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Published Date: 2012-04-05 21:48:46
Subject: PRO/EDR> Legionellosis - New Zealand (02): (AU) fatal
Archive Number: 20120405.1091797

LEGIONELLOSIS - NEW ZEALAND (02): (AUCKLAND), FATAL
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[1]
Date: Thu 5 Apr 2012
From: Simon Baker <SBaker@adhb.govt.nz> [edited]

To fill in some gaps not covered by the newspaper articles: The 1st illness onset date was 19 Feb 2012; there are 11 cases in total now, all _Legionella pneumophila_ serogroup 1 (LP1); (we would normally expect 1-2 LP1 cases at a maximum in a 6-week period in Auckland). [Cases are] widely dispersed across our region. Auckland is roughly the size of London, but with a much smaller population (1.5 million). There are no obvious links so far, but diary-type re-interviewing is currently underway.

In light of the difficulty we knew we could have in identifying a source with such a widely-dispersed outbreak and with no obvious links between cases, and with difficulties we have experienced in the past where the time taken to locate a source may have delayed definitive public health action, we took the pragmatic step of issuing a media release asking all building managers -- whether of commercial buildings or industrial complexes -- to shock-dose cooling towers or similar systems as soon as possible. We have had excellent support from our local council who are contacting building mangers and industry contractors directly. The industry seems fully aware of the issue, and we have had no complaints from building managers.

The comment that "300 buildings may be affected" is a misunderstanding by the journalist. We don't know how many buildings may be affected; it may just be one. But we are asking that all be decontaminated. There is no particular link to Auckland CBD [Central Business District]. Cases are from all over the region.

--
Dr Simon Baker
Medical Officer of Health, Environmental Health Team
Auckland Regional Public Health Service
http://www.arphs.govt.nz
<SBaker@adhb.govt.nz>

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[2]
Date: Thu 5 Apr 2012
From: Steve Berger <mberger@post.tau.ac.il> [edited]

Note that among the major English-speaking countries, rates of legionellosis are highest in Australia and New Zealand [1-3]; see graph: http://www.gideononline.com/wp/wp-content/uploads/Leg-EngSpk.png.

References:
1. Berger SA. Infectious Diseases of New Zealand, 2012. 413 pp, 136 graphs, 1534 references. Gideon e-books, http://www.gideononline.com/ebooks/country/infectious-diseases-of-new-zea=land/.
2. Berger SA. Legionellosis: Global Status, 2012. 94 pp, 110 graphs, 840 references. http://www.gideononline.com/ebooks/disease/legionellosis-global-status/.
3. Gideon graph tool at http://www.GIDEONonline.com/wp/wp-content/uploads/Gideon-Graphs.pps.

--
Steve Berger
Geographic Medicine
Tel Aviv Medical Center
<mberger@post.tau.ac.il>

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[3]
Date: Thu 5 Apr 2012
Source: The National Business Review [edited]
http://www.nbr.co.nz/article/legionnaires-outbreak-claims-first-life-more-may-die-co-115960

A Legionnaires' disease outbreak in Auckland claimed its 1st life on Wednesday [4 Apr 2011] night, with a public health specialist predicting more may die.

Secretive Auckland council bureaucrats refused to tell the public which city buildings have been urgently "shock-dosed" with chemicals this week against the disease. The council's "help desk" told NBR Online that information could not be given to the media, and senior council management were said to be in meetings this afternoon [5 Apr 2012].

Wednesday's [4 Apr 2011] death follows 11 cases of the disease confirmed by Auckland Public Regional Health Services (APRHS) from a mid-February 2012 outbreak, medical officer of health Simon Baker says. "Unfortunately, one lady has now died. I don't want to go into much detail, but she was elderly and already ill, and it was not unexpected," Dr Baker says. He mentioned the Auckland district health board but did not clarify whether the woman died in hospital.

The Property Council alerted its members this afternoon [5 Apr 2011], requesting building owners or managers with water-powered/water-cooled air conditioning systems to immediately chemically treat their systems in order to kill any _Legionella_ bacteria that may be present.

It takes between 2 and 14 days for Legionnaires' [disease] to get a grip, which makes it difficult to pinpoint a source and say how widespread the outbreak could go, Dr Baker says. "The cases are dispersed so widely over the city, and you have only got to take one breath of contaminated air to get infected. It is almost impossible for people to remember where they went everyday and remember where they took a breath. Because of the incubation period, we won't know for 2 weeks if our message for people to shock-dose their systems has worked. I would expect we would see more cases because it will be at least 2 weeks before we know if it has made any difference," Dr Baker said.

Typically in New Zealand, one person dies from every 20 cases of Legionnaires' disease reported annually. Overseas, it can be as high as one in 5. Dr Baker says the chances of catching Legionnaires' [disease] are 3 in 100 000, and it cannot be transmitted from person to person.

He says it can only be caught by breathing air-borne contamination from water-powered/water-cooled air conditioning systems and is hard to catch. No buildings would be searched, and it is highly unlikely any would be quarantined, he said. "Hopefully, they are all being shock-dosed now, because we aren't requesting any testing to be done, and we are not going to find out which building is the cause. There was an outbreak in Christchurch in 2005, and it was quite big, and people were dying. They tried very hard to find the source, and, unfortunately, more people kept on getting sick, and they never really found a cause. Basically, they did what we did straight off, so we learnt from that," Dr Baker said.

Once building owners and managers shock-dose buildings, they have been asked to call the Auckland Council's building help desk. Building help desk staff say they are not allowed to release information to media but say calls were continually being received from owners and managers who have treated their systems. Senior management staff at Auckland Council could not be reached for comment on how many buildings had been treated or whether any had been quarantined because they were in meetings.

Property developer Andrew Krukziener said it is standard practice for buildings to be treated regularly and that he had not received any warning about a Legionnaires' [disease] outbreak. Mr Krukziener said buildings with independent air conditioners were fine, including NBR's CBD [Central Business District] offices in Achilles House, and that it is central, water-cooled systems which spread Legionnaires' [disease].

[Byline: Conor O'Brien]

--
Communicated by:
Denis Green <legion@q-net.net.au>

[ProMED-mail thanks Dr. Simon Baker for his clarification of the situation concerning the Legionnaires' disease outbreak across the Auckland region and Dr. Steve Berger for his background information on the comparative incidence rates of this disease in English-speaking countries.

There are now 11 cases with one fatality. Contaminated water has been hypothesized as the source rather than contaminated potting mix, because _Legionella pneumophila_ serogroup 1, a water-borne pathogen, has been incriminated in all cases rather than _Legionella longbeachae_, a species that is commonly found in potting mix, compost, and soil and cultured from the respiratory specimens in patients with community-acquired pneumonia associated with gardening and exposure to potting mix and compost, especially in Australia and New Zealand. It would be important to do genotyping of _L. pneumophila_ isolated from patients in the current outbreak. A single genotype would suggest a common source, and could be matched to any environmental isolates.

The Auckland region is on the North Island; it is one of the 16 regions of New Zealand, with a population of almost 1.5 million (1/3rd of the nation's residents) in 2011, and is the country's largest urban area, which encompasses the Auckland metropolitan area, smaller towns, rural areas, and the islands of the Hauraki Gulf (http://en.wikipedia.org/wiki/Auckland_Region). The Auckland Central Business District is densely built-up, with high-rise buildings mainly used for commercial and retail uses, although there are residential high-density buildings and a population of about 40 000 residents (http://en.wikipedia.org/wiki/Auckland_CBD).

The HealthMap/ProMED-mail interactive map of New Zealand can be accessed at http://healthmap.org/r/1VY. - Mod.ML]

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