Dutch stymied about stealth-killer disease

Ten years ago, 32 people died and 230 people fell violently ill within 24 hours of visiting the popular annual Flora flower show in Bovenkarspel in The Netherlands, just north of Amsterdam.The visitors had all been struck down by Legionnaire's Disease.

There were tens of thousands of cheerful visitors on this glorious spring day to the hugely popular annual Flora agricultural show in the West Friesland region -- and most had walked past two bubbling hot-tub displays which were located right at a central junction inside the show grounds. There, visitors had breathed in the deadly Legionella Pneumonia bacteria from the displays' fine aerosol mist, a criminal investigation has since found. Yet things could have been so much worse if it hadn't been for a student-bacteriologist - who immediately suspected legionaire's disease when the first cases were brought in. On his own initiative, he started re-examining all the test results in the Westfries Gasthuis hospital in Hoorn 's laboratory - and confirmed his worst suspicions. His older colleagues agreed with his prognosis -- and the alarm was raised. The floral show was hurriedly closed down by the Ministry of Health. see No-one has ever been prosecuted, and several cases are still in litigation. And to this day, at least 100 of the 230 victims also still suffer debilitating after-effects - although local scientists are stumped by this, saying they still don't know whether these long-term effects are caused by the original bacterial infection or not. In the United States, an annual 8,000 to 18,000 people are hospitalized with Legionnaires' disease pneumonia. However, many infections are not diagnosed nor reported, so this number may be higher. More illness is usually found in the summer and early fall, but it can happen any time of year. Legionnaires' disease death rates range from 5% to 30% of all the cases in the US. And there are growing worries that the present pharmacopia of antibiotics are also becoming resistant to this bacterium, which thrives in damp, dark, anaerobic environments such as air-conditioning units, cooling- and heating towers and hot-tubs' drainage pipes. Europeans are also noticing a growing number of outbreaks. To get a centralised grip on the true extent of the problem, a Dutch Euro-parliamentarian has now launch a campaign to get all the outbreaks mapped centrally and thus exercise better preventative-control. Doctors are stumped about long-term effects: The Academic Medical Centrum in Amsterdam's Head of Infectious Diseases, Prof. Dr Peter Speelman has been in charge of the medical panel which studies the long-term after effects of the devastating Legionella outbreak at Bovenkarspel in The Netherlands. And, he tells Digital Journal, their most important conclusion was that 'a group of the patients who survived Legionella pneumonia, have very long-term after effects, in any case much longer than our 18-month study has indicated. "It is difficult to say whether this is due to the Legionella bacteria, the patient's own immune system, all the media attention in being involved in a disaster, or something else. A rapid diagnosis and adequate treatment are crucial to the survival chances of Legionaire's Disease victims. " Their initial 18-month study of survivors from Bovenkarspel showed that symptoms of Legionaire's Disease can persist for more than 18 months in elderly patients and those with other diseases. And in a seperate development several of the victims have also developed cancer since the outbreak including in his own kidneys, reports Nico Hoffer, secretary of the Foundation Legionella in the Netherlands. The AMC-research team was unable to determine whether the long-term effects, which manifested as severe pneumonia, were caused by the Legionella Pneumophila bacteria "or whether the outbreak situation itself had been responsible for this prolonged impact of the disease episode on the subjects' well-being.' "After six months, most patients had recovered fully from pneumonia. Older patients, patients with co-morbid illness and those with pneumococcal pneumonia had more symptoms...' his report noted. Stealth murderer strikes each spring After the Bovenkarspel disaster, the Dutch health authorities now report more new outbreaks each year. Dutch MP Jan Boelhouwer ]calls it 'a stealth murderer' which emerges each spring to strike down unwitting victims. As is also being noted in the United States and other parts of the world, the Dutch MP says that many more victims die of it than the authorities are aware of. In fact, Legionaire's Disease is spreading rapidly throughout Europe. Dutch Christian-democrat Euro-parliamentarian Ria Oomen-Ruijten has been campaigning for much stricter European guidelines for combatting it including a central register of its original sources -- including fly-by-night companies which install faulty water-reticulation systems. New victims registered all over Europe She says that over the past years, new victims are registered each year throughtout Europe. "We must create greater awareness to prevent more victims - and to help the survivors.' She calls on the European authorities to set up a central register for each confirmed case to identify the exact sources of each outbreak. "The number of victims in The Netherlands actually are many more than we are able to establish,' said MP Boelhouwer at an urgent parliamentary hearingin February 2009 with Minister Jacqueline Cramer of the environmental ministry, VROM. Basically, the Dutch cabinet has been sitting on its hands about taking more aggressive, proactive measures such as severely punishing fly-by-night operators who install faulty aquatic reticulation systems which make residents ill. The guidelines are already in place -- but the government seems reluctant to enforce these, to make these stick, say Dutch MPs and the victims of the Bovenkarspel outbreak. Lack of Legionella control measures On February 16 2009, the liberal VVD party MP Helma Nepperus and the socialist party MP Paulus Jansen asked environment minister Jacqueline Cramer some probing questions in a parliamentary hearing -- after a radio programme had cited top inspectors of water-reticulation systems in The Netherlands that 'ninety percent of the Legionella control measures were carried out improperly, and were not followed up with inspections...' Nepperus, a multi-talented fiscal lawyer, also is a senior director of the Traffic and Water Affairs Inspection Department (IVW) and is well versed in making laws for preventative health controls -- she was for instance, instrumental in setting up the stringent noise-pollution control measures around airports and improved air-traffic safety measures. The liberal politician is an enthusiastic environmental campaigner with a very common-sense approach. Yet, she says, ten years after the Bovenkarspel disaster in West Friesland, the Dutch government still doesn't know to prevent such outbreaks. "Of course the authorities can't control everything, but at least they should punish questionable water-installation technical companies which botch up their jobs. Cancel the registration certificates of such fly-by-nighters, launch legal measures against them. Such a pro-active approach will be to the advantage of reputable companies.' see Book by survivor One of the 230 survivors of the Bovenkarspel outbreak, Sanny de Zoete, now 54, agrees with Nepperus' assesment. She wrote in her book, "Legionella, een ramp" (Legionnaire's Disease: a disaster), that the long-term investigation among the survivors basically stopped after 18 months. Yet ten years later, she and at least 100 others still suffer from debilitating side-effects. De Zoete says however that her doctor even tells her that her debilitating and often very painful symptoms basically are caused by something 'between my ears' -- even though many survivors also suffer identical after-effects: severe short-term memory loss, debilitation of the muscles and motor-neuron system; a general feeling of malaise which just won't go away. This is confirmed by other survivors, who formed the Foundation of Legionaire's Disease in The Netherlands to fight for their long-term rights for a better health-analysis of their situation. On October 1, a large scientific congress teaching medical personnel and water-systems-technicians will be held in the Dutch city of Amersfoort. It's a start, says De Zoete. Hot-tub exhibitors are scapegoats There's also widespread bitterness amongst everyone who was involved in the deadly outbreak -- from hot-tub exhibitors to victims and their families, about the way the authorities have failed to deal with the outbreak - mainly by appearing to just sweeping it beneath the carpet, many say. The hot-tub exhibitors are particularly angry: they were made the 'scapegoats' for something they'd had absolutely no control over, says one of them, Jan Jong. Prince won't be at commemorative service March 12 On March 12, they hold their ten-year commemorative service at the monument for the victims in Bovenkarspel, and more bitter words are expected to be spoken. They'd invited Dutch crown-prince Willem Alexander as guest-speaker, but he declined most courteously - although he's known as the "Water Management Prince' worldwide. Chlorine does not kill legionnaire's bacteria: "So little is still known about legionnaire's disease and many billions have meanwhile already been spent on preventative measures, yet the number of cases still rise steadily worldwide. And still, that same ridiculous story which also is repeatedly told everywhere: 'if only we'd poured a bottle of chlorine in the water...' "The fact is, chlorine does not kill this bacterium, it's resistant to it. Yet I had people tell me straight to my face that I was the 'murderer of their father..."' In this case, he added, there's really only one group of winners: the lawyers who are still engaged in all kind of litigation. They will be earning plenty for years,' says Jan Jong in an interview with De Telegraaf newspaper. Japan Meanwhile the bacterial pneumonia infection still marches steadily across the world: for instance, eleven infants born between December 18 and 22 at a private hospital in Cyprus contracted Legionnaires' disease. Three have since died. see The National Institute of Infectious Diseases in Japan said the infections have increased almost fivefold in Japan, reports the Mainichi Daily News. Speculation is that this is due to the increased use of public whirlpool spas and hot springs. Egypt: On 29 October 2008, the Belgian newspaper De Morgen reported about an outbreak of legionella in an Egyptian hotel which struck down 140 Belgian guests. The Netherlands: On Jul 1, 2008, the care centre for frail elderly in Amsterdam-East was hit by Legionella, and in December, the Den Bosch hospital and the Thermal pools in Ridderkekr closed down because of Legionella. see United States seminar In California's Carlsbad Inn Beach Resort, a seminar is planned between May 19-21 for engineers, water treatment specialists and industrial hygienists, "Performing High Quality Legiuonella Assessments'. Matt Freije, author of "Legionellae Control in Health Care Facilities, a guide for minimizing risk,' will be the primary instructor. Alas, there's only room for 15 students.