December 19, 2015
by Micheal Kosnar, NBC News
From birth, Northern California newborn Ryland Joseph always seemed happy with a constant smile and twinkle in his brown eyes. But just four months after he was born, the child was diagnosed with Wiskott-Aldrich Syndrome, a rare genetic disorder.
His parents, Rodd and Kellie Joseph, knew their son's only chance for survival was a bone marrow transplant. They chose the highly regarded Benioff Children's Hospital at the University of California San Francisco Medical Center for the procedure.
But after a successful operation, the boy's health took a serious turn just days later. He died on May 16, 2013. The Josephs said they were shocked to learn Ryland didn't die as a result of the transplant or even his genetic disorder — he died from the Legionnaires' disease that he contracted in his own hospital room.
"I was angry like I've never been angry in my life. This was my only son," Rodd Joseph told NBC News. "I mean, had they tested for it, my son might still be here."
Since the Legionnaires bacteria was first identified after scores of men fell ill at Philadelphia's American Legion Convention in 1976, thousands are still sickened every year in the U.S., even though some experts say it's almost entirely preventable.
At risk in particular are hospitals, with unsuspecting patients — even babies — vulnerable to a killer in the water.
Most people get Legionnaires by breathing in mist from water that contains the bacteria. It can cause severe pneumonia.
At Benioff Children's Hospital, Ryland, who had a weakened immune system, was in a special unit away from other people and sources of infection.
The hospital had a policy in place prohibiting "tub baths or showers" in the rooms which would have prevented the spread of Legionnaires through the inhalation of microscopic water droplets.
But hospital cleaning personnel violated that policy by turning on the shower.
The Legionella bacteria thrives in warm water environments like cooling towers and large plumbing systems, but the hospital hadn't tested for it since 2006.
"It was a shock to me," Kellie Joseph said. "And I think that people need to be aware of what it is, and that it's lurking, and it's in the hospitals."
The Josephs sued the UCSF Medical Center for the wrongful death of their son. The case was later settled out of court.
In court documents, the hospital admits that Ryland contracted Legionnaires' Disease in their facility.
The hospital states it had been using Legionella mitigation practices consistent with industry standards, such as heating water to a certain temperature as it comes into the building from the city, and that it implemented new policies after Ryland's death.
"There are people in public health that are afraid to tell people that this bacteria survives water treatments in our water systems," [Dr Janet] Stout said. "The thing we hear about is we don't want to start panic. We don't want to alarm people unnecessarily. So what happens is inaction. The hospitals don't test their water because the Center for Disease Control and Prevention says wait until there are cases before you go looking for the source. And we think that's backwards."
December 19, 2015
December 07, 2015
Legionnaires' disease: cause, diagnosis and treatment
Listen to the interview with Dr. Janet Stout, who was a guest WRVO's health and wellness program, Take Care, hosted by Lorraine Rapp and Linda Lowen. The interview aired December 6. Following is an excerpt about the interview:
Legionnaires’ disease is a kind of pneumonia spread through the legionella bacteria. Unlike other some other kinds of bacteria that sickens humans, this one is spread through water, not by person-to-person contact. The bacteria usually live in manmade water systems, like in buildings.
People contract the disease by breathing in mist with the bacteria or they drink the water, but it has to get into the lungs, says Stout.
But it can be difficult to figure out where Legionnaires’ is coming from, says Stout. For one reason, the time of exposure to legionella bacteria to a patient showing signs of Legionnaires’, like fever and cough, can be anywhere from two to 10 days.
September 30, 2015
NEW YORK— Thirteen more people were diagnosed with Legionnaires’ disease in the Morris Park section of the Bronx. Although one patient has died, medical specialists are saying that the diagnoses itself should be seen as a good thing.
“It’s not an outbreak. It’s an outbreak of diagnosis,” said Janet Stout, a microbiologist who has researched Legionella, the bacteria that causes Legionnaires’ disease, for more than 30 years.
Legionnaires’ disease, a rare but severe form of pneumonia, had taken 12 lives and sickened more than 120 people in July and August during an unrelated outbreak in South Bronx.
But the increase of Legionnaires’ infections doesn’t necessarily indicate that more people are getting sick. It means more doctor are testing for it, showing a critical shift in the New York medical establishment’s attitude toward the disease that can potentially save many lives.
Legionella is a bacteria that is commonly found in the water supplies of large buildings. It doesn’t pose any danger to most healthy people. But it can be life-threatening for the elderly and people with weak immune systems. Since it is an uncommon illness, Legionnaires’ disease has historically been misdiagnosed as some other form of pneumonia.
The number of deaths caused by the Legionella bacteria is still unknown. The Centers for Disease Control and Prevention (CDC) estimates somewhere between 8,000 to 18,000 people are hospitalized with Legionnaires’ disease each year in the United States, yet only about 3,000 cases are reported to CDC each year. The rest are misdiagnosed.
This is worrisome because according to the World Health Organization, Legionnaires’ patients who are diagnosed and treated early can fully recover with few side effects while those who go untreated after a week can face cognitive damage, organ failures, or death.
Sadly, outbreaks and deaths are what it takes to get people’s attention.
Legionella.org, an advocacy organization run by Victor L. Yu, M.D., and Stout, Ph.D, believe that because of the severity of the malady, Legionnaires’ disease should be tested significantly more often than it is.
“Sadly, outbreaks and deaths are what it takes to get people’s attention,” Stout said.
- Amelia Pang, Epoch Times | September 30, 2015
August 12, 2015
Tess Owen | VICE News | August 12, 2015
The massive pharmaceutical company GlaxoSmithKline (GSK) had to temporarily shutter its North Carolina factory -— which produces medications for respiratory conditions —after Legionella bacteria was detected in one of the plant's cooling towers this week.
The factory, which is located in Zebulon, North Carolina, reportedly handles more than 30 brands, including Combivir, which treats HIV, the antidepressant Wellbutrin, and Zofran, which is used to prevent chemotherapy induced nausea. Respiratory drugs that the plant produces are Advair, Breo, and Ellipta, all of which come in the form of an inhaler and are prescribed to people with asthma and chronic lung diseases. Advair is the largest product line at the Zebulon plant.
Legionella bacteria tends to thrive in warm water — and is often found in hot tubs, extensive plumbing systems, decorative fountains, or cooling towers. To become infected, a person has to be exposed to the mist or vapor containing the bacteria — it can't spread from one person to another.
GSK representative Marti Skold Jordan told VICE News on Wednesday that "the cooling tower is a standalone structure which does not come into contact with product manufactured at the facility."
Jordan also said that all employees working at the facility had been sent home and the cooling towers will be fully cleaned and retested before the factory reopened.
GSK's detection of the bacteria coincides with a recent outbreak of Legionnaire's disease in the South Bronx, which has so far killed 12 and infected over 100.
The incubation period for the Legionella bacteria usually lasts between two and 10 days, but people can still begin exhibiting symptoms around two weeks after exposure. A report from the New York City's Department of Health and Hygiene says that all 12 people who died had existing medical problems, which Legionnaire's complicated.
Janet Stout, director of the Special Pathogens Lab in Pittsburgh, told VICE News that she thought GSK's decision to close the factory was overly cautious. Many cooling towers will test positive for traces of Legionella bacteria, Stout says, but those traces won't necessarily lead to an outbreak of Legionnaire's disease.
"You just need to adjust your water treatment program to get those numbers [Legionella bacteria] down," she said.
"People get very anxious when an outbreak occurs," she added while commenting on the Bronx outbreak. "But when you look at all the people who are exposed to the bacteria, only 2-5 percent become infected."
August 07, 2015
New York City is in the throes of a major outbreak of Legionnaires’ disease. A hundred people have been stricken and at least ten are dead. The origin is thought to be building cooling towers in which bacteria are growing.
Although they receive little attention, outbreaks of Legionnaire’s disease, which is caused by a bacterium called Legionella, are not uncommon, and they’re increasing. The number of cases in New York City has tripled during the last decade, increasing from 73 in 2004 to 225 in 2014. Nationally, reported cases more than tripled between 2001 and 2012. The fatality rate is 5 to 30 percent.
The country is ill-prepared to stem the tide of Legionnaire’s outbreaks, in large part because of the flawed policies of the federal Centers for Disease Control and Prevention (CDC).
Legionella lurks at low levels in natural fresh water sources (such as rivers, lakes and streams) in virtually every part the world, most often with little impact on humans. It becomes hazardous when it survives municipal water treatments and subsequently contaminates and grows in man-made building water systems such as hot tubs, decorative fountains, shower heads and cooling towers. Left undetected in these sites, it can multiply to high concentrations. People become sickened after inhaling contaminated aerosol droplets generated from these sources. Unlike most other pneumonias caused by microorganisms, this disease is not transmitted person-to-person; it is purely of environmental origin.
The only way to determine whether a water source is a high-risk Legionella-contaminated system is to take samples of the water to see whether the bacteria grow from them, in a simple and inexpensive culture test in a laboratory. But instead of mandating regular monitoring of possible sources, the CDC endorses a “disease surveillance” strategy–a reactive approach that relies on screening for bacteria after cases are detected, at which time a response is quickly undertaken to prevent further infections. Although this strategy works well for person-to-person transmissible diseases where the source of the disease is another infected individual, it is not well suited to situations in which the source of disease is in the environment.
Former Assistant U.S. Surgeon General Dr. J. Donald Millar, who used the disease surveillance approach as the head of CDC’s hugely successful Smallpox Eradication Program, has long been critical of CDC’s approach to Legionnaire’s disease. In1997 he warned that disease surveillance was being misapplied to the prevention of Legionnaires’ disease because it is not transmitted from person to person but is contracted solely by exposure to bacteria-contaminated aqueous sources. For such diseases of environmental origin, proactive environmental surveillance, rather than reactive disease surveillance, is the appropriate prevention strategy.
And yet CDC officials remain intransigent, discouraging environmental testing until an outbreak occurs, at which point they demand testing to demonstrate that all evidence of Legionella is absent for up to a year
after the outbreak. Inexplicably, CDC’s current recommendation is still that “an epidemiological association with a probable source should be established before intervention methods, such as disinfection, are undertaken” [emphasis added].
This contradiction–environmental surveillance not indicated before an outbreak, but required afterwards–in effect uses people as “canaries in the coal mine” to detect high-risk water sources.
August 06, 2015
With its rather innocuous name, Legionnaires’ Disease can easily be underestimated. But the bacteria-borne infection can be devastating, leaving some victims with lifelong complications—even amputations—and has a mortality rate of up to 30 percent.
And while the average person might be baffled by the little-talked-about but deadly illness, researchers who have studied it for decades have few questions about Legionnaires’ Disease, how it spreads, and how to prevent it. We’ve had this knowledge for years, so why are people still dying?
Right now, a community in the south Bronx in New York City is in the throes of a deadly outbreak of Legionnaires’ Disease. Since July 10, there have been 86 confirmed cases of the disease. Seven people have died.
This week, New York Mayor Bill de Blasio said officials identified Legionella—the bacteria that causes the disease—in five water cooling towers at apartment complexes in the Bronx. Cooling towers hold the water used to heat, cool, and circulate air in large buildings, though officials aren’t yet clear on how many of the towers contributed to this breakout.
The number of cases being reported is slowing, but with a mortality rate of 8 percent so far, it’s not an outbreak to be ignored.
“We know an awful lot about the organism of the disease, where to find it, and how to stop it,” explained Janet Stout, the director of the Special Pathogens Lab and an environmental engineering professor at the University of Pittsburgh. Stout has specialized in researching Legionella for more than 30 years and says we should be able to prevent these kinds of outbreaks with better monitoring.
Legionnaires’ disease got its name after a deadly outbreak in 1976 during a convention in Philadelphia for members of the American Legion. Since naming the disease, researchers have been able to identify the related bacteria and understand a great deal about the causes, treatment, and possible prevention of the disease.
“It’s not as rare as people think.”
There are actually 58 members of the Legionella family of bacteria, Stout told me, only half of which can cause the illness. Legionella bacteria are found naturally in rivers and ponds, but usually in small, harmless numbers. The trouble comes when a small number of Legionella bacteria travel through our water treatment systems—the bacteria isn’t very susceptible to the chemicals we use to treat our water, Stout said—and winds up in a cozy environment where it can start a family.
“It finds conditions that it likes or needs to grow: warm temperatures, other sources of food like the dirt and sediment normally found in pipes and cooling towers, and other microbes and bacteria that help Legionella to grow and multiply,” Stout said over the phone. “All of those conditions are present in those warm water systems.”
Motherboard.vice.com | by KALEIGH ROGERS | August 6, 2015
August 05, 2015
At least seven people in New York City have died and 86 have been infected in an outbreak of Legionnaires' disease. The illness can cause high fevers and pneumonia.
But despite the current outbreak, most people in the region aren't at any increased risk of getting Legionnaires'. The disease is not communicable between people, and only those with weakened immune systems or other health impairments tend to fall ill. In addition, most people who do get Legionnaires' can be treated with antibiotics.
From its source to its treatment, here are some of the most important things to know about the disease and the current outbreak. [5 Things You Should Know About Legionnaires' Disease]
1. What is Legionnaires' disease?
The disease is caused by a genus of bacteria known as Legionella, which lives in watery environments. The bacteria's natural hosts are other single-celled organisms such as amoebae. However, occasionally these bacteria may infect people, and can cause cough, high fever, pneumonia and death, said Dr. Victor Yu, a researcher at the Special Pathogens Laboratory at the University of Pittsburgh.
2. Is there treatment?
Yes. Legionnaires' disease can be treated effectively with antibiotics. Without treatment, the disease can kill up to 40 percent of the people who come down with symptoms, Yu said. But if the disease is caught and treated early, the mortality rate plummets to less than 5 percent, he added.
3. Who is at greatest risk of Legionnaires' disease?
In theory, anyone can catch the disease, but in reality, Legionnaires' typically sickens the elderly or those with weakened immune systems, such as transplant patients or individuals with diabetes, said Janet Stout, a microbiologist and the director of the Special Pathogens Laboratory.
"It essentially infects older people, and the most common are elderly men who smoke cigarettes," Yu said.
In the current outbreak in New York, everyone who has fallen ill had some underlying medical condition or health problem, according to the New York City Department of Public Health.
4. When was Legionnaires' disease first identified?
It was first identified in 1976, after a large number of people — mostly men who belonged to the veterans' organization the American Legion — fell ill after attending a convention at the Bellevue-Stratford Hotel in Philadelphia. Epidemiologists eventually identified the bacterial strain as the responsible culprit. The bacteria were found in the hotel's air conditioning system.
5. How is it spread?
Legionella cannot be passed between people. Instead, people become infected by inhaling mist or water droplets that are contaminated with the bacteria.
"The majority of cases of Legionnaires' disease occur as a result of the warm water system," Stout said.
The most common sources of outbreaks are drinking water systems in hospitals, hotels and other institutional facilities, she said. In those instances, people typically acquire the infection after breathing in a little bit of fluid, such as can happen when drinking something or taking a shower. Nowadays, more and more hospitals sanitize their water to prevent the spread of Legionnaires' disease, Yu said.
Most of these outbreaks last a long time, but involve only a few sporadic cases.
But when "explosive" outbreaks hit many people at once, water-cooling towers are often the culprits, Stout said. The current New York City outbreak is just such an explosive outbreak, as was a 2012 outbreak in Quebec City, Canada, that sickened 170.
"These devices provide Legionella bacteria with everything they need to grow," Stout said. The towers provide a warm, wet environment, while filters suck in dirt from the environment that provides perfect food for the bacteria to multiply. The towers also give off an aerosolized mist that can transmit the disease to people passing by, she added.
by Tia Ghose, Senior Writer | August 05, 2015 12:22pm ET
August 04, 2015
August 04, 2015
THE BRONX — The city will require all cooling towers to be registered and inspected regularly for the bacteria that causes Legionnaires' disease following an outbreak in the South Bronx that has so far killed 7 people and sickened 86 others.
The city believes that the outbreak is linked to five cooling towers at Lincoln Hospital, Concourse Plaza, the Opera House Hotel, a Verizon office building and Streamline Plastic Co. where the bacteria that causes Legionnaires' disease was found. The outbreak began July 10.
"This is the largest outbreak of Legionnaires' disease that we are aware of in New York City," Health Commissioner Dr. Mary Bassett said at a press conference with Mayor Bill de Blasio.
Bronx Borough President Ruben Diaz first called for legislation requiring inspections of building cooling towers last week when the death toll was still at three.
... The mayor said he is currently working on with the City Council to draft the law, which will be introduced later this week.
The mayor also said no law regarding cooling towers was in place because there were no recommendations to have one from the national Centers for Disease Control and Prevention.
Under the new law, there will be financial penalties for failing to register, test or decontaminate cooling towers where legionella is found. The city will also have the power to step in and clean a cooling tower and bill the landlord if they refuse to follow procedures.
"For too long the risk of Legionnaires was underestimated," de Blasio said.
Janet Stout, director of Special Pathogens Laboratory in Pittsburgh and an associate professor of research at the School of Civil and Environmental Engineering at the University of Pittsburgh, has studied Legionnaires' disease for 30 years.
She said the United States lags other countries and cites such as Australia, England, the Netherlands and Spain when it comes to preventing outbreaks.
"It saddens me greatly every time these outbreaks occur because they are absolutely preventable," said Stout.
After 10 years, Stout said the American Society of Heating, Refrigerating and Air-conditioning Engineers approved a standard risk management framework to prevent the spread of Legionnaires' in building cooling systems.
But the recommendations did not include a standard for testing due to industry concerns, said Stout who was a voting member of the committee. Bassett said the city is consulting a team of scientists to help develop standards.
Quebec City, which had an outbreak of 180 cases and 13 deaths in 2012, now has some of the toughest Legionnaires' inspection standards around and requires monthly testing of cooling towers, said Stout.
"The rest of the world has really been much more proactive than the United States," Stout said. "That's why legislation is so important because people will respond and do the right thing if there are consequences."
DNAinfo/Jeff Mays | August 4, 2015 3:23pm