Disneyland: The Sickest Place on Earth?

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Disneyland’s official tagline is the “happiest place on Earth.” It’s the place referenced by every Super Bowl champion, a cultural landmark known across the world, and ultimately, a place for families to go for entertainment and fun. It is considered a place of magic for many, but unfortunately in October 2017, it also became a place of sickness when multiple cases of Legionnaires’ disease became associated with the park. 

Legionnaires’ disease is a type of pneumonia not typically spread from person to person but rather through breathing in small droplets of water which contain the bacterium Legionella. This bacterium is able to multiply rapidly in water systems that have not been cleaned properly or on a regular basis. The most common water systems affected by this bacterium are mist machines, cooling machines, pools, and fountains.1 Since the water systems for these machines/objects are complex, it can be hard to correctly and completely clean every aspect of them, causing Legionella to grow and spread in an easier fashion.1,2

The pneumonia caused by Legionnaires’ disease generally appears two to ten days after exposure and will typically present with headache, muscle pains, chills, and a fever over 104°F. A few days after these symptoms appear, the disease may progress, causing symptoms such as cough, chest pain, trouble breathing, nausea/vomiting, and mental status changes. Not all individuals are at equal risk for development of the disease.1,3  Those with highest risk include smokers, people who have a weakened immune system, those with a pre-existing lung condition (such as asthma or chronic obstructive pulmonary disease [COPD]), or who are aged 50 years or older.1 If the disease is left untreated, it can lead to potentially dangerous and life-threatening complications such as respiratory failure, septic shock, or acute kidney failure.1,3 Treatment typically consists of antibiotics as no vaccine is available. However, the most important aspect of the disease is that is it preventable through proper maintenance of the complex water systems, which serve as the growth medium for the bacteria

On October 27th, 2017, county heath contacted Disney about an outbreak of Legionnaires’ disease in the area. This led the park to discover bacteria were present in cooling towers that provided air throughout the whole park, which were subsequently shut down. However, this was not however until nine people who attended the park were reported to have developed the disease.  A further three people who visited the area (but not the park) were also found to have developed Legionnaires’ disease. The infected patients were between 52-94 years old and 10 of them were hospitalized for their illness.3,5 Due to these cases, the water towers have been in the process of being cleaned until they are approved to be back up and running again.  Unfortunately, no updates have been available in the news to the current operating status of the towers since the outbreak.   

This outbreak at Disneyland demonstrates the unfortunate dangers and consequences of Legionnaires’ disease.  In this particular case, there were no preventative measures that travels could have taken to protect themselves, as the park had full responsibility to maintain that safety of their cooling towers and other water systems, which are subject to potential contamination. The take away message? No matter how popular or magical a place may be, there are risks present in all environments.

References:

  1. Legionnaires’ disease. Mayo Clinic. Published August 2, 2017. Accessed December 31, 2017.
  2. Legionella (Legionnaires’ Disease and Pontiac Fever). Centers for Disease Control and Prevention, Published September 14, 2017. Accessed December 31, 2017.
  3. Prognosis and outcome- Legionellaorg. Accessed December 31, 2017
  4. Cullinane S. Disneyland shuts down cooling towers over Legionnaires’ cases. CNN. Published November 13 2017. Accessed December 31, 2017
  5. Barboza T. Disneyland shuts down 2 cooling towers after Legionnaires’ disease sickens park visitors. Los Angeles Times. Published November 11, 2017. Accessed December 31, 2017.

This article was written by Jennifer Yannuzzi, student pharmacist at Duquesne University School of Pharmacy, and reviewed by her faculty advisor, Dr. Jordan Covvey.

Jennifer is currently a fifth-year pharmacy student at Duquesne University School of pharmacy. She currently works as an intern at a retail pharmacy.  Jennifer holds school leadership positions in the American Pharmacists Association (APhA) Academy of Student Pharmacists and Helping to educate and Rehabilitate Together (HEART) organizations and is also active in other pharmacy organizations.  After graduation, Jennifer places on pursuing a pharmacy residency and hopes to practice in a clinical setting with a specialty in pediatrics.

Dr. Covvey is an Assistant Professor in Pharmacy Administration at the Duquesne University School of Pharmacy. She earned her Doctor of Pharmacy from the University of Kentucky in 2010, and then completed residency training at Virginia Commonwealth University Health System in 2011. She subsequently passed her board certification in pharmacotherapy (BCPS) and was selected as a recipient of a Fulbright grant to complete a Doctor of Philosophy at the University of Strathclyde Institute of Pharmacy and Biomedical Sciences in Scotland. She currently teaches in the public and global health curriculum for pharmacy students at Duquesne, and her research area is in the utilization of healthcare data, such as electronic medical records, for quality improvement in prescribing.