Legionnaires' disease outbreak 2012: Is penny pinching in your building putting you at risk?

Legionnaires' disease outbreak 2012: Is penny pinching in your building putting you at risk?

By Jerome Burne

PUBLISHED: 19:50 EST, 6 June 2012 | UPDATED: 09:08 EST, 7 June 2012

Experts fear the worst of the latest outbreak of Legionnaires’ disease may still be to come â€" and despite one death, 12 other people critically ill in an Edinburgh hospital and 19 more suspected of having the bug, the cause has still not been identified.

Perhaps even more worrying is that many of them are warning this may be just the start of a terrifying rise in the number of cases in Britain.

They are blaming the recession and the soaring cost of energy for creating conditions in which the bacteria thrive. 

Legionnaires' disease, also known as Legionellosis, is associated with poorly maintained air conditioning cooling towers and potable water systems

Simon French, a legionella consultant to businesses, says: ‘Plumbing systems used to run at 60c, which was enough to kill it off. But now some hotels, hospitals and public buildings are cutting that back to 50c, which isn’t.’

People catch Legionnaires’ when tiny water droplets carrying the legionella bacteria get into the lungs.

The illness starts with flu-like symptoms â€" tiredness, high fever, headache, muscle aches and dry cough. It can then develop into lung infections or pneumonia, which prove fatal in one in ten patients.

The bacteria thrive in warm â€" but not hot â€" water. Sources of infection include showers, hot tubs, spas and the hoses or cooling towers of air-conditioning systems.

In all of these, the water is pressurised, which creates fine spray that can ride into your lungs when you inhale.

Official figures state there are around 400 Legionnaires’ cases a year in the UK, although some experts believe the true figure is as high as 9,000 â€" because, they say, only a small proportion of cases is reported.

And leading public-health experts and microbiologists are now warning that we are likely to see an increase, as managers of public buildings â€" such as hotels, hospitals and swimming pools â€" lower their hot-water temperatures to save money during the recession.

At the lower temperatures, there is a risk of people catching the disease from a shower or even a bath.

Experts, including Simon French, are calling for improved monitoring of water systems in public buildings, and routine testing of people with suspected symptoms.

They claim that nearly all of the estimated 9,000 cases a y ear could be prevented with proper checks.

But because people with pneumonia-like illnesses are frequently not tested for Legionnaires’, it is difficult to detect the buildings that might be infected with the deadly bacteria. 

Checks: An Edinburgh distillery yesterday, one of the possible sources of the Legionnaires disease outbreak

Last year a leaked email revealed that as many as one in three trains on Britain’s rail network could have their water tanks infected with legionella.

Droplets could potentially be released into the air each time a toilet is flushed or spray-style taps â€"with lots of tiny jets rather than one big one â€" are used to wash hands.

Public health consultant Dave Harper says. ‘People are surprised that it’s been found on trains but conditions there are perfect for it. The water tanks are located in the roof of carriages and are difficult to access and disinfect.

They are often not refilled for weeks or even longer, and in warm weather they can heat up to temperatures that allow the legionella bacteria to thrive.’

However, the Health Protection Agency says that the risk of infection on trains is extremely low, and that it is not aware of any cases of Legionnaires’ disease associated with rail travel.

Meanw hile hospitals are regularly failing to test for the disease, meaning it is often misdiagnosed as pneumonia.

Therefore, these patients get the wrong treatment. Microbiologist Dr Tom Makin, co-author of official Legionnaires’ guidelines, says: ‘About 200,000 to 300,000 people catch pneumonia, and two to three per cent of them actually have Legionnaires’ disease. So we know there are around 9,000 cases a year and up to 1,500 deaths.’

What makes this infectious disease different from others is that nearly all the deaths are preventable if proper safety procedures are followed.
Dr Makin says: ‘Patients are dying because they haven’t been tested fast enough. 

12 people remain in intensive care in the Royal Infirmary of Edinburgh due to the latest outbreak of Legionnaires

‘If you come into hospital with serious breathing problems because you’ve caught Legionnaires’ showering in a hotel with poor safety standards, you’ll be given standard antibiotics for pneumonia.

‘Trouble is, they don’t work for Legionnaires’.

‘It’s only after you are obviously not responding that you’ll get a test to see if it’s Legionnaires’ and they can switch drugs.

‘But this disease can come on fast. It could be too late.’

This happened to Simon Turner, a 45-year-old shop assistant from Brighton, when he came back from a holiday in Spain in 2009.

He went to hospital complaining of severe headaches and nausea but was sent home after being tested for a migraine â€" even though his wife had come down with flu-like symptoms on the coach.

Three days later Mr Turner collapsed and died of Legionnaires’.

'Conditions on trains are p erfect for the bacteria to spread'

His brother Paul says: ‘If he’d had a standard urine test for the bug, he’d be alive today.’

Unlike Britain, doctors in Ireland now have to test all suspected pneumonia cases for legionella.

Dr Makin says: ‘As a result, the death rate has more than halved.’
In Britain, the failure to routinely test patients with pneumonia-type symptoms extends to older people, even though they are more likely to develop Legionnaires’.

Dr John Lee, a former water-scheme consultant to the Health Protection Agency, says: ‘People are more vulnerable to infection as they get older.

But official figures for this infection actually drop for people over 65. They are not being tested. This makes it very hard to pinpoint which care homes have poor water- safety procedures.’

‘And if we only have estimates for the number actually falling dangerously ill with legionella, we know nothing about how many people get it m ildly.

One of Dr Lee’s investigations involved a hairdressers’ shop that had a client who ended up in hospital with Legionnaires’.

‘I traced all the other people who’d been there in a two-week period and found that seven had been suffering from what they called “the flu”,’ he says.

‘It’s mild cases like this that are never picked up, yet they are all preventable and add up to lots of misery and days off work.’

So what can we do to protect ourselves?

Dr Makin says: ‘If you are seriously ill with a pneumonia-like condition, then insist that you’re tested as soon as possible.

‘It’s a cheap and simple dipstick urine test that gives an answer right away.’

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