{"id":22248,"date":"2019-12-04T18:09:17","date_gmt":"2019-12-04T17:09:17","guid":{"rendered":"https:\/\/www.kwrwater.nl\/?p=22248"},"modified":"2020-04-06T09:06:37","modified_gmt":"2020-04-06T07:06:37","slug":"multiple-sources-of-genesee-county-legionella-outbreak-in-2014-2015","status":"publish","type":"post","link":"https:\/\/www.kwrwater.nl\/en\/actueel\/multiple-sources-of-genesee-county-legionella-outbreak-in-2014-2015\/","title":{"rendered":"Multiple sources of Genesee County Legionella Outbreak in 2014-2015"},"content":{"rendered":"
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In 2017 the State of Michigan asked KWR to investigate the epidemic of Legionnaires\u2019 Disease in Genesee County, Michigan in 2014 and 2015. The research team \u2013 led by principal scientist Gertjan Medema – found evidence for three sources: strong evidence for exposure to a Flint hospital in 2014 and 2015, and weaker evidence for exposure to City of Flint water at home or living in the proximity of a specific cluster of cooling towers, both only in 2014. The research is published today in scientific journal Environmental Health Perspectives<\/em>.<\/p>\n<\/div>\n

Legionnaires\u2019 disease is a severe kind of pneumonia (lung infection) caused by the bacteria Legionella pneumophila<\/em>. These bacteria can grow in warm water systems and become airborne in showers, cooling towers, and air conditioning systems. People typically catch it by breathing in air with tiny water droplets (called aerosols) that contain the Legionnaires\u2019 disease bacteria.<\/p>\n

In order to prevent new outbreaks in Genesee County – and elsewhere – it is vital to understand how people got exposed to Legionnaires\u2019 disease bacteria. If we know how people got exposed it helps to understand what caused the outbreak.<\/p>\n

Independent Legionnaires\u2019 disease research<\/h2>\n

The research team travelled to Lansing and Flint and studied the information that was available about the Legionnaires\u2019 disease epidemic in Genesee County in 2014 and 2015. The team evaluated medical records, disease and death statistics, Census data, address data, water connection and use data, hospital data, Flint water data, geographical data, and weather data.<\/p>\n

To ensure an independent research practice we did not rely on what others had collected or analysed but went back to the most primary data available. Gertjan Medema: \u201cWe basically positioned ourselves as first on the scene and took the research steps that epidemiologists take when confronted with an outbreak. <\/em>We reviewed information about each of the 86 residents from Genesee County who was diagnosed with Legionnaires\u2019 Disease in 2014-2015 and used multiple reviewers per file (each file was reviewed twice). We were able to find out when each person got Legionnaires\u2019 disease, and how each person might have been exposed to the Legionnaires\u2019 disease bacteria.\u201d<\/p>\n

Three sources associated with the outbreak of Legionnaires\u2019 disease<\/h2>\n

An outbreak of Legionnaires\u2019 disease occurred in 2014-2015 among people who lived in Genesee County. A total of 86 residents of Genesee County developed Legionnaires\u2019 disease. Most of the people who developed Legionnaires\u2019 were age 65 or older and had a chronic health condition.<\/p>\n

We found strong evidence (CDC class I<\/a>) for exposure to a Flint hospital in 2014 and 2015, and weaker evidence (<\/p>\n\nbuilding water systems. Falls Church, VA: AIHA. Centers for Disease Control and Prevention (CDC). 2003. Guidelines for environmental infection control in health-care facilities. Atlanta, GA: CDC, U.S. Department of Health and Healthcare Infection Control Practices Advisory Committee. CDC. 2017. Developing a water management program to reduce Legionella growth and spread in buildings: A practical guide to implementing industry standards. Version 1.1. Atlanta, GA: CDC. Centers for Medicare & Medicaid (CMS). 2017. Requirement to reduce Legionella risk in healthcare facility water systems to prevent cases and outbreaks of Legionnaires\u2019 disease. Atlanta, GA: CDC. U.S. Department of Veterans Affairs (DVA). 2014. Prevention of healthcare-associated Legionella disease and scald injury from potable water distribution systems. Washington, DC: VHA.\" class=\"note-link\" aria-expanded=\"false\" aria-controls=\"note-1429\">CDC class 2<\/abbr><\/i>ASHRAE. 2015. Standard 188 legionellosis: Risk management for building water systems. Atlanta, GA: ASHRAE. American Industrial Hygiene Association (AIHA). 2015. Recognition, evaluation and control of Legionella in
\nbuilding water systems. Falls Church, VA: AIHA. Centers for Disease Control and Prevention (CDC). 2003. Guidelines for environmental infection control in health-care facilities. Atlanta, GA: CDC, U.S. Department of Health and Healthcare Infection Control Practices Advisory Committee. CDC. 2017. Developing a water management program to reduce Legionella growth and spread in buildings: A practical guide to implementing industry standards. Version 1.1. Atlanta, GA: CDC. Centers for Medicare & Medicaid (CMS). 2017. Requirement to reduce Legionella risk in healthcare facility water systems to prevent cases and outbreaks of Legionnaires\u2019 disease. Atlanta, GA: CDC. U.S. Department of Veterans Affairs (DVA). 2014. Prevention of healthcare-associated Legionella disease and scald injury from potable water distribution systems. Washington, DC: VHA.<\/i><\/span>\n

) for exposure to City of Flint water at home or living in the proximity of a specific cluster of cooling towers in Flint.<\/p>\n

Flint hospital<\/h3>\n

Nearly half (42 of 86 persons) had been in this hospital before they got sick with Legionnaires\u2019 disease. Most of these 42 people had been hospitalized, but some of them were visitors or outpatients. We have strong evidence that people in Genesee County got sick with Legionnaires\u2019 disease because of their contact with this hospital:<\/p>\n