California Health Care Facility Legionnaires outbreak: 1 dead, 1 ill

A Legionnaires’ disease outbreak at the California Health Care Facility (CHCF), a prison and hospital, is being investigated by state corrections officials after an inmate-patient died from the severe form of pneumonia.

The facility, located in south Stockton, provides medical care and mental health treatment to inmates who have the most severe and long-term needs, according to the state department of corrections website. There are 1.4 million square feet of space in 54 buildings that accommodate 2,704 patients and a staff of 2,500.

Officials discovered that the inmate-patient who died tested positive for Legionella, the bacteria that causes Legionnaires’ disease, during a postmortem analysis. The inmate-patient died at an outside hospital, but no other information was released on the victim.

The CHCF subsequently started testing all inmate-patients suffering from “radiologically confirmed pneumonia.” Sixteen more inmate-patients were tested, and one other case of Legionnaires was found; 14 inmate-patients tested negative, and results are pending for one inmate-patient.

A Legionnaires’ disease outbreak at the California Health Care Facility prison-hospital in Stockton has resulted in the death of one of two inmate-patients who were sickened.

California Health Care Facility:
Preventative measures taken

CHCF officials said they have implemented these control measures out of an abundance of caution:

• provided education to both staff and patients on Legionnaires’ disease
• provided bottled water for drinking and sanitary functions
• halted the use of aerosolizing equipment
• shut down the use of some showers.

California Health Care Facility:
Numerous investigators

The California Department of Corrections and Rehabilitation, California Correctional Health Care Services, California Department of Public Health, and San Joaquin County Public Health officials are all involved in the investigation. Officials from those organizations said that if they determine a full investigation is necessary, these steps would be taken:

• environmental assessment
• environmental sampling with cultures performed by a Centers for Disease Control and Prevention (CDC) ELITE laboratory (note: ELITE stands for Environmental Legionella Isolation Techniques Evaluation)
• comparison of clinical and environmental isolates
• decontamination of environmental source(s)
• revision of existing water-management programs or development of new programs.

A full investigation would be performed by local health departments or by an experienced environmental consultant contracted by the CHCF.

The Sacramento Bee reported that a prison health executive informed prison staff in a March 22 email of two suspected cases of Legionella pneumonia, urging them to take precautions in two affected buildings.

California Health Care Facility:
High-risk demographics

Legionnaires’ disease is contracted by inhaling microscopic water droplets in the form of mist or vapor containing Legionella. Most people exposed to the bacteria do not get sick, but people 50 and older – especially those who smoke or have a chronic lung disease or COPD – are at a higher risk.

Other people more susceptible to infection include:

• organ-transplant recipients
• anyone on a specific drug protocols, such as corticosteroids
• alcoholics.

The list also includes anyone with an immune system compromised because of:

• frequent and recurrent pneumonia, bronchitis, meningitis, sinus infections, ear infections, or skin infections
• organ inflammation and infection
• blood disorders, such as anemia or low platelet counts
• digestive problems, such as cramping, nausea, diarrhea, or appetite loss
• delayed growth and development.

After Legionnaires’ disease has been diagnosed, hospitalization is usually necessary. In the most severe cases, complications can include respiratory failure, kidney failure, septic shock, or even death.

California Health Care Facility:
Legionnaires symptoms

A 2015 study by the CDC stated that “75 percent of (Legionnaires’ disease) acquired in health-care settings could be prevented with better water management.” The disease usually develops two to 10 days after exposure to Legionella, and it frequently begins with these symptoms:

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

By Day 2 or 3, symptoms can worsen to include:

• coughing, which can bring up mucus or blood
• dyspnea (shortness of breath)
• pleurisy (chest pains)
• gastrointestinal problems, such as nausea, vomiting, and diarrhea
• confusion and other mental changes.

Although Legionnaires’ disease primarily affects the lungs, it can cause infections elsewhere in the body, including the heart.