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A Legionnaires’ disease outbreak at a California prison is being investigated by state corrections officials after an inmate died from the severe form of pneumonia.

The outbreak occurred at the California Health Care Facility (CHCF) in Stockton, which serves as both a prison and a hospital. The facility provides medical care and mental health treatment to inmates who have the most severe, long-term needs. It has 1.4 million square feet of space in 54 buildings that accommodate 2,704 patients and a staff of 2,500.

Officials discovered that the inmate tested positive for Legionella, the bacteria that causes Legionnaires’ disease, during a post-death analysis. The inmate died at an outside hospital, but no other information was released on the individual.

The CHCF began systematic testing of all patients with “radiologically confirmed pneumonia.” Sixteen additional patients were tested, and one other case of Legionnaires was confirmed; 14 patients were negative for the disease, and results are pending for one patient.

Measures taken by officials

CHCF officials have implemented the following control measures, out of an abundance of caution:

  • provided bottled water for drinking and sanitary functions
  • halted the use of aerosolizing equipment
  • shut down the use of showers in specific areas
  • and provided education to both staff and patients.

The California Department of Corrections and Rehabilitation, California Correctional Health Care Services, California Department of Public Health, and San Joaquin County Public Health officials are all involved in the investigation.

Full investigation possible

If a full investigation is deemed necessary, the following steps would be taken:

  • evaluation of potential environmental exposures
  • environmental assessment
  • environmental sampling with cultures performed by a Centers for Disease Control and Prevention (CDC) ELITE* laboratory
  • comparison of clinical and environmental isolates, if available
  • decontamination of the environmental source(s), if identified
  • revision of existing water-management programs or development of new ones.

The full investigation may be performed by local health departments (all or in part) or by an experienced environmental consultant contracted by the facility.

According to the Sacramento Bee, a prison health executive informed prison staff in an email on March 22 of two suspected cases of Legionella pneumonia, urging them to take precautions in two affected buildings.

(* Note: ELITE stands for Environmental Legionella Isolation Techniques Evaluation.)

More on Legionnaires

A 2015 study by the CDC stated that “75 percent of (Legionnaires’ disease) acquired in health-care settings could be prevented with better water management.”

Legionnaires’ disease is contracted by inhaling microscopic water droplets in the form of mist or vapor containing Legionella. Most people exposed to the bacteria do not get sick, but people 50 years old and older – especially those who smoke or have chronic lung conditions – are at a higher risk.

Other people more susceptible to infection include:

  • recipients of organ transplants
  • individuals who are on specific drug protocols (corticosteroids, to name one)
  • heavy drinkers of alcoholic beverages.

This list also includes anyone with an immune system weakened by:

  • frequent and recurrent pneumonia, bronchitis, sinus infections, ear infections, meningitis or skin infections
  • organ inflammation and infection
  • blood disorders, such as low platelet counts or anemia
  • digestive problems, such as cramping, appetite loss, diarrhea, and nausea
  • delayed growth and development.

After Legionnaires’ disease has been diagnosed, hospitalization is often necessary. In the most severe cases, complications can include respiratory failure, kidney failure, septic shock, or even death.

Disease symptoms

Legionnaires’ disease usually develops two to 10 days after exposure to Legionella, and it frequently begins with the following symptoms:

  • headaches
  • muscle pains
  • chills
  • fever, which can be 104 degrees Fahrenheit or higher.

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

  • cough, which can bring up mucus and blood
  • shortness of breath
  • chest pains, or pleurisy
  • 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 in other parts of the body, including the heart.

Pontiac fever

A mild form of Legionnaires’ disease is Pontiac fever, which can produce symptoms that also include a fever, chills, headaches, and muscle aches. Pontiac fever, however, doesn’t infect the lungs, and those symptoms usually go away on their own within two to five days.