Scientists to test Flint water for Legionella

Karen Bouffard, Kim Kozlowski, and Jacob Carah
The Detroit News

Flint — Scientists will investigate whether changes in the city’s water chemistry contributed to a deadly Legionnaires’ disease outbreak, as one researcher suggests the system could have bred a more virulent strain of the bacteria.

The state Department of Health and Human Services agreed Monday to provide startup funding for a panel of scientists, led by Wayne State University, to test the water system in Flint for possible links to the Legionnaires’ outbreak in Genesee County in 2014 and 2015, the university and agency announced Tuesday.

The approach comes just a week after state health officials cited a recommendation from the Centers for Disease Control and Prevention against testing municipal water for Legionella, focusing instead on testing buildings that epidemiological studies indicate are associated with the outbreak. The health department didn’t say what prompted the change when asked by The Detroit News.

The News reported last week that Flint’s water had never been tested for Legionella despite being identified in fall 2014 as a likely source of the disease outbreak.

With the new grant funding, researchers welcomed the opportunity to study how the complex changes in Flint’s municipal water system may have contributed to the Legionnaires’ outbreak that sickened 87 Genesee County residents, killing 9, after the city switched to highly corrosive Flint River water in April 2014 from Detroit’s system as a money-saving measure.

“That was such an unusual change in the chemistry of the water, and an unusual rise in cases, that I think we should investigate and use it as a test case to better understand how water chemistry can affect the burden of microbes, including Legionella, in the water supply,” said Dr. Michele Swanson, a professor of microbiology and immunology at the University of Michigan Medical School. She will be part of the Wayne State University collaborative.

“Absolutely, I would like to take water samples from the Flint distribution system. There’s some really interesting biology going on that is not well-described. I would love to know if the chemistry of the water before and after Flint made the switch had any direct impact on the biology and the resilience of this organism.”

Some scientists have speculated that bacteria-fighting chlorine used to treat E. coli contamination in Flint’s water system may have resulted in the growth of stronger, more resilient Legionella.

According to Swanson, researchers in Paris, France, compared the number of Legionella bacteria in water systems treated with chlorine to the number in water systems without the treatments.

“Surprisingly, the (number) of Legionella was actually higher in systems that were treated with chlorine,” she said. “In general in the microbial world, microbes can adapt to whatever harsh conditions you throw at them.”

Swanson said she will propose a study to find out if changes in Flint’s water chemistry have resulted in more resilient bacteria as part of the research effort.

None of the five government agencies involved in Flint’s water crisis — including the state health department and the EPA — previously tested the city water system for the deadly bacteria. The Michigan Department of Environmental Quality, CDC and the Genesee County Health Department also did not test city water for Legionella.

State health department spokeswoman Jennifer Eisner on Tuesday said the decision to fund the Wayne State study was among “steps moving forward with the local health department, the CDC, and experts in academia in anticipation of the warmer months — this contract is a part of those efforts.”

“The contract with Wayne State supports the development of new surveillance strategies that emphasize a rapid follow-up and evaluation of new cases, and facilitates the appropriate collection and testing of specimens,” Eisner said.

Whether it’s still possible — nearly two years after the initial Legionnaires’ cases in Genesee County — to directly link the bacteria found in patients with Legionella collected from city water now, Swanson said: “Theoretically, that is possible to do.”

The state health department laboratory has done molecular typing on samples of Legionella collected from patients.

To prove a link, scientists will look for an exact match with Legionella collected from the environment, in this case the municipal water system.

“The gold standard is you have to do molecular typing; it’s like fingerprinting,” Swanson said. “It’s critical to collect those isolates (from the environment) to find the smoking gun.”

Top researchers on team

The Wayne State University research group, called the Flint Area Community Health and Environment Partnership, will include top researchers from Wayne State and other universities.

“Our No. 1 goal at this early stage of the study is to connect with the people of Flint and Genesee County and build strong partnerships that will benefit the entire community,” said Shawn McElmurry, a WSU environmental and civil engineering associate professor. “Our team has been in contact with Mayor (Karen) Weaver’s office and community organizations in Flint, and we look forward to working closely with these and other partners.”

McElmurry will lead the effort along with epidemiological investigator Dr. Paul Kilgore from Wayne State’s Eugene Applebaum College of Pharmacy and Health Sciences.

The first phase of the Wayne State project, which received $125,000 in funding, is set to begin this week.

Researchers will meet with the community to set up enhanced disease and environmental surveillance in Flint and Genesee County.

The phase also will include plotting out a timeline for the study and estimating costs, McElmurry said. Wayne State will then submit a proposal to the state for funding to implement the project.

“We fully expect the scope of our research to evolve as we get more input from the community and government in the coming months,” McElmurry said. “We have assembled a very talented group of researchers with different expertise and backgrounds so we can be nimble in our response to any change in direction the study may take.”

Experts increasingly believe aging water systems across America, like the one in Flint, are contributing to a dramatic increase in Legionnaires’ cases.

Mark Durno, the EPA’s supervising engineer who was in Flint on Tuesday, said the city’s many blighted homes and abandoned buildings have created “dead-ends” in the water system where microorganisms can thrive during warmer months.

“We’re not only concerned about the general water main, we’re also concerned about what is happening at residential dead-ends,” Durno said. “These residential dead-ends have a lot of standing water that can be susceptible to bacteria when it gets hot outside.”

Where the bacteria grows

Exposure to Legionella bacteria can come from hot tubs, large plumbing systems, air-conditioning units and fountains. But some experts, including Virginia Tech’s Marc Edwards, say municipal water system also can be suspect, especially in cities with aging infrastructure.

“Proactive water systems and building managers would be advised to have a plan to control Legionella, and in the future, it is likely that some form of testing will be required,” Edwards said. “However, such testing is not currently routine in Michigan or elsewhere in the U.S.”

The Environmental Protection Agency announced an $80,000 grant for Virginia Tech researchers to sample and test Flint’s water distribution system for the possible source of the bacteria.

A primary problem with the Flint system, EPA Administrator Gina McCarthy said Tuesday in Flint, “is that it has been disinvested for years, and it needs attention. You actually lose somewhere between 30 percent in excess to leaks in the system.”

The city didn’t receive needed corrosion control treatments during from April 2014 to October 2015. As a result, the city’s water pipes continue to shed particulate matter that provide nourishment for a world of tiny organisms.

Places where water can warm and become stagnant are perfect environments for deadly pathogens, according to Genesee County Environmental Health Supervisor Jim Henry.

“I’ve been informed by the experts, that when you look in the right places in any municipal water system, you’ll find Legionella, not just in Flint,” Henry said.