Potential for Serious Legionnaire's Disease Outbreak in London

A recent Health and Safety Executive (HSE) report in England leaked information regarding a serious health concern to the people of London. As a result of mismanaged cooling towers and evaporative condensers that are located near English Olympic sites, and other highly visited public locations such as train stations and airports, London residents and visitors now may be at risk for being infected with the serious and sometimes fatal Legionnaire’s disease.

Prior to the 2012 Summer Olympics in London, health and safety inspectors tested sites such as Heathrow Airport, London City Airport, London Bridge Station and Saint Pancras train station, as well as sites where Olympic games were to be held. Out of all the sites tested, 62 sites around London tested positive for Legionella bacteria, the cause of Legionnaire’s disease. This means that nearly 75 percent of the sites tested were positive, indicating poor levels of compliance for health and safety policies.

Such non-compliance could lead to the potential for prosecution for individuals and businesses. Non-public sites had better compliance rates than public sites. All sites that were found to be non-compliant were either given a written improvement notice, a verbal warning, or a written warning, and only one is being considered for prosecution. The HSE recommends weekly monitoring of wet cooling systems for Legionella bacteria. In addition to the United Kingdom, many other areas of the world also test for Legionella bacteria such as the City of Garland, Texas, and the country of Malta.

It is predicted that a Legionnaire’s Disease in London could be worse than the outbreak Edinburgh, the Scottish capital, was faced with in June of this year. In Edinburgh, three people died as a result of the outbreak and nearly 100 were infected and ill with Legionnaire’s disease. The outbreak was later linked to the cooling towers to the south and west of the city. London is expected to have a more severe and widespread outbreak due to the amount of people that travel around the areas that tested positive.

There was also another outbreak of Legionnaire’s Disease in July of this year in Stoke-on-Trent. This outbreak was believed to be linked to a hot tub display. This resulted in illness for 21 people and the deaths of two others. Chicago, Illinois also experienced an outbreak in 2012 due to the presence of Legionella bacteria in a decorative lobby fountain of the JW Marriot Hotel. There were 8 confirmed cases of Legionnaire’s disease among hotel occupants, with a 30 percent mortality rate.

Emeritus professor of bacteriology at the University of Aberdeen, Dr. Hugh Pennington, states that the details leaked in the HSE report call for immediate action to keep London and those who live and travel there safe. Although fatal, Legionella can be prevented and treated.

Legionnaire’s disease is caused by gram negative, aerobic bacteria. Most cases are caused by the bacteria Legionella pneumophila, which is a widespread aquatic organism that does best in temperatures between 25 and 45 degrees Celsius. This is why the bacteria thrive in cooling towers, as well as other water areas. Legionnaire’s disease causes a high fever and pneumonia, a severe lung infection. The same bacteria can also cause Pontiac fever; however it causes a more mild respiratory illness, not pneumonia, and acts like the flu. Pontiac fever also resolves on its own without treatment.

Legionnaire’s disease became known by such a name in 1976 when people attending an American Legion convention at the Bellevue-Stratford Hotel in Philadelphia, PA experienced an outbreak of pneumonia. The bacteria causing the outbreak were previously unidentified. Strangely, some individuals can contract these bacteria and only show mild symptoms or none at all. Generally, outbreaks are not seen and certain individuals contract this on their own and do not pass it on to others. People who are middle-aged and older are more likely to succumb to the Legionella bacteria. Outbreaks of Legionnaire’s disease are more often to occur in the summer and early fall than any other time of year.

Those who contract Legionnaire’s disease usually have such symptoms as cough, fever, and chills. The cough can be dry, or produce sputum. Other common symptoms are headaches, muscle aches, ataxia, diarrhea, vomiting, deceased or loss of appetite, and fatigue. Severe cases may involve confusion and a low heart rate. Most of the time a diagnosis of Legionnaire’s disease cannot be made by chest x-ray alone. Though a chest x-ray will show pneumonia, it cannot show which bacteria caused the pneumonia. In order to thoroughly diagnose Legionnaire’s disease the sputum of an infected patient much be tested, or urine or blood tests must be conducted.

Legionnaire’s disease is very rare, which has lead to an under-reporting challenge across the globe. Many medicine practitioners have never truly seen a case of Legionnaire’s disease, which can lead to misdiagnosis. A wide range of symptoms are also attributed to this disease, also making it harder to pinpoint the correct diagnosis.

The treatment for Legionnaire’s disease is antibiotics. Many different antibiotics are effective in treating Legionnaire’s disease such as levofloxacin, azithromycin, erythromycin and tetracycline. If the correct antibiotics are started quickly, the mortality rate is now only 5 percent. If antibiotics are not started early, the mortality rate can go up to 30 or 40 percent.

Legionella bacteria are spread through the air, potentially originating through an infected aquatic source. It can also travel at least 6 km from its source. Poorly ventilated areas are prone to the presence of Legionella bacteria. Outbreaks can be linked to air conditioning, humidifiers, nebulizers, showers, windshield washers, ice-making machines, hot tubs misting equipment, as well as many other types of machinery that use water. Hosipitalshotels, prisons, cruise ships, and fountains are common places where these bacteria are spread. Once an individual has been exposed to Legionella bacteria it usually takes two to ten days for the disease to be developed. For the milder Pontiac fever, it can only be a few hours to two or three days from exposure to onset of illness.

Outbreaks related to cooling towers can be large scale, as is the current concern with the situation in London. This is because the Legionella bacteria are present in the air, and anyone minding their own business, walking down the street, getting on a bus or preparing to see a sporting event can become infected.

The HSE claims warnings of severe Legionnaire’s disease outbreaks are unwarranted and that the inspector who made the report was only speculating and inferring a personal opinion about what could happen. The HSE claims this warning of such propensity is not backed up by any founded research or evidence. A final version of the HSE report is yet to be released.

Author: +Duncan Hollis