Canadian Officials ID Mystery Illness

TORONTO — Toronto health officials on Thursday said Legionnaires’ disease was likely the cause of 16 deaths at a Toronto nursing home and, while relieved they had found the culprit, warned more deaths were possible before the bacteria was fully contained.

Dr. David McKeown, the chief medical officer for Public Health Toronto, said there had been no new deaths since Wednesday, when six more elderly people residing at the Seven Oaks Home for the Aged succumbed to the bacteria.

"We have a lot of sick people in hospital still, so I’m not going to make any more predictions about deaths," he said.

In all, 70 residents, 13 employees and five visitors to Seven Oaks have been affected by the elusive bacteria and at least 45 of were hospitalized on Thursday.

Though officials had earlier ruled out Legionnaires’ based on preliminary tests, they said cultures taken from autopsies, which took several days to grow, proved positive.

"We’ll continue to look for other possibilities, but we feel pretty confident … we’re dealing with Legionnaires’ disease," said Dr. Donald Low, chief microbiologist at Mount Sinai Hospital. "Some patients are fragile enough that they may still succumb to this."

Legionnaires’ disease is a type of pneumonia named after a severe outbreak that killed 34 people at a meeting of the American Legion in Philadelphia in 1976. The bacteria is typically found in the environment, usually in water.

McKeown said the bacteria grows best in warm water, such as hot water tanks and large plumbing and air conditioning systems. He said the home’s ventilation system had been shut down and bottled water was brought.

When asked about a recent sewage pipe break at a nearby park, McKeown said investigations were under way as to how the bacteria made its way into the nursing home.

"Our environmental investigation is going to leave no stone unturned," he said.

The disease typically affects middle-aged or elderly people and more commonly hits those already ill or suffering from respiratory problems. Officials, however, were at a loss Thursday to explain why so many people died in a single outbreak.

Toronto Mayor David Miller sought to reassure residents and tourists that the outbreak is under control.

"This disease cannot be transferred from person to person," he told a news briefing. "There is not – and there never was – a threat to the general population of Toronto. This disease is environmental, it is not contagious."

City officials have been eager to downplay any threat of contagion, losing an estimated $1 billion in tourism dollars during the SARS outbreak in the spring of 2003, when 44 people died of the respiratory syndrome in Toronto and an estimated 774 people worldwide died of the illness that year.

Fears over the mystery bug have also been fanned by recent warnings by the United Nations and World Health Organization of a global influenza pandemic provoked by a strain of the avian flu. President Bush on Tuesday suggested that the military might be needed to enforce mass quarantines, raising the specter of a pandemic.

"This is not SARS and this is not avian flu," Ontario Health Minister George Smitherman said Thursday. "It has not spread beyond the walls of Seven Oaks, and there is no evidence to suggest that it will."

Legionnaires’ disease can have symptoms like many other forms of pneumonia, so it can be hard to diagnose at first. It can cause death in 5 percent to 30 percent of cases, according to the U.S. Centers for Disease Control and Prevention. Most cases can be treated successfully with antibiotics, and all Twin Oaks residents and workers were being treated with antibiotics since the beginning of the outbreak on Sept. 25.

The red-brick nursing home in the suburban Scarborough neighborhood was still closed to visitors and family members Thursday. Employees could be seen inside wearing masks, but there did not appear to be any sense of panic.

"I’m nervous about it; I think just about everybody in the building is," said Trixie Legge, whose sister-in-law is at Seven Oaks. Legge, 77, lives in the neighboring complex for senior citizens.

Another resident in the building, Margaret Paterson, said she’s concerned health officials may be keeping something from the public. "Like that avian flu, half the people who get that are dying, so we need to know what it is over there," she said.

Her friend, Tanya Cussion, however, said she trusted medical officials to take precautions to protect the public.

Officials believe Legionnaires’ is probably underreported. There are occasional deadly outbreaks. In southern Japan in 2002, six people died and hundreds were infected when they shared the bubbling waters of a new hot spring resort.

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On the Net:

CDC site on Legionnaires’: http://www.cdc.gov/ncidod/dbmd/diseaseinfo/legionellosis  

Toronto Public Health: http://www.toronto.ca/health