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Worsening Legionnaires outbreak rises to 18 cases at Florida federal women's prison

Miami Herald logo Miami Herald 2/6/2020 By Ben Conarck and Carli Teproff, The Miami Herald

An outbreak of Legionnaires’ disease at a women’s work camp at Coleman Federal Correctional Complex has worsened to 18 confirmed cases as health and prison officials search for the source of the contamination, dramatically escalating the Sumter County prison’s public health crisis.

The outbreak at the prison, beset by sexual assault allegations, dwarfs past Legionnaires’ disease cases at Federal Bureau of Prison facilities, which last had one confirmed case in May 2019, officials said. In 2015, an outbreak at San Quentin State Prison in California that made national news was contained to 13 cases among prisoners.

Legionnaires’ disease is a type of pneumonia (or lung infection) caused by breathing in water that contains legionella bacteria. The disease can cause flu-like symptoms, including coughing, aching muscles and headaches, according to the Centers for Disease Control and Prevention.

Such clusters are unusual, as the cases typically pop up for one or two individuals, epidemiologists said on Wednesday. The fact that so many cases were confirmed in a prison is troubling, as the bacteria that causes the disease — legionella — could still be circulating among people living in a confined, densely populated environment.

David Krause, who has a Ph.D. in toxicology and was the former state toxicologist at Florida Department of Health from 2008-2011, said the bacteria often lives in warm water, and sources like water heaters and cooling towers are highly suspect.

“The [Department of Health] should be able to look at the epidemiological data and tell if it’s associated with a single water heater source or whether it’s a cooling tower outside the building that’s affecting the whole prison,” Krause said.

The work camp is part of a much larger complex housing thousands of inmates, mostly men.

The BOP said on Wednesday that it had installed two recirculating pumps and point-of-use filters for shower heads and sink faucets, which Krause said would help contain an outbreak caused by a water heater. The agency did not immediately say whether cooling towers were present at the work camp.

A BOP spokesperson said the prison is working with Department of Health officials on a plan to identify the source of legionella, monitor for new cases, manage current ones and take “necessary precautionary measures.”

“The BOP uses a comprehensive approach to managing infectious diseases in federal prisons that includes testing, appropriate treatment, prevention, education, and infection control measures,” the spokesperson said. “All levels of the agency are involved in the management, recommendations and monitoring of any disease outbreak, in collaboration with state and local agencies.”

Federal prison officials ignored inquiries about the outbreak for days. About a week ago, officials confirmed “some” cases, then bumped the number up to 18 on Wednesday morning.

Loved ones of those at the work camp are concerned that the federal prison agency has fumbled its response to the outbreak. Paul Forkner, whose daughter is incarcerated there, said she recently told him that inmates are complaining about not being able to access medical treatment or testing and that some are being diagnosed with a cold but given antibiotics anyway.

“My guess is they are undercounting as much as possible,” Forkner said.

Forkner’s daughter cast doubt on whether the response by BOP was sufficient, saying that water filters had been installed in only about four sinks in her dorm — less than half, she said, describing the efforts as “lipstick on a pig.” She also reported that an outside consulting form was at the “powerhouse,” which she said handled water and sewer connections.

Mary Jo Trepka, a professor of epidemiology at Florida International University and former epidemiologist for Miami-Dade County, said there were nearly 500 cases in Florida in 2018 but that it’s rare to have such a large cluster in one place.

“If you’ve got people incarcerated and it’s one very large system, I would be concerned about the environmental conditions related to that,” Trepka said.

Krause, the former health department official, said epidemiological investigations are “notoriously vague and often inconclusive” in defining the sources of contamination. He said health and prison officials likely do not have the expertise to investigate the outbreak on their own and would have had to turn to a consulting firm for assistance.

BOP officials did not immediately answer whether it or the health department had enlisted an outside firm.

Legionnaires’ disease got its name from the first-known outbreak: at an American Legion convention in Philadelphia in 1976 that coincided with the Bicentennial. In total, 149 Legionnaires were stricken and 33 other persons associated with the convention hotel or in the area also became sick. Of the total of 182 cases, 29 people died.

Legionnaires can still be fatal if not promptly treated with antibiotics.

The Coleman outbreak comes nearly two months after women at the prison banded together and filed a lawsuit claiming male corrections officers sexually harassed and assaulted them with no consequences. Following a Miami Herald story about the lawsuit, U.S. Sen. Marco Rubio demanded that the Bureau of Prisons conduct a thorough review. Rubio has still not received an update.

An earlier version of this story misstated the year for the total number of Legionnaires’ disease cases in Florida. The most recent data is for 2018.


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