Dáil Éireann debate -
Wednesday, 7 May 2003

Vol. 566 No. 1

Written Answers. - Legionnaires' Disease.

Ciarán Cuffe

Question:

112 Mr. Cuffe asked the Minister for Health and Children the way in which he intends to respond to the recent fatal cases of Legionnaires' Disease; if his attention has been drawn to the way in which they were caused; and if he will make a statement on the matter. [12111/03]

Bernard J. Durkan

Question:

543 Mr. Durkan asked the Minister for Health and Children the position in regard to the number of incidents of Legionnaires' disease; and if he will make a statement on the matter. [12378/03]

Minister for Health and Children (Mr. Martin)

I propose to take Questions Nos. 112 and 543 together.

Legionnaires' disease is an uncommon form of pneumonia that may have serious consequences for some people, especially people in the older age groups. It is caused by an organism called legionella pneumophila. Legionella is a group of bacteria commonly found in low, harmless numbers in water, including tap water, but they can multiply to high levels in stagnant water, especially in water temperatures in the range 20ºC to 45ºC. These organisms do not appear to multiply below 20ºC and do not survive above 60ºC. They may, however, remain dormant in cool water and multiply when temperatures reach a suitable level.

People become infected when they breathe in air that contains legionella bacteria which have been dispersed into the air in very fine droplets of water known as aerosols. If the bacteria gets inhaled into the lungs they can cause infection. Person to person spread does not occur. Anyone can develop legionnaires' disease but, the elderly, cigarette smokers, heavy drinkers, persons with chronic lung conditions, persons with immuno-compromising conditions and persons receiving immuno-suppressive drugs are all at increased risk. Cases may arise in community settings or in hospitals.

Recognised and potential sources of legionella are hot and cold water systems; cooling towers and evaporative condensers in air-conditioning systems; respiratory and other therapy equipment; spa pools – jacuzzis-natural pools-thermal springs; fountains-sprinklers; humidifiers for food display cabinets; water cooling machine tools; and vehicle washer-carpet cleaner.

The bacteria live naturally in environmental water sources but if they get into water systems in buildings they can cause a risk to humans through air conditioning systems or through contaminated water systems used for showers, etc. Control and prevention of the disease is through treatment of the source of infection, i.e. the contaminated water systems.

As the Deputies will understand, I cannot refer to the specifics of individual cases due to patient confidentiality. However, I am aware that the South-Eastern Health Board is preparing a report on their recent case which I await.

There are less than ten cases reported in Ireland each year. Notification of cases of legionnaires' disease is made by the attending physician to the local public health department. Clinical staff are responsible for the management of a given clinical case. On notification to the public health department by clinicians, public health and other staff such as environmental health officers manage the public health and environmental health aspects of the case in accordance with National Disease Surveillance Centre guidance. Legionella is the subject of an enhanced surveillance system which means that more information is collected when cases of this disease occur as would be the case with other communicable diseases.

The public health department notifies the NDSC of cases as they occur which in turn makes information available to my Department about the numbers of cases, as they do with all other infectious diseases on an on going basis. There is no reason for my Department to become involved in operational aspects of the public health management or surveillance of legionnaires' disease. These are handled as a matter of routine by the health boards and the NDSC. My Department's role in the matter is to ensure that the relevant guidance is followed by the health boards.

The management of public health aspects of legionnaires' disease is carried out in accordance with multidisciplinary guidance which was produced by the NDSC and covers the prevention, environmental health management, contact tracing and surveillance of cases of legionnaires' in both hospital and community settings. This is available on the NDSC website at www.ndsc.ie. Investigations are designed to identify the source of disease transmission and recommend appropriate prevention and control measures such as decontamination of the water source.