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.

Governor Bruce Rauner’s administration recently shifted course and stated that it will rebuild residence halls at the Illinois Veterans Home in Quincy (IVHQ), which housed victims of a Legionnaires’ disease outbreak in which 13 people died among dozens sickened since 2015.

The plan was announced less than two months after the Republican governor said the state would replace the outdated plumbing system, which could be the likely source of the Legionella bacteria that cause outbreak.

“The cost and the disruption and the construction that would be involved, not to mention the time it would take to do this [plumbing replacement] would just not be worth the effort when you think about building a brand-new building,” said Erica Jefferies, director of the Illinois Department of Veterans’ Affairs (IDVA). “We do not want to spend years tearing up 70-year-old buildings to put brand-new piping in when we know that might not be a total solution.”

The plan to tear down several of the dorms on the 130-year old campus in western Illinois would take place within 3 to 5 years.

Legionnaires’ and Illinois

In other recent Illinois-related Legionnaires’ news:

  • Senator William “Sam” McCann (R-Plainview) called for the resignation of Nirav Shah, director of the Illinois Department of Public Health (IDPH). “We have people living in that facility who survived the battlefield, but they may not survive us,” McCann said.
  • The Illinois House passed a unanimous vote (104-0) asking the IVHQ, the IDVA, the IDPH, and Gov. Rauner’s administration to report on what officials “knew and when they knew it” regarding the outbreak.
  • The Illinois House’s veterans’ affairs committee approved a bill (House Bill 4310) that would require IVHQ officials to notify residents, family and staff of a Legionnaires’ disease outbreak within 24 hours. When the first outbreak occurred in 2015, it took officials six days to notify the public, saying they didn’t realize they were dealing with an “epidemic.”
Legionnaires' disease bacteria
Legionella bacteria

Eradication may not be possible

Representatives from the Centers for Disease Control and Prevention (CDC) returned last month to the IVHQ to review testing protocols for individuals with respiratory illness, at the request of the IDPH.

The CDC warned 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 each of the past 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.

Legionnaires’ facts and figures

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 its nonspecific signs and symptoms.

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

Contracting Legionnella
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:

  • cooling towers of air conditioning systems
  • large plumbing systems
  • water systems such as those used in hospitals, nursing homes, and hotels (IVHQ undertook a nearly $5 million, state-of-the-art rehabilitation of its water-treatment plant in summer 2016)
  • hot tubs and whirlpools
  • physical therapy equipment
  • mist machines and hand-held sprayers
  • hot-water tanks and heaters
  • showers and faucets
  • swimming pools
  • 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.

Who is most susceptible?
Anyone can get the disease, but those most susceptible to infection include:

  • people 50 or older
  • smokers, both current and former
  • heavy drinkers of alcohol
  • 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).

Legionella bacteria was positively identified by the Florida Department of Health in Sarasota County (FDOH) after testing of a hot water heater in the fitness area at the IslandWalk at West Villages gated community in North Port, FL, according to news reports.

However, the FDOH believes the pool and spa area are where people came into contact with the bacteria, despite the fact that those areas returned negative results for the bacteria after testing.

FDOH officials said that by the end of February, 13 residents had been confirmed with Legionnaires’ disease, which is a severe type of pneumonia caused by Legionella infection. No additional cases have been seen in nearly a month, so officials said they believe the threat is contained.

“The temperature of the water heater was lower than it should have been,” Environmental Health Director Tom Higginbotham said. “This was a low-use hot water heater that wasn’t serving any showers, just hand sinks, so I don’t see any negligence at this point.”

Domestic water heaters need to be maintained at 140 degrees Fahrenheit and water delivered at the faucet at a minimum of 122 degrees in order to control the growth of Legionella, according to the Occupational Safety and Health Administration.

The spa and pools have been sanitized, according to IslandWalk officials, and they are replacing the contaminated water heater.

IslandWalk at the West Villages
The pool and spa area at IslandWalk remain temporarily closed until health officials give the all clear.

IslandWalk at the West Villages

IslandWalk at the West Villages is an 830-acre, gated, lakefront community of luxury single-family homes, patio homes, and townhomes surrounded by lakes and preserves. The community’s features include a resort center, fitness center, movement studio, resort and lap pools, and sports courts.

North Port is located in southern Sarasota County.

Residents or visitors to the IslandWalk gated community who are exhibiting pneumonia- or flu-like symptoms (see symptoms below) should seek immediate medical attention from their primary health-care provider.

Legionnaires’ facts and figures

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.

Contracting Legionella
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 Legionnaires’ disease from home plumbing systems, although the vast majority of outbreaks have occurred in large buildings because complex systems amplify the conditions for bacteria to grow and spread more easily.

Who is most at risk for infection?
Anyone can get the 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).

Symptoms are numerous
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.

New testing conducted at the Robinson Renaissance office building in downtown Oklahoma City no longer showed the existence of Legionella bacteria, according to a report by that city’s KFOR-TV.

At least six employees who worked in the building tested positive for Legionella bacteria infection in February, according to KFOR-TV sources, which is why testing was ordered. Laboratory testing at that time returned evidence of the bacteria in one of the building’s cooling systems.

Legionella is the bacteria that causes Legionnaires’ disease – a potentially deadly type of pneumonia – and a milder, flu-like condition known as Pontiac fever.

No additional information regarding the condition of the sickened employees or the severity of their illness was made available.

Officials confirmed that regular screenings of the building’s cooling tower will be added to the building’s maintenance schedule in an effort to identify potential issues, so that problems can be remediated more quickly.

Employees or recent visitors to the Robinson Renaissance building or the surrounding area who may be exhibiting flu-like or respiratory illness (see symptoms below), or who have concerns about their health, should immediately contact their medical provider.

The 13-story Robinson Renaissance building is located at 119 N. Robinson Ave. It is owned by the Commissioners of the Land Office state agency, which paid $8.95 million for the 174,140-square-foot, U-shaped building in 2014. It was originally called the Perrine Building when it opened in 1927.

Legionnaires' disease bacteria

How is Legionella contracted?

Legionella bacteria are contracted by inhaling microscopic water droplets 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 range of sources, such as:

  • cooling towers in air conditioning systems
  • large plumbing systems
  • hot-water tanks and heaters
  • hot tubs and whirlpools
  • swimming pools
  • showers and faucets
  • decorative fountains
  • mist machines
  • equipment used in physical therapy.

What are the symptoms?
The symptoms of Legionnaires’ disease – also called legionellosis or Legionella pneumonia – are similar to other forms of pneumonia or flu, which is why so many cases go unreported annually. Early symptoms can include the following:

  • chills
  • fever (potentially 104 degrees or higher)
  • headaches
  • loss of appetite
  • muscle aches.

After the first few days, symptoms can worsen to include:

  • chest pain when breathing (called pleuritic chest pain, due to inflamed lungs)
  • confusion and agitation
  • a cough, which may bring up mucus and blood
  • diarrhea (about one-third of all cases result in gastrointestinal problems)
  • nausea and vomiting
  • shortness of breath.

The incubation period – the amount of time between breathing in the bacteria and developing symptoms – is usually 2 to 10 days after exposure and can be as much as 16 days.