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31 July 2017 Why that nasty cold you picked up on your last holiday could be MUCH worse than you think

posted 1 Aug 2017, 08:09 by Ian Clarenbone

Frail and suffering from various health problems, 79-year-old William Hammersley's DIY days were behind him. But when his son Des, 53, arranged a trip to a home-improvements superstore, the grandfather-of-two from Chesterton, Staffordshire, was delighted. 'Dad loved DIY,' recalls Des, a plumber. 'So I took him to the nearby JTF Warehouse.' It was a fatal decision. William fell victim to Legionnaires' disease. A poorly maintained hot tub on display infected 21 people, killing three, including William. He died in North Staffordshire Hospital in August 2012. Among the survivors were William's wife Clarissa, 82, and Des's partner Claire, who was left with a damaged lung. This month, the company responsible for the outbreak was fined £1 million. During the court case, Clarissa suffered a stroke. As Des told Good Health: 'This has been a complete tragedy for the whole family.'

It's a heartbreak that affects hundreds of families in the UK every year. Official statistics put the number affected by Legionnaires' disease in England and Wales at over 550 a year. But some experts believe the true figure is as high as 9,000.

There are also concerns that the number affected on holiday abroad is rising, with tourists being warned to be particularly wary of hotels and villas in hot climates that have lain empty for months over winter.

And yet the disease is entirely preventable — so why are people still dying from it?

Legionnaires' is a nasty form of pneumonia, caused by the bacterium Legionella pneumophila, that kills about one in ten of its victims by causing rapid lung failure and depriving organs of oxygen. In its early stages, it is easily mistaken for flu. Even if pneumonia is diagnosed, if Legionella isn't recognised as the culprit the wrong antibiotics may be given. Legionella occurs naturally in ponds, lakes, rivers and reservoirs. There, it's harmless. Swallowing infected water is very unlikely to cause an infection, since concentrations are too low and the bug has to be breathed into the lungs. The problem is when Legionella finds its way into man-made water systems, where conditions can be ideal for it to breed. It feeds on nutrients including rust and scale and thrives in temperatures between 20c and 45c.

In poorly maintained equipment such as air-conditioning cooling towers, spa pools and showers, infected water can be 'aerosolised', converted into a fine spray that's easily breathed in. Without prompt treatment, Legionella breeds rapidly in the lungs — but with early symptoms of headache, muscle pain and a temperature of 38c or above, the disease can easily pass for flu. But as the bacteria start to multiply (incubation takes between two and ten days), the tiny air sacs in the lungs become inflamed and fill with fluid. At first, this causes a persistent dry cough, but as the condition worsens, those affected start to produce phlegm and experience increasing shortness of breath.

‘Anyone with these symptoms should seek help, especially if they've been abroad’, says Richard Russell, a consultant respiratory specialist at Lymington New Forest Hospital and adviser for the British Lung Foundation.

'Giving your doctor a history of foreign travel will make the penny drop quicker,' he says. Some people are more vulnerable than others. Most cases of Legionnaires' disease are among the over-50s, with the majority aged 70 or more. People who smoke, drink heavily, have an existing lung condition or are generally in poor health should 'consider avoiding water systems that could be contaminated, such as spas', says NHS England.

Figures show cases in England and Wales have been steadily increasing for the past four years. But, shockingly, one expert says the official figures might be way off the mark. 'It's possible that the number is closer to 9,000 a year and that the number of deaths could realistically be more like 900,' says Debbie Green, operations director at Nemco Utilities, a buildings risk management consultancy specialising in Legionella control. This is based partly on European research suggesting that up to three per cent of the 300,000 infections diagnosed as pneumonia in the UK are in fact Legionnaires' disease. The Health and Safety Executive (HSE) insists regulations regarding Legionnaires’ in the UK are strict. These involve regular treatment of water storage containers with chemicals and, crucially, keeping water at the correct temperatures. Under UK regulations, cold water must be stored below 20c.

The bug is extremely rare in the home because domestic water systems are fed directly from clean mains supplies and daily water usage is sufficient to 'turn over' the entire system. So why are there still so many cases in the UK? Debbie Green fears some organisations may be cutting corners. 'It's possible that insufficient funding, particularly in the public sector, has a part to play,' she told Good Health.

Statistics from the HSE show that poorly maintained hot and cold-water systems cause a quarter of the cases, followed by cooling towers (16 per cent) and spa pools (14 per cent). In the case of the JTF Warehouse outbreak, there had been a 'misguided assumption' that JTF could manage the risk without spending on specialist consultants, said the crown court judge.

Another concern is that the number of Britons infected abroad has increased, rising more than 65 per cent from 2013, to 146 cases. Spain, where 26 Britons contracted the disease in 2015, heads a top ten of at-risk destinations for Legionnaires issued by Public Health England, followed by Italy (21 cases) and Greece (17).

A growing threat is in the increasingly popular destination of Dubai. With over 10.8 million visits from UK tourists in 2015, the chance of catching the disease in Spain is 2.8 in a million. The risk in Dubai is far greater, 41 in a million — almost on a par with Thailand, says PHE.

Tourists should be wary of hotels and villas in hot climates that have lain empty for months over winter, warns Nick Harris, former head of international holiday and travel law at solicitors Simpson Millar. 'The Greek islands are a classic example. At the beginning of the holiday season, there will be a spike in legionella claims, and a lot of that is because the hotels close down over winter.'

There is little really that tourists can do apart from being aware of the symptoms, says Simon Dooner of risk-management company Legionella Control International. 'I know of people who will run showers in their holiday villas before they will use them. While it can't do any harm, in the end you have to trust that the people operating the systems are taking the correct precautions.' He says in hotter countries 'the authorities allow cold water to be stored at 25c'. So 'unless you are treating the water chemically, you've got conditions conducive to the growth of the bacteria'.

Kevin Dick, a 54-year-old sales manager from Inverness, caught Legionnaires on holiday in Thailand with his wife Linda in May. He started to feel ill shortly before landing at Heathrow. 'It felt like flu,' he says. 'I was sweating; hot and cold. I assumed I'd picked up a bug on the plane.' After trying for three days to fight what he thought was the flu with Lemsip, his temperature hit 41c. Rushed to Raigmore Hospital, he was diagnosed with pneumonia and put on antibiotics: the diagnosis of Legionnaires wasn't made until a week later. In all, he would be off work for nine weeks. 'It was only later when I read up about it that I realised what a lucky escape I'd had,' says Mr Dick.

So how can you tell if it might be Legionnaires or 'just' flu? Professor Mark Britton of the British Lung Foundation explains that early symptoms such as muscle aches, tiredness, headaches, a dry cough and sudden high fever are 'very similar to flu, but usually more severe and more acute in onset'. 

'If you experience a sudden high temperature, shivering, and a loss of alertness, together with some of the above symptoms and may have been exposed to water droplets such as at a spa, urgently seek medical advice.'