In the first 10 months of the year, the Legionella microbe, which thrives in cooling towers, hot tubs, jacuzzis and water tanks, has killed two Maltese residents and infected another 14. Five of those infected by the killer microbe were tourists spending their holidays in Malta, but the health authorities would not reveal the names of the hotels where the they contracted the disease. According to the Health Department, two Maltese hotels experienced an outbreak of the infection and at least two tourists in each hotel contracted the disease. Luckily neither of the tourists infected by the microbe died. Legionnaire’s is a very serious disease which can lead to death. Infection is caused by inhaling small droplets of water suspended in the air which contain the Legionella bacterium.

Outbreaks of the disease occur from water systems like cooling towers, where temperatures are warm enough to encourage growth of the bacteria.

Dr. Charmaine Gauci, director of Health Promotion and Disease Prevention, told MaltaToday that the source of infection leading to the two Maltese deaths is still under investigation, but so far the source of the disease has not been identified.

She also confirmed that during the first 10 months of the year two clusters of the disease were registered in two Maltese hotels.

Clusters occur when more than one case of the disease occur in the same place. But the Health authorities are refusing to reveal the names of the two hotels involved.

Charmaine Gauci told MaltaToday that the health authorities have always found full cooperation from hotels.

“Whenever a case of legionnaire’s disease is notified a full investigation is carried out. Each suspected site is tested and the necessary control measures are instituted.”

According to Gauci, in some cases the hotel is closed until the situation is remedied but in other cases this is not necessary as long as adequate measures are taken, Gauci told MaltaToday.

Cases of legionnaire’s diseases have increased dramatically from five in 2006, to 16 cases in the first 10 months of 2007.

In 2006, three of the five cases of the disease also occurred in hotels. Likewise, hotels were the suspected source of infection in all five cases of the disease occurring in 2005, and in 13 out of 14 cases occurring in 2004.

This sharp increase has prompted the Health Department to issue a circular to all doctors working in hospital advising them on how to tackle the disease.

In order to decrease the occurrence of the lethal disease, a code of practice was distributed to all hoteliers in Malta. A legal notice issued in January 2006 aimed at controlling the spread of the disease forbids the installation of cooling towers and evaporative condensers in new schools and health centres.

The installation of this equipment in other places like hotels is only permitted when alternative dry cooling systems are not deemed practical. _The law states that any such equipment must by certified by a competent engineer and registered with the Superintendent for Public Health.

Every six months owners are obliged to test a sample of water circulating in the cooling tower to detect any presence of bacteria causing legionnaire’s disease. The health department is also carrying out an audit of all hotels to ensure that they all fully abide by the law.

While in the past three years most cases affected tourists residing in hotels, in the past year the health authorities were faced by an increased incidence of the disease among the local population.

Gauci advised the public to ensure proper maintenance of air-conditioners and water tanks.

“Water tanks should be regularly and insulated to keep the temperature of the water from warming up. We also advise the public to keep geysers at a constant temperature above 60 degrees centigrade.”

Gauci also warns that geysers should not be switched on and off in a way that the water cools down to temperatures where the microbe can thrive.

Consumers are also advised not to buy water from bowsers which are not registered with the Health Department as private water suppliers.

Profile of a deadly disease

Legionnaires’ disease is a type of pneumonia caused by bacteria. You usually get it by inhaling water vapour that contains the bacteria. The vapour may come from hot tubs, showers or air-conditioning units for large buildings. The bacteria does not spread from person to person.

The overall fatality rate is about 15 per cent, but this increases in those with underlying diseases.

Symptoms of legionnaires’ disease include fever, chills, a cough and sometimes muscle aches and headaches. You will probably need a chest X-ray to diagnose the pneumonia.

Lab tests can detect the specific bacteria that cause legionnaires’ disease.

The bacteria are more likely to make you sick if you are older than 65, smoke, have a lung disease and a weak immune system.

The disease is treated by antibiotics, which are effective when the disease is detected early. As with any acute illness, patients who recover from legionnaires’ disease can suffer long term side effects. The most common are fatigue and lack of energy for several months.

The disease owes its name to the victims of the first recorded outbreak of the disease in 1976 at the Bellevue Stratford Hotel in Philadelphia, Pennsylvania, where members of the American Legion, a United States military veterans association, had gathered for the American Bicentennial.

Within two days of the event’s start, veterans began falling ill with a then unidentified pneumonia. As many as 221 people were given medical treatment and 34 deaths occurred.

The world’s largest outbreak of legionnaires’ disease happened in July 2001 in Murcia, Spain, where 800 cases were reported after the legionella microbe found its way in the cooling towers of a hospital.

jdebono@mediatoday.com.mt