Date: Sat, 9 Dec 2000 23:33:05 -0500 (EST)

From: ProMED-mail <promed@promed.isid.harvard.edu>

Subject: PRO> Legionellosis - Spain: 2000

LEGIONELLOSIS - SPAIN: 2000

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[see also:

Legionellosis - Spain (Barcelona) 20001116.2005

Legionellosis - Spain (Vigo, Arbizu) 20001018.1796

Legionellosis - Spain (Vigo, Arbizu) (02) 20001026.1860]

Date: 8 Dec 2000 08:23:22 -0800

From: ProMED-mail <promed@promedmail.org>

Source: Eurosurveillance Weekly - Issue 49, 7 Dec 2000 [edited]

Via: CDPC Weekly, Mail-II

Outbreaks of Legionella infection in Spain, 2000

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Seven outbreaks of legionnaires' disease have been notified to Spain's national centre for epidemiology in 2000. In 4 of them patients acquired infection in the community and in three the infection was hospital acquired. The European Working Group for Legionella Infections (EWGLI) has also reported 4 clusters of legionellosis in tourists who visited Spain in 2000; 15 cases were identified. This report describes 3 large community acquired outbreaks.

From 16 Sep to 8 Oct 2000, 70 cases of legionellosis (43 men and 27 women; aged 20 to 95 years) were reported by the local health authorities of Alcoi, in the Valencia region. [A total of] 2 patients died. Cases were diagnosed on the basis of urinary antigen tests for Legionella pneumophila and in 3 cases L. pneumophila serogroup (sg) 1 Pontiac Knoxville was isolated. Preliminary enquiries revealed an association with visiting and living in a certain area of the city. Exposure to this same area focused the investigation on the possibility of aerosol transmission from contaminated cooling towers. Clinical isolates and water samples from cooling towers from the area were sent to the national reference laboratory. All the cooling towers in the suspected area were disinfected. Intensified surveillance is continuing.

On 9 Oct 2000, 5 cases of legionnaires' disease were diagnosed on the basis of urinary antigen tests for L. pneumophila, and an increased number of cases of atypical pneumonia was notified to the regional health authorities of Galicia by a hospital in Vigo (1). The epidemiological investigation resulted in the identification of 28 cases (21 men and 7 women; aged 30 to 79 years), 3 of whom died. The first case became ill on 18 Sep 2000, and no cases with dates of onset since 1 Oct 2000 have been notified. Preliminary enquiries on 10 Oct 2000 showed an association with visiting and living in a certain area of the city. A hospital based matched case control study carried out on 11 Oct 2000 with 17 cases and 37 controls confirmed that living, working, or walking in the area near the hospital was associated with illness (odds ratio 4.29; 95 percent confidence interval 1.6 to 18.0). One clinical isolate and water samples from cooling towers from the area were sent to the National Reference Laboratory. The clinical isolate was identified as L. pneumophila SG 1 Pontiac and all the environmental samples were negative. All the cooling towers in the suspected area were disinfected.

From 14 Sep to 16 Nov 2000, 40 cases of legionellosis were reported by the local health authorities of Barcelona, Catalonia. One patient died. Cases were diagnosed on the basis of urinary antigen tests for L. pneumophila. Preliminary enquiries showed an association with visiting and living in a neighborhood of the city of Barcelona. Exposure to this area and the absence of any other potential source focused the investigation on the possibility of aerosol transmission from contaminated cooling towers. Samples from suspect cooling towers were taken, and the towers were then disinfected. Intensified surveillance is continuing.

References:

1. Hervada X, Cano R. A community outbreak of legionnaires’ disease: Galicia, Spain. Eurosurveillance Weekly 2000; 4: 001026. <http://www.eurosurv.org/2000/001026>

Reported by Salvador de Mateo de Ontanon <smateo@isciii.es> and Rosa Cano <rcano@isciii.es> Centro Nacional de Epidemiología, Madrid, Spain.