The public was not notified of a recent outbreak of Legionnaire’s disease in Anaheim until reporters asked about it, because there was no ongoing public health threat, according to the Orange County Health Care Agency (OCHCA).

The Health Care Agency Friday night sent Voice of OC and other news outlets details of the September Legionnaire’s disease outbreak in response to questions asked earlier in the day. The outbreak sickened 12 people, including one person with additional health complications, who died.

Nine of the 12 people who became ill also attended Disneyland, which said it shut down two water cooling tanks on Nov. 1 after routine testing showed elevated levels of the Legionella bacteria that causes the respiratory disease.

Legionnaire’s disease is spread by inhaling contaminated water vapor, and is not spread person-to-person or by human contact. The bacteria occurs naturally and is generally only dangerous when found in high concentrations in human-made water sources.

By the time medical tests determined a cluster of the cases occurred in Anaheim in September, routine tests already had led to disinfecting the two water cooling tanks at Disneyland, according to Health Care Agency spokeswoman Jessica Good.

The Health Care Agency still is awaiting test results to clear the water tanks of unsafe levels of bacteria.

According to federal Centers for Disease Control (CDC) spokeswoman Kristen Nordlund, there’s no federal requirement on how or when Legionnaire’s disease cases are reported to the public, but the CDC encourages local authorities to communicate with people who may be at risk for getting Legionnaire’s once the source of the outbreak has been identified.

“For example, if a hotel’s water system is confirmed to be the source of an outbreak, we would encourage that hotel to inform people who recently stayed at the hotel and those who have upcoming reservations about the situation, so that those people know what to do if they develop pneumonia symptoms or can choose to change their hotel reservations if they haven’t yet traveled,” Nordlund said in an email.

In the case of Disneyland, Good said the agency didn’t notify the public of the outbreak because there was “no known, ongoing risk associated with this event.” Instead, the agency sent a notice to doctors, hospitals and other medical providers alerting them to the outbreak.

According to the Health Care Agency, people would have been exposed to the contaminated water at Disneyland from September 12 to 27. The theme park has since treated the water with chemicals that destroy the bacteria.

Disneyland also did not notify its visitors until after reporters’ inquiries, later posting a letter from its Chief Medical Officer Pamela Hymel on its website.

“We follow the lead of OCHCA and the CDC, who both sent the advisories to just medical professionals,” said Disney spokesperson Melissa Britt.

By state law, doctors and testing facilities are required to report new cases of more than 80 diseases to local public health authorities, information which is then passed on to the CDC.

Doctors have to notify authorities of new cases of Legionnaire’s disease within seven days of identifying the condition. Communicable diseases like measles are required to be reported immediately.

Symptoms of Legionnaire’s disease usually develop between two and 10 days after exposure, and include fever, chills, cough, muscle aches, and headaches. Infected individuals can often develop pneumonia and may need to be hospitalized.

Given the time it takes to test and confirm a diagnosis of the disease, it may have taken some time after initial exposure for the CDC and Health Care Agency to receive reports of the disease, said Good.

The first case was reported to the Health Care Agency on Sept. 27 and the most recent case was reported Nov. 9.

The Health Care Agency itself was not aware of the outbreak until the CDC notified them the week of October 20th. According to Good, the CDC is able to detect outbreaks more quickly because it receives reports of diseases from doctors and medical providers all over the country.

On Oct. 27, after determining Disneyland was a common source of eight cases, the Health Care Agency contacted Disneyland. The theme park reported on Nov. 3 that their contractor, as part of routine testing, found elevated levels of Legionella on Oct. 2 and disinfected the towers two days later.

“Neither Disney nor the contractor would have been aware of the human cases at that time,” Good said.

The cooling towers, which store water that is later chilled and used around the theme park for purposes like refrigeration, were taken out of service on Nov. 1, tested and disinfected again, and then brought back into service three days later.

But because there’s no assurance the cooling tanks are clear of the bacteria until test results return, Disney took the towers out of operation again on Nov. 7.

There have been 55 cases of Legionnaire’s disease reported in Orange County so far this year; 53 reported in 2016 and 33 in 2015.  This year, there was one other cluster of two cases in Orange County, associated with a contaminated hot tub, and four other deaths.

Contact Thy Vo at tvo@voiceofoc.org or follow her on Twitter @thyanhvo.

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