2018 Hampton outbreak: Almost 50 Legionnaires cases, says NH

New Hampshire health officials released a final report on the 2018 Hampton outbreak of Legionnaires’ disease, and concluded that there were 49 “confirmed, probable or suspected” cases of the disease, including two fatalities.

The total is a far cry from the original total of 18 cases and one death announced last September by the New Hampshire Department of Health and Human Services (DHHS).

The outbreak was revealed when two Massachusetts residents were diagnosed last August with Legionnaires’s disease, a severe type of pneumonia (also called legionellosis and Legionella pneumonia) caused by Legionella bacteria. The infectious bacteria are contracted by inhaling microscopic water droplets (vapor or mist).

DHHS officials traced the initial illnesses to a hot tub at The Sands Resort at Hampton Beach. Other locations were investigated, but no evidence was found to suggest the outbreak began anywhere but at The Sands.

The hot tub at The Sands Resort was identified by New Hampshire health officials as the most likely source for the 2018 Hampton outbreak of Legionnaires’ disease. Nearly 50 people were sickened in the outbreak, the state announced.

2018 Hampton outbreak:
Evidence points to hot tub

No additional cases were reported after the DHHS shut down The Sands’ hot tub.

“The inadequate maintenance of The Sands Resort hot tub – as well as other conditions within the facility, such as low hot water temperatures – may have favored the growth of Legionella bacteria,” the 103-page report concluded. “Legionella bacteria were detected in nearly half of the environmental samples collected at the hotel, with six samples from the hot tub having the same strain of Legionella pneumophila serogroup 1 as was found in respiratory specimens from two people with confirmed Legionnaires’ disease who stayed at The Sands Resort.”

All told, there were 34 “confirmed” illnesses and an additional 15 “suspected” cases, 14 of which were classified as “probable.” Patients ranged in age from 3 years old to 88 years old.

Seventy percent of the cases involved people who had lodged at The Sands within 14 days of developing symptoms. Fifteen victims did not stay at The Sands, but all reported walking past or being within proximity of the hotel.

2018 Hampton outbreak:
Rare outbreak for NH

The incident was New Hampshire’s first reported outbreak of Legionnaires’ disease in 15 years. The DHHS said it received an average of 32 reports of legionellosis each year from 2013 to 2017.

Joining the DHHS in the outbreak investigation were the New Hampshire Department of Environmental Services, the Centers for Disease Control and Prevention (CDC), and Hampton officials.

At least eight people sickened during the outbreak have filed suit against The Sands. Olsen represents one of the Massachusetts residents who were sickened.

2018 Hampton outbreak:
Oversight lacking

Nationally, hospitals and nursing homes are required to bolster control of building water systems and medical equipment that could expose anyone to harmful Legionella. There is, however, little regulatory oversight of apartments, hotels and other non-medical buildings.

“There’s not a lot of people checking up on a hotel, a condominium or a large building,” Olsen told USA Today for an article published recently. “I am not aware of any oversight really at any level.”

2018 Hampton outbreak:
About the disease

The CDC estimates that there are about 25,000 cases of pneumonia due to Legionella bacteria yearly in the United States, but only 5,000 cases are reported because of the disease’s nonspecific symptoms. The first day or two, those symptoms often include:

• muscle pains
• severe headaches
• fever, which can be 104 degrees Fahrenheit or higher
• chills.

By the second or third day, symptoms can worsen and include:

• cough, which can bring up mucus and blood
• difficulty breathing, or dyspnea
• chest pains, or pleurisy (also called pleuritic chest pain)
• gastrointestinal symptoms, such as nausea, vomiting, and diarrhea
• mental confusion.

Although Legionella primarily attack the lungs, the bacteria occasionally can cause infections in wounds and elsewhere in the body, including the heart.

High-risk groups
Anyone can become ill from the bacteria, but people most susceptible to infection include:

• anyone 50 or older
• smokers, current or former
• anyone with a chronic lung disease (CLD) or chronic obstructive pulmonary disorder (COPD, most commonly emphysema or bronchitis)
• anyone with a weakened immune system
• organ-transplant recipients
• anyone on a specific drug protocol, such as corticosteroids
• alcoholics.