List of Legionnaires' disease outbreaks
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This is a list of Legionnaires' disease outbreaks; Legionnaire's is a potentially fatal infectious disease caused by gram negative, aerobic bacteria belonging to the genus Legionella.{{cite book | author = Ryan KJ, Ray CG | title = Sherris Medical Microbiology | edition = 4th | publisher = McGraw Hill | year = 2004 | isbn = 0-8385-8529-9 }}{{page needed|date=July 2017}}{{cite book |vauthors=Swanson M, Heuner K |title=Legionella: Molecular Microbiology |publisher=Caister Academic Pr |year=2008 |isbn=978-1-904455-26-4}}{{page needed|date=July 2017}} The first reported outbreak was in Philadelphia, Pennsylvania in 1976 during a Legionnaires Convention at the Bellevue-Stratford Hotel.{{cite news |first1=Lawrence K. |last1=Altman | name-list-style = vanc |date=August 1, 2006 |title=In Philadelphia 30 Years Ago, an Eruption of Illness and Fear |url=https://www.nytimes.com/2006/08/01/health/01docs.html |work=The New York Times }}
An outbreak is defined as two or more cases where the onset of illness is closely linked in time (weeks rather than months) and in space, where there is suspicion of, or evidence of, a common source of infection, with or without microbiological support (i.e. common spatial location of cases from travel history).{{Cite web|title=Legionella Outbreak Toolbox|url=https://legionnaires.ecdc.europa.eu/?pid=205|access-date=2020-07-01|website=legionnaires.ecdc.europa.eu}}
Worldwide listings by year
=1960s=
| class="wikitable sortable" | |||||||
| Year | City | Venue | Source | Cases | Deaths | Fatality rate || Notes | |
|---|---|---|---|---|---|---|---|
| 1965 | Washington, D.C., United States | St. Elizabeths Hospital | Unknown | 94 | 16 | 17% | The outbreak occurred in 1965, but was not identified as legionnaires' disease until saved blood serum was exposed to bacterial samples from the 1976 Philadelphia Legionnaires' disease outbreak.{{cite news|title='Legion Fever' Germ Killed 16 Here in 1965 | url = https://www.washingtonpost.com/archive/local/1977/01/31/legion-fever-germ-killed-16-here-in-1965/b5c1a8e5-8519-4e89-b2dc-94f5d0554ccb/ |newspaper=Washington Post|access-date=16 December 2021| date = 1977-01-31 | author=B. D. Colen }} |
=1970s=
=1980s=
| class="wikitable sortable" | |||||||
| Year | City | Venue | Source | Cases | Deaths | Fatality rate || Notes | |
|---|---|---|---|---|---|---|---|
| 1985 | Wollongong, Australia | social club building | small cooling tower | ||||
| 1985 | Stafford, England | Stafford District Hospital | Air conditioning | {{sort|175|175}} | {{sort|028|28}} | 16% | In April 1985, 175 patients were admitted to the District or Kingsmead Stafford Hospitals with chest infection or pneumonia. A total of 28 people died. Medical diagnosis showed that Legionnaires' disease was responsible and the immediate epidemiological investigation traced the source of the infection to the air-conditioning cooling tower on the roof of Stafford District Hospital. |
| 1986 | Adelaide, Australia | community | small cooling tower at hospital | ||||
| 1987 | Wollongong, Australia | shopping centre | small cooling tower at a shop | ||||
| 1988 | Adelaide, Australia | community | potting mixes | ||||
| 1988 | Westminster, England | BBC headquarters | cooling tower at Broadcasting House | ||||
| 1989 | Sydney, Australia | bowling club | small cooling tower | ||||
| 1989 | Burnie, Australia | community | small cooling tower at hospital |
=1990s=
=2000s=
=2010s=
= 2020s =
Governmental controls to prevent outbreaks
=Regulations and ordinances=
The guidance issued by the UK government's Health and Safety Executive (HSE) now recommends that microbiological monitoring for wet cooling systems, using a dipslide, should be performed weekly. The guidance now also recommends that routine testing for legionella bacteria in wet cooling systems be carried out at least quarterly, and more frequently when a system is being commissioned, or if the bacteria have been identified on a previous occasion.[http://www.hse.gov.uk/lau/lacs/46-2.htm#para8] {{webarchive|url=https://web.archive.org/web/20121020031125/http://www.hse.gov.uk/lau/lacs/46-2.htm|date=2012-10-20}}
Further non-statutory UK guidance from the Water Regulations Advisory Scheme now exists for pre-heating of water in applications such as solar water heating systems.{{cite web |date=November 2014 |title=Preheated Domestic Hot Water: Storage of Preheated Domestic Hot Water and Possible Growth of Legionella Bacteria |url=https://www.wras.co.uk/downloads/public_area/publications/general/preheated_water_Nov_2014.pdf |publisher=The Water Regulations Advisory Scheme |vauthors=Makin T |access-date=2017-07-01 |archive-date=2017-01-08 |archive-url=https://web.archive.org/web/20170108122407/https://www.wras.co.uk/downloads/public_area/publications/general/preheated_water_Nov_2014.pdf/ |url-status=dead }}
The City of Garland, Texas, United States requires yearly testing for legionella bacteria at cooling towers at apartment buildings.{{cite web |url=http://www.dallasnews.com/sharedcontent/dws/news/localnews/stories/DN-legionella_01eas.ART0.East.Edition1.29739cd.html |title=The Dallas Morning News, Garland tough on bacteria |publisher=Dallasnews.com |date=2007-02-01 |access-date=2010-09-11 |archive-date=2010-04-24 |archive-url=https://web.archive.org/web/20100424212858/http://www.dallasnews.com/sharedcontent/dws/news/localnews/stories/DN-legionella_01eas.ART0.East.Edition1.29739cd.html |url-status=dead }}
Malta requires twice yearly testing for Legionella bacteria at cooling towers and water fountains. Malta prohibits the installation of new cooling towers and evaporative condensers at health care facilities and schools.{{cite web |url=http://www.doi.gov.mt/EN/legalnotices/2006/01/LN5.pdf |title=299601 Legionella |access-date=2010-09-11 |archive-date=2011-06-06 |archive-url=https://web.archive.org/web/20110606130555/http://www.doi.gov.mt/EN/legalnotices/2006/01/LN5.pdf |url-status=dead }}
The Texas Department of State Health Services has provided guidelines for hospitals to detect and prevent the spread of nosocomial infection due to legionella.Report of the Texas Legionnaires' Disease Task Force, Texas Department of State Health Services{{full citation needed|date=July 2017}}
The European Working Group for Legionella Infections (EWGLI){{cite web |url=http://www.ewgli.org |title=European Working Group for Legionella Infections |publisher=Ewgli.org |access-date=2010-09-11 |archive-url=https://web.archive.org/web/20121225121713/http://www.ewgli.org/ |archive-date=2012-12-25 |url-status=dead }} was established in 1986 within the European Union framework to share knowledge and experience about potential sources of Legionella and their control. This group has published guidelines{{cite web |url=http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1274093149925 |title=European Guidelines for Control and Prevention of Travel Associated Legionnaires' Disease |access-date=2017-07-01 |url-status=dead |archive-url=https://web.archive.org/web/20110706104006/http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1274093149925 |archive-date=2011-07-06 }} about the actions to be taken to limit the number of colony forming units (i.e., the "aerobic count") of micro-organisms per mL at 30 °C (minimum 48 hours incubation):
| class="wikitable" | ||
| width=22% | Aerobic count | Legionella | Action required |
|---|---|---|
| align=center| 10,000 or less | 1,000 or less | System under control. |
| align=center| more than 10,000 up to 100,000 | more than 1,000 up to 10,000 | Review program operation. The count should be confirmed by immediate re-sampling. If a similar count is found again, a review of the control measures and risk assessment should be carried out to identify any remedial actions. |
| align=center|more than 100,000 | more than 10,000 | Implement corrective action. The system should immediately be re-sampled. It should then be 'shot dosed' with an appropriate biocide, as a precaution. The risk assessment and control measures should be reviewed to identify remedial actions. |
Almost all natural water sources contain Legionella and their presence should not be taken as an indication of a problem. The tabled figures are for total aerobic plate count, cfu/ml at 30 °C (minimum 48 hours incubation) with colony count determined by the pour plate method according to ISO 6222(21) or spread plate method on yeast extract agar. Legionella isolation can be conducted using the method developed by the US Center for Disease Control using buffered charcoal yeast extract agar with antibiotics.{{citation needed|date=July 2017}}
Copper-Silver ionization is an effective industrial control and prevention process to eradicate Legionella in potable water distribution systems and cooling towers found in health facilities, hotels, nursing homes and most large buildings. In 2003, ionization became the first such hospital disinfection process to have fulfilled a proposed four-step modality evaluation; by then it had been adopted by over 100 hospitals.{{cite journal | vauthors = Stout JE, Yu VL | title = Hospital-acquired Legionnaires' disease: new developments | journal = Current Opinion in Infectious Diseases | volume = 16 | issue = 4 | pages = 337–41 | date = August 2003 | pmid = 12861086 | doi = 10.1097/00001432-200308000-00005 | s2cid = 37897523 }} Additional studies indicate ionization is superior to thermal eradication.{{cite book |first1=Yu-Sen E. |last1=Lin |first2=Janet E. |last2=Stout |first3=Victor L. |last3=Yu |year=2001 |chapter=Control of Legionella |pages=505–12 |chapter-url={{Google books|3f-kPJ17_TYC|page=505|plainurl=yes}} |editor1-first=Seymour Stanton |editor1-last=Block | name-list-style = vanc |title=Disinfection, Sterilization, and Preservation |publisher=Lippincott Williams & Wilkins |isbn=978-0-683-30740-5 }}
A 2011 study by Lin, Stout and Yu found Copper-Silver ionization to be the only Legionella control technology which has been validated through a 4-step scientific approach.{{cite journal | vauthors = Lin YE, Stout JE, Yu VL | title = Controlling Legionella in hospital drinking water: an evidence-based review of disinfection methods | journal = Infection Control and Hospital Epidemiology | volume = 32 | issue = 2 | pages = 166–73 | date = February 2011 | pmid = 21460472 | doi = 10.1086/657934 | s2cid = 8790329 }}
{{citation needed|date=July 2017}}
It was previously believed that transmission of the bacterium was restricted to much shorter distances. A team of French scientists reviewed the details of an epidemic of Legionnaires' disease that took place in Pas-de-Calais in northern France in 2003–2004. There were 86 confirmed cases during the outbreak, of whom 18 died. The source of infection was identified as a cooling tower in a petrochemical plant, and an analysis of those affected in the outbreak revealed that some infected people lived as far as 6–7 km from the plant.
A study of Legionnaires' disease cases in May 2005 in Sarpsborg, Norway concluded that: "The high velocity, large drift, and high humidity in the air scrubber may have contributed to the wide spread of Legionella species, probably for >10 km."{{cite journal | vauthors = Nygård K, Werner-Johansen Ø, Rønsen S, Caugant DA, Simonsen Ø, Kanestrøm A, Ask E, Ringstad J, Ødegård R, Jensen T, Krogh T, Høiby EA, Ragnhildstveit E, Aaberge IS, Aavitsland P | title = An outbreak of legionnaires disease caused by long-distance spread from an industrial air scrubber in Sarpsborg, Norway | journal = Clinical Infectious Diseases | volume = 46 | issue = 1 | pages = 61–9 | date = January 2008 | pmid = 18171215 | doi = 10.1086/524016 | doi-access = free }}
In 2010 a study by the UK Health Protection Agency reported that 20% of cases may be caused by infected windscreen washer systems filled with pure water. The finding came after researchers spotted that professional drivers are five times more likely to contract the disease. No cases of infected systems were found whenever a suitable washer fluid was used.{{cite news|last=Wilkinson |first=Emma | name-list-style = vanc |url=http://news.bbc.co.uk/1/hi/health/10293519.stm |title=Windscreen water infection risk |publisher=BBC News |date=2010-06-13 |access-date=2010-09-11}}
Temperature affects the survival of Legionella as follows:{{cite web |url=http://www.relianceworldwide.com/site/fs_legionella.htm |archive-url=https://web.archive.org/web/20071009184051/http://www.relianceworldwide.com/site/fs_legionella.htm |archive-date=October 9, 2007 |title=Legionella: What is Legionnaires' Disease? |publisher=Reliance Worldwide }}{{MEDRS|date=July 2017}}
- {{convert|70|to|80|C|F}}: Disinfection range
- At {{convert|66|°C|°F|abbr=on}}: Legionellae die within 2 minutes
- At {{convert|60|°C|°F|abbr=on}}: They die within 32 minutes
- At {{convert|55|°C|°F|abbr=on}}: They die within 5 to 6 hours
- Above {{convert|50|°C|°F|abbr=on}}: They can survive but do not multiply
- {{convert|35|to|46|C|F}}: Ideal growth range
- {{convert|20|to|50|C|F}}: Growth range
- Below {{convert|20|°C|°F|abbr=on}}: They can survive but are dormant
Removing slime, which can carry legionellae when airborne, may be an effective control process.{{cite journal | vauthors = Potera C | title = Studying slime | journal = Environmental Health Perspectives | volume = 106 | issue = 12 | pages = A604-6 | date = December 1998 | pmid = 9831548 | pmc = 1533243 | doi = 10.1289/ehp.98106a604 }}
See also
References
{{Reflist|30em}}
External links
- {{cite web |first1=Gerard A. H. |last1=van Amerongen |first2=John V. |last2=Lee |first3=Jean-Marc |last3=Suter | name-list-style = vanc |date=April 22, 2013 |title=Legionella and solar water heaters |url=http://www.vaconsult.net/Downloads/report-scf-legionella-and-solar-water-heaters--final-2013-04.pdf }}
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Legionnaires' disease outbreaks
Category:Lists of disease outbreaks