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Second Death In Legionnaire's Outbreak

A second person has died of Legionnaires' disease following an outbreak in Cumbria, health officials said today.

A woman aged in her 50s died overnight becoming the second victim of the disease which has already infected more than a hundred others.

Last night 23 patients were in intensive care with two giving doctors cause for concern.

It was not known whether the second victim of the disease was one of those two seriously ill.

An 88-year-old great-grandfather died a week ago after contracting the disease following months of failing health.

Pensioner Richard Macaulay, who was known as Gerry, became the outbreak's first victim last Friday.

The bug, a form of pneumonia, is carried on tiny water droplets and is more dangerous among those with poor immune systems, such as the elderly or the very young.

So far, a total of 110 people have been confirmed as having caught the disease.

But the incubation period of the bug, which can as long as 10 days, means doctors are anticipating new cases to be admitted to hospital through the weekend.

Around 150 have needed hospital treatment for confirmed or suspected cases of the disease - making it the biggest outbreak in the UK for more than a decade.

All had been in or around the centre of Barrow-in-Furness during July.

Since the outbreak was uncovered 10 days ago, more than 1,250 people have been tested for the bug - equivalent to more than one in 60 people living in the Cumbrian port town.

A 30-year-old air conditioning system at the council-run Forum 28 arts centre was closed down last Thursday after being blamed as the source of the outbreak.

Tests on the system found traces of the Legionnella bacteria, which causes the disease, in the water treatment plant.

A council officer responsible for maintaining the system has been suspended pending the results of a police and Health and Safety Executive investigation.

Legionnaires' disease earned its name in 1976 after an outbreak of pneumonia at an American Legion convention in Philadelphia, from which 29 people died.

Morecambe Bay Hospitals Trust chief executive Ian Cumming said the woman had been admitted "a few days ago" and was suspected to have contracted the disease from the suspect air conditioning unit.

He told BBC Radio 4's Today programme that there were still 90 patients in hospital with the disease, some of whom were "really quite poorly".

Asked whether there might be further deaths, he said: "This is a very nasty disease and people do tend to deteriorate very quickly. Obviously we are hoping we will not see any more deaths, it's too soon to be complacent."

A spokesman for Morecambe Bay Hospitals NHS Trust later confirmed that the woman had died at Furness General Hospital in Barrow.

"Our thoughts and deepest sympathy go out to the family and friends of this lady at this time," added chief executive Mr Cumming.

Mr Cumming said the number of new patients being admitted to hospital was now dropping.

About 100 patients were still receiving hospital treatment, though many were now making good progress.

However, he added: "We are by no means through this terrible time."

A total of 1,400 tests had been carried out during the outbreak, with 110 people being confirmed as having the disease.

Of those, 38 patients had already been discharged from hospital, leaving a total of 94 being treated for confirmed or suspected Legionnaires' disease.

Fifteen patients were in intensive care units in Barrow, Lancaster, Chorley, Preston and Blackpool with a further six in high dependency wards.

Two patients were giving doctors cause for concern.

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Legionnaires' Disease: Sydney Outbreak Reaches 10 Cases As Authorities Search For Source

People who have visited Sydney's CBD recently have been warned to be alert for symptoms of legionnaires' disease.

NSW Health says 10 people who developed the disease spent time in the city between 15 December and 23 December.

But what is legionnaires' disease, how can you catch it, can it be fatal and what caused this outbreak?

What is legionnaires' disease?

Legionnaires' disease – named after an outbreak at a conference of American Legionnaires in 1976 – is a form of pneumonia, or lung infection, caused by legionella bacteria.

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The bacteria can be found in damp environments and, in Australia, the two most common types are found in water and soil.

Legionnaires' disease is a notifiable disease – meaning doctors must tell NSW Health if a patient tests positive.

What are the symptoms?

Symptoms include fever, chills, a cough and shortness of breath. Some people may also have muscle aches, headaches, tiredness, loss of appetite and diarrhoea.

Legionnaires' disease may lead to severe chest infections such as pneumonia. It can also affect the liver, kidneys or heart. Most people recover but the disease is occasionally fatal, according to NSW Health.

Richard Bentham, an associate professor from Flinders University, says legionnaires' disease is fatal for about 10% of people who contract it. However, those who develop the disease are a susceptible subgroup of the general population.

"Most people who are exposed to the bacteria won't show any symptoms at all, or they [might] show mild symptoms, feel a bit off for a couple of days and get over it," Bentham says.

Those at highest risk of contracting the disease are smokers, people over 50, those with existing chest or respiratory disease and immunocompromised people.

Can we expect more cases?

Given it's still the incubation period for the current cluster, Bentham says it "wouldn't be surprising" if a few more cases appeared in people who don't yet know they've been infected.

"[But] I would expect there wouldn't be many more cases after another five to seven days."

How do you catch it?

People can contract legionnaires' disease by breathing in contaminated dust or water vapour. NSW Health says the disease is not spread from person to person.

There are only a few cases in the legionella literature regarding possible transmission between people, with the general view being it is not a transmissible disease, Bentham says.

Symptoms can develop up to 10 days from the time of exposure to contaminated water particles in the air.

Who contracted it and where?

In the current outbreak, 10 people have been identified with the legionella bacteria that causes legionnaires' disease. They include three women and four men ranging in age from their 20s to their 70s – plus three additional people not included in the initial health alert.

The 10 people independently visited locations in the Sydney CBD between Bathurst Street, Sussex Street, Elizabeth Street and Circular Quay between 15 December and 23 December.

They have all been admitted to hospital for the treatment of pneumonia.

What is the source of the Sydney cluster and what's being done about it?

The legionella bacteria are often associated with contaminated cooling towers of large buildings. These work to cool buildings by recirculating water through a heat exchanger.

Air comes into the cooling tower from outside – bringing dust and dirt which acts as food for bacteria. Cooling towers operate at about 25C to 30C when warming water.

"So basically the bacteria find themselves in a nutrient-filled incubator," Bentham said.

The current Sydney cluster could be attributed to the Christmas break when some buildings shut down. The cooler weather also means air conditioning could be turned off.

"If the cooling towers [are] turned off and left off for a while, the legionella grows in that slime; the slime detaches, then when it is turned on, a big flush of bacteria suddenly goes into the cooling tower and goes out in a drift, and that may happen before the chemical treatment can get to them and treat them," Bentham says.

Cooling towers generate a fine mist – or aerosol – which is released into the air and can be inhaled into the lungs. This is how people can contract the disease.

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NSW Health environmental health officers are working with the City of Sydney to inspect cooling towers. A review of maintenance records "will also help determine further towers to be inspected and sampled", the department says.

Managers of buildings with cooling towers are being contacted and asked to ensure they are operated and maintained correctly.

Prof Mark Ferson from the public health unit at the South Eastern Sydney Local Health District says there are various enforcement mechanisms NSW Health can use if cooling towers are not operating correctly – including improvement notices with fees.

It takes five to seven days for a laboratory to grow the legionella bacteria and determine whether a cooling tower is contaminated.

Can the cluster be linked to a specific cooling tower?

NSW Health says a cooling tower that is the source of an outbreak may not be identified despite careful investigations. That's because it could be transiently contaminated by bacteria floating through the air and the cooling tower's regular cleaning processes may decontaminate it – even before infected patients are diagnosed.

How is legionnaires' disease treated?

People can be diagnosed with legionnaires' disease by a urine or sputum test and a chest X-ray. They usually require antibiotic treatment in hospital.

For serious infections, patients may be treated in the intensive care unit and have their breathing assisted using a ventilator.

Should people be wearing masks?

NSW Health is not advising people in the Sydney CBD to wear masks – but instead remain on the lookout for any symptoms.

Bentham says wearing a mask "wouldn't be a bad idea" for those most at risk until the outbreak is over.

"They will provide some protection," he says. "The sort of masks that we wear around the street won't stop aerosol but will reduce the amount of aerosol getting into the lungs and [help prevent] people getting sick."

Why do these outbreaks happen and can we stop them?

The only real way to manage the spread of legionella bacteria into the community via cooling towers is continual maintenance, experts say.

"If they are well managed, legionella is well controlled and there aren't cases of legionnaires' disease but … that doesn't always happen," Bentham says.

"Because [cooling towers sit] on the roof just providing air conditioning, they tend to get a bit forgotten."

There are Australian standards for designing and maintaining cooling towers as well as regulations in NSW. The latter includes monthly checks and sampling for bacteria, including legionella. The health department can also conduct random inspections.

Legionnaires' Outbreak: Council Worker Suspended

A council officer responsible for the maintenance of an air-conditioning plant thought to be at the centre of a massive outbreak of Legionnaires' disease has been suspended, it emerged today.

The technical manager at Barrow Borough Council was suspended on full pay "to minimise contact with other officers" while investigations into the source of the outbreak were ongoing.

Today the chief executive of the council said it was co-operating fully with the police and the health and safety executives but was not in a position to reveal details about if the plant has been properly serviced.

The council had been notified early on Thursday afternoon that there was a possible outbreak of the potentially fatal form of pneumonia and closed down the Forum 28 arts and civic centre three hours later.

Speaking at a news conference at Furnace General Hospital, council chief executive Tom Campbell said he would accept ultimate responsibility if it were proved that any council worker's negligence was to blame.

He said: "A man has died and if it were established that in any way an employee for whom I was responsible was negligent I will carry that burden to the grave."

The air-conditioning system at Forum 28 was around 30 years old and Mr Campbell said that the council always "experienced difficulties" with old equipment.

It was due to be replaced within the next three years but the council had not been aware of any fault with the system before it was shut down on Thursday.

At the very least the system should have been doused and checked for bacteria no less than once a month, Mr Campbell said.

All records showing if that had taken place had been handed over to the police and the Health and Safety Executive and the council had been advised not to comment further.

More than 70 people were in five hospitals across the north west of England as a result of the outbreak.

Forty-five patients have definitely contracted the disease and a further 29 men and women were awaiting test results.

Fifteen patients were in intensive care units in Barrow, Lancaster, Blackpool, Burnley and Chorley, four of whom were giving doctors cause for concern after developing complications.

An 89-year-old man died on Friday after contracting the disease.

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