infection. The pool and spa were to remain closed pending acceptable test results.
Dubai • May 2017
The European Centres for Disease Prevention and Control (ECDC) identified 60 cases of Legionnaires’ disease among travelers to Dubai between Oct 2016 and May 2017, most of whom had stayed in hotels. The number of cases is higher than normal.
Orlando • April 2017
A fitness center in Orlando notified its members by email on April 18th that three people who had recently used the gym contracted Legionnaires’ disease. The fitness center decontaminated its hot tub and installed filtered shower heads per health department recommendations.
Macau, Hong Kong • March 2017
Three Hong Kong men who had stayed at or visited a new 3000-room casino resort in Macau between December and March were diagnosed with Legionnaires’ disease. All three men were hospitalized – one in critical and two in serious condition – were treated, and recovered. Health authorities inspected the property’s fountains, whirlpool spas, swimming pools, and plumbing systems, collected samples, and ordered disinfection of the spas and plumbing systems.
Mihara, Japan • March 2017
Legionella was detected in 39 people who complained of pneumonia-like symptoms after visiting an onsen in Mihara, Japan. 37 were hospitalized, including a man in his 50s who has died. The onsen has indoor and outdoor bathing facilities supplied by hot spring water at approximately 45 degrees C (113 degrees F) and an adjoining inn with hot spring baths in each guest room. It was closed on March 21.
Melbourne • March 2017
Three men and two women ranging from 51 to 71 years of age were hospitalized with Legionnaires’ disease in late March to early April. All five reported spending time in the eastern end of Melbourne’s central business district in the days before onset of illness. One of the patients required life support in intensive care but all have been discharged. Authorities are sampling in search for the source and have disinfected several systems and warned people experiencing pneumonia or flu-like symptoms to see their physician.