The New York City Department of Health and Mental Hygiene (DOHMH) is investigating a Legionnaires’ disease community cluster after 11 people were sickened with the illness in the last seven days in upper Manhattan, according to multiple news reports.

“We may continue to see additional cases,” DOHMH Commissioner Dr. Mary T. Bassett said at a community meeting at Saint Luke’s African Methodist Episcopal Church. The meeting was held to discuss the outbreak and answer questions.

The illness has affected individuals from a 20-block area in southern Washington Heights and northern Hamilton Heights. Ten of the 11 infected were hospitalized, and eight remain hospitalized. Ages of the patients have ranged from under 40 to over 80, but the majority were over the age of 50.

The illnesses are categorized as a “cluster” and not an “outbreak” because the cases are linked in space (20-block area) and time (seven-day period). If a single source is discovered to be the cause for all the illnesses, officials would then categorize it as an “outbreak.”

Cooling towers suspected
Also known as legionellosis and Legionella pneumonia, Legionnaires’ disease is a sometimes-deadly lung infection, and on average 10 percent of people infected will die. “Thankfully, there have been no fatalities, yet,” New York City Council member Mark Levine said in a news briefing about the community cluster.

Officials are “actively looking” for the source of the infection, Bassett said, and “we worry about cooling towers.” They are the suspected culprit in this cluster.

“The department has already identified all of the cooling towers that are registered with the city in this geography,” Bassett said. “And (we have) tested all of these cooling towers.”

Said Levine: “Don’t confuse this with water towers, which are in almost every building. This has nothing to do with water towers. This is cooling towers that are used in buildings with central air conditioning, that give off a water vapor, and when it’s hot out – and it’s been really hot the last couple of weeks – this bacteria thrives.”

Inspectors took water samples from 20 cooling-tower systems from buildings between 145th and 155th Streets. Preliminary testing results are expected soon; full results – using cultures, where the bacteria is grown in a laboratory – take two weeks to be completed.

The city has already treated the towers’ water, according to Dr. Demetre Daskalakis, the deputy commissioner of Disease Control.

Putting the community at ease
Officials informed the community that Legionnaires’ disease is not transmitted person-to-person.

“While most people exposed to Legionella don’t get sick, individuals ages 50 and above – especially those who smoke and have chronic lung conditions – are at a higher risk,” Bassett said in a statement. “This disease is very treatable with antibiotics. I encourage anyone with symptoms of Legionnaires’ disease to seek care early.”

Others who are more susceptible to infection include:

  • heavy drinkers of alcoholic beverages
  • people with compromised immune systems
  • recipients of organ transplants
  • people on specific drug protocols (corticosteroids, for example).

NYC’s largest outbreak killed 12 in 2015
The largest outbreak in New York City history occurred in 2015. Contaminated cooling towers were blamed for producing Legionnaires’ disease that killed 12 people and sickened more than 120 others in the South Bronx.

Every year, between 200 and 500 people are diagnosed with the disease in New York, according to city health officials. The majority of those are individual cases not associated with a cluster or outbreak.

Legionnaires’ information

Legionnaires’ disease 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 yearly in the U.S. Only 5,000 cases are reported, however, because of its nonspecific signs and symptoms.

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?
Legionnaires’ disease clusters and outbreaks have been linked to numerous sources, such as:

  • cooling towers of air conditioning systems
  • large plumbing systems
  • water systems, such as those used in hospitals, nursing homes, and hotels
  • 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
  • decorative fountains.

What are the symptoms?
Legionnaires’ disease is similar to other types of pneumonia, and its symptoms can resemble those of flu, such as:

  • cough
  • difficulty breathing
  • fever
  • muscle aches
  • headaches
  • gastrointestinal symptoms, such as nausea, vomiting, and diarrhea.

Water testing of the pool and spa area at Four Seasons Palm Springs returned positive results for Legionella, the bacteria that causes Legionnaires’ disease.

The tests linked the pool’s bacteria to the same strain of Legionella that sickened two community residents with Legionnaires’ disease in January.

Environmental testing was ordered by the Centers for Disease Control and Prevention (CDC) after it learned in June of the two resident’s illnesses. The only commonality between the two infected people was that both had used the pool area.

Four Seasons management was hopeful that the 55-plus active-retirement community’s common areas could be reopened in time for the July 4th holiday, but the closure remains in effect until cleared by the Riverside County Department of Environmental Health (REHS).

“Our department is requiring the pools and spas to remain closed while the Four Seasons works with the remediation company in disinfecting areas/systems,” Dottie Merki, REHS program chief, wrote in an e-mail.

With the pool returning positive results for Legionella, residents, employees and visitors to Four Seasons Palm Springs exhibiting pneumonia- or flu-like symptoms (see the list of symptoms below) should seek immediate medical attention from their health-care provider.

Still no relief from the heat
Residents use the pool and spa areas as a source of temporary solace and comfort from the heat. Daily high temperatures in the Palm Springs area are forecast to hit triple digits throughout July, so the continued closure, which started in late June, remains an inconvenience.

Four Seasons management has made accommodations for residents to use pool amenities at ARRIVE, a nearby hotel in Palm Springs.

Legionella bacteria found in pool at Four Seasons Palm Springs
The pool at Four Seasons Palm Springs, a gated 55-plus active retirement community, tested positive for Legionella bacteria.

Legionnaires’ info

Legionnaires’ disease – also known as legionellosis and Legionella pneumonia – is a severe type of lung infection. According to the CDC, an estimated 25,000 cases of pneumonia due to Legionella bacteria (Legionella pneumophila) occur yearly in the United States, but only 5,000 cases are reported 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:

  • 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.

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.

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, both 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).

Two contractors working on a Wayne State University (WSU) construction site have been diagnosed with Legionnaires’ disease, according to an alert sent to the campus community by university officials.

“The health departments in Detroit and the counties in which the workers live have confirmed the cases,” the university said in a statement. “The individuals are currently receiving medical treatment.”

No additional information – such as the ages, genders or whether either individual required hospitalization – was announced.

The contractors were working on the Anthony Wayne Drive Apartments, a 395,000-square-foot development that will include 841 beds in 575 units, a 9,700-square-foot student health center, and 17,000 square feet of retail space. The first phase of the complex, which is scheduled to open in August, is the center 11-story building with room for nearly 400 residents. The second phase, which will be completed in June 2019, consists of the two wings north and south of the central tower that are six and eight stories and add room for an additional 400 residents.

 

Anthony Wayne Drive Apartments
Artist rendering of the Anthony Wayne Drive Apartments. Photo: Wayne State University

Legionella: A campus-wide problem?
In late May, a WSU employee who works in the Faculty Administration Building took ill with Legionnaires’ disease.  Subsequent testing found Legionella bacteria in three cooling towers and three bathrooms. (Legionella is the bacteria that causes Legionnaires’ disease.)

Further testing found Legionella at various levels in additional cooling towers and potable water systems at more than two dozen locations on campus.

According to the university statement, “it’s difficult to determine with any certainty how and where the workers contracted the disease. However, our comprehensive plan of testing and remediation is continuing.”

Remediation efforts, including replacing and sanitizing equipment and increasing water temperatures, occurred wherever the bacteria was detected, even in the smallest amounts.

One cooling tower remains shuttered
PathCon Laboratories, WSU’s outside Legionella remediation experts, has tested and retested all the cooling towers on campus and all, except the Towers Residential Suites, have been found to have low or non-detectable levels of Legionella bacteria. The cooling tower on Towers Residential Suites continues to be shut down until “consistently acceptable test results” are returned.

“We’re treating any detectable level as a source of remediation,” a university spokesperson told the Detroit Free Press. “I suspect that we’re going way beyond what would be necessary. We’re remediating every place where anything is detectable.”

The Detroit Health Department will review WSU’s remediation efforts, and its approval will be needed before the Towers Residential Suites’ cooling tower is reactivated.

Suffering symptoms? See a doctor
Officials recommend that students, employees or visitors to the campus who have recently suffered from or are currently suffering from pneumonia- or flu-like symptoms should seek immediate medical attention from their health-care provider. “The disease is easily treatable with antibiotics when caught early,” the university said in its statement.

Legionnaires’ disease – also known as legionellosis and Legionella pneumonia – is similar to other types of pneumonia, which is an infection of the air sacs in one or both lungs that might produce fluid in the lungs. Symptoms can resemble flu-like symptoms in the following forms:

  • coughing
  • difficulty breathing
  • high fever
  • muscle aches and pains
  • headaches
  • gastrointestinal symptoms, such as nausea, vomiting, and diarrhea.

For updates on the university’s investigation, visit http://go.wayne.edu/fab-health.

Legionnaires’ facts and figures

The Centers for Disease Control and Prevention (CDC) estimates that 25,000 cases of Legionnaires’ disease occur in the United States on a yearly basis. Only 5,000 cases are reported, however, 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.

Warm, stagnant water provides ideal conditions for growth, according to the Occupational Safety and Health Administration (OSHA). At temperatures between 68 degrees and 122 degrees Fahrenheit, the organism can multiply. Temperatures of 90 degrees to 105 degrees are ideal for growth.

Water sources that provide optimal conditions for the growth of the infectious bacteria, according to 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 (including bathrooms, showers, and drinking fountains) with water heaters that operate below 140 degrees and deliver water to taps below 122 degrees
  • 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 68 degrees and sometimes as warm as 98.6 degrees 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 most significant 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 specific drug protocols (for instance, corticosteroids).

Two veterans have been diagnosed with Legionnaires’ disease after visiting the Chalmers P. Wylie V.A. Ambulatory Care Center in Columbus, OH. In addition, five other patients have Legionnaires’ symptoms, but they have not been confirmed with the disease.

The two veterans who were confirmed with the sometimes-deadly respiratory infection visited the clinic’s primary-care area sometime after May 28. One was diagnosed at Chalmers and did not require hospitalization; the other was diagnosed at Mount Carmel East Hospital, where they are still hospitalized.

Both are being treated with antibiotics, according to a V.A. spokesperson. No information on their ages or genders was provided.

V.A. officials have temporarily shut down the facility’s ice makers and 26 water fountains at the clinic until tests can determine if the water is the source of Legionella, which is the bacteria that causes Legionnaires’ disease. If the facility’s water is found to be the common source for the infections, officials would label this a Legionnaires’ disease outbreak.

“This is the time of year that Legionnaires’ disease is most common and, often, the cases are never connected and there is no considered ‘outbreak,’ ” health officials told the Columbus Dispatch.

The company that regularly tests the facility for Legionella performed its quarterly water test on June 25. Results are expected within two weeks.

Bottled water will be provided to visitors and employees at Calmers until the facility is determined to be Legionella free. Approximately 2,000 veterans visit the facility per day.

Columbus Public Health (CPH) has confirmed 41 cases of Legionnaires’ disease in 2018, with 26 of those coming in June, a common seasonal increase. None of the 41 cases has been connected to one another, according to a CPH spokesperson.

Franklin County Public Health (FCPH) has investigated 23 cases in 2018, 17 in June alone. None of the 23 cases has been connected in any way, according to an FCPH spokesperson.

V.A.-acquired cases decreasing

According to a recent study published online in JAMA Network Open, there was an increase in the overall number of Legionnaires’ disease cases at V.A. hospitals from 2014-16, but a decrease in the number of cases where the patients contracted the illness during inpatient visits to the facilities.

There were a total of 491 cases of Legionnaires’ disease reported during 2014-16, with 91 percent of the cases having no V.A. exposure or only outpatient V.A. exposure.

“The rate of disease for patients with V.A. overnight stays at the population level was reduced by more than half, from 5.0 to 2.3 per 100,000 enrollees,” wrote researcher Shantini Gamage, PhD, of the V.A. National Infectious Disease Service.

The analysis followed the 2014 implementation of a system-wide policy  including frequent monitoring and specific water-heating temperatures known to kill Legionella – aimed at reducing Legionnaires’ disease within the V.A. health system after several high-profile outbreaks, including a 2011 outbreak at the Pittsburgh V.A. medical center that killed six patients and sickened more than 20.

“Data in the V.A. LD databases showed an increase in overall LD rates over the three years, driven by increases in rates of non-V.A. LD,” the authors wrote. “Inpatient V.A.-associated LD rates decreased, suggesting that the V.A.’s LD prevention efforts have contributed to improved patient safety.”

Largest OH outbreak 5 years ago

In 2013, the largest Legionnaires’ disease outbreak in Ohio history occurred when six people died and 39 others were sickened at the Wesley Ridge Retirement Community in Reynoldsburg, a suburb of Columbus. A cooling tower and potable water were the sources for that outbreak, which affected individuals whose ages ranged from 63 to 99 years old. All six patients who died were residents of the retirement community.

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

Legionnaires’ 101

Legionnaires’ disease – also called legionellosis and Legionella pneumonia – is a severe type of 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:

  • 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.

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.

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, both 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).

The Centers for Disease Control and Prevention (CDC) ordered the temporary closure of the pool and spa area at the Four Seasons Palm Springs after two people were sickened by Legionnaires’ disease, according to news reports. The Four Seasons is a gated 55-plus active-retirement community.

The two individuals were sickened in January. Both reported using the community pool.

Public health notified the CDC of the illnesses this week and ordered the facility to close the pool and spa area, according to a CDC representative.

Individuals 50 or older are more at risk for Legionnaires’ disease, which is why the CDC is reacting “out of an abundance of caution.” Others that are more susceptible to infection include:

  • smokers
  • heavy alcoholic drinkers
  • people with chronic lung disease
  • people with compromised immune systems
  • recipients of organ transplants
  • and individuals on specific drug protocols (corticosteroids, to name one).

A certified lab will be taking water samples with the CDC staff on hand to oversee the collection. Results of the testing can take up to two weeks to be returned.

The pool and spa are expected to be shuttered until lab results are received.

Unfortunate timing

For residents of Four Seasons Palm Springs, the closure of the pool couldn’t have come at a worse time – daily high temperatures in the Palm Springs area are forecast to hit triple digits for at least the next 10 days.

Four Seasons management has made accommodations for residents to use pool amenities at ARRIVE, a nearby hotel in Palm Springs.

The pool area at Four Seasons at Palm Springs
The pool area at Four Seasons Palm Springs, which has been temporarily closed by the CDC.

Legionnaires’ 101

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 its nonspecific signs and symptoms. Ten percent of those who become infected will die.

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:

  • swimming pools
  • hot tubs and whirlpools
  • equipment used in physical therapy
  • showers and faucets
  • mist machines and hand-held sprayers
  • hot water tanks and heaters
  • 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. That, however, is a sporadic occurrence.

What are the symptoms?
Legionnaires’ disease, which is also known as legionellosis and Legionella pneumonia, is similar to other types of pneumonia, an infection of the air sacs in one or both lungs that can produce fluid in the lungs. Legionnaires’ symptoms can resemble flu-like symptoms in the following forms:

  • coughing
  • difficulty breathing
  • high fever
  • muscle aches and pains
  • headaches
  • gastrointestinal symptoms, such as nausea, vomiting, and diarrhea.

Quarterly water safety tests at the Jerry L. Pettis Veterans Affairs Medical Center in Loma Linda showed evidence of Legionella, the bacteria that causes Legionnaires’ disease. Officials responded by taking the water fountains out of service until the problem is resolved, according to news reports.

“This does not mean there is a Legionella outbreak,” Pettis Medical Center Public Affairs Officer Wade J. Habshey wrote in a statement.  “The facility has a zero-tolerance policy for Legionella.”

Water was shut off to all areas that tested positive, and V.A. officials say only one patient room was affected. No patients were exposed, and no illnesses have been reported.

Information was not made available regarding the length of time it will take to remove the Legionella or whether patients have been transferred to other rooms during mitigation efforts.

Employees at the facility told CBS Los Angeles that they weren’t told about the latest water tests, but they would not agree to be interviewed on camera. They said they didn’t know what, if any, long-term efforts were being taken to prevent future issues with the water system.

“Service chiefs are notifying staff members as appropriate” regarding the remediation, Habshey said.

Cover-up alleged

The Loma Linda facility made news in May when the Orange County Register reported that several employees had filed a federal whistleblower complaint in February against hospital officials alleging a cover-up of a Legionella outbreak.

That same month, hospital officials sought bids for Legionella remediation for the entire Loma Linda health-care system, which includes the V.A. hospital as well as clinics in Blythe, Corona, Palm Desert, Rancho Cucamonga, Murrieta, and Victorville.

The V.A. Loma Linda Healthcare System serves more than 76,000 veterans and has more than 2,400 employees and 1,300 volunteers. The Pettis Medical Center has 162 acute-care beds and a 108-bed community living center.

The yearlong Legionella remediation project is estimated to cost as much as $1 million, according to an online bid notice.

Legionnaires’ information

Legionnaires’ disease, which is also known as legionellosis and Legionella pneumonia, is similar to other types of pneumonia, an infection of the air sacs in one or both lungs that can produce fluid in the lungs. Legionnaires’ symptoms can resemble flu-like symptoms in the following forms:

  • coughing
  • difficulty breathing
  • high fever
  • muscle aches and pains
  • headaches
  • gastrointestinal symptoms, such as nausea, vomiting, and diarrhea.

Who is most at risk?
Anyone can contract Legionnaires’ disease, but people 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).

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.

How does one become ill?
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. That, however, is a sporadic occurrence.

The Hawaii State Department of Health (DOH) has confirmed three additional cases of Legionnaires’ disease at The Queen’s Medical Center in Honolulu. One of the four patients being treated for the disease died in May after being hospitalized.

The news comes a week after the DOH announced an investigation into an individual case of Legionnaires’ disease, a potentially fatal type of pneumonia.

The DOH is working with the Centers for Disease Control and Prevention (CDC) to locate the source of the illness, both inside and outside the hospital, according to state health officials.

Environmental samples were collected at The Queen’s Medical Center (QMC) by the DOH to see whether the hospital is the source of Legionella bacteria, which causes the sometimes-deadly respiratory illness. According to the CDC, one in 10 patients infected with Legionnaires’ will die from the disease.

The ages, gender and current conditions of the patients infected with Legionnaires’ was not released, although it has been confirmed that they are being treated at the hospital. It is believed that two cases were the result of community-acquired illnesses, and the other two were sickened by Legionella after being admitted.

The DOH is trying to determine if the cases are linked by a common source of infection.

A QMC spokesperson said the hospital is proactively asking all health-care providers to take additional precautions with patients at greatest risk of contracting the disease and recommending that high-risk patients avoid exposure to tap water at the medical center.

They advised that patients temporarily avoid the following, under state and federal guidelines:

  • drinking water from a fountain
  • using ice from the ice machine
  • taking showers
  • flushing toilets.

Additionally, the QMC has undertaken the following preventative measures to ensure the safety of its patients and staff:

  • increased chlorination of water
  • increased surveillance of water cultures and testing in conjunction with DOH and water experts
  • replacement of laminar flow devices on faucets
  • scheduled running of showers and faucets as part of routine room cleaning.

Six of the eight confirmed cases of Legionnaires’ in Oahu this year were residents of the island, according to the DOH.

Residents or visitors to Oahu or the QMC exhibiting pneumonia- or flu-like symptoms should seek immediate medical attention from their health-care provider.

The Queen's Medical Center
The Queen’s Medical Center.
Photo: Honolulu Star-Advertiser file photo.

Legionnaires’ 101

Anyone can become ill from Legionella, but those most susceptible to infection include:

  • people 50 years of age or older
  • smokers, both 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 even resemble those of flu, which is why it often goes under-reported.

Symptoms can include:

  • cough
  • shortness of breath
  • fever
  • muscle aches
  • headaches
  • gastrointestinal symptoms, such as nausea, vomiting, and diarrhea.
Where do Legionella live?
Outbreaks have been linked to a number of sources:

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

How is Legionella contracted?
Legionnaires’ disease – also called legionellosis and Legionella pneumonia – is a severe type of 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.

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.

One case of Legionnaires’ disease has been diagnosed on the island of Oahu and is being investigated by the Queen’s Medical Center in Honolulu and the Hawaii State Department of Health (DOH), according to KHON2 TV.

Dr. Leslie Chu, chief medical officer at Queen’s Medical Center, confirmed that the patient is being treated there but did release the age or gender of the patient, or their current condition. Chu told KHON2 that the hospital is investigating potential sources of the disease.

Residents or visitors to Oahu exhibiting pneumonia- or flu-like symptoms (see the list of symptoms below) should seek immediate medical attention from their health-care provider.

Oahu is the third-largest of the 140 islands that make up the state of Hawaii (tourists visit only the six largest islands: Hawaii, Maui, Oahu, Kauai, Molokai, and Lanai). Oahu is home to the city of Honolulu, Waikiki Beach, Pearl Harbor, Diamond Head and the Polynesian Cultural Center, which are among the most popular destinations in the state.

Locating the source of the Legionella bacteria, which causes Legionnaires’ disease, is of extreme importance, because Legionnaires’ disease, which is a potentially fatal type of pneumonia, often presents in clusters or outbreaks. Being able to identify the cause of the patient’s illness could eliminate the threat for others.

Outbreak or cluster?
Clusters and outbreaks are where multiple cases are reported in or around the same proximity and within a designated period. Multiple illnesses reported within days or weeks, rather than months, are identified as an outbreak and occur in a more limited geographic area. When multiple diseases occur in the same general vicinity within a period of three to 12 months, a cluster is suspected.

Climate change

Legionnaires’ disease cases in Hawaii have increased each of the past two years (12 in 2016 and 14 in 2017), after a slight decrease in 2015 (7 cases), according to the DOH. Nine cases were reported in both 2013 and 2014.

The most recent Hawaiian outbreak occurred in June 2016, when two confirmed cases and a third suspected case forced the temporary closure of the WorldMark Kapaa Shore Resort in Kapaa, Kauai.

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

Legionnaires’ 101

Legionnaires’ disease – also called legionellosis and Legionella pneumonia – is a severe type of 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:

  • 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.

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.

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, both 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).

Three campus cooling towers and three bathrooms have tested positive for Legionella bacteria on the Wayne State University campus in Detroit, according to a university communique released this week. Legionella is the bacteria that causes Legionnaires’ disease.

The university began conducting tests after an employee who works in the Faculty Administration Building was diagnosed with Legionnaires’ disease on May 29. The employee, whose age and gender have not been disclosed, has been under the care of a physician since becoming ill. Their current condition is not known.

Preliminary results identified Legionella in cooling towers of the Towers Residential Suites, Purdy/Kresge Library and the College of Education Building. Remediation in the three towers has begun using the “prescribed disinfection process,” according to the university’s statement.

A private bathroom in the Faculty Administration Building, a first-floor men’s bathroom in Scott Hall, and a men’s bathroom in the Cohn Building also tested positive for Legionella. The bathrooms will be closed until they can be further assessed.

“As a result of these findings, the university will continue comprehensive testing of the campus, including potable water, to ensure all water sources are safe,” the university’s release stated. “The expert consultants will return to campus this weekend to continue sampling.

“Moving forward, we will work with the experts to re-evaluate our water treatment and monitoring protocols and make any necessary adjustments to ensure that this problem does not occur in the future.”

The university has notified the Detroit Health Department about the findings, and health department officials said they will assist WSU closely with the investigation moving forward.

Officials are unaware of any additional Legionnaires’ cases connected to the campus.

Students, employees or visitors to any of the buildings or bathrooms where Legionella was found and who have recently suffered from or are currently suffering from pneumonia- or flu-like symptoms (see below) should seek immediate medical attention from their health-care provider.

For updates on the university’s investigation, visit http://go.wayne.edu/fab-health.

Legionnaires’ 101

Legionnaires’ disease – also known as legionellosis and Legionella pneumonia – is similar to other types of pneumonia, which is an infection of the air sacs in one or both lungs that might produce fluid in the lungs. Symptoms can resemble flu-like symptoms in the following forms:

  • coughing
  • difficulty breathing
  • high fever
  • muscle aches and pains
  • headaches
  • gastrointestinal symptoms, such as nausea, vomiting, and diarrhea.

Who is most at risk for illness?
Anyone can get Legionnaires’ disease, but people 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).

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.

How does Legionella infect a person?
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:

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

A Wayne State University (WSU) employee was diagnosed with Legionnaires’ disease, and university officials said they will respond by conducting water tests, according to news reports.

WSU is a public research university located in Detroit, with more than 27,000 graduate and undergraduate students.

The employee, who works in the faculty administration building, is under the care of a doctor, according to a letter written by Michael Wright, WSU’s chief of staff.

“While it is very unlikely that this person contracted the disease from a campus source,” Wright wrote, “through an abundance of caution we will check the building for a potential source.”

The water tests will be performed to see if Legionella bacteria is present in the system. Legionella is the bacteria that causes Legionnaires’ disease.

The university also plans to review the building’s heating and cooling system to see if additional actions are required.

Students, employees or visitors to the administration building who have recently suffered from or are currently suffering from pneumonia- or flu-like symptoms (see below) should seek immediate medical attention from their health-care provider.

For updates on the university’s investigation, visit http://go.wayne.edu/fab-health.

WSU prof leads Flint investigation
Coincidentally, Shawn McElmurry, an associate professor of civil and environmental engineering at WSU, is heading a team of researchers that has been investigating the 2016 Legionnaires’ outbreak in Flint, MI. The Flint water crisis, which occurred in 2014-15, resulted in 12 deaths and more than 90 people contracting Legionnaires’ disease.

McElmurry’s team consists of Flint residents, WSU students, and students from other universities. The team is receiving funding from the state of Michigan but is working independently. The team expects to have a significant portion of research completed by the end of the year.

Legionnaires’ information

Legionnaires’ disease – also known as legionellosis and Legionella pneumonia – is similar to other types of pneumonia, which is an infection of the air sacs in one or both lungs that might produce fluid in the lungs. Symptoms can resemble flu-like symptoms in the following forms:

  • coughing
  • difficulty breathing
  • high fever
  • muscle aches and pains
  • headaches
  • gastrointestinal symptoms, such as nausea, vomiting, and diarrhea.

Who is most at risk?
Anyone can get Legionnaires’ disease, but people 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).

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.

How does one become ill?
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. That, however, is a very rare occurrence.