Water Health Educator
Water Health Educator
Promoting advocacy for access to clean water
Disease Focus: Legionella
Thank you to Rachel Berman, RD, CDN for offering her content on VeryWell on Hepatitis to enhance our learning forum! Please see https://www.verywell.com/hepatitis-4014707 Thank you!!
Legionella – A Brief
By Nicole Kraatz
Legionella, also known as Legionnaires' disease, is a severe form of pneumonia caused by the bacteria Legionella pneumophila. This disease was first discovered at a hotel in Philadelphia in 1976. The hotel was hosting a convention for the Pennsylvania American Legion when approximately 200 of it’s attendees developed pneumonia, eventually resulting in a number of fatalities. After viewing laboratory results of the lung tissue, the bacterium was found and later named Legionella pneumophila.
In order to contract Legionella, a person has to come in contact with water contaminated by the Legionnaires' disease bacteria. Inhaling aerosolized forms of the Legionnaires' disease bacteria can also cause illness to occur. The time of infection to the onset of symptoms for those infected with Legionella takes 2-10 days. Symptoms are that of standard pneumonia illnesses, such as cough, high fever, muscle aches, headaches and shortness of breath. Those that are healthy generally do not get sick after exposure to the bacteria. However, there are populations more at risk of contracting the disease than others. Those populations include people over age 50, current or former smokers, those with chronic lung diseases as well as those with weak immune systems.
To prevent further complications after being diagnosed with Legionella, those infected must begin treatment with antibiotics such as azithromycin, erythromycin, and clarithromycin. This ensures successful recovery for patients. Because Legionella is a waterborne disease, prevention is mainly centered around maintenance of water systems. Currently, there are no vaccines for Legionella and it is imperative for those at risk to stay away from high risk exposures such as hot tubs, decorative fountains or other stagnate bodies of water.
Legionella Cases in St. Joseph’s Hospital
By Jason Zheng
St. Joseph’s Hospital in Syracuse, New York confirmed with additional water testing that presence of Legionella bacteria is present at the facility. The results were released to the public, showing that the bacteria was found in two patient sinks and one ice machine at the hospital. The test was ordered by the New York State Department of Health after three patients were diagnosed with Legionnaire’s pneumonia in late September and early October of 2015.
United States Senator Charles Schumer stated that the cases of Legionnaires’ disease in Syracuse hospital requires the action of federal government requiring hospitals and other large buildings to regularly test their water supplies for the disease. Legionnaires' is a severe form of pneumonia which can be deadly for elderly people with lung disease and weakened immune systems. The bacteria can be found in air conditioning cooling towers as well as drinking water supplies.
Recently, the state of New York requires all building owners to register their cooling towers with the state and have them regularly rested for Legionella bacteria.
According to the Center for Disease Control and Prevention (CDC), up to 18,000 people are hospitalized for the disease in the U.S. each year. Schumer says that this is preventable, however it comes down to adjust current health regulations. He clearly blames the CDC for this incident because the agency did not take actions even when there was active cases present in the U.S.
Senator Schumer wants the federal government to devote $250 million for the CDC to conduct more research on Legionnaires’ and to create a national testing standards for the bacteria. He urges Senate to include this in the Fiscal Year (FY) 2016 Labor, Health and Human Services, Education and Related Agencies’ appropriation bill $500 million for this program. To fulfil this Schumer has sent out letters to Senate Appropriators (Chairman Blunt and Ranking Member Murray) and the CDC (Dr. Tom Frieden). These letters are made available online and can be found here.
Senator Schumer also recommends that health protocols should be compared nationwide among all states, that way better regulations can be enacted to provide more efficient treatments.
Policy Briefing
Legionnaires' Disease and Low Income Communities
by Sheima Amara
Legionella in Ohio
By Nora Rideg
Legionella is a type of bacteria found naturally in freshwater environments, like lakes and streams. However, it can become a health concern when it grows and spreads in human-made building water systems such as cooling towers, showerheads, hot tubs, hot water tanks and plumbing systems. Once Legionella grows and multiplies in a building's water system, it can spread to people primarily by inhaling mist or small droplets containing the bacteria, which can cause Legionnaires' disease or Pontiac fever. Less commonly, people can get sick by aspirating drinking water containing Legionella. Ohio has experienced several Legionella outbreaks, emphasizing the need for increased awareness and prevention efforts.
Reports of Legionnaires’ disease in Ohio have been increasing, with around 600 cases in 2015. Legionnaires' disease outbreaks underscore the ongoing challenges in managing water systems to prevent bacterial growth. One such incident occurred at Mount Carmel Grove City hospital in Ohio, faced severe outbreaks linked to inadequate disinfection of hot water systems. This led to 16 cases and two fatalities shortly after the hospital's opening. Another outbreak at Mount Carmel East Colombus hotel later in October, resulting in three more cases of Legionnaires' disease where guests were affected due to contamination of the water system. This prompted immediate health measures to control the spread. The outbreak emphasizes the critical importance of regular monitoring and maintenance of water systems to mitigate such risks.
Meanwhile, there is a recent confirmation of five Legionnaires' disease cases has prompted investigations into potential sources and raised community concerns, particularly centered around Adena Health System's Chillicothe campus. The county’s Health Department emphasized that there have been no outbreaks or healthcare-associated cases of Legionnaires' disease in Ross County in 2023. However, examination has fallen on Adena Health System’s main campus in Chillicothe after nine individuals reported symptoms and one fatality was linked to the disease. Despite accusations from patients, the hospital denies any connection to the facility. The Ohio Department of Health has confirmed the five cases but is restricted by state privacy laws from releasing details.
In 2024, Cleveland Clinic Mercy Hospital in Canton, Ohio, has taken proactive steps following the confirmation of two patients testing positive for Legionnaires' disease bacteria after their stays at the facility, local news reported on February 15. Officials from Cleveland Clinic Mercy and Canton City Public Health are currently investigating the source of the legionella exposures. In response, the hospital has initiated proactive measures such as treating the water system, installing faucet filters, and using bottled water where necessary.
This bacterium impacts human health, particularly the lungs. Most healthy individuals exposed to the bacteria do not get sick, but those at higher risk include people aged 50 or older, smokers, individuals with chronic lung disease, weakened immune systems, cancer, or other underlying health issues.
The Ohio Department of Health (ODH) plays a crucial role in managing and mitigating the risks of Legionella. A water management plan is essential for preventing Legionella growth and effectively handling outbreaks in buildings. It includes forming a dedicated team, documenting water systems, identifying risk areas, implementing control measures, and monitoring protocols to ensure they work well. Environmental assessments are crucial for spotting risks and guiding monitoring efforts, focusing on factors like temperature and chlorine levels. Long-term strategies involve maintaining hot water systems above 120°F, ongoing disinfection with chlorine or alternatives such as copper-silver ionization or UV radiation and using point-of-use filtration. Compliance with manufacturer guidelines is important, and for some systems, meeting public water system regulations may be necessary. Proper maintenance and regular cleaning of cooling towers and HVAC systems are also important for preventing Legionella growth and maintaining water safety.
References:
Carbajal, E. (2024, February 15). 2 test positive for legionella bacteria after Cleveland Clinic mercy stay. Becker’s Hospital Review. https://www.beckershospitalreview.com/infection-control/2-test-positive-for-legionella-bacteria-after-cleveland-clinic-mercy-stay.html
Centers for Disease Control and Prevention. (2024, January 29). About legionnaires’ disease. Centers for Disease Control and Prevention. https://www.cdc.gov/legionella/about/index.html
Centers for Disease Control and Prevention. (2024b, January 29). How legionella spreads. Centers for Disease Control and Prevention. https://www.cdc.gov/legionella/causes/index.html
Colley Shroyer Abraham. Legionnaires’ outbreak at Ohio Hospital Sparks wrongful death lawsuits. https://www.colleyshroyerabraham.com/articles/legionnaires-outbreak-at-ohio-hospital-sparks-wrongful-death-lawsuits/
Legionella—Environmental | Ohio Department of Health. https://odh.ohio.gov/know-our-programs/legionella-environmental/legionella-environmental-welcome
Myers, D. (2023, August 29). State Dept. of Health confirms five cases of legionnaires disease in Ross Co. https://sciotovalleyguardian.com/2023/08/28/ross-co-health-department-confirms-five-cases-of-legionnaires-disease/, https://sciotovalleyguardian.com/2023/08/28/ross-co-health-department-confirms-five-cases-of-legionnaires-disease/
Ohio Department of Health. (n.d.-g). Legionella - Resources & Trainings. https://odh.ohio.gov/know-our-programs/legionella-environmental/resources/legionella-resources-and-trainings
Olsen, E. (2020, January 5). 2019 legionnaires outbreaks: Another busy year for legionella. Legionnaires’ Disease News. https://www.legionnairesdiseasenews.com/2020/01/2019-legionnaires-outbreaks/