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Vermont health official on why we're hearing about Legionnaires' disease, and what to watch for

A visual showing blue bacteria, which look like two pills attached to each other end-to-end.
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After investigating a cluster of Legionnaires' disease cases in the area, Vermont health officials are asking people in St. Albans to keep an eye out for symptoms, which include shortness of breath, fever and fatigue.

Vermont's Department of Health recently concluded an investigation into a cluster of cases of Legionnaires' disease in and around St. Albans in Franklin County.

The state confirmed five cases, including one that resulted in death.

Vermont Edition's Mikaela Lefrak spoke with Deputy State Epidemiologist Laura Ann Nicolai about identifying and preventing Legionnaires' disease. Their conversation has been edited and condensed for clarity.

Mikaela Lefrak: So first tell us what is Legionnaires’ disease, for someone who’s never heard of it before?

Laura Ann Nicolai: Sure. Legionnaires’ disease is a form of pneumonia. It's caused by Legionella bacteria. And these bacteria occur naturally in freshwater environments.

Where Legionella bacteria cause problems is when they enter manmade water systems. And so those are normally larger, complex buildings, cooling towers … there's, you know, big air conditioning units on top of large buildings, hot tubs, cooling misters, decorative fountains, or even any just large, complex plumbing system, where the conditions are right for the bacteria to just multiply.

What are the specific symptoms that people should be looking out for?

Symptoms of Legionnaires’ disease include shortness of breath, fever, fatigue. It is pneumonia, so it should be detectable by a chest X-ray.

So these cases that we're talking about occurred back in August. Why are they making headlines now?

In consulting with our colleagues across the Health Department and also with CDC, we were able to identify some specific locations of concern, and are moving forward with environmental testing in those locations.

But really, the primary point of notification and of the press release was so that individuals in the St. Albans community who develop any signs or symptoms of illness consistent with Legionnaires’ disease could just have that in their mind, and then consult with their health care provider, seek medical care, because seeking care early, early diagnosis and antibiotic treatment, is going to lead to the best health outcome.

"... seeking care early, early diagnosis and antibiotic treatment, is going to lead to the best health outcome."
Vermont Deputy State Epidemiologist Laura Ann Nicolai on Legionnaires' disease

I read that the fatality rate for Legionnaires’ disease is 10%, according to the CDC. That does seem quite high.

So it is important to note though, that only individuals at increased risk are likely to develop Legionnaires’ disease. Folks who, you know, are younger and don't have underlying health concerns or conditions are likely not to be impacted.

But people who are 50 or older, anyone who's immunocompromised, or anyone who has underlying health conditions, especially underlying respiratory conditions, or who has smoked heavily previously, or who is a current smoker, those are all folks who are at increased risk for developing Legionnaires’ disease if they are exposed to the bacteria.

OK, so those are the folks who should really be keeping an eye out for this and for their symptoms.


Ahead of our conversation. I was doing a little bit of research into Legionnaires’ disease. And I learned that the name comes from an outbreak in the 1970s. I was surprised by it, I think people associate that name with, here's something of the World War I era.

No, you're right. I think it was maybe in 1976 as part of the Bicentennial celebrations, and the [American Legion] convention was occurring in Philadelphia, and there was this outbreakof pneumonia respiratory illness, there were several deaths. So yes, you're right.

Turning away from Legionnaires' for a moment here. Of course, as an epidemiologist, you and your team have had a very busy couple of months and years, and we're heading to cold and flu season. And of course, we're still seeing COVID cases regularly. Are there any particular concerns for you right now as an epidemiologist for the state? What is your office keeping a close eye on?

So we are looking at outbreaks within schools, outbreaks within other facilities such as long-term care facilities, and just keeping track of what is going on, and continuing to message and recommend vaccination.

Now that we have the new omicron boosters, we're really encouraging everyone to take advantage of that opportunity. Now is an excellent time to get your COVID booster and get your flu booster. You can get your flu shots and your COVID shots on the same visit, and feel good about the level of protection that you have going into the fall and winter months.

Have questions, comments or tips? Send us a message or tweet us @vermontpublic.

Mikaela Lefrak is the host and senior producer of Vermont Edition. Her stories have aired nationally on Morning Edition, All Things Considered, Weekend Edition, Marketplace, The World and Here & Now. A seasoned local reporter, Mikaela has won two regional Edward R. Murrow awards and a Public Media Journalists Association award for her work.
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