Legionnaires' disease (LD) is a preventable, curable but potentially fatal, pneumonia-like illness caused by the bacterium, Legionella. People of all ages can develop LD by inhaling water mists carrying high concentrations of Legionella. Well-known sources of water mists carrying Legionella are cooling towers, evaporative condensers, whirlpool spas, showerheads and fountains. The recent LD outbreaks and resulting deaths in Edinburgh, Scotland and Stoke-on-Trent, England could have been prevented if:

  • The businesses responsible for maintaining the attributed sources of Legionella had taken required prevention and control measures, which includes regular inspections and testing for Legionella;
  • The Health and Safety Executive (HSE), the watchdog agency responsible for enforcing health and safety at workplaces in Great Britain, performed more inspections for Legionella at common sources; and 
  • The hospitals had quickly tested patients with pneumonia-like symptoms for LD and treated them with LD-specific drugs.

LD Outbreak in Edinburgh, Scotland

The outbreak began in late May, 2012, and officially ended on July 18, 2012. A team of experts identified a cluster of water cooling towers in South West Edinburgh as the most likely source of the Legionella that caused the LD outbreak. The cooling towers were treated with strong amounts of chemical disinfectant. There were 53 confirmed cases, 48 suspected cases and 3 deaths caused by outdoor, airborne exposure to Legionella.

LD Outbreak in Stoke-on-Trent, England

This outbreak began around mid-July, 2012. When the number of confirmed LD cases had reached 18, health officials tested a hot tub at a warehouse discount store and found an unusual strain of Legionella that had never been seen anywhere in the world. The strain matched those taken from the patients.

Moreover, detailed patient histories confirmed that 17 of the 18 patients had visited the warehouse in the two weeks before they fell ill. The hot tub had been placed by the entrance of the store where people entering it could inhale the mist.

Currently, there are 20 confirmed LD cases and two deaths. Although the hot tub was decommissioned on July 24, 2012, more LD cases are expected. This is because people generally do not experience symptoms of LD until five or six days on the average after exposure, and then they usually wait a few more days to see the doctor.

Legionella Prevention and Control

Pursuant to general health and safety laws, businesses bear the primary responsibility, not the HSE, to take suitable precautions to protect employees and the wider public from the risk of exposure to Legionella. Detailed guidelines for prevention and control of Legionella are available at the HSE website.

The HSE website contains a veritable list of important prevention and control measures that business must take. Of central importance, however, is (1) regular testing for the presence of Legionella and the conditions that favor its growth and (2) consistent monitoring of water systems to ensure that the prevention and control measures are effective.

Reasons for the Legionella Outbreaks

Legionella experts have offered several reasons for the outbreaks:

  • Recession - When economic times are tough, businesses tend to cut costs by first cutting the maintenance budget, which usually means laying off some maintenance personnel. A reduction in maintenance staff often leads to careless or intentional disregard of proper safety practices. One leading LD expert has claimed that businesses are intentionally falsifying their safety logs. Shoddy safety practices can lead to the creation of environmental conditions suitable for the growth of Legionella. To make matters worse, budget cuts have caused the HSE to significantly cut back workplace safety inspections. 
  • Not enough HSE oversight - When the cat's away, the mice will play. Between 2009 and 2011, proactive, HSE Legionella inspections fell by 44 percent. Surprise inspections have been reduced by a third in the last year. Further, between 2010 and 2011, the HSE inspected only 13 percent of the 2900 cooling towers that fall under its jurisdiction. Moreover, the businesses that were suspected of causing the Edinburgh outbreak had not been inspected in the last two years or more. Infrequent inspections does not engender good safety practices. These include failure to regularly inspect, maintain and test water systems for Legionella and the environmental conditions that make it thrive.
  • Soaring cost of energy - Electricity for many establishments is almost prohibitively expensive now. Whereas plumbing systems used to operate at 60 C (140 F), some hospitals, hotels and public buildings are now operating plumbing systems at 50 C (122 F) to save energy. While this may good for the environment, this is not good in terms of preventing the growth of Legionella, which likes warm water, not hot.

Reason for the Deaths

LD is curable when it is diagnosed. Unfortunately, hospitals do not regularly test for Legionnaires' disease when patients present with pneumonia-like symptoms. Instead, hospitals treat with standard antibiotics, which are ineffective against LD.

A preeminent microbiologist stated that people are dying from LD because they are not tested fast enough. Only when patients do not respond to standard antibiotics will they receive a test for LD, which is a cheap, simple urine test. For some people, the test may come too late.

What We've Got Here Is Failure to Test

Businesses are not testing for Legionella for economic reasons. The HSE has cut back on Legionella inspections for budget reasons. Hospitals will not regularly test for Legionella for curious reasons. Anyway, these are the reasons for the LD outbreaks and deaths, and they could have been prevented.

Author: +Duncan Hollis