NEW YORK -- Another traveler on a New York cruise ship to Bermuda has been hospitalized with the symptoms of Legionnaires' disease, and the condition of two of the three of those with confirmed cases has worsened, New Jersey health and hospital officials said yesterday.
As word of the outbreak spread, hundreds of worried vacationers called New York and New Jersey health officials yesterday. The three confirmed victims, and five others hospitalized with symptoms of the potentially fatal disease, were all passengers on the Horizon, a ship operated by Celebrity Cruises that sailed to Bermuda June 25 and returned to New York July 2.
"People who've been on any boat larger than the family sailboat at any time in the last two years or who plan to go at any time in the next two years have been calling," said Steven J. Matthews, an associate commissioner of the New York City Department of Health. "We haven't heard from anyone who was on the battleship Missouri, but it's coming close to that."
Yet, a spokesman for the Centers for Disease Control and Prevention in Atlanta said that the source of the disease, a form of bacterial pneumonia transmitted by airborne droplets of water, may not have anything to do with the ship that is the most obvious common denominator.
Bob Howard, a spokesman for the CDC, said that the source of contamination, which is often transmitted through air blowing across standing water, could have been on the ship, in Bermuda, or even back home in New Jersey.
All three of the confirmed cases, as well as a fourth who may have the disease, are from Toms River, N.J., part of the township of Dover, which has a population of 80,000. And the other four who have been hospitalized are also from New Jersey, health officials said.
"That's absolutely something we're looking at," Mr. Howard said of the New Jersey connection. "We're looking for the common thread, areas people may have been, any common experience that would link these people together."
He said that past investigations of Legionnaires' disease have taught investigators that the most obvious link is not always the one that turns out to be the source of contamination. For example, he cited a Louisiana outbreak in which all of those who contracted Legionnaires' disease worked together. Initially, everyone assumed that the work site was the problem, Mr. Howard said, but the contamination was eventually traced to a vegetable mister at a grocery store where all the victims had shopped.
In a brief written statement, Al Wallack, senior vice president of passenger services for Celebrity Cruises, emphasized that the cause of the outbreak had not yet been pinpointed and promised to cooperate fully with the Centers for Disease Control.
Two investigators are still on board the Horizon, which sailed from New York on Saturday and arrived in Bermuda yesterday. And dozens of other investigators are working on the case, "doing shoe-leather epidemiology," Mr. Howard said, conducting lengthy interviews with the sick, their doctors and nurses and with anyone who may have come in contact with them within the incubation period of two to 10 days.
He said that the investigation could take several weeks.