The mysterious illness that drove them to their knees - Ah, that Legionnaires’ disease – A historical reflection of the work in Legionnaires’ disease in New Zealand (1978 to mid-1990s) and the ‘One Health’ paradigm

And so, formed the basis for the song Legionnaires’ disease (LD) composed by the legendry musician Bob Dylan shortly after this mysterious illness dramatically entered the clinical and epidemiological scene in July 1976 at an American hotel. Now more than forty years have passed since Legionella pneumophila, the causative agent of LD, was formally identified in 1977. Once the publicity associated with the outbreak subsided, there was the challenge to science and health professionals of what was an extremely complex and intriguing health concern. In the United States, the outbreak investigation that eventually solved the mystery had taken an array of surprising twists and turns. Globally, it revealed the strengths and weakness of countries’ health systems in response to the outbreak from an unknown agent. Extensive international coverage of the outbreak also marked a turning point in journalism’s efforts to hold officials accountable for their response to epidemics that had the potential to threaten the lives of hundreds of people. In 1979, New Zealand became an active participant in the international efforts towards increasing the understanding of infection caused by Legionella species and set up a centralized laboratory diagnostic service. By 1980 LD had become a notifiable disease making New Zealand one of the first countries globally to do so. This historical narrative in the decade or so from its recognition, provides a unique insight into how the One Health paradigm was instrumental in New Zealand’s early response to LD in tandem with control strategies. The findings show that from 1979 the distribution of the Legionella species in New Zealand did not follow patterns observed in studies carried out globally.