Legionnaires' Disease Outbreaks 1999-2001

As of 4 September 2001, 17 confirmed cases and 2 probable cases of Legionnaires’ disease had been identified in an outbreak on the west coast of Norway, in the city of Stavanger. 2 of the 19 have died. The cases occurred in persons ranging from 30 to 94 years of age -- 16 men and 3 women. All the patients had visited a limited area of Stavanger within 10 days of onset of symptoms, which were noticed 26 July in the first patient and 1 September in the latest patient. The investigation has focused on an outdoor decorative fountain and several cooling towers, but a source has not been implicated. Molecular subtyping is underway to compare environmental and clinical isolates. The fountain was shut down and the cooling towers have been disinfected. Source Eurosurveillance Weekly, 6 September  2001, as reported by Preben Aavitsland and Hans Blystad  of the National Institute of Public Health, Oslo, Norway; and Jens Holm of the Medical Health Office, Stavanger, Norway.  Top

Hospital Hot Water Blamed for 18 Cases, 3 Deaths, August 2001
The hot water system at a hospital in Pamplona, Spain is believed to be the source of 18 cases of Legionnaires’ disease that occurred between 29 July and 18 August 2001. Three of the cases were fatal. The cases were confirmed by urinary antigen tests. The victims ranged in age from 39 to 96 years. 16 of the 18 cases occurred in patients who developed pneumonia in the hospital; the other two were in persons who accompanied patients to the hospital. Legionellae were found in the hot water distribution system. Clinical isolates and positive environmental samples have been sent to the national reference laboratory, presumably for subtyping to determine if the Legionella strains found in the hot water system match those detected in patients. Hyperchlorination was carried out during the night of 17 August 2001. Source: Eurosurveillance Weekly, 23 August  2001. Reported by Aurelio Barricarte and Mikel Urtiaga, Regional Health Council of Navarra, Spain, and Salvador de Mateo, National Centre of Epidemiology, Madrid, Spain.  Top

Record-setting outbreak hits Spain, July 2001
The city of Murcia, located about 250 miles southeast of Madrid, has been hit with the most extensive outbreak of Legionnaires' disease ever recorded. The cases occurred between 26 June and 16 July, 2001. As of 18 July, 745 cases of pneumonia had been diagnosed, of which 315 have been confirmed as Legionnaires' disease by urinary antigen tests. One-third of the cases were less than 50 years of age. Twelve were admitted to intensive care. Two have died, one 65 and the other 61 years of age. Health authorities speculate that the low death rate is due in part to the quick diagnosis and treatment of the patients. On 7 July 2001, doctors at hospitals in Murcia noticed an unusually large number of patients with pneumonia, so they alerted health officials and started testing for Legionnaires'. The health department determined that 80 percent of the cases came from the same section of town. The area's water supply and cooling towers were shut off and checked for Legionella. Legionellae were found in 14 cooling towers at 6 buildings. Several towers were positive by PCR, but Legionella pneumophila serogroup 1 has yet to be isolated. Potential sources of contamination were disinfected. Source: News media.

26 October 2001 Update: The source of the biggest Legionnaires’ outbreak to date is still unknown. Legionella strains found in cooling tower samples did not match the ones found in patients. According to Francisco Marques, head of the local health unit, 800 cases of pneumonia have been reported, of which 420 have been confirmed as Legionnaires’ disease. 4 people have died. A report based on data from the Centro Nacional de Epidemiologia Instituto Carlos III, Madrid, estimates that the final number of confirmed cases could reach 650. 

26 August 2003: A complete report of this outbreak is posted at http://www.cdc.gov/ncidod/EID/vol9no8/03-0337.htm. 

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Hospital, Paris, 12 cases, 6 deaths, July 2001
It was thought that the Pompidou hospital (Paris) was legionellae-safe after changes to the hot water system were completed in March 2001. Corrective measures had been implemented because of an outbreak of Legionnaires’ disease at the hospital that involved 9 cases and 3 deaths between November 2000 and January 2001. But three additional cases occurred between 29 June 2001 and 9 July 2001, two of which resulted in death, bringing the total to 12 cases, including 6 deaths. Additional measures will be put in place to control legionellae. Source: Financial Times Information, Dow Jones.  Top

Three Cases in Las Vegas, Feb.-June, 2001
The Clark County Health Department reported that three people staying at a Las Vegas timeshare resort contracted Legionnaires’ disease in recent months. The first was in February; the most recent was in June. All three were hospitalized and have since recovered. Only one patient's specimen was saved and tested. Health officials reported that legionellae were found in a water heater and a rooftop spa, and that the Legionella strain in the environmental samples matched the strain found in the patient who was tested. The property owner voluntarily shut down the floors served by the water heater in which the bacteria were found and relocated about 300 guests. According to health officials, evidence is insufficient to conclude for certain that the three people were exposed to legionellae while staying at the resort. Source: Associated Press  Top

London, 3 cases, May-June 2001
Three confirmed cases of Legionnaires’ disease were associated with central London between 22 May and 3 June, 2001.  All three were men, ranging from 31 to 61 years of age. Two of the men worked in the Portman Square area of London. The third man had been visiting the Portman Square area prior to the onset of illness. The cases were diagnosed by urinary antigen detection. L. pneumophila serogroup 1 was identified in water systems and cooling towers in three buildings in the vicinity.  Control measures have been taken at all three sites and further investigation is under way.  Source: Eurosurveillance Weekly Issue 26; 28 Jun 2001.  Top

Legionnaires' hits Ford a second time, April 2001
Two Ford Motor Company workers became ill shortly after repairing a ruptured pipe on 4 April. The pipe carried pond water to the Dynamometer Building in Ford's Research and Engineering complex in Dearborn, Michigan. Legionnaires' disease was confirmed in one of the men; the other showed elevated antibodies to Legionella bacteria. Both have returned to work. Source: The Detroit News. Top

7 cases, 2 deaths, Melbourne hospital, March-June 2001
Seven cases of Legionnaires' disease have been associated with a Melbourne (Australia) hospital -- four patients, one construction worker at an adjacent site, and two hospital employees. Three of the cases occurred in late March or early April, one in May, and three in early June. Two men who were outpatients have died. One of the hospital employees remains in serious condition but is improving. The hospital CEO said 14 cooling towers at the hospital and surrounding buildings had been tested for Legionella but the bacterium was not detected, which is the reason the hospital waited two months to announce the outbreak. Health authorities have not identified the source. Source: Australian Broadcasting Corporation and news.com.au. Top

Ford Motor Plant, Ohio USA, 4 cases, 2 deaths, March 2001
Two workers at the Ford Motor plant in Brook Park, Ohio, have died of Legionnaires' disease, one on 9 March and the other on 16 March. Both were men, ages 53 and 61. Two additional cases were confirmed. The 2,500-employee casting plant was shut down from Wednesday 14 March through Monday 19 March while the (US) CDC conducted an investigation and disinfected mechanical systems. The source of contamination was not pinpointed. Brook Park is located southwest of Cleveland. Ford shut down two sections of another plant on Saturday 24 March after finding Legionella bacteria in water systems. No cases of Legionnaires' disease were reported at that plant. Source: news media  Top

New hospital in Paris, 4 cases, Dec. 2000
Four individuals contracted Legionnaires’ disease in December 2000 at a hospital in Paris. One of the patients has died, but his death was related to a heart condition, according to the hospital director. The ultramodern 750-bed hospital opened in July. Because the hospital was only partially occupied, officials suspect that stagnant water in unused portions of the plumbing system was the source of contamination. Source: Associated Press, 30 December 2000. Top

Melbourne, 1 nosocomial case, 3 others, Dec. 2000
A patient who died from Legionnaires’ disease at a hospital in Melbourne on 12 December 2000 had been there for more than two weeks, indicating that the illness was acquired at the hospital (nosocomial). Graham Brown, the head of the Victorian Infectious Diseases Service, located at the hospital, said the patient who died would most likely have been infected by legionellae sprayed from the cooling towers when he went out on a balcony or outside the hospital. However, legionellae were found in only 2 of the hospital's 12 cooling towers, and at low levels. Three other patients were confirmed as having legionellosis. Two of them were admitted with flu-like symptoms, suggesting that their cases were not nosocomial. Source: www.theage.com.au. Top

Another community outbreak in Spain--40 cases--Nov. 2000
40 cases of Legionnaires’ disease were identified in Barcelona from 14-16 November. The victims range in age from 38 to 92. As of Friday, 17 November, four patients were in serious condition. All the victims live in Barceloneta, a neighborhood on Barcelona's Mediterranean waterfront. City health officials are investigating. Source: The Associated Press. Top

Rennes, France, 19 cases, 5 deaths, Fall 2000
Between the end of July and 15 Nov 2000, 19 cases of Legionnaires' disease were reported in Rennes, France, five of whom have died. The French National Reference Centre has reported that the same strain of Legionella pneumophila serogroup 1 was found in seven of the patients. The source of infection is unknown. An investigation is in process. Source: Eurosurveillance Weekly, 20 Dec 2000. Top

Spain, 70 cases, Sept.- Oct. 2000
Another major outbreak has occurred in Spain, this one in the Valencia region. 70 cases were reported -- 43 men and 27 women ranging from 20 to 95 years of age -- from 16 September to 8 October 2000. Two patients have died. The investigation has revealed an association with visiting or living in a certain area of the city, but the source of contamination has not been identified. All the cooling towers in the suspected area were disinfected. Intensified surveillance is continuing. Source: Eurosurveillance Weekly, 7 Dec 2000. Top

Community Outbreak in Spain -- 28 cases, 3 deaths -- Sept.-Oct. 2000 
28 cases of Legionnaires’ disease were identified in Galicia, Spain between 18 September and 1 October 2000--21 men and 7 women, ranging from 30 to 79 years of age. Three have died. An epidemiologic study confirmed that living, working, or walking in the area near a particular hospital was associated with illness. Investigators are focusing on the hospital cooling towers, but no source has been implicated. Source: Eurosurveillance Weekly, 26 October 2000. Reported by Xurxo Hervada, Servicio de Información de Saúde Pública, Dirección Xeral de Saúde Pública, Galicia. Spain, and Rosa Cano, National Center of Epidemiology. Madrid. Spain.  Top

Washington DC schools, two cases, Aug-Oct 2000
On 6 October 2000, DC health officials reported that a case of Legionnaires' disease contracted by a teacher at Benning Elementary was the second case of the disease involving city school workers recently. The first case occurred in August 2000 in a custodian who worked at Eastern Senior High School. The case at Benning involved a woman of only 24 years of age. She was still recovering in the hospital as of 6 October. Health authorities are investigating the buildings. Source: The Washington Post, 7 October 2000.  Top

Two community cases, Virginia, Sept. 2000
Two cases of Legionnaire's disease were reported in Covington, Virginia over a two week period. The two individuals live six blocks apart. As of 15 September, both patients were still on lung ventilators. Health Department officials are trying to determine the source of infection. Richmond Times Dispatch, 15 September 2000.  Top

Hospital, UK, 2 cases, July 2000
At least two patients at Leeds hospital have contracted Legionnaires' Disease and several others are showing symptoms of the illness. A hospital spokesperson said the patients were infected when they stayed in a ward in the Jubilee Building at Leeds General Infirmary in June. He added that a potential source has been identified. An investigation is under way. Source: BBC News Online, 14 July 2000.  Top

Spa bath, Australia, 3 cases, June 2000
A 32-year-old woman who works as a student masseur at the Collingwood Football Club is in critical condition after contracting Legionnaire's disease. The disease was also confirmed in two men, ages 47 and 48, who were at the club on 3 and 4 June; both have recovered. Environmental tests have indicated the club's spa bath as the source of the infection. Source: news media.  Top

Public bath, Japan, 14 cases, 1 death, June 2000
14 individuals ranging in age from 58 to 85 contracted an illness with symptoms similar to Legionnaires disease. A 73-year-old man has died and three others are in serious condition. All 14 victims had used the same public bath between early May and 24 June, when it was closed because of the outbreak. Health officials are investigating the Ibaraki bath house for legionellae. Ibaraki is located 63 miles northeast of Tokyo. Source: Associated Press, via Miami Herald   Top

2 cases in same apartment building, Denmark, Spring 2000
Two individuals who lived in the same block of flats and shared the same hot water system contracted Legionnaires’ disease; the two cases were reported to Copenhagen health officials in the spring of 2000. Legionellae were found in each of the two flats and also in the water circulating line for the entire building. Three serogroups of Legionella pneumophila were found in the water. The serogroup found in one of the patients matched one of the serogroups found in the circulating water. The serogroup found in the other patient matched the serogroup found in both of the flats and in the circulating water. Subtyping indicated identical matches. Water temperatures were increased to 60 C (140 F). One month later, legionellae were still found in water samples, but at lower levels. The water system was then disinfected with chlorine. More samples will be collected in the fall. Source: Eurosurveillance Weekly, 5 October 2000 and Epi-News 2000.  Top