Category Archives: Legionnaires Disease Control & Outbreaks

Potentially Lethal Legionella Bacteria in Aged Care Facilities

POTENTIALLY lethal Legionella bacteria have been discovered in the water supplies for two care homes in Barnet, prompting calls for an inquiry from a trade union.

Staff and residents in Apthorpe Lodge in Nurserymans Road, New Southgate, and Dell Field Court in Etchingham Park Road, Finchley, were sent letters yesterday explaining the situation.

Both facilities are run by Freemantle Trust who were subcontracted by Catalyst Homes, who Barnet Council are due to pay around £7 million following arbitration after a dispute about their care contract.

The elderly are particularly vulnerable to the bacteria, which can cause legionnaires’ disease, and can be contracted by inhaling water vapour.

Common methods of stopping the bacteria from spreading include keeping hot water above 45 degrees Celsius.

Forty pensioners are cared for at Dell Field Court and 50 in Apthorpe Lodge and both were built in 2003.

However, the problems have led to calls from Barnet Unison secretary John Burgess for an inquiry into how the bacteria were allowed to develop.

He said: “These are relatively new facilities, so how does something like this happen. Legionella is a very serious bacteria, who was performing the proper checks?

“Barnet Council needs to run a full inquiry to find out how this happened.”

A statement from Barnet Council said the bacteria were found during routine tests and the water systems have already been treated to “ensure there is no significant danger to residents or staff”.

Legionella Bacteria Hiding in treated water

Legionella ‘hiding’ in treated water
February 22, 2011

BACTERIA that cause the deadly legionnaire’s disease can persist in drinking water even after it has been chemically treated, according to the results of research in Sydney that suggests a need for increased testing.

The bugs can hide inside amoebae – generally harmless micro-organisms resistant to chlorine disinfection – which may later burst to release pathogens, say University of NSW scientists.

The phenomenon could explain a rise in the disease despite filtration and disinfectants in public water supplies.

A microbiologist at the University of NSW, Jacqueline Thomas, began researching amoebae in drinking water after legionella was found in Nepean Hospital’s water system and a car wash in Victoria in May 2008.

”[We wanted] to find how legionella was growing and spreading through water systems even after extensive treatment with chlorine and other filtration methods,” she said.

In NSW, infections from the bacteria increased between 2004 and 2007 and have since stabilised. The young, elderly and people with compromised immune systems are the most susceptible to the infection.

Ms Thomas said identifying the extent to which drinking water contributed to legionella infections in NSW was difficult because of limited testing and poor tracing of infections to their environmental source. But the Centres for Disease Control and Prevention in the United States found legionella accounted for 29 per cent of all drinking-water-borne disease outbreaks in that country between 2001 to 2006.

State water utilities are not required to regularly test for amoebae or legionella in their treatment and distribution systems under the Australian Drinking Water Guidelines, which are set and reviewed by the National Health and Medical Research Council.

Ms Thomas and her colleague Nicholas Ashbolt found bacteria such as legionella can become more infectious living inside amoebae.

”They can actually grow and replicate quite well in there, and because amoebae are bigger organisms they are resistant to drying out from chlorine to a larger degree,” said Ms Thomas, who is completing her doctorate with the university’s Water Research Centre. ”The thing that was really surprising was just how frequently amoebae were detected across all types of drinking water systems. It was a lot higher than anyone in the water industry had anticipated.”

Sydney Water said it used adequate disinfection and managed its flow rates to avoid stagnant water and increased temperatures to minimise the growth of amoebae and legionella.

Drinking water is tested and monitored at every stage of the supply system, including after it is treated, in distribution pipes and at customers’ taps, a spokesman said.

But Ms Thomas found amoebae could also breed inside house pipes, shower heads and taps.

Ms Thomas’s review of international research is published in the journal Environmental Science & Technology.

About 200 people who attended the Playboy Mansion were infected by Legionella Bacteria

The water-borne infections that struck guests of the Playboy Mansion are more common than you think.

According to the Los Angeles County Health Department, about 200 people who attended a recent Playboy Mansion fundraiser were infected by Legionella bacteria. Four of them came down with Legionnaires’ disease, a sometimes deadly pneumonia; the rest had Pontiac fever, a flu-like illness that lasts about three days.

As many as 18,000 people in the United States contract Legionnaires’ disease each year, according to the Centers for Disease Control and Prevention (CDC), 5% to 30% of whom die from it within a few days or weeks.

About 90% of Legionnaires’ cases go undetected, in part because physicians treat the pneumonia but don’t test for Legionella bacteria.

“That’s a big problem,” says Matt Freije, author of Protect Yourself from Legionnaires’ Disease: The waterborne illness that continues to kill and harm. “If Legionella is not recognized as the cause of the infection, then no investigation is performed to pinpoint and fix the plumbing system, hot tub, or other water system that caused it, and that water system can continue to make people sick.”

Pontiac fever is even less likely than Legionnaires’ disease to be diagnosed because it is less severe. Most of us don’t even go to the doctor when we get the flu, let alone try to find out what caused it. Generally, Pontiac fever is recognized only when physicians in the same vicinity report several flu-like illnesses at the same time, attracting the attention of the health department, as with the Playboy event.

According to Freije. “Laws in much of Australia and Europe require building owners to maintain water systems to minimize Legionella bacteria but prevention is not mandated in the United States. I have received emails from many Legionnaires’ survivors who were outraged to find out they suffered from a disease that is preventable.”

Steve Sederstrom is one of the Legionnaires’ survivors who tells his story in Freije’s book. “My experience with Legionnaires’ disease was the worst thing I have ever been through. After five months I still have a major problem with short-term memory-I forget where I am going, or forget people’s names even though I have known them for years. I am afraid that I will never get my memory back.”

Water Management Australia Pty Ltd awarded Total Water Management Contract

Water Management Australia Pty Ltd was awarded a Total Water Management Contract by a major Food Production Facility. Water Management Australia Pty Ltd was awarded the contract because they were able to provide the best value for money & manage all of the cooling towers, evaporative condensers, fluid coolers, evaporative air coolers, warm water systems, showers, brine loops, hot water boilers, steam boilers, water softeners, potable water systems, ultra violet disinfection units, reverse osmosis plants, water filters, ice makers & waste water treatment plant.

Nalco fined over Legionnaires Disease Outbreak

HSE prosecutes HP Bulmer Ltd and Nalco Ltd following outbreak at Hereford site, which killed two people


London – The Health and Safety Executive is warning companies to ensure that water storage and cooling systems are adequately treated to prevent the growth of the legionella bacteria. The call comes after HP Bulmer Ltd and Nalco Ltd were fined over an outbreak of Legionnaire’s disease at Bulmer’s Cider Mills site in Hereford.

The outbreak, which occurred in 2003, caused the deaths of two people, with the Health Protection Agency attributing a total of 26 cases of legionnaire’s disease to the outbreak. In Hereford Crown Court on 1 July, the companies were each fined £300,000 with costs of £50,000, having previously entered guilty pleas following a HSE investigation into cooling towers at the plant.

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Two More West Australians Diagnosed with Legionnaires Disease

February 4, 2011 – 9:00 AM
Two more West Australians have been diagnosed with Legionnaires’ disease after travelling to Bali in the past few months.

This brings the total number of WA travellers found to have the disease to nine, with four more people from other Australian states diagnosed since the start of December.

Department of Health communicable disease control director Paul Armstrong said while the exact source of the disease was not yet known, all but one of the 13 people had stayed at the Ramayana Resort and Spa Hotel in Kuta.

Indonesian Government has been advised of the Australian cases by the Australian Government and is working with the World Health Organisation to investigate the possible source of the disease,” Dr Armstrong said.
“The investigating team has taken steps to disinfect potential sources at the hotel, but it’s not yet clear this has been successful.”

Early symptoms of the disease are typical to severe flu-like illnesses and can include fever, chills, muscle soreness, headaches, dry coughs and breathlessness.

The Department of Health is advising recent travellers to Bali and who have developed flu-like symptoms to contact their GP.

Legionnaires’ disease is communicable by the inhalation of water droplets from contaminated water, and cannot be caught from other people or animal contact.

Amoebas In Drinking Water

1/31/11 3:56 PM
Amoebas In Drinking Water: A Double Threat – Science News
Page 1 of 5


By Janet Raloff
Web edition : Friday, January 28th, 2011

Amoebas in drinking water: a double threat
Analysis reveals widespread, hidden contamination by the
sometimes lethal parasites
Amoebas — blob-shaped microbes linked to several deadly diseases
— contaminate drinking-water systems around the world, according to
a new analysis. The study finds that amoebas are appearing often
enough in water supplies and even in treated tap water to be
considered a potential health risk.
A number of these microorganisms can directly trigger disease, from
a blinding corneal infection to a rapidly lethal brain inflammation. But
many amoebas possess an equally sinister if less well-recognized alter
ego: As Trojan horses, they can carry around harmful bacteria,
allowing many types to not only multiply inside amoeba cells but also
evade disinfection agents at water-treatment facilities.
Even though recent data indicate that amoebas can harbor many
serious waterborne human pathogens, U.S. water systems don’t have
to screen for the parasites, according to study coauthor Nicholas
Ashbolt of the U.S. Environmental Protection Agency’s National
Exposure Research Laboratory in Cincinnati. He coauthored a study of
amoebas’ “yet unquantified emerging health risk” in the February 1
Environmental Science & Technology.
He and Jacqueline Thomas of the University of New South Wales in
Sydney analyze data from 26 studies conducted in 18 countries. All
had identified amoebas in drinking-water systems. Some reports had
focused on measurements at treatment plants, others in exiting
water; some even extracted the parasites from tap water. Indeed,
among 16 studies that looked for tap-water contamination, 45
percent reported finding amoebas.
In 2003, Francine Marciano-Cabral of Virginia Commonwealth
University in Richmond and her colleagues identified one species of
amoeba that is directly lethal — Naegleria fowleri — in water
throughout the plumbing of an Arizona home where two young boys
had recently died. The amoeba explained the boys’ fatal encephalitis,
a brain disease.
“We suspect they got it from submerging in the bathtub,” Marciano-
Cabral says. The family’s private water supplies had not been
chlorinated, a disinfection process that can limit amoeba
Thomas and Ashbolt reviewed six studies that together included data
from 16 different water-treatment plants and probed for sources of
the amoebas that the studies had turned up. Five of those studies
reported finding a high prevalence of the parasites — in anywhere
from 75 to 100 percent of the surface waters, such as rivers, that
were sampled. After water treatment, often using carbon filtration or
chlorination, contamination levels dropped somewhat, to fewer than
50 percent of water samples.
In general, the new analysis points out, water treatment appears to
reduce amoeba concentrations to a tenth or one-hundredth of starting
concentrations, “but breakthrough events do occur and release
potentially high numbers of free-living amoebae” — roughly 110 of
the parasites per liter — into drinking-water distribution systems.
For instance, Megan Shoff of the Ohio State University in Columbus
and her colleagues analyzed water from storage tanks above home
toilets throughout Broward, Palm Beach and Dade counties in Florida.
These free amoebas — ones not shielded by a slimy biofilm — turned
up in 55 of 283 samples, or almost one in five. Eight samples
contained Acanthamoeba, a type that other studies have associated
with corneal infections in contact lens wearers.
Such findings indicate that these amoebas either survived the
upstream water-treatment plant or entered the community
distribution system, perhaps through cracks in feeder pipes, Thomas
and Ashbolt say.
Acanthamoeba is but one of several genera of amoeba that can
harbor Legionella pneumophila, the bacterium responsible for virtually
all cases of Legionnaires’ disease. Indeed, Ashbolt says, studies have
shown that residing in an amoeba “increases the virulence of
Legionella,” the leading source of waterborne disease in America. So if
these bacteria have spent time in an amoeba host, he says, “they are
more likely to be infectious in us.”
Gunnar Sandström of the Karolinska Institute in Stockholm is finding
much the same with Vibrio cholerae germs. Cholera epidemics, he’s
found, occur most frequently when the waterborne germs occur
together with amoeba, including Acanthamoeba. And in the lab he’s
shown that residence inside an amoeba increases the expression of
438 V. cholerae genes and reduces the expression of 396 others.
“We don’t yet know exactly what these genes do,” he acknowledges,
but the end result is bacteria that survive better within amoebas —
replicating to populations that can easily reach the 100 million cells
that he says are needed to trigger human infection.

Sandström says his preliminary data show that “If we feed V.
cholerae to one amoeba, the bacteria will grow until they reach
around 100 cells. Then stop.” In the lab, if he then feeds one of those
bacteria to a new amoeba, the bacteria won’t stop multiplying until
populations inside the amoeba reach 10,000 cells. By continuing this
iterative process, he has observed germ growth within a single
amoeba of up to one billion cells.
He concludes that amoebas “appear to be a training ground for the
Vibrio and key to the infectivity of cholera.”
The Thomas and Ashbolt paper “is a beautiful synthesis of prior work
that was really much needed for progress on both the pathogenic-
amoeba issue as well as for understanding Legionella disease” and the
natural ecology of other bacterial diseases associated with home
plumbing, says Marc Edwards of Virginia Tech in Blacksburg.
Amoeba contamination of drinking water probably should be
regulated, Edwards contends, but can’t be until more data quantify
the occurrence and risks associated with these pathogens. This new
paper “is a critical first step” in that process, he says. Its synthesis of
more than 100 studies “shows there’s just overwhelming evidence
that this microorganism is occurring at levels that are a health
concern in a large percentage of [water-distribution] sites.”
J. Raloff. Big water losses. Science News blog, October 22, 2008.
J. Raloff. The case for very hot water. Science News blog. October 23,
2008. Available
J.O. Falkinham, et al. 2008. Mycobacterium avium in a shower linked to
pumonary disease. Journal of Water and Health 6(2):209. Available
G.J. Kirmeyer and M.W. LeChevallier. 2001. Pathogen Intrusion Into
Distribution Systems [Project #436]. American Water Works
Association Research Foundation.
H.Y. Lau and N.J. Ashbolt. The role of biofilms and protozoa
in Legionella pathogenesis: implications for drinking water. Journal of
Applied Microbiology, Vol. 107, August 2009, p.
368. doi:10.1111/j.1365-2672.2009.04208.x. Abstract
1/31/11 3:56 PM
Amoebas In Drinking Water: A Double Threat – Science News
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F. Marciano-Cabral, et al. Identification of Naegleria fowleri in Domestic
Water Sources by Nested PCR. APPLIED
ANDENVIRONMENTAL MICROBIOLOGY, Vol. 69, October 2003, p. 5864.
DOI:10.1128/AEM.69.10.5864–5869.2003. Abstract
M.E. Shoff. Prevalence of Acanthamoeba and other naked amoebae in
South Florida domestic water. Journal of Water and Health, Vol. 6, p.
99. doi:10.2166/wh.2007.014. Abstract
G. Sandström, A. Saeed and H. Abd. Acanthamoeba polyphaga is a
possible host for Vibrio cholerae in aquatic environments. Experimental
Parasitology, Vol. 126, September 2010, p. 65.
DOI:10.1016/j.exppara.2009.09.021. Abstract
J.M. Thomas and N.J. Ashbolt. Do Free-Living Amoebae in Treated
Drinking Water Systems Present an Emerging Health Risk?
Environmental Science & Technology, Vol. 45, February 1, 2011, p.
860. DOI: 10.1021/es102876y. Abstract at:


14 Bali Tourists now have Legionnaires Disease

ur opinion! Denpasar. A total of 14 foreign tourists are now confirmed to have contracted Legionnaires’ disease in Bali since reports of an outbreak emerged earlier this month, health officials said on Saturday.

The previous tally of 11 recorded cases was announced on Jan. 21 and involved nine Australians, one Dutch national and a French national, all of whom have since returned to their respective countries.

The three new cases all involve Australians, Nyoman Sutedja, head of the Bali Health Office, said at a discussion with tourism industry stakeholders on combating the outbreak.

He said a joint investigation by the Health Ministry and the World Health Organization following the initial reports in the middle of this month had pinpointed the source of the infection to a hotel in the vicinity of Matahari Square in the tourist hub of Kuta.

Sutedja said the hotel owner had cooperated with the authorities in checking for the Legionella bacteria that causes the diseases, including allowing them to check the hotel’s air-conditioning cooling tower, shower heads, faucets, plumbing and swimming pool.

He also said there were fears that the water vapor-borne bacteria could have spread around the island to popular tourist sites such as Tanah Lot, Ubud, Singaraja and Karangasem.

“We’ve asked health officials in all districts to carry out thorough investigations into cases of respiratory illnesses and report to us routinely,” he said.

Anak Agung Ngurah Jaya Kusuma, director of medicine and nursing at Denpasar’s Sanglah General Hospital, said at the same discussion that cases of Legionnaires’ disease might date back to July 2010, when an Australian tourist died of Legionnaires’-like symptoms at Sanglah.

He added that the following September, Australian authorities confirmed that three of their citizens had tested positive for the disease after returning from trips to Bali.

Jaya Kusuma said Sanglah, the island’s biggest hospital, did not have the equipment needed to detect Legionnaires’ infections.

“Just to order the diagnostic equipment is as complicated as trying to order a Ferrari – you have to get on an import waiting list,” he said.

Sutedja called on hotel owners to take extra measures to prevent the spread of the bacteria, including drying out AC cooling towers not in use, cleaning pools and other sources of standing water, and ensuring that all towels and linen are kept dry.

Participants at Saturday’s discussion agreed to include Legionella bacteria in the health office’s watch list for routine inspections, which also looks for salmonella and E. coli.

The health office currently charges each hotel Rp 200,000 ($22) to test for the two latter bacteria.

“With the new check for Legionella, we might need to charge an extra Rp 1 million to Rp 1.2 million,” Sutedja said.

Perry Markus, head of the Bali chapter of the Indonesian Restaurant and Hotel Association (PHRI), said the extra cost would not be a problem for hotel owners.

“We want to show that we’re serious about preventing Legionnaires’ from spreading like bird flu, swine flu or SARS,” he said.

He added that while the effect of the outbreak on tourism was still negligible, foreign tour operators were expressing concern.

Ida Bagus Subhiksu, head of the Bali Tourism Office, said it was important to stop the outbreak from crippling the island’s all-important tourism industry.

“Bali has a very high profile, so when visitors come here, we don’t want them going home sick,” he said.