On 9 October 2000, five cases of
legionnaires' disease were diagnosed on the basis of urinary antigen
testsfor L. pneumophilia, and an increased
number of cases of atypical pneumonia was notified to theregional health authorities of Galicia by a hospital in Vigo
(1). The epidemiological investigationresulted in the identification of 28 cases (21 men and 7 women;
aged 30 to 79 years), three of whomdied. The
first case became ill on 18 September 2000, and no cases with dates of onset
since 1 Octoberhave been notified. Preliminary enquiries on 10 October showed an
association with visiting and living in a certain area ofthe city. A hospital based matched case control study carried
out on 11 October with 17 cases and 37controls confirmed that living, working, or walking in the area
near the hospital was associated withillness
(odds ratio 4.29; 95% confidence interval 1.6 to 18.0). One clinical isolate and
water samplesfrom cooling towers from the
area were sent to the National Reference Laboratory. The clinical
isolatewas identified as L. pneumophila SG 1 Pontiac and all the environmental samples
were negative. All the coolingtowers in the suspected area were disinfected.
From 14 September to 16 November 2000, 40 cases of
legionellosis were reported by the local healthauthorities of Barcelona, Catalonia. One patient died. Cases
were diagnosed on the basis of urinaryantigen
tests for L. pneumophila. Preliminary enquiries showed an association with
visiting and living ina neighbourhood of the
city of Barcelona. Exposure to this area and the absence of any other
potentialsource focused the investigation on
the possibility of aerosol transmission from contaminated coolingtowers. Samples
from suspect cooling towers were taken, and the towers were then disinfected.
Intensifiedsurveillance 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/2000/001
Sanidade
affirms to have located and controlled the center of legionella in Vigo that
caused the death to two people
VIGO, 12 October 2000
The outbreak of
legionella in the last detected days in Vigo and thatit has already caused
the death of two people has been located by sanitary authorities in the
surroundings of the Xeral Hospital, in the zone Great Via and Seat of Spain,
according to it assured the director today general of Public Saúde of the
Consellería de Sanidade, Farjas Pillar, who added that the outbreak is controlled
after the adoption of measures of prevention
The xeral director of Public Saúde discarded that the origin of the
outbreak one had taken place inside this hospitable center, although recently a
sanitary worker passed away but he does not have himself been able to confirm
that she was by this cause. The Xeral Hospital already it underwent a outbreak of
this disease at the end of 1998, when watchman contracted the disease in the
showers of the center. water conductions of the hospital were reformed to
eradicate it appears.
Of the 19 detected cases, 11 remains in diverse
centers hospitable of the city, of them four are in Units of Intensive Cares.
Thus, nine are admitted the Hospital Xeral, one in the Hospital do Meixoeiro and
another one in the Clinic of Fátima. In addition other 5 cases exist that are in
study majority of hospitable income was made 28th and 29th of september and
the 3rd and the 4th of October.
The affected ones by the outbreak of legionella in Vigo rise to
23
VIGO, 13th October 2000
The number of affected by the
outbreak
of ' legionellá detected in Vigo rises to 23, thirteen of which they remain
entered and ten they were registered. In this number they are not entered both
deceaseds by the disease in theXeral-Cíes Hospital of Vigo.
The 25
patients infected altogether, 23 were dealed with in Xeral hospital, 11 of which
they are entered, and the other two in Fátima and in the Meixoeiro, being both
still entered, according to indicated the Service Galego de Saúde (Sergas) in a
press note.
Ten patients exist who are being studied in case they could
to be infected by the bacterium. The Sergas emphasizes in a note of press that
is not the appearance of new cases but that new detected they are fruit of the
confirmation of some patients in study
Equipment of
inspection will try to locate the exact place of the outbreak of legionella in Vigo
VIGO, 13
October 2000
Equipment of inspection will make new trackings in the
search of exact point where the outbreak of legionella in Vigo
was originated, that it caused at least two deaths in last
days.
The zone on which it will be acted is the included/understood
one between the streets Vázquez Varela, Great Via, Puerto Rico and Urzáiz,
according to indicated xeral director of Public Saúde, To pound Farjas.
Two will be investigated swimming pools, and the cooling towers of a
commercial center and of a hotel.
In press conference, Farjas
Pillar explained that today five were detected new probable cases of
infected people, that not yet they are confirmed, between patients who
already were entered it does several days reason why any new entrance
by neumonía did not take place of no type.
With respect to the
cooling towers whose samples are analyzing and whose results will be known
in the term of two weeks, it indicated that they fulfilled of suitable
form the recommendations of maintenance. One is the facilities of the
Xeral Hospital, commercial center and a hotel.
At least two died and 22 affected in a outbreak of "
legionella " in Vigo
The
infection is controlled, according to the Galician Department of Health
VIGO.
- At least two people are dead, of a total of 24 affected, during the last days
due to a outbreak of legionella located in Vigo. The authorities consider that one
third mortal victim due to the bacterium could exist.
Wasting
optimism, the chief of a main directorate of Public Health of the Council of
Health and Social Services, To pound Farjas, it clarified yesterday that the
outbreak
is controlled
The Galician
autonomic Administration has been able to limit the nucleus of the city in which
he has appeared the same one, in the centric streets of Great Via, Pizarro and
seat of Spain, well-known zone like the district of Casablanca. At the moment,
the cooling towers of the establishments of the zone that could emit the
bacterium, in concrete the systems of the Xeral Hospital have been supervised, a
commercial center and a hotel.
Throughout
the next week, the collection of samples will extend by the systems of
ventilation of banks and establishments public of the zone. The results of the
cultures already gathered also will be ready in the next days.
As
one remembers, in January of the last year four people passed away in the
Hospital of Navarre due to a similar outbreak.
14th October 2000
The affected ones by the
outbreak of legionella in Vigo rise to 36
The
family of a possible victim of the epidemic asks for the autopsy judicially
VIGO.
- I infect by legionella extends in Vigo as they spend the days. The number
could reach the 36 people already. The Council of Health confirmed yesterday to
last hour of afternoon, through a note of press, only 23 infected patients,
without both counting deceaseds by the disease in theXeral-Cíes hospital of
Vigo, nor a third deceased, slope of autopsy to confirm the cause of the
death.
The
relatives of this third victim, who worked in the service of administration of
theXeral-Cíes hospital, have solicited, by judicial channel, that practices the
autopsy to him. Of the 23 cases confirmed by Health, 13 remain hospitalized (3
of them in the UCI) and other 10 have been registered.
appearance of
legionella, according to showed Farjas.
However, it
discarded that the outbreak comes from the interior of some premises or the Xeral
Hospital of Vigo and remembered that " the zone has been limited to locate the
center, in different streets of downtown, next to the hospital.
Farjas rejected
in addition that the contagios had taken place by the running water. " the
citizens can drink and to shower with tranquillity ", assured.
The investigations are centered in the zone next to the
Seat of Spain of Vigo because the origin of the infection possibly is in the
transmission to the particle outside coming from refrigeration systems,
aimed.
Complaint by
homicide against the hospital
The Association
of Affected by Medical Negligences will present/display the next Monday a
criminal complaint against the managing director of the Hospital Xeral Cíes of
Vigo by three presumed crimes of homicide by imprudence and other 16 of
injuries. This complaint also will extend to the head of maintenance of the
hospital vigués and to all the people who could appear as guilty of the outbreak of
legionella.
In
addition, the Association of Affected by Negligences considers subsidiary civil
person in charge to the Galician Service de Salud (Sergas) and to the
Consellería de Sanidad of the Xunta of Galicia. To the complaint the families of
several affected have adhered, including some of the deceaseds, according
toexplained Alfonso yesterday Churches, legal and
medical adviser of the association.
Churches
lamented " deeply " the behavior of the sanitary authorities with respect to
this outbreak of legionella, that considered " mimetic " with that also it had the
Galician Administration in the case of aspergilius. It criticized the fact that
the Xunta says that " this outbreak is controlled but that its origin is not known ",
to consider that " it is very difficult to have controlled a question when its
origin is not known ".
Alfonso
Churches showed that " rational indications that exist they impute the origin
from the outbreak to the Hospital Xeral Cies of Vigo: five of the affected ones are
workers of this center and the rest, of a form or another one, has had contact
with the hospitable center vigués
The Xunta will demand that
blamed its hospital of the outbreak
They indicated to
Xeral-Cíes of Vigo like the center of legionella
MIGUEL ANGEL VERGAZ.
Special for the WORLD
SANTIAGO. - The chief of a main directorate of Public Health of the
Xunta of Galicia, Farjas Pillar, and the Secretary General of the Council of
Health and Social Services, Manuel Antonio Silva, appeared yesterday in press
conference to inform into the state of the outbreak of legionella, as well as to
announce actions against which they indicate the facilities of the Hospitable
Complex Xeral-Cíes, in Vigo, as the center of this outbreak.
In this sense, Silva declared that the legal services of the Council
are studying the declarations made yesterday by the doctor and lawyer Alfonso
Churches that, like legal representative of the Association of Affected by
Medical and Hospitable Errors, a next criminal complaint against the managing
director and the head of maintenance of the hospital of Vigo
announced.
Farjas praised the speed whereupon it had been acted in this
case, successfully obtaining and giving information to identify the problem and
to alert to the population through information means: " there is no precedent
neither in Europe nor the United States of which a case of similar
characteristics has been analyzed with total agreement between the
administrations in a term of 48 hours ".
17th October 2000
The Xunta does not manage to
clarify the origin of legionella that has caused two deaths in
Vigo
Although the number of affected
by the outbreak of Legionella detected day 9 in Vigo already is
known accurately, and although the Xunta assures that the infection is
controlled, persists the doubts on the origin of the bacterium and begins to
arise the judicial suspicions of negligence, complaints and the political
denunciations.
The council of Health of the Xunta admits that perhaps
never it manages to determine the origin of the infectious center. The lawyer
Alfonso Churches, nevertheless, already presented displayed yesterday in a court
of individual Vigo complaints in name of the Association of Affected by Sanitary
Deficiencies and the family of a deceased. According to Churches, " indications
exist that aim at that the cause of the infectious outbreak is in the system of air
conditioning of the Xeral Hospital vigués, of whose directors requests the
processing. As endorsement of its suspicions indicates that seven of the
infected ones are workers of the sanitary center.
The data of Churches do
not agree with the contributed ones yesterday in press conference by the advisor
of Health, Jose Maria Hernandez Cochón. This one does not consider that the
outbreak
comes from the hospital and says that, of the 26 patients with safe diagnosis
of legionella , only an employee is infected. It admitted, however,
that other seven suffer pneumonía.
It was stated the total of
affected is of 26, after the results were known the practiced tests yesterday
five possible ones infected; from these, only one was infected.
Other five patients are pending of
verification. Of the total of patients, thirteen remain hospitalized, eleven
were registered and two passed away.
The precision of affected the
sanitary people in charge when informing into the number of does not correspond
with the doubts who provoke themselves when she is asked for the origin of the
infection. They mention the systems of refrigeration of several buildings,
discard an internal center of the Xeral Hospital, but they do not give a
concrete location. They admitted yesterday that " once they conclude all the
studies are probable that we did not prune to indicate the concrete origin of
the bacterium, or that they have been several simultaneous centers .
This ignorance, nevertheless, does
not prevent the advisor to reiterate that the outbreak is controlled
.
Jose Maria Hernandez Cochón presented displayed yesterday in the
Parliament of Galicia an urgent request to be able to go to the plenary session
of the Camera and to explain this episode. As much nationalistic as socialist,
in the opposition, they had formulated individual requests in the same sense in
which they criticize to the Council of Health.
Another dead by legionella in Vigo
while the Xunta insists on which the outbreak is
controlled
SANTIAGO
The outbreak of legionella detected in Vigo received yesterday
another victim, who passed away in the Xeral Hospital, where had entered the
previous night. The death agreed with the appearance of the advisor of health of
the Xunta, Jose Maria Hernandez Cochón, before the Parliament to insist in which
the outbreak is controlled, although ignores from where it divided to the bacterium
cause.
The announcement of the death was made by the own advisor in its
intervention before the Camera, that carried out to own request to explain the
outbreak of legionella .
This one has summoned up three lives already and has affected other
twenty-nine people, of whom six follow hospitalized. The advisor does not
discard that they can appear more ill. The outbreak of legionella appeared
in the center of Vigo, in a zone where they are the Xeral Hospital, department
store and a hotel. In all those buildings circuits of refrigeration exist where
the bacterium can have been born, that expands by means of the pulverized water.
The proprietors of the commercial center and those of the hotel rejected
anyrelation with the outbreak. The same he made the direction of the union
representing hospital.
Los of the sanitary center think that the origin is in its facilities.
They argue, in addition to a precedent, that in last years the air conditioning
channels have both not been cleaned. Hernandez Cochón showed that they had
studied all the possibilities, in spite of which could not make specific the
origin of the epidemic. He explained that he could originate itself in " any
site where exists water ", and remembered that have been more cases in Navarre
and Alcoy. Source
Media Edited 25th December 2000
20th October 2000
a bacterium causes alarm in
different points from Spain
The Xunta of Galicia confirms 25 patients
of legionella and investigates ten cases more
The authorities not yet have found the center of the disease, that has
already caused the death to two people in Vigo
COMPOSTELA. SANTIAGO
The people affected by the outbreak of
legionella detected in Vigo could be 35 and 19, as initially the Xunta of
Galicia said, according to did not admit the Council of Health yesterday. So
far, the Galician authorities have the absolute certainty, in any case, of which
the bacterium legionella affected 25 citizens, whereas other ten "
cases are in study ".
The sanitary authorities insist on which the center
cause of the disease is controlled, although the exact point is not known in
where it has occurred. Of the total of confirmed cases of the disease, 13
patients remain hospitalized, 10 already were registered and other two
died
The increase in the number of affected does not correspond to new
cases detected after the first outbreak, but that must to a better knowledge of the
real reach of the epidemic. " the center does not increase, but that, fruit of a
retrospective search between the patients entered by neumonía we are finding
more cases of legionella , said sources of Health.
The same sources
also stood out that for seven days " we have not been having new cases ". The
chief of a main directorate of Public Health, To pound Farjas, declared that
this Sunday could occur by closed the episode, since then ten days will have
passed without they have registered themselves new infected.
The Council
of Health also recognized that it does not manage to locate the exact point in
which appeared the center of legionella . One knows that the outbreak is right
in the center of Vigo, between the seat of Spain and the Great one Via, but it
has not been possible to determine the exact origin accurately.
In this
zone is the Xeral hospital - where they are entered most of the affected ones -,
a hotel and department store, as well as two swimming pools. The chief of a main
directorate denied that the origin of bacterías can be within the own welfare
center.
The systems of air conditioning and the water conductions of all
these facilities could have facilitated the diffusion of legionella . In
all these points, equipment of Health gathered samples that are being put under
analysis. The results of these tests will still be delayed two weeks, according
to the chief of a main directorate of Health.
Also, it added that in
principle the studied conductions of refrigeration " fulfill of suitable way the
habitual guidelines of operation and maintenance ".
When the origin of
the outbreak settles down, the Council of Health is had it also jeopardize to
initiate a preventive work between the people in charge of maintenance of
buildings with air conditioning systems. In particular, To pound Farjas
announced that they will enter contact with the companies that have installed
those devices in the last five years in order that they carry far the cares on
the conservation of the good state of the conductions.
THE
GALICIAN GOVERNMENT COMPLETES THE DECREE MOTIVATED SPECIFICALLY TO PREVENT THE
LEGIONELLA
The Xunta will force to twice disinfect to the year all the
systems of refrigeration
The
Galician Government already has prepared the new decree that will regulate the
air conditioning systems and of water heating with accumulation in great
deposits with which he tries himself to avoid the propagation of legionella, a
bacterium that has caused four died in Vigo.
The norm, quite demanding, will affect to all the devices of conditioned
air and the buildings that store great amounts of hot water - from schools to
hospitals, happening through sport hotels and complexes and will at least twice
force to its cleaning and disinfection per year, a measurement that now
discretion of the holders of the systems had left and buildings.
This norm, that the Xunta will approve shortly, does not include
exceptions and will be valid also for all the buildings previous to 1998 - most
of them, year of take effect of the Regulation of Thermal Facilities in
Buildings, that already the obligatory nature establishes to clean them and to
disinfect them.
For all the equipment previous to 1998, the new decree will grant in any
case a term of adaptation to the new norm of two years like minimum.
This specific norm has been ordered to consellerías of Industria and
Sanidade after taking place in Vigo a outbreak of legionella, whose center has still
not detected, that it the past ended the life of four people in month of
October.
The Galician Government made then the decision to regulate the control of
the air conditioning equipment and water heaters with great storage
cells,since legionella finds in the
cooling towers, water condensers and deposits a broth of suitable culture for
its reproduction and propagation to the medio.ambiente.
Spring and autumn
"
the decree will force the periodic disinfection of all the existing facilities,
which supposes that, in addition to the cleaning of the same ones, a
disinfectant will have to be used. Like general rule, it will be come to the
disinfection in spring and autumn ", they explained sources of the Galician
Government.
This measurement has been taken - to lack still to be ratified by the
Consello of the Xunta- after listening to the allegations and recommendations of
the official schools of superior technical industrial engineers and architects,
the Association of Maintenance of Heating and Refrigeration, the Association of
Maintenance and Technicians and the Galician Federation of Associations of
Heating, Gas, Air conditioning and Compatible.
The future decree distinguishes two great types of facilities, since
the level maintenance and the regularity of cleaning settle down based on the
power. Whatever more discharge is, more times will have to be put under
maintenance tasks.
In a group the air conditioning systems are included, heating or
refrigeration by means of apparatuses that affect outer atmospheres, with
equipment of transferences of masses of water in evaporativos cooling tower,
airflow and condenser, and in inner atmospheres with apparatuses of evaporativo
cooling.
In the second type all the facilities of buildings are
included that incorporate sanitary hot water with accumulation (with great
deposit) and that they have as destiny the collective use of people, such as
educative hospitals, clinics, residences, quarters, centers, jails, swimming
pools, clothes of sport complexes, hotels or bath.
Source Media Edited
25th December 2000
16th November 2000
It alerts in all Spain
The main directorate of Public Health of the Ministry of
Health and Consumption has been put in contact with the different autonomic
councils to recommend that preventive measures are adopted before the possible
appearance of new outbreaks of legionella , after the detected ones in Vigo
(Galicia), Alcoy (Valencia) and now in Barcelona.
Minister Celia Villalobos remembered that the communities
have total competitions in public health and that the ministry is limited
coordination workings from the Interterritorial Council (participated by the
ministry and the autonomic councils). Villalobos thought that the
administrations implied in the last I appear " have taken the opportune
measures.
Complaint
by a death by legionella in
Vigo
The relatives of the last mortal victim of the outbreak
of legionella detected in Vigo presented/displayed yesterday in the
courts a complaint by a crime of guilty homicide against the manager of
the Xeral-Cíes hospital, the head of maintenance of the center and the Galician
Service de Salud.
The lawyer of the Galician Association de Afectados by
Medical Errors and the family maintain that the woman infected itself of
legionella in the hospital after being entered by a problem cardiac.
The Association of Affected presented/displayed a complaint
already and the family of another deceased, another one. The School of Doctors
of Pontevedra expressed yesterday its preoccupation by the complaints received
on the lack of information on the outbreak.
