By Gina Martinez
In 2017, New York state had a record number of cases of Legionnaires’ disease, more than any other state in the country per capita, according to the Allegiance to Prevent Legionnaires’ Disease.
This news comes months after a cluster that plagued Downtown Flushing in October led to 15 diagnoses of the disease.
Legionnaires’ disease is caused by the bacteria Legionella. Symptoms typically include fever, cough, chills, muscle aches, headache, fatigue, loss of appetite, confusion and diarrhea, and they appear two to 10 days after significant exposure to the bacteria, according to the City Department of Health and Mental Hygiene.
Legionnaires’ disease cannot be spread from person to person; most cases can be traced to plumbing systems where conditions are favorable for Legionella growth, such as cooling towers, whirlpool spas, hot tubs, humidifiers, hot water tanks, and evaporative condensers of large air-conditioning systems, the DOH said.
In August 2015, New York recorded the worst outbreak of Legionnaires’ disease in the state’s history when 133 Bronx residents contracted the disease, resulting in 16 deaths. Emergency state and city regulations were enacted. The Allegiance to Prevent Legionnaires’ Disease reports that despite the regulations, two years later, New York state led the nation again with 1,009 cases reported to the Centers for Disease Control, a 38 percent increase in cases compared with 2016.
Of the state total, New York City recorded 441 cases, a 65 percent increase over 2016. The city’s 2017 case total outpaced 2015, the year of the city’s worst outbreak.
Daryn Cline, APLD spokesman, said the continued rise in New York is because of the city’s focus on water management.
“This is especially troubling since New York is holding itself out as the leader in Legionnaires’ disease prevention,” he said. “The truth of the matter is their emphasis on water management inside the building has not had an impact on decreasing the rate of disease.”
APLD has been critical of the New York City and state’s response to preventing cases of Legionnaires’ since regulations were put in place after the Bronx outbreak in 2015.
John Letson, a member of the organization and vice president of plant operations at Memorial Sloan-Kettering Cancer Center, said APLD’s main contention is that the regulations are too narrowly focused on building equipment and do not address the source problem — Legionella entering buildings from the public water supply and distribution system.
“Building equipment uses the same water source that supplies our shower heads and faucets,” Letson said. “Without addressing the bacteria entering our buildings from the public distribution system, the issues we face with Legionella are not going to end.
“According to the CDC, 35 percent of Legionnaires’ disease outbreaks can be attributed to conditions and disruptions to water service outside of the building. In order to keep people safe, especially those with compromised immune systems and patients receiving outpatient care, more must be done to remove the threat of Legionella in our public water.”
DOH spokesman Christopher Miller said that the number of Legionnaire’s disease cases reported nationwide has been on the rise since 2000 and that the increase is likely the result of increased awareness, better reporting and improved testing. DOH said other factors include an aging population that is more vulnerable to disease and aging infrastructure.
Miller said that New York City is the most aggressive in following up on all Legionella cases reported and that the department tries to obtain exposure history for all cases. Miller said not all U.S. jurisdictions do this, so there is an incomplete picture of Legionella-related disease in the U.S.
Miller said that every year, there are 200 to 450 cases of Legionnaires’ disease in the city. The trend in disease cases in New York City mirrors the national data, according to the CDC.
“After the outbreak in the South Bronx in 2015,” Miller said, “the Health Department announced a comprehensive plan to reduce the risk of Legionnaires’ disease outbreaks in the city, including implementation of the toughest cooling tower regulations in the nation, the hiring of more inspectors and training of existing city personnel to inspect towers if needed, expanded lab capacity, and faster community notification. This robust public health measure is unique in the U.S.”
Reach Gina Martinez by e-mail at gmart