Las Vegas Sun

October 1, 2014

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County working on rules to fight disease outbreaks

About Legionnaire's Disease

Water heaters, cooling towers and warm, stagnant water can provide ideal conditions for the growth of Legionella bacteria, which causes Legionnaires' disease.

People become infected by inhaling aerosol water containing the bacteria or by drinking water containing the bacteria.

There is no evidence that the disease is transmitted from one person to another.

Early symptoms include a slight fever, headache, aching joints and muscles, lack of energy or tiredness and loss of appetite. Later symptoms include a fever of 102 to 105 degrees, a cough that is dry at first but later produces phlegm, shortness of breath, chills, chest pain, vomiting, diarrhea, nausea and abdominal pain.

Legionella is one of the top three causes of sporadic, community-acquired pneumonia.

It is estimated that more than 25,000 cases of the illness occur each year and cause more than 4,000 deaths.

The fatality rate is similar to that of other forms of pneumonia, about 15 percent.

Most people have resistance to the disease and fewer than five of 100 people exposed to water contaminated with Legionella will develop Legionnaires' disease.

People who have underlying illnesses or weakened immune systems are the most susceptible to the disease, including the elderly, smokers, anyone with chronic obstructive pulmonary disease, corticosteroid therapy patients and organ transplant patients.

Source: U.S. Department of Labor's Occupational Safety and Health Administration

Working with the knowledge that Las Vegas has its first suspected case of SARS, the Clark County Health District is developing new regulations designed to contain or minimize the risks of outbreaks of infectious diseases.

In the coming weeks, the health district will present new regulations designed to both minimize bacteriological threats and contain viral diseases such as Norwalk and SARS.

Norwalk has hit the cruise industry hard, while SARS, or severe acute respiratory syndrome, is spreading worldwide and may have arrived in Las Vegas.

An outbreak of infectious disease in Las Vegas is viewed by many local policy makers as potentially apocalyptic for tourism, the area's single dominant industry.

Existing regulations in Clark County's and Nevada's public accommodations laws are not enough, said health district environmental health supervisor Daniel Maxsom.

"We all have a vested interest in the survival of the tourist industry," Maxsom said.

Maxsom said the new rules, still under development, will target the biohazards in the city's big resorts in two ways. One will be to limit the environment for bacteria such as Legionella, which forms colonies in water such as on a showerhead or a faucet and leads to Legionnaires' Disease.

The second goal of the new set of rules will be to limit the spread of a virus in the rooms of resorts. Maxsom said the regulations will require every major resort to at least have a plan to deal with such an eventuality -- to disinfect areas exposed to blood, vomit and other fluids.

The new rules could be in place by the end of July, Maxsom said.

The problem is not only known diseases, he said. New, "emerging" diseases seem to be appearing yearly, and some of those can be airborne, highly infectious and equally dangerous, he said.

Maxsom said the health district's proposal would expand the number of pages of regulations now on the books from a half-dozen to more than 40, and make Las Vegas a model for disease control among tourist destinations in the United States.

Dr. Linda Stetzenbach, a microbiologist with the Harry Reid Center and the University of Nevada, Las Vegas, complimented the health district for "taking a proactive role here."

"I applaud these efforts, and look forward to seeing them in detail," Stetzenbach said. "Any time that people congregate, the likelihood of transmitting diseases person to person increases."

The experts do not know how many cases of disease might be prevented with the new protocols the health district is developing, but they know that Las Vegas has been hit by infectious disease within the last decade.

Cases of the Norwalk virus, the same disease that has struck thousands of cruise ship passengers, have appeared here, Maxsom said. The virus has not had the same affinity for mischief as it has aboard ships -- it loves enclosed spaces and is readily transmittable but rarely fatal -- but has gotten a toehold in a few resorts, he said.

An outbreak of Legionnaires' Disease struck Las Vegas as recently as 2001. Polo Towers, a time share resort, had a number of instances of the disease over the course of more than a year, and the experience has provided impetus to the local control efforts.

"This is a problem in high-rises and new construction in particular," said Stephen Cloobeck, chairman of Diamond Resorts, Polo Towers' management company.

He said Polo Towers has thoroughly reworked its plumbing to ensure there is not a repeat of the 2001 event, going well beyond the maintenance standards in the area's regulations.

"You want to make sure you are safe," Cloobeck said.

He refused to say how much money Polo Towers spent to get rid of its Legionella.

Steve Records, an environmental hygiene specialist with Ondeo Nalco, a multinational company offering environmental services, worked on the Polo Towers overhaul and offered advice in the development of the new health district regulations.

He said both the district and Polo Towers are "way ahead of the curve" in terms of responding to both existing threats and what is likely to come.

One of the most important steps, Records said, is for institutions to understand the risks that they have.

"A risk assessment is the first step in most facilities," he said. "People don't understand the risks that they have. You have to get around the 'head in the sand' syndrome -- that way we can recommend something to mitigate the risks."

Legionnaires' Disease is one of the biggest local threats, and one that is frequently ignored, Records said.

"Legionnella is a water-borne pathogen," Records said. "The bacteria has to be in a water source, in an environment where water can be aerosolized, and inhaled deeply into the lungs."

Unfortunately, that is exactly the environment provided in many showers, especially ones that are not regularly flushed. Records said he believes many cases of Legionnaires' Disease are not reported, and that 40 percent of local resorts would find evidence of the bacteria if they looked hard enough.

Most cases will be brushed off as just a cold and cough, he said. It usually takes a serious problem affecting a number of people before health experts will identify a Legionnaires outbreak.

"As there's more known about this disease, it is being diagnosed more and more," Records said.

Providing the cure for the problem can be expensive, in the hundreds of thousands of dollars. But ignoring the problem can be much more expensive in the long run -- in the millions of dollars, Records said.

"You're talking well below one-tenth of the cost" to control the problem before there is an outbreak, he said.

Dr. Jim Christensen, a district health board member and Las Vegas area physician, said a proactive approach could save the entire tourist economy.

He said that is the primary reason that the region already has "some of the strictest food-handling laws in the nation."

"A food-borne illness -- it would cripple this town."

An outbreak of infectious or environmental disease could do the same thing, Christensen warned.

"It's important to look at these things," he said. "Let's look at this, be rational, measured, but let's make sure we're covering the bases."

Viruses in particular have a troublesome ability to mutate, to appear in new forms for which people do not have immunity.

"That's why you see these things come out of nowhere," Christensen said. "These are troubling times."

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