Legionella E-news -- 9 November 2006

Legionella E-news, 9 November 2006
HC Information Resources Inc.
Matthew R. Freije, Editor

**IN THIS ISSUE**
1. Recent Outbreaks
2. Spike in LD Cases due to Extreme Weather?
3. Insurance Policies may Exclude Legionnaires' Disease
4. Disinfection Byproducts and Fetal Survival
5. Legionella Management Plans

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1. RECENT OUTBREAKS
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So many reported outbreaks have occurred since the last issue of Legionella Enews, that we will give only a brief synopsis of each:

Rheinfelden, Switzerland: In July thirty persons living in three multifamily residences contracted Pontiac fever, a flu-like illness caused by Legionella bacteria. The hot water system was the suspected source of contamination.

England, whirlpool spa at a leisure club: Two confirmed cases of Legionnaires' disease, three confirmed cases of Pontiac fever, and 113 probable cases of Pontiac fever occurred in August. There were no reports of illness among club members who did not use, or were not close to, the whirlpool spa. Legionella pneumophila serogroup 1 was found in water samples taken from the spa pool, the return flow from the massage jets, and a short supply line. No Legionella was found in samples from the swimming pool or showers.

Upstate New York nursing home: In August, Legionnaires' disease was confirmed in six residents, all of whom were hospitalized and recovered. More information at http://www.thedailystar.com/news/stories/2006/09/02/disease2.html.

Venice: Fifteen confirmed cases of Legionnaires’ disease were associated with the city centre of Venice from late July through August. No deaths have occurred.

Pennsylvania Senior Citizen Center: Three cases of Legionnaires' disease were reported between April and September. All three were 85 years old and recovered after hospitalization.

France: Twelve cases of legionellosis were identified in the small town of Lorquin in northeast France in September. None of the patients have died. The 11 patients who responded to a questionnaire reported visiting or working at a craft fair that was held in the town on 9-10 September. Although the source of the outbreak was not proven by environmental tests, investigators believe that a whirlpool spa displayed at the event was responsible. Source: Eurosurveillance Weekly, 12 October 2006

Allegheny County, Pennsylvania: Two cases of Legionnaires disease were identified in residents of an apartment building for the elderly. The first case was reported in April and the second in September.

Paris: Local health authorities identified 26 cases of Legionnaires’ disease that occurred in southeast Paris from late July through August. The cases ranged in age from 21 to 86 years; 85 percent were men. Two have died. All patients had stayed in or visited an area near the Gare d'Austerlitz railway station. The Legionella strain isolated from six patients matched the strain found in cooling towers at one of four sites in the area. Those cooling towers were shut down on 7 September. All cooling towers in the area were disinfected. Source: Eurosurveillance Weekly, September 2006

West Haven, Connecticut: Two cases of Legionnaires disease were reported in October. Both men were admitted into the same hospital on the same day. One of them died.

Malaysia: Three confirmed cases of Legionnaires' disease occurred in October among a group of veterans and their spouses who were visiting camps where they served in the 1950s. Two of the cases are wives who accompanied their husbands on the trip; the other is a veteran. Source: BBC

UK: On 2 November the Bexley Times reported that two staff members and a patient at a hospital in Sidcup had contracted Legionnaires' disease. One of the staff members was still in intensive care at a London hospital at the time of the news report. A hospital spokesperson said that the other staff member was making a good recovery and the patient had been discharged from the hospital. Legionella was found in several locations in the hospital.

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2. SPIKE IN LD CASES DUE TO EXTREME WEATHER?
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Extremely hot summer weather is suspected as the cause of record numbers of Legionnaires' cases in August and September in the United Kingdom and the Netherlands. See http://www.eurosurveillance.org/ew/2006/061018.asp#1.

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3. INSURANCE POLICIES MAY EXCLUDE LEGIONNAIRES' DISEASE
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Hospitals, hotels, and other building owners may soon have to pay Legionnaires'-related legal claims themselves rather than relying on their insurance companies. On November 7th, the Insurance Journal reported that the American Association of Insurance Services (AAIS), a national advisory organization that develops policy forms and rating information used by more than 600 property and casualty companies throughout the United States, is filing a new "virus or bacteria" exclusion designed to exclude losses that arise from organisms that can cause disease.

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4. DISINFECTION BYPRODUCTS AND FETAL SURVIVAL
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Researchers at the University of North Carolina School of Public Health found that drinking water disinfection byproducts (DBPs), in the range common in the United States, do not affect fetal survival. The researchers looked at three locations with varying DBP levels and evaluated 2,409 women in early pregnancy. DBP concentrations and water use (ingestion and bathing/showering) were considered. Based on 258 pregnancy losses, the finding did not show an increased risk of pregnancy loss in relation to ingested amounts of DBPs. The news story, posted at http://www.eurekalert.org/pub_releases/2006-09/tmsh-msr090606.php, did not disclose the organization that funded the study. The paper published in the November issue of the American Journal of Epidemiology can be accessed at http://aje.oxfordjournals.org/.

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5. LEGIONELLA MANAGEMENT PLANS
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For hospitals: http://hcinfo.com/318info.htm

For nursing Homes and Senior Living Facilities: http://hcinfo.com/319info.htm

For hotels: http://hcinfo.com/320info.htm

The management plans read like an in-house policy manual. Each is available in print (softcover) or on a CD for US$149 plus shipping, or can be downloaded at www.hcinfo.com for $119.

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HC Information Resources Inc. provides consulting services (facility assessments, domestic water disinfection recommendations, management plans, litigation support), seminars, publications, research, and training pertaining to Legionella and other waterborne pathogens.