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).