Aug
31
2015
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San Quentin

San Quentin, a prison in California, has turned off its water after six inmates were diagnosed with Legionnaires’ disease.  Dozens of other inmates also presented with symptoms consistent with pneumonia.

As a result of this Legionnaires’ disease outbreak, authorities at San Quentin shut off water to the prison and instead brought in portable toilets, bottled water, and water tanks.  Showering and cooking with water is currently not allowed.

“Fortunately, Legionnaires’ is not an infectious disease — it cannot be transmitted person to person. It is transmitted through aerosolized water [such as steam], or inhaling contaminated soil,” said Joyce Hayhoe, a spokeswoman for the team responsible for California inmate healthcare.

There are over 3,700 inmates in San Quentin and more than 1,200 employees.  The California Department of Corrections and Rehabilitation (CDCR) has been investigating the source of Legionnaires’ disease and testing inmates who show any symptoms consistent with the illness.

To read more about this, please click here and here.

Posted by jzacher">jzacher at 4:42 pm
Aug
31
2015
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Illinois Veterans Home

According to officials, 28 residents at a western Illinois veterans’ home have contracted Legionnaires’ disease.  Two of these residents died last week.

Ryan Yantis, a spokesman for Illinois Veterans Home, says that the residents are being monitored and that any person who shows symptoms consistent with Legionnaires’ disease will be treated immediately as if they have it until test results come back.

The source of this outbreak has not yet been determined, but is currently being investigated by the Adams County Health Department.

To read more about this story, please click here and here.

Posted by jzacher">jzacher at 12:12 pm
Aug
28
2015
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NY Presby Weill Cornell

Two people have been diagnosed with Legionnaires’ disease in New York City and are unrelated to the South Bronx outbreak resulted in over 120 illnesses and 12 deaths.

One patient is a 77-year-old woman from East Orange, NJ.  No information about the other victim, also a woman, was available.

Both women are being treated at New York Presbyterian Hospital.

To read more about this story, please click here.

Posted by jzacher">jzacher at 1:07 pm
Aug
27
2015
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Metro Group cleans cooling tower

New York State Assemblyman Thomas Abinanti of Westchester County has introduced legislation that would require the inspection and maintenance of cooling and heating systems statewide.

A spokesman for Abinanti said that the bill deals with both heating and cooling systems as opposed to cooling towers only as with the recently passed legislation in New York City.  The bill does not, however, include a statewide registry of heating and cooling systems or towers.

Gov. Andrew Cuomo also announced emergency statewide Legionnaires’ disease regulations a little over a week ago, but his proposed regulations include the registration of heating and cooling systems.

The full press release from Abinanti’s office is below:

“Following reports of the presence of legionella bacteria in Westchester and Rockland counties, Assemblyman Tom Abinanti (D-Greenburgh/Mt. Pleasant) has introduced legislation that would require the periodic inspection and maintenance of both heating and cooling systems throughout the state.

The recent discovery of Legionella bacteria in a Yonkers school and cases of legionnaire’s disease in Rockland County come on the heels of a now-contained outbreak in the South Bronx. Over the last several years, there have been reports of other incidents around the state.

“Unfortunately, the reach of this potentially fatal disease is widespread,” said Abinanti. “We need a comprehensive, coordinated approach to prevent further outbreaks throughout the state.”

According to the Centers for Disease Control, the key to preventing legionnaire’s disease is properly maintaining water systems in which legionella grow – including both heating and cooling systems – in all types of commercial and residential buildings.

As New York City officials responded to the South Bronx outbreak, Governor Andrew Cuomo ordered the Department of Health to issue emergency statewide regulations ordering inspections and registration of cooling towers. Abinanti called the emergency regulations a good first step, but cautioned that there should be language in statute.

The language in Abinanti’s bill does not supersede stronger municipal rules, regulations, codes or statutes when it comes to detecting and preventing the presence of legionella bacteria.

“Dealing with heating and cooling systems in all types of commercial and residential buildings shows that New York State understands the depth and breadth of the problem,” said the Westchester Assemblyman. “This is a serious, statewide health issue deserving a permanent statewide legislative solution.”

To read more about this story, please click here.

Posted by jzacher">jzacher at 4:33 pm
Aug
26
2015
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NY Presby Weill Cornell

A case of Legionnaires’ disease has been confirmed in Manhattan just six days after the NYC Department of Health declared the outbreak in the Bronx to be over.

Little is known about the individual except that they were a patient at New York Presbyterian Hospital’s Weill Cornell Campus when diagnosed with Legionnaires’ disease.

The hospital is said to be taking precautionary measures despite water testing results that showed the system was clean of the bacteria.

To read more about this story, please click here.

Posted by jzacher">jzacher at 4:39 pm
Aug
24
2015
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Yonkers Riverside HS

Mayor Mike Spano announced on Friday that Legionella bacteria were discovered at Riverside High School in Yonkers, NY during cooling tower testing.

The decision to test the cooling towers occurred after the recent Legionnaires’ disease outbreak that sickened over 100 people in the South Bronx and resulted in 12 deaths.

“In the effort to protect the public health and safety of Yonkers residents combined with the recent outbreak of Legionnaire’s disease in neighboring Bronx County earlier this month, our administration proactively directed all city-owned and operated cooling towers to undergo preventative maintenance,” said Spano in a statement Friday. “After checking cooling towers at our school facilities, Riverside High School’s tower tested positive for the Legionella bacteria. The facility was closed immediately out of an abundance of caution to allow for the proper disinfecting and cleaning process to occur. Riverside was reopened today and the cooling tower does not pose any health risk to students, administrators, staff or other members of the public. I want to thank all city and school facilities staff who acted swiftly and professionally to ensure our residents remain safe.”

The state of New York established a free hotline to answer any questions about the new regulations at 1-888-769-7243.  Additionally, those who need to register a cooling tower can visit the State’s Department of Health website at www.health.ny.gov.

To read more about this story, please click here.

Posted by jzacher">jzacher at 4:53 pm
Aug
24
2015
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West Chester U

As a precaution, West Chester University of Pennsylvania (WCU) has temporarily turned off the hot water supply to ten buildings after test results came back positive for Legionella bacteria.

The tests were ordered after a school employee contracted Legionnaires’ disease last month.  Cooling towers of several buildings were subsequently tested.  According an official of WCU, the cooling towers have since been cleaned and disinfected.

The school official went on to say that the Legionella found in the water is “not cause for immediate concern” and there will be no disruption to Monday’s classes.

Students seem to be confident in the university’s ability to handle the situation, but are also glad that the bacteria were not found in the dormitories.

“It’s obviously concerning. I’m just glad it’s not in the dorms because that’s obviously where we’re showering and stuff,” Jeenal Shah of Phoenix, Arizona said.

To read more about this story, please click here.

 

Posted by jzacher">jzacher at 2:16 pm
Aug
21
2015
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NYC_Health.svg

The NYC Department of Health and Mental Hygiene announced in a press release yesterday that the Legionnaires’ disease outbreak in the South Bronx that caused 12 deaths and over 100 illnesses was over and that the source of the outbreak had been determined.

The NYC Health Department’s Public Health Laboratory worked closely with the State’s Wadsworth Center Laboratory and the CDC to determine that the source of the outbreak was the Opera House Hotel located at 436 E. 149th St., Bronx, NY 10455.  The Health Department is continuing its investigation to determine the circumstances at the hotel that led to the cooling tower being the source of the deadly Legionnaires’ disease outbreak.

“After extensive review and coordination of laboratory data at the city, state, and federal levels, we have identified the source of the outbreak in the South Bronx – the Opera House Hotel’s cooling tower,” said city Health Commissioner Bassett. “We eliminated the danger posed by the Opera House Hotel’s cooling tower as soon as it tested positive for disease-causing Legionella . Today, all cooling towers in the affected area have been disinfected, and all cooling towers across the City are being evaluated and disinfected if necessary. Historic legislation passed by the City Council and signed by Mayor de Blasio should help prevent tragic outbreaks like this from occurring again.”
“Control of Legionella is complex, and disease detection, environmental science, and laboratory advance work helped bring this unfortunate outbreak to an end. We hope to advance the science about how to improve control from New York’s experience,” said Dr. Anne Schuchat, assistant surgeon general and director of CDC’s National Center for Immunization and Respiratory Diseases. “The quick and thorough reaction from local and state authorities likely prevented many others from developing Legionnaires’ disease. CDC is appreciative of our collaborative work with New York’s public health experts.”

To read the full press release, please visit the NYC Department of Health website.

Posted by jzacher">jzacher at 3:52 pm
Aug
20
2015
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The Importance of Legionella Testing in Light of the Recent Legionnaires’ Disease Outbreak in the South Bronx and Legislative Implications

by Jules Zacher, Esquire, Tawny Vu, MPH

Legionella_Plate_01

I.  Introduction

Bronx, New York is currently experiencing its second outbreak of Legionnaires’ disease within an eight-month time period.  The second most recent outbreak occurred in December 2014, and the current outbreak began mid-July of this year.  In a recent news report, Bronx Borough President Ruben Diaz, Jr. calls for legislation that would compel repeat inspections of cooling towers.1  This paper will emphasize the importance of testing for Legionella bacteria and discuss why Diaz’s legislative response, while admirable, is inadequate for the needs of the Bronx.

The press release issued by Mr. Diaz states that he will call for an inspection system “for coolant systems, rooftop water tanks and other standing water infrastructure that could be a breeding ground for this disease and others.”  He goes on to say that “The city must create a new inspection system for these systems, just as we inspect other critical systems such as elevators.”2  While Diaz’s call for mandatory inspections is commendable, it does not seem to require testing or sampling of the water in these cooling towers for the presence of Legionella bacteria, the cause for the recent 86 cases of Legionnaires’ disease and seven deaths in South Bronx.  Any legislation passed by the New York City Council should contain such a requirement in all large facilities to truly make an impact.

II.  Current Outbreak

According to recent news reports, seven people have died from Legionnaires’ disease, with 86 people contracting the disease of which at least 57 have been hospitalized.  An investigation by the New York City Department of Health and Mental Hygiene has revealed that five cooling towers in various buildings within a 20-square-block area in the South Bronx tested positive for the presence of the Legionella bacteria that causes the disease.3  The health department is expecting additional people to present with Legionnaires’ disease as they may have been exposed prior remedial efforts.

III.  Calls for Legislation

Bronx Borough President Ruben Diaz, Jr. has called for regular inspections of cooling towers, which is the suspected source of current outbreak.  Unfortunately, simply inspecting cooling towers without regularly sampling for the presence of Legionella is insufficient.

A variety of elements can fall under the term “inspection,” i.e. records of system maintenance, water treatment, and system shut-down and start-up.  While all of these are important indicators of the state of cooling towers and evaporative condensers, they do not verify the final effect, i.e. the presence of Legionella bacteria at dangerous concentrations in the cooling tower and/or potable water systems.  This information can only be ascertained by sampling and testing for the presence of the bacteria.  Only verification through regular testing can cooling towers and potable water systems be considered safe to be among the public.

IV.  Recent ASHRAE Guidelines

             The American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE) recently approved a standard for managing water systems to prevent the buildup of the Legionella bacteria, ANSI/ASHRAE 188-2015 Legionellosis: Risk Management for Building Water Systems.4  Section 7.2 of this standard deals with cooling towers and evaporative condensers.  Nowhere in the standard, however, is there a requirement for sampling for the presence of Legionella.  Rather, the standard deals with “preventive measures,” including equipment siting, new-system start-up, system maintenance, and water treatment to control microbiological activity, scale and corrosion.5

ASHRAE’s reasoning for not requiring sampling is found in an older ASHRAE document, ASHRAE 12-2000.  As stated, “…routine culturing of samples from building water systems may not be predictive of the risk of transmission…”6  The ASHRAE 12-2000 guideline then goes on to cite four reasons for making this conclusion.

The first reason is that “presence of the organism cannot be directly equated to the risk of infection”.7  While this is true, unsuspecting victims will contract Legionnaires’ disease if the Legionella levels reach dangerous concentrations as a result of improper water maintenance on the part the building or cooling tower owner.  While proper preventive measures may be able to control the bacteria, there is no way to ensure these preventative measures are working unless sampling and testing are performed to confirm bacteria levels.

The second reason provided by ASHRAE is “Interpretation of the results of culturing of water is confounded by use of different bacteriological methods in various laboratories, by variable culture results among sites sampled within a water system, and by fluctuations in concentration of Legionella isolated from a single site.”8 There are currently numerous labs around the country that have been certified by the CDC Environmental Legionella Isolation Techniques Evaluation (ELITE) Program to be authorized to analyze samples for Legionella.  These labs are more than adequate to determine if a sample has Legionella as they have been certified by a government entity. It is admitted that sampling often reveals Legionella in one location of a building and not another, as well as differing concentrations of the bacteria in the building or cooling tower and plumbing systems.  Do either of these findings deny that Legionella exists in the building or its various water systems?  Hardly.

The third reason given is “The risk of illness following exposure to a given source is influenced by a number of factors other than the concentrations of organisms in the sample.  These factors include but are not limited to strain virulence, host susceptibility, and how efficiently the organisms are aerosolized …”.9  While it is true these factors play a role in whether someone contracts the disease, emphasis on the victim is misplaced.  Whether a person is more or less susceptible shifts the burden to the victim and not the perpetrator.

The strain virulence is another red herring.  Doctors treating patients with the disease are not concerned with the virulence of the source bacteria; they only know they have a sick patient.  Regardless of the virulence of a strain of bacteria, the concentration was sufficient for infection.  In addition, aerosolization of the bacteria may not be an issue at all as some experts have stated the disease is caused by aspiration rather that inhalation of the disease.10

The final reason given by ASHRAE for not routine culturing of the water is “Test results only represent the counts at the time the sample was collected.  A negative result from such a sample is likely to lead to a false sense of security because any amplifier can quickly become heavily colonized if it suffers neglect.”11

The focus here needs to be shifted to regular testing for Legionella in addition to regular maintenance methods.  If testing were done on a regular basis, a false sense of security would not be a problem as a baseline for Legionella levels would be provided12.  Testing for Legionella is important in determining whether or not adjustments need to be made to maintenance plans in order to protect the public.

V.  Conclusion

No doubt there will be pressure on legislators, such as Mr. Diaz, not to include a requirement for sampling in any proposed legislation dealing with the recent outbreak in the Bronx.  Industries such as hotels and electric generation will certainly weigh in on the subject because once they find the bacteria they must take some corrective action. These lobbyists will most likely point to the recent ANSI/ASHRAE 188-2015 discussed above as justification to not include sampling.  The reasons stated by ASHRAE, however, do not hold up.

It is incumbent on our legislators, therefore, not to succumb to this pressure.  Legionnaires’ disease is an entirely preventable illness and so preventative action is the key.  Only mandatory testing on a regular basis for the presence of Legionella in cooling towers and plumbing systems will prevent the next outbreak of Legionnaires’ disease.

Footnotes

1 Benjamin Mueller, “Unease Spreads in Bronx as Disease Claims 4th Life”, NYT, August 4, 2105, p. 4

2 Website of Ruben Diaz, Jr http://bronxboropres.nyc.gov/

3 Ibid, Benjamin Mueller, “Unease Spreads in Bronx as Disease Claims 4th Life”, NYT, August 4, 2105, p. 4

4 “Legionellosis: Risk Management for Building Water Systems”, ANSI?ASHRAE Standard 188-2015, American National Standards Institute, June 26, 2015

5 Ibid, “Legionellosis: Risk Management for Building Water Systems”, ANSI/ASHRAE Standard 188-2015, American National Standards Institute, June 26, 2015, p. 7

6 “Minimizing the Risk of Legionellosis Associated with Building Water Systems”, ASHRAE Guideline 12-2000, ASHRSAE, February 10, 2000, p. 13

7 Ibid, “Minimizing the Risk of Legionellosis Associated with Building Water Systems”, ASHRAE Guideline 12-2000, ASHRSAE, February 10, 2000, p. 13

8 Ibid, “Minimizing the Risk of Legionellosis Associated with Building Water Systems”, ASHRAE Guideline 12-2000, ASHRSAE, February 10, 2000, p. 13

9 Ibid, “Minimizing the Risk of Legionellosis Associated with Building Water Systems”, ASHRAE Guideline 12-2000, ASHRSAE, February 10, 2000, p. 13

10 Yu cita

11 bid, “Minimizing the Risk of Legionellosis Associated with Building Water Systems”, ASHRAE Guideline 12-2000, ASHRSAE, February 10, 2000, p. 13

12 Carl B. Fliermans, Ph.D.  E-mail Correspondence of August 4-6, 2015.

 

Posted by jzacher">jzacher at 11:57 am
Aug
20
2015
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Les Terrasses de la Chaudière

Legionella bacteria were discovered at high levels during routine testing on August 14 at Gatineau federal office building of Les Terrasses de la Chaudière.  The potentially deadly bacteria were found in the heating, ventilation, and cooling system of the government building complex.

Bacteria levels exceeded the concentration of 100 colony forming units per milliliter (cfu/mL) set by Health Canada, but fell below the Quebec provincial reporting threshold of 1,000 cfu/mL.

According to Public Works and Government Services Canada, the water system was flushed and disinfected and follow-up testing showed that the bacteria levels are now within safe limits.

To read more about this story, please click here.

Posted by jzacher">jzacher at 10:50 am