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Salem Legionnaires Disease Outbreak

Posted in Legionella,Legionnaire's disease,Our Blog,Outbreaks & Recalls on October 22, 2019

The Salem Board of Health has confirmed two cases of Legionnaires’ disease at the Pequot Highlands apartment complex. The Salem Board of Health notified the management of apartment complex earlier this week and according to a spokesman from the complex, outside company’s testing of Legionnaires in the building also came back positive. Here’s what you need to know about this Salem Legionnaires Disease Outbreak:

Residents were asked to vacate the apartments, if they could and if they chose to stay they were asked to keep precautions like not fill up the tub or sink very fast or take any showers so as to avoid water vapor. 

Legionnaires is a severe form of pneumonia that affects the lungs. It spreads when a person breathes in a mist or water vapor contaminated with legionella bacteria. Not everyone who breathes in the contaminated mist will get sick but some will. 

The apartment complex is hoping that they will be able to treat the water system by Sunday. The authorities started the treatment by Saturday morning. It takes around 24 to 30 hours before the treatment starts becoming effective. 

No information about the residents who contracted the disease is available. Jamie Leopoldo who lives in the building said, “They hired some people, completely cleaned up the water and tape them up so we didn’t actually do it. They let some people spend nights in hotels and stuff. Just now, they said it’s okay to use, they gave us test strips and everything’s fine now.” 

The management is also changing shower heads and faucet aerators in every unit. Once the treatment is finished, the company will test the water and the complex says that they will regularly test in the following weeks so as to make sure that water system is completely free of Legionella bacteria. 

Legionella bacteria commonly becomes a problem in large buildings like nursing homes, hotels, hospitals and apartment complexes. This routinely happens in summer and early fall when temperatures are high and bacteria is easily able to thrive. 

About Legionella:

Legionella bacteria is a kind of bacterium that is found naturally in freshwater environments, like lakes and streams. It becomes a health concern only when the bacteria enters plumbing systems. When the conditions are right, legionella thrives in the water system and spreads through the plumbing.

What water conditions causes legionella to grow?

Warm and stagnant water temperatures can cause the bacteria to multiply so when the temperatures are between 68 degrees Fahrenheit to 122 degrees Fahrenheit. Other favorable conditions include formation of rust, scale or biofilm, pH of the water is not balanced or disinfectant levels become low. These conditions are ideal for the growth of legionella bacteria. 

What happens once they start thriving?

When the legionella bacteria grows to the contamination levels, it can spread to the plumbing system and gets into small aerosolized droplets (small droplets of water or mist that can be inhaled). Any source that produces large amount of these small aerosolized droplets can infect humans. Some common sources include:

  • Showerheads and faucets
  • Hot tubs
  • Cooling towers
  • Air conditioning systems
  • Decorative fountains

Once anyone inhales this droplet, they are at risk of the infection. Some people are more likely to get sick with legionella than others:

  • Those who have a weakened immune system
  • Elders aged 50 and above
  • Those who are heavy smokers or had a history of smoking
  • Those who have any underlying disease like diabetes, lung infection etc. 

These people are more at risk of developing complications as a result of the infection as well. 

Incubation period of legionnaires is 2-10 days and symptoms usually start with

  • Cough
  • Fever 
  • Headaches

After a day or two, you will also start experiencing the following symptoms:

  • Shortness of breath
  • Chest pain
  • Muscle aches
  • Gastrointestinal symptoms such as diarrhea, abdominal cramps
  • Mental changes such as confusion

Once the patients describe their symptoms, the infection is confirmed by a chest X-ray that reveals lung infection, urine test and testing a sample of sputum (phlegm) for the bacteria. 

The treatment is done via antibiotics. Most of the patients needs to be hospitalized. Legionnaires has a very high fatality rate at 10% and even those who recover completely might have recurring symptoms. Legionnaires disease isn’t contagious, which means it can’t spread from person to person. 

Legionella bacteria can also cause a mild form of illness called Pontiac fever. It causes the same symptoms as legionnaires but the symptoms are much less in intensity. Pontiac fever can cause cough, slight headaches and muscle aches and fever – but it doesn’t infect your lungs. Pontiac fever usually goes away on its own and doesn’t require any treatment. 

The only way to prevent legionella is to develop a proper mitigation plan allying with water safety programs set by health officials to prevent legionella in large plumbing systems. A water management programs should cover these important areas:

  • Identify areas in the building where legionella can grow and spread
  • Reduce risk in these areas with the help of proper management and monitoring in place
  • Have a proper mitigation plan ready when the risk is identified

Some specific preventive measures include:

  • Maintaining and cleaning cooling towers, hot tubs, faucets, shower caps and any other source of aerosolized droplets regularly with disinfectant. This should include cleaning twice a year and periodically using chlorine or any other effective biocide. 
  • Keeping water temperatures at an optimum levels i.e. less than 68 degrees Fahrenheit or more than 122 degrees Fahrenheit.  
  • Frequently flushing water lines that are not used. This will prevent stagnation and formation of bioscale, film. 
  • Get local assistance from the health department if you have any doubts or to make sure that the program will be effective in the long run. 

Legionnaires’ cases have continued to increase in the US since it was discovered in 1976. The reason could be an increase in reporting or better investigation of the outbreaks but it surely becomes a burden on the entire health community especially in summer and early fall season. 

By: Pooja Sharma, Contributing Writer (Non-Lawyer)