New York City Department of Health and Mental Hygiene (DOHMH) officials met with tenants of the Co-Op City complex last week to inform them that no new cases of Legionnaires’ disease have been found and the risk of contracting the disease is very low, according to a story posted on Bronx.News12.com.

The community meeting comes weeks after the residents were alerted that a cluster of three Legionnaires’ cases had been confirmed at Co-Op City’s Building 11 within the past 12 months, including the death of an elderly tenant.

The three cases occurred in Building 11, which is actually three smaller, connected buildings at the complex, which share a water supply. They do not, however, have a cooling tower, which is a common breeding ground for Legionella bacteria, the bacteria that causes Legionnaires’ disease.

The first case was reported last year, while two others have occurred within the past 60 days. Had the illnesses occurred within a six-month period, health officials would categorize it as an “outbreak” instead of a cluster.

The notification took place as part of the DOHMH’s public notification protocol for Legionnaires’ disease, which requires management to notify tenants when there are two or more cases reported at a single building in a 12-month period.

Riverbay Corporation, Co-Op City’s property management company, installed a copper-silver ionization system last week to proactively disinfect the water supply. Copper-silver ionization is a disinfection process, primarily used to control Legionella. The technology is recognized by the World Health Organization (WHO) and the Environmental Protection Agency (EPA) to control Legionella within potable water distribution systems found in hospitals, hotels and other large facilities.

No information was released by health officials or the management company regarding the results of the water testing performed in late April. Results typically take 2-3 weeks to become available.

Residents, visitors to, and employees of Co-Op City who have recently suffered from or are currently suffering from pneumonia- or flu-like symptoms should seek immediate medical attention from their primary health-care provider. They should also contact the DOHMH to report the illness.

Co-Op City, located in the Baychester section of the borough, is the largest cooperative housing development in the world. It has 15,372 apartments in 35 high-rise buildings and seven townhouse groups with approximately 50,000 residents. It is situated at the intersection of I-95 and the Hutchinson River Parkway and is part of Bronx Community District 10.

The three buildings in Co-Op City are located at 100, 120, and 140 Carver Loop in zip code 10475 in the north Bronx.

Congressmen concerned

Robert R. Redfield, director of the Centers for Disease Control and Prevention (CDC), wrote to Congressmen Eliot Engel recently that the DOHMH is heading up the investigation into the Legionnaires’ cases at Co-Op City. They’re “checking the internal plumbing of the building affected, and out of an abundance of caution sampling the building’s internal water supply,” Redfield wrote.

Congressmen Eliot Engel
Congressmen Eliot Engel

“An abundance of caution is the only way to handle something like this,” Congressman Engel wrote on his website, “so I am encouraged to hear that’s the track being taken with this very serious issue.

“Though the CDC has made clear that DOHMH is carrying out the investigation, they have assured me that they are in close communication with the city, and stand ready to assist if needed,” he added. “I will remain in contact with officials at both the federal and local level to ensure this is handled quickly and appropriately.”

Redfield’s reply was in response to an April 26 letter from Engel, which requested the CDC’s assistance. “I am extremely alarmed by these cases and ask that the Centers for Disease Control and Prevention work with the New York City Department of Health and Mental Hygiene to investigate the cause of these cases without delay,” Engel wrote.

Legionnaires’ timeline

In 2012 and 2013, two residents in Building 27 of Co-Op City were sickened with Legionnaires’, which they were believed to have contracted through contaminated shower heads. Tenants did not learn of those illnesses until early 2014, angering many residents. Officials of Riverbay Corp., Co-Op City’s management company, said testing did not find Legionella, which is why residents were never told.

Between December 2014 and January 2015, there were eight cases of Legionnaires’ disease at Co-Op City. Those illnesses were linked to a cooling tower infected with Legionella bacteria. Riverbay paid a chemical treatment company $200,000 to disinfect that water with chlorine and clean the tower to eliminate Legionella from the system.

Legionnaires’ 101

Legionnaires’ disease – also called legionellosis and Legionella pneumonia – is a severe type of pneumonia (lung infection). According to the CDC, an estimated 25,000 cases of pneumonia due to Legionella bacteria (Legionella pneumophila) occur yearly in the U.S. Only 5,000 cases are reported, however, because of its nonspecific signs and symptoms.

Ten percent of people who become infected with Legionnaires’ disease will die from the infection.

Legionella bacteria are contracted by inhaling microscopic water droplets, usually in the form of mist or vapor. The bacteria, which grow best in warm water, are found primarily in human-made environments.

Where do Legionella live?
Outbreaks have been linked to a number of sources, such as:

  • large plumbing systems
  • showers and faucets
  • hot-water tanks and heaters
  • swimming pools
  • hot tubs and whirlpools
  • decorative fountains
  • mist machines and hand-held sprayers
  • equipment used in physical therapy
  • water systems, such as those used in hospitals, nursing homes, and hotels
  • the cooling towers of air conditioning systems.

Who is most at risk?
Anyone can become ill from Legionella, but those most susceptible to infection include:

  • people 50 years of age or older
  • smokers, current and former
  • heavy drinkers of alcoholic beverages
  • people with chronic lung disease
  • people with compromised immune systems
  • recipients of organ transplants
  • individuals who are on specific drug protocols (corticosteroids, to name one).

Legionnaires’ symptoms
Legionnaires’ disease is similar to other types of pneumonia. Symptoms can even resemble those of flu, which is why it often goes under-reported. Symptoms include:

  • cough
  • shortness of breath
  • fever
  • muscle aches
  • headaches
  • gastrointestinal symptoms, such as nausea, vomiting, and diarrhea.

Several employees at the Jerry L. Pettis Memorial V.A. Medical Center in Loma Linda, CA, have filed a federal whistleblower complaint against hospital officials alleging that they are covering up a Legionella bacteria outbreak, the Orange County Register (OCR) recently reported. The complaint says that officials put patients, hospital visitors, and staff at risk for catching Legionnaires’ disease.

A five-page, redacted complaint was submitted to the U.S. Office of Special Counsel Robert Wilkes, acting Secretary of Veterans Affairs. The complaint, which was obtained by the Southern California News Group, claims “gross mismanagement, abuse of authority, gross waste of funds, and substantial and specific danger to public health and safety.”

“We have an administration not following Veterans Administration directives to protect the welfare of employees, patients, and visitors from exposure to Legionella,” said Dr. Linda Hyder Ferry, chief of preventive medicine at Pettis Medical Center and among more than a dozen whistleblowers (physicians and nurses).

Ferry told the OCR that federal officials visited the hospital and collected hundreds of pages of patients’ records after the whistleblowers filed their complaint.

Officials deny problems exist

Wade J. Habshey, a spokesperson for Pettis Medical Center, dismissed there was a Legionella issue at the facility.

“(The) V.A. takes Legionella prevention very seriously,” Habshey said in an email to the OCR. “V.A. directives on Legionella are among the most stringent in the country. The V.A. Legionella prevention program addresses the education of staff on how to prevent Legionella, reduction of conditions for Legionella growth, (and) monitoring and remediation if found.”

Water quality is monitored quarterly at the Pettis Medical Center, according to Habshey, and the facility has a prevention team to deal with any Legionella problems.

“We have been very successful and have a zero history of hospital-acquired Legionella cases,” he said.

Administration failed to communicate

The complaint alleges that the hospital’s administration knew of the Legionella issue in 2017 but failed to notify the medical staff, failed to correct the problem, and denied that bacteria existed at the facility.

“There are many employees and patients who could have been exposed from August-September to November from the sporadic growth of Legionella in the water system,” the complaint reads.

The whistleblowers specifically cite Melissa Lloyd, the hospital’s associate director for patient care services, for her lack of communication with the medical staff, after she learned of a positive Legionella test. “None of the physicians were informed of the presence of Legionella,” states the complaint.

The whistleblowers also state that Pettis Medical Center officials have not been forthcoming with the California Department of Public Health. “Public health investigators were told by Loma Linda V.A. officials that there was no Legionella exposure to report, there was no verified index case, and that the water testing was negative,” according to the complaint.

State health officials said they had no reports of a Legionella outbreak. One whistleblower – who asked to remain anonymous out of fear of retribution – said they are unconvinced and concerned Legionella is widespread.

“We don’t know how many patients may have died from Legionnaires’ pneumonia,” the whistleblower said. “If they don’t tell doctors (about the existence of Legionella), we don’t do testing.”

Legionella: A V.A. problem

There have been many instances of Legionella contamination or disease cases plaguing V.A. hospitals across the country the past few years. Some examples:

  • February 2018: Four residents at the Illinois Veterans Home in Quincy were confirmed with Legionnaires’ disease, marking the fourth consecutive year the facility has battled an outbreak. There have been 68 people infected and 13 deaths since the first outbreak in 2015.
  • January 2018: A resident of the Fresno, CA, Veterans Home tested positive for Legionnaires’ disease. It’s unknown whether the illness was caught at the facility.
  • January 2017: Testing discovered the existence of Legionella at the V.A. Pittsburgh Healthcare campus. There were no reports of hospital-acquired Legionnaires’ disease after the discovery. The same facility was not as lucky during a Legionnaires’ outbreak in 2011-12, when 22 patients were infected and six of them died.
  • August 2016: Two residents contracted Legionnaires’ while living at the Ussery Roan Veterans Home in Amarillo, TX.
  • November 2015: Water samples at the Minneapolis, MN, Veterans Medical Center tested positive for Legionella, although no illnesses were reported.
  • August 2015: The V.A. Hospital in Phoenix, AZ, relocated 20 patients after routine testing indicated “unacceptable levels” of Legionella in the water system of one building. None of the patients contracted Legionnaires’ disease.
  • October 2014: Legionella were discovered in nine positive tests at the Prescott, AZ, V.A. hospital. It was caught before any illnesses were reported.
  • August 2014: Six buildings on the campuses of New Jersey V.A. Hospitals in East Orange and Lyons were found to be contaminated with Legionella.
  • February 2014: Hospital-acquired Legionnaires’ disease claimed the life of a patient at Bay Pines V.A. Medical Center in Bay Pines, FL. In September 2014, testing returned positive results for Legionella in nine of 19 sites in Building 1. Follow-up testing in December showed the bacteria was even more prevalent, with 11 of 20 sites testing positive.
  • June 2013: An 80-year-old veteran died from Legionnaires’ disease contracted at the Castle Point veterans campus of the Hudson Valley, NY, Health Care System.

What is Legionnaires’?

Legionnaires’ disease – also called legionellosis and Legionella pneumonia – is a severe type of pneumonia (lung infection). According to the Centers for Disease Control and Prevention (CDC), an estimated 25,000 cases of pneumonia due to Legionella bacteria (Legionella pneumophila) occur annually in the United States. Only 5,000 of those cases are reported, however, because of the disease’s nonspecific signs and symptoms.

Ten percent of people who become infected with Legionnaires’ disease will die from the infection.

Legionella bacteria are contracted by inhaling microscopic water droplets, usually in the form of mist or vapor. The bacteria, which grow best in warm water, are most commonly found in human-made environments.

Where do Legionella live?
Outbreaks have been linked to a number of sources:

  • large water systems, such as those in hospitals, nursing homes, and hotels
  • large plumbing systems
  • equipment used in physical therapy
  • cooling towers of air conditioning systems.
  • showers and faucets
  • hot-water tanks and heaters
  • hot tubs and whirlpools
  • swimming pools
  • mist machines and hand-held sprayers
  • decorative fountains.

The state of Michigan and Governor Rick Snyder have ended the free bottled water distribution program to Flint residents, according to news reports. The 2-year-old program began in January 2016 as part of a $450 million state and federal aid package that was put in place after lead-tainted water plagued the city during the Flint water crisis, which started in 2014, sickening thousands of children, seniors, and pets.

It’s also believed that the tainted water is responsible for a 2015 Legionnaires’ disease outbreak in which 12 people died and nearly 90 sickened. In addition, the area experienced a decrease in fertility and increase in infant deaths and miscarriages.

Gov. Rick Snyder
Michigan Gov. Rick Snyder

“I have said all along that ensuring the quality of the water in Flint and helping the people and the city move forward were a top priority for me and my team,” Gov. Snyder said in a news release. “.We have worked diligently to restore the water quality, and the scientific data now proves the water system is stable and the need for bottled water has ended.”

State testing has shown Flint’s water supply has passed federal standards for nearly two years. Recent results put the lead levels at 4 parts per billion (ppb), which is below the federal action level of 15 ppb, according to state officials.

The Points of Delivery (POD) – where the bottled water distribution took place – were officially closed April 10, after the last of the free water was distributed, according to the Michigan Department of Environmental Quality (MDEQ). The state said the program cost an average of $22,000 a day this year.

“One of the things we said right from the beginning [was] that those PODs stay open until we got through the lead service line replacements,” Flint Mayor Dr. Karen Weaver said in a news conference. “We’re not through that yet … that was very insensitive to the people when you look at everything we’ve been through.”

Mayor Dr. Karen Weaver
Flint Mayor Dr. Karen Weaver

Weaver said she will lobby Gov. Snyder for an extension of the water distribution program until the state has replaced all residential lead and galvanized steel water service lines, which is expected to be completed by the end of 2019. A spokesperson said the governor would meet with Weaver “when his schedule allows.”

Water crisis started in 2014

The Flint water crisis began in April 2014 after the city switched its public water source from Lake Huron to the Flint River to cut costs. The switch introduced lead, iron and organic matter into Flint’s water supply, leading to the Legionnaires’ outbreak and other medical issues.

Soon after the switch, residents complained that the water started to look, smell and taste funny. Tests by the Environmental Protection Agency (EPA) and scientists at Virginia Tech University showed alarming levels of lead in the residents’ water.

A class-action lawsuit charged that the state wasn’t treating the Flint River water with an anti-corrosive agent, a violation of federal law. The improperly treated water was eroding the iron water mains, turning the water brown. Additionally, about half of the service lines to Flint homes are made of lead, and because treatment of the water wasn’t adequate, lead also began leaching into the water supply.

More than a dozen lawsuits, including several class-action suits, were filed against the state of Michigan and the city of Flint, as well as various state and city officials, and employees involved in the decision to switch the water source.

Free water filters and replacement cartridges will continue to be made available for residents who have water line work in progress – which could cause short-term spikes of lead into the water – or who feel more comfortable using a filter until their confidence in the water quality is restored. Residents can find them at City Hall or by calling the Community Outreach Resident Education Program (CORE) at 810-238-6700. The CORE program was established to ensure Flint residents are correctly installing, using and maintaining the water filters.

Non-profit groups also have been distributing free bottled water at Flint churches, and that will likely continue, although with the discontinuation of the city program, it could affect how they administer the distribution. “Normally, we give out whatever a family wants,” Bill Quarles, a deacon at the First Trinity Missionary Baptist Church in Flint, told NBC News. “But now we may have to limit that until more supplies come in.”

What is Legionnaires’ disease? 

Legionnaires’ disease – also called Legionellosis and Legionella pneumonia – is a severe type of pneumonia or lung infection. According to the Centers for Disease Control and Prevention (CDC), about 25,000 cases of pneumonia due to the Legionella bacteria (Legionella pneumophila) occur each year. However, only 5,000 cases are reported because of the disease’s nonspecific signs and symptoms, and 10 percent of those illnesses will end in death.

Contracting Legionella
Legionella bacteria are contracted by inhaling microscopic water droplets (mist or vapor). The bacteria, which grow best in warm water, are found primarily in human-made environments.

Outbreaks have been linked to a range of sources:

  • large plumbing systems and large water systems, such as those used in hotels, hospitals, and nursing homes
  • air conditioning systems’ cooling towers
  • hot water tanks and heaters
  • showers and faucets
  • swimming pools
  • hot tubs and whirlpools
  • physical therapy equipment
  • mist machines and sink sprayers
  • decorative fountains.

The New York City Department of Health and Mental Hygiene (DOHMH) is investigating a cluster of Legionnaires’ disease illnesses at Co-Op City in the Bronx, including the death of an elderly resident.

Co-Op City, located in the Baychester section of the borough, is the largest cooperative housing development in the world. It has 15,372 apartments in 35 high-rise buildings and seven townhouse groups with approximately 50,000 residents. It is situated at the intersection of Interstate 95 and the Hutchinson River Parkway and is part of Bronx Community District 10.

The three cases occurred in three connected buildings at the complex within the past year; the first case was reported last year, while two others occurred within the past 60 days. Had the illnesses occurred within a six-month period, health officials would categorize it as an “outbreak” instead of a cluster.

All three people who became ill had conditions that increased their prospects of catching Legionnaires’ disease. The two residents who survived their illnesses have been released from the hospital, according to the health department.

Neither the name of the deceased has been released, nor when their illness occurred.

“Residents of this building who are over 50 or have underlying medical conditions should avoid showering until the investigation is completed,” the DOHMH warned in a statement. The statement included information that said tap water is safe to drink.

The DOHMH will test the building’s plumbing to see if a common source of Legionella bacteria can be located. (Legionella is the bacteria that causes Legionnaires’ disease.) The three buildings where the illnesses occurred do not have a cooling tower but share the same plumbing system.

A history of Legionnaires’

Between December 2014 and January 2015, there were eight cases of Legionnaires’ disease at Co-Op City. Those illnesses were linked to a cooling tower infected with Legionella bacteria. Seven of the eight people infected lived in different buildings.

At that time, Co-Op City’s management company, Riverbay Corporation, paid a chemical treatment company $200,000 to disinfect that water with chlorine and clean the tower to eliminate Legionella from the system.

In 2012 and 2013, two residents in Building 27 of the housing development were sickened with Legionnaires’, which they were believed to have contracted through contaminated shower heads. Tenants did not learn of those illnesses until early 2014, angering many of the residents. Testing, however, did not indicate the existence of Legionella, which is why residents were never told, according to Riverbay officials.

In 2015, cooling towers were responsible for an outbreak in the Bronx that sickened 133 people and killed 16, making it the largest outbreak of Legionnaires’ disease in New York City history.

Residents, visitors to, and employees of Co-Op City who have recently suffered from or are currently exhibiting pneumonia- or flu-like symptoms (see below) should seek immediate medical attention from their primary health-care provider. They should also contact the DOHMH to report the illness.

Legionnaires’ info

Legionnaires’ disease is similar to other types of pneumonia. Symptoms can resemble those of flu, such as:

  • cough
  • shortness of breath
  • fever
  • muscle aches
  • headaches
  • gastrointestinal symptoms, such as nausea, vomiting, and diarrhea.

Who is most at risk?
Anyone can become ill from Legionella, but those most susceptible to infection include:

  • people 50 years of age or older
  • smokers, current and former
  • heavy drinkers of alcoholic beverages
  • people with chronic lung disease
  • people with compromised immune systems
  • recipients of organ transplants
  • individuals who are on specific drug protocols (corticosteroids, to name one).

What exactly is Legionnaires’?
Legionnaires’ disease – also called legionellosis and Legionella pneumonia – is a severe type of pneumonia (lung infection). According to the Centers for Disease Control and Prevention (CDC), an estimated 25,000 cases of pneumonia due to Legionella bacteria (Legionella pneumophila) occur in the U.S. annually. However, only 5,000 cases are reported because of its nonspecific signs and symptoms.

Ten percent of those who become infected with Legionnaires’ disease will die from the infection.

Legionella bacteria are contracted by inhaling microscopic water droplets, usually in the form of mist or vapor. The bacteria, which grow best in warm water, are found primarily in human-made environments.

Where do Legionella live?
Outbreaks have been linked to a number of sources, such as:

  • large plumbing systems
  • showers and faucets
  • hot-water tanks and heaters
  • swimming pools
  • hot tubs and whirlpools
  • decorative fountains
  • mist machines and hand-held sprayers
  • equipment used in physical therapy
  • water systems, such as those used in hospitals, nursing homes, and hotels
  • the cooling towers of air conditioning systems.

The Florida Department of Health in Lake County has confirmed two Legionnaires’ disease cases at a 55-plus community in Lady Lake, FL, according to Villages-News.com.

Two sickened with Legionnaires' disease at Water Oak Country Club.
Hot tub sickens two with Legionnaires’ disease at Water Oak Country Club, FL, community.

Laboratory testing determined that the hot tub at the Water Oak Country Club clubhouse was the source of the illnesses. No further information was available on the current condition of the victims, or whether they required hospitalization.

Residents, visitors and employees who have used the hot tub since Feb. 1 and who have had or are currently exhibiting pneumonia- or flu-like symptoms (see below) should seek immediate medical attention from their primary health-care provider. They should also contact the Department of Health at (352) 771-5573 to report their illness.

The 300-acre, active gated-community is located near The Villages, off U.S. 27/441 between Leesburg and Ocala, approximately one hour north of Orlando. Amenities include an 18-hole golf course, four tennis courts, bocce ball court, horseshoe pit, an Olympic-size swimming pool, and fitness center, equipped with a Jacuzzi and sauna.

Water Oak Country Club is part of Sun Communities, Inc., a real-estate investment trust with more than 300 manufactured home communities and RV resorts located in 29 states throughout the United States and Ontario, Canada. Sun Communities offers all-age communities, Sun RV resorts, and active 55-plus communities. Water Oak is one of Sun’s 100 active 55-plus communities in 71 cities.

A rough 2017 for Orlando

There were 21 confirmed cases of Legionnaires’ disease last year in Orange County, for which Orlando is the county seat. Some of the more high-profile incidents included:

  • Seven guests at three LA Fitness clubs in the metropolitan area were infected with Legionnaires’ between April and June. In April, three guests of the LA Fitness in Ocoee (1560 E. Silver Star Road) contracted the disease, although tests for Legionella at that facility were negative. And last June, four members of the Metro West area LA Fitness (4792 Kirkman Road) and the Hunter’s Creek LA Fitness (12700 S. Orange Blossom Trail) were sickened.
  • In July, two residents at Summit Greens, a 55-and-older living community in suburban Orlando, were infected with Legionnaires’ disease.

Legionnaires’ 101

Legionnaires’ disease – also called legionellosis and Legionella pneumonia – is a severe type of pneumonia or lung infection. According to the Centers for Disease Control and Prevention (CDC), an estimated 25,000 cases of pneumonia due to Legionella bacteria (Legionella pneumophila) occur each year, but only 5,000 cases are reported because of the disease’s nonspecific signs and symptoms.

Ten percent of those who become infected with Legionnaires’ disease will die from the infection.

Legionella bacteria are contracted by inhaling microscopic water droplets, usually in the form of mist or vapor. The bacteria, which grow best in warm water, are found primarily in human-made environments.

Outbreaks have been linked to a number of sources, such as:

  • hot tubs and whirlpools
  • swimming pools
  • showers and faucets
  • equipment used in physical therapy
  • hot-water tanks and heaters
  • mist machines and hand-held sprayers
  • the cooling towers of air conditioning systems
  • large plumbing systems
  • water systems, such as those used in hospitals, nursing homes, and hotels
  • decorative fountains.

People also can contract Legionnaires’ disease when they “aspirate” contaminated drinking water – that is, choking or coughing while drinking can cause water to go down the wrong pipe into the lungs. It is also possible to contract the disease from home plumbing systems. Both of these, however, happen very rarely.

What is an outbreak?
A Legionnaires’ disease outbreak occurs when two or more people are exposed to Legionella bacteria and get sick in the same vicinity around the same time, according to the CDC.

Who is at risk?
Anyone can get Legionnaires’ disease, but those most susceptible to infection include:

  • people 50 years of age or older
  • smokers, current and former
  • heavy drinkers of alcoholic beverages
  • people with chronic lung disease
  • people with compromised immune systems
  • recipients of organ transplants
  • individuals who are on specific drug protocols (corticosteroids, to name one).

What are the symptoms?
Legionnaires’ disease is similar to other types of pneumonia. Symptoms can resemble those of the flu in the following forms:

  • cough
  • shortness of breath
  • fever
  • muscle aches
  • headaches
  • gastrointestinal symptoms, such as nausea, vomiting, and diarrhea.

An Orlando, FL, resident has filed suit against a fitness club after being sickened with Legionnaires’ disease last May, according to the Florida Record (https://flarecord.com), an online publication owned by the U.S. Chamber Institute for Legal Reform.

The complaint (Orange County Circuit Court case #18CA003106) was filed by Reinaldo Mariaca of Orlando against Fitness International, LCC, in Orange County Circuit Court. Mariaca’s suit alleges that the club failed to maintain the premises in a safe condition for its clients. Fitness International operates the health club chain LA Fitness.

Mariaca, who was a business invitee to the club, contracted Legionnaires’ disease, a sometimes-deadly form of pneumonia, after using the club’s amenities. He said he suffered bodily injury, lost the enjoyment of life, incurred a loss of earnings and the ability to earn money, and incurred expenses for hospitalization and medical treatment.

Mariaca alleges Fitness International failed to adequately inspect the showers, water fountains, spas, pools and water fixtures on the premises to determine whether Legionella – the bacteria that causes Legionnaires’ disease – existed before guests used the club.

Mariaca is asking for a trial by jury and seeing damages in excess of $15,000, plus interest and court costs.

A rough 2017 for Orlando’s LA Fitness clubs

Seven guests at three LA Fitness clubs in the Orlando-area, including Mariaca, were infected with Legionnaires’ disease between April and June last year.

Both the Metro West area LA Fitness (4792 Kirkman Road), which is where Mariaca was sickened, and the Hunter’s Creek LA Fitness (12700 S. Orange Blossom Trail) returned positive results for Legionella last June.

In April, three guests of the LA Fitness club in Ocoee (1560 E. Silver Star Road) contracted the disease, but tests for Legionella at that facility were negative.

About 25,000 cases annually

Legionnaires’ disease is a severe type of pneumonia or lung infection. According to the Centers for Disease Control and Prevention (CDC), an estimated 25,000 cases of pneumonia due to Legionella bacteria (Legionella pneumophila) occur in the United States on a yearly basis. However, only 5,000 cases are reported because of the disease’s nonspecific signs and symptoms.

Legionella bacteria are contracted by inhaling microscopic water droplets in the form of mist or vapor. The bacteria, which thrive in warm water, are found primarily in human-made environments, such as cooling towers, air-conditioning systems, hot tubs, and spas, to name just a few.

Ten percent of those who become infected with Legionnaires’ disease will die from the infection.

Sources of Legionella infection
Outbreaks have been linked to a number of sources:

  • hot-water tanks and heaters
  • showers and faucets
  • swimming pools
  • hot tubs and whirlpools
  • equipment used in physical therapy
  • mist machines and hand-held sprayers
  • the cooling towers of air conditioning systems
  • large plumbing systems
  • water systems such as those used in hospitals, nursing homes, and hotels
  • decorative fountains.

People also can contract Legionnaires’ disease when they “aspirate” contaminated drinking water – that is, choking or coughing while drinking can cause water to go down the wrong pipe into the lungs. It is also possible to contract the disease from home plumbing systems. Both of these, however, happen very rarely.

A preliminary report by the Illinois Department of Veterans’ Affairs (IDVA) recommends replacing the Illinois Veterans Home in Quincy (IVHQ) with a state-of-the-art facility and other improvements, all of which would cost the state as much as $278 million.

The report concludes that the best options for eradicating Legionella bacteria from the facility would include construction of a new residential building (approximately $250 million), replacing plumbing campus-wide (approximately $16 million), and drilling a well and buying a nearby nursing home (approximately $12 million).

A final report from the IDVA is due in May.

Dozens of IVHQ residents have contracted Legionnaires’ disease, which has claimed 13 lives at the facility since 2015. Four residents were infected with the disease earlier this year; that represents the fourth consecutive year a Legionnaires’ outbreak has hit the home.

Families of 11 of the residents who died have filed suit against the state.

Legionnaires’ disease has continued to plague the IVHQ despite the installation of a $6.4 million water filtration system in 2016. Three illnesses that year occurred after the rehabbed plant was made operational.

CDC: Eradication may not be possible

Representatives from the Centers for Disease Control and Prevention (CDC) visited the IVHQ this year to review testing protocols for individuals with respiratory illness, at the request of the Illinois Department of Public Health (IDPH).

The CDC had warned last month in a 20-page report that the “complete eradication of Legionella in any large, complex building water system may not be possible.” The information was compiled in response to last year’s Legionnaires’ disease outbreak at the IVHQ.

“There is no known safe level of Legionella in building water systems, and cases have been associated with very low levels of bacteria,” the report concluded.

Despite efforts to eliminate Legionella from the IVHQ, the ST36 strain of the bacterium has been identified in the IVHQ water system in each of the previous three years.

“It is probable that this strain persists in protective biofilm, scale, and sediment that are present in the plumbing infrastructure,” according to the CDC report.

What is Legionnaires’ disease?

Legionnaires’ disease – also called legionellosis and Legionella pneumonia – is a severe type of pneumonia or lung infection. According to the CDC, an estimated 25,000 cases of pneumonia due to Legionella bacteria (Legionella pneumophila) occur each year, but only 5,000 cases are reported because of the disease’s nonspecific signs and symptoms.

Ten percent of those who become infected with Legionnaires’ disease will die.

Legionnaires’ risk factors
Anyone can get Legionnaires’ disease, but those most susceptible to infection include:

  • people 50 years of age or older
  • smokers, current and former
  • heavy drinkers of alcoholic beverages
  • people with chronic lung disease
  • people with compromised immune systems
  • recipients of organ transplants
  • individuals who are on specific drug protocols (corticosteroids, to name one).

Legionnaires’ sources
Legionella bacteria are contracted by inhaling microscopic water droplets, usually in the form of mist or vapor. The bacteria, which grow best in warm water, are found primarily in human-made environments.

Outbreaks have been linked to a number of sources, including:

  • hot-water tanks and heaters
  • showers and faucets
  • swimming pools
  • hot tubs and whirlpools
  • equipment used in physical therapy
  • mist machines and hand-held sprayers
  • cooling towers of air conditioning systems
  • large plumbing systems
  • water systems, such as those used in hospitals, nursing homes, and hotels
  • decorative fountains.

People also can contract Legionnaires’ disease when they “aspirate” contaminated drinking water – that is, choking or coughing while drinking can cause water to go down the wrong pipe into the lungs. It is also possible to contract the disease from home plumbing systems. Both of these, however, happen very rarely.

Scientists at the Technical University of Munich in Germany said they have developed a measuring chip that will identify the existence of Legionella within 34 minutes, according to recently published research in the journal “Biosensors and Bioelectronics.”

Legionella is the bacteria that causes Legionnaires’ disease, which can be identified with a urinalysis. Trying to determine the exact source of the illness, however, can be time-consuming – especially when time is of the essence.

The current method of testing for the existence of Legionella involves the collection of water samples. That, however, typically takes from 10 to 14 days to return a result.

The illness’ origin is confirmed when germs in the process water of a technical system exactly match those identified in the patient. Often, however, numerous systems must be tested. Finding the source of the illness quickly is imperative.

The problem with such delayed reporting is that the existence of Legionella – rod-shaped bacteria that multiply in warm water and can cause life-threatening pneumonia or respiratory infection – can reach an infectious level in as short as one week. If a disease outbreak has already occurred, identifying the actual source as soon as possible becomes critical for preventing additional exposures.

Chip gets name: “LegioTyper”

The measuring chip, which was given the name “LegioTyper,” is an inexpensive, one-time use device that contains a microarray of 20 different antibodies. Each of the antibodies binds to a different subtype of Legionella pneumophila, which is responsible for 80 percent of all infections and is considered the most dangerous of the almost 50 Legionella species.

If any of the Legionella subtypes are present in the water sample, the chip will detect its presence within 34 minutes (chemicals such as luminol and hydrogen peroxide are used to make the subtype appear by causing a chemiluminescence reaction).

The LegioTyper project, which was funded by the German Federal Ministry of Education and Research, will be introduced to the public for the first time at the Analytica 2018 trade fair in Munich next week.

Climate change to blame?

Legionnaires’ disease outbreaks have made headlines across the United States nearly annually since the disease was discovered in 1976. That was the year more than 200 attendees at an American Legion Convention in Philadelphia were sickened, and 34 of them died.

Legionnaires’ disease – a severe type of pneumonia or lung infection – is “an emerging disease in the sense that the number of recorded cases of Legionnaires’ in the United States continues to increase,” said Laura Cooley, MD, MPH from the Respiratory Diseases Branch of the Centers for Disease Control and Prevention (CDC).

Cooley said the increase is due to a rise in the susceptibility of the population, with more and more people on immunosuppressive medications. In addition, there could be more Legionella in the environment, with warmer temperatures creating the right conditions for bacterial growth.

The last three years have been the hottest years on record, with NASA ranking 2016 as the warmest and 2017 second-warmest.

Legionnaires’ facts and figures

The CDC estimates that 25,000 cases of Legionnaires’ disease occur in the United States on a yearly basis. Only 5,000 cases, however, are reported, because of the disease’s non-specific signs and symptoms.

Legionella bacteria are contracted by inhaling microscopic water droplets (generally, mist or vapor). The bacteria, which thrive in warm water, are found primarily in human-made environments. Water sources that provide optimal conditions for the growth of the infectious bacteria, according to the Occupational Safety and Health Administration (OSHA), include:

  • cooling towers, evaporative condensers, and fluid coolers that use evaporation to reject heat; these include many industrial processes that use water to remove excess heat
  • domestic hot-water systems with water heaters that operate below 60°C (140°F) and deliver water to taps below 50°C (122°F)
  • humidifiers and decorative fountains that create a water spray and use water at temperatures favorable to growth
  • spas and whirlpools, such as those in hotel pool areas
  • dental water lines, which are frequently maintained at temperatures above 20°C (68°F) and sometimes as warm as 37°C (98.6°F) for patient comfort
  • other sources including stagnant water in fire sprinkler systems and warm water for eyewashes and safety showers.

Who is most at risk of infection?
Anyone can get the disease, but those at the greatest risk of infection include:

  • people 50 years old or older
  • smokers (current or former)
  • heavy drinkers of alcoholic beverages
  • people with chronic lung disease
  • people with weakened immune systems
  • organ-transplant recipients (kidney, heart, etc.)
  • individuals following certain drug protocols (for instance, corticosteroids).

A federal judge in New Orleans awarded a summer intern $310,000 in his lawsuit over a near-deadly bout of Legionnaires’ disease contracted onboard a ship, according to the Bangor (MA) Daily News.

Bryan Higgins, 27, of Concord, NH, took ill in August 2013 while working aboard an offshore vessel for LaBorde Marine Management LLC of New Orleans. He contracted the disease cleaning out a refrigerator drain without being instructed in proper safety methods, according to court papers.

Higgins was hospitalized for a month, and it took a year before he was fully recovered. He graduated from Maine Maritime Academy in 2015, a year later than his classmates, because of his illness.

U.S. District Judge Ivan L.R. Lemelle found the company to be negligent in keeping Higgins’ safe from the disease. The judge also concluded that there was no credible evidence that the company’s conduct crossed from negligence to wanton misconduct, so the plaintiff’s demand for punitive damages was denied.

Higgins received a judgment of $150,000 for pain and suffering, $150,000 for lost wages, and $10,000 for treatment of post-traumatic stress disorder (PTSD) after a jury-waived trial.

Higgins’ attorney called the judgment “a landmark decision. Other people will be able to use this case to pursue actions concerning Legionella.

When the judge issued his ruling, Higgins was working on a ship and unavailable to comment.

Where is Legionella found?

Legionella bacteria are widespread in natural water sources, including rivers, streams, and ponds. Legionella also are found in many recirculating water systems, as well as hot- and cold-water systems.

It has never been isolated in salt water, so vessels that make all their potable water by evaporation have a lower risk of the bacteria being present.

How is Legionella contracted?

Only when water contaminated with Legionella bacteria is made into a very fine spray (aerosol) that can be inhaled does it pose a risk to health. For example, Legionella can be inhaled:

  • when taking a shower
  • when running sink faucets
  • when warm, moist air is circulated by air conditioning, heating units, and humidifiers
  • when using fire hoses (if fresh water is used)
  • when washing the hold of a ship (again, if freshwater is used).

What measures should be taken?

Assess the water systems of the vessel and identify all risk areas:

  1. Study the hot- and cold-water system plans and identify all water outlet points “dead legs,” any potential “dead ends” (blanked off pipes where the water cannot circulate) or long pipe runs.
  2. Check the water temperature of ALL hot- and cold-water points (i.e. taps, showers, hoses).
    1. Allow hot water to run for one minute and cold water for two minutes before taking a reading.
    2. The boiler output temperature must be above 140 degrees Fahrenheit.
    3. The hot supply must be greater than 122 degrees.
    4. The cold supply must be less than 68 degrees.
  3. Check what actual cleaning, maintenance, and disinfection routines are in place on the vessel.
  4. Assess and identify ALL points where water could be made into an aerosol and be breathed in by the crew, passengers and visitors.
  5. Document findings so that the information can be included in the planned maintenance or ISM procedures, which then can be referred to by any Master or responsible officer. An ideal vessel at least risk is one where the temperature readings are satisfactory, there are no “dead ends,” the “dead legs” are used frequently, the vessel makes all potable water by evaporation, and cleaning and disinfection procedures are in place.

What procedures should be implemented?

The minimum recommended requirements for cleaning and maintenance are as follows:

  • The hot water boiler outlet temperature must be greater than 140 degrees.
  • Dismantle, inspect, clean and soak the shower heads and pipework in a disinfectant or chlorine solution for a few hours at least once every three months. Remove any sediment, algae, or calcified deposits.
  • Super-chlorinate the freshwater tanks twice a year, and flush the water through all outlet points “dead legs.”
  • Any crew or passenger cabin that has been out of use for two to four weeks must have the shower cleaned and soaked in a chlorine solution before the cabin can be used.
  • Have the water bacteriologically tested if hot- and cold-water temperatures are outside the recommended range.

A senior living community in Dallas is taking action to prevent a Legionnaires’ disease outbreak after a resident was sickened, the Dallas Morning News reported.

Highland Springs in Far North Dallas is treating the water in two of its buildings after being notified of a positive Legionnaires’ disease test by the Collin County Health Care Services (CCHCS), according to a Highland Springs spokesperson.

The hot-water system in both buildings is being inspected and treated with a hyper-chlorination technique, according to the spokesperson. The building where the resident was sickened also was given water restrictions.

The residents in the affected building have been provided bottled water for cooking and drinking, and filters were installed in the showers. Normal water use throughout the community will resume once the CCHCS has given its approval.

The existence of Legionella bacteria found during testing was at low to “inconclusive” levels. Legionella is the bacteria that causes Legionnaires’ disease.

Residents of Highland Springs were notified of the situation via written statements, town hall meetings and communication with staff.

About Highland Springs

Highland Springs, which opened in 2006, is located at 8000 Frankford Road in Dallas. It’s an 89-acre continuing care retirement community that offers adults age 62 and older independent living, assisted living, memory care, post-acute rehabilitation, and skilled nursing care, and includes an on-site medical center and in-home care by a licensed private duty nurse.

Residents, staff or visitors to Highland Springs who are exhibiting pneumonia- or flu-like symptoms (see below) should seek immediate medical attention from their primary health-care provider.

What is Legionnaires’ disease?

Legionnaires’ disease – also called legionellosis and Legionella pneumonia – is a severe type of pneumonia or lung infection. According to the Centers for Disease Control and Prevention (CDC), an estimated 25,000 cases of pneumonia due to Legionella bacteria (Legionella pneumophila) occur each year, but only 5,000 cases are reported because of its nonspecific signs and symptoms.

Ten percent of those who become infected with Legionnaires’ disease will die from the infection.

Legionella bacteria are contracted by inhaling microscopic water droplets, usually in the form of mist or vapor. The bacteria, which grow best in warm water, are found primarily in human-made environments.

Outbreaks have been linked to a number of sources, such as:

  • hot-water tanks and heaters
  • showers and faucets
  • swimming pools
  • hot tubs and whirlpools
  • equipment used in physical therapy
  • mist machines and hand-held sprayers
  • the cooling towers of air conditioning systems
  • large plumbing systems
  • water systems such as those used in hospitals, nursing homes, and hotels
  • decorative fountains.

People also can contract Legionnaires’ disease when they “aspirate” contaminated drinking water – that is, choking or coughing while drinking can cause water to go down the wrong pipe into the lungs. It is also possible to contract the disease from home plumbing systems. Both of these, however, happen very rarely.

Who is at risk?

Anyone can get Legionnaires’ disease, but those most susceptible to infection include:

  • people 50 years of age or older
  • smokers, current and former
  • heavy drinkers of alcoholic beverages
  • people with chronic lung disease
  • people with compromised immune systems
  • recipients of organ transplants
  • individuals who are on specific drug protocols (corticosteroids, to name one).

What are the symptoms?

Legionnaires’ disease is similar to other types of pneumonia (lung infection). Symptoms can resemble flu-like symptoms in the following forms:

  • cough
  • shortness of breath
  • fever
  • muscle aches
  • headaches
  • gastrointestinal symptoms, such as nausea, vomiting, and diarrhea.