March 16, 2016
Infectious Disease News, March 2016
“Our proactive message is seek Legionella out and you will protect your patients. ... Health care facilities should be testing for Legionella, especially in Genesee County.” —Dr. Janet E Stout
A recent outbreak of Legionnaires’ disease in Genesee County, Michigan, underscored surveillance issues surrounding the sometimes deadly lung infection, according to experts.
The outbreak — involving both area health care facilities and the community — is thought to have been caused by municipal water originating from the Flint River, which also was shown to have carried high levels of lead into the homes of area residents. The outbreak infected 87 people between 2014 and 2015, killing nine.
“The United States has lagged far behind the rest of the world in having some kind of standard or requirement for addressing Legionella in building water systems,” Janet E. Stout, PhD, president of Special Pathogens Laboratory in Pittsburgh, told Infectious Disease News.
Research by Stout and others has shown the potentially lifesaving benefits of protecting against outbreaks of Legionnaires’ disease by proactively testing water for Legionella, an approach she has been recommending for more than 30 years.
However, national guidelines regarding Legionella are generally reactive, according to Stout.
“The increase in chance of death happens when there’s a delay in diagnosis and a delay in initiating appropriate therapy,” she said.
The benefits of proactive testing
Stout and colleagues showed in a 1982 study that during an outbreak of Legionnaires’ disease, Legionella was more widely distributed at a Veterans Affairs hospital in Pittsburgh than previously believed. The hospital’s water distribution system was identified as the reservoir for the pathogen.
In a 2005 study, Stout and colleagues demonstrated that guidelines favoring a proactive approach significantly decreased the number of nosocomial Legionnaires’ disease cases in Allegheny County, Pennsylvania, even as there was an increase in community-acquired cases in the area. The county recommended routine testing of the hospital water distribution systems even in the absence of reported cases — a departure from national guidelines.
Flint outbreak follows switch to river water source
In April 2014, the city of Flint, Michigan, switched its primary water source from the Detroit water system to the Flint River. The switch was to last 2 years while construction of a pipeline from Lake Huron was completed. However, amid an outcry over the levels of lead in the water, Flint was reconnected to the Detroit water system on Oct. 15, 2015.
Two outbreaks of Legionnaires’ disease were detected in Genesee County during the time Flint was getting its water from the river, according to the Michigan Department of Health and Human Services (MDHHS). The first, between June 2014 and March 2015, included 45 confirmed cases, with five associated fatalities. Between May and October 2015, there were 42 confirmed cases and four deaths. The average number of Legionnaires’ disease cases reported in Genesee County over the previous 4 years was between six and 13.
According to the MDHHS, 36% of the patients in the outbreaks used Flint city water in their homes, and 48% had stayed overnight in an area hospital in the 2 weeks before the onset of their symptoms.
During the initial increase between June 2014 and March 2015, more than half of cases had contact with McLaren Medical Center within 2 weeks of symptom onset. McLaren, where Stout has been consulting since August 2015 after working with the county health department, gets its water from the City of Flint. She said the lessons learned from the outbreak are clear.
“Our proactive message,” she said, “is seek Legionella out and you will protect your patients. ... Health care facilities should be testing for Legionella, especially in Genesee County.”
March 09, 2016
Legionella services, education and ASHRAE risk management services expand
March 9, 2016 (Pittsburgh, Pa.)—Special Pathogens Laboratory (SPL) announced today that Bill Pearson, CWT, has joined SPL to expand the firm’s Legionella services, including education and ASHRAE 188 risk management resources. Pearson comes with a wealth of experience in industrial water treatment and business development having spent the last 40 years at Southeastern Laboratories, Inc., where he served as executive vice president and director of sales, consulting and technical services since 1989. As a biologist, biochemist, and certified water treatment professional, Pearson brings more than 25 years of leadership experience in professional and trade organizations, in which he specializes in bridging the gap between water treatment and Legionella management programs.
Bill Pearson will serve as SPL’s Senior Vice President of Business Development to meet the urgent demand for Legionella education and prevention, especially among the water treatment industry, while advancing SPL’s goal to end Legionnaires’ disease.
“Legionella knowledge and preventing Legionnaires’ disease has been my passion since the historic outbreak in Philadelphia in 1976. As a biology major fresh out of academia, I was fascinated by Legionella and endeavored to learn all I could. And now, since the passage of ASHRAE Standard 188 and the New York City legislation, the demand for people with combined expertise in Legionella is huge but scarce. That’s why SPL was the only choice for me,” says Pearson, the author of numerous publications on water treatment and Legionellosis, including the Association Water Technologies (AWT) Legionella document, and numerous technical manuals, educational training workshops and seminars.
“I’m excited to join the world’s authority on Legionella and use my technical expertise and love of teaching to advance ending this disease. Legionnaires’ disease is a preventable disease so why not prevent it?” he says.
Pearson is one of only two American Society of Heating Refrigeration and Air-Conditioning Engineers (ASHRAE) approved instructors for their ALI course on ANSI/ASHRAE 188-2015: Legionellosis: Risk Management for Building Water Systems. He is past chair (2007-2009) of the ASHRAE Water Treatment Technical Committee, and a voting member on the ASHRAE SSPC-188 (Legionellosis) committee and the Cooling Technology Institute (CTI) Legionellosis committee.
“I’m thrilled to welcome Bill to the SPL team,“ says Dr. Janet E Stout, president and director of Special Pathogens Laboratory. “Few in the industry possess Bill’s enthusiasm, leadership, knowledge, and depth of experience in both water treatment and Legionella prevention. I can think of no other person better than Bill to build strong, lasting partnerships with the water treatment industry and advance the prevention of Legionnaires’ disease.”
A past AWT president and board member, Bill is the recipient of the prestigious Ray Baum Water Technologist award. A leader in many water treatment technical trade associations, he serves as the AWT liaison to ASHRAE and CTI, and is on AWT’s Task Force to the American Society for Healthcare Engineering (ASHE), the Green Task Force to the U.S. Green Building Council (USGBC)and leads the Legionella Task Force.
Special Pathogens Laboratory, The Legionella Experts®, helps prevent Legionnaires' disease through a cohesive strategy to detect, control, and remediate Legionella and waterborne pathogens in water systems. Founded by Drs. Janet Stout and Victor Yu, world-renowned experts in Legionnaires’ disease prevention, SPL provides Legionella and pathogens testing, education, and expert consultation based evidence-based research to healthcare, hospitality, and water treatment industries, as well as government, commercial and industrial sectors.
February 17, 2016
By COREY WILLIAMS, ASSOCIATED PRESS DETROIT — Feb 16, 2016, 4:55 PM ET
Another part of the problem, according to Stout, is the CDC does not tell hospitals to test for legionella as a preventative measure.
"Our group ... has been saying that's backward and they should be making sure health care facilities should be testing," she said.
Michigan, seeking to prevent another oversight fiasco after lead poisoning in Flint and a deadly Legionnaires' disease outbreak in the area, is considering new water testing rules for hospitals and possible changes to how large facilities manage their water systems that could include new monitoring requirements.
State officials are analyzing Michigan's public health code in terms of "the requirement and enforcement of water testing in hospitals and other facilities," Jason Moon, a spokesman for the Department of Licensing and Regulatory Affairs, told The Associated Press.
The Legionnaires' outbreak killed 9 people and sickened at least 78. Water testing found Legionella bacteria in at least one Flint hospital.
In addition, officials are looking at updated guidelines for building operators to mirror the standards developed by a national industry group that require building owners and managers to conduct annual surveys to look out for Legionella bacteria risks and develop plans to control it.
Both are part of the response by Gov. Rick Snyder's administration to the surge in Legionnaires' cases after Flint switched its water source in 2014 from the Detroit water system to the Flint River water that wasn't properly treated. The move, while the city was under emergency state financial management, allowed lead to leach from old pipes into Flint homes and businesses. Tests later showed high lead levels in some Flint children.
Moon did not give details of the testing requirements, so it's difficult to say whether any changes would put Michigan at the forefront of building water systems safety. One expert tells The AP that no state requires any advance or preventative testing for Legionella in building water systems, and another notes that the drawback to the standards developed by the American Society of Heating, Refrigerating and Air Conditioning Engineers is that they are voluntary.
"To get teeth, it needs to be adopted into plumbing, regulatory codes," said Janet Stout, president of Pittsburgh-based Special Pathogens Laboratory, who has researched links between Legionella bacteria and public water supplies. "The only way" to prevent it "is to test before somebody gets sick."
Webinar: ANSI/ASHRAE Standard 188-2015 Legionellosis: Risk Management for Building Water Systems by Dr. Janet Stout
February 16, 2016
When: Wednesday, Feb 17, 1-2 EST
Description: In response to current events in Flint, MI, this live webcast will feature Special Pathogens Laboratory owner, Janet E. Stout, PhD, who will describe the context of Legionnaires' disease and the new national guidelines for water systems. The ANSI/ASHRAE Standard 188-2015 Legionellosis: Risk Management for Building Water Systems is intended to provide guidelines for those involved in the creation and maintenance of human-occupied facilities, including but not limited to healthcare facilities.
This learning opportunity will provide information for communities and health professionals addressing outbreak situations and for those interested in Legionella prevention strategies.
Speaker: Janet Stout, PhD, President/Director of Special Pathogens Laboratory and Research Associate Professor at the University of Pittsburgh Swanson School of Engineering
Who Should View This Webcast: Public health professionals including nurses and health educators, healthcare and other facility managers, and anyone interested in learning more about Legionnaires’ disease and its prevention.
- Identify basic elements of Legionnaires’ disease (CHES Area of Responsibility 1.4.3)
- Recognize approaches for Legionella detection and control (7.1.1, 7.1.3, 7.5.2)
Continuing Education Credit
- 1.0 Nursing Contact Hours
- 1.0 CHES Category I CECH
- Certificate of Completion
The Office of Public Health Practice at the University of Michigan School of Public Health is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
The Office of Public Health Practice at the University of Michigan School of Public Health, MI0094, is a designated provider of continuing education contact hours (CECH) in health education by the National Commission for Health Education Credentialing, Inc. through December 31, 2016.
Requirements for Successful Completion
- Register for this training
- Sign into the training within 10 minutes of start time and view the training
- Complete the evaluation
This webcast is provided by the Michigan Public Health Training Center and the Genesee County Health Department (Flint, MI). The Michigan PHTC is a part of the Region V Great Lakes Public Health Training Collaborative.
This webcast is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UB6HP27881 Region V Public Health Training Collaborative (total award amount $884,366). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
WKAR's Current State Interviews Dr. Janet Stout on Michigan State Health Department Response to Legionnaires' in Flint
February 15, 2016
Detroit News investigation reveals state’s laissez-faire response to Flint Legionnaires’ outbreak
The state of Michigan is under fire over information contained in newly released emails that show a less than urgent response to an outbreak of Legionnaires’ Disease in Flint. We talk about it with Chad Livengood of the Detroit News and Dr. Janet Stout, a researcher from the University of Pittsburgh.
The Flint Water Crisis has mushroomed beyond a dire public health crisis to a political lightning rod rife with missteps, accusations and hints of cover-up.
Last Friday, The Detroit News reported on the state’s delayed response to cases of Legionnaires’ Disease that surfaced in Flint in early 2014. Reporters combed through some 24,000 emails voluntarily released by the Snyder administration. Some of those notes indicate the governor himself did not learn of the outbreak until months later.
Current State talks with Chad Livengood, the capitol reporter for The Detroit News, and an expert on Legionnaires’ Disease, Dr. Janet Stout, a research associate professor and president of the Special Pathogens Laboratory at the University of Pittsburgh.
February 15, 2016
Quick state action to involve federal agencies and inform the public might have shortened an outbreak of Legionnaires’ disease in the Flint area and saved lives, a national expert on the respiratory disease told The Detroit News.
Michigan turned down help from the U.S. Environmental Protection Agency and the Centers for Disease Control and Prevention, according to a Detroit News analysis of more than 24,000 pages of emails released by the Snyder administration and Genesee County.
State agency officials also tried to steer Genesee County health officials away from examining the municipal water system as a potential source of the Legionella bacteria that sickened 87 people between May 2014 and November 2015, killing nine.
Legionnaires’ disease is caused in warmer months by a bacteria in warm, fresh water that leads to a severe form of pneumonia and can be found in large plumbing systems, hot tubs and air-conditioning units.
The state’s handling of the crisis contrasts markedly with how New York state officials dealt with a Legionnaires’ outbreak last summer in the Bronx, said Dr. Janet Stout, a research associate professor with the University of Pittsburgh who assisted with both outbreaks. The Bronx spate included 133 cases, resulting in six deaths.
“New York City and New York state were very, very aggressive in terms of doing the testing and informing the public, and as a result they were able to contain the outbreak very quickly,” said Stout, president of Special Pathogens Laboratory, which conducted water testing in the Bronx.
The outbreak lasted about a month — from July 8 to Aug. 3 — and was traced to a cooling tower on top of a hotel, according to New York City.
“As a result, they were able to contain the outbreak very quickly,” Stout added. “If you don’t make that progression of doing the testing of the environment, the cases continue — which is what we saw in Flint.”
A study by state of Michigan epidemiologists of 45 Flint area cases that occurred from June 2014 through March 2015, resulting in five deaths, found that 16 cases were associated with McLaren Regional Medical Center in Flint.
Stout, who was hired by McLaren as a consultant, concluded Legionella bacteria likely entered the hospital through brown water from the municipal water system. But the cache of emails between state, county and federal health agencies documents the state’s reluctance to search the water system for clues or relinquish control of the scientific investigation.
by Karen Bouffard, The Detroit News, February 15, 2016
January 22, 2016
Water testing during an outbreak of Legionnaires’ disease in Genesee County found Legionella bacteria was present in water at McLaren Regional Medical Center — and an expert hired by the hospital said this week the organism likely came from Flint River water delivered by the city water system.
In an email to The Detroit News, McLaren spokeswoman Laurie Prochazka confirmed the facility undertook “aggressive testing” of it’s water after noting an increase in Legionnaires’ there and at other hospitals in the spring of 2014. “Early test results indicated the presence of a low level of Legionella,” she said.
The medical center took action, and “All Legionella testing continues to show the McLaren Flint water supply is well within safety and quality standards,” Prochazka added.
Janet Stout, a research associate professor at University of Pittsburgh’s Swanson School of Engineering and an expert on Legionnaires’ disease, said this week the germ likely entered the hospital via brown water, which was delivered by the Flint water system, laden with organic matter on which Legionella and other bacteria feast. McLaren hired Stout early on in the outbreak to assess the possible presence of the bacteria and recommend remediation, if necessary.
State epidemiological reports found more cases “associated” with McLaren than with any other source of exposure, but have not made a connection with Flint River water. The clash highlights the controversy over the state’s insistence the city’s contaminated water isn’t the definitive source of the outbreak.
Asked Thursday if Flint River water caused the outbreak, Michigan Department of Health and Human Services spokeswoman Jennifer Smith said a “strain match” is needed “to make a definitive statement on environmental causation.” Officials have said it’s impossible to identify the strain because Legionella samples were never kept from the patients who had Legionnaires’.
According to Stout, studies have estimated Legionella would be found in about 50 percent of hospitals if water testing were required by the federal Centers for Disease Control and Prevention.
According to Stout, studies have estimated Legionella would be found in about 50 percent of hospitals if water testing were required by the federal Centers for Disease Control and Prevention.
Legionnaires’ disease is caused in warmer months by a certain bacteria in warm fresh water that leads to pneumonia and sometimes death. The bacteria can be found in large plumbing systems, hot tubs, air-conditioning units and fountains.
Read entire article on Detroit News web site.
- Karen Bouffard, The Detroit News
December 21, 2015
December 19, 2015
by Micheal Kosnar, NBC News
From birth, Northern California newborn Ryland Joseph always seemed happy with a constant smile and twinkle in his brown eyes. But just four months after he was born, the child was diagnosed with Wiskott-Aldrich Syndrome, a rare genetic disorder.
His parents, Rodd and Kellie Joseph, knew their son's only chance for survival was a bone marrow transplant. They chose the highly regarded Benioff Children's Hospital at the University of California San Francisco Medical Center for the procedure.
But after a successful operation, the boy's health took a serious turn just days later. He died on May 16, 2013. The Josephs said they were shocked to learn Ryland didn't die as a result of the transplant or even his genetic disorder — he died from the Legionnaires' disease that he contracted in his own hospital room.
"I was angry like I've never been angry in my life. This was my only son," Rodd Joseph told NBC News. "I mean, had they tested for it, my son might still be here."
Since the Legionnaires bacteria was first identified after scores of men fell ill at Philadelphia's American Legion Convention in 1976, thousands are still sickened every year in the U.S., even though some experts say it's almost entirely preventable.
At risk in particular are hospitals, with unsuspecting patients — even babies — vulnerable to a killer in the water.
Most people get Legionnaires by breathing in mist from water that contains the bacteria. It can cause severe pneumonia.
At Benioff Children's Hospital, Ryland, who had a weakened immune system, was in a special unit away from other people and sources of infection.
The hospital had a policy in place prohibiting "tub baths or showers" in the rooms which would have prevented the spread of Legionnaires through the inhalation of microscopic water droplets.
But hospital cleaning personnel violated that policy by turning on the shower.
The Legionella bacteria thrives in warm water environments like cooling towers and large plumbing systems, but the hospital hadn't tested for it since 2006.
"It was a shock to me," Kellie Joseph said. "And I think that people need to be aware of what it is, and that it's lurking, and it's in the hospitals."
The Josephs sued the UCSF Medical Center for the wrongful death of their son. The case was later settled out of court.
In court documents, the hospital admits that Ryland contracted Legionnaires' Disease in their facility.
The hospital states it had been using Legionella mitigation practices consistent with industry standards, such as heating water to a certain temperature as it comes into the building from the city, and that it implemented new policies after Ryland's death.
"There are people in public health that are afraid to tell people that this bacteria survives water treatments in our water systems," [Dr Janet] Stout said. "The thing we hear about is we don't want to start panic. We don't want to alarm people unnecessarily. So what happens is inaction. The hospitals don't test their water because the Center for Disease Control and Prevention says wait until there are cases before you go looking for the source. And we think that's backwards."
December 19, 2015