Some U.S. municipalities taking action after Legionnaires’ death in Ohio

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Following the death of a patient amid an outbreak of Legionnaires’ disease in a recently opened central Ohio hospital, some North American municipalities are taking extra precautions with drinking water.

State officials in Illinois, for instance, are considering doubling the amount of chlorine in municipalities’ drinking water. For systems with marginal issues, chlorine provides effective results at 0.5 ppm. If the rule passes, the minimum would be one milligram per litre. According to the Illinois Department of Public Health, 42 Illinoisans lost their lives to Legionnaires’ disease last year.

Officials at the Mount Carmel Grove City Hospital in Ohio believe the disease outbreak originated from the building’s hot water system and that improper disinfection may have occurred. Investigators are running tests, implementing water restrictions and performing supplemental disinfection of the water supply. Health officials in Ohio say 10 people have now been diagnosed with Legionnaires at the recently opened hospital near Columbus.

In Michigan, officials at the McLaren-Flint Hospital say they’ve spent more than $2 million to safeguard its water system in less than three years. More intense testing increases the likelihood that there will be more low-level findings of legionella, officials added.

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The U.S. Centers for Disease Control and Prevention warns that hospitals and nursing homes, in particular, need to work harder to keep bacteria from getting into places where patients might be exposed, such as showers, sinks and bathtubs, as well as medical equipment that uses water.

Legionnaires’ disease is a serious respiratory illness that results in pneumonia. Legionella bacteria that live in water can also cause Pontiac fever, a milder illness.

Water conservation efforts can occasionally inadvertently amplify legionella bacteria growth.

“The pathogen proliferates in poorly maintained water systems and can cause Legionnaires’ disease, a serious and sometimes fatal flu-like illness that has increased more than five-fold between 2000 and 2017,” states NSF International, using data from the U.S. Centers for Disease and Prevention Control (CDC).

According to the Public Health Agency of Canada, the average number of reported cases of Legionnaires’ disease north of the border is generally less than 100 per year.

While Canada has no ongoing issues around Legionnaires’ disease, the country doesn’t have to look too far in its rearview mirror. In 2018, Ontario’s University of Windsor shut off water taps in several campus buildings after discovering legionella bacteria in the system. More notably, in 2012 a significant outbreak of Legionnaires’ disease occurred in Québec City, resulting in 13 deaths and 170 documented cases of the disease. The source of the infection was a cooling tower in a Québec City building. Quebec developed new regulations for the operation and maintenance of cooling towers following the outbreak, including the creation of legionella control plans for each cooling tower that must be certified by a licensed professional engineer.

In Quebec, public servants at a government building in Gatineau, Quebec, say they weren’t told that legionella bacteria had been found in their workplace until weeks after the discovery.

An international lineup of public health and sustainability experts from four continents will discuss complex hospital water systems, cooling towers, proactive water quality monitoring and other topics at the Legionella Conference 2019 on September 11-13, in Los Angeles.

Legionella pneumophila was first discovered following a pneumonia outbreak at the 1976 Convention of the American Legion in Philadelphia.

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  1. Canada has shown leadership in addressing Legionella risks but more certainly needs to be done. Standardizing surveillance, risk messaging and response across the country is an area that needs improvement for example. Proactive steps from Canada include: Quebec requires the registration of all cooling tower systems, which are commonly associated with outbreaks, and has established maintenance and sampling requirements. Hamilton, was the first city in North America to require building owners to register their cooling towers and create a risk management plan. Vancouver approved a registration requirement for cooling towers and other common sources of community outbreaks recently. Vancouver is leading discussions with more than 20 agencies from across North America to develop standardized cooling tower registration system that addresses sustainability and public health goals. The Canadian federal government has established some of the most comprehensive strategies for managing waterborne risks for building water systems for its Crown owned buildings. On the private sector side of the equation, there are several Canadian firms in leadership roles addressing the public health challenges. Spartan Bio (Ottawa) has developed an innovative technology allowing for rapid DNA testing for legionella that can quantify viable organisms that can cause disease (most DNA tests cannot make this distinction). Groveware Technologies (Toronto) is one of the leading business workflow and data integration solutions used by cities to stand up cooling tower registration/inspection systems and water management plans created by private sector firms. Canada’s leadership on these issues will be on full display at Legionella 2019 (www.legionellaconference.org) in Los Angeles, CA September 11 to 13th. Cities/stakeholders/agencies from across Canada will be presenting/attending.

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