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Information On Legionella

What is Legionnaires' disease?

Legionnaires' disease is a lung infection caused by a bacterium named Legionella pneumophila. The name Legionella pneumophila was derived from the original outbreak at the 1976 American Legion Convention in Philadelphia

What organism causes Legionnaires’ disease?

Legionnaires’ disease is caused by bacteria that belong to the family Legionellaceae. This family now includes 48 species and over 70 serogroups. Legionella pneumophila is responsible for approximately 90% of infections. Most cases are caused by Legionella pneumophila, serogroup 1. Legionella species are small (0.3 to 0.9 μm in width and approximately 2 μm in length) faintly staining Gram-negative rods with polar flagella (except Legionella oakridgensis).

What is the natural habitat of Legionella bacteria?

Legionella organisms are readily found in natural aquatic bodies and some species have been recovered from soil. Temperature is a critical determinant for Legionella growth. Colonization of hot water tanks is more likely if tank temperatures are between 40 and 50oC (104 to 122o F). Legionella and other microorganisms become attached to surfaces in an aquatic environment forming a biofilm. Legionella has been shown to attach to and colonize various materials found in water systems including plastics, rubber and wood. Organic sediments and scale provide Legionella with a surface for attachment and a protective barrier. The growth of other environmental organisms is stimulated by organic sediment, which in turn leads to the formation of by-products that stimulate the growth of Legionella.

The public health threat posed by legionella can be addressed via preventive measures. Although it is impossible to eradicate the source of infection, it is possible to reduce the risks substantially. Prevention of Legionella depends on good maintenance of possible sources, including regular cleaning and disinfection and the application of other physical (temperature) or chemical measures (biocide) to minimise growth.

Temperature affects the survival of Legionella as follows

70 to 80 °C (158 to 176 °F): Disinfection range

At 66 °C (151 °F): Legionella die within 2 minutes

At 60 °C (140 °F): Legionella die within 32 minutes

At 55 °C (131 °F): Legionella die within 5 to 6 hours

Above 50 °C (122 °F): They can survive but do not multiply

35 to 46 °C (95 to 115 °F): Ideal growth range

20 to 50 °C (68 to 122 °F): Legionella growth range

Below 20 °C (68 °F): Legionella can survive but are dormant

In 2010 a study by the UK Health Protection Agency reported that 20% of Legionella cases may be caused by infected windscreen wiper water. The finding came after researchers spotted that professional drivers are five times more likely to be infected.

See http://www.bbc.co.uk/news/10293519

 

What are the symptoms of Legionnaires' disease?

The incubation period of Legionnaires' disease is from 2 - 10 days; this is the time it takes before symptoms of the illness appear after being exposed to the bacteria. For several days, the patient may feel tired and weak. Most patients who are admitted to the hospital develop high fever often greater than 39.5°C (103°F). Cough can be the first sign of a lung infection. Gastrointestinal stomach symptoms are common with diarrhoea being the most distinctive symptom. Many patients have nausea, vomiting, and stomach discomfort, other have headaches, muscle aches, chest pain, and become short of breath.

Is Legionnaires' disease contagious?

Legionnaires' disease is not contagious. No special precautions are necessary. The disease is transmitted via water and not by infected persons.

What is the prognosis and outcome for patients who have contracted Legionnaires' disease?

If the patient is treated with appropriate antibiotics near the onset of pneumonia, the outcome is excellent, especially if the patient has no underlying illness that compromises his/her immune system. For patients whose immune systems are compromised, including transplant recipients, delay of appropriate therapy can result in prolonged hospitalization, complications, and death.

How is Legionnaires' disease diagnosed?

Specialized laboratory tests are necessary and, may not be available in all hospitals. These include culture on specialized Legionella media. Culture media furnish nutrients for the bacterium. Other tests include direct fluorescent antibody, in which the bacterium can be stained and become visible under a fluorescent microscope. Urinary antigen is a test that detects Legionella in the urine. Antibody testing is a blood test in which antibodies that are reactive against Legionella are present in the human body showing that the patient has come into contact with the bacterium previously.

How is Legionnaires' disease treated?

There is no vaccine currently available for Legionnaires’ disease. Many antibiotics are highly effective against Legionella bacteria.

Where do Legionella bacteria come from?

Legionella are natural inhabitants of water and can be detected in rivers, lakes, and streams. One type of Legionella species (Legionella. longbeachae) has been found in potting soil. See http://www.iwa-microbiology.org/index.asp?id=4540

How do people contract Legionella?

The most popular theory is that the organism is aerosolized in water and people inhale the droplets containing Legionella. However, new evidence suggests that another way of contracting Legionella is more common. "Aspiration" is the most common way that bacteria enter into the lungs to cause pneumonia. Legionella enters the lung via aspiration (choking) when foreign particles including bacteria escape the gag reflex and fall directly into the respiratory tract (windpipe and lung). Once Legionella enters the mouth, for example, by drinking water contaminated by Legionella, the organism is prevented from going into the lung by cilia on the cells of the respiratory tract. Cilia are hair-like structures which sweep back and forth and keep the respiratory tract clear of particles including bacteria. In patients who smoke cigarettes or in ill patients, this process is impaired and it is easier for bacteria to bypass the gag reflex and the ciliary process and fall into the respiratory tract (aspiration). Legionella can also stick (adhere) onto the cells of the respiratory tract, and then enter and multiply within cells of the respiratory tract.

Once Legionella enters into the lung, white blood cells will migrate to the Legionella in an attempt to engulf and kill them. The alveolar macrophage is the most important cell. The alveolar macrophages engulf Legionella, but the Legionella can escape the killing mechanisms of the alveolar macrophage and multiply within the macrophage. The Legionella multiplies until the cell ruptures, and the liberated bacteria are released into the lung only to be engulfed by other cells, and the cycle of multiplication and release begins anew. Other white blood cells are recruited from the blood. However, the Legionella can escape the killing effects of these other cells by hiding in the respiratory tract cells or alveolar macrophages. That is why Legionella is called an intracellular pathogen.

In a simplified explanation, the human body has two major components of the immune system:

1) Humoral immunity in which antibodies produced by the human body attach to the Legionella and facilitate killing of Legionella by white blood cells

2) cell-mediated immunity in which white blood cells attack, engulf, and kill the organism. The major host defence against Legionella is considered to be cell-mediated immunity, but Legionella can often escape the effects of this host defence.

The intracellular location of Legionella is also important in therapy. Many antibiotics effective against pneumonia are ineffective against Legionella because they do not penetrate the respiratory tract cells or alveolar macrophages. However, newer antibiotics do penetrate cells and effectively kill Legionella.

What have been the water sources for Legionnaires' disease?

The major source is water distribution systems of large buildings including hotels and hospitals. Cooling tower are known to be a major source for Legionella, other sources include mist machines, humidifiers, whirlpool spas, and hot springs.

Recent Significant Legionella Outbreaks

Reported Legionella Outbreaks 2012

September

Newark Hill Primary closed after legionella bug found

Legionella, the bacteria which can cause the potentially fatal Legionaires' disease, has been found in a school water system. The bug was discovered during routine testing at the Newark Hill Primary School in Peterborough. The City Council said the school had been closed temporarily until 10 September as a "precaution".

The school's hot water system has been treated with chlorine, which kills the bacteria.

 

Northampton Borough Council bacteria fountain stays off until 2013

A fountain which was turned off in Northamptonshire because traces of dangerous bacteria were found in the water will stay off until 2013, the borough council said.

The fountain, located in the market square, was switched off in August after levels of legionella were found. Experts were brought in to find ways to prevent it becoming infected in future.

The borough council said the fountain, normally switched off in the winter, will stay off until April.

David Mackintosh, leader of the borough council, said: "We think there may need to be structural changes made to the fountain.

"We want to work out what happened, why it occurred and what we need to do to make it safe in the future."

http://www.bbc.co.uk/news/uk-england-northamptonshire-19516939

 

August

Legionella alert in Dundee community centre showers

Potentially deadly legionella bacteria have been found in showers at a community centre in Dundee.

The bug, which can cause Legionnaires' disease, was found by routine testing at Menzieshill Community Centre about two weeks ago.

Dundee City Council said there are no "public health issues" and that the shower area had been closed and the water system thoroughly treated.

http://www.bbc.co.uk/news/uk-scotland-tayside-central-19355446

 

Update 17 August: Legionnaires' disease in Stoke-on-Trent

The outbreak of Legionnaires’ disease in Stoke-on-Trent that resulted in 21 cases and two deaths has been declared over by public health experts from the Health Protection Agency (HPA).

Of the two patients remaining in hospital, one patient is due to be discharged today (Friday). The second is improving and has been transferred from critical care to a ward.

It is now 25 days since the probable source - a hot tub on display at JTF Warehouse in Fenton - was decommissioned and health experts no longer expect to see cases associated with this outbreak.

Officers from Stoke-on-Trent City Council will be continuing their investigation with a view to possible enforcement action and also to provide the Coroner with any information he may require for his inquest.

http://www.hpa.org.uk/NewsCentre/NationalPressReleases/2012PressReleases/120817StokeonTrentLegionnairesdiseaseoutbreak/

 

Northampton Borough Council considers altering water fountain after Legionella found

Experts are looking for ways to alter a water fountain in Northampton to prevent it becoming infected with bacteria, the borough council said. The fountain, located in the market square, was switched off last week after "higher than normal" levels of legionella were found in the water.

The Health Protection Agency said so far there were no reported cases of infection despite Legionella and traces of E.coli were found during routine tests.

The bacterium legionella pneumophila and related bacteria are common in natural water sources such as rivers, lakes and reservoirs, but usually in low numbers. It can cause lung infection or pneumonia.

The fountain will stay off for the next two weeks for further tests, according to the borough council.

Councillor Tim Hadland, cabinet member for regeneration, enterprise and planning, said: "We have asked an independent expert to suggest improvements to the water feature and whether there is anything else we can do to further reduce the likelihood of this happening again.

"We are now going through a process of disinfecting the fountain and will be testing and re-testing the water quality so we can feel confident to switch it back on again."

The fountain was built in 2010 and cost £98,000.

http://www.bbc.co.uk/news/uk-england-northamptonshire-19357147

 

July

Update on Legionnaires’ disease clusters associated with a hotel in Spain

The Health Protection Agency (HPA) has been alerted by Spanish public health authorities to a further three cases of Legionnaires’ Disease associated with the Diamante Beach Hotel in Calpe, Costa Blanca. All three cases were in Spanish residents, bringing the total number of cases associated with this hotel since January 2012 to 36. The clinical histories of the cases show they were exposed to the legionella bacteria before the closure of the hotel.

The Health Protection Agency (HPA) has been alerted to a further twelve cases of Legionnaires’ disease associated with the Diamante Beach Hotel in Calpe, Costa Blanca. Five of the cases are from Belgium and seven from Spain, there have been no additional cases in UK residents since May. This brings the total number of cases associated with this hotel since January 2012 to 33.

This is the third cluster of Legionnaires’ cases associated with this hotel in 2012. Since the latest cases came to light, the hotel has again been temporarily closed while investigations to identify the source continue. The HPA continues to monitor the ongoing situation in Spain closely and to support the Spanish public health authorities who are leading on the investigation and management of this incident.

http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1317135122627?p=1317132140479

 

June

Edinburgh Legionnaires' outbreak: Cases rise to 95

The number of people thought to have been affected by an outbreak of Legionnaires' disease in Edinburgh has risen to 95. There are now 48 confirmed cases and 47 suspected cases, with three of the patients in intensive care.

The first case was identified on 31 May and two people have died.

It is thought there was a common airborne exposure to the Legionella bacterium over south west Edinburgh but the exact source has not been located. The Scottish government said that the 95 cases included 12 people being treated in general wards, 20 being treated in the community and 51 who have been discharged from hospital. Seven cases are being treated out with the NHS Lothian area.

The ages of the confirmed cases ranges between 33 and 85, with more males than females affected.

The Health and Safety Executive and Edinburgh City Council are continuing their investigations into the possible source of the outbreak.

Health Secretary Nicola Sturgeon said: "As well as the efforts being made by health service staff to treat those who are critically ill in hospital, a tremendous amount of work is being undertaken by the Health and Safety Executive and the City of Edinburgh Council to identify and deal with the source of the outbreak." Initial tests on cooling towers at the centre of the Legionnaires' outbreak in Edinburgh proved inconclusive.

However, an incident management team (IMT) concluded last week there was evidence which suggested the source of the exposure was "most likely to have been the cluster of cooling towers in Wheatfield Road".

The most common type of Legionella bacterium, Legionella pneumophila serogroup1, has been identified as the cause of infection in patients.

http://www.bbc.co.uk/news/uk-scotland-edinburgh-east-fife-18587273

 

Legionnaires' disease bacteria at Jersey hospitals

The bacteria which causes Legionnaires' disease has been found in the water at two Jersey hospitals.

Legionella was found in water supplies at the Gwyneth Huelin Wing for outpatients at the General Hospital and in part of St Saviour's Hospital, not used by patients.

The health department said there was a "very low risk" of people getting ill. It added that the hospitals would be decontaminated over the weekend while services operated as normal.

http://www.bbc.co.uk/news/world-europe-jersey-18920290

 

Legionnaires' outbreak in Fenton, Staffs.

Hot tubs are known to be effective mechanisms for spreading legionella infection, an official at the Health Protection Agency said this week. That statement followed the death of one person from Legionnaires' disease and 18 further cases in Stoke-on-Trent since 24 July.

A hot tub displayed in a store at JTF Warehouse in the town is thought to be the "probable" source after samples from it were found to match those taken from the patients. Hot tubs or spa pools are popular in gyms, hotels and increasingly in people's back gardens - but experts say they can be a health risk if they are not looked after.

The water in hot tubs is kept at between 30 and 35 degrees, close to body temperature, which is the ideal environment for legionella bacteria to grow. The bubbling and frothing of the aerosols in a hot tub can then throw the bacteria into the air for several yards around the tub. So you don't have to be sitting in the hot tub to inhale the bacteria.

Professor Nick Phin, head of Legionnaires' Disease at the Health Protection Agency, says an outbreak of the disease in the Netherlands in 1999 illustrates how far the spray can travel. "Over 140 people were affected at a Dutch flower show by two spa baths being exhibited. People were just passing through and breathing in the fine spray. But not everyone who walked past the hot tubs was infected by the legionella bacterium, you have to be susceptible to it. There was a very low attack rate of 0.2% in the Holland example." People aged over 50 are more likely to be affected, as are people with existing health problems, particularly lung damage, and those who smoke.

Cleaning and maintaining the hot tub regularly is the only way to ensure that bacteria do not concentrate in the water and the spray. As a result, the HPA has produced guidance on how to clean hot tubs and spa pools with chemicals which disinfect the water. In general, cases of Legionnaires' disease have been increasing in number over the past 30 years. In the last 10 years, HPA figures show that cases have averaged 350 each year.

There is no knowing how many of these are due to hot tubs, because of the difficulty of finding the exact source of an outbreak. Around half of cases are linked to overseas travel.

But there are some other potential problems with hot tubs if they are not maintained properly.

The amount of skin that is shed in hot tubs can lead to cases of Pseudomonal infection and some people have also had boils appear on their bodies.

"If spa pools are not looked after properly then they can cause other diseases," Prof Phin says.

Local authorities will carry out inspections and private owners should make sure they use the appropriate chemicals to clean tubs and disinfect the water too.

http://www.bbc.co.uk/news/health-19097187

http://www.hpa.org.uk/NewsCentre/NationalPressReleases/2012PressReleases/120730Legionnairesdailyupdate

 

Legionella bug found at Llandrindod Wells hospital

A hospital's water system has been flushed through after part was found to contain legionella, the bacteria which can cause Legionnaires' disease.

The bug was discovered at Llandrindod Wells Hospital in Powys following concerns over water quality. Bottled water was used for washing until the water system was cleaned through on Friday.

Powys Teaching Health Board said there had been no reported cases of anyone being affected by the bacterium so far.

Meanwhile, an outbreak of Legionnaires' disease is being investigated in Carmarthen after three people needed treatment. The outbreak is believed to centre on Carmarthen, said Public Health Wales.

Health officials said the hospital remained "operational" and that additional measures were taken to reduce exposure and ensure patient safety.

Due to the layout of the hospital, it only affected certain areas of the site.

Dr Sumina Azam, the health board's director of public health, said: "It's important to remember that there have been no reported cases of Legionnaires' disease and that the disease cannot be passed from person to person."

The health board said legionella bacterium had the potential to cause Legionnaires' disease, which starts with flu-like symptoms and could lead to pneumonia.

 

May

Edinburgh Legionnaires' outbreak: Distillery shuts down cooling towers

Cooling towers have been shut down at a whisky distillery in Edinburgh which is at the centre of an investigation into an outbreak of Legionnaires' disease. The Health and Safety Executive has served an improvement notice on the North British Distillery for alleged failures to adequately control the risk of legionella in one of its towers. The company said it had taken its towers offline and halted production at its Gorgie plant as a precaution.

 

February

More Legionella treatment for Guernsey hospital water

The hospital's water system was flushed over two weekends in January. Further treatment has started at a Guernsey hospital after tests showed a higher level of Legionella than authorities were "prepared to accept". Following work in January the majority of the hospital's water supply has tested within acceptable levels.

Richard Evans, director of corporate services, said higher bacteria levels in water at the new clinical block meant further treatment. It will involve the water being heated and chemically treated.

 

Newtownabbey's Valley Leisure Centre water test results faked

A Newtownabbey Leisure Centre has said a company hired to test for a bacteria which causes legionnaires' disease has admitted producing fake test results. The Valley Leisure Centre was given the fabricated results over a six-month period last year.

Legionnaires' disease can be caused by breathing in water droplets contaminated with Legionella bacteria. The centre employed east Belfast-based Healthy Buildings International Ireland Ltd, to carry out monthly checks.

The chief executive of Newtownabbey Borough Council Jacqui Dixon explained what happened. "The council received an anonymous letter last week which made allegations about the testing of Legionella in our swimming pools. So we launched an immediate investigation into the matter, as a result of the company who were involved in the testing admitted that our results were falsified for a six-month period during 2011."

The council has said the swimming pool does not pose a risk to the public, however the spa area remains closed while further tests are carried out. Billy Webb, mayor of Newtownabbey, said: "I cannot believe any company would carry out such an action." The Health and Safety Executive is now investigating what happened.

In a statement, Healthy Buildings International said they were in the process of issuing legal proceedings against a former employee, & are investigating what they described as an anonymous and defamatory letter and would issue a fuller statement once legal clearance had been given.

http://www.bbc.co.uk/news/uk-northern-ireland-17077333

 

'Legionella concerns' remain at Basildon hospital

The prevention and control of legionella at an Essex hospital remains a "significant concern", according to a health care watchdog, as three people contracted legionella while they were at the hospital last year.

The Care Quality Commission (CQC) said Basildon University Hospital had taken several measures to combat the disease, but further improvements were needed. It said three people had acquired the disease while at the hospital in 2011. The report followed a recent inspection on 9 February. It said there had been a history of people catching legionella at the hospital, citing 13 cases since 2002, with the most recent cases being in August, September and November 2011

The hospital's trust said it was already taking further steps to address the issue and other areas of concern. The report said the hospital had made an "investment in measures to control legionella" including the introduction of a silver and copper ionisation disinfection system, to replace its chlorine dioxide one.

It added a legionella management group met once a month and the hospital worked with several other agencies regarding the outbreaks.

http://www.bbc.co.uk/news/uk-england-essex-17113785

 

Gardeners warned of Legionnaires' risk in compost

Gardeners in Scotland have been warned to wash their hands after handling compost following a spate of cases of a rare form of Legionnaires' disease. Over the past five years, one person has died and five others have become ill after contracting a strain of Legionella linked to compost. Experts think the victims inhaled Legionnaires' from water droplets in compost.

http://www.bbc.co.uk/news/uk-scotland-18236852

 

January

Guernsey hospital reports Legionella in water supply

Legionella bacteria has been detected in the water supply of Guernsey's Princess Elizabeth Hospital. The island's Health and Social Services Department said the level of bacteria was higher than acceptable, and decontamination would take place. It added that no patients or staff had been taken ill, and the bacteria posed a minimal health risk.

Guernsey's director of public health has urged hotels and businesses to check their water systems for legionella bacteria, chlorinated water was flushed through water pipes in the Princess Elizabeth Hospital, in a second and final stage of cleansing.

http://www.bbc.co.uk/news/world-europe-guernsey-16483861

Health board fined £24,000 over legionnaires case

Legionella bacteria was found at three sources at the hospital NHS Lanarkshire has been fined £24,000 over health and safety breaches which saw a woman get Legionnaires' Disease. The 64-year-old developed the condition while being treated at Hartwood Hill Hospital in November 2008. She was treated for this, pneumonia and severe sepsis at Wishaw General.

A subsequent investigation by the Health and Safety Executive (HSE) identified that legionella bacteria was present in three sources in the water system at Hartwood Hill Hospital. Two of those sources, including the shower used by the patient on a daily basis, matched the strain of legionella bacteria that had caused her illness.

Hospital failings

The HSE investigation also established that a suitable and sufficient assessment of the risks from the potential presence of legionella bacteria to persons using the facilities had not been carried out. It was also found that there was not a safe scheme in place to manage and control the risks of exposure to the form of bacteria in the water system at Hartwood Hill Hospital.

Elaine Taylor, head of the Crown Office health and safety division, said: "Over a significant period of time there was no suitable and sufficient assessment or management of the risks of there being legionella bacteria at Hartwood Hill. This resulted in members of the public, including patients who were relying on the hospital for their care, to be exposed to a risk from the bacteria".

http://www.bbc.co.uk/news/uk-scotland-glasgow-west-16767108

 

Jan 2011 Bali

The Australian Govt has issued a Legionnaires Disease Alert for Bali as 11 confirmed cases of Legionnaires Diseases are reported by hospital authorities. The Kuta Area has been identified as the area to centralise an investigation as a preventative clean-up is underway.

See - http://www.balidiscovery.com/messages/message.asp?Id=6682

March 2011 - Miami

The number of Legionella pneumonia cases at Miami Valley Hospital has risen to 10, after an additional patient was diagnosed. A case of Pontiac fever, a milder form of Legionella, also has been confirmed, according to the hospital’s public relations manager.

After four Miami Valley Hospital patients were diagnosed with Legionnaires’ disease in February, the facility implemented water restrictions Feb. 22 in its new 12-story patient

Feb 2011 – Barnet, London

Deadly legionella bacteria found in water systems at two Barnet care homes

See - http://www.times-series.co.uk/news/8862512.Deadly_Legionella_found_in_water_at_two_care_homes/

Feb 2011 – Los Angeles

Playboy Mansion mystery illness linked to Legionella after 200 people exposed to fine spray.

See - http://www.pasadenastarnews.com/ci_17548824

Feb 2011 – Teeside

A Teeside man has died after contracting Legionnaires’ disease, health officials confirmed today.

See - http://www.gazettelive.co.uk/news/teesside-news/2011/02/12/legionnaires-bug-claims-a-redcar-man-s-life-84229-28157467/#ixzz1Gy1LHDKG

Jan 2011 – London

Moorfields Eye Clinic has been given the all-clear following an outbreak of Legionnaires' disease. The clinic was closed from December 31 as a precautionary measure after three people were hospitalised with the potentially fatal illness.

See - http://www.ealinggazette.co.uk/ealing-news/local-ealing-news/2011/01/21/moorfields-gets-the-all-clear-after-legionnaires-outbreak-64767-28031262/

Jan 2011 – Alabama

A jury in Calhoun County Circuit Court awarded two men $4.5 million after they were stricken by Legionnaires’ disease.

See - http://www.prlog.org/11201587-legionnaires-disease-leads-to-45-million-verdict.html

Nov 2010 - Scotland

Pupils at the new Kinlochleven High School complex have been told to stay at home after Legionella bacteria was found in the school's hot and cold water systems. A council spokesman said it planned to re-open the school on 15 November after disinfection. Opened in 2008, Kinlochleven school was built under the Public Private Partnership programme.

July 2010 - Leeds

Legionella bacteria have been found in pipework at the Clarendon Wing at Leeds General Infirmary. No-one had contracted the disease and work was taking place to contain the bacteria. Leeds Teaching Hospitals NHS Trust routinely tests water supplies in all hospital buildings on a regular basis.

June 2010 - Cardiff

A bone marrow transplant patient contracted Legionnaires' disease while at the transplant unit at the University Hospital of Wales, Cardiff. The likely source of the infection was the sink in his room said Cardiff and Vale University Health Board.

Successful Court Actions brought in the UK

April 2010 – SJ Care Homes

A care home company has been fined £5,000 after putting elderly residents in Manchester at risk of catching Legionnaires’ disease. SJ Care Homes Ltd was prosecuted by HSE after the company failed to comply with an enforcement notice issued at one of its nursing homes.

See - http://www.hse.gov.uk/press/2010/coi-nw-048sjcarehomes09.htm

February 2010 – First Metal Finishers Ltd

Despite warnings from Water Management Companies, Ernest Jones of Coseley-based First Metal Finishers Ltd failed to put a management system in place for the control of legionella. He was fined £3,000.

See - http://www.hse.gov.uk/press/2010/coi-wm-58809.htm

October 2009 - Liverpool Heart and Chest Hospital NHS Trust

Following an HSE investigation at the NHS Trust's hospital on Thomas Drive, Liverpool was fined £48,000. The investigation found unsafe levels of legionella in the water supply system for the showers, baths and sinks at the hospital. But it was not able to conclude whether two patients, who both contracted legionnaire’s disease before their deaths in early 2007, were infected at the hospital or elsewhere. The NHS Trust ignored the recommendations it had been given by a Water Management Company to control the levels of legionella in the water system. No one took, or was given, responsibility for managing the bacteria, and suitable control measures were not in place

See - http://www.hse.gov.uk/press/2009/coinw036trust09.htm

See - http://www.workplacelaw.net/topic/show/list/Legionella

August 2009 - DEBA UK Ltd

During 2007, the company were commissioned to carry out legionella water risk assessments at Nursing Homes operated by Craegmoor Healthcare in Tredegar and Llangattock, and rated the risk as low. A subsequent routine check of these nursing homes revealed there to be inadequate controls for legionella at these premises.

HSE inspector Matthew Hamar said: "The nursing home operators commissioned DEBA UK Ltd to carry out the surveys in good faith and to help them comply with their responsibilities to manage the risk posed by legionella on their premises. They were badly let down in this case.

DEBA UK Ltd were fined £41,276

See - http://www.legionellanews.com/news.php?anchor=31

July 2009 - Kepak UK Ltd

Two employees caught the disease at Kepak's Carr Place premises on the Walton Summit Industrial Estate, Bamber Bridge, Preston. An earlier water risk assessment made by a water management company recommended regular testing of the water systems but this was ignored exposing the employees to legionella. The court heard that the first case of Legionnaires' disease was diagnosed on 26 September 2006 and a second on 3 October 2006, following notification of the two legionella cases, an outbreak committee was formed made up of HSE, South Ribble Borough Council's Environmental Health Department, Central Lancashire Primary Care Trust, the Health Protection Unit and Lancashire Teaching Hospitals.

The company was fined £25,000 and ordered to pay £20,000 in costs at Preston Crown Court.

See - http://www.shponline.co.uk/incourt-content/full/legionella-risks-prompts-factory-closure

Other notable significant Legionella outbreaks

Norway 2005

In Fredrikstad 56 people became ill and ten died from Legionnaires' disease caused by bacteria growing in an air scrubber of a nearby factory.

UK 2002

An outbreak of Legionnaire’s disease occurred in Barrow-In-Furness resulting in 7 deaths, with another 172 people also confirmed as contracting the disease. An HSE investigation identified the cause to be a contaminated cooling tower at the Forum 28 arts centre. The outcome of a court case saw Barrow Borough Council becoming the first public body in the UK to be charged with corporate manslaughter, which was found to be unsubstantiated. However both they and the buildings architects were fined under Health and Safety regulations in a trial that ended in 2006.

See http://www.hse.gov.uk/legionnaires/barrowreport.pdf

Spain 2001

The world’s largest outbreak of Legionnaires' disease happened in July 2001 in Murcia, Spain. Over 800 suspected cases were recorded by the time the last case was treated, however 449 confirmed, and 6 deaths.

The resulting investigation implicated the cooling towers at the Morales Meseguer Hospital.

See http://www.medscape.com/viewarticle/460121_3

Australia 2000

An outbreak of Legionella pneumophila occurred in Melbourne. This outbreak resulted in 125 confirmed cases of Legionnaire's disease, with 95 (76%) hospitalised. It is reported that 4 died from the outbreak. The investigation traced the source of the infection to the cooling tower at the newly opened aquarium.

See http://www.mja.com.au/public/issues/180_11_070604/gre10735_fm.html

Holland 1999

An outbreak occurred during a flower exhibition in Bovenkarspel. 200 people became ill and at least 32 people died. There is a possibility that more people died from it, but these people were buried before the Legionella infection was recognized.

See http://www.q-net.net.au/~legion/Legionnaires%60_Disease_Netherlands_1999.htm

UK 1985

175 patients were admitted to hospitals in Stafford with chest infection or pneumonia, and 28 people died. Medical diagnosis proved that Legionnaires' disease was responsible and the immediate investigation traced the source of the infection to the air-conditioning cooling tower on the roof of Stafford District Hospital.

USA 1976

The first recognized outbreak occurred on July 27 1976 at the Bellevue Stratford Hotel, Philadelphia, Pennsylvania, where members of the American Legion were attending a reunion. Within two days of the event’s start, attendees began falling ill with a then unidentified illness - 221 people were given medical treatment but unfortunately 34 deaths occurred.

Legionella Species

Legionella adelaidensis
Legionella anisa
Legionella beliardensis
Legionella birminghamensis
Legionella bozemanii
Legionella brunensis
Legionella busanensis
Legionella cherrii
Legionella cincinnatiensis
Legionella donaldsonii
Legionella drancourtii
Legionella drozanskii
Legionella erythra
Legionella fairfieldensis
Legionella fallonii
Legionella feeleii
Legionella geestiana
Legionella genomospecies 1
Legionella gratiana
Legionella gresilensis
Legionella hackeliae
Legionella impletisoli
Legionella israelensis
Legionella jamestowniensis
Legionella Candidatus jeonii
Legionella jordanis
Legionella lansingensis
Legionella londiniensis
Legionella longbeachae
Legionella lytica
Legionella maceachernii
Legionella micdadei
Legionella moravica
Legionella nautarum
Legionella oakridgensis
Legionella parisiensis
Legionella pneumophila
Legionella quateirensis
Legionella quinlivanii
Legionella rowbothamii
Legionella rubrilucens
Legionella sainthelensi
Legionella santicrucis
Legionella shakespearei
Legionella spiritensis
Legionella steigerwaltii
Legionella taurinensis
Legionella tucsonensis
Legionella wadsworthii
Legionella waltersii
Legionella worsleiensis
Legionella yabuuchiae