Another traveler on a New York cruise ship to Bermuda has been hospitalized with the symptoms of Legionnaires' disease, and the condition of two of the three of those with confirmed cases has worsened, New Jersey health and hospital officials said yesterday.
As word of the outbreak spread, hundreds of worried vacationers called New York and New Jersey health officials yesterday. The three confirmed victims, and five others hospitalized with symptoms of the potentially fatal disease, were all passengers on the Horizon, a ship operated by Celebrity Cruises that sailed to Bermuda on June 25 and returned to New York on July 2.
"People who've been on any boat larger than the family sailboat at any time in the last two years or who plan to go at any time in the next two years have been calling," said Steven J. Matthews, an associate commissioner of the New York City Department of Health. "We haven't heard from anyone who was on the battleship Missouri, but it's coming close to that."
But a spokesman for the Centers for Disease Control and Prevention in Atlanta, Bob Howard, said that source of the disease, a form of pneumonia transmitted by bacteria in airborne droplets of water, might not have anything to do with the boat that is the most obvious common denominator between the cases.
Common Thread Sought
Mr. Howard said that the source of contamination, which is often transmitted through air blowing across standing water, could have been on the boat, in Bermuda -- or even back home in New Jersey.
All three of the confirmed cases, as well as a fourth who may have the disease, are from Toms River, N.J., part of Dover Township, which has a population of 80,000. And the other four who have been hospitalized are also from New Jersey, health officials said.
"That's absolutely something we're looking at," Mr. Howard said of the New Jersey connection. "We're looking for the common thread, areas people may have been, any common experience that would link these people together."
He said that past investigations of Legionnaires' disease had taught investigators that the most obvious link was not always the source of contamination. For example, he cited a Louisiana outbreak in which all of those who contracted Legionnaires' disease worked together. Initially, everyone assumed that the work site was the problem, Mr. Howard said, but the contamination was eventually traced to a hose used to spray vegetables at a grocery store where all the victims had shopped.
In a brief written statement, Al Wallack, senior vice president of passenger services for Celebrity Cruises, emphasized that the cause of the outbreak had not yet been pinpointed and promised to cooperate fully with the Centers for Disease Control and Prevention.
Conditions of Two Worsen
Two investigators are still on board the Horizon, which sailed from New York on Saturday and arrived in Bermuda yesterday. And dozens of other investigators are working on the case, "doing shoe-leather epidemiology," Mr. Howard said, conducting lengthy interviews with the sick, their doctors and nurses, with others on the boat and with anyone who may have come in contact with them within the incubation period of 2 to 10 days.
He said the investigation could take several weeks.
Whatever the source of the contamination, health officials stressed that the vast majority of those who are exposed to the bacteria causing Legionnaires' disease never become ill. The most vulnerable are the elderly or those whose immune systems are already compromised. The disease is usually treated with the widely prescribed and low-cost antibiotic erythromycin.
Legionnaires' disease was first identified and named when 221 people fell ill and 34 later died after an American Legion convention in 1976.
At Community Medical Center in Toms River, the condition of a 64-year-old man who is one of those suffering from Legionnaires' disease went from serious to critical yesterday, and he remained on a ventilator. The condition of a second victim, a 67-year-old man, worsened from stable to serious, said a hospital spokeswoman, Deborah Hoyt.
A third man with the disease, who is 43, was treated with antibiotics and released on Friday. Results of blood tests that will show whether a fourth person at the hospital has Legionnaires' disease are expected today.
'Will There Be More?'
Blood tests are also pending on two other passengers hospitalized in Belleville, N.J., and one in West Hudson. The latest person to be hospitalized with symptoms was a woman admitted to Passaic General Hospital on Sunday.
Ms. Hoyt said that doctors at the Toms River hospital correctly guessed that the three, all of whom walked into the emergency room with the symptoms of an upper respiratory tract infection, had Legionnaires' disease. Ms. Hoyt said the doctors believed that the cruise ship was the source of the contamination.
"They're not related and didn't even know each other before the trip," she added.
The disease has been fatal in 5 percent to 15 percent of known cases and can be diagnosed only with a blood test, health officials said.
"Will there be more? I would think so, but who knows?" said Bernard Edelman, a spokesman for the New Jersey Department of Health. "Whether it's something on board the ship, in a port of call or here in New Jersey, I don't know. That's what the C.D.C. is looking into."
