Legionnaires in the Bronx

Legionnaires ’ disease has once again raised its slippery head, and once again, in the Bronx borough of New York City.

In a low-income apartment complex in the Bronx, New York Department of Health officials say that two tenants at the Bronx River Houses have fallen ill with Legionnaire’s disease in the past year. The tenants received a letter from the health department last Tuesday to inform them that water testing will be conducted in an effort to pinpoint the source of the disease. Among the eleven buildings in the complex is a community center that hosts both senior citizens and youth programs.

In April 2018, New York City’s Health Department investigated an outbreak of Legionnaires’ at Co-Op City, another large low-income apartment complex in the Bronx. Three individuals contracted the disease at the apartment complex that shares a hot water supply. One elderly person died.

The Legacy of Legionnaires

Legionnaire’s Disease acquired its name from a previously-unknown illness that struck down over one hundred people that had attended a bicentennial celebration in Philadelphia. Six of fourteen men died after suffering symptoms of severe pneumonia.

According to the Center for Disease Control (CDC), the number of cases reported to CDC has been on the rise since 2000. “Health departments reported almost 7,500 cases of Legionnaires’ disease in the United States in 2017. However, because Legionnaires’ is likely under-diagnosed, this number may underestimate the true incidence.”

Why the increase in this deadly disease?  According to Dr. Laura Cooley of the Respiratory Diseases Branch for the CDC, “there is definitely an increase in the susceptibility of the population in the United States. The population is aging, and there are more and more people on immunosuppressive medications.”

Dr. Cooley further postulated that the Legionella bacterium responsible for the disease is more prevalent in today’s environment, and the reasons are three-fold. Ever-increasing warmer temperatures are ideal for the bacteria to thrive. An aging infrastructure insofar as large, industrialized buildings could also play a factor. Thirdly, improved diagnostic procedures for the detection of respiratory infections have uncovered the presence of the Legionella bacterium, along with heightened physician awareness of Legionnaires’ outbreaks.

Between 2000 and 2014, analysis of twenty seven outbreaks of Legionnaires’ disease revealed that the most common settings for the outbreaks were hotels, long-term care facilities, and hospitals. Legionnaires was found to be significantly represented by potable water sources (showers and sinks), followed by water tower cooling facilities. 

What You Should Know About Legionnaires’ Disease

Legionnaires’ disease is a type of pneumonia that occurs when a person inhales the Legionella bacteria. Legionnaire affects approximately 5,000 people every year in the United States, and occurs all over the world.  It derives from a strain of L. pneumophila (Legionella pneumophila) and thus is a pneumonia-like illness that affects the lungs. It is frequently contracted by breathing in air droplets or mist that contains the Legionella bacteria. In an analysis of the history and presentation of Legionella, the American Society for Microbiology theorized that L. pneumophila in potable water (safe for drinking or food preparation) was isolated most frequently from sediment in hot water tanks and plumbing fixtures where contamination can occur.

Additionally, even though L. pneumophila is susceptible to the deleterious effects of chlorine, the chlorine is not as effective in high-temperature water such as found in hot tubs or heated pools, where the bacterium tends to thrive. Temperatures between 68 and 113 degrees Fahrenheit are ideal for the multiplication and spread of the bacterium.

As mentioned above, the bacterium responsible for Legionnaires’ disease prefers warmer water (especially stagnant water) and in addition, an ideal environment also provides algae, sludge, rust, and lime scale as food for the bacteria. Large buildings such as hospitals and hotels that rely on water-cooled air conditioning systems often provide such an environment. Other water systems such as fountains, water taps, gardening sprinklers, spas, and the evaporative condensers of large scale air conditioning systems, and humidifiers can potentially harbor the bacteria. Legionella thrives in aerosolized mist from air conditioning ducts and can therefore infect large numbers of people. Legionella thrives in aerosolized mist from air conditioning ducts and can therefore infect large numbers of people. Factors that encourage production of Legionella include:

• Water temperature between 68 and 113 degrees Fahrenheit
• Stagnated water
• Scale and/or sediment in the water

Those most at risk for contracting Legionnaires’ disease include individuals over the age of 50, smokers, those with chronic obstructive pulmonary disease (COPD), patients with lung cancer, and individuals with immunosuppressive diseases such as diabetes, kidney disease, leukemia, and those who are undergoing chemotherapy.

If you are an individual with the above health issues, you can minimize your risk by not taking a shower, not even a cold one! Water vapor mist is what spreads the disease. Take a bath instead and fill it slowly. Be careful washing dishes or doing anything that may create a vapor mist.

Legionellosis usually causes symptoms in affected individuals within two to ten days after exposure to the bacteria, and initially the symptoms are as follows:

• Headache
• Muscle pain
• Chills
• Fever of 104 degrees Fahrenheit or higher

After two or three days, other symptoms may include:

• Cough that can bring up mucus and sometimes blood
• Shortness of breath
• Chest pain
• Gastrointestinal difficulties such as nausea, vomiting, and diarrhea
• Confusion

What Can be Done to Curtail Legionnaires’ Disease

The CDC has been in the process of reviewing procedures in order to ameliorate the instances of Legionnaires’ disease. They have been promoting tools for effective water management, seen as possibly the most efficient way to staunching the disease. The United States Environmental Protection Agency has written and released a summary of various technologies that could be utilized to control the Legionella bacterium in plumbing systems. Additionally, the Centers for Medicare and Medicaid Services have issued a requirement for water management programs in some health care facilities.

In a concluding statement, Dr. Cooley of the CDC stated that steps in the prevention of Legionnaires’ disease require a multidisciplinary response. She added, “It’s public health, it’s clinicians, it’s health care facility leaders, it’s the environmental health team, it’s everyone working together to prevent Legionellosis in health care facilities.”

By: Kerry Bazany, Contributing Writer (Non-lawyer)