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Legionnaires’ disease remains underreported after 25 years

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PHILADELPHIA — Twenty-five years after Legionnaires' disease was first identified, public health officials are still trying to get doctors and hospitals to pay closer attention to the disease.

As many as 90 percent of Legionnaires' cases go unreported, and only one in five U.S. hospitals routinely tests for the pneumonia-like illness, according to the Centers for Disease Control and Prevention.

"We think it's important for doctors to have a heightened suspicion of the possibility of Legionnaires' disease," especially in the elderly, smokers, transplant recipients and others with weakened immune systems, said Dr. Anne Schuchat, chief of the CDC's respiratory diseases branch.

The illness was discovered in 1976, when 34 people died and 221 became ill at an American Legion convention in Philadelphia. Retired Air Force Capt. Raymond Brennan was the first known victim, succumbing on July 27, 1976. The CDC identified the bacterium responsible for the outbreak in January 1977, calling it Legionella pneumophilia.

Legionnaires' disease is a respiratory infection that generally spreads through inhalation of mist from contaminated water. It can be found in air conditioning cooling towers, hot water tanks, whirlpool spas, humidifiers, faucets, shower heads and moist soil.

The latest Legionnaires' outbreak occurred this month in Murcia, Spain, with two dead, another 337 confirmed cases and 468 people suffering pneumonialike symptoms.

Valerie Greene of Plymouth, Mich., believes her father's death in 1997 could have been prevented had a hospital tested him for Legionnaires' disease as soon as he was admitted.

Instead, the hospital waited five days before giving him the test. By then, it was too late, said Greene, who believes he got the disease during a previous hospital visit.

"The most horrible thing about Legionnaires' disease is the horrible way these people suffer," she said. "They literally suffocate. It's like somebody has their hands around their neck."

Some say hospitals should routinely test their water supplies for the presence of the Legionella bacterium, but the CDC prefers to focus on testing patients stricken with pneumonia.

The lead proponent of water testing, Dr. Victor Yu of the University of Pittsburgh, says periodic sampling can help determine whether a hospital should take steps to fix its water system. If more than 30 percent of the shower heads, faucets and other water sources in the hospital test positive for Legionella, there is a high risk of an outbreak, Yu said.

Based on his research, health officials in Pittsburgh started requiring all hospitals to test their water supplies at least once a year.

The number of Legionnaire's cases has since fallen steeply, from 30 annually to about eight, said Yu's associate, Janet E. Stout.

The state of Maryland recently sided with Yu, recommending that hospitals routinely test water systems. Several cases of the illness appeared in the Baltimore area in 1999 and four people died in Harford County.

The CDC argued that testing of water is generally unreliable and that the presence of Legionella in water does not necessarily indicate an outbreak is imminent.

"It's our feeling that whether or not you have Legionella in that water system, you should be doing aggressive clinical surveillance," said Dr. Richard Besser, who oversees Legionnaires' research for the CDC.

But Yu insists hospital water systems should be tested.

"Why don't (hospitals) want to look? Because the CDC has told them, 'You're going to get sued.' The reason these places are getting sued is people are dying from a preventable disease," he said.

On the Net: www.cdc.gov