Legionellosis historical perspective
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ogechukwu Hannah Nnabude, MD Tarek Nafee, M.D. [2]
Overview
Legionnaires' disease acquired its name in 1976 when an outbreak of pneumonia occurred among people attending a convention of the American Legion in Philadelphia. On January 18, 1977 the causative agent was identified as a previously unknown bacterium, subsequently named Legionella. Outbreaks of Legionellosis are listed below in chronological order.
Historical Perspective
Philadelphia, 1976
The first recognized legionella outbreak occurred in 1976 during a meeting of the American Legion in Philadelphia, Pennsylvania. About 29 of the 182 people that contracted the infection died [1]. It was after the bacterium had been successfully isolated that previous cases of Legionella were identified.
United Kingdom, 1985
In 1985, Stafford District General Hospital experienced a Legionella outbreak. A total of 68 confirmed cases were treated in hospital and 22 of these patients died. A further 35 patients were suspected cases of Legionnaires' disease, 14 of whom only required treatment at home. Legionella was found in the water within the cooling tower and a chiller unit which cooled the air entering the outpatient department. The chiller unit is believed to be the major source of the outbreak [2].
Netherlands, 1999
During a flower exhibition in Bovenkarspel, Netherlands, an outbreak of Legionella occurred. It is believed to have been caused by a contamination of the whirlpools in halls 3 and 4, and the sprinkler in hall 8, all of which tested culture positive for Legionella. There were 133 confirmed cases and 55 possible cases out of the 77061 visitors to the exhibition [3].
Spain, 2001
In Murcia, Spain, over 800 suspected cases of Legionnaires' disease were recorded. Of these cases, 449 were confirmed to be caused by Legionella. This is currently the largest outbreak of Legionella ever recorded. About 1% of affected patients died from the disease [4].
Norway, 2001
The first recognized outbreak of Legionella in Norway was in 2001 when 28 people were infected in the city of Stavanger, and seven died. Of the 28 patients, 21 were within the city of Stavanger, five were in other areas in Norway, and two were other countries, with one being in England and the other in Germany. This was initially a mystery to the investigators. However, it was discovered that a cooling unit from a nearby hotel was the source of the infection. The air outlet was found to be just over 16 feet above the ground and located close to a bus station. This was determined source of contact for the patient in Germany and the patient in England [5]
United Kingdom, 2002
In 2002, six women and one man in Barrow-In-Furness died as a result of the illness, another 172 people also contracted the disease. The outbreak was traced to a contaminated cooling tower at the town’s Forum 28 arts center.
France, 2004
Researchers found that the Legionnaires' disease bacteria spread through the air up to 6 kilometers from a large contaminated cooling tower at a petrochemical plant in Pas-de-Calais in northern France. That outbreak killed 21 of the 86 people with laboratory-confirmed infection.
Norway, 2005
In May 2005 there was a second—greater—outbreak in Norway, this time originating in the southeastern town of Fredrikstad. As of 8 June 2005, 52 patients were confirmed infected and ten people were dead. The dead were all from Fredrikstad or nearby cities, in age ranging from 68 to early 90's. The source of the outbreak unexpectedly came from an air scrubber (an industrial air purification facility; this particular one operated by Borregaard Industries in Sarpsborg). Such an installation has never before been reported as a source of Legionellosis anywhere in the world. Although the source was finally identified by DNA matching, it was also fairly well identified by analysing risk increases from people living near suspected sources.
New Zealand, 2005
An outbreak of Legionnaire's disease hit the New Zealand city of Christchurch in mid-2005, with 20 reported cases (three fatal) between late April and August. A cooling tower at the city's Ravensdown Fertiliser Plant was implicated in the outbreak. The outbreak led to plans by the city council to create a registry of all air-conditioning cooling towers within the city.
Toronto, 2005
In October 2005 at least 21 people died and over 100 fell ill during an outbreak at the Seven Oaks Home for the Aged in Toronto, Ontario, Canada. Legionnaire’s disease was originally ruled out as being the cause, but post-mortem examinations confirmed that victims had Legionella bacteria in their lungs. The outbreak is still being investigated, and researchers believe this particular outbreak may be related to a new strain of the bacteria.
Australia, 2007
The outbreak is believed to have started during New Year's Eve celebrations at Circular Quay, on Sydney's harbour. Thought to have started from a cooling tower (where 1,400 cfu/ml Legionella was found) from an adjacent office building, four cases were initially confirmed, but there were concerns due to the fact that Circular Quay is one of the most populated areas in Sydney on New Year's Eve. As a result, there could have been potentially many more cases. On Saturday, January 20 the NSW Health Authority reported that three more cases had developed overnight, bringing the total reported cases to 7.
New York, 2007
An outbreak of Legionnaires' disease occurred in Long Island, New York. It was believed to have started on September 27, 2007. It occurred in 2 separate nursing homes.
Michigan, 2014 - 2016
An outbreak of Legionnaires' disease was reported in Flint, Michigan. The outbreak infected more than 87 individuals. Following investigations, it is thought that the outbreak may be associated with elevated lead concentrations in the watery supply.
Las Vegas 2017
In June 2017, 2 people became ill after staying at a hotel in Las Vegas. This outbreak may be associated with contaminated air ducts in hotels. The patients have developed pneumonia and no deaths have been reported.
Sources
- CDC Legionellosis [3]
References
- ↑ Fraser DW, Tsai TR, Orenstein W, et al. Legionnaires’ disease: description of an epidemic of pneumonia. N Engl J Med 1977; 297: 1189–97.
- ↑ O'Mahony MC, Stanwell-Smith RE, Tillett HE, Harper D, Hutchison JG, Farrell ID; et al. (1990). "The Stafford outbreak of Legionnaires' disease". Epidemiol Infect. 104 (3): 361–80. doi:10.1017/s0950268800047385. PMC 2271767. PMID 2347381.
- ↑ Cordasco G, Cicciù D, Lo Giudice G, Matarese G, Nucera R, Mazza M (1999). "Kinesiographic investigations in children with increased nasal airways resistance". Bull Group Int Rech Sci Stomatol Odontol. 41 (2–3): 67–72. doi:10.3201/eid0801.010176. PMC 2730281. PMID 11799746.
- ↑ García-Fulgueiras A, Navarro C, Fenoll D, García J, González-Diego P, Jiménez-Buñuales T; et al. (2003). "Legionnaires' disease outbreak in Murcia, Spain". Emerg Infect Dis. 9 (8): 915–21. doi:10.3201/eid0908.030337. PMC 3020623. PMID 12967487.
- ↑ Outbreak of legionellosis in Stavanger, Norway – final report Blystad, H and Bjorlow, E and Aavitsland, P and Holm, J, Weekly releases (1997–2007), 5, 2059 (2001), https://doi.org/10.2807/esw.05.47.02059-en.