Legionnaires' disease reports up more than fivefold since 2000; oversight is lacking

Robert Callender was returning home after a day of delivering meals to elderly residents in the Bronx in July when he fell off his bicycle and felt disoriented.

The accident might have saved his life.

The 45-year-old Meals on Wheels deliveryman wasn't injured in the fall, but he spent nearly a month in a hospital battling a severe illness that made him feel as if he “blacked out with my eyes wide open.”

Callender is among a group of New York City residents last year who contracted Legionnaires' disease, a type of pneumonia acquired by inhaling a strain of legionella bacteria found in poorly maintained building water systems.

Nearly 7,500 people contracted Legionnaires' disease in 2017, a more than fivefold increase in the number of cases since 2000, according to the Centers for Disease Control and Prevention. Far more people probably had the disease but never sought care or testing.

Federal health officials said that increasing reports of the once-mysterious disease can be explained by better awareness, improved testing and an aging population more susceptible to Legionnaires'. About one in 10 cases end in death. 

The disease is named for an outbreak at a Philadelphia hotel during an American Legion convention in 1976. Those who get the sickest tend to be over 50, have medical conditions such as chronic obstructive pulmonary disease or diabetes or have a history of smoking.

 “It’s been on a strong upward trend for the last couple of years, both the number of cases and outbreaks,” said Chris Edens, an epidemiologist on CDC’s Legionella team.

More:Legionnaires disease: What it is

Among recent outbreaks: 

• Thirty-two people were sickened and one died in October in the Lower Washington Heights neighborhood of Manhattan. The city tested water-cooling systems within a mile radius of the cluster and cleaned those that tested positive with a chemical treatment. It was the city’s largest outbreak since 2015.
• Three people died and 11 became ill in November at the University of Wisconsin Hospital in Madison. Tests of the hospital’s hot-water systems revealed elevated levels of the bacteria. The hospital applied high doses of chlorine and continues to test water systems. The hospital, the Wisconsin Department of Health Services and CDC are investigating. A report has not been completed.
• More than a dozen veterans died and dozens more were sickened at an Illinois Department of Veterans Affairs home in Quincy in 2015. Then-Gov. Bruce Rauner faced criticism for his administration's initial response to the outbreak.
• Last month, a veteran died at the Manteno Veterans Home in Illinois. Gov. J.B. Pritzker ordered a comprehensive review of the state's Department of Veterans Affairs health and safety procedures. 

Early diagnosis  is crucial 

Legionnaires' can be cured with antibiotics, but doctors must recognize signs of the disease and order tests.

Symptoms, which appear two to 10 days after exposure to legionella bacteria, include cough, shortness of breath, fever, muscle aches and headaches. Legionnaires' is not spread from person to person. 

The CDC has tried to make doctors aware of the need to test when appropriate, Edens said. He gave the hypothetical example of a person with severe pneumonia and potential exposure to the harmful bacteria in a hotel or hospital.

The most common type of Legionnaires' can be diagnosed with a simple urine test. 

More:Disneyland tower likely source of 22 cases of Legionnaires’ disease

"The message we really push is the earlier you diagnose a case, the quicker you can get them on proper antibiotics," Edens said. "It does have a relatively high mortality rate. If people are successfully diagnosed and treated early in the disease, you can definitely cure this."

Perhaps the more effective way to address Legionnaires' disease is to reduce exposure to potentially harmful bacteria. That usually means scrutinizing a building's water systems, a prime breeding ground for legionella pneumophila bacteria during the warm summer months and early fall.

Even medical equipment such as eyewash stations, CPAP machines and hot tubs or saunas should be monitored, according to the Centers for Medicare and Medicaid Services.

An outbreak in the South Bronx sickened 138 people and killed 16 in 2015. New York has since adopted the nation's most aggressive measures against the disease: The city required property owners to register cooling towers and get them inspected every 90 days when they are in use.

New York City remains the only municipality with those requirements. New York state has enacted similar oversight.

Little oversight at some buildings

The Centers for Medicare and Medicaid Services requires hospitals and nursing homes to bolster oversight of building water systems and medical equipment that could expose patients to harmful bacteria. There's little regulatory oversight at apartments, hotels and other nonmedical buildings.

In 2016, the CDC studied Legionnaires' disease in hospital and long-term care settings and concluded most cases could be eliminated with proper water management techniques.

"For health care facilities, there are groups already out there looking for these types of things," Edens said. "But for hotels and public accommodations, there’s really nothing at the national level" like the Centers for Medicare and Medicaid Services requirements.

"There’s not a lot of people checking up on a hotel, a condominium or a large building," said Elliott Olsen, an attorney who has filed personal-injury lawsuits on behalf of Legionnaires' patients and their families. "I am not aware of any oversight really at any level."

Callender, the Bronx deliveryman, still feels weak and struggles with throbbing back pain. He is slowly recovering but has been unable to work.

“Every night, I go to sleep with back pain,” he said. “This is a bad thing to go through. Some people don’t make it back from this."

The New York City Health Department confirmed two cases of Legionnaires' disease at the Bronx building where he lives. 

The department notified residents of his apartment building last fall that testing found legionella bacteria in the water system. The bacteria has since been cleared, the department said in a notice to residents Feb. 1.