Edinburgh legionella outbreak: One dead and 16 critical By NATALIE WALKER Published on Tuesday 5 June 2012 23:39 ONE MAN has died and 16 people are in a critical condition in hospital in the worst single outbreak of Legionnaires" disease in Scotland. A further 15 suspected cases of the illness are being investigated in Edinburgh and some of those people are critically ill in hospital, NHS Lothian confirmed late on Tuesday. The man who died was in his fifties and had an underlying health condition. He died at Edinburgh Royal Infirmary, where the other cases are being treated. Fourteen men and two women aged 33 to 74 are in a critical condition and are being treated in intensive care. One man has recovered and been allowed to go home. Health officials warned on Tuesday that the outbreak, which began last Thursday and has affected people living or working in south-west Edinburgh, might not be over and more cases could emerge in the coming days. The symptoms of Legionnaires" disease, which is not contagious, can take up to two weeks to develop. It affects people who have been exposed to droplets of contaminated water. Symptoms include mild headaches and muscle pain, escalating to a high fever, persistent cough and sometimes vomiting, diarrhoea and confusion. The disease is commonly found in water sources, included rivers and lakes, and can end up in artificial water supply systems, such as air-conditioning systems, water services and cooling towers. It cannot be contracted through drinking water. Despite a wide-reaching clean-up operation now under way in the affected area of the capital, public health officials have yet to identify the source of the outbreak. Officials said they were awaiting the results from tests carried out on 16 industrial cooling towers in the Gorgie, Dalry and Saughton areas of Edinburgh. Experts suggested it could take until the middle of next week before results are confirmed, as legionella is a difficult bacterium to identify. Dr Duncan McCormick, consultant in public health medicine and chair of the incident management team at NHS Lothian, expressed his sympathy to the family of the dead man last night and said every effort was being made to bring the outbreak under control. I would like to express my sincere condolences to the family of the patient that died. Investigations into the possible source of this outbreak are on-going," he said. Meanwhile, medical staff have been actively identifying possible cases to allow us to ascertain the full extent of this outbreak. I would like to reassure the public that household water supplies are safe and that Legionnaires" disease cannot be contracted by drinking water." He said older people, particularly men, heavy smokers and those with other health conditions are at most risk of contracting the disease. Dr McCormick said the cooling towers were suspected as being the source of the outbreak, but other sites had not been ruled out and the situation would be monitored round the clock. Health officials urged anyone who developed symptoms to contact NHS 24 or their GP. Bacteria expert Professor Hugh Pennington said last night it might be difficult trace the exact source of the Legionnaires" outbreak. He said: "Essentially, it is a preventable disease. Industrial water cooling towers are quite a common source of the bug. The bug lives in warm, fresh water. Basically, what should be done is that disinfectant should be put in the water to stop the bug growing. "Clearly, that hasn't happened, and the aerosol of water that comes out of these cooling towers contains the bug, people breathe it in and get Legionnaires" disease, which is essentially a very, very severe pneumonia. The aerosol can spread in the wind, and that's one of the reasons why it can be quite difficult to track down a particular source. Prof Pennington advised people not to be "too concerned" about the current outbreak saying the number of cases was "relatively small." He said: "This is very concerning for those who are infected, but it's probably going for a particular vulnerable section of the community - men with lungs already damaged by other diseases, and so on - and it is a fairly straightforward disease to diagnose once you know that it is a possibility." The organisations responsible for maintaining the cooling towers have been told to carry out additional chemical treatment to the water in the systems as a precaution. A wide variety of industries and manufacturing companies use cooling towers as a means of removing unwanted heat from industrial or manufacturing processes. Environmental health services and the Health and Safety Executive, working alongside staff from Edinburgh city council's environmental health department, will continue to test the towers over the coming days to ensure control measures are working. There are strict regulations regarding the maintenance and control of water supply systems, such as either keeping the water cooled below 20C (68F), or heated above 60C (140F), in order to prevent an outbreak of Legionnaires" disease. The first case in this latest outbreak was identified last Thursday. NHS Lothian first announced that there were cases of the disease in Edinburgh three days later. The biggest legionella outbreak in the UK happened in 2002 in Barrow-in-Furness, Cumbria. A contaminated cooling tower at an arts centre was the source of that outbreak. A total of 172 people were affected and seven died as a result of the illness. Barrow Borough Council became the first public body in the UK to be charged with corporate manslaughter, but it was cleared. The council was, however, fined for breaches of health and safety regulations at the art centre.