Two Whitehall nursing home residents were hospitalized last month with respiratory infections caused by legionella bacteria.

The Manor at Whitehall is now working with Franklin County Public Health and a private contractor to determine whether the bacteria came from the water systems inside the 150-bed facility on Langley Avenue.

In the meantime, water restrictions are in place for residents.

Legionella causes pneumonia-like symptoms and is most often spread when a person inhales contaminated water droplets from the air.

Though occasional, isolated cases of legionella infection are common, two or more cases at a single location could signal the start of an outbreak and requires investigating, Franklin County Public Health commissioner Joe Mazzola said.

"We're working closely with the facility to find the potential source of legionella and any additional next steps needed for remediation," Mazzola said. "We take this very seriously."

The second case was confirmed July 25, but water sample test results won't be available for another week or so, he said.

Until the issue is resolved, the Manor at Whitehall's residents must consume only bottled water and bagged ice purchased by the nursing home. Bacteria-removing filters have also been installed on all shower-heads. Jim Lark, the nursing home's administrator, said he's providing daily updates to residents, their families and staff members at meetings and in written communications.

"Our care-giving team and I will do the next right thing to ensure the safety of those we care for," Lark said.

Legionella must be reported to public health officials within a day of a confirmed or suspected case, according to the Ohio Department of Health.

It can cause a serious type of pneumonia called Legionnaires' Disease in people with compromised immune systems, including the elderly. More often, the bacteria causes a milder, less-serious infection that can go undiagnosed.

It's not yet known if the Whitehall residents had the more-serious disease.

The two infected residents were both men in their mid-60s.

Symptoms of legionella infection include cough, fever, aches and shortness of breath. Typically they appear within two to 10 days of exposure to the bacteria.

The disease is treated with antibiotics and though most people make a full recovery, about 1 in 10 people who get Legionnaire's Disease will die from complications.

The CDC's most recent data says diagnosed cases of Legionnaries' Disease have increased by more than 400 percent nationwide in recent years — from 0.4 cases per 100,000 people in 2000 to 2 cases per 100,000 people in 2015.

About 20 percent of outbreaks were associated with long-term care facilities.

Medicare-certified health care facilities are required to have water management plans in place to reduce the risk legionella infection, according to new guidelines distributed June 2 by the federal Centers for Medicare and Medicaid Services.

Franklin County Public Health has established a hotline to answer questions about the Manor at Whitehall's case: 614-525-3097.

awidmanneese@dispatch.com

@AlissaWidman