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Updated: Officials Probe Legionnaires Outbreak

July 25, 2013

ST. MARYS — A county health official says the investigation into an outbreak of Legionnaires disease remains ongoing.

Auglaize County Health Commissioner Charlotte Parsons confirmed two area residents who both worked at AAP in St. Marys contracted the disease within the past month, including one who died as a result of the illness. Parsons declined to identify the names of those individuals, but noted second person is currently being treated for the disease.

"Legionnaires disease is one of the diseases that is required by law to be reported to public health agencies," Parsons said. "We found out there were two and they were linked epidemiologically, meaning they both worked in the same place, then we need to investigate to see if there's a source of infection at the common place they worked."

Parsons said health officials, along with those at AAP, are trying to determine the source of the outbreak. Legionella bacteria, Parsons said, is typically found in water sources and a person contracts the diseases by breathing in infected water droplets. Parsons said there should be no concern for employees at the facility.

"When dealing with a communicable disease, we are trying to No. 1, get anyone who is sick treated and taken care of and No. 2, contain the disease and not have it spread any further," Parsons said. "That involves trying to determine the source of the infection. Legionella bacteria is pretty much every where around us."

Legionella bacteria survive outdoors in soil and water but rarely cause infections.  Indoors, Legionella bacteria can multiply in fresh water systems, such as hot tubs, hot water tanks and cooling towers. Most people become infected when they breathe in contaminated microscopic water droplets in the air.  Legionella cannot be spread from person to person.

Parsons said officials have yet to pinpoint the source of the outbreak. Water samples have been taken from AAP and those have been sent to a lab, and results are expected in early August.

"It's very hard to pinpoint a specific source of it," Parsons said. "But part of our requirement is to try and determine if there is a source and if we can find it, we would make sure through remediation that the source is no longer there and that's the process we are working through."

Parsons said the public should not be concerned with contracting the illness from an infected person.

"There's no need to wear masks or gloves," Parsons said. "Most people get infected by breathing in really small water droplets that have the bacteria in it."

Without test results, Parsons said she cannot confirm the outbreak originated at AAP.

AAP Senior Manager of Associate Relations Dan Hosek issued a statement to The Evening Leader regarding the investigation into the outbreak.  

“AAP is committed to the health and safety of our associates and our thoughts are with the two associates and their families who have been affected by Legionellosis (Legionnaires’ Disease). As we understand the situation, two cases of Legionnaires disease have been diagnosed — one in Mercer County and one in Auglaize County. While no source of the Legionella bacteria has yet been identified, AAP is taking every possible precaution to protect our associates, and is working with local and state health experts to implement additional water testing and safety procedures at our company’s facilities. We have long-standing policies and practices that work to protect our workplace and our associates. We will continue to work with our local and state health departments, OSHA, and others to make certain that we are taking the proper actions and that appropriate information is being shared with associates.”

Ohio Department of Health Spokesperson Tess Pollock said the illness is one that is automatically reported to the state once a patient is diagnosed. Typically outbreaks occur in nursing facilities, hotels or hospitals.

"It's usually a water source that people are inhaling," Pollock said. "That can be shower heads, decorative fountains or hot tubs. Once there is a Legionella outbreak, and two or more cases is an outbreak, we work with the local health department and try to ID the source."

Once a source of an outbreak is discovered, several steps are taken to make sure no other infections take place. Pollock said water is sterilized via hypochlorination or can be "super heated." Samples are taken and lab officials attempt to grow the bacteria — if there is bacteria growth in a sample, then that is a source of the disease.

"Once you ID where it's coming from based on bacteria growth, you can take additional steps," Pollock said. "It's an ongoing thing to make sure it doesn't come back. You need to put a regular maintenance plan in place to make sure the growth doesn't get to that point."

On a national level, Pollock said health officials typically see influxes of Legionnaires disease in May through early fall.

The vast majority of people exposed to Legionella bacteria do not become sick. In some people, the germ cause a mild flu-like illness called Pontiac fever that usually does not require treatment. Legionnaires disease most often effects people 50 years of age or older, persons who smoke or have a chronic lung disease such as emphysema, and those whose immune systems are weakened by diseases such as diabetes, kidney disease, or cancer. Early symptoms of illness develop two to ten days after exposure to a source and include headache, chills, high fever, and muscle pain. Later signs and symptoms may include chest pain, cough, shortness of breath, gastrointestinal upset, and/or confusion or other mental changes.

Pneumonia that is caused by Legionella cannot be distinguished from other types of pneumonia based only on examination of the patient. The proper tests must be ordered for confirmation. The disease can usually be successfully treated with antibiotics, especially when treatment begins early in the course of the disease.

There have been no additional confirmed cases reported to public health authorities. The investigation is continuing, and the cooperation with AAP  is ongoing. The health departments will also investigate any other potential sources of infection that may arise.

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