Outbreak of legionnaires in Jülich in 2014

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The 2014 legionellosis outbreak in Jülich was an increased occurrence of atypical, severe pneumonia from August 14, 2014. A total of around 70 cases of illness and suspected legionellosis were known, the last patient was reported on October 17. Two people died of pneumonia during the epidemic, and Legionella was detected in one case. Microbiological findings showed that the cause of the disease, also known as Legionnaires' disease , was the pathogen Legionella pneumophila . This bacterium multiplies at temperatures between 25 and 40 ° C in water supply and cooling systems and is - spread as a bioaerosol - ingested by those affected via the respiratory tract .

Course of the outbreak

Starting on Thursday, August 14, 2014 the were in the local hospital, St. Elizabeth Hospital on 40 patients with severe pneumonia received for inpatient treatment. The maximum value was reached with 25 inpatient admissions for community- acquired pneumonia on one weekend. The accumulation of severe pneumonia observed over the weekend was reported to the responsible health authorities on the following working day . This has been the third largest epidemic in Germany since the registration of legionellosis in accordance with Section 7 of the Infection Protection Act of January 1, 2001.

Treatment and confirmation of the diagnosis

Legionella pneumophila under the scanning electron microscope

In view of the severity of the clinical picture of the assigned patients, the treating physicians gave immediate and effective treatment priority over the requirements of establishing a diagnosis. The early and consistent treatment with a suitable combination of antibiotics has thus probably contributed to the fact that the mortality rate of 10 to 15% cited in the relevant literature was significantly below the detriment of clear microbiological findings .

After a pathogenic concentration of Legionella was found in the cooling towers of the Weisweiler coal-fired power station , a special laboratory in Dresden cultivated and typed the Legionella found in the cooling system and in the patients in order to show a complete causal chain from the Legionella found to the pathogens found in the patients.

An expert for environmental hygiene had already pointed out the sources of danger from legionnaires and the inadequate regulation in Germany in 2010 and was critical of the outbreak of the latest epidemic:

"Legionellosis is a completely preventable infection with appropriate precautions."

- Martin Exner , Director Instit. f. Hygiene & Public Health, Business Manager Director Center f. Infectiology & Infection Protection Uni Bonn

In the further course of the epidemic, Exner demanded the legal anchoring of the examination for Legionella in all pneumonia in order to ensure correct treatment. With this measure sources of legionnaires would be detected earlier. The number of unreported cases of diseases is considerable and the length of the interval when examining cooling towers should be halved (currently every six months if VDI standard 6022 is used voluntarily), since legionella can multiply to dangerous concentrations within 2 months in previously cleaned recooling plants .

Media coverage

Since September 17, 2014, the media has been reporting under different headings (examples: “Jülich: Riddle about lung infections”, “Wave of pneumonia and three deaths in Jülich”) on the unusual accumulation of pneumonia. After 12 days, parallels were drawn with the legionnaire's disease outbreak in Warstein 2013 . All reports refer to pneumonia. The weaker form, which occurs in about 90% of infections in the form of Pontiac fever , is not mentioned.

Find the source of infection

Weisweiler coal-fired power station. Block F was contaminated with 275,000 CFU of pathogenic legionella in 2014  .
Aerial view of Weisweiler. The aerosol from cooling towers can be a source of infection over 10 km away.

The coal-fired power station Weisweiler and the research center Jülich were dubbed by the press as possible causes. According to wind simulations, the probability of the coal-fired power station being the source of infection seemed high, and that of the research center was very low. The Ministry of the Environment of North Rhine-Westphalia reported on October 1st that 61,500 colony-forming units per 100 mL were detected in Block F  , the WDR four days later that the affected Block F was switched off, the Blocks E, G and H contaminated with at least 7,500 CFU stayed on the net. Legionella were also detected in the cooling system of a plastics and metal processing company, but a concentration that is not critical according to the city administration in Düren . The contaminated cooling systems in the FZJ and the factories were switched off immediately.

After the first wave of infections had subsided without securing the pathogen, a single case on September 15 ensured that a sample of the bacterium could be taken. The identification of the source of infection was made easier by the rare serogroup 5 of the bacterium, which often occurs in the company of amoebas or bacteria of the order Desulfuromonadales . Up to November 6th, Legionella had been proven to be pathogens in 39 people, but the source of the infection was still unclear. What these patients had in common was a stay in Jülich. Samples from the waters in and around Jülich were genetically not identical to the patient samples, as were the legionella from the FZJ's cooling system (analysis result: serogroup 1).

Another legionnaire's disease was detected in the Düren district on October 10, the source of the infection was probably not yet eliminated in October (legionnaires are not transmitted from person to person, the incubation period is 2–10 days ). On October 28, the contamination in block F was still 25,000 CFU, which, according to the district government, was not proven to be the cause of the epidemic.

The district of Düren declared the epidemic to be over on November 11th without assigning sources, and the known contaminated cooling plants should still be checked closely afterwards.

Effects of the outbreak

  • On September 19, the district of Düren ordered all operators of recooling plants in the city of Jülich to register.
  • The state environment ministry instructed the district government of Cologne and RWE in September to reduce legionella pollution.
  • In September, RWE switched off the heavily contaminated Unit F of the Weisweiler coal-fired power plant .
  • On October 2nd, a panel of experts met in the state environment ministry and analyzed the epidemic. The ministry then ordered a nationwide review of all cooling towers.
  • In October, the state government introduced a legislative initiative through the Federal Council that cooling systems must be regularly checked for Legionella.
  • The Cologne regional government demanded RWE on October 28 on a disinfection of cooling water and cooling tower of the now used again block F. An investigation in consultation with the State Ministry of the Environment had recently confirmed a contamination with 25,000  CFU Legionella per 100 mL and thus the inadequacy of the previous measures. Exchanging the cooling water and cleaning were not effective and were supplemented with the use of biocides between November 7th and 9th .
  • The LANUV forbade the restart of Block F, which was shut down on November 28, when 275,000 CFU were detected in the cooling circuit. After submitting a short-term concept of measures to achieve a load below 50,000 CFU and long-term 10,000 CFU, the ban was lifted.
  • The Environment Committee of the City of Wuppertal ordered a test of all open cooling systems in the city for Legionella on December 2nd. This decision was made after an application with reference to the legionnaires in Warstein and Jülich.

Legal regulations

Germany

Natural draft cooling towers with a thermal output of up to 200 MW are subject to the VDI 2047 series of guidelines "Hygiene in recooling plants". In Germany, registration is required in accordance with the 42nd BImSchV.

For large systems from which drinking water is released to the public, there is an annual inspection obligation.

The operators of drinking water installations in which there is a large system for heating drinking water must have the drinking water checked routinely every three years if drinking water is supplied from this within the scope of an exclusively commercial activity (e.g. in larger residential buildings). The first investigation had to be completed by December 31, 2013.

Switzerland

Legionnaires have been obliged to report in Switzerland since 1988. Epidemics have shown that contaminated cooling towers within a radius of over 10 km can cause infections. To protect the population, the following intervention values ​​apply: Up to 1,000 CFU / L no special measures; between 1,000 and 10,000 CFU / L checking and corrective measures depending on the situation; over 10,000 CFU / L fastest possible shutdown, remediation and other bacteriological monitoring. The cooling towers in Weisweiler had concentrations of 7,500 to 275,000 CFU / 100 mL, which corresponds to 75,000 to 2,750,000 CFU / L. According to Swiss law, the entire power plant should have been shut down from September to December 2014.

Further cases of contaminated cooling systems

In recooling plants that work with open water circuits, there is a risk of germs and germs spreading by aerosol . This finding has been proven several times since legionnaires were recorded in Europe:

  • European epidemics: Murcia, Spain (2001, ventilation system with a cooling tower); Barrow-in-Furness, England (2003, cooling tower); Lens, France (2004, cooling tower) and Geneva, Switzerland (2001, likely cooling tower).
  • In summer 2012, over 20 people in Rhineland-Palatinate and Saarland were infected with Legionella through a cooling tower.
  • The outbreak of legionnaires in Warstein in 2013 is attributed to a recooling plant.
  • The coal-fired power plant Moorburg was shut down in trial operation in 2013, as Legionella with 2,300 CFU / 100 mL were detected in the cooling circuit.

Web links

Individual evidence

  1. ↑ a b c Legionella alert the authorities. WDR , September 19, 2014, accessed October 5, 2014 .
  2. ↑ Legionella: One track leads to the Jülich Research Center. District of Düren , 2014, accessed on October 24, 2014 .
  3. ↑ a b Jülich: The search for a source of legionella continues. WDR , October 17, 2014, accessed October 23, 2014 .
  4. ↑ a b c Mass disease: Are power plants the culprit? WiWo Green , November 6, 2014, accessed on November 11, 2014 .
  5. ↑ a b wave of pneumonia and three deaths in Jülich. Aachener Zeitung , September 17, 2014, accessed on October 5, 2014 .
  6. ↑ a b c d source of outbreak still unclear. WDR , October 9, 2014, accessed October 11, 2014 .
  7. ↑ a b Legionellosis in Jülich: Third largest outbreak in Germany. Aachener Zeitung , September 25, 2014, accessed on October 5, 2014 .
  8. ↑ a b c Block F switched off. WDR , September 19, 2014, accessed October 5, 2014 .
  9. ↑ The wave of illnesses in Warstein continues to rise - 86 people are affected. WAZ , August 22, 2013, accessed August 23, 2013 .
  10. ↑ Legionella infection wave faster than the legislator. Aachener Zeitung , October 7, 2014, accessed on November 15, 2014 .
  11. ↑ working paper legionnaires; Medical and environmental hygiene aspects. Institute for Hygiene and Public Health at the University of Bonn , November 7, 2001, accessed on November 15, 2014 .
  12. ↑ Other power plants checked. Kölner Stadt-Anzeiger , September 24, 2014, accessed October 5, 2014 .
  13. ↑ Jülich: Legionella: One track leads to the Jülich Research Center. Düren Magzin, September 26, 2014, accessed on October 5, 2014 .
  14. ↑ a b Legionella in Jülich: Source in Weisweiler? Aachener Zeitung , September 30, 2014, accessed on October 23, 2014 .
  15. ↑ a b c d New findings in the search for sources on the Legionella outbreak in the city of Jülich ( memento of the original from October 6, 2014 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. . Press release from the Ministry of the Environment of North Rhine-Westphalia. Retrieved October 1, 2014. @1@ 2Template: Webachiv / IABot / www.umwelt.nrw.de
  16. ↑ New findings in the search for sources on the Legionella outbreak in the city of Jülich. District of Düren , 2014, accessed on October 5, 2014 .
  17. ↑ New Legionella case raises hope in search of source. Westfälische Nachrichten , September 24, 2014, accessed on October 12, 2014 .
  18. ↑ Rare Legionella identified as a cause of pneumonia in the Jülich area. District of Düren , 2014, accessed on October 7, 2014 .
  19. ↑ a b No source found. Die Welt , November 11, 2014, accessed November 15, 2014 .
  20. ↑ Legionella in Jülich: Source in Weisweiler? Aachener Zeitung , October 9, 2014, accessed on October 23, 2014 .
  21. ↑ Sickness makers thrive in the cooling tower. (No longer available online.) Energiezukuft.de, October 15, 2014, archived from the original on October 25, 2014 ; accessed on October 23, 2014 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.energiezukunft.eu
  22. ↑ a b The latest measurements confirm legionella findings: Cologne district government requests RWE to disinfect the cooling water. (No longer available online.) Cologne District Government , October 28, 2014, archived from the original on October 30, 2014 ; accessed on October 30, 2014 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.bezreg-koeln.nrw.de
  23. ↑ Legionella in Jülich: The difficult search for the cause. Aachener Zeitung , September 20, 2014, accessed on October 5, 2014 .
  24. ↑ Other power plants checked. Die Welt , October 2, 2014, accessed October 5, 2014 .
  25. ↑ a b Another legionella alarm at the Weisweiler power plant. WDR , December 3, 2014, accessed on March 23, 2015 .
  26. ↑ Minutes of the meeting of the Environment Committee (SI / 0412/14) on December 2nd, 2014. (No longer available online.) Management Committee for the Environment, City of Wuppertal , December 2, 2014, archived from the original on April 5, 2015 ; accessed on March 23, 2015 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.wuppertal.de
  27. ^ Application by the SPD parliamentary group: Status report 'Open cooling systems in Wuppertal'. (pdf) (No longer available online.) SPD parliamentary group in the council of the city of Wuppertal, November 5, 2014, archived from the original on April 4, 2015 ; accessed on March 23, 2015 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.spdrat.de
  28. ↑ www.vdi.de series of guidelines 2047
  29. ↑ Drinking water ordinance and regulations for legionella
  30. ↑ a b http://www.laborveritas.ch/php/bdata/files/filesDatei_bdataFileExtPDF/53_Legionellen_Bericht_BAG.pdf
  31. ↑  ( page no longer available , search in web archives )@1@ 2Template: Dead Link / www.bag.admin.ch
  32. ↑ Ludwig Fembacher (LGL Oberschleißheim, Bavarian State Office for Health and Food Safety): Microbiological contamination in evaporation re-cooling plants (VRKW) ( Memento of the original from August 12, 2011 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. (accessed on September 13, 2013; PDF; 979 kB) @1@ 2Template: Webachiv / IABot / www.enz-wassertechnik.de
  33. ↑ - ( Memento of the original from October 6, 2014 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / lua.rlp.de
  34. ↑ Legionella paralyze Moorburg. klimaretter.info , September 4, 2013, accessed on October 12, 2014 .