Legionella positive

“IT’S BAC(teria)!” NJ faces spike in Legionnaires cases

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During the summer of 1976, thousands of WWII veterans and members of the Pennsylvania State American Legion gathered in Philadelphia for their annual three-day convention, and to commemorate the 200th anniversary of the American Revolution. Hundreds of these “Legionnaires” stayed downtown at the stately Bellevue-Stratford Hotel on Broad Street.

Almost immediately after the convention started, some of the Legionnaires became profoundly ill – coughing, wheezing, chest pains, high fever. Within days of the conclusion of the convention, people started dying. The first was Ray Brennan, a 61-year-old retired US Air Force captain and an American Legion bookkeeper, who returned home from the convention feeling “tired.” He was dead within three days. He was followed almost immediately by three other elderly Legionnaires who passed away by July 30. Over the ensuing days and weeks, in what became a nightmarish national fascination, an unknown disease afflicted approximately 200 people who had attended the convention, most of whom were hospitalized, and roughly 30 of whom died.

The CDC mobilized immediately and undertook one of the largest investigations in its history. Initially, the focus was on finding a “patient zero” who presumably introduced some unknown pathogen at the convention. It wasn’t until January 1977, however, when they realized the intruder was already inside the building; the bacterium causing the illness, Legionella pneumophila, was breeding in the cooling tower of the Bellevue-Stratford Hotel. In something of a requiem for the victims of the convention, the more-virulent illness caused by the bacteria was formally named Legionnaires’ disease.

In the almost-fifty years since its introduction, much has been learned about Legionnaires’ disease; the bad news is that Legionella pneumophila is virtually ubiquitous; wherever there are water systems (cooling towers, building pipes, hot tubs), the bacteria is there. The good news is that it requires a very large concentration in order to represent a health risk, existing within a certain temperature range (77֯ to 113֯.) Even then, it is generally not transmissible except through inhalation of aerosolized droplets of water.

It is not an exaggeration to say that vigilance and wariness of Legionnaires disease has single-handedly changed the way both municipalities and corporate entities use, store, and transfer water. National guidelines and regulations now dictate conditions and rituals designed specifically to prevent outbreaks of Legionnaires’ disease; temperatures at which standing water is to be maintained, concentrations of various compounds to be used in storage tanks, etc.

It is in this context that a recent spike in confirmed cases of Legionnaires’ disease in two New Jersey counties has raised concerns. In Middlesex and Union County, New Jersey, there have been approximately 40 cases of confirmed Legionnaires’ disease over a three-month period from August to October. While there have been no reported fatalities, this is a 300% increase over the normal number of cases usually registered in the same amount of time. No geographic link, either within the counties, or between the counties, has yet been identified.

Local health officials are monitoring, but have been quick to try to quell any sort of mounting panic, advising that persons who have visited either county are at extremely low risk of infection. They caution, however, that persons having visited either county who develop flu-like symptoms should immediately seek medical attention.