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The Cuyahoga County Board of Health (CCBH) released a 20-page report on the Legionnaires’ disease outbreak in Parma, Ohio, concluding that the cooling system at St. Columbkille Parish was the likely source of the Legionella bacteria that killed one and sickened 10 others this summer.

“The investigation indicates that the design, operation, and location of the current cooling system at St. Columbkille church provided a significant risk and a very likely mode of transmission and pathway for exposure for the Legionnaires’ disease cases,” according to the report.

The CCBH’s investigation covered a period from June 1 to July 31. Investigators identified 31 cases of Legionnaires’ disease that occurred within a 10-mile radius of the church. They successfully contacted and questioned 25 of those sickened, and 11 reported attending St. Columbkille during their incubation period.

Outbreak affected most susceptible
All 11 sickened – eight females and three males – were parishioners at the church. Their illness onset dates ranged from June 4 to July 10, and their ages ranged from 74 to 93 years old; the only fatality was a 93-year-old woman.

Anyone can become ill from Legionella, although the majority of healthy people exposed to the bacteria do not. Those at greatest risk of infection include:

  • people 50 or older
  • smokers (current or former)
  • heavy drinkers of alcoholic beverages
  • people with chronic lung disease
  • people with weakened immune systems.

After Legionnaires’ disease has been diagnosed, hospitalization is often necessary. It was not reported how many of the 11 required hospitalization in this outbreak.

In the most severe Legionnaires cases, complications can include respiratory failure, kidney failure, septic shock, or even death.

All signs point to cooling tower
The cooling tower – located on the west side of the building, close to walkways where the public enters and leaves the building – was considered a “significant public health threat,” based on the fact that it put parishioners in position to breath in aerosols it produced. The church staff confirmed that the air cooling system was turned on only for church services.

Environmental samples collected from the cooling tower were negative for Legionella, but the only commonality with all 11 victims is that they had visited the church. Non-viable (or dead cells) of Legionella were found in samples collected from the church’s downstairs drinking fountain, but it’s not considered a possible source for the illnesses since only one of the 11 reported drinking from the fountain.

The CCBH, in consultation with the Ohio Department of Health (ODH) and the Centers for Disease Control and Prevention (CDC), recommended that the current cooling tower not be operated again unless it is relocated or replaced with a non-aerosol-generating cooling system.

Common bacteria sources
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:

  • air-conditioning system cooling towers
  • large plumbing systems
  • water systems of large buildings (hospitals, nursing homes, hotels, etc.)
  • hot-water heaters and tanks
  • bathroom showers and faucets
  • swimming pools
  • whirlpools and hot tubs
  • physical-therapy equipment
  • mist machines and hand-held sprayers
  • decorative fountains.

Church complies
According to a statement released by the Catholic Diocese of Cleveland, the steps taken by the St. Columbkille Parish to ensure compliance with the Board of Health’s recommendations include:

  • The church building air conditioning system was immediately shut off on or about July 19 on the recommendation of the CCBH, and short and long-term potential air conditioning solutions were evaluated.
  • A short-term solution has been implemented, and the air conditioning is now safely operating with the approval of the Board of Health and the EPA.
  • The parish retained engineering consultants to conduct a thorough review of the church air conditioning system, and plans are being made to remove the (non-operational) cooling tower and to install an air-cooled system in an appropriate location as a long-term solution.
  • The parish is working to develop an ASHRAE 188-compliant Legionella water management plan for all water sources in the parish facilities.

CDC: About 25,000 cases annually

Legionnaires’ disease – also called legionellosis and Legionella pneumonia – is a severe type of pneumonia or lung infection. The bacterial infection is treatable with antibiotics, although if it is not diagnosed early, it can lead to severe complications and even become deadly. It is not contagious; that is, it cannot be passed from person to person.

According to the 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.

What are the symptoms?
Legionnaires’ disease usually develops two to 10 days after exposure to Legionella bacteria. It frequently begins with the following signs and symptoms:

  • headache
  • muscle pain
  • chills
  • fever, which can be 104 degrees Fahrenheit or higher.

By the second or third day, other signs and symptoms develop, including:

  • cough, which can bring up mucus and sometimes blood
  • shortness of breath
  • chest pain
  • gastrointestinal symptoms, such as nausea, vomiting, and diarrhea
  • confusion and other mental changes.

Although Legionnaires’ disease primarily affects the lungs, it occasionally can cause infections in wounds and other parts of the body, including the heart.

A mild form of Legionnaires’ disease — known as Pontiac fever — may produce signs and symptoms including a fever, chills, headache and muscle aches. Pontiac fever doesn’t infect your lungs, and symptoms usually clear within two to five days.