Legionnaires disease - underestimated threat

24th of October 2013
Legionnaires disease - underestimated threat

ECJ German correspondent Thomas-Schulte-Marxloh reports on recent cases of Legionnaires disease.

The term Legionnaires’ disease names a bacterial infection with an organism that was first identified in 1976; but earlier cases were confirmed as far back as 1947. An outbreak of the disease in Philadelphia in 1976, largely among people attending a state convention of the American Legion, coined the name.

Subsequently the bacterium causing the illness was called Legionella pneumophila and the name of the illness was changed to legionellosis. Legionellosis can be a mild respiratory illness or it can be severe enough to cause death. In Germany about 600 infections are reported annually - 15 per cent of formerly healthy patients and 71 per cent of patients with low immunity or heart/lung diseases die from the infection.

Legionella exist naturally in water and moist soil but also in hot and cold water taps, hot water tanks, water in air conditioning cooling towers and evaporative condensers, and soil at excavation sites.

Warstein outbreak

The disease appears to be spread through the air from a soil or aerosols. All studies to date have shown that person-to-person spread does not occur. The early symptoms of Legionellosis may be flu-like with muscle aches, headache, tiredness and dry cough followed by high fever, chills and occasionally diarrhoea; chest X-rays often show pneumonia.

This August the city of Warstein was hit by the most severe outbreak of Legionellosis in Germany. A total of 152 people were infected, three of them died. Investigations are still going on to find the source and potential locations of dissemination.

The hygiene expert Professor Martin Exner who carried out the on-site investigation and consulted the regional administration explained in an interview: ”I believe that Germany needs to rethink regarding the hazards of Legionella: although they cause severe pneumonia they are significantly underestimated.

“In recent years 630 to 650 cases have been reported annually; according to data of the network for ambulant acquired pneumonia there are 15,000 to 20,000 case of Legionella related pneumonia. The general public should be informed.”

So far investigators believe that a re-cooling system which was operated with infected water from the local river was the source. Therefore Professor Exner demands a mandatory registration of re-cooling systems and the periodic examination of process water (including raw water) regarding Legionella contamination. Stricter regulations would allow monitored maintenance and, in case of an outbreak, a fast identification of the source. “There should be a warning on any re-cooling plant: ’Warning! Life-threatening for general public and staff when not maintained’,” says Exner.

Other regulations in terms of Legionella prevention came into effect this January:  water pipe-lines and taps (particularly for warm water) in apartment buildings have to be inspected triennially, respective installations in commercial facilities every year. Luckily, the contract cleaning industry already offers a broad range of services to fight the omnipresence of Legionella in whirlpools, public swimming pools, saunas, bathrooms or commercial facilities. People in charge just have to use them.


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