Legionnaires’ sickens 2, maybe more, at Ohio V.A. clinic

Two veterans were diagnosed with Legionnaires’ disease after visiting the Chalmers P. Wylie V.A. Ambulatory Care Center in Columbus, OH.

Five other patients at the clinic have Legionnaires’ symptoms, but the two veterans are the only ones to have been confirmed with the disease.

The two veterans who were confirmed with the sometimes-deadly respiratory infection visited the clinic’s primary-care area sometime after May 28. One was diagnosed at Chalmers and did not need to be hospitalized; the other was diagnosed at Mount Carmel East Hospital, and is still hospitalized. No information on their ages or genders was provided.

Two veterans sickened: measures taken

V.A. officials have temporarily shut down the facility’s ice makers and 26 water fountains at the clinic until tests can determine if the water is the source of Legionella, the bacteria that causes Legionnaires’ disease.

“This is the time of year that Legionnaires’ disease is most common and, often, the cases are never connected and there is no considered ‘outbreak,’ ” health officials told the Columbus Dispatch.

The company that tests the facility for Legionella performed its quarterly test on June 25. Results usually take two weeks to return.

Bottled water will be provided to visitors and employees at Calmers until the facility is determined to be Legionellafree. Approximately 2,000 veterans visit the facility per day.

Two veterans sickened: busy 2018 in Columbus

Columbus Public Health (CPH) has confirmed 41 cases of Legionnaires’ in 2018, with 26 of those coming in June. None of the 41 cases has been connected to one another, a CPH spokesperson said.

Franklin County Public Health (FCPH) has investigated 23 cases so far this year, 17 in June. None of the 23 cases has been connected in any way.

Two veterans contracted Legionnaires’ disease after visiting a V.A. clinic in Columbus, OH. Five other patients have Legionnaires’ symptoms but have not been confirmed with the disease.

Two veterans sickened: V.A.-acquired cases decreasing

According to a study published online in JAMA Network Open, there was an increase in the overall number of Legionnaires’ disease cases at V.A. hospitals from 2014-16, but a decrease in the number of cases where patients contracted the disease during inpatient visits to the facilities.

There were 491 cases of Legionnaires’ disease reported during 2014-16, with 91 percent of those cases having no V.A. exposure or only outpatient exposure.

“The rate of disease for patients with V.A. overnight stays at the population level was reduced by more than half, from 5.0 to 2.3 per 100,000 enrollees,” wrote researcher Shantini Gamage, PhD, of the V.A. National Infectious Disease Service.

The analysis followed the 2014 implementation of a system-wide policy – including frequent monitoring and specific water-heating temperatures known to kill Legionella – aimed at reducing Legionnaires’ disease within the V.A. health system after several outbreaks, including one in 2011 at the Pittsburgh V.A. medical center in which six patients died and another 20 sickened.

“Data in the V.A. LD databases showed an increase in overall LD rates over the three years, driven by increases in rates of non-V.A. LD,” the authors wrote. “Inpatient V.A.-associated LD rates decreased, suggesting that the V.A.’s LD prevention efforts have contributed to improved patient safety.”

Two veterans sickened: 2013 was largest OH outbreak

The largest Legionnaires’ disease outbreak in Ohio history occurred in 2013, when six people died and 39 others were sickened at the Wesley Ridge Retirement Community in the Columbus suburb of Reynoldsburg. A cooling tower and potable water were the sources for that outbreak, which affected people whose ages ranged from 63 to 99. All six people who died were residents of the retirement community.

Two veterans sickened: Legionnaires’ info

Legionnaires’ disease, which is also known as legionellosis and Legionella pneumonia, is a severe type of lung infection. According to the Centers for Disease Control and Prevention (CDC), an estimated 25,000 cases of pneumonia due to Legionella bacteria (Legionella pneumophila) occur yearly in the United States. However, only 5,000 cases are reported because of its nonspecific signs and symptoms.

Ten percent of people who become infected with Legionnaires’ will die from the infection.

Legionella are contracted by inhaling microscopic water droplets, generally mist or vapor. The bacteria, which grow best in warm water, are found primarily in human-made environments.

Legionella sources
Outbreaks in the United States have been linked to a number of sources:

• large plumbing systems
• showers and faucets
• hot-water tanks and heaters
• swimming pools
• hot tubs and whirlpools
• decorative fountains
• mist machines and hand-held sprayers
• physical-therapy equipment
• water systems, like those used in hospitals, nursing homes, and hotels
• cooling towers of air conditioning systems.

Most at risk
Legionella can sicken anyone, but those most susceptible to the bacteria include:

• people 50 or older
• smokers, current and former
• heavy drinkers of alcohol
• people with chronic lung disease
• people with weakened immune systems
• organ-transplant recipients
• people on specific drug protocols (corticosteroids, for instance).

Disease symptoms
Legionnaires’ disease is similar to other types of pneumonia, and symptoms can even resemble those of flu. Those symptoms include:

• coughing
• difficulty breathing
• fever
• muscle aches and pains
• severe headaches
• gastrointestinal symptoms (nausea, vomiting, diarrhea).

Two veterans sickened: Climate change to blame?

Legionnaires’ disease outbreaks have made headlines across the U.S. nearly annually since the disease was discovered in 1976. That year, more than 200 attendees at an American Legion Convention in Philadelphia were sickened, and 34 of them died.

Legionnaires’ disease is “an emerging disease in the sense that the number of recorded cases of Legionnaires’ in the United States continues to increase,” said Laura Cooley, MD, MPH from the CDC’s Respiratory Diseases Branch. Cooley said the increase is due to a rise in the population’s susceptibility, with more and more people on immunosuppressive medications.

There also could be more Legionella in the environment; warmer temperatures create the right conditions for bacterial growth. The previous three years have been the hottest years on record – NASA ranked 2016 as the warmest and 2017 second-warmest.