An Invisible Killer stalks a summer Resort Panic sweeps the island of Martha's Vineyard as residents and tourists succumb to the symptoms of a lethal bacteria its victims once active and healthy are left Delirious struggling to breathe as the illness spreads medical investigators race to find its source before it threatens more lives [Music] [Music] some of the names in this program have been changed Martha's Vineyard just over an hour from Boston is one of the most popular vacation spots in America the summer home of artists politicians and actors each June nearly 100,000 tourists flock to the island but in the summer of 2000 another visitor arrived an unseen enemy stalking the streets of the island June 18th 2000 40-year-old Patrick ryer was working at a construction site on the western side of the island a landscaper by trade he was digging holes to plant [Music] trees normally Patrick enjoyed his physically demanding job but this morning he began to feel lethargic run down to Patrick it felt like a case of the flu he decided to take the rest of the day off by that evening he was too weak to even answer the phone his girlfriend tried to reach him when he didn't answer she became concerned and drove to his house paulist strople knew Patrick had been feeling ill for several days but he looked even worse than she [Music] expected Patrick was pale shaking with fever sweating uncontrollably and I said please let me take your temperature you know when you touched his skin he was getting warmer and warmer he was just burning up with fever the Mercury had shot up so high Paula thought the thermometer must be [Music] broken she tried again Patrick's temperature was 106° PA needed to get Patrick to the hospital right away she knew it would be faster if she took him herself and it was hard dragging him to the car because he was like dead weight you know he was not resistant but he was just heavy I was afraid he was going to pass out or something on the way to the hospital Patrick started to become incoherent the fever was affecting his brain he seemed to be getting progressively worse he was talking under his breath and I didn't understand what he was even saying half the time by the time they reached Martha's Vineyard Hospital Patrick wasn't even able to speak he got really quiet and that scared me even [Music] more he was taken into an examination room where a nurse took his Vital sign his temperature was still 105.9 [Music] de the ER staff rushed him to intensive care fluids were administered to bring down his fever if they didn't work fast the fever could cause seizures brain damage even organ failure listening to Patrick's chest the doctor heard sounds that suggested he might be suffering from pneumonia inflamed lung tissue confirmed the diagnosis Patrick had pneumonia but doctors didn't know exactly what had caused the disease [Music] in the hospital lab technicians analyzed Patrick's blood and urine samples looking for Clues a high white blood cell count indicated the body was fighting off a possible bacterial infection but the small Island Hospital didn't have the facilities to test the samples further they would have to be sent to the Massachusetts state lab the results would take several days doctors tried to treat Patrick as best they could starting him on intravenous antibiotics that would attack many kinds of bacteria but it would take 24 to 48 hours for the medication to take [Music] effect it was amazing how how weak he was is how there there wasn't much left of him he was just laying there and I I I cried I was just beside myself I really didn't think he was going to survive the whole evening that night the ER physician alerted the hospital's infectious disease specialist Dr Dennis Hulk pneumonia in the summer in an otherwise healthy person who's a strong unhealthy worker is just is a little more unusual and you have to think of different things that might be happening what's happening in the community doctors question Paula about his medical history I think when Dr hul learned that Patrick was a landscaper working outside he began to suspect that the source of his infection might be an insect [Music] bite Martha's Vineyard has this unusual collection of tick born diseases Taria babesiosis ER liosis Rocky Mountain spotted fever and lime disease and the local Physicians knowing that we've got this collection of diseases really have to think about it in any fever that comes through in the summer Dr Hulk believed Patrick was suffering from a tick born illness but he had to wait for lab results and his patient wasn't getting any better on the other side of the island another Resident had contracted a mysterious summer illness this time the victim was a child 13-year-old Chris Baker had been looking forward to spending the day at the beach with his friends instead dead he had a fever and was too weak to move there his mother Mary was becoming concerned she and her husband decided to take Chris to the hospital the Bakers lived at the Eastern tip of Martha's Vineyard the hospital was almost half an hour away [Music] Chris started to cough his condition was deteriorating with each passing minute his parents were scared but there was nothing they could do for their boy until they reached a doctor at Martha's Vineyard Hospital Emergency Room Physicians examined the teenager Chris was running a low grade fever it was hard to figure out what was going on it seemed like the flu but the Bakers had never seen him so sick the doctor couldn't find anything that would explain his illness he inspected Chris for insect bites or other Telltale markings but couldn't find [Music] any he drew samples of blood for analysis and ordered a series of chest x-rays the results Chris's lungs were inflamed like Patrick ryer he was suffering from pneumonia two cases in the summer within a week of each other was [Music] unusual especially at a small island Hospital thank you so much thank you the ER physician contacted infectious disease specialist Dr Dennis hul the doctor asked Chris if he had suffered an insect bite recently his parents couldn't recall any until the lab results came back the exact cause of this illness remained a mystery all the doctor could do was prescribe multiple antibiotics Dr Hulk was troubled by the sudden increase in summer pneumonia cases he started reviewing the literature on infectious diseases searching for Clues the two cases were so similar it reinforced his theory of a tick born illness Martha's Vineyard is home to all sorts of ticks they thrive in the warm summer months hidden away in the High Island grasses and they can carry a whole list of diseases Dr Sam tford has monitored tickborne diseases on Martha's Vineyard for nearly a decade for the Harvard School of Public Health tford tracks the creatures across the island Island trying to gauge their impact we study the patterns of tick abundance how many ticks are there each month how many cases do we see each month of any of the tickborne diseases now Dr tford would need to go back over his findings for the summer and so the idea is that by looking at ticks can we find out some pattern that'll allow us to predict whether a year will be bad or tick transmitted disease or relatively few cases will be around so far he hadn't noted anything unusual but with this mysterious disease on the island his search would intensify a brownish patch on the bottom here at the hospital Dr hul pursued the investigation further Patrick ryer wasn't out of the woods yet but he was at least is coherent enough to answer a few questions Dr hul asked Patrick about any animal contact a frequent source of ticks and infections still weak and dazed Patrick couldn't remember anything unusual Hulk decided to check if other cases with similar symptoms had come in earlier that summer he went back through Hospital files and found yet another pneumonia patient John Franklin a man in his late 40s had contracted pneumonia just 2 weeks earlier that made a third suspicious case in Boston at the Massachusetts Department of Public Health technicians tested the blood samples from the three patients what they were looking for was a Telltale clue the antibodies the body builds up to fight off bacteria it has been exposed to when a reagent is added to the samples a color change indicates the presence of an antibody evidence of an [Music] infection viewed under a microscope a positive sample will glow green all three patients blood were testing positive for Tulia an unusual bacterial infection that is both rare and deadly there are many ways you can get the disease bites from infected ticks can cause skin ulcers but if it is inhaled it can lead to life-threatening pneumonia Taria most commonly infects small mammals it's widespread among rabbits and rodents even cats and dogs but it doesn't always kill them many people refer to it as rabbit fever because the rabbit is a mammal that happens to carry it often but it's not the only mammal that does there are probably hundreds of different kinds of mammals that can carry Taria and these are animals won't always get sick and so they're what we call a reservoir they allow the bacteria to grow and reproduce and then it gets from them to people in a variety of different ways because it takes such a small amount of the bacteria to cause infection Tulia is on the government's list of possible biological weapons Dr matios and the Massachusetts Department of Public Health were concerned 200 cases of Taria occur in the United States each year only 20 of those are the dangerous pneumonic forming up here because now Martha's Vineyard had experienced three in less than a month at least there's a better chance it was more necessary than usual to make sure that we knew what we were dealing with and the reason for that is that pneumonic cmia is uh it's a dangerous disease to have health officials worried that news of a possible outbreak might create widespread fear they didn't want to start a panic especially in tourist season we really worked very hard to keep people comfortable and not afraid um we are a vacation community and we we do exist on a lot of the dollars that come through in the summertime a lot of us do a lot of people on the island do and you would hate to see people not come here because of this kind of a panic at the end of June as fairies continued to bring in thousands of tourists Martha's Vineyard was entering the height of the summer season but somewhere on the island a deadly bacteria was spreading by the end of June 2000 three residents of Martha's Vineyard had contracted a mysterious form of pneumonia for a resort tent dependent on tourism it was an alarming development especially given the cause a dangerous disease known as Taria State Health officials didn't know who or where it would strike next they contacted the Centers for Disease Control and prevention [Music] when she first heard of the situation on the island the cdc's Dr Katherine Feldman was alarmed the organism that causes Taria is considered a category a uh biot terrorist agent category a means high priority and it gets that classification because um it's potentially easy to disseminate it it has a high mortality if untreated um it can cause up to 60% um mortality in folks who who acquire infection and it has the potential to cause um Widespread Panic in this case we certainly had to consider whether this was a biot terrorist event one of the most infectious bacteria known to man and almost always deadly if not treated Taria has the makings of a classic biot terrorist agent investigators from the CDC responded immediately meeting with officials from the Massachusetts Department of Public Health agents reviewed the patients information trying to figure out how the cases had Arisen there were a number of clues in this investigation that made us lean towards this being a naturally occurring outbreak the outbreak on Martha's Vineyard was not clustered in time or space what you might think with the bioterrorist event is that there would be one release of the agent say at a concert or at a public forum or something in this case um all the all of the patients in July um were spread out over time they didn't come to the hospital in one or two days they they really occurred throughout the whole month of July in addition they um lived all over the island the evidence pointed away from a premeditated attack but investigators were no closer to finding the source of the bacteria all they knew was that it did not spread person to person take it back the way they live other diseases that are similar such as plague if somebody gets the pneumonia form of plague they can transmit it to another person by coughing in in the case of Taria that's never been documented people will get the pneumonia form they may be coughing and yet there's been no evidence that you can transmit tmia from person to person then only days after their arrival in Massachusetts they learned of another confirmed case this is Dr Feldman only this time the patient was miles away from Martha's Vineyard in a Boston Hospital officials wondered how the disease apparently not transmitted from person to person had made the jump to the mainland agents interviewed 58-year-old Neil Kravitz they asked if he had recently visited Martha's Vineyard they learned he he owned a cottage on the island and often spent weekends there a few days prior to his illness he had been at the cottage mowing his lawn and playing golf thank you for time with four confirmed cases of a highly infectious disease Health officials knew they had an outbreak on their hands they feared the disease was spreading through the air or insect bites or some totally different way The Hunt For answers was on CDC investigators met with the medical staff at the Martha's Vineyard hospital we wanted to learn what the Physicians Impressions were when they first um saw the patients and then as they worked them up and diagnosed holia their first step was to determine the scope of the problem they needed to know whether any pre previous cases of Taria had gone unnoticed or misdiagnosed we reviewed maybe around 40 charts at that time and found that none of them fit the criteria for taramia so we really do not believe that there were any cases before those initial cases besides the patients symptoms and their time Outdoors there were few similarities investigators went back to find the first confirmed case of Taria [Music] John Franklin had contracted pneumonia 2 weeks before Patrick ryer agents wanted to pinpoint the location where he could have gotten the disease the very first patient reported running over a rabbit with a brush cutter so we had an obvious exposure for him rabbits are clearly associated with tmia and he had a rabbit exposure the other patients had begun their slow recovery l sound good sounds great 13-year-old Chris Baker was lucky he had recovered without complications after nearly a week Patrick ryer was released from the hospital investigators hoped he would help them pinpoint the source and we started thinking about the environment we started um thinking about where the patients lived where the patients worked to get a sense of whether This was um isolated to one part of the island whether it was clustered in one part of the island Patrick didn't know where he could have picked up the disease all he could tell them was that around the time he became ill he was working at a construction site on the west coast of the island he couldn't remember coming in contact with any dead animals any ticks or anything else suspicious the invent investigators still hadn't ruled out ticks as a possible Source they hunted for samples of the insects at the home of the young boy who had contracted the disease they also talked to the baker family the boy did not know any of the other victims and none of their activities overlapped with their tick and soil samples in hand investigators turned to Dr Sam telford's research for answers the CDC tends to come in when there's a public health emergency when we're invited in by the state to help respond to something and so Dr telr has the advantage of being able to go back over time he has collections of ticks or of isolates from tick by extracting blood from ticks and small mammals on the island who can carry the bacteria tford tries to isolate any tick born diseases in his research earlier that summer he hadn't found anything unusual except an increase in the number of tick species that carry the disease the Martha's Vineyard outbreak has been such a mystery we need to make sure of what we're seeing so we need to take our time in in doing our testing and if we're confident in our results then when we're trying to piece together the puzzle as to how people have gotten infected we can rely on on what we're trying to conclude and make some recommendations as to what can we do about it but so far he had no explanations of how and where people were coming down with pneumonic Taria and he Health officials needed more information infection control nurse Donna Styles Enos asked doctors to keep her informed of any patients exhibiting symptoms of Taria anyway we just really had heightened aware Ness as to what was going on and um we really started to screen very carefully all of the patients that would come to the emergency room that did have anything that could be a flu type illness that could possibly be a tickborne illness with doctors and investigators on the lookout for new patients and new Clues the month of July came to a close and as it did more tourists continued to pour on to the island each of them unaware of the potential danger in the summer of 2000 a rare disease began striking residents on Martha's Vineyard four cases of pneumonic Tulia had been confirmed on the tiny Island the source of the the outbreak remained a mystery then on August 25th 2 months after the first cases appeared the outbreak took a terrifying turn Douglas Carter a 43-year-old house painter and landscaper staggered into the ER with a high fever he had been sick for over a week and thought he had the flu in the ER he went into respiratory distress soon he could no longer breathe on his own the staff intubated him inserting a tube into his windpipe so a respirator could pump air to his lungs the emergency room physician gave me a call and said do you think this might be Tulia pneumonia how should we Pro proceed with in terms of antibiotics the chest x-ray showed that the patient's lungs were inflamed Carter had clearly contracted pneumonia because of the high number of Taria cases doctors decided to treat him for the disease within several hours however uh this patient uh clinical situation deteriorated very rapidly and the pneumonia was uh rapidly progressing the infection had a head start and the antibiotics couldn't stop it his grave condition required a greater degree of care than the tiny local hospital could give him we are a very small rural hospital and although we do a pretty good job with what we do anytime someone needs higher technology or uh critical care we ship them out quick racing against the clock emergency technicians airlifted Carter to the mainland 20 minutes away by [Music] helicopter at a Boston Hospital the high fever and pneumonia continued to ravage Carter's body [Music] and then without warning his organ systems began to fail one after another the medical staff tried desperately to save him but the bacteria had done too much damage Douglas Carter died the first casualty of the outbreak um any fatality will make you think twice then about what's going on and be more observant about your own health and what the factors are that may have led up to that the medical examiner performed an autopsy on the deceased patient because the deadly bacteria might still be alive in Carter's tissue The Examiner had to wear protective clothing he sent samp of the lung tissue to the CDC laboratory there technicians cultured the samples and confirmed the disease that killed Douglas Carter was [Music] Taria for Martha's Vineyard it was a nightmare in the making it was the Saturday before Labor Day weekend one of the busiest holiday days of the year news of the outbreak would have a disastrous impact on the [Music] community but Health officials had no choice now they had to warn the public stories of the rare disease and Carter's death made news in the Boston papers the community became very concerned and uh wanted more information wanted to know how we could possibly prevent this for the teams of Health officials on the island and Agents from the Centers for Disease Control the search now took on an extra Edge they decided to do a case control study Distributing questionnaires to the patients who contracted Taria they had discovered a promising clue okay the only commonality was that they most of these individuals worked in landscaping they went to talk to local landscapers looking for answers the team tried to narrow down precisely what about the occupation could have allowed the patients to contract the disease we really don't know uh whether these people all acquired it by inhalation after landscaping or whether they were bitten by something and just didn't notice a bite and then it spread secondarily and I think that's the the issue here investigators didn't know what had caused the disease but almost everyone who got it had mowed their lawns before becoming ill Public Health officials issued an alert the folks on the island were very concerned and we had the public advisers posted on kiosks and everywhere we could think of so that really everybody was doing their part to try to get the word out residents were cautioned that if they were going to mow their lawns they should be careful to wear masks while mowing to wear insect repellent at all times and not to handle dead animals but they still weren't sure exactly where the disease was coming from unlike the situation where you you know CDC or or a state health department or a local Health Department can track something down to the food item on a shelf and then pull them all and everybody's okay there was nothing like that here you know there were there were people who had been all over the island and there had been no one place that they shared and and there was no smoking gun that allowed us to say Yep this is where they were exposed investigators had several theories first they wondered if something unusual could be happening in the domestic animal populations we contacted veterinarians and we asked about cats cats can get a severe illness associated with Tulia so if we asked if they'd um seen cats that came in with some sort of fever and um feeling lethargic and whether they thought there was an increased number of these kinds of animals compared to previous years the veterinarians reported that they'd seen nothing out of the ordinary next investigators talked to researchers looking at at wild animal populations across the island we asked whether they were seeing um more sick animals than they'd seen in previous years or whether they thought the rabbit population had gone up or gone down or whether they thought um there was one particular species of wildlife whose population had gone up or gone down we were just trying to look for for changes from previous years we weren't sure exactly what we were looking for but we were looking for something different while investigators looked for any sign of something different on the island more people were getting sick by the end of August 2000 2 months after the outbreak began Health officials were still no closer to finding a conclusive source of the Taria [Music] outbreak as tourists left the island each day doctors were becoming concerned that if they were infected they might not receive the right treatment for this deadly disease when they returned home I'm sure there are many visitors who come to the island get a tick bite and then they go back to Ohio or New Jersey or Iowa or somewhere where the Physicians there may not think about the particular diseases we've got here investigators were worried that an infected pet or rodent could have carried the disease on on a ferry back to the mainland if this mysterious outbreak began to spread across the country the effects could be [Music] devastating at a Boston Hospital 43-year-old Douglas Carter had lost his battle with Taria a rare illness spread by a highly infectious bacteria doctors had done everything they could to save him but the disease was just too aggressive Carter was one of eight other residents who had contracted Taria on Martha's Vineyard most of the infected patients had worked in landscaping and had mowed lawns before becoming sick as public health officials tracked the source of the outbreak their research pointed them in One Direction our patients lived all over the island there were no clues gained by where the patients lived lived however when we looked at where they had actually used a lawnmower it seemed that most of the cases um were associated with the southern part of the island this area of the island is less developed making it a Haven for wildlife including ticks CDC agents decided it was time to conduct an environmental investigation the cases have been presenting as pneumonia and so the idea is that people who are working in the the soil who are Landscaping are breathing in the organism somehow and getting infected that way how it gets in the soil we don't know suited up against the danger they visited possible exposure sites trying to recreate the patient's lawn mowing activities they had a radical new theory that it was the lawn mowing itself that was creating the danger in this case we believe that lawn mowing uh over over the grass in which the the bacterium is sitting we believe that that was enough to aerosolize the bacterium and let people inhale it the investigators collected samples of the grass and clippings for analysis but in the lab as the samples were cultured for Taria the results were disappointing unfortunately our lawnmowing samples were all negative again we tried to grow the bacterium out of those samples and they were negative the epidemiologist decided they had to turn their attention back to the mammals to determine which species might be carrying the bacteria but it wouldn't be easy to capture a wild animal that's infected catching a sick animal is um tough because if they're really sick they're not interested in food anymore and they're not going to come to your trap traps were set in rural areas of the island where they believed the patients had come in contact with the disease they did manage to catch several small mammals including a rabbit mice skunks and rats the rat population uh in particular seems to have increased in recent years on Martha's Vineyard and we we initially pointed our fingers at rats because rats are one of the few animals that don't die of Tulia and therefore are good candidates for reservoirs they can keep the organism the bacteria going uh from year to year the investigators plucked ticks off the captured animals and took blood samples from all of them they needed to determine if these mammals were carrying the disease lab test detected Taria in two of them a skunk and a rat really all that indicates is that they also were exposed to tmia which is interesting because each of those animals was from a property where we believed a patient had been exposed so that's further evidence that that Taria was on those properties now for the first time they had at least a partial idea of where the disease was coming from determined to capitalize on their Discovery the CDC team packed up their specimens and their samples with Summer drawing to a close they headed back to the labs but just when they thought it was safe to leave the island the bacteria struck again again the summer season was done but the disease wasn't and then all of a sudden a bunch of cases started coming in and we contined to have cases in September and even one in October by the time all was said and done there had been 15 cases of Taria reported from the island 11 of which were pneumonic cases and as winter hit New England the cases stopped what officials didn't know was the disease hadn't disappeared it had merely gone into hibernation and outbreak of Taria on Martha's Vineyard had claimed one life and infected more than a dozen other people Health officials and scientists had few conclusive answers to why the disease had appeared on the island some speculated people became infected inhaling particles of dust soil or grass contaminated with the bacteria while mowing lawns others felt that an infected rat and skunk they had discovered meant that animals were in some way passing the disease but there was no clear answer and as the next summer approached doctors at Martha's Vineyard Hospital braced themselves in the year 2001 the advisories were updated in anticip ipation of perhaps the same kind of cluster of cases happening it happened sooner than they anticipated in May 2001 Tammy and Frank Daly brought their 4-year-old son Jonathan to a children's hospital in Boston the boy was feverish and suffered a variety of symptoms including headache an ear infection swollen glands and an ulceration on his neck's the parents told doctors they had discovered an engorged tick at the sight of the [Music] wound that was 9 days earlier on a family vacation on Martha's Vineyard they pulled out The Tick but the bite grew infected well going to do the doctor's diagnosis came fast to Loria you think that's a good idea the boy had contracted it from a tick but no signs of the deadly pneumonia the summer season had not yet arrived and already Taria had reemerged on Martha's Vineyard we don't know much about how the bacteria that causes Taria goes from year to year anywhere uh and uh it's especially important for the Martha Vineyard outbreak because we don't even know how the people are getting infected as invest investigators searched for answers another case turned up in June of 2001 landscaper Daniel Marsh arrived at an emergency room in a Boston hospital he and his wife lived outside of the city but every Friday the landscaper cut lawns on the vineyard he thought he had the flu but his wife grew more concerned when his temperature climbed past 100° we have Marsha's lungs were inflamed an infectious disease specialist diagnosed pneumonia Daniel Marsh had Taria the patient was put on high doses of antibiotics to help him fight off the infection looks like but as the illness raced through his body the high fever left him delirious Marsh was dangling on the [Music] edge Health officials feared that Martha's Vineyard was once more in the grip of a Taria outbreak just in time for the tourist season the CDC hurried to the island eager to pursue their Landscaping Theory from the previous summer 3/4 of the cases that we've seen in recent Rec L have been in landscapers and therefore we need to see whether the Landscaping population in general is at more risk than the rest of the population this time investigators needed to get more definitive proof setting up a table outside a lawnmower repair shop they obtained blood samples from patrons the evidence was conclusive the epidemiological stud I that have been done by the CDC and our group show that landscapers are maybe at six times greater risk than the general population for getting Taria Daniel Marsh began to recover from the disease that turned out to be pneumonic Taria because of his case and others the CDC put out a new alert for Physicians warning them to be extra vigilant for any person Contracting pneumonia with a history of lawn mowing or brush cutting get better soon the investigators had defined a brand new way of catching the lethal disease it had never been documented before that um people could get toia from mowing their lawns so we were able to identify something new that was going on some some new way of getting um Taria unfortunately we haven't been able to figure out everything landscaper Patrick ryer took months to recover from his near fatal bout he had barely survived the disease for a while everyday life was a struggle the disease affected me for about 2 months after I got out of the hospital I could do something for about a half an hour and had to go lay down or sit down I really didn't have much strength to do anything Patrick finally did recover and on August 3rd 2002 he and Paul were married to this day he is grateful for her quick thinking and for his life it really shocked me that somebody could have died from this um who didn't seek medical attention and I'm really grateful that I did grateful to my girlfriend that she you know took the time to to take my temperature and give me to the doctors cuz I if I was alone I probably wouldn't have and on the fourth day or the fifth day I probably would have been dead you know it's that serious today Dr tford continues taking tick samples on Martha's Vineyard while he and the CDC had several breakthroughs their work on how the disease is transmitted is only beginning wonderful as it looks um we know that tuler is transmitted by tick we found it in tick we found it in animal uh material from The Vineyard but we haven't found it in soil we haven't found it in lawnmower clipping things that people would have inhaled during the course of their activities so it's been a real mystery to us as to how people are actually getting T investigators continue their tireless search to locate the source of the bacteria in the Summers that have followed the first outbreaks a half dozen cases of pneumonic Taria have been reported on the island troubling but not nearly as bad as many had feared but the mystery remains and the investigators are still looking for Clues answers that like the disease lie dormant in the soil just waiting to emerge an island in Hawaii is invaded by a terrifying virus entire communities are infected and the disease is on the move it is spread by mosquitoes that feed on human blood there is no vaccine and no cure No One Is Safe from the potentially deadly threat now Health officials must eradicate The Source before the virus threatens the entire Island [Music] Maui is one of the most popular tourist destinations in America each year over 2 million people from all over the world visit the island to enjoy Luxury Resorts and unspoiled [Music] beaches but tourists only experience a small part of the Island's Beauty over 700 square miles of Maui is covered with Untamed jungle there the warm temperatures and frequent rain have created a Tropical Paradise it is also the perfect breeding ground for a deadly disease in September 2001 Maui Health officials responded to an emergency call doctors on the remote Eastern side of the island had reported several cases of a bizarre illness I think this is a little bit further up here any idea where we are on the map yeah I I think we're right here just Dr Lauren Pang heads Maui's District Health office he and Chris Mills an epidemiology Specialist made the 2 and 1/2 hour drive from their office to the isolated Village of niku it's right down here lower niku the doctors who first treated the sick patients had never seen these symptoms before they could not make a [Music] diagnosis got this but as epidemiologists Pang and Mills are trained to investigate mysterious infectious diseases you sure this is the place right yeah I think so if this disease was spreading they needed to get a firsthand look at the patients and their symptoms hi Debbie oh hi hi I'm Debbie Stoner first contacted Public Health officials when her entire family became ill my husband's not feeling well no Bruce people from the health department are here Mr Stoner now her husband and daughter were sick and Debbie was worried what do you have today fever headache somehow those words don't describe how I feel Bruce Stoner was suffering from blinding headaches extreme muscle pain and exhaustion his fever had spiked to 104° my daughter's upstairs okay she's feel Mills went to check on the stoner's daughter while Dr Pang examined Bruce get sick a lot never get sick so this is something unusual for you huh mahina hi mahina I'm Chris I'm with the health department how you feeling I'm not feeling very good no you don't look like you're feeling too well let me just um 16-year-old mahino was so weak she could barely move like her father she was experiencing extreme headaches joint pain and fever Mills took a medical history and a blood sample maybe the lab could figure out what was making mahina's family so sick feel better talk to you in a few days for my whole family to come down with it was very scary because uh it was a strange illness and and I was the first one to be sick for 6 days I was in bed for 6 days okay you right handed yes okay so head now mahina and Bruce were also sick the health officials also took blood samples from the entire family knees elbows ankles mostly my ears your ears as Mills examined Debbie she found an alarming symptom hey Lauren yeah get a second can you come over and look at this press this for about a minute yeah look at Debbie's rash oh I need some lighter Debbie's arms were covered with a strange rash I looked like I'd been boiled and it was so itchy I could hardly stand it I came on at night and it felt like pins and needles when I first got it like your hands had been asleep and they were waking up and then it just got so itchy and there was nothing I could do to stop the itching yeah and it's a little spotty you see that nothing on the face though you no the rash was worrisome but what Debbie told Pang next alarmed him well I'd heard rumors of people being sick in the neighborhood from my neighbor and uh she told me she goes Debbie I've been so sick she disappeared for two weeks and I hadn't seen her and she told me Debbie I've been so sick it was the strangest thing MH Mills and Pang did not yet know know what they were dealing with but they knew it could be infectious gy the stoner's neighbor lived less than a mile away can you uh just have a seat there I'll draw your blood first and then we'll talk a little bit later she had gotten sick 2 weeks ago okay can you put your arm up up here she still felt weak and tired we interviewed her and gathered as much information about her illness her recent if she had any recent travel where she could have also gotten sick and we did draw her blood G's symptoms were identical to the Stoners did you have a lot of contact with the Stoners stay overnight meals together anything like that but she had not come in contact with them for over a month okay hang on to that okay okay so you have the fever just like them anybody else sick in the hiku that you know of ah yes really like you sick like you not the flu yeah same thing the pattern was ominous Pang and Mills feared they were seeing the beginning of an outbreak for about a minute by the end of the day they had seen four cases of the mysterious illness okay I tell you what let's just they agreed no single symptom pointed to a specific disease wor about that they all got the same thing yeah they all have fever at least at least 102 sometimes higher headache Debbie had the rash for 4 days mahina just started but the combination of symptoms worried Dr Pang the fever when it's associated with a rash when you don't know what it is you worry okay cuz it could be lots of things which could be lethal following protocol Dr Pang sent his detailed case notes to the State Department of Health in Honolulu on the island of aahu Michelle nikada received the information as an epidemiology specialist for the state it is her job to monitor disease outbreaks on the seven main Hawaiian Islands it seems like uh other members of the family are also ill and N reviewed the case notes with State Health director Dr Bruce Anderson hey Paul come on over here for a second let me know what you think she also consulted Dr Paul kitsutani an expert in infectious diseases as they brief kitsutani Chris Mills called from Maui it looks like this guy hi Chris did you get a chance to look at that fact we just sent you yes I just got it I'm just taking a look at it right now Great Mills had assembled the small staff from the Maui Health office they were anxious to hear n's opinion on the cases what are your thoughts on what we should rule out have you looked at mles and rebella or even the flu simple flu well we haven't but that would be easy to do let spirosis this is also a possibility and I and I hate to say it but I think we really need to rule out Den too oh okay I think you should be very alarmed o that's a biggie um Nika was worried about Deni fever the Maui team was surprised okay if there's anything that we can do to help you uh give me a call again let me know I most definitely will thanks thanks Den fever Deni is a human disease that is carried by the 80s of time mosquito but in the 1950s this species had been eradicated from the island a Deni outbreak seemed impossible and Unthinkable historically Deni outbreaks are massive and Unstoppable thousands can die when the disease strikes Deni fever is caused by a virus that attacks the body's immune system there is no vaccine and there is no cure it is often referred to as break bone fever because patients experience pain similar to their bones being broken brucea quindy suffered with the disease I'd say this would be easily 100 times worse than than your worst headache you've ever can imagine you know um right behind the eyes your head's pounding you feel like your eyes are going to pop out of your head a a week after becoming infected patients break out in a painful rash a condition caused by veins bleeding under the skin after two more weeks the symptoms disappear if Deni spreads unchecked victims with a repeat infection can develop Deni hemorrhagic fever with this patients bleed internally and from the eyes nose and mouth the disease can be fatal [Music] if Deni fever had invaded Maui nikata had to determine the extent of the outbreak she sent a medical alert to hospitals and healthc Care officials Statewide she advised them to watch out for patients with rashes headaches joint pain and high fever the main reason that we asked them to do this was to get prompt notification of new cases at the Maui District Health Department the small lab wasn't equipped to test blood for Deni a technician prepared blood samples collected in the remote Village of niku for shipment hi Dr P they would send them to a specialized Lab at the Centers for Disease Control and prevention in Puerto Rico tragedy struck in New York City this morning two planes crashed into the World Trade Center towers a third plane hit the Pentagon in Washington DC we will keep you updated terrorists had struck on September 11th for the first time in history air traffic was shut down all over the country all departing flights are suspended indefinitely uh passengers should either stay home if they're local residents or if they're tourists they should not check out of their hotel Maui was cut off isolated it affected Us in the sense that we couldn't send out samples to be tested for dangi fever but so it was very challenging pack it up hold our sample hold it for CDC they were dealing with a potentially deadly outbreak another and they had to face it on their own without lab tests Mills and Pang went back to nahiku to examine more of the residence you Bruce first they checked on the Stoners Bruce was starting to feel better but their daughter mahina was still weak is any of this tender her fever had subsided but she achd all over okay okay just fever all right I'll tell you what there was little her family could do but give her fluids and some medication for the pain I'll come back at the Town Pavilion Chris Mills questioned more of the residents who was that she believed she might be looking at as many as 20 new cases it was more than the small staff could handle Maui had an epidemic on its hands when the possibility of dangi fever came to Maui it really over overwhelmed our office so we really needed a lot of help Mills asked the state health Department to send her more manpower to deal with the epidemic while flights outside of Hawaii were grounded flights between the islands were still running Dr Paul kitsutani and a team of epidemiologists arrived from Honolulu they needed to examine every suspected case and quickly an outbreak was Unthinkable if the virus was Deni fever nobody knew where it came from or where it would strike [Music] next with a suspected Deni fever epidemic on the island of Maui Public Health officials were perplexed and overwhelmed they asked for help from the State Health Department a team of epidemiologists arrived on the island as they made their way into the Hot Zone Maui Health official Chris Mills briefed the epidemiologists we went out and did a community meeting yesterday in Laur niku but like I said we set up the town meeting so fast there could be a lot more in the community than even those 20 there's about 150 to 200 people in the community so that's the number we the population of Nika was Tiny and it was in a remote location far away from the more populated areas in such a small community officials hoped they could locate the source of the disease and stop it before it spread arriving in niku they set up a temporary medical station worried residents were already waiting [Music] The District Health Team needed to get a better idea of the number of people who had been sick most residents were past the debilitating stage of the [Music] illness tasted metallic but they had all suffered from fever muscle aches and a persistent painful rash volunteers from the local Clinic took case histories and drew blood samples are you okay with needles no okay you can just don't look okay just a little stick okay okay good hold it okay we're all done within a few hours they documented over a dozen suspected cases Mills entered the patients information into a database all the symptoms continued to point To Deni fever in Hawaii it is not unusual to see isolated cases of the disease great thanks L but the victims are always Travelers who caught the virus in another country other tropical areas such as Tahiti Samoa the Philippines uh were all experiencing increased rates of danging from the interview so far no one had traveled outside of Maui they headed to the town church to meet with residents for now the outbreak was isolated to the small town of niku Dr Pang explained that their blood could not be shipped out for testing the 911 terrorist attack had halted all air traffic without laboratory analysis they could not confirm Den fever still Pang recommended a massive spraying campaign to protect the residents from the virus with Stakes this high they couldn't afford to wait for lab results think we should start spraying pesticides around any pesticides no DDT anything sprayed on Myer we're not going to spray DDT we have something else to spray which is quite safe but residents knew mosquitoes were everywhere how are you going to get rid of all these mosquitoes anyway we're not getting rid of them all just the rounds ones around your house the response was overwhelmingly negative the residents of niku live simply and close to Nature they did not want pesticides to pollute their Tropical Paradise Pang was fighting a losing battle despite the risk the town's people wanted confirm before they would allow the health department to act they are very opposed to spraying any kinds of pesticides in their Town um and we really were trying to respect their wishes but at the same time and the outbreak Bruce and Debbie Stoner were the only residents to allow spraying outside their home they were terrified for their family if any of them were infected with the virus again it could Lead To Deni hemorrhagic fever a painful and potentially fatal form of the disease the risk was too great The Stoners hoped that spraying would protect them Health officials went to the most remote corners of niku during their interviews they learned that many more people were sick from theth department investig at one home Dr kitsutani found a woman who said her daughter had come down with a severe case of flu 2 weeks earlier she was still feeling weak from the disease her symptoms were familiar fever headache joint pain and a rash Mar we'd like to take if it's okay with you uh your daughter Juliet to the uhing where we set up a station okay you come what did you carry the girl was too weak to walk to the car the company continued to a week after the first case was reported the team got unexpected good news it looked like they lifted the airb to the main agents began checking passengers in the first were those from diverted flights many of them were international flights which Transportation officials say will return to its origin on September 19th the ban on US Air Travel had been lifted 7:4 a.m. at last the blood samples could be sent to the CDC lab it would still take them several days to identify the virus Chris Mills shipped the samples on the first available flight to Puerto Rico Maui Health officials would finally get the answers they needed and they could call in reinforcements from the mainland at the cdc's lab in Puerto Rico the niku blood samples were given top priority scientists there specialize in Deni fever the fastest way to test for Deni is to inject the patient's blood into the most common carrier of the disease the 80s egypti mosquito samples of the species are kept Frozen for testing purposes if Deni is present the virus will multiply inside the mosquito the insect's tissue is highly sensitive to the virus tissue samples are then removed from the carrier and combined with the reagent under an ultraviolet light infected blood cells will glow scientists finally had their answer hi they're all they were facing a full-blown epidemic okay guys it was the worst case scenario the niku blood samples had tested positive for Deni fever given how many mosquitoes we have here and from the history of other countries and tropical areas not ever being able to get rid of it it was it was a big deal the situation was urgent there were now 30 documented cases of the disease in niku the health department was losing the fight we were told by the CDC that no one can catch or control a Deni epidemic once it begins CDC told us in general every time you detect one case to your system there's two or 300 more out there undetected how many do do you really according to the cdc's calculations the number of victims could now be in the thousands [Music] and they still had no idea how the virus was spreading the species of mosquito that carries Deni had been eradicated from the island in the 1950s had the80s egypti mosquito returned to answer that question Maui Health officials brought in an entomologist a scientist who specializes in insects they needed to catch mosquit and examine them to learn whether another species was spreading the disease Dr Paul reer works for the CDC you think he is an expert on Maui's number one Public Health enemy the mosquito uh the first thing that we were interested to know was what mosquitoes are around here and of course we knew before we came here uh that ads Alber pictus which is another species it's actually now known as the Asian tiger mosquito uh was in fact common and how common we hadn't expected to see at least not until we came here in nahiku rer and his colleague conducted an experiment to measure the mosquito population the best way to measure the number of mosquitoes is to collect them in an aspirator reer used himself as bait look at that in minutes they had collected dozens of the insects in the lab they only found the80s albop pictus or Asian tiger mosquito this species carries the Deni virus but doesn't exclusively feed on humans and is rarely the cause of an outbreak this year breeding conditions had been ideal the mosquito population swelled with so much competition for food Asian tiger mosquitoes were now biting More Humans there were millions of Asian tiger mosquitoes all over the island and they were carrying a deadly [Music] disease in the fall of 2001 Maui Health officials fought to contain an outbreak of Deni fever millions of mosquitoes carried the virus the entire Island was at risk the DGA fever outbreak is bigger than we thought originally State Health director Dr Bruce Anderson held a press conference announcing the outbreak hundreds of calls flooded the health department retired nurses were recruited to help with the workload the phones just kind of went off off the hook calls from the mainland us tourists who had either been here and were worried about did I get sick or tourists who were coming and then our local people who were really upset few people in Maui had ever heard of Deni fever Panic swept through the community the Department of Health distributed leaflets explaining the symptoms of the disease and its dangers for mosquitoes on the they asked res resents and tourists to call the health department if they experienced Den's characteristic pain fever and rash the effect on Maui was immediate and devastating Island hotels cleared out reservations were cancelled outbreak here on the um basically Hawaii's tourist industry was already suffering from the effects of the terrorist attacks on September 11th right thank you now it was also dealing with an epidemic officials went back once again to nahiku and pleaded with residents to let them spray some people were still very opposed to pesticides in their property but a lot more people were much more open they they figured they'd rather have the pesticides and help prevent other people people from getting sick technicians sprayed pesticides around the homes of infected residents they sprayed the tropical flowers with soap and water the solution killed the larae without harming the environment there was no way they could spray enough to kill all the mosquitoes but if they could reduce the insect population they might keep the mosquitoes from spreading the virus when news of the outbreak hit the island sold out of insecticide the health department received an emergency shipment to keep residents and tourists protected the public health nurses opened up a booth where tourists and also were a lot of local people who live here pass by and they handed out information and also uh wipes or spray if people didn't have bug repellent with them but Mills knew they would have to fight them at their Source pools of water surrounded nahiku insect larvea the next wave of mosquitoes were visible on the surface the stagnant streams were caused by a reservoir which diverted Maui's water supply to the tourist areas District Health officers requested the water be [Music] released if they flooded the streams it might destroy the mosquitoes breeding ground the reservoir was open the water rushed towards nahiku a few hours later Pang and mil inspected the streams the water level had barely increased their attempt to destroy the breeding grounds had failed I heard they open the mosquitoes were multiplying and the virus was still spreading Health officials were outnumbered and surrounded 10 miles away from niku in the town of Hana doctors were called in to examine a group of sick high school students the disease had spread out of The Hot Zone in nahiku Deni was on the move for epidemiologists the high school students provided an important clue the students had recently visited Tahiti a country that was also suffering a Deni outbreak Dr Paul kitsutani wondered if the high school students had become infected with Deni fever in Tahiti and then brought it back to Hawaii okay just a little stick okay ready blood samples were sent to the CDC where they could compare the strain found in Hana with the strain from Tahiti as they waited for results students like Cara Henderson were frightened 89 everybody in Hana was really worried there were lots of people getting sick and so everybody was trying to take care of each other the outbreak had already spread from nahiku to Hana two neighboring communities on the east coast of Maui I wasn't surprised to hear of more cases um outside of our community because it spread so fast in our community I was you know kind of sad for the people out there and I wanted to warn them you know to watch out wear mosquito repellent and wear long sleeves and pants and don't come down here the health department was fighting a losing battle roadblocks would keep residents and tourists away from high-risk areas but as the CDC had told them the mosquitoes would be nearly impossible to contain the swarm of hungry insects threatened both both human life and tourism the main source of the state's economy State Health official Michelle NADA Hawaii is because it's still part of the United States um it's considered to be a nice tropical exotic venue and I think with the Deni fever appearing the impact was that you lost some of that safety nikata flew to Maui to help the team [Music] these are nures but the number of cases continued to multiply at the time that I arrived in Maui we were fighting an uphill battle they were just getting lots of telephone calls of possible cases and there was just a lot of work that needed to be done okayu this is where we have most cases here's what we got these all confirmed cases okay so uh it looks like we got it to this side for now okay on September 21st 2 weeks into the outbreak Dr Pang received devastating news another suspected case of Deni had turned up outside The Hot Zone is this true hip okay the virus appeared to be moving towards a more populated area to a town called Haiku East was quite isolated and we kind of drew a line kind of like drawing a Line in the Sand and we said if it crossed over to this area called Haiku Haiku is very wet lots of mosquito and the population is about four times as big as the other side I said if it crosses into here we're dead I mean we it it'd be like a fire raging out of control investigators drove several hours North to Haiku Chris Mills and her team had to stop this latest outbreak in its tracks technicians from vector control armed with pesticides had already arrived at the patient's house once they got confirmation it was Deni they would move into action don't look like you're feeling too well wow look at this rash is okay a Telltale rash on Sunny wesner's arm confirmed her worst fears once again Deni had spread to another [Music] area technicians began spraying around the home this is a on D fever Mills gave the family detailed information on how to prevent further infection syps she told them to wear long pants and long sleeves outside and to use bug spray it was important to reduce the m mosquito population around the home but Mills wondered if it was doing any good when cases of dangi fever started happening in other parts of Maui were like it's going to be spread all over the island and we're just going to be living with this forever and that's that's kind of a scary thought not just as a health worker but as a resident thanks as the disease raged through the village of haiku reports of Deni fever came in faster than ever you guys got a moment oh it just got another stack lower aiku up to 38 the team was frustrated and worried right and grand total by late September they had 60 suspected cases the Maui officials refused to give up keep with this they knew that if they didn't stop the virus it could turn deadly in October of 2001 Deni fever was spreading across the island of Maui the mosquito born disease had been confined to three small villages on the island now it was spreading West and threatening more populated areas not only did haikou start having cases but far away in Lana with a population of twice 177,000 twice High cool now you have a lot of people but it's not so wet and you wonder well how did it get there located on the western side of the island Laha is where the tourist vacation and has the highest concentration of people because of Maui's fragile tropical environment they couldn't do aerial spraying to store water in containers officials would have to combat the mosquitoes house by house house their massive eradication effort wasn't working new cases were reported by the hour if Dr Pang and Chris Mills hoped to fight the epidemic they needed to map where it was spreading we called in the Pacific Disaster Center to help with GPS mapping so we could get a a good view of of where every possible case and confirmed case of dangi fever lived um out in the niku and Hana area most of these homes don't actually have physical addresses doctors met with Mike Napier at the Pacific Disaster Center Napier monitors earthquakes volcanoes tsunamis and severe storm activity in the Pacific and Indian Ocean regions we have for health officials this outbreak could be just as devastating and Thea area with Napier's help the team would use satellite imagery to get an overview of the epidemic but first they had work to do on the ground the team assembled in niku Napier outfitted them with handheld Global Positioning Systems or GPS units handheld computerss in which all have aerial photos um working in pairs their goal was to map each household that had either confirmed or even suspected cases of Deni fever should we also map say like the stream the church some other points of interest yes I think landmarks would be very beneficial on Anis this overview would help health officials visualize where climate and vegetation might be harboring concentrations of the mosquitoes got to move out okay get it going let me see those BLS on your hand in the field the teams interviewed each patient who exhibited symptoms of Deni they use the GPS units to record their geographical position the State Health Department used the points to show where exactly the outbreak was occurring and um to as a to a certain extent uh limit travel to those areas at the end of one day Napier downloaded each team's data into his computer Health officials would finally see their enemy swarms of mosquitoes all over the island they laid out a perimeter around the houses and outlined areas or hotpots to be targeted for mosquito control a few there huh we created uh 200 yard circles around each hot case and U the reason we did that is because the alop pictus mosquito has a range of 200 yards Dr P Dr kitani now that the teams knew exactly where the mosquitoes were they targeted areas around the houses of any suspected cases all these green dots are positive cases that we have GPS by now there were a 100 suspected cases documented covering a 70 mile area across the island each area had to be sprayed by hand to prevent further infection they needed to find more resources and fast in October 2001 scientists and health officials on Maui had identified the source of an epidemic mosquitoes millions of them nearly a 100 cases of Deni fever were confirmed thousands were suspected Dr Lauren Pang and his team were in a Race Against Time they had to stop the mosquitoes or people could [Music] die the outbreak along with the events of September 11th threatened to destroy the main source of Maui's economy tourism many workers lost their jobs others fac the outbreak of a deadly disease you want to cancel what's that rival day Maui was in [Music] trouble the Hawaiian government responded with a bold and practical solution Hawaiian state senate representative colani English we took people that were employed that lost their jobs from 911 um and other unemployed people we skipped the Civil Service roles allowed them to come directly on hired directly gave them training and had them go out to eradicate uh breeding grounds for mosquitoes so we created what's known as the emergency environmental Workforce the newly formed task force was grateful for the work and highly motivated their own families were at risk day after day they cut down brush eliminating the mosquitoes breeding ground pesticide spraying intensified but so did the infection rate there were now over a 100 confirmed cases of Deni Chris Mills was worried it was scary as a health worker we just didn't know if we were going to be able to handle it or or actually get rid of it a Deni epidemic had never been successfully contained but all across the island residents pitched in to help an empty garden pot a new series of public service announcements educated them on the dangers of den a clogged rain gutter 1,000 mosquitoes an uncovered wheelbarrow 10,000 mosquitoes most importantly they learned how to stop the mosquitoes from breeding how do you around your home your to end D residents checked around their homes for stagnant water where mosquitoes lay their eggs those who had been sick were particularly concerned they were terrified of getting a repeat infection Ro after months of of work the number of cases of Deni fever in Maui dwindled and then stopped at one point we were projecting uh literally hundreds of thousands of cases which would have been a worst case scenario uh as it turned out we had um just over 100 cases and um and the problem was largely kept under control since the first case in niku scientists at the CDC had tested hundreds of blood samples and found the source of the outbreak in this case we found the Hawaiian dingi virus was most closely related to the Tahiti virus of the which we got from the same year and more distantly related to the Samoan dingy one of the previous year so our conclusion is that the most likely origin of the Hawaiian virus was Tahiti for the people who had been infected recovery was long and difficult but the quick action of the health department averted a disaster as soon as the health department found out about it they acted on it immediately they came out the next day and uh they were very interested and very detailed gave us a lot of personal attention and started meetings with the community right away they really made me feel more secure about the whole thing 8 months after Debbie Stoner reported the first case of Deni fever on Ma the outbreak was contained we declared the outbreak to be officially over in April that was about 2 months since the last case was reported we figured that um given that mosquitoes live for about a month um if it were no longer circulating in the mosquito population then there uh would be no longer any risk of transmission miraculously there had been no fatalities I think we were successful and stopping or having an effect because of the early response and I think we had an early response because we had education and people told us so we knew where it was and we could respond very quickly so a lot of people said how can I personally help so breeding sight control and all that so we had a very very motivated educated Community Health officials doctors scientists and the public had achieved The Impossible working together they had contained an epidemic defeated a disease and restored Hawaii as a safe Tropical Paradise for the first time in history Hawaiian Public Health officials had stopped an outbreak of Deni fever a small Virginia town is terrorized by a mysterious outbreak victims rush to the emergency room hospitals fill with the sick and the [Music] dying as doctors battle An Invisible Killer scientists hunt for [Music] Clues unless they can pinpoint the source of a deadly infection many more people will die [Music] [Music] some of the names in this program have been changed Virginia's Blue Ridge Mountains Are peaceful it's a safe secure place to live but on October 14th 1996 something went terribly wrong at 9:00 a.m. 66-year-old James linkis was rushed to the hospital from his home in [Music] Christiansburg as his Vital Signs plummeted his fever hit 105 if they didn't make it to the hospital soon the elderly man would die James was taken to Montgomery Regional hospital where he was stabilized come right out with me just breathe nice and easy with your mouth open Dr David Lander assessed his condition in the ER James was a smoker Lander knew this would make him more vulnerable to respiratory infections well he came in with a fairly typical picture of pneumonia he had fever and cough he was feeling weak um he also had some nausea which sometimes happens and uh his oxygen level had dropped somewhat in his blood chest x-rays confirm the diagnosis white streaks and cloudy patches revealed the patient had a severe case of pneumonia large amount of fluid had built up in his lungs making breathing difficult and painful but x-rays alone could not show the truth a vicious killer had already invaded the body of James linkis Dr John White was on rounds when he received a page from the ER as a pulmonologist white specializes in respiratory disorders he was about to take on the most complex case of his career hello hi John Dave Lander here yeah I have a 66-year-old fell here he's got pneumonia his oygen was 87 got okay that sounds pretty bad I'll be right down chrisy we got a bad to an experienced physician like Dr White the symptoms set off alarm Bells de breath pneumonia can range in severity to um mild cough without even any fever some mild shortness of breath and such um but can also kill you it can be very severe it can progress and involve multiple loes of the lung until it involves an entire lung or even both lungs um and it can kill you by asphixiation pneumonia is not a disease it is a physical reaction to a larger problem a patient can develop pneumonia from an infection an allergic reaction or even from exposure to toxic substances at this point there was no way of knowing what had caused James pneumonia without performing a battery of tests for you I want you to try to take slow deep breaths on this this goes right into the lungs as they wait for results a steroid treatment helped James Breathe It reduced the swelling and opened the bronchial tubes in his lungs he was also put on antibiotics to fight any possible infection little his doctors weren't taking any chances pneumonia kills over 60,000 people every year in the United States the elderly with their weaker immune systems are its most common victims okay I've take pneumonia very seriously even the milder cases I've seen turn bad with appropriate treatment and turned bad in a hurry James linkis was a bad case turned worse even with treatment his condition spiraled downward oxygen levels did not increase he was still struggling to breathe he was transferred to intent of care for closer monitoring in the hospital lab a technician analyzed the patient's blood a CBC or complete blood count would help rule out an allergic reaction toxic exposure or a viral infection as the cause of the pneumonia extremely high levels of white blood cells confirmed it James linkis had a bacterial infection but the kind of infection would remain a mystery with potentially deadly consequences 2 hours later a second patient arrived at the ER Mary Reynolds could barely breathe she had collapsed with dizzy spells and nausea a few days ago she thought she was coming down with the flu now she was too weak to even stand the symptoms were unmistakable she had pneumonia later the same morning uh Dr Lander called me again with another pneumonia case with a a little note of resignation in his voice like this going to be one of those days because Reynolds was so weak Dr White ordered a portable chest x-ray Mary Reynold was presented with a several Day history of shortness of breath fever cough she had some nausea too she was quite ill when she came in taking a big deep breath and hold it when the patient's daughter Vicki sheretta arrived at the hospital her mother was already in intensive care my father called me and said she had gotten worse she was delirious um and in pain of some kind very very uncomfortable Vicki was terrified her mother had always been a healthy and active senior now she could barely move when we would try to have a conversation she'd start out with a normal tone of voice and then it would end up in a whisper and became very labored Dr white was worried the X-ray confirmed Mary Reynolds diagnosis our daughter VI glad to meet you nice to meet you how are you Miss RS just good like James linkis Mary's body was fighting off an unknown infection it was a fight they were both losing within an hour a third patient arrived at the ER my he was coughing uncontrollably you just take him and have a seat after waiting he had been sick for several days with muscle aches and fatigue his temperature had soared to 104° he was suffering from abdominal pain and nausea his symptoms were identical to the two patients admitted earlier that day your head back back pneumonia rates are highest in Winter even then the hospital might expect to see only one case a day Dr White was treating three cases of severe pneumonia all in one 12-hour shift I really got a feeling that there was more than just this this wasn't a normal call day that there was something going on in terms of the numbers of infections that we were seeing the signs on each chest x-ray were unmistakable taken individually each seemed like a textbook case of pneumonia but to White there was one recurring symptom that troubled him most of these patients had nausea and that was disturbing that's not something that you would see routinely in large numbers of patients with pneumonia white feared he might be dealing with something more dangerous whatever it was it was spreading quickly by the end of the day he had admitted three more patients with the same symptoms and if we're getting more pneumonia patients get me a call throughout the night white was alerted as two more patients were admitted to Montgomery Regional the hospital had never seen this many pneumonia patients in in one 24-hour period James linkis the first of the patients was deteriorating by the hour he was sedated and could no longer breathe on his own Dr White was concerned the sheer number of cases as well as their severity alarmed him I became convinced that there was indeed an outbreak or something going on following procedure Dr White reported his suspicions to the health department hey operators Dr White would you give me the New River Valley Health Department please Katrina Watson is a public health nurse with the New River Health District Katrina Watson her experience with epidemics told her something was very wrong in Christiansburg anytime there is an increased number of cases with respiratory illness pneumonia and no one knows what's causing that and you have several cases there's a possibility for Community Panic there are families presenting in the emergency department you don't know whether it will affect just children whether it will affect adults the last thing that you want is community Panic I'll call you back later the pneumonia cases at Montgomery Regional Hospital were definitely out of the norm she alerted Dr jod Hershey director of the New River Valley Health District in his job is to track infectious diseases measles menitis influenza AIDS anything that spreads and sprads quickly at mon region go on and get some whether there's they were looking at the first troubling signs of an outbreak this was the middle of October it was not flu season it was not what I would have expected to have been occurring at that time so we got on the phones and we called other hospitals we checked local doctor's offices we checked regionally and we found that in fact there weren't any other hospitals doctor's offices that we're seeing an unusually large number of pneumonia or upper respiratory tract infection the cases pointed to One Source a single point of infection but as Dr Hershey knew a group of cases at One hospital could easily grow into the hundreds unless they could stop the source uh Hershey teamed up with Dr White to scour every detail of the Case Files the number of cases the age of the patients and even the unusual nausea symptoms become Clues when you're tracking an outbreak break increasing short of for Hershey and white those Clues would lead to a shocking conclusion everything pointed to a single killer Legionella numafa they thought they were dealing with Legionnaire disease I was very concerned I was really alarmed if this in fact was Legionnaire Legionnaire can make a lot of people sick very very quickly and it can be a killer Legionnaire disease first made headlines in 1976 when an outbreak of pneumonia struck over 200 people at a Philadelphia Hotel within weeks 29 people were dead most were members of the American Legion they had attended a convention at the hotel after months of Investigation colonies of bacteria were found living inside an air conditioning system The Germ had been dispersed into the air and inhaled by hundreds of [Music] guests although the Legionnaire bacteria occur in nature this was the first time humans had been infected a deadly new disease was born Mr L I'm going to take a listen to your heart and your now 20 years later later people were falling ill in Christiansburg Virginia Doctors and health officials feared the [Music] worst a biological Predator was on the loose how many more victims would fall ill before they could find the source of the infection and stop it in October 1996 doctors and Christiansburg Virginia battled a mysterious and potentially deadly outbreak in Just 2 days 15 patients were rushed to the emergency room of Montgomery Regional hospital they each suffered from the same condition severe cases of pneumonia now Dr jod Hershey director of the New River Health District suspected they were dealing with something far more threatening a possible outbreak of Legionnaire disease if they had legionaire pneumonia we needed to know it we needed to find out what the causes of the pneumonia were to prevent other people from coming to the hospital and being very sick Public Health officials developed a protocol for local doctors to follow every patient diagnosed with pneumonia was given blood and urine tests [Music] these samples were then sent to the Virginia State Health lab for further [Music] testing Mary Reynolds one of the first patients to show symptoms remained in very serious condition she was not responding to the antibiotics Dr White had prescribed Mary was having trouble breathing her oxygen levels were Dangerously low when Mary's daughter Vicki sheretta heard they were testing for Legionnaires she became alarmed it was quite frightening because her progress was so slow then when the word legionnaires popped up it really got your attention at the New River Health District Dr hershy struggled to come to terms with an outbreak that was growing larger with each passing day he called in a team of epidemiologists men and women specially trained to track and prevent the spread of disease a lot of work um I know you all are calling the hospitals I know you all have divided up in teams to try to get information they systematically contacted hospitals in the area to determine exactly how many pneumonia patients had been identified 21 cases have had been diagnosed although Hershey suspected they were connected to the outbreak without test results he had no proof all of a sudden in our health district we have 20 some people in the hospital still pending results so it was alarming the blood samples were sent to the division of Consolidated laboratory services in Richmond [Music] technicians analyze them trying to positively identify the infection first they process the blood in a centrifuge to separate red and white blood cells from the serum this is where evidence of potentially fatal bacteria would be found the serum was then placed on a slide with a solution added to detect if the body had been fighting Legionella bacteria scientist viewed the slide under a microscope with an ultraviolet light if Legionella were present then antibodies to the bacteria would glow [Music] green researchers had their answer four cases tested positive for Legionella bacteria [Music] hello this is Dr Hershey Dr Hershey's theory was confirmed who do you have any of the other done yet his team was facing a full-blown outbreak of Legionnaire's Disease number of community to stop the outbreak from spreading they would have to find the source of the deadly bacteria Hershey reviewed each patient's medical history searching for patterns but we need them it's important although all of the patients lived and worked in the Christiansburg area they had little else in common if they hoped to find the source Katrina Watson knew they needed more it was very important to talk to patients because we wanted to find out if they shared any common experiences because we wanted to make sure people did not continue to get ill teams of medical investigators were dispatched to area hospitals to interview patients Hershey emphasized the need for highly detailed information he reminded them that time was not on their side the over the last couple the news of these confirmed legioner pneumonia really ramped up the investigation we knew we were dealing with a potential killer we knew we were dealing with a disease that could make a lot of people sick and we knew that we very quickly had to find the source with a deadly outbreak threatening the region Dr Hershey went public with his findings people needed to recognize the early symptoms of legionnaires and to understand its treatment we don't know what the source is we are presently doing an investigation to try to identify the source as investigators searched for answers Dr Hershey urged the public to remain calm people over 50 who have some chronic under but with no end to the growing list of victims Panic had already taken [Music] home something in Christiansburg was infecting people Health officials had no idea what until they did no one was safe in October 1996 more than 20 people in Southwestern Virginia were stricken with a life-threatening strain of pneumonia when blood tests confirmed four cases of Legionnaire disease District Health director Dr jod Hershey warned the public the story was breaking news on every station people prot themselves simply four area hospitals were now treating patients several in critical condition condition family and friends had no idea whether they would be the next victims people were afraid to go out they were scared they were afraid to go shopping they were afraid to go to football games they were afraid to go to church co-workers of sick patients were especially alarmed local businesses asked Dr Hershey to address employees concerns officer there was tremendous public concern you know people wanted to know how was this thing transmitted could I get sick can my children get sick calm here hoping to calm their fears Hershey explained that Legionnaire's Disease is not contagious and rarely strikes children people over age 50 with compromised immune systems are most at risk only those individuals who'd come in contact with the source of the disease could become infected doctors at area hospitals monitored their patients closely administering antibiotics to fight off any sign of infection okay try for those who responded to treatment recovery time averaged 2 weeks but for the elderly fighting the infection was a slow and pain painful process Mary Reynolds was one of the first patients to become ill she had received supplemental oxygen and aggressive antibiotic therapy still her condition continued to worsen Mary's daughter Vicki sheretta could only wait while her mother fought for her life there was a point where we did not see any Improvement in her health um maybe on some particular days even worse than the day before and I got scared each new patient in the region was tested for legionaires the state lab was overwhelmed as they tried to process all the samples within days the outbreak threatened to become a public health Nightmare and still they had no answers about the source it was necessary to continue to monitor the numbers of people coming to the hospital confirm that they did or did not have legioner pneumonia and then look to see if we could find an environmental Source causing it finding the source was the only way to stop the outbreak based on a handful of Clues Dr Hershey suspected it was located somewhere in or around Christiansburg and they're doing cre he just had to find where aded on the 14th um okay Chris which hospital I've contact Legionella bacteria live in or near water scientists have found it in fountains and along Riverbanks normally small pockets of bacteria are not enough to cause infection but in warm moist conditions the bacteria multiply if large numbers of the bacteria become aerosolized it can become infectious and deadly there was no alternative Hershey's team would have to identify and test every source of aerosolized water in the region it was a huge undertaking Hershey called in an environmental specialist Vic maruson maruson is an expert at investigating potential environmental factors that threaten Public Health in the very beginning we didn't know where to look and that's why we look everywhere anywhere and everywhere that that aerosolized water could have could have come from the 1976 outbreak occurred because of a faulty air conditioner marcusen began by inspecting all the coolant systems in the area the bacteria can reproduce quickly in a coolant system that is not properly maintained we were looking for water that contained the Legionella bacteria as that water became aerosolized people would inhale it and that's how they contracted the disease anything that produced water under pressure was suspect Marcus took samples of the moisture found in and around vents of the large coolant structure the samples were sent to a lab for testing over the course of 3 days the samples were cultured to see if bacteria would grow the results were disappointing all of the cultures were free of Legionella still Dr Hershey was certain The Source was in Christiansburg as an experienced disease detective he moved the focus of his investigation away from the laboratory and back to the patients we were looking specifically to identify any common threads any linkages between these patients uh did they have a common exposure we were looking for a common environmental source and if we could identify that common environmental Source then we could go in and hopefully find a Pinpoint location within that source and then stop it prevent further transmission of the infection Dr Hershey brought in health officials from all over the state to administer a detail questionnaire they needed to know where the victims lived where they worked and shopped and how they spent their free time we had to know what was going on where those patients had been and the two weeks prior to getting sick and even though it was challenging because those people were very very ill we knew we had to ask the questions we had to ask the right questions so that we could get to the bottom of what was going on a few people like the interviews were a slow and painstaking process especially in the wake of a widening crisis but team members like epidemiologist Betty Rouse refus to give up when we don't know the source of something that is life-threatening potentially to a large number of people U it is a cause for emergency it's a cause for uh work till the work's finished uh however many people it takes to get it done after interviewing many of the patients the list of potential sources began to narrow some of the links began to emerge almost immediately locations in Christiansburg that had been visited by either all of the individuals or most of the individuals involved included such things as a grocery store and a department store and a home center Mary Reynolds told Dr Hershey she had made several trips to the grocery store before she became ill it was hard to believe that grocery shopping could cause legionnaires yet something as simple as handling fresh fruit and vegetables could be the key to her illness Hi how are you doing oh think I help you with yeah I think I need under normal conditions the water used to keep vegetables fresh is treated to kill bacteria but an improperly maintained produce Mister can Prov provide the perfect breeding ground for deadly [Music] bacteria an investigative team was called in from the Centers for Disease Control and prevention in Atlanta the outbreak had already grown too large for State Health officials to handle alone the CDC is the lead Federal Agency for investigating and preventing outbreaks their job is to track and stop deadly infectious diseases first they were briefed by Hershey's team of doctors nurses and public health officials next they would inspect each of the locations they were looking for water or for anything that could create enough water vapor to spread the disease of the three possibly contaminated locations the grocery store seemed the most likely in investigators went there first looking for signs of fine water vapor which could be inhaled and caused sickness they were most interested in water droplets found on a produce Mister to be about right now and on the vegetable sitting below misters had tested positive for Legionella in the past samples would be rushed to the CDC lab in Atlanta for analysis if they if that's or not we just don't know it would take 3 days to determine if the bacteria in question were [Music] present Dr Hershey moved on to a department store the next location on their list he told stunned employees he needed to take water samp samples from their bathrooms their water fountains and from the central air conditioning [Music] unit we've been talking with Dr jod Hershey from the New River Health District and we've been talking about Legionnaire's Disease as the hunt for the bacteria continued the public demanded information all right um we do have some phone calls on the air we'll go ahead good morning you're on the air yes my boyfriend has a really bad cough and I was wondering is that a sign of the Legionnaire disease everyone who had a cough or a cold was terrified they had legionnaires Hershey did his best to maintain calm and explain the facts about the disease you the common symptoms is that we were talking [Music] earlier despite his efforts fear swept through the community at a Montgomery County Hospital one patient took a turn for the worse 50-year-old Paul Douglas had been in critical condition for days doctors fought to save his life but on Sunday October 27th 1996 Virginia's Legionella outbreak claimed its first fatality unless investigators found The Source it would not be the last good morning I'm Christine McKinnon with wfn are continuing news Health officials have confirmed a patient diagnosed with legionaire disease who was in critical condition has died a deadly outbreak of Legionnaire disease terrified a small Virginia Community in [Music] 1996 with the help of the Centers for Disease Control and prevention District Health director jod Hershey was desperately trying to locate the source of the outbreak before the bacteria claimed more lives it had been 2 weeks since the first patients with pneumonia likee symptoms were rushed to the emergency room at Montgomery Regional Hospital one of the first patients to contract the disease Mary Reynolds was still being closely monitored for her daughter Vicki sheretta The Waiting was painful she didn't look like my mother she was sick she was very sick and I had no idea that legionnaires made you that ill of the nearly 25 people who had been diagnosed with pneumonia Dr jod Hershey now had 15 confirmed cases of Legionnaire's Disease a team of doctors and public health officials work day and night to pinpoint the source of the infection they had narrowed their search to three principal sites a grocery store a department store and a Home Improvement Center samples taken at both the grocery store and the department store turned out negative this left one probable source for the infection the Home Improvement Center was really looking like it was the possible source of the infection so we sent a team into the Home Improvement center and we identified and pinpointed any sources of water vapor there investigators scoured every Department of the Home Improvement Center in the garden area they tested hoses a sprinkler system and a decorative Fountain the Home Improvement Center also had a hot tub on on display another potential Source in the past hot tubs had been responsible for outbreaks of Legionnaire's Disease across the US bacteria are usually found in the filter Environmental Specialist Vic marcuson examined the hot tub we had initially gone to where the hot tubs were on display and sampled the water tested the water tested the temperature identified the disinfectants that were in the water right there you ready the closer investigators looked the more they were convinced the hot tub was at the center of the outbreak none of the store employees had gotten sick but most of them were young with immune system strong enough to fight off the toxic bacteria older customers weren't at lucky can you guys put the cover to prevent more people from becoming infected the hot tub was covered until the water could be analyzed the samples along with the hot tub filter were sent directly to the CDC none of the samples taken from the garden center or other parts of the store tested positive for Legionella that left the hot tub filter the filter was rinsed with purified water forcing any bacteria out the water was then passed through a specialized filter to collect the bacteria once isolated it could be cultured Dr Barry fields at the cdc's division of bacterial diseases performed the test we'll put this on the on our media that we used to grow the organism and use a dissecting microscope to look for growth that's characteristic of Legionella a positive test result would not only confirm the presence of lianella but the exact strain that information would be the key to Unlocking The Mysterious outbreak when the test was completed Dr Barry Fields contacted Hershey with the results hello Dr hershy he was stunned by their findings no Legionella bacteria were present in the hot tub filter or in any of the water samples okay thank you very much with people still getting sick it was a huge setback state and federal health officials knew they were racing the clock and getting nowhere fast and we were frustrated we were disappointed we had spent a lot of time testing we had spent a lot of time in interviews and he had pointed to the Home Improvement center and Hershey and his team pressed on despite the negative tests the director was still convinced the Home Improvement Center was the source his instincts told him that if the bacteria wasn't in the hot tub then it had to be somewhere else in the store they just had to find itms public health officials launched a case control study by comparing the movements of both sick and healthy people people throughout the store they would be able to pinpoint the exact location where the victims became infected not RAC State epidemiologist Betty Rouse located subjects for the study what it basically involves is finding controls that is individuals who themselves were not ill that matched the cases very closely by age by sex and by medical condition after scouring thousands of medical records C from local doctor's offices epidemiologists had a list of names frightened by reports of the outbreak the public was eager to help members of the community submitted to a long and detailed interview those who had shopped at the Home Improvement store were asked more specific questions when and how long did they shop up a ofes what departments did they visit many of the healthy people told the same story they recalled being in the store in the weeks prior to the outbreak they hadn't been anywhere near the hot tub display years and they were in and out of the store in less than 30 minutes I got the maybe but people who had contracted Le spent over an hour in the store they had all shopped in the area near the hot tub [Music] display the study supported the Virginia health official's Theory a hot tub was responsible for the outbreak but scientists at the Centers for Disease Control and prevention could find no evidence nothing in the home and Improvement Center tested positive for Legionella still after 3 weeks of searching investigators were convinced they were on the right track they needed proof and they were running out of time in 1996 Health officials in Christiansburg Virginia struggled to find the source of a deadly disease the bacteria Legionella had already killed one victim and left 15 others fighting for their lives the most likely suspect was a hot tub display in a local Home Improvement center but when test results came back negative for the bacteria even the experts were baffled to Dr jod Hershey and his team of investigators worked on we refus to give up all links and all instincts pointed to the fact that the hot tub was the source of that outbreak we went back in to the Home Improvement center and furthered our investigation by talking to staff follow-up interviews are a key part of any investigation often Witnesses remember more details over time the story manager recalled something he'd forgotten to tell investigators during his first interview after checking his records he remembered that there were originally two hot tubs on display one had been dismantled just 3 weeks earlier and sold to an employee health officials rushed to the employees home the second hot tub could have been the source but if the employee had cleaned the tub or discarded the filter they might not find any sign of the bacteria they were in luck the owner had not washed the hot tub or set it up for use all of the parts were there it had been sitting for 3 weeks if the filter had dried out there would be little chance of finding any traces of Legionnaire's Disease [Music] remarkably the filter was still slightly moist it was shipped to the CDC labs in Atlanta Dr Barry Fields was relieved by the results Legionella colonies have a distinct appearance they're white um and they have a little iridescent edge around them that can be red or purple or green so they're fairly distinctive Legionella was present but that wasn't enough Legionella can be common in the environment and just finding it doesn't mean that it's caused disease we've got to be sure that we found the source of the outbreak or or the case that occurred he next tried to determine if this was the same bacteria that had made people sick in Christiansburg DNA test were performed on the bacteria found in the tub as well as on bacteria infecting the patients so what do we have the two samples matched Dr Hershey finally had proof the source of the outbreak had been identified good job it was commendable that local state and federal Public Health officials quickly and effectively collaborated to identify the source of this mystery illness and then got together further to avert an epidemic that could have been much worse for Dr John White the end of the outbreak brought profound relief it was one of the more challenging experiences of my career to have um that number of pneumonia patients coming in that I felt responsible for by myself to also feel like something was going on in the community uh not knowing what it was having more cases coming in it was scary Public Health officials believe Mary Reynolds and the other victims inhaled bacteria that had been growing in the hot tub for weeks how it got there is unclear as a result government guidelines on hot tub cleaning and disinfection now apply to all spas including those just on display according to Dr jod Hershey legionaire disease has changed this quiet corner of Virginia this outbreak has and continues to have a lasting effect on the New River Valley it will never be forgotten uh it was a scary process an outbreak of a potentially infectious unknown disease Virginia's Legionella outbreak of 1996 was the second largest in history in all 23 people were stricken with Legionnaire's Disease tragically two lost their lives so 70-year-old Mary Reynolds successfully fought off the disease and survived after weeks in the hospital she returned home to be with her family her recovery and the recovery of dozens like her was due to the hard work of a team of doctors Public Health officials and lab technicians who work tirelessly to find and stop An Invisible Killer [Music] [Music]