Source of Ohio Legionnaires' Outbreak Confirmed

The Ohio Department of Health and the Occupational Safety and Health Administration (OSHA) in collaboration with the Lake County General Health District (LCGHD) recently confirmed the source of a Legionnaires’ disease outbreak in Lake County, Ohio, that started in July.

According to a press release, on August 25, 2016, the LCGHD was notified of a possible Legionnaires’ disease case at a Lakeland Boulevard business in Eastlake; however, a Legionella Environmental Assessment showed “no areas of concern.” Approximately one month after initial investigations, the Ohio Department of Health reported two additional cases of Legionnaires’ disease at different businesses in the same area. A second Environmental Assessment conducted in late September yielded the same results as the first, showing “no areas of concern.” It was not until early October that an Environmental Assessment at Consolidated Precision Products (CPP)—a business at an address near the initial case report—that the LCGHD noted “several areas of concern.” In late October, LCGHD and OSHA collected water samples from CPP cooling towers to be tested for Legionella, after which CPP sanitized and cleaned their cooling towers “in accordance with protocols approved by Ohio Department of Health.”

On November 16, 2016, testing of samples collected prior to the sanitization process confirmed the presence of Legionella in one of the company’s cooling towers; however, samples collected after sanitization showed that the bacteria were no longer inhabiting the cooling towers. Lake County Health Commissioner, Rob H. Graham stated in the press release, “It’s important to know that we will never really know the true source of the bacteria, we do know that one cooling towers was positive.”

Legionnaires’ disease is caused by Legionella, which can be found in freshwater. According to the Centers for Disease Control and Prevention, Legionella can also grow in man-made water systems, such as hot tubs, water tanks, plumbing systems, decorative fountains, and cooling towers (such as the CPP cooling tower). Legionnaires’ spreads through the inhalation of contaminated water droplets, or through water aspiration. Person-to-person transmission is rare, but possible. Individuals who are at an increased risk of contracting Legionnaires’ disease include those who are over 50 years of age, smokers or ex-smokers, chronic lung disease patients, immunocompromised individuals, or those taking immunosuppressants, such as transplant or chemotherapy patients.

In an exclusive interview with Contagion, Laura Cooley, MD, MPH, medical epidemiologist, Respiratory Diseases Branch, Division of Bacterial Disease, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, explained how healthcare providers can protect their patients from becoming infected with Legionella.

The LCGHD confirmed that “test results indicate that any potential risk from this site has been eliminated at this time.” The LCGHD noted CPP’s full cooperation with the investigation as well as the sanitization processes. Since the beginning of the outbreak, 12 cases of Legionnaires’ in Lake County, Ohio have been lab-confirmed, with one death. The deceased was not an employee of CPP.