Legionnaires Disease Lurks in Hotels,
Hospitals, Homes, Ships, & Factories.

Legionnaires Disease causes over 4,000 deaths and 25,000-30,000 illnesses each year in the USA according to the U.S. Occupational Safety & Health Administration webpage.

Microbiologist Dr Tom Makin estimates that in the UK up to 9,000 infections and 1,500 deaths occur each year from Legionnella contamination. (ref: DailyMail June 7, 2012)

However, some authorities claim the real number of Legionnaires Disease cases is grossly under-reported, especially in developing countries, as many go undetected or are mistakenly classified as other respiratory and pneumonia-associated illnesses.

In fact, Grundfos (the world's largest pump manufacturer... a Danish company with over 18,000 employees worldwide) tells us in its literature:

One Press Release cited a conference in New York in July 2011 as stating that "200,000 persons die on(sic) Legionnaire's disease worldwide each year, 2 million are infected."

Published on Aug 31, 2012 by NTDTVCanadaNews.
*Update:13th Sept 2012... Latest reports confirm 13 dead, 180 infected by Legionnaires Disease from cooling towers in two high rise buildings in Quebec City, Canada.

Legionella Hot Spots... The Scary Truth.

The Legionnella bacteria thrives in stagnant/slow-flowing water sources between 25-45°C (77-113°F)... hot water units should be set above 55°C (131°F), and cold water systems below 20°C (68°F).

It seems in some regions people have been turning down their thermostats during the present recessionary times to cut power bills. Others have been selecting lower temperatures thinking it will avoid the risk of scalding if children or the elderly are around. Doing this is dangerous!

Here are just a few examples of where Legionnaires Disease has cropped up... and this is just the "tip of the iceberg" you might say.

• Factories... usually from contaminated cooling towers.
  *2001... 2 die-4 infected at Ford Factory Ohio, USA.
  *2003-4...18 die-86 infected by petro-chemical plant cooling tower in Pas-de-Calais, France. Some victims lived 7 km away... this disease can travel long distances (ref: Wikipedia).
  *2005... 10 die-56 infected by factory air scrubber Fredrikstad, Norway.
  *2012... 3 die-99 infected by cooling tower in Edinburgh, Scotland.
  
  
• Hotels... from contaminated air-conditioning systems/water fountains.
  *1976... 34 Legionnaires die-221 infected in Philadelphia, USA.
  *2001...6 die-12 infected from hot water system Pompidou Hotel, Paris.
  *2011... 1 dead-9 infected at Las Vegas hotels, USA.
  *2012...3 die-18 infected by solar water heater Diamante Beach Hotel, Spain.
  
  
• Public buildings & High-rises... from contaminated cooling towers.
  *2000... 4 die-125 infected at new Aquarium Melbourne, Australia.
  *2001... 7 die-28 infected from outdoor fountain/cooling towers Stavanger, Norway.
  *2002... 7 die-172 infected in Art Centre in Barrow-in-Furness, UK.
  *2012... 13 die-180 infected in two high rises Quebec City, Canada.
  *2012... 3 die-10 infected by lobby fountain Marriott Hotel Chicago, Illinois.
  
  
• Hot tubs, Spas, & Pools... that are under chlorinated.
  *1999... over 32 die-318 infected at hot tub exhibition in Bovenkarspel, Netherlands. (ref: Wikipedia)
  *1999... 4 die-41 infected from hot tub at trade fair Kapellen, Belgium.
  *2011... 200 infected by hot tub at Playboy Mansion L.A. California.
  *2012... 1 dead-19 infected at hot tub warehouse Fenton, UK.
  
  
• Hospitals & Nursing Homes acquired Legionnaires Disease.
  *1985... 28 die-175 infected Stafford District Hospital, UK.
  *2001... 6 die-800 infected in hospital Murcia, Spain.
  *2001...3 die-18 infected from hot water system Pamplona, Spain.
  *2005... 21 die-127 infected home for aged Toronto, Canada.
  *2008... 2 die-6 infected by drinking water Brunswick, New Jersey.
  
  
• Car-washes & Windscreen-wash... from contaminated water aerosol.
  *2008... 7 infected at car wash in Victoria, Australia.
  *UK Health experts estimate up to 20% of LD infections come from windscreen wash bottles and urge that screen-wash detergent be added.
  
  
• Ships & Trains... travel-related infections.
  *1984... 70 infected-295 had flu-like illness when air-conditioning was turned on onboard a ship in Bordeaux, France.
  *1994... 1 dead-34 infected from a spa pool on US cruise ship.
  *1995... 1 dead-1 infected on a Rhine River cruise, Germany.
  *1995... 1 dead-2 infected from ship's water supply on an Italian cruise.
  *1997... 6 infected from a hot tub on Rhine River cruise.
  *2001... 2 die; they were mechanics repairing a cargo ship's water pump in Barcelona, Spain.
  *2004... 1 dead-7infected from a spa pool on Iceland cruise.
  *2011... leaked British email reveals up to 1 in 3 trains with on-board toilets and wash-basins could have contaminated water tanks.
  
  
  
• Biofilm/slime/scale build up in pipes and tubing encourages bacterial colonisation, makes chemical disinfection more difficult, and can slow water flow and encourage stagnation.
  
  
• Potting mixes & Compost can harbour pathogens and require careful handling (wearing an appropriate face mask a wise idea).
  
  

Prevention of Legionnaires Disease.

Legionnaires Disease -Preventing a Public Relations Nightmare.
Published on Apr 24, 2012 by BuildingOpsMgmt

Factors to be considered are:

1. Careful design of water systems to prevent low water flow or stagnation.
   
2. Use of materials that best resist bacterial colonisation (e.g. metals vs rubbers vs plastics).
   
3. Careful placement of equipment away from people to minimise risk of pathogen release... but remember, this disease travels long distances.
   
4. Regular maintenance by adequately trained staff of all water systems by thorough physical cleaning.
   
5. Maintaining safe and correct operating temperatures.
   
6. A program of regular chemical disinfection with appropriate biocides.
   
7. Risk increases dramatically in premises that are closed down for periods of time (e.g. hotels during the off season, nursing homes during renovation, etc).
   

Legion Fever Strikes... 1976.

Legionnaires Disease is named after an sudden outbreak of pneumonia at an American Legion Convention in July 1976 at the Bellevue-Stratford Hotel in Philadelphia, USA. The previously unknown pathogen that caused 221 infections and 34 deaths was first identified here and named Legionella.

Legionella Bacteria.

Legionella pneumophila (a gram negative, aerobic bacteria) is the main culprit and is responsible for around 90% of Legionnaires Disease.

A milder version of Legionnaires Disease, called Pontiac Fever, is caused by the same bacteria but doesn't result in pneumonia and usually clears up by itself in 5 days (often being passed off as "the flu").

Up to 50 types of Legionella bacteria have been identified, half of which can cause illness in humans. These bacteria are found naturally in the environment in warm, damp places and warm water... in soil, lakes, rivers, creeks, hot springs, and potting mix.

*These bacteria thrive in moist, damp conditions between between 25-45°C (77-113°F). Below 20°C (68°F) they can survive but are dormant; at 55°C (131°F) they die within 6 hours.

Disease Transmission.

1. By Inhalation... microscopic water droplets from aerosols or fine sprays carry the bacteria into the lungs from contaminated water supplies.
   
   
2. By Aspiration... accidental access of bacteria to the respiratory tract while drinking or swallowing.
   
   
3. Hospital-acquired pneumonia where naso-gastric tubes, mechanical ventilators and respiratory therapy equipment (humidifiers & nebulizers) are used on health-compromised patients... only sterile water should be used when rinsing and cleaning such equipment.
   
   

It is believed transmission from one person to another does not occur.

Legionnaires' Disease: What You Need to Know...
Uploaded by IAQMarketer on Jan 13, 2011

Signs & Symptoms;

Pontiac Fever, the milder version, has an incubation period of up to 48 hours leading to fever, headache, chills, muscle pain, and malaise. It is not fatal, does not lead to pneumonia, and lasts only 2-5 days.

Full blown Legionnaires' Disease exhibits the following:

• An incubation period of 2-14 days, sometimes a little longer.
  
• A duration of weeks.
  
• Fever.
  
• Loss of appetite.
  
• Headache.
  
• Chills.
  
• Malaise & lethargy.
  
• Muscle aches & pains.
  
• Nausea, vomiting, diarrhoea.
  
• Confusion and delirium.
  
• Shortness of breath, chest pain.
  
• A cough, often with phlegm (sometimes streaked with blood).
  
• Possible pneumonia, respiratory failure, shock, multi-organ failure.
  
• Death occurs in about 15% of cases.
  

Legionnella pneumophila is an "opportunistic" pathogen that is much more likely to strike down the elderly, smokers, people with weak immune systems, those with chronic debilitating illnesses, Chronic Obstructive Pulmonary Disease, organ transplant recipients or people on corticosteroid therapy.

However, it can strike healthy, younger individuals as well.

Diagnosis & Treatment.

A diagnosis of pneumonia must be quickly be confirmed by a doctor based on a chest x-ray, and positive laboratory tests which confirm the presence of the LD bacteria from sputum, respiratory secretions, lung tissue, or pleural fluid... and urinary antigen detection.

Treatment involves the timely administration of antibiotics... usually the newer macroglide group (including Azithromycin, and Clarithromycin, & Erythromycin) or the quinalones (including fluoroquinolone, levofloxacin, moxifloxacin).