• Correction due: CDC must own data error in VA water case

    August 02, 2017

    July 30, 2017 12:00 AM By the Editorial Board / Pittsburgh Post-Gazette

    Responsible for protecting us from threats and curing what ails us, the U.S. Centers for Disease Control and Prevention have a public respect accorded few other federal agencies. Sadly, the CDC betrayed the public trust by obfuscating data in a 2015 journal article on an outbreak of Legionnaire’s disease at the Pittsburgh VA Healthcare System. CDC officials corrected the article nearly two years later only after the Post-Gazette’s Sean D. Hamill exposed their shenanigans and the journal’s editor, Robert Schooley, pursued the correction.

    The manipulation of data is a reprehensible breach of scientific ethics. The CDC should be contrite. Instead, it’s defiant, acknowledging a “small data error” in its findings — as if two numbers had been innocently transposed — while insisting that the misrepresentation had no effect on the article’s conclusions. The real conclusions to be drawn here relate to the agency’s broken culture, with has permitted lapses in judgment to multiply like bacteria in a petri dish.

    Dr. Schooley, the editor of Clinical Infectious Diseases, and U.S. Rep. Tim Murphy, R-Upper St. Clair, understand the significance of the CDC’s wayward behavior. Dr. Schooley has called the article’s language “misleading” and the correction “a big deal.” Mr. Murphy, chairman of the Energy and Commerce Subcommittee on Oversight and Investigations, gave Mr. Hamill’s July 23 story on the belated correction to new CDC chief Brenda Fitzgerald and told her it deserved attention. According to Mr. Murphy, Dr. Fitzgerald agreed to look into it.

    Six veterans died from the 2011-12 Legionnaire’s outbreak in the VA hospital’s water, and 16 others were seriously sickened. In December, Mr. Hamill reported that CDC official appeared less interested in determining the true cause of the outbreak than in using the tragedy to discredit the water disinfection system there and two former VA researchers who had championed it. The bias carried over into the journal article, which said the disinfection system failed to kill the Legionella bacteria “within” 24 hours but failed to note that the data also revealed success “at” the 24-hour mark. 

    In its own investigation, the VA’s inspector general faulted maintenance of the disinfection system, not the system itself. 

    In December, after the CDC’s misconduct came to light, Mr. Murphy and U.S. Sen. Bob Casey Jr. asked the CDC to conduct an internal review. Months later, the CDC acknowledged a “small data error,” cited the correction in the journal and, demonstrating an unscientific aversion to further inquiry, pronounced the matter “closed.”

    The CDC has layered one misdeed upon another. It sullied the investigation of a fatal disease outbreak, misrepresented its findings in a professional journal and tried to evade accountability for its misdeeds. When articles are inaccurate, scientists should rush to correct them, knowing that the public and other researchers rely on their findings. In this case, Dr. Schooley said he had to approach the agency about a correction, which appeared in the journal’s June issue. 

    Dr. Fitzgerald would be wise to heed Mr. Murphy’s advice.  The CDC needs to be put under a microscope.


  • Post-Gazette article spurs Rep. Murphy to ask new CDC head to take another look at Legionnaires' investigation

    July 27, 2017

    CDC was forced to correct journal article about Pittsburgh VA Legionnaires' outbreak

    [EXCERPT FROM THE PITTSBURH POST-GAZETTE; Sean D. Hamill:shamill@post-gazette.com or 412-263-2579 or Twitter: @SeanDHamill.]

    The new head of the Centers for Disease Control and Prevention told U.S. Rep. Tim Murphy on Tuesday afternoon that she would “look into” why the CDC had to correct a journal article about the Legionnaires’ outbreak at the Veterans Affairs Pittsburgh Heatlhcare System.

    That promise from Brenda Fitzgerald, the former head of the Georgia Department of Public Health who was just appointed to the CDC on July 7, came after Mr. Murphy gave her a copy of the Post-Gazette’s July 23 article that examined why the CDC corrected the journal article — a rare and embarrassing move for researchers.

    “The first thing I did was hand her [the Post-Gazette’s] latest article,” Mr. Murphy said in a phone interview after the meeting. “She told me she’s going to look into this.”

    Dr. Fitzgerald told Mr. Murphy she was unfamiliar with the issue, but Mr. Murphy explained that it was an important issue that deserved additional attention.

    The CDC was forced to make a correction to the Clinical Infectious Diseases journal article last month after the Post-Gazette ran a two-part series in December about the CDC’s investigation and reporting of the outbreak.

    The Post-Gazette’s stories demonstrated that the CDC’s investigators and leaders held biases before they began the 2012 investigation of the Legionnaires’ outbreak at the Pittsburgh VA. The outbreak sickened 22 veterans and led to the deaths of six of them. Those biases led to questionable investigation techniques and alteration of data in the journal article from what was originally discovered during the investigation.

    “This is a huge breach of science [in an outbreak] that led to deaths,” Mr. Murphy said in an interview Tuesday.

    The investigators and leaders openly expressed bias against the copper-silver ionization system that the Pittsburgh VA used to combat Legionella in its water, as well as bias against two former VA researchers who are experts on Legionnaires’, Victor Yu and Janet Stout.

  • CDC corrects journal article on Pittsburgh VA Legionnaires' outbreak

    July 23, 2017

    Journal editor said Post-Gazette series led to the change
    [EXCERPT FROM THE PITTSBURH POST-GAZETTE; Sean D. Hamill:shamill@post-gazette.com or 412-263-2579 or Twitter: @SeanDHamill.

    In a rare move, the federal Centers for Disease Control and Prevention has  corrected a journal article it authored about its investigation of the 2011 and 2012 Legionnaires’ outbreak at the Veterans Affairs Pittsburgh Healthcare System.

    The editor of the Clinical Infectious Diseases journal said the correction last month in the 2015 article was the result of the Pittsburgh  Post-Gazette’s series in December that revealed that CDC officials involved in the investigation held biases against two Legionnaires’ experts who used to work at the VA, as well as the disinfectant system that the VA had been using to control Legionella.

    That bias, the series disclosed, appears to have affected the way the VA not only investigated the outbreak — which sickened 22 veteransleading to the death of six of them — but how it ultimately reported its findings. It blamed the copper-silver ionization disinfectant system for the outbreak instead of the people who managed and maintained it for the VA.

    Those findings contradicted a VA Inspector General report in 2013 that found that the outbreak was due to poor management generally and poor maintenance of the copper-silver system specifically — not that the copper-silver system itself had failed. The system is considered the gold-standard in the industry. 

    “It seems here [the CDC employees] had an agenda with the way they did the article from the beginning,” said Robert Schooley, the journal’s editor and the head of the division of infectious diseases at the University of California at San Diego.

    The biases were expressed by CDC officials in emails they sent to each other, which were obtained by the Post-Gazette through a Freedom of Information Act request . . .

    . . .  In the emails, CDC officials openly discussed their biases against copper-silver systems, as well as two researchers who used to work at the Pittsburgh VA and had long battled the CDC over a variety of issues related to Legionnaires’ disease, including copper-silver systems, which the researchers believe are effective.

    In one email, Cynthia Whitney, the head of the CDC’s respiratory disease branch, said that because the outbreak was at the Pittsburgh VA where two Legionnaires’ researchers disliked by some CDC officials had worked, and because there was a copper-silver system in use there, investigating the outbreak would be “poetic justice.”

    The two Legionnaires’ experts maligned by CDC officials in their emails, and representatives from the two copper-silver ionization manufacturers that worked with the Pittsburgh VA, all took issue with the journal article and the CDC’s attempt to minimize what it did.

    “This is not an honest error,” said Janet Stout, the Legionnaires’ expert who now runs a private laboratory in Pittsburgh’s Uptown neighborhood with her colleague, Victor Yu. “The CDC’s 2015 article had an agenda to discredit copper-silver ionization. Now we can see the CDC deliberately misrepresented their lab data only to support their view. They took their whole experiment and cherry-picked data.”

    “That really is misconduct,” she said.

    Dr. Yu agreed: “When I see an error like that, I believe it was deliberate. They had an experiment that showed it worked, then they said it didn’t.”

  • Special Pathogens Laboratory Hires Technical Director with Legionella Water Management and Engineering Expertise

    July 21, 2017

    Special Pathogens Laboratory welcomes back Frank P. Sidari III, PE, BCEE, as technical director for SPL Consulting Services.

    Frank P. Sidari III returns to Special Pathogens Laboratory after serving as an engineering project management and coordinator for capital improvements of water treatment and distribution systems at Pittsburgh Water and Sewer Authority. He brings significant water and wastewater experience from his work at major engineering firms including URS and ARCADIS/Malcolm Pirnie. In those positions, he conducted all phases of water and wastewater projects including, client and proposal development, studies, field services, detailed design and specification, permitting, and construction services.

    Dr. Janet E. Stout, director of Special Pathogens Laboratory and research associate professor at the University of Pittsburgh Swanson School of Engineering, says, “We're excited that Frank's returning to SPL in this new role to advance our engineering capacities and research in managing the risk of Legionella in water systems.”

    A registered professional engineer, board certified environmental engineer and certified construction document technologist, says he is excited to refocus his efforts on managing risk of Legionella in water systems.

    "With mounting industry and regulatory direction on managing Legionella in building water systems, I am excited to return to SPL to assist our clients with the design of new systems and management of existing facilities," says Sidari.

    Sidari published the first field evaluation of chlorine dioxide disinfection of a hospital campus water system to control Legionella pneumophila, which appeared in Journal of the American Water Works Association. In 2014, he was awarded the Consulting-Specifying Engineer’s 40 under 40 award for combining engineering expertise with a specialization in water quality and Legionella.

  • Legionnaires' not listed as cause of death for Flint water manslaughter victim

    July 20, 2017

    If prosecutors are looking for evidence to prove manslaughter charges against five government officials charged with the death of a man they say contracted Legionnaires' disease from Flint water, they may have to look further than his death certificate.

    The certificate, filed in the Genesee County Clerk's Office, lists the 85-year-old Genesee Township man's cause of natural death as "end stage congestive heart failure." Neither Legionnaires' disease nor Legionella is listed on the county's record of Robert Skidmore's death.

    MLive-The Flint Journal was not able to reach Genesee County Medical Examiner Brian Hunter for comment.

    However, Oakland County Medical Examiner Dr. Ljubisa J. Dragovic said that, if foul play is not suspected in a death and an autopsy is not performed on a body, causes of death are often "educated guesses" and that mistakes can be made.

    "Each and every death is different, and obviously there are questions with each death, and certainly if there's no autopsy," Dragovic said....

    But Skidmore's listed heart failure can be an indication that he was at a higher risk to contract Legionnaires' disease, said Dr. Janet Stout, president and director of the Pennsylvania-based Special Pathogens Laboratory and an expert in legionella.

    Cancer, kidney failure, respiratory failure or heart failure -- as in Skidmore's case -- can render a person more susceptible to contracting Legionnaires', Stout said.

    (Excerpt from MLive)

  • Southwestern Veterans' Center confirms Legionella bacteria in water

    July 07, 2017


    The Southwestern Veterans' Center has confirmed it’s had low levels of Legionella bacteria in its water.

    Channel 11 learned there are still precautions being taken there with patients and staff drinking bottled water, while retesting is going on after low levels of Legionella were found there.

    11 Investigates uncovered Tuesday that a patient at the Southwestern Veterans' Center tested positive for Legionnaires' Disease on June 8 and was admitted to the VA Hospital in Oakland for treatment....

    "In order to get Legionnaires' Disease, you have to be exposed to the bacteria from the water, it has to get into your lungs and the lungs of the individual have to be susceptible to an infection,” said Dr. Janet Stout, an expert in Legionnaires' Disease at Special Pathogens Laboratory in Pittsburgh. Stout told Channel 11 a long-term disinfection plan is as important as an aggressive cleaning when the bacteria is first discovered.

    "Those single knock downs, Legionella comes right back up, so it grows again even though you've controlled it initially,” Stout said.

    (Excerpt from WPXI)

  • Scaling Up! Episode 9: The L Word

    July 02, 2017

    Legionella and Legionnaires' disease are often misunderstood. The topics can be hard to talk about, and it can be even harder to find the information you need. Join Dr. Janet Stout and Trace Blackmore discuss all things Legionella on Scaling Up!, the podcast for water treaters by water treaters.

    Get to the bottom of what Legionella is, what you need to know about it, and how everyone can work together to end Legionnaires' disease by listening to "The L Word" from Scaling Up!.

  • Study: More Than 1 in 3 Heater-Cooler Devices Contaminated

    June 15, 2017

    Testing of heater-cooler units used in open heart surgery often turned up Mycobacterium chimaera -- an organism linked to fatal patient infections -- as well other bacteria and fungi, despite decontamination attempts.

    Among samples sent to one specialty testing laboratory from 89 heater-cooler devices at 23 centers, 51% tested positive for nontuberculous mycobacteria and 37% were positive specifically for M. chimaera.

    Four units were also colonized with Legionella, John Rihs, vice president of laboratory services at Special Pathogens Laboratory in Pittsburgh, reported at the Association for Professionals in Infection Control and Epidemiology meeting in Portland.

    Of the 653 samples cultured from July 2015 through December 2016, 15% were so contaminated with bacteria and fungi, with heterotrophic plate counts up to five million CFU/mL, that initial results were uninterpretable.

    The other species recovered from these units, such as M. abscessus/chelonae and M. gordonae, have not been associated with disease in this setting, Rihs said in an interview (which was monitored by conference media relations).

    "But if it's raining down M. chimaera over the surgical field, it's likely raining down those too," Rihs told MedPage Today, noting that such infections have probably occurred without being connected to the devices.

    (Excerpt from MedPageToday) 

  • Open-chest devices pose infection risk to more patients, new research shows

    June 15, 2017

     A device used routinely in open chest surgery may have put many more patients at risk of infection from a rare but deadly form of bacteria than earlier believed, according to a study by a Pittsburgh researcher released Wednesday.

    The research, released at a national conference of infection prevention experts in Portland, Ore., has prompted at least one local hospital system, Allegheny Health Network, to begin notifying about 3,000 patients who were involved in such surgeries at either Allegheny General Hospital or West Penn Hospital since 2012. UPMC said it is not notifying its patients.

    The problem with the device — heater-cooler units that are used to warm or cool patient bodies — has been known since early 2015, after research in European countries first linked infections in patients to contamination in one particular type of unit, the Stockert 3T made by LivaNova of Germany.

    U.S. regulators have since found the same problem they suspect led to the infections from the Stockert 3T — cooling fans aerosolizing leaking water — was possible with other manufacturers as well. Almost all of the reported cases of infection have come from the Stockert 3T, but a few have been associated with other manufacturers’ units as well.

    The new study by Jack Rihs, head of laboratory services at Special Pathogens Laboratory in the Pittsburgh Bluff neighborhood, found that the rate of contamination in heater-cooler units was much higher than the U.S. Food and Drug Administration believed last fall when it said up to 500,000 people might be at risk.

    In samples of water from the units — all of them Stockert 3Ts, which once made up 60 percent of the market in the U.S. — Mr. Rihs found that 33 of 89 of the heater-cooler units he tested from 23 states, the District of Columbia and Canada tested positive for mycobacterium chimaera.

    “I was surprised that so many were positive,” Mr. Rihs said, “because [M. chimaera] is such a rare pathogen and to find so many in these devices all over the U.S. is unusual.”

    (Excerpt from Pittsburgh Post Gazette)

  • Hot Tubs Eyed as Another Case of Legionnaires' Reported

    June 13, 2017


    Big buildings, hot tubs and warm weather might have led to the conditions that resulted in several local cases of Legionnaires’ disease, medical and building experts said.

    A day after news broke of four cases of Legionnaires’ disease tied to two LA Fitness gyms in Orlando, Lake County health officials confirmed a seniors community in Clermont is also being investigated.

    Health investigators are also focusing on hot tubs, which may help spread the deadly bacteria, at the Summit Greens community in Clermont....

    Buildings with large water systems can be susceptible to Legionella growth and hot tubs can help spread bacteria, said Bill Pearson, senior vice president of Special Pathogens Laboratory in Pittsburgh.

    “When the bacteria is able to find favorable conditions to multiply, it becomes a health hazard,” he said.

    (Excerpt from Orlando Sentinel)