By Thomas Michael Simmons
From PHN Issue 53, Summer 2023
Many baby boomers recall 1976, when people attending an American Legion convention fell gravely ill to a form of pneumonia later named “legionnaires disease.” Legionnaires disease is caused by the bacteria Legionella pneumophila, which is among the most common causes of pneumonia. Legionella can be attributed to biofilms found in plumbing and water storage systems, construction, and water temperature fluctuations. They thrive and grow quickly in 98.6-degree Fahrenheit environments. Legionella grows best in large, complex, and poorly maintained water distribution systems, such as air conditioning and cooling systems.
Usually Legionella live in natural freshwater locations, rarely causing illness. Human-made settings foster its growth, and the bacteria can make it into showers, fountains, and cooling towers. The infected vapor-water droplets can be inhaled into the lungs. Even if exposed, most healthy people don’t develop the disease. It’s not spread through person-to-person contact.
Cases of legionnaires disease can range from mild to severe. Symptoms include a “dry” cough, chest pains, shortness of breath, muscle aches, and fever. Legionella attacks the lungs and respiratory tract. More severe cases present with higher fever, abrupt chills, or changes in mental state. Depending on the severity, people who contract legionnaires disease might need hospitalization and antibiotic therapy. Legionnaires can be more dangerous for people who have a compromised immune system. Treatment involves a 10-14 day (21 if immunocompromised) course of antibiotic therapy.
Diagnosing legionnaires disease involves chest x-rays followed by tests on phlegm expelled from the lungs. Being 50 years or older, a current or former smoker, having chronic lung diseases, or having a weakened immune system from diseases or medications are risk factors for more severe illness.
At least two California prisons have had Legionella, with some cases of legionnaires disease diagnosed. Administrators and health care staff initiated protocols that limited exposure to fresh water supplies. These involved closing access to showers, fountains, hot water, and ice dispensers. Portable showers were brought in, and one gallon of bottled water was issued to every inmate daily for consumption, face-washing, and oral hygiene. Inmates with symptoms were brought into medical treatment clinics for evaluation and, if needed, treatment.
A methodical, unit-by-unit, site-by-site hyperchlorination of all areas was employed. Toilets, sinks, water fountains, and related plumbing were drained, flushed with chlorine for several hours, then flushed again. This was followed by testing of the water systems, a process that can take several weeks for results and determinations to be made.
During such situations, accurate information is paramount to prevent unnecessary worries or panic among inmates, their families, and local communities. Administrators and custody and health care staff working with Inmate Peer Educators and Men’s/Women’s Advisory Council members can be a vital link to the population at large to ensure correct information, and not speculation or rumors, is provided.
Prison Health News 