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
July 01, 2015
Nine years in the making, the United States has its first standard to manage risk for Legionella. The ANSI/ASHRAE Standard 188-2015, Legionellosis: Risk Management for Building Water Systems, approved June 26, 2105, establishes minimum legionellosis risk management requirements for building water systems
The standard applies to owners and managers of human-occupied buildings d those responsible for design, construction, installation, commissioning, operation, maintenance and service of centralized building water systems and components.
According to the news release from ASHRAE, “The industry interest and input into developing this standard has been tremendous,” said Tom Watson, chair of the committee. “With 8,000 to 10,000 cases of Legionnaires’ disease reported each year in the United States, and with more than 10 percent of those cases fatal, it is vital that we set requirements to manage risk of this bacteria.”
Specific requirements include:
• Minimum Legionellosis risk management requirements for buildings and potable and non-potable water systems.
• Establishing a program team and water management program
• Specific and detailed requirements what control strategies must accomplish and documented
While the standard provides information on what to do, there are no specific directions for implementing risk managment strategies.
To assist you in controlling Legionella, Special Pathogens Laboratory will be offering education and services that include compliance with the ASHRAE 188 standard. For more information, please contact us.
Legionella Engineer for Special Pathogens Laboratory Receives Consulting-Specifying Engineer 40 under 40 Award
May 15, 2015
Legionella engineer and Special Pathogens Laboratory Vice President of Consulting Services Frank P. Sidari III, PE, BCEE, is the recipient of Consulting-Specifying Engineer’s 40 under 40 award for combining engineering expertise with a specialization in water quality and Legionella, the waterborne bacteria that causes Legionnaires’ disease.
Given to 40 building industry professionals age 40 and younger, CSE’s award recognizes those who stand out in all aspects of their lives, particularly in the nonresidential building community.
Sidari stood out for creating a unique niche by combining his engineering expertise with a specialization in water quality and Legionella control. This novel approach promotes building water safety and prevents disease caused by waterborne pathogens.
Early in his career, Sidari conducted the first field evaluation of chlorine dioxide disinfection of a hospital campus water system to control Legionella. At that time, chlorine dioxide was a new technology that was a potential alternative to chlorine. His work was published in the Journal of the American Water Works Association (JAWWA) in 2004. Since then, chlorine dioxide has become an industry standard and is used worldwide to control Legionella. Subsequently, Sidari’s most recent publication (JAWWA, Oct. 2014) confirmed the findings of the original study.
“Recognition for Frank’s accomplishments is well deserved,” says Dr. Janet E Stout, president of Special Pathogens Laboratory. “Disease caused by waterborne pathogens, especially Legionella, in the built environment is a growing public health issue. Frank’s rare skill set and ability to apply his expert knowledge of water systems to Legionella control is critical to disease prevention and advancing knowledge.”
In addition to his seminal work in engineering and water quality and Legionella, Sidari was also recognized for his commitment to mentoring young girls in science, technology, engineering and math (STEM). For more than 10 years, he has volunteered and assisted classes at The Ellis School, an all-girl institution in Pittsburgh. Under his engineering mentorship of the school’s Future City team, three teams made it to the competition's national finals held during National Engineers Week in Washington, DC.
“These diverse young professionals are dedicated to the building profession,” said Amara Rozgus, Editor-in-Chief of Consulting-Specifying Engineer. “Now in its eighth year, the program has increased in the number of nominees, and each winner truly stands out both professionally and personally.”
Candidates for CSE’s 40 under 40 award were nominated by a professional colleague or mentor and judged on nine areas including: their commitment to excellence in their academic, professional, personal, and community involvement. Winners will receive their awards at the presentation ceremony held in Chicago on Tuesday, Sept. 29.
May 06, 2015
Chlorine treatments meant to stop dangerous bacteria that can lead to Legionnaires' disease are eating away metal pipes across the Veterans Affairs Pittsburgh Healthcare's plumbing system, threatening long-term damage that could cost millions to correct, an independent evaluation shows.
Premature corrosion at VA campuses in Oakland and O'Hara eventually could force exorbitant bills for plumbing repairs and slash the pipes' lifespan by years, according to disinfection and engineering experts briefed on the matter. A 57-page analysis obtained by the Tribune-Review blames high chlorination for pitted pipes and outright failures found in the water distribution system, where workers report occasional dark discharge from faucets.
“This is a hospital, and we are afraid to drink the water,” said Colleen Evans, a registered nurse and executive vice president for the American Federation of Government Employees Local 2028. The union represents about 2,500 VA Pittsburgh workers.
VA officials said chlorination, adopted in 2013, has proven effective in containing Legionella bacteria that led to the deaths of at least six VA Pittsburgh patients and sickened at least 16 others in 2011 and 2012.
“Our real goal is patient safety. A trade-off of a little more maintenance and repair is worth it if we're saving lives,” said Dr. Brooke Decker, infection prevention director for the VA Pittsburgh, who acknowledged some darkened tap water might be related to the chlorine treatments.
The analysis released last May by Cyrus Rice Water Consultants in Coraopolis showed chlorine levels up to five parts per million, or 20 percent higher than limits for drinking water set by the federal Environmental Protection Agency.
VA officials said the levels have since eased up, complying with drinking water standards and maintaining chlorine low enough that it poses no health risks.
Decker said the last Legionnaires' case linked to the VA Pittsburgh was in 2012, before the health system replaced its less corrosive copper-silver ionization technology with chlorination to stave off the waterborne bacteria.
Workers block off affected spigots and pass out bottled water if chlorine levels exceed standard ranges, Decker said.
The VA did not specify the cost of chlorine-related plumbing damage but reported spending $11.7 million in 2013 on anti-Legionella upgrades, including chlorination equipment in Oakland and O'Hara. Water filters, chemicals, routine testing and related Legionella-prevention expenses — excluding pipe repairs — totaled about $632,000 in 2014, according to the VA.
The agency did not quantify the volume of chlorine-related plumbing problems, although a facilities manager said the issues are concentrated around 19 injection points for the chlorine.
It's very clear in multiple publications that these negative consequences are associated with ongoing use of chlorine,” said Janet Stout, a former VA Pittsburgh worker, a microbiologist and president of the Special Pathogens Lab,Uptown.
January 28, 2015
Can Total Bacteria Measurement Be Used To Predict Legionella Presence?
Microbiological growth in cooling water systems presents several challenges for water treatment providers. Culture methods such as heterotrophic plate count (HPC) and “dipslides” provide valuable information related to general microbiological water quality but require several days to produce results. Alternative methods using adenosine triphosphate (ATP) measurement provide faster results and have been applied when rapid water quality assessment is necessary. Our evaluation reviewed potential applications for ATP analysis in cooling water systems. We also assessed whether total bacteria measurement using culture methods or ATP analysis can predict the Legionella presence/absence using both experimental data and data collected from field observations.
Dr. Stout will present study results on Monday, February 9 at 11 a.m. at CTI in Nashville.
Legionella Controlled with Monochloramine in Hospital Hot Water System, Says First US Study Published in ICHE
October 27, 2014
Legionella is effectively controlled with a new onsite monochloramine generation system in a hospital hot water system, says an SPL study in November’s Infection Control and Hospital Epidemiology available online.
Evaluation of A New Monochloramine Generation System for Controlling Legionella in Building Hot Water Systems is the first field trial and published study in the US to evaluate the efficacy of a monochloramine generation system to control Legionella in a hospital hot water distribution system. Prior to this technology, monochloramine had been only used at the municipal level in cold water.
According to Janet E. Stout, PhD, director of Special Pathogens Laboratory, who led the team of researchers that conducted the 29-month study, “This prospective collaboration provides important objective scientific evidence that demonstrates that onsite generation of monochloramine was effective and that treating only the hot water prevented further cases of Legionnaires’ disease. ”
Researchers installed the system (Sanikill, a product of Sanipur [Italy]) at a Pittsburgh 459-bed hospital. Early results, publically reported at the Association of Water Technologies annual conference in 2012, reported a rapid and significant reduction of Legionella within the first week of application. Throughout the study, Legionella was controlled. There was no significant increase in microbial population and none of the negative effects associated with monochloramine use in municipal cold water systems.
“Monochloramine is a promising new technology and viable alternative to historic disinfection methods, especially chlorine, ” says Dr. Stout.
October 17, 2014
In 2004, SPL published the first field trial of chlorine dioxide for control of Legionella pneumophila applied to a hospital's secondary water distribution system. (See Keeping Legionella out of Water Systems. Sidari, F.P., Stout, J.E., VanBriesen, J.M., Bowman, A.M., Grubb, D., Neuner, A., Wagener, M.M., Yu, V.L., Journal of the American Water Works Association, Vol. 96, No. 1, pp. 111-119, January 2004.) The results of that 18-month study, which appeared in the Journal AWWA, showed chlorine dioxide was effective in controlling Legionella.
Recently, SPL conducted a case study of that same hospital, which had been using chlorine dioxide since 2000, to validate the conclusions of the 2004 study and evaluate long-term use of this biocide. The article Maintaining Legionella Control in Building Water Systems by Frank P, Sidari III, Janet E Stout. et al., appears in the October issue Journal American Water Works Association.