Sweden, August 31st 2004 - - Two elderly men have died following two major outbreaks of the bacterial infection Legionnaire's disease. On Tuesday it was reported that there are now nine confirmed cases with two more suspected in Lidköping, with one death, while another outbreak in July has come to light in Umeå where three people fell ill and one elderly man died.
The outbreak earlier this summer - apparently kept out of the press by Swedish Institute for Infectious Disease Control (SMI) in order to avoid public panic - has been linked to an old spraying system at the OBS Supermarket in Umeå that is used to keep fruit and vegetables moist. The store was temporarily closed.
Over the past years SMI has been researching different potential sources of legionella infection, and claims it has checked some 40 different vegetable spraying units in supermarkets, without ever finding any trace of the bacteria behind the disease.
Despite this, the board of the Svensk Dagligvaruhandel, a branch organisation for fresh produce retailers in Sweden, has advised its members to turn off all water spraying units in their stores.
"There isn't actual reason to do so, but it is the only way to stop all the discussion and concern that has spread amongst our clients," commented Thomas Svaton, head of the industry organisation Svensk Dagligvaruhandel, to the Swedish media.
"There aren't that many units anyway, since many stores don't see the need for this additional moisturizing system, but those that are in operation should be closed until we have better guidelines on cleaning and maintenance."
Aftonbladet reported that Boverket, the National Board of Housing, Building and Planning, had warned of the dangers of vegetable sprayers in a report back in 1999.
"Apparently people need to die before this is taken seriously," commented Boverket's General Director, Ines Ussman.
"As long as there is no central agency that can hand out sanctions, the role of the government is limited to an educational one, and I'm afraid things won't change."
It is not clear what the cause of the Lidköping outbreak is, but all supermarket spraying systems are being checked. Attention has also turned to the town's public air-conditioning systems.
"We know from outbreaks abroad that air-conditioning systems are a common infection source," commented Martin Wahl from SMI's West Götaland division to Dagens Nyheter.
"There are many cases where people have been infected by aerosol being emitted from cooling towers on industrial sites, and there are three such sites in Lidköping."
SMI has been roundly criticized for not going public with the first outbreak earlier. However, the man who died was also suffering from another unrelated illness and so Legionnaire's was not immediately recognized as being part of the cause of death.
Legionnaire's disease is a caused by the Legionella pneumophila bacterium. Although SMI's ongoing research showed that there are worryingly high levels of the bacteria in Lake Mälaren, there are no statistics from Lake Vänern, where Lidköping is located.
The name Legionella pneumophila was derived from the first identified outbreak in 1976 at an American Legion Convention in Philadelphia. Europe-wide Legionnaire's disease claims the lives of 14% of sufferers.
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