Study Links Water Wall, Legionnaires' Disease Uptick

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Audie Cornish talks with Thomas Haupt, respiratory disease epidemiologist for the Wisconsin Division of Public Health. He's the lead author of the study that helped uncover the source of a mysterious and large uptick in Legionnaires' disease cases. The study, "An Outbreak of Legionnaires Disease Associated with a Decorative Water Wall Fountain in a Hospital" was published in the online journal Infection Control and Hospital Epidemiology.


Here's a title for a medical study that you just couldn't make up: An Outbreak of Legionnaires Disease Associated with a Decorative Water Wall Fountain in a Hospital. Yikes. The study was published yesterday in the journal Infection Control and Hospital Epidemiology. It found that a water wall in a Wisconsin hospital lobby - perhaps intended to be soothing - in fact helped to spread a potentially life-threatening bacteria. Thomas Haupt is the lead author of that study. He's an epidemiologist for the Wisconsin Division of Public Health. Thomas, welcome to the program.

THOMAS HAUPT: Glad to be here.

CORNISH: First of all, explain briefly what Legionnaires' disease is.

HAUPT: Legionnaires' disease is a respiratory infection that results in pneumonia. Symptoms would include headache, high fevers, lack of appetite. It has about a 10 percent fatality rate and that's something that actually is caused by inhalation of bacteria from a contaminated water source.

CORNISH: So Thomas, in 2010, eight people contracted Legionnaires'. They had all been in the hospital lobby, but they call came from different places and I'm wondering how you did the detective work to link them to this particular water wall.

HAUPT: Well, it started off with our routine surveillance for Legionnaires' disease in Wisconsin. We did notice that within a four week period in this small area we had at least eight cases of Legionnaires' disease. Our follow-up is to ask questions as to where they may have been in the 10 days prior to their onset of illness. At least six of the patients identified that they had been in one particular hospital.

Through further follow-up, the other two patients actually we found out that they were in the hospital as well, picking up some pharmaceuticals at the pharmacy, which is directly adjacent to the water wall. We tried to get a hypothesis as to what exactly was being - what was the cause, and the water wall seemed to be the most logical. So we did the follow-up testing on the water and on the foam that was in the water, which was used to prevent splashing. And we found that they were badly contaminated.

CORNISH: Now, how is that possible? I would assume you might be able to use chlorine or something to keep it clean. I mean, what was the problem with the water wall specifically?

HAUPT: The use of chlorine within - and this, again, is in an atrium of a hospital - would have caused a lot of smell. The hospital did great routine maintenance, but one of the downfalls was - actually, there were several. So they put this foam in and they also had lights underneath, plus the water wall was also directly adjacent to a fireplace. Now, Legionella disease, every water supply has some if you look for it closely enough. But the fact that it was warm water through the heat that was produced, it produced very high amounts of Legionella disease. Now...

CORNISH: So you basically have a breeding ground and then the conditions for breeding.

HAUPT: That's exactly right. You know, and just a small portion of that foam had well over a million colony forming units of Legionella bacteria, which is very, very high.

CORNISH: Wow. So just walking by it, you can essentially take in vapors?

HAUPT: You can take in vapors. Actually, it's an aerosol mist from water and it usually affects - Legionella affects people who have some kind of an underlying illness, or are on some kind medications where their immunity may be lower. Smoking is also a risk factor, where your lungs are affected and by just getting small amounts of Legionella inhaled, you can actually come down with Legionella disease.

CORNISH: And it's interesting detective work because I think in your report, I read that one of the patients who came down with it was a delivery person who had been a smoker.

HAUPT: That's right. And when he came down with it, he actually was not in a position - he was very sick and we had to look back at his manifests from his truck route and we tracked it down to find out that yes, indeed, at least twice in that 10 days prior to his onset of illness, he had been in that hospital lobby.

CORNISH: Thomas, thanks so much for talking with us.

HAUPT: Thank you very much for having me on.

CORNISH: Thomas Haupt is the lead author of a study linking a water wall in a Wisconsin hospital to an outbreak of Legionnaires' disease. By the way, all eight of the people who contracted Legionnaires' have recovered.

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