Le­gion­naires cases up lo­cally and na­tion­wide

Disease can be mis­taken for the flu or a stom­ach bug.

Dayton Daily News - - FRONT PAGE - By Kara Driscoll Staff Writer

Le­gion­naires disease is be­com­ing in­creas­ingly preva­lent in the Day­ton re­gion — and across the United States — yet the symp­toms are so com­mon they can be mis­taken for the flu or a stom­ach bug.

Re­ported cases of Le­gion­naires disease in Mont­gomery County this year sur­passed cases re­ported in the past two years, and are well above what was re­ported a decade ago.

Across Ohio, the num­ber of Le­gion­naires disease cases rose by more than 160 per­cent within the past decade, ac­cord­ing to data an­a­lyzed by the Day­ton Daily News. The in­for­ma­tion was col­lected from 2007 to 2017 by the Ohio De­part­ment of Health.

The state has seen ris­ing cases in re­cent years with 510 in 2016; 566 in 2015; and 409 in 2014.

From 2004 to 2012, the num­ber of cases each year stayed in the 200s with the ex­cep­tion of an in­crease in 2011 when 390 cases were re­ported in Ohio.

Cough, fever, chills, short­ness of breath, mus­cle aches and di­ar­rhea are all early symp­toms of Le­gion­naires disease.

Le­gionella is a type of bac­terium found nat­u­rally in fresh­wa­ter en­vi­ron­ments, like lakes and streams. It can be­come a health con­cern when it grows and spreads in hu­man-made build­ing wa­ter sys­tems like show­er­heads and sink faucets, cool- ing tow­ers, hot tubs and large plumb­ing sys­tems, ac­cord­ing to the Cen­ters for Disease Con­trol and Preven­tion.

Lo­cal health de­part­ment of­fi­cials urge peo­ple to seek med­i­cal help if they be­lieve they’ve con­tracted the disease.

Af­ter Le­gionella grows and mul­ti­plies in a build- ing wa­ter sys­tem, Le­gion- naires’ disease can be spread by breath­ing in small droplets of wa­ter in the air that con­tain the bac­te­ria.

Ap­prox­i­mately 36 cases have been re­ported in Mont- gomery County so far this year, an in­crease from 24 cases last year and 26 in 2016. It’s down from the 51 cases re­ported in 2015, but well above the eight cases re­ported in the county in 2008 and the five re­ported in 2009.

El­derly, smok­ers most at risk

Ex­perts the­o­rize the uptick in re­ported cases coun­try- wide could be at­trib­uted to an ag­ing pop­u­la­tion, cli­mate change, in­creased test­ing and out­dated in­fra­struc­ture.

The el­derly, smok­ers and those with a chronic lung disease or weak­ened im­mune sys­tem are most at risk of dy­ing from the disease. The disease is not thought to be trans­mit- ted from per­son to per­son.

“We’re c on­cen­trated on stop­ping the spread of disease,” said Dan Suf­fo­letto, spokesman for Pub­lic Health-Day­ton & Mont- gomery County.

Leaky air con­di­tion­ing units, dirty hot tubs and stand­ing wa­ter in base­ments are all likely en­vi­ron­ments for the Le­gionella bac­te­ria to grow. Le­gion­naires’ disease can be deadly.

Dr. Steven Bur­dette, med­i­cal direc­tor of in­fec­tion preven­tion at Mi­ami Val­ley Hos- pital, said cases typ­i­cally spike in the hot sum­mer months. It’s chal­leng­ing to di­ag­nose, Bur­dette said, and the num­ber of ways to treat it are limited.

Rou­tine tests for pneumo- nia do not de­tect Le­gion- naires disease, so a urine test is used to di­ag­nose it. Only three an­tibi­otics are used to treat Le­gion­naires com­pared to the mul­ti­ple an­tibi­otics that can be used to treat pneu­mo­nia.

While Bur­dette doesn’t think this sum­mer will be a record high for Le­gion­naires cases in the re­gion, the hospi­tal saw “quite a few cases” in July, he said.

“We were not as bad as two or three years ago,” he said.

The Ohio De­part­ment of Health said it does not have com­plete data for Le­gion- naires cases in 2018, but a large out­break ear­lier this sum­mer in Parma, Ohio, left 10 sick and one dead — a 93-year-old woman.

Two vet­er­ans in Colum­bus were also di­ag­nosed with Le­gion­naires disease this sum­mer, ac­cord­ing to the Colum­bus VA Am­bu­la­tory Care Cen­ter.

The Day­ton re­gion bat­tled its own Le­gion­naires’ out­break in 2011 when 11 pa­tients were sick­ened at Mi­ami Val­ley Hospi­tal. In­suf­fi­cient heat­ing of the hospi­tal’s hot-wa­ter sys­tem caused an out­break that, at the time, was the state’s largest Le­gion­naires’ out­break since 2004. The Ohio Plumb­ing Code re­quired the hospi­tal to make wa­ter sup­plied to show­ers and faucets was heated to no more than 120 de­grees Fahren­heit.

Pos­si­ble link: warm tem­per­a­tures

Le­gion n aires disease re­ports are ris­ing across the U.S., ac­cord­ing to med­i­cal pro­fes­sion­als, though the causes are hotly de­bated.

The an­nual num­ber of re­ported cases has in­creased nearly 4.5 times since 2000 when 1,110 cases were re­ported, ac­cord­ing to a re­cent ar­ti­cle pub­lished in the Jour- nal of the Amer­i­can Med­i­cal As­so­ci­a­tion. In 2016, 6,141 cases were re­ported, about the same as in 2015 but higher than the ap­prox­i­mately 5,000 re­ported cases in 2014.

Some ex­perts at­tribute the rise in cases to un­sea­son­ably warm tem­per­a­tures caused by cli­mate change. A study by Ohio Uni­ver­sity re­searcher Jeff Vasiloff showed it was likely that warmer wa­ter tem- per­a­tures could be con­tribut­ing to in­creased cases of Le­gion­naires disease.

Vasiloff, an as­sis­tant clin­i­cal pro­fes­sor, found that weather changes and in­fec­tious dis­eases have been as­so­ci­ated for cen­turies.

The Ohio Uni­ver­sity study found there were 3,515 re­ported cases of Le­gion­naires disease from 2005 to 2016 in Ohio. In­ci­dence per 100,000 of Le­gion­naires’ disease jumped from 1.8 in 2005 to 4.4 in 2016, ac­cord­ing to Vasiloff ’s re­search. Over that time, the av­er­age an­nual air tem­per­a­ture in Ohio in­creased by 0.8 de­grees Fahren­heit. Ad­di­tion­ally, the max­i­mum ice cov­er­age of Lake Erie de­creased from 89.4 per­cent from 1975-1995 to 76 per­cent in 1996-2016, ac­cord­ing to the study.

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