Pitt study at odds with CDC on Legionnaire's

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Pitt study at odds with CDC on Legionnaire's

By Robin Acton

PITTSBURG-TRIBUNE-REVIEW

Thursday, August 23, 2007

http://pittsburghlive.com/x/pittsburghtrib/news/rss/s_523549.html

Infectious disease experts say new evidence shows thousands of lives

could be saved every year by checking all of the nation's hospital

water systems for the Legionnaire's disease bacteria.

Results of a study released Wednesday by the University of

Pittsburgh School of Medicine found routine monitoring of

institutional water systems can help predict the risk of hospital-

acquired cases of Legionella pneumonia.

The deadly bacterial pneumonia is named for a 1976 outbreak that

killed 34 people and sickened 221 others who attended the 58th

Pennsylvania American Legion Convention in Philadelphia. Researchers

estimate it has killed more than 39,000 people and sickened untold

thousands of others since 1982, when it was first linked to common

tap water.

" This is an important scientific development. I think it will save

lots of lives, " said Dr. Victor Yu, a professor of medicine at Pitt

and senior author of the two-year study conducted at 20 hospitals in

14 states.

The study, reported in the Journal of Infection Control and Hospital

Epidemiology, calls for reconsideration of the current national

infection-control policy to include routine testing of hospital

water systems to prevent outbreaks. It is at odds with standards

maintained by the Centers for Disease Control and Prevention, which

recommends testing only after cases of Legionnaire's occur.

" I think that's been shot down with this study, " Yu said, referring

to the CDC approach.

Dr. Matt , a Legionnaire's specialist with the CDC, did not

return a call seeking comment.

Yu said that only those surveyed hospitals with high levels of

Legionella bacteria in their water systems were found to have had

patients who contracted Legionnaire's disease. He said it is

important to identify risk because the condition often goes

undetected until it is too late.

Dr. Janet Stout, a study author and research assistant professor in

Pitt's department of civil and environmental engineering, said the

results provided " much-needed evidence " to require routine testing

of water systems of health care facilities .

" We think this long-overdue approach should be adopted by infection

control and infectious disease practitioners nationwide, " said

Stout, who has maintained for years that the CDC is wrong. " How much

longer do we have to wait and how many more lives will be lost? "

People contract Legionnaire's through aspiration, when bacteria are

inhaled into the lungs while drinking water or inhaling mist from a

contaminated source, such as a shower or hot tub. It also has been

linked -- although infrequently -- to humidifiers and cooling

towers.

Legionnaire's, with an average fatality rate of 28 percent, is

estimated by the CDC to be responsible for up to 20,000 cases in the

United States every year. About 35 percent of all cases are acquired

in hospitals, where the death rate from infection can be as high as

40 percent, the CDC said.

Most at risk are patients who are already ill, people with cancer,

the elderly and heavy smokers because their breathing and immune

systems are weakened.

In recent years, the practice of routine testing and disinfection at

hospitals has been adopted by a number of other countries, including

Denmark, Spain, France, Germany, Italy and Taiwan, as well as in the

state of land. New York is expected to follow suit later this

year, Yu said.

It also is required at hospitals in Allegheny County.

Dr. Bruce Dixon, director of the county Health Department, said the

practice undoubtedly saved lives in Pittsburgh, where hospital-

acquired cases of Legionnaire's have virtually disappeared. He said

Yu and Stout -- each regarded as a world expert in Legionnaire's

research -- deserve credit for making hospitals safer for patients.

In late 1981, Stout identified tap water as the source of the

bacteria. Their research team developed testing and disinfection

methods to prevent the disease and found the antibiotics to cure it.

Nevertheless, their work has not been without controversy.

Yu, formerly the chief of the Infectious Disease Section, and Stout,

the former director of the Special Pathogens Laboratory, were fired

from their jobs at the Pittsburgh VA Health System Medical Center in

Oakland last year.

At the time, spokesman Cowgill said the VA determined the

research team was conducting unauthorized commercial testing for

hospitals outside the VA system -- something Yu and Stout had done

publicly for years. The lab was shut down and an undetermined number

of testing specimens were destroyed by the VA, leaving outraged

medical professionals across the country without a testing location.

Yu said he feels vindicated by results of the study, which was paid

for by a national Department of Veterans Affairs Merit Review Grant.

" At the national level, they knew of our work. Now, they've told all

of the VA hospitals to start looking at Legionnaire's disease, " he

said.

Robin Acton can be reached at racton@... or 724-830-6295.