List of Legionnaires' disease outbreaks

Last updated

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 . [1] [2] The first reported outbreak was in Philadelphia, Pennsylvania in 1976 during a Legionnaires Convention at the Bellevue-Stratford Hotel. [3]

Contents

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). [4]

Worldwide listings by year

1960s

YearCityVenueSourceCasesDeathsFatality rateNotes
1965 Washington, D.C., United States St. Elizabeths Hospital Unknown941617%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. [5]

1970s

YearCityVenueSourceCasesDeathsFatality rateNotes
1973,1977 Benidorm, Spain Hotel Rio Park Shower pipesat least 44unknownThe first outbreak in Hotel Rio Park occurred in 1973, four tourists died, but at the time it was not recognized as Legionnaires' disease until a subsequent outbreak in the same hotel in 1977. [6]
1976 Philadelphia, Pennsylvania, United States 1976 Philadelphia Legionnaires' disease outbreak Air conditioning 2213415.4%This was the first recognized outbreak of legionellosis, although earlier cases of legionellosis were later discovered to have occurred as far back as 1947. The Philadelphia outbreak, however, had the highest death rate. [7] [8] [9]
1978 Memphis, Tennessee, United States Baptist Memorial Hospital-Memphis (1912–2000) air-conditioning cooling tower44 1978 Memphis Legionnaire's Disease Outbreak
1979 Melbourne, Australialight industrial buildingmedium-sized evaporative condenser [10]
1979 Ballarat, Australiapsychiatric hospitalshower water system [10]

1980s

YearCityVenueSourceCasesDeathsFatality rateNotes
1985 Wollongong, Australiasocial club buildingsmall cooling tower [10]
1985 Stafford, England Stafford District Hospital Air conditioning 1752816%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, Australiacommunitysmall cooling tower at hospital [10]
1987 Wollongong, Australiashopping centresmall cooling tower at a shop [10]
1988 Adelaide, Australiacommunitypotting mixes [10]
1988 Westminster, England BBC headquarterscooling tower at Broadcasting House
1989 Sydney, Australiabowling clubsmall cooling tower [10]
1989 Burnie, Australiacommunitysmall cooling tower at hospital [10]

1990s

YearCityVenueSourceCasesDeathsFatality rateNotes
1992 Sydney, Australiashopping centresmall cooling tower [10]
1994 Sunshine Coast, Australiaholiday apartment unitprivate spa pool [10]
1995 Sydney, Australiashopping centresmall cooling tower at hospital [10]
1999 Bovenkarspel, Netherlands 1999 Bovenkarspel legionellosis outbreak Hot tub 3183210%In March 1999, an outbreak occurred in the Netherlands during the Westfriese Flora flower exhibition in Bovenkarspel. 318 people became ill and at least 32 people died. There is a possibility that more people died from it (which might make it the deadliest recorded outbreak), but these people were interred before the Legionella infection was recognized. The source of the bacteria was a hot tub in the exhibition area. [11] [12]

2000s

YearCityVenueSourceCasesDeathsFatality rateNotes
2000 Melbourne, Australia Sea Life Melbourne Aquarium Cooling tower 12543.2%In April 2000, an outbreak of Legionella pnemophila serogroup 1 occurred in Melbourne, Australia. The outbreak resulted in 125 confirmed cases of Legionnaire's disease, with 95 (76%) hospitalised. It is reported that 4 died from the outbreak. The investigation traced the source of the infection to the cooling tower at the newly opened aquarium. [13] Since this outbreak, legionella infection statistics are required to be reported by the state government as a notifiable disease. [14] Regulations were introduced by the state to control legionella in 2001. [15]
2000 Vizela, Portugal Public squareDecorative fountain1100%In August 2000, an outbreak of Legionnaires' disease occurred in Vizela, Northern Portugal. [16] A total of 11 persons with Legionnaires' disease were admitted to the hospital. [17] There were no fatalities. All patients had been in the main square of Vizela in the night of August 11–12, 2000, where the annual festivities of the municipality were being held. [16] Investigators traced the source of the outbreak to a decorative fountain located in the square. [17]
2001 Murcia, SpainHospitalCooling Towers [18] 800+60.8%The world's largest outbreak of Legionnaires' disease happened in July 2001 with patients appearing at the hospital on July 7, in Murcia, Spain. More than 800 suspected cases were recorded by the time the last case was treated on July 22; 636–696 of these cases were estimated and 449 confirmed (so, at least 16,000 people were exposed to the bacterium) and 6 died . A case-fatality rate of approximately 1%. [18]
2002 Barrow-in-Furness, England 2002 Barrow-in-Furness legionellosis outbreak Air conditioning 17274.1%In 2002, Barrow-in-Furness in England had an outbreak of Legionnaires' disease. Six women and one man died as a result of the illness; another 172 people also contracted the disease. The cause was found to be a contaminated cooling tower at the town's Forum 28 arts centre. [19] Barrow Borough Council later became the first public body in the UK to be charged with corporate manslaughter but were cleared. They were, however, along with architect Gillian Beckingham, fined for breaches of Health and Safety regulations in a trial that ended in 2006.
2003-2004 Pas-de-Calais, FrancePetrochemical plant Cooling tower 861820.93%This was the worst outbreak of Legionnaires in French history. [20] [21]
2004 Zaragoza, SpainHospital Cooling tower 27726%Five out of seven of the fatalities were above the age of 50. [20]
2005 Toronto, CanadaSeven Oaks Home for the Aged Cooling tower 1272116.5%In late September, 2005, 127 residents of a nursing home became ill with Legionella pneumophila . Within a week, twenty-one of the residents had died. Culture results at first were negative. The source of the outbreak was traced to the air-conditioning cooling towers on the nursing home's roof. [22]
2005 Fredrikstad, NorwayFactory Air scrubber 103109.7%At least 103 people became ill and ten died from Legionnaires' disease caused by bacteria growing in an air scrubber of a nearby factory. [23]
2007 Jastrzębie Zdrój, Poland 2nd District Specialist Hospital, Ophthalmic WardWater system4375%In January 2007 in the 2nd district specialist hospital in Jastrzębie-Zdrój two patients on the ophthalmic ward unexpectedly died. It was noted that they suddenly had a high fever, coughs and hallucinations. First they were transferred to the infectious diseases ward for some hours with a suspicion of pneumonia, later they were transferred to intensive care.

Tests showed that both patients had legionellosis. The disease proved to be the cause of death of one of the patients, the other also had circulatory failure. The bacteria responsible for legionellosis was found in four patients from this hospital. [24] In total the outbreak resulted in three deaths [25]

2008 New Brunswick, New Jersey, United States Saint Peter's University Hospital Drinking water 6233.3% Chlorination in the water system had dropped below effective levels. [26]

2010s

YearCityVenueSourceCasesDeathsFatality rateNotes
2010 Wales South Wales Valleys Likely cooling towers 2229%Thought to be cooling towers in local industry. [27]
2011 Dayton, Ohio, United States Dayton Hospital air conditioning11545%Was the largest outbreak in Ohio since 1994 at the time. [20]
2012 Québec City, Canada Lower Québec CityPossibly cooling towers 180137.22%180 confirmed cases as of September 14, 2012, probably due to contaminated water in industrial cooling towers. [28]
2012 Calp, Spain AR Diamante Beach HotelPlumbing system18317%Large hotel with solar water heating system for spa and domestic hot water. A month before the deaths, local government authorities may have known about the problem, but were accused of not alerting the public to avoid disruption of the tourism industry. [29]
2012 Edinburgh, ScotlandSouth west of EdinburghPossibly cooling towers 9243%56 confirmed cases, with a further 36 suspected cases, bringing the total number of people affected to 92. Four people are known to have died from the outbreak. [30]
2012 Chicago, Illinois, United StatesJW Marriott Hotel Decorative Lobby Fountain 10330%8 confirmed cases with people who stayed at the JW Marriott Chicago during July–August 2012. [31]
2012 Auckland, New ZealandUnknownWater Source and/or Air Conditioning 1119%The number of people affected in a major outbreak of Legionnaires' disease in Auckland, which has claimed one life, has risen to 11. [32]
2012 Stoke-on-Trent, England Warehouse, Fenton Hot tub 1915.2%Infection began in warehouse hot tub. Seventeen of the confirmed cases visited the warehouse a couple of weeks before becoming ill. [33]
2012 Pittsburgh, Pennsylvania, United States Veteran's Administration Hospital unknown 22627%2012 Pittsburgh legionellosis outbreak [34] [35] [36]
2014 Portugal 2014 Legionella outbreak in Portugal Cooling tower [37] 375123.2%A widespread outbreak in Vila Franca de Xira district, Portugal. [38]
2015 Bronx, New York, United States Co-op City, South Bronx, and Morris Park Cooling Towers in the Bronx, such as Co-op City, Lincoln Hospital, and Concourse Plaza.140139.3%12 people sickened in January 2015. No fatalities reported. [39] The 2015 New York Legionnaires' disease outbreak was investigated the New York City Health Department [40] [41] Out of 17 buildings with cooling towers, five tested positive for the disease, including cooling towers in the Concourse Plaza Hotel and Lincoln Hospital. [42] The Opera House Hotel in the South Bronx is also considered a source of the outbreak. [43] The outbreak is currently being investigated by the New York City Health Department [44] [45] "Environmentalists sampled 35 cooling towers in the Morris Park area, and 15 came back with positive results." [46] In total 52 buildings were sampled and 20 of them came back positive.
2015 Northland, New Zealand Pahiatua Fonterra PlantUnknown30UnknownThis outbreak occurred at one of Fonterra's milk plants in Northland, New Zealand, in November 2015. Currently three cases have been reported, though currently no deaths.
2015 Quincy, Illinois, United States Veterans homeUnknown581327.7%The outbreak investigation is ongoing [47] [48] [49]
2014–2016Flint, Genesee County, Michigan, United States Countywide McLaren Regional Medical Center 871213.8% Investigation by Frontline also examined cases diagnosed as pneumonia that could have been misdiagnosed and diagnosed as Legionnaires' Disease. [50] McLaren and the Michigan Department of Environmental Quality is being sued for $100 million in regards to the outbreak. [51] See also Flint water crisis, possibly linked to legionnaires disease
2016 Sydney, Australia Sydney Town Hall Suspected cooling towerat least 40 [52]
2016 Hopkins, Minnesota, United States Citrus Systems, Inc.Cooling tower2314.3%Confirmed by Minnesota Department of Health. 23 people became sick, 17 were hospitalized, and one person died. [53]
2017 Manhattan, New York, United States Lenox Hill TBD7114.3% [54]
2017 Las Vegas, Nevada, United States Rio Hotel and CasinoWater system2 [54] 00
2017 Round Rock, Texas, United States SpringHill Suites hotelSwimming pool and hot tub6 [55] [56] 00
2017 Anaheim, California, United States Disneyland Cooling towers2214.5% [57]
2017 Lisbon, Portugal São Francisco Xavier Hospital Cooling tower [58] 56611%In November 2017, an outbreak of Legionnaires' disease occurred in São Francisco Xavier Hospital, in Lisbon, Portugal. The outbreak resulted in 56 confirmed cases of Legionnaire's disease, of which 6 died. [59] The investigation traced the source of the infection to a cooling tower in the hospital. [60] [61]
2018 Bloomsbury, London University College London Water cooler10
2018 Washington Heights, New York, United States The Sugar Hill Project (Building) [62] [63] Cooling towers [64] [65] [62] [63] 27 [66] [65] 1 [65] 3.7%
2019Westminster, London, England Dolphin Square Water System300%First case confirmed by NHS England 20 March 2019. [67] Samples taken from the flexible shower hose and bathroom sink of the affected resident's flat, showed legionella bacteria present in those specific locations. Third case confirmed by Public Health England 1 July 2019.
2019 Evergem, Belgium Ghent/Evergem Port [68] Stora Enso [69] Cooling Towers [68] 32 [70] 2 [71] 6.7%Five samples collected from 17 initially suspected cooling towers at the Port of Ghent near Evergem, tested positive for Legionella pneumophila, 3 with average and 2 in high quantities. [68] [72] Genetic testing confirmed 1 of 2 towers with high quantities to have links with the patients. [73] Swedish-Finnish Stora Enso admitted to be responsible. [74]
2019 Ohio, New Jersey and Michigan, United States Multiple locationsNot yet determined Flint MI Water Crisis32618.75%As of June 4, 2019, 32 have fallen sick during the outbreaks across the states of New Jersey and Ohio. Many have fallen sick and died from drinking or being near the contaminated water in Flint, Mi.
2019 Atlanta, United States Sheraton downtown110 Legionnaires' Disease Outbreak May Have Sickened Dozens in Atlanta
2019 Fletcher, North Carolina, United States North Carolina Mountain State Fairhot tub display1414

Four People Have Died From A Legionnaires' Outbreak Linked To A Hot Tub Display At A State Fair Legionnaires' outbreak linked to hot tub display kills third North Carolina fairgoer N.C. Officials Trace 124 Legionnaires' Disease Cases To Hot Tub At A Fair Investigation of an Outbreak of Legionellosis in Western North Carolina

2020s

YearCityVenueSourceCasesDeathsFatality RateNotes
2020 Vernon Hills, Illinois,

United States

Brookdale Senior LivingUnder investigation5120%Outbreak of Legionnaires' disease up to five reported cases at Vernon Hills senior living center. [75]

Number Of Legionnaires Cases Rises To Five At Brookdale Vernon Hills Senior Living Facility. [76]

2020 Vila do Conde, Póvoa do Varzim, Matosinhos, Porto District,

Portugal

Multiple locationsUnder investigation881517%88 cases and 15 deaths (11 of these were also infected with SARS-CoV-2). The source of the bacteria is still unknown. The deadliest Legionella outbreak in Portugal, it was declared extinct on January 13, 2021. [77]
2022 San Miguel de Tucumán, Tucumán Province,

Argentina

Health clinicUnder investigation22627%Cluster of pneumonia cases associated with a health clinic. 22 cases and 6 deaths (all with comorbidities). The source of the bacteria is still unknown. [78]
2023 Rzeszów, Subcarpathian Voivodeship,

Poland

Multiple locationsUnder investigation1644125%Ongoing outbreak. The source of the bacteria is suspected to be contaminated water sources. [79]

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. [80] 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. [81]

The City of Garland, Texas, United States requires yearly testing for legionella bacteria at cooling towers at apartment buildings. [82]

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. [83]

The Texas Department of State Health Services has provided guidelines for hospitals to detect and prevent the spread of nosocomial infection due to legionella. [84] The European Working Group for Legionella Infections (EWGLI) [85] 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 [86] 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):

Aerobic countLegionellaAction required
10,000 or less1,000 or lessSystem under control.
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.
more than 100,000more than 10,000Implement 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 ]

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. [87] Additional studies indicate ionization is superior to thermal eradication. [88]

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. [89] [ citation needed ]

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. [21]

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." [90]

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. [91]

Temperature affects the survival of Legionella as follows: [92]

  • 70 to 80 °C (158 to 176 °F): Disinfection range
  • At 66 °C (151 °F): Legionellae die within 2 minutes
  • At 60 °C (140 °F): They die within 32 minutes
  • At 55 °C (131 °F): They die within 5 to 6 hours
  • Above 50 °C (122 °F): They can survive but do not multiply
  • 35 to 46 °C (95 to 115 °F): Ideal growth range
  • 20 to 50 °C (68 to 122 °F): Growth range
  • Below 20 °C (68 °F): They can survive but are dormant

Removing slime, which can carry legionellae when airborne, may be an effective control process. [93]

See also

Related Research Articles

<span class="mw-page-title-main">Cholera</span> Bacterial infection of the small intestine

Cholera is an infection of the small intestine by some strains of the bacterium Vibrio cholerae. Symptoms may range from none, to mild, to severe. The classic symptom is large amounts of watery diarrhea lasting a few days. Vomiting and muscle cramps may also occur. Diarrhea can be so severe that it leads within hours to severe dehydration and electrolyte imbalance. This may result in sunken eyes, cold skin, decreased skin elasticity, and wrinkling of the hands and feet. Dehydration can cause the skin to turn bluish. Symptoms start two hours to five days after exposure.

Pontiac fever is an acute, nonfatal respiratory disease caused by various species of Gram-negative bacteria in the genus Legionella. It causes a mild upper respiratory infection that resembles acute influenza. Pontiac fever resolves spontaneously and often goes undiagnosed. Both Pontiac fever and the more severe Legionnaire's disease may be caused by the same bacteria, but Pontiac fever does not include pneumonia.

<i>Legionella</i> Pathogenic genus of gram-negative bacteria and the related disease

Legionella is a genus of pathogenic gram-negative bacteria that includes the species L. pneumophila, causing legionellosis including a pneumonia-type illness called Legionnaires' disease and a mild flu-like illness called Pontiac fever.

Atypical pneumonia, also known as walking pneumonia, is any type of pneumonia not caused by one of the pathogens most commonly associated with the disease. Its clinical presentation contrasts to that of "typical" pneumonia. A variety of microorganisms can cause it. When it develops independently from another disease, it is called primary atypical pneumonia (PAP).

<i>Klebsiella pneumoniae</i> Species of bacterium

Klebsiella pneumoniae is a Gram-negative, non-motile, encapsulated, lactose-fermenting, facultative anaerobic, rod-shaped bacterium. It appears as a mucoid lactose fermenter on MacConkey agar.

<span class="mw-page-title-main">Cooling tower</span> Device which rejects waste heat to the atmosphere through the cooling of a water stream

A cooling tower is a device that rejects waste heat to the atmosphere through the cooling of a coolant stream, usually a water stream, to a lower temperature. Cooling towers may either use the evaporation of water to remove heat and cool the working fluid to near the wet-bulb air temperature or, in the case of dry cooling towers, rely solely on air to cool the working fluid to near the dry-bulb air temperature using radiators.

<i>Legionella pneumophila</i> Species of bacterium

Legionella pneumophila is an aerobic, pleomorphic, flagellated, non-spore-forming, Gram-negative bacterium of the genus Legionella. L. pneumophila is the primary human pathogen in the genus Legionella. In nature, L. pneumophila infects soil amoebae of the genus Acanthamoeba and freshwater amoeboflagellates of the genus Naegleria. This pathogen is thus found commonly near freshwater environments and invades the unicellular life found in these environments, using them to carry out metabolic functions.

Legionella longbeachae is one species of the family Legionellaceae. It was first isolated from a patient in Long Beach, California. It is found predominantly in potting soil and compost. Human infection from L. longbeachae is particularly common in Australia, but cases have been documented in other countries including the United States, Japan, Greece and the UK.

<span class="mw-page-title-main">Waterborne disease</span> Diseases caused by pathogenic microorganisms transmitted by waters

Waterborne diseases are conditions caused by pathogenic micro-organisms that are transmitted by water. These diseases can be spread while bathing, washing, drinking water, or by eating food exposed to contaminated water. They are a pressing issue in rural areas amongst developing countries all over the world. While diarrhea and vomiting are the most commonly reported symptoms of waterborne illness, other symptoms can include skin, ear, respiratory, or eye problems. Lack of clean water supply, sanitation and hygiene (WASH) are major causes for the spread of waterborne diseases in a community. Therefore, reliable access to clean drinking water and sanitation is the main method to prevent waterborne diseases.

<span class="mw-page-title-main">Pathogenic bacteria</span> Disease-causing bacteria

Pathogenic bacteria are bacteria that can cause disease. This article focuses on the bacteria that are pathogenic to humans. Most species of bacteria are harmless and are often beneficial but others can cause infectious diseases. The number of these pathogenic species in humans is estimated to be fewer than a hundred. By contrast, several thousand species are part of the gut flora present in the digestive tract.

<span class="mw-page-title-main">Copper-silver ionization</span>

Copper-silver ionization is a disinfection process, primarily used to control Legionella, the bacteria responsible for Legionnaires' disease. There is strong evidence that treating water supplies in hospitals with this technique decreases the risk.

<span class="mw-page-title-main">1976 Philadelphia Legionnaires' disease outbreak</span> First occasion of a cluster of a pneumonia cases later identified as Legionnaires disease

The 1976 Legionnaires' disease outbreak, occurring in the late summer in Philadelphia, Pennsylvania, United States was the first occasion in which a cluster of a particular type of pneumonia cases were determined to be caused by the Legionella pneumophila bacteria. Previous outbreaks were retroactively diagnosed as being most probably caused by Legionella bacteria.

Legionella anisa is a Gram-negative bacterium, one of more than 40 species in the family Legionellaceae. After Legionella pneumophila, this species has been isolated most frequently from water samples. This species is also one of the several pathogenic forms of Legionella having been associated with rare clinical cases of illness including Pontiac fever and Legionnaires' disease.

Legionella cherrii is an aerobic, flagellated, Gram-negative bacterium from the genus Legionella. It was isolated from a heated water sample in Minnesota. L. cherrii is similar to another Legionella species, L. pneumophila, and is believed to cause major respiratory problems.

<span class="mw-page-title-main">Legionnaires' disease</span> Form of atypical pneumonia

Legionnaires' disease is a form of atypical pneumonia caused by any species of Legionella bacteria, quite often Legionella pneumophila. Signs and symptoms include cough, shortness of breath, high fever, muscle pains, and headaches. Nausea, vomiting, and diarrhea may also occur. This often begins 2–10 days after exposure.

<span class="mw-page-title-main">2014 Portugal legionellosis outbreak</span> Disease outbreak in Portugal

The 2014 Portugal legionellosis outbreak was an outbreak of legionellosis in multiple cities of the Lisbon district in Portugal, caused by the release of Legionella bacteria from the cooling towers of a fertilizer plant in Forte da Casa, Vila Franca de Xira. It began on 7 November 2014 and affected mostly people in Póvoa de Santa Iria, Forte da Casa and Vialonga, in the municipality of Vila Franca de Xira. Paulo Macedo, the Portuguese Health Minister, declared the outbreak extinct on 21 November. The outbreak resulted in 375 cases and 12 casualties.

<span class="mw-page-title-main">2015 Bronx Legionnaires' disease outbreaks</span> Disease outbreaks in New York City, United States

In 2015, there were two outbreaks of Legionnaires' disease in the Bronx, New York City, United States. Between January and August 2015, one hundred and thirty people in New York City were infected with Legionnaires', but the majority of them were in the Bronx.

Legionella clemsonensis was isolated in 2006, but was described in 2016 by Clemson University researchers. It is a Gram-negative bacterium.

<span class="mw-page-title-main">2022 Tucumán legionellosis outbreak</span> Disease outbreak in Argentina

The 2022 Tucumán legionellosis outbreak refers to an epidemic that originated in San Miguel de Tucumán, Argentina. It was first identified on Saturday, 20 August 2022, when 7 people arrived at the Tucumán Hospital with fever, malaise, shortness of breath, and headache.

Infectious disease on cruise ships is a hazard associated with cruises. Outbreaks of contagious diseases can spread quickly due to the confined cruise ship environment, reliance on shared spaces, the lack of healthcare facilities, and the large number of passengers and crew members from disparate points of origin.

References

  1. Ryan KJ, Ray CG (editors) (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. ISBN   0-8385-8529-9.{{cite book}}: |author= has generic name (help)[ page needed ]
  2. Swanson M, Heuner K (2008). Legionella: Molecular Microbiology. Caister Academic Pr. ISBN   978-1-904455-26-4.[ page needed ]
  3. Altman LK (August 1, 2006). "In Philadelphia 30 Years Ago, an Eruption of Illness and Fear". The New York Times.
  4. "Legionella Outbreak Toolbox". legionnaires.ecdc.europa.eu. Retrieved 2020-07-01.
  5. B. D. Colen (1977-01-31). "'Legion Fever' Germ Killed 16 Here in 1965". Washington Post . Retrieved 16 December 2021.
  6. "Timeline: legionnaires' disease outbreaks in Britain". The Daily Telegraph . 2012-06-06. Retrieved 31 July 2015.
  7. McDade JE, Brenner DJ, Bozeman FM (April 1979). "Legionnaires' disease bacterium isolated in 1947". Annals of Internal Medicine . 90 (4): 659–61. doi:10.7326/0003-4819-90-4-659. PMID   373548.
  8. Fraser DW, Tsai TR, Orenstein W, Parkin WE, Beecham HJ, Sharrar RG, Harris J, Mallison GF, Martin SM, McDade JE, Shepard CC, Brachman PS (December 1977). "Legionnaires' disease: description of an epidemic of pneumonia". New England Journal of Medicine . 297 (22): 1189–97. doi:10.1056/NEJM197712012972201. PMID   335244.
  9. Tsai TF, Finn DR, Plikaytis BD, McCauley W, Martin SM, Fraser DW (April 1979). "Legionnaires' disease: clinical features of the epidemic in Philadelphia". Annals of Internal Medicine. 90 (4): 509–17. doi:10.7326/0003-4819-90-4-509. PMID   434627.
  10. 1 2 3 4 5 6 7 8 9 10 11 Broadbent C (1996). Guidance for the Control of Legionella. National Environmental Health Forum Monographs. ISBN   978-0-642-25247-0.[ page needed ]
  11. "The Westfriese Flora flower exhibition and fair". Q-net.net.au. Archived from the original on 2009-03-02. Retrieved 2010-09-11.
  12. "25 februari 1999: Legionellabesmetting Westfriese Flora, Bovenkarspel" (in Dutch). Zwaailichten disaster website. 2005. Retrieved December 2, 2011.
  13. Greig JE, Carnie JA, Tallis GF, Ryan NJ, Tan AG, Gordon IR, Zwolak B, Leydon JA, Guest CS, Hart WG (June 2004). "An outbreak of Legionnaires' disease at the Melbourne Aquarium, April 2000: investigation and case-control studies". Medical Journal of Australia . 180 (11): 566–72. doi:10.5694/j.1326-5377.2004.tb06093.x. PMID   15174987. S2CID   15441893.
  14. "Legionella pneumophila cases" (PDF). Docs2.health.vic.gov.au. Archived from the original (PDF) on 2016-02-04. Retrieved 2015-08-30.
  15. "Health (Legionella) Regulations 2001 S.R. No. 13/2001" (PDF). Legislation.vic.gov.au. Retrieved 2017-07-01.
  16. 1 2 Vizela já enfrentou a legionella em Agosto de 2000 com 11 infectados [Vizela already faced legionella in August 2000, with 11 cases] (in Portuguese). Porto Canal. 13 November 2014. Retrieved 5 March 2019.
  17. 1 2 Correia, AM; Gonçalves, G; Reis, J; Cruz, JM; Castro e Freitas, JA (July 2001). "An outbreak of legionnaires disease in a municipality in northern Portugal". Euro Surveill. 6 (7): 121–4. doi: 10.2807/esm.06.07.00228-en . PMID   12631957.
  18. 1 2 García-Fulgueiras A, Navarro C, Fenoll D, García J, González-Diego P, Jiménez-Buñuales T, Rodriguez M, Lopez R, Pacheco F, Ruiz J, Segovia M, Balandrón B, Pelaz C (August 2003). "Legionnaires' disease outbreak in Murcia, Spain". Emerging Infectious Diseases. 9 (8): 915–21. doi:10.3201/eid0908.030337. PMC   3020623 . PMID   12967487.
  19. "legionnaires disease, Barrow-in-Furness". Archived from the original on 2002-08-16. Retrieved 2013-08-30.
  20. 1 2 3 "The 12 Worst Legionnaires Outbreaks in the World". Healthcare Business & Technology. May 11, 2012. Retrieved 3 June 2019.
  21. 1 2 Nguyen TM, Ilef D, Jarraud S, Rouil L, Campese C, Che D, Haeghebaert S, Ganiayre F, Marcel F, Etienne J, Desenclos JC (January 2006). "A community-wide outbreak of legionnaires disease linked to industrial cooling towers--how far can contaminated aerosols spread?". The Journal of Infectious Diseases. 193 (1): 102–11. doi: 10.1086/498575 . PMID   16323138.
  22. "Toronto legionnaires' outbreak linked to 3 more deaths". CBC News. October 21, 2005.
  23. Simonsen Ø, Wedege E, Kanestrøm A, Bolstad K, Aaberge IS, Ragnhildstveit E, Ringstad J (March 2015). "Characterization of the extent of a large outbreak of Legionnaires' disease by serological assays". BMC Infectious Diseases. 15: 163. doi: 10.1186/s12879-015-0903-2 . PMC   4383209 . PMID   25887275.
  24. www.ideo.pl, Ideo Sp. z o.o. -. "Legionellosis case in Jastrzębie-Zdrój will be included in subject literature | News | Science & Scholarship in Poland". scienceinpoland.pap.pl. Archived from the original on 2017-08-02. Retrieved 2017-08-02.
  25. "Wyborcza.pl". wyborcza.pl. Retrieved 2017-08-02.
  26. "Second patient with Legionnaires' disease dies at New Brunswick hospital". The Star-Ledger . September 24, 2008. Retrieved 2011-10-08.
  27. "South Wales legionnaires' disease outbreak declared over". NHS Wales. 12 October 2010. Retrieved 6 June 2012.
  28. "DRSP - Direction régionale de santé publique de la Capitale-Nationale" (in French). September 12, 2012. Archived from the original on 2012-10-17. Retrieved 2013-08-30.
  29. Govan F (7 February 2012). "Legionnaires' disease that killed three Britons at Spanish hotel was detected a month before action taken". The Daily Telegraph. Retrieved 2017-01-18.
  30. "Legionnaires' Disease outbreak: Third death reported". bbc.co.uk. 3 July 2012. Retrieved 3 July 2012.
  31. "3 dead in Legionnaires' outbreak tied to downtown hotel". Chicago Tribune . August 27, 2012. Retrieved 2012-08-27.
  32. "Legionnaires' cases rise to 11". [The Press]. April 6, 2012. Retrieved 2012-06-04.
  33. "Stoke-on-Trent Legionnaires' source 'could be hot tub'". [The Press]. July 31, 2012. Retrieved 2012-08-02.
  34. Pittsburgh Veteran's Administration Hospital water contamination investigation ongoing
  35. Noah Brode (23 April 2013). "Investigation Reveals Failures of Pittsburgh VA Hospital in Legionnaires' Outbreak". wesa.fm.
  36. "Families of Legionnaires' victims outraged by report on VA outbreak". Pittsburgh Post-Gazette .
  37. "Joint Communication — Preliminary report of Legionnaries' disease 07 to 21 November 2014". Direção-Geral da Saúde . 21 November 2014. Retrieved 5 March 2019.
  38. "Extinto o surto de legionella". rr.sapo.pt (in Portuguese). November 21, 2014. Retrieved November 23, 2014.
  39. "Co-op City towers contaminated with Legionnaires' Disease". New York Daily News . 2015-01-13. Retrieved 2015-08-29.
  40. "Legionnaires' Disease Bacteria Found in A/C on Bronx Hospital, Mayor says". DNAinfo New York. Archived from the original on 2015-08-01.
  41. David Shortell (2 August 2015). "There have been 65 cases since mid-July". CNN News .
  42. "City confirms 71 cases of Legionnaire's Disease". capitalnewyork.com.
  43. Hu, Winnie; Remnick, Noah (10 August 2015). "Hotel that enlivened the Bronx is now a 'hot spot' for Legionnaire's". The New York Times .
  44. "Health Department Investigating Cluster of Legionnaires' Disease in Morris Park Section of the Bronx" (Press release). City of New York. September 28, 2015. Archived from the original on September 30, 2015. Retrieved September 30, 2015.
  45. "Legionnaires' Disease". Department of Health and Mental Hygiene. City of New York. Archived from the original on October 7, 2015. Retrieved October 6, 2015.
  46. Campanile C (September 30, 2015). "Latest Bronx Legionnaires' disease outbreak turns fatal". New York Post . Retrieved September 30, 2015.
  47. "Illinois is spending $2.3M to fix a Legionnaires disease outbreak in Quincy". Journal Star. Peoria, IL. 2015-09-10. Retrieved 2017-07-01.
  48. "Death toll stands at 13 after Quincy Legionnaires' outbreak". Abc7chicago.com. 2015-09-17. Retrieved 2017-07-01.
  49. "Fourth case of Legionnaires' disease confirmed at Quincy veterans home in one week". WQAD.com. 2018-02-21. Retrieved 2018-07-24.
  50. https://www.pbs.org/wgbh/frontline/article/flint-water-crisis-legionnaires-disease-deaths (April 25, 2019). Retrieved October 28, 2019.
  51. John Wisely & Jennifer Dixon, Fieger files $100-million suit over Flint Legionnaires' disease cases, Detroit Free Press (February 2, 2016).
  52. "Town Hall area cooling tower suspected after four men contract Legionnaires disease". The Sydney Morning Herald. 2016-03-09. Retrieved 2016-03-10.
  53. Thiede, Data (2016-10-12). "Source of Legionnaires' outbreak in Hopkins ID'd". Kare 11. Retrieved 2023-05-24.
  54. 1 2 Nir SM (2017-06-16). "Legionnaires' Outbreak on Upper East Side Kills One and Sickens Six". The New York Times. ISSN   0362-4331 . Retrieved 2017-06-17.
  55. Austin, CBS. "Sixth case of Legionnaires' disease confirmed at Round Rock hotel". KEYE. Retrieved 2017-10-10.
  56. Osborn C (2017-10-10). "Sixth case of Legionnaires' disease confirmed from Round Rock hotel". Austin American-Statesman. Archived from the original on 2017-10-11. Retrieved 2017-10-10.
  57. Perez M (November 11, 2017). "Disneyland shuts down two cooling towers after Legionnaires' disease outbreak". Newsweek. Retrieved November 11, 2017.
  58. "Surto de legionella com origem pelo menos numa das torres de arrefecimento do São Francisco Xavier" [Legionella outbreak with origin in at least one of the cooling towers of São Francisco Xavier]. Jornal de Negócios (in Portuguese). November 16, 2017. Retrieved November 24, 2017.
  59. "Comunicado — 03/12/2017" [Communiqué — 3 December 2017]. Direção-Geral da Saúde (in Portuguese). 3 December 2017. Retrieved 5 March 2019.
  60. Campos, Alexandra (17 November 2017). "Torre de arrefecimento do S. Francisco Xavier tinha estirpe fatal de Legionella" [Cooling tower in S. Francisco Xavier Hospital had the fatal strain of Legionella] (in Portuguese). Público. Retrieved 5 March 2019.
  61. David Cardoso, Margarida (29 November 2017). "Torre de refrigeração na origem do surto tinha manutenção deficiente, diz DGS" [Cooling tower at the origin of the outbreak had poor maintenance, says Directorate General for Health] (in Portuguese). Público. Retrieved 5 March 2019.
  62. 1 2 "pr065-18". www1.nyc.gov. Archived from the original on 2018-09-06. Retrieved 2018-09-06.
  63. 1 2 "NYC Health Officials ID Source Of Legionnaires' Outbreak In Upper Manhattan". 2018-08-15. Retrieved 2018-09-06.
  64. Levine, Alexandra S. (17 July 2018). "New York Today: A Legionnaires' Disease Outbreak". The New York Times. Retrieved 2018-07-18.
  65. 1 2 3 "NYC Legionnaires cluster up to 18 cases, 1 death reported". ABC7 New York. 2018-07-17. Retrieved 2018-07-18.
  66. "Notice to Residents of Lower Washington Heights" (PDF). NYC Department of Heath. NYC Department of Health. 24 June 2018. Retrieved 24 July 2018.
  67. "Health officials probe case of deadly Legionnaires' Disease at one of London's most famous apartment blocks". Evening Standard . 21 March 2019. Retrieved 18 June 2019.
  68. 1 2 3 "5 positieve stalen met legionella in Evergem". Het Nieuwsblad (in Flemish). 20 May 2019. Retrieved 2019-05-20.
  69. "karton- en papierfabrikant Stora Enso".
  70. lla, SVG (29 May 2019). "Overeenkomst gevonden tussen vijf legionellapatiënten en koeltoren, mogelijk raakten nog meer mensen besmet". Het Nieuwsblad Mobile (in Flemish). Retrieved 2019-05-29.
  71. Maes, Thierry Goeman en Cédric (14 May 2019). "50-jarige man eerste dodelijk slachtoffer legionella-uitbraak: "Op het laatste had hij 2 procent longcapaciteit"". Het Nieuwsblad Mobile (in Flemish). Retrieved 2019-05-14.
  72. "Legionella gevonden in stalen Gentse haven".
  73. lla, SVG (29 May 2019). "Overeenkomst gevonden tussen vijf legionellapatiënten en koeltoren, mogelijk raakten nog meer mensen besmet". Het Nieuwsblad Mobile (in Flemish). Retrieved 2019-05-29.
  74. tg (4 June 2019). "Papierfabrikant veroorzaakte legionella in Gents havengebied". Het Nieuwsblad (in Flemish). Retrieved 2019-06-14.
  75. Norman, James T. (17 February 2020). "Outbreak of Legionnaires' disease up to five reported cases at Vernon Hills senior living center". Chicago Tribune. Retrieved 2020-07-06.
  76. "Number Of Legionnaires Cases Rises To Five At Brookdale Vernon Hills Senior Living Facility". 2020-02-20. Retrieved 2020-07-06.
  77. "Surto de Legionnella no Grande Porto dado como extinto com 88 casos e 15 mortos". Observador. 2021-01-13.
  78. "Legionella identified as cause of cluster of pneumonia cases in Tucuman, Argentina". PAHO. 2022-09-05.
  79. "Bakteria Legionella pneumophila w Rzeszowie. Nie żyją trzy zakażone osoby". PAP. 2023-08-23. Retrieved 2023-08-23.
  80. Archived 2012-10-20 at the Wayback Machine
  81. Makin T (November 2014). "Preheated Domestic Hot Water: Storage of Preheated Domestic Hot Water and Possible Growth of Legionella Bacteria". The Water Regulations Advisory Scheme. Archived from the original (PDF) on 2017-01-08. Retrieved 2017-07-01.
  82. "The Dallas Morning News, Garland tough on bacteria". Dallasnews.com. 2007-02-01. Archived from the original on 2010-04-24. Retrieved 2010-09-11.
  83. "299601 Legionella" (PDF). Archived from the original (PDF) on 2011-06-06. Retrieved 2010-09-11.
  84. Report of the Texas Legionnaires' Disease Task Force, Texas Department of State Health Services[ full citation needed ]
  85. "European Working Group for Legionella Infections". Ewgli.org. Archived from the original on 2012-12-25. Retrieved 2010-09-11.
  86. "European Guidelines for Control and Prevention of Travel Associated Legionnaires' Disease". Archived from the original on 2011-07-06. Retrieved 2017-07-01.
  87. Stout JE, Yu VL (August 2003). "Hospital-acquired Legionnaires' disease: new developments". Current Opinion in Infectious Diseases. 16 (4): 337–41. doi:10.1097/00001432-200308000-00005. PMID   12861086. S2CID   37897523.
  88. Lin YS, Stout JE, Yu VL (2001). "Control of Legionella". In Block SS (ed.). Disinfection, Sterilization, and Preservation. Lippincott Williams & Wilkins. pp. 505–12. ISBN   978-0-683-30740-5.
  89. Lin YE, Stout JE, Yu VL (February 2011). "Controlling Legionella in hospital drinking water: an evidence-based review of disinfection methods". Infection Control and Hospital Epidemiology. 32 (2): 166–73. doi:10.1086/657934. PMID   21460472. S2CID   8790329.
  90. 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 (January 2008). "An outbreak of legionnaires disease caused by long-distance spread from an industrial air scrubber in Sarpsborg, Norway". Clinical Infectious Diseases. 46 (1): 61–9. doi: 10.1086/524016 . PMID   18171215.
  91. Wilkinson E (2010-06-13). "Windscreen water infection risk". BBC News. Retrieved 2010-09-11.
  92. "Legionella: What is Legionnaires' Disease?". Reliance Worldwide. Archived from the original on October 9, 2007.[ unreliable medical source? ]
  93. Potera C (December 1998). "Studying slime". Environmental Health Perspectives. 106 (12): A604-6. doi:10.1289/ehp.98106a604. PMC   1533243 . PMID   9831548.