1976 Philadelphia Legionnaires' disease outbreak

Disease outbreak in Pennsylvania, United States December 2025 February 2025 thumb|The Bellevue-Stratford Hotel in Philadelphia, site of the first known outbreak of Legionnaires' disease. The hotel closed in November 1976, four months after the outbreak The 1976 Legionnaires' disease outbreak, occurring in the late summer in Philadelphia, Pennsylvania, at an annual American Legion convention, was the first occasion in which a cluster of a particular type of pneumonia cases were determined to be caused by the Legionella pneumophila bacteria. Previous outbreaks were retroactively diagnosed as being most probably caused by Legionella bacteria. Background Legionnaires' disease On July 21, 1976, the American Legion opened its annual three-day convention at The Bellevue-Stratford Hotel in Philadelphia, Pennsylvania. More than 2,000 Legionnaires, mostly men, attended the convention. The date and city were chosen to coincide with America's celebration of the 200th anniversary of the signing of the Declaration of Independence in Philadelphia in 1776.Time http://content.time.com/time/magazine/article/0,9171,914553,00.html The Philadelphia Killer August 16, 1976 January 18, 2014 April 7, 2015 https://web.archive.org/web/20150407050431/http://content.time.com/time/magazine/article/0,9171,914553,00.html dead On July 27, three days after the convention ended, Legionnaire Ray Brennan, a 61-year-old retired US Air Force captain employed as a Legion bookkeeper, died at his home of an apparent heart attack. Brennan had returned home from the convention on the evening of July 24 complaining of feeling tired. On July 30, another Legionnaire, Frank Aveni, aged 60, also died of an apparent heart attack, as did three other Legionnaires. All of them had been convention attendees. Twenty-four hours later, on August 1, six more Legionnaires died. They ranged in age from 39 to 82, and, like the five previous victims, all had complained of tiredness, chest pains, lung congestion, and fever. Three of the Legionnaires had been patients of Dr. Ernest Campbell, a physician in Bloomsburg, Pennsylvania, who noticed that the only common link between the three was that they had attended the convention. He contacted the Pennsylvania Department of Health. Officials at the American Legion also began getting notices of the sudden deaths of several members, all at the same time. Within a week, more than 130 people, mostly men, had been hospitalized, and 25 were reported dead. In total, there were 149 Legionnaires who became sick and 33 other persons associated with the hotel or in the area who also became sick. Of these 182 cases, 29 persons died.Klaus Heuner Michele Swanson Legionella: Molecular Microbiology https://books.google.com/books?id=6v2-2h5SYawC&pg=PA3 2008 Caister Academic Press Norfolk, UK 978-1-904455-26-4 3–4 Ch. 1: Legionnaires' Disease: History and Clinical Findings Epidemiology The U.S. Center for Disease Control mounted an unprecedented investigation and, by September, the focus had shifted from outside causes, such as a disease carrier, to the hotel environment itself. In January 1977, the Legionella bacterium was finally identified and isolated and was found to be breeding in the cooling tower of the hotel's air conditioning system,September 4, 1978 Spread by airborne droplets? Legionnaire's disease linked to water The Globe and Mail The New York Times Service 10 https://news.google.com/newspapers?nid=1454&dat=19780903&id=bLssAAAAIBAJ&pg=2736,405917 January 18, 2014 which then spread it through the building.Ronald Kotulak August 31, 1986 Legionnaires' Disease Less Mysterious, Still Deadly Chicago Tribune 3 https://www.chicagotribune.com/1986/08/31/legionnaires-disease-less-mysterious-still-deadly/ January 18, 2014Karina Barrymore April 8, 1994 Legionella Liability 'A Legal Minefield' – Legionnaires Disease: New Outbreak Expected To Hit Our Cities Australian Financial Review http://www.afr.com/all_search January 18, 2014 February 26, 2015 https://web.archive.org/web/20150226230118/http://www.afr.com/all_search dead This finding prompted new regulations worldwide for climate control systems.Lawrence K. Altman In Philadelphia 30 Years Ago, an Eruption of Illness and Fear https://www.nytimes.com/2006/08/01/health/01docs.html By early August, news organizations across the country were reporting that 6 to 14 of the men in Pennsylvania had died. The New York Times August 1, 2006 2011-10-08 Complicating the situation was a fear among the public that the original cluster of 14 cases, six of whom died within a few days of each other, represented an outbreak of swine flu. The total number of cases reached 211, and of those, 29 had died.Legionnaire disease http://www.britannica.com/EBchecked/topic/335050/Legionnaire-disease Encyclopædia Britannica May 10, 2016 At the time of the outbreak, epidemiological investigation protocols did not include active participation by both laboratory specialists and investigators. No effective communication existed between scientists in the field interviewing patients, and those in the laboratory testing specimens.10.1093/oxfordjournals.epirev.a036076 1765117 1991 Hoge Charles W. Advances in the epidemiology and control of Legionella infections Epidemiologic Reviews 13 329–40 Breiman Robert F. Discovery of Legionella pneumophila Legionella pneumophila While the Center for Disease Control (as it was called in that era) responded rapidly, as did the Pennsylvania Health Department, it took six months for the CDC microbiologist Joseph McDade to discover the cause of the outbreak. He initially thought the cause was viral because blood and tissues from the patients failed to grow bacteria when incubated in culture medium. His subsequent attempts to isolate the viral agent in eggs included antibiotics to kill off "contaminating" bacteria. It was only when he omitted the antibiotics that the bacteria grew in eggs. Attempts to reproduce the disease in mice, the standard laboratory animal model, also failed. The disease was finally produced in guinea pigs. The CDC announced the discovery at a press conference on January 18, 1977.Garrett Laurie The Coming Plague: Newly Emerging Diseases in a World Out of Balance 1995 Penguin Books Toronto; New York 0140250913 184–186 registration https://archive.org/details/comingplaguenewl00garr/page/184373548 https://www.annals.org/article.aspx?volume=90&issue=4&page=659 1979 McDade Joseph E. Legionnaires' disease bacterium isolated in 1947 Annals of Internal Medicine 90 4 659–61 Brenner Don J. Bozeman F. Marilyn 10.7326/0003-4819-90-4-659 subscription 10.1056/NEJM197712012972201 335244 Legionnaires' Disease — Description of an Epidemic of Pneumonia New England Journal of Medicine 297 22 1189–1197 December 1, 1977 Fraser David W. Tsai Theodore R. Orenstein Walter Parkin William E. Beecham H. James Sharrar Robert G. Harris John Mallison George F. Martin Stanley M. McDade Joseph E. Shepard Charles C. Brachman Philip S. etal 10.1056/NEJM197712012972202 335245 Legionnaires' Disease — Isolation of a Bacterium and Demonstration of Its Role in Other Respiratory Disease New England Journal of Medicine 297 22 1197–1203 1977 McDade Joseph E. Shepard Charles C. Fraser David W. Tsai Theodore R. Redus Martha A. Dowdle Walter R. The bacterium was later named Legionella pneumophila.Winn W C January 1988 Legionnaires disease: historical perspective. Clinical Microbiology Reviews 1 1 61 10.1128/CMR.1.1.60 0893-8512 3060246 358030 Legionella pneumophila is the most common cause, but sometimes other species of Legionella bacteria also cause Legionnaires' disease.https://www.who.int/ith/diseases/legionellosis/en/ https://web.archive.org/web/20141018121942/http://www.who.int/ith/diseases/legionellosis/en/ dead October 18, 2014 Legionellosis World Health Organization (WHO) 2018https://wwwnc.cdc.gov/travel/yellowbook/2018/infectious-diseases-related-to-travel/legionellosis-legionnaires-disease-pontiac-fever Legionellosis (Legionnaires' Disease & Pontiac Fever) U.S. CDC Preeta K. Kutty Laurel E. Garrison May 31, 2017 The terms "Philadelphia fever" and "Legion fever" appear to have been used at the time of the outbreak and for shortly thereafter,https://www.washingtonpost.com/archive/local/1977/01/31/legion-fever-germ-killed-16-here-in-1965/b5c1a8e5-8519-4e89-b2dc-94f5d0554ccb/ 'Legion Fever' Germ Killed 16 Here in 1965 Washington Post B. D. Colen January 31, 1977 although at least one 2008 source which covers disease in a historical narrative sense also included "Legion fever" as alternate name.George C. Kohn Encyclopedia of Plague and Pestilence: From Ancient Times to the Present https://books.google.com/books?id=tzRwRmb09rgC&pg=PA303 3rd 2007 Facts on File, Inc. (InfoBase Publishing) New York, NY 978-1-4381-2923-5 303 Both the World Health Organization in 2018 and the United States Center for Disease Control and Prevention (CDC) in 2017 only use the term Legionnaires' disease to refer to the serious version with pneumonia. Retrospective diagnosis of earlier outbreaks as Legionnaires' disease CDC investigators quickly discovered outbreaks of respiratory disease caused by L. pneumophila dating back to 1959. An outbreak of what was dubbed Pontiac fever occurred in a health department in Pontiac, Michigan in July 1967. No one died.Winn WC Legionnaires disease: historical perspective Clin. Microbiol. Rev. 1 1 60–81 January 1988 3060246 358030 10.1128/cmr.1.1.60 Although caused by the same bacterium, Pontiac fever is a milder ailment than Legionnaires' disease. Pneumonia is absent in those with Pontiac fever. An outbreak of pneumonia in July–August 1965, at St. Elizabeths Hospital in Washington, DC, which killed 16 persons out of 78 infected was later determined to be Legionnaires' disease.Harold M. Schmeck Jr. January 19, 1982 Legionnaire's Disease: 5 Years Later the Mystery Is All But Gone https://www.nytimes.com/1982/01/19/science/legionnaire-s-disease-5-years-later-the-mystery-is-all-but.html The New York Times C1 July 26, 2022 A September 1974 convention of the Independent Order of Odd Fellows was also held at the very same Bellevue-Stratford Hotel. Out of approximately 1,500 members who attended, 20 developed pneumonia and two died. A later article in The Lancet reported: "Illness [high fever and pneumonia] was significantly associated with attendance at one convention activity held on Monday morning, September 16, 1974, in the grand ballroom of the hotel." Oddly, staff members of the hotel seemed immune to infection and the CDC has yet to discover the reason for this apparent immunity.Terranova William Mitchell L Cohen David W Fraser 15 July 1978 1974 Outbreak of Legionnaires' Disease Diagnosed in 1977: Clinical and Epidemiological Features The Lancet 312 8081 122–124 10.1016/s0140-6736(78)91507-6 0140-6736 78324 5619028 See also 1999 Bovenkarspel legionellosis outbreak List of legionellosis outbreaks References External links Category:1976 disease outbreaks Category:1976 disasters in the United States Category:1976 in Philadelphia Category:American Legion Category:Building biology Category:Health in Pennsylvania Category:Disasters in Pennsylvania 1976 Philadelphia Legionnaires disease outbreak Category:Industrial hygiene Category:Legionellosis Category:July 1976 in the United States