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18 April 2008
Piperdam outbreak: advice on killer bug
Hundreds of letters from NHS Tayside have been sent to staff, club members and recent visitors to Piperdam Golf and Leisure Resort, issuing advice on the Legionnaires’ disease outbreak at the facility, near Dundee (writes Alan Wilson).
The resort has been closed since Wednesday, when it was confirmed the legionella bacterium had been found in a shower head and hot tub at one of the site’s wooden chalets.

Health experts found the bacterium after a 60-year-old man — who had recently holidayed at Piperdam — died in a Norfolk hospital of suspected Legionnaires’ disease.

NHS Tayside set up a dedicated helpline yesterday to offer advice to members of the public concerned they may have been exposed to the potentially fatal legionella bacterium.

Environmental health officers are carrying out tests at some of the other 46 lodges in the resort to see if the bacteria are also present there.

NHS Tayside have already sent out letters to tourists who stayed at the resort between April 2 and April 15 and used the shower facilities there.

The lodges at Piperdam — which sleep from two to 12 people and have been given a four-star rating by tourism authority VisitScotland — are a popular base for tourists visiting the East Coast of Scotland.

The resort — which is celebrating its 10th year in operation this year — boasts a gym, swimming pool and spa, and the facilities are open both to people who stay at the lodges and to members of the public on a pay per use basis.

Piperdam management have voluntarily closed the lodges, swimming pool and spa pending the outcome of the public health investigation.

NHS Tayside said today inquiries were ongoing and a helpline — 08000282816 — has been set up to offer advice to anyone with concerns.

The Health and Safety Executive issues prevention and treatment advice to resorts, hotels, gyms and other public places with similar facilities as a general rule.

The HSE offers various forms of guidance including an Approved Code of Practice and guidance outlining companies’ responsibilities under health and safety law, aimed at preventing people from being exposed to legionella.

Health clubs and leisure centres, hotels, swimming pools, even blocks of flats with a communal spa bath for residents have responsibilities under several pieces of health and safety law.

Among those are The Health and Safety at Work Act 1974 The Control of Substances Hazardous to Health Regulations 2002 and the Management of Health and Safety at Work Regulations 1999, to manage any risks associated with using the equipment, the control of legionella bacteria in water systems, Legionnaires’ Disease: A guide for employers and a video on control of legionella.

Advice is also available from the environmental health department of local authorities, professional bodies such as the Institute of Sports and Recreation Management; associations such as the Water Management Society or British Association for Chemical Specialities.

In addition those responsible for manufacturing or supplying equipment are offered advice and guidance and are informed of their legal requirements by the HSE.

There are actually several pneumonia-like diseases caused by different types of legionella bacteria, known as legionellosis.

Anyone can be infected by legionella bacteria, but older people (over 45), smokers, heavy drinkers, those suffering from chronic breathing problems or kidney disease, and those with impaired immune systems (eg HIV positive) are more likely to develop life-threatening symptoms.

Legionella bacteria occur naturally in our environment (rivers, lakes etc) where they are not a problem for people.

However, they also live in water systems associated with buildings and the workplace, eg hot or cold storage tanks, cooling towers, fire-fighting equipment and spa baths.

In these situations, if the bacteria get into water sprays or mists, people can breathe them in.

Exposing the lungs to the bacteria could then lead to Legionnaires’ disease.

The bacteria can also be found in soil and potting mix.

The bacteria can survive at low temperatures, although will not multiply.

However, at 20 to 45C they thrive and readily multiply.

The bacterium Legionella pneumophila was first identified in 1977, as the cause of an outbreak of severe pneumonia in a convention centre in the USA in 1976.

It has since been associated with outbreaks linked to poorly maintained artificial water systems, particularly cooling towers or evaporative condensers associated with air conditioning and industrial cooling, hot and cold water systems in public and private buildings, and whirlpool spas.

Legionnaires’ disease has an incubation period of two to 10 days (but up to 16 days has been recorded in some recent well-documented outbreaks).

Initially, symptoms are fever, loss of appetite, headache, malaise and lethargy.

Some patients may also have muscle pain, diarrhoea and confusion.

The severity of disease ranges from a mild cough to a rapidly fatal pneumonia.

Death occurs through progressive pneumonia with respiratory failure and/or shock and multi-organ failure.