Legionnaires’ disease linked to Aria

The tests were done only after health officials determined that six former patrons of the hotel had been diagnosed with the disease, a form of pneumonia.

And that, says a CDC official, is the proper protocol.

"We recommend what they did there at first, an environmental assessment," said Laurel Garrison, a CDC specialist in the disease.

Health officials explained their procedures in the wake of the news Thursday that Aria officials are notifying patrons who stayed at the hotel from June 21 to July 4 that they might have been exposed to the sometimes-fatal Legionnaires’ bacteria.

It’s the latest bad news for the CityCenter development, whose mothballed Harmon tower came under scrutiny earlier this week after a structural engineer said it had construction defects that could cause it to collapse in an earthquake.

Six former patrons of the Aria, people who stayed there between December 2009 and April, have come down with the disease. All have recovered. It wasn’t until all six cases were linked that officials felt the need to test the hotel’s water.

Though the Aria cases stretch back almost to the Dec. 16, 2009, grand opening of the 4,000-room hotel, officials say they need to notify only those guests who stayed during the recent two-week period because of the disease’s incubation period of two to 14 days. So far, none of the notified patrons, nor any hotel employees, has reported contracting the disease, according to the health district’s Jennifer Sizemore.

The notification letter informs people of symptoms and advises them to seek medical attention if they feel ill. The letter also urges anyone who has further questions to contact company representatives at 1-877-326-2742. Alan Feldman, senior vice president of public affairs for MGM Resorts International, declined to say how many letters had been sent out to customers of the hotel.

NO INDICATION OF OUTBREAK IN JUNE 2010

When health district environmental health employees inspected the Aria in June 2010, they found nothing to make them think that a possible outbreak was under way.

"We then did a stem-to-stern assessment of the Aria," said Mark Bergtholdt, a district environmental health supervisor. "What we found was a hot water system that was in great shape."

Legionella, the bacterium that causes Legionnaires’ disease, is often found in air-conditioning cooling towers, whirlpool spas, showers, faucets or other water sources. The bacterium can rapidly reproduce in warm, stagnant waters.

The two cases that had been reported to the CDC by state health officials — and then reported to the Southern Nevada Health District — were several months apart, in 2009 and 2010, according to Bergtholdt.

Even as the Aria was being inspected in 2010, another report of a possible case linked to the hotel came to the health district from the CDC.

Yet given what Bergtholdt and other environmental specialists found during the inspection at the Aria — what appeared to be complete compliance with guidelines — the determination was made not to test the water.

"If we had found anything to suggest that they had a breeding ground for Legionella, we would have tested water for it," Bergtholdt said.

"What we’re doing is risk assessment," he said.

And officials, he admitted, are conscious of the cost of testing.

"It costs $200 a test," he said. "Just one room of faucets and showers and so forth can cost $1,000. Test ten rooms and you’re talking about $10,000."

During this year, Bergtholdt said, three more cases possibly stemming from the Aria were reported to the health district from the CDC. The two most recent cases, from this spring, were reported in June.

"That showed a definite association (with the Aria), and testing began," he said. Elevated levels of the bacteria causing the disease were found during tests between June 21 and July 4.

Multiple rooms were found to have the bacterium in either faucets or showers. Bergtholdt won’t specify which rooms were found to have it or exactly how many rooms had it. MGM’s Feldman said three rooms were involved but did not say which ones.

Bergtholdt said to ensure that none of the bacteria continue to exist at the Aria, extra chlorine has recently been fed into the hot water system of rooms that are fed by a single water outlet.

"You let it sit and then you flush the system," Bergtholdt said.

Blocks of 500 to 1,000 rooms of the 4,000 room hotel are closed off during the cleansing effort, which he said "takes overnight to complete."

Public health officials don’t have to test other hotels in the CityCenter complex because water lines that go to Aria aren’t shared with other hotels, he said

At this point the health district, or taxpayers, are picking up the tab for the work at the Aria, said Bergtholdt, who added that the district might ask the Aria to pick up the tab. He said the district has conducted water tests on fewer than 15 rooms, and the Aria is doing tests of its own on water outlets in other rooms.

A ‘UBIQUITOUS ORGANISM’

CDC’s specialists Garrison and Laurie Hicks called Legionella a "ubiquitous organism" that can be found in many locations, including in natural as well as artificial water systems. Although tests can show evidence of bacteria, they said, the disease is only caught through inhaling contaminated water vapor.

It is possible, Garrison said, that others came down with symptoms of the disease and were treated with anti­biotics, but the cases were never diagnosed as Legionnaire’s disease.

Doctors must do a specific test to confirm the diagnosis, she said.

The disease can be very serious; the CDC reports that it can cause death in 5 percent to 30 percent of cases. Most cases can be treated successfully with antibiotics, and healthy people usually recover from infection.

"In an abundance of caution, we are attempting to notify guests who may have been exposed to these bacteria during this short period," Paul Berry, vice president of hotel operations at Aria, wrote in a letter mailed to guests and posted online at www.arialasvegas.com/facts.

Feldman said the hotel has implemented a comprehensive abatement effort.

All subsequent tests have come back with no detectable levels of active Legionella, Feldman said.

Berry said Legionella is a concern for all large buildings, and Aria has a comprehensive water management program in place, which includes regular testing.

"We will continue to monitor our water quality on an ongoing basis to ensure the safety of the water system and our guests," he said.

DISEASE FIRST IDENTIFIED IN 1976

Legionnaires’ disease was first identified in 1976 when an outbreak of pneumonia sickened hundreds of people who had attended an American Legion convention at Philadelphia’s Bellevue-Stratford Hotel, resulting in dozens of deaths. Initially a mystery, the cause of the disease was not identified for several months.

Over the years, there have been a number of cases of Legionnaires’ disease in the Las Vegas Valley, including at least one confirmed death in 1981. After an outbreak at the Polo Towers in 2001, in which three guests of the time-share condominiums on the Strip had contracted the disease, health district officials issued new regulations designed to protect the public.

The regulations required property owners to maintain proper chlorine levels in pools and spas and ensure temperatures in water heaters are escalated periodically to 150 degrees to kill the bacteria.

The regulations targeted hotels, motels and resorts as well as other commercial buildings with large air-conditioning system or cooling towers.

The CDC’s Garrison noted that new national guidelines to keep Legionella at bay are being formulated by the American Society of Heating, Refrigeration, and Air-Conditioning Engineers.

"The document is not yet final and when it is, it will be up to governing bodies in communities to adopt it," said Garrison, who said the CDC has played a role in drafting it.

Review-Journal reporters Howard Stutz and Chris Sieroty contributed to this report. Contact reporter Paul Harasim at pharasim@reviewjournal.com or 702-387-2908.