The risk of Legionella cases in hospitals “cannot be completely eliminated” even with the strictest prevention measures, an infectious diseases specialist told Phileleftheros, as a newborn who developed symptoms of the infection remains in critical but stable condition at Makarios Hospital.
Nikolaos Spernovasilis, director of infectious diseases at the German Medical Institute and assistant professor of internal medicine and infectious diseases at European University Cyprus, said this is because the bacterium can survive and re-emerge in complex plumbing networks despite systematic control measures.
The newborn and the tests
The baby developed symptoms on Friday and, according to the latest available update, is still being treated in the neonatal intensive care unit. The Health Ministry has brought in a specialist from abroad to help manage the baby’s care, and the specialist has been in Cyprus since Monday. Initial tests found signs of Legionella at two points in the water network of a private hospital in Nicosia, but the source of the baby’s exposure has not been definitively confirmed. The first laboratory indications from water samples taken at the hospital and at the family’s home are expected on Wednesday or Thursday.
Rebecca Kokkinofta, director of the State General Laboratory, said the analyses take four to five days and that the laboratory would not announce any result it was not certain of. She said the first positive indication had come from a scheduled check, almost at the same time as the case emerged, regardless of whether the case had been made public. “Whether it was announced or not, we had a positive indication,” she said.
How Legionella spreads
Newborns and infants, the elderly, immunosuppressed patients, smokers and people with chronic illnesses are particularly vulnerable, Spernovasilis explained. The fatality rate ranges between 40 and 80 per cent in people whose immune systems do not function adequately, he added.
Legionella is found mainly in natural and artificial water environments, including the water systems of buildings. It grows especially in stagnant water and at certain temperatures, and can survive for long periods inside plumbing. Exposure does not necessarily lead to infection, he stressed, but it can cause Legionnaires’ disease, a potentially serious form of pneumonia.
It is transmitted mainly by inhaling tiny water droplets, or aerosols, that contain the bacterium, and by aspirating contaminated water, while person-to-person transmission is extremely unlikely. In hospitals, the bacterium can colonise water networks, tanks, taps and shower heads, forming biofilms that make it difficult to remove.
Prevention
Prevention relies on a comprehensive water safety management programme that includes regular maintenance and disinfection, temperature control, avoiding stagnant water, risk assessment and microbiological monitoring, Spernovasilis said. High-risk departments may need additional measures, such as special filters at water outlets. He stressed that prevention is not limited to disinfection, but also requires continuous risk assessment and early identification of possible cases.
This does not mean cases are inevitable, he added. Combining risk reduction with early detection greatly reduces the likelihood of cases, and many of those recorded around the world, some of them outbreaks, could have been prevented or at least limited in number.
The prevention of waterborne infections will also be on the agenda of the European Seminar on Infection Prevention and Control in Limassol on Friday and Saturday, 23 and 24 October. The guest speaker will be Dutch professor Andreas Voss, whom Spernovasilis described as one of Europe’s leading experts on infection prevention and control. Health professionals will travel from abroad to attend, and local health professionals are more than welcome, he said.
