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A Cuyahoga County Board of Health (CCBH) report on this summer’s Legionnaires’ disease outbreak in Parma, Ohio, concluded that the St. Columbkille cooling system was the likely source of Legionella bacteria that killed one and sickened 10 others.
“The investigation indicates that the design, operation, and location of the current cooling system at St. Columbkille church provided a significant risk and a very likely mode of transmission and pathway for exposure for the Legionnaires’ disease cases,” the 20-page report stated.
The CCBH investigation, which covered June 1 to July 31, identified 31 cases of Legionnaires’ disease that occurred within a 10-mile radius of the suburban Cleveland church. Investigators questioned 25 victims, and 11 of them reported attending St. Columbkille during their incubation period.
All 11 – eight women and three men – were parishioners at the church. Their illness onset dates ranged from June 4 to July 10, and their ages ranged from 74 to 93 years old; the victim who died was a 93-year-old woman.
St. Columbkille cooling system on only during services
The church’s cooling tower was considered a “significant public health threat” because it put parishioners in position to breath in aerosols. The tower is located close to walkways where the public enters and leaves the building.
In addition, church staff said the cooling system was turned on only for church services.
Environmental samples collected from the cooling tower were negative for Legionella but the only commonality with all 11 sickened parishioners was the church. Non-viable (or dead cells) of Legionella were found in samples collected from the downstairs drinking fountain, but that is not considered a possible source for the illnesses because only one of the 11 reported drinking from it.
The CCBH, in consultation with the Ohio Department of Health and the Centers for Disease Control and Prevention (CDC), recommended that the cooling tower not be operated again unless it is relocated or replaced with a non-aerosol-generating cooling system.
St. Columbkille cooling system: Legionnaires FAQs
What is it?
Legionnaires’ disease is a severe type of pneumonia or lung infection contracted by inhaling Legionella bacteria. The disease is also known as legionellosis or Legionella pneumonia.
The infection is treatable with antibiotics, if diagnosed early enough. If that does not happen, however, it can lead to severe complications and even death. It is not contagious.
Who can catch it?
Anyone can become ill from Legionella, but those at the greatest risk of infection include:
- people 50 years old or older
- current and former smokers
- people with a chronic lung disease, or chronic obstructive pulmonary disease (COPD, most commonly emphysema or bronchitis)
- heavy drinkers of alcohol
- people with compromised immune systems.
After Legionnaires’ disease has been diagnosed, hospitalization is often required. In the most severe Legionnaires cases, complications can include respiratory failure, kidney failure, septic shock, or even death.
Where do Legionella live?
Legionella bacteria are contracted by inhaling microscopic water droplets (vapor or mist). The bacteria thrive in warm water, and they are found primarily in human-made environments, including:
- air-cooling systems
- large plumbing systems
- water systems of large buildings (churches, hospitals, nursing homes, hotels, etc.)
- hot-water heaters and tanks
- showers and faucets
- swimming pools, hot tubs, and whirlpools
- physical-therapy equipment
- mist machines, like those in the produce sections of grocery stores
- hand-held sprayers
- decorative fountains.
What are the symptoms?
Legionnaires’ disease usually develops two to 10 days after exposure to Legionella bacteria. The disease frequently begins with the following signs and symptoms:
- muscle aches
- fever, which can be 104 degrees Fahrenheit or higher
By the second or third day, symptoms can worsen to include:
- coughing, which can produce mucus and blood
- shortness of breath (dyspnea)
- chest pains
- gastrointestinal symptoms (diarrhea, nausea, vomiting, etc.)
- confusion and other mental changes.
Although Legionnaires’ disease primarily affects the lungs, it occasionally can cause infections in wounds and other parts of the body, including the heart.
How prevalent is it?
The CDC estimates about 25,000 annual cases of pneumonia due to Legionella bacteria (Legionella pneumophila) in the United States. Only 5,000 cases are reported, however, because of the disease’s nonspecific signs and symptoms.