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FDA sends warning to American Cruise Lines after guests contract Legionnaires' disease

By Nathan Diller, USA TODAY,

2023-02-21

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The Food and Drug Administration said American Cruise Lines had not provided sufficient proof of changes to procedures after multiple guests were diagnosed with Legionnaires' disease, according to a warning letter to the line.

The agency found evidence of legionella bacteria, which causes the illness, in the potable water systems of the line's American Star and American Heritage vessels after inspecting them periodically between December 2021 and August 2022, according to the Jan. 24 letter. The agency addressed the letter to the line's executive vice president, Paul E. Taiclet.

American Cruise Lines had not provided adequate documentation of new measures and verification of their effectiveness, according to the FDA. Any failure on the cruise line's part to "adequately address this matter may result in legal action including, without limitation, seizure and injunction," the letter said.

The cruise line "immediately responded with the documentation requested," American Cruise Lines spokesperson Alexa Paolella told USA TODAY.

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"More importantly, American took the matter very seriously in 2021, and implemented new water management policies and equipment on its ships," Paolella said in an email. "We have had no further cases since 2021, nor any others in our company's history." The cruise line added that all potentially impacted guests were quickly notified.

A spokesperson for the FDA said in an email, "The FDA has received the firm’s response and will respond directly to the firm."

What did the FDA find on American Cruise Lines' vessels?

Three passengers who sailed with the line in 2021 were diagnosed with Legionnaires' disease. During the FDA's inspection, the agency found that the cruise line had failed to monitor potable water parameters and disinfection effectiveness on the vessels.

On American Star, the agency found legionella in showerhead pipes in both passenger and crew rooms, a potable water holding tank and elsewhere, a showerhead pipe in a passenger cabin, and a bathroom faucet aerator on American Heritage, according to the letter.

"Although we are not aware of a case of Legionnaires’ disease being associated with any (other vessels in your fleet), based on your practices on the American Star and American Heritage, we have concerns about the potable water on your other vessels," the FDA said. "Specifically, if adequate practices are not followed regarding potable water on those vessels, there is a potential for waterborne illnesses to occur."

What is Legionnaires' disease?

Legionnaires' disease is a "very serious type of pneumonia," according to the CDC. Common sources of infection include water in showers, hot tubs and cooling towers that are part of big air conditioning systems.

"In nature, Legionella live in fresh water and rarely cause illness," the CDC said in a fact sheet . "In man-made settings, Legionella can grow if water is not properly maintained." People typically get infected when they breathe in droplets containing the bacteria after it has gotten into the air. The disease does not usually spread from person to person.

Symptoms can include cough, shortness of breath, headache, and fever. The disease can be treated with antibiotics, and while most people diagnosed have to seek medical care in a hospital, they make a full recovery. Roughly 1 in 10 people with Legionnaires' disease die as a result, according to the CDC.

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"Most healthy people do not get Legionnaires’ disease after being exposed to Legionella," the agency said. "Being 50 years or older or having certain risk factors can increase your chances of getting sick." Those include smoking – or having been a smoker – having a weakened immune system and having chronic lung disease.

Other cruise passengers diagnosed with Legionnaires' disease

American Cruise Lines passengers are not the only ones who have come down with Legionnaires' disease following a sailing. Two guests on Norwegian Cruise Line's Norwegian Prima ship were diagnosed with the disease after traveling on the vessel late last year, the cruise line told USA TODAY.

"While it has not been confirmed if the exposure occurred on the ship or elsewhere, we are working closely with the Centers for Disease Control and Prevention (CDC) to investigate these cases, as well as mitigate any further incidents, and have notified the appropriate guests and crew directly per the CDC’s guidance," a spokesperson for the line said in an email. "We have elevated our sanitation procedures as part of our routine measures to ensure a safe environment on board and will continue to take any necessary measures to protect our guests and crew."

Nathan Diller is a travel reporter based in Tennessee. You can reach him at ndiller@usatoday.com

This article originally appeared on USA TODAY: FDA sends warning to American Cruise Lines after guests contract Legionnaires' disease

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