Legionnaires` disease 2001

Since July 2001, three cases of indigenously acquired legionella infection have been reported in residents of a west London health district, and one in a person who had worked in the same area. All cases are males, aged between 31 and 78 years. All the cases have been confirmed by urinary antigen test, but no isolates are available.

Two of the cases are linked to an industrial estate in the area which has several cooling towers. These are the focus of investigations by the local health authority and environmental health department, and the Health and Safety Executive with support from the PHLS Food, Water, and Environmental Laboratory and CDSC regional services.

Colleagues are asked to ensure that cases of atypical pneumonia are fully and promptly investigated to rule out legionella infection.

One case of legionnaires¡ disease and two cases of non-pneumonic legionella infection have been confirmed in an outbreak associated with a hotel in south west England.

Reports of illness indicate that there are at least a further seven unconfirmed cases with symptoms suggestive of Pontiac fever.

The case of legionnaires` disease occurred in a woman aged 84 years and the two non-pneumonic cases in men aged between 60 to 70 years.

All those affected were part of a group and stayed at the hotel at the beginning of October. Exposure to a spa bath in the leisure facilities is likely to be the source of their illness. Guests from the party experienced a relatively sudden onset of fever, myalgia, and headache within 24 to 48 hours of using the spa bath.

Ten cases were admitted to hospital either locally or on return from their holiday. All cases of Pontiac fever are thought to have recovered.

The patient with legionnaires' disease was exposed to the spa bath (although did not enter it) three to four days before the onset of symptoms. Legionellae pneumophila serogroup 1 antigen has been detected in urine from the three cases and L. pneumophila sg1 isolated in one sample of water from a shower in the hotels pool area.

All guests staying at the hotel during the first week of October have been contacted by letter and have been asked to complete a questionnaire.

A pensioner has died and two other men are recovering following an outbreak of Legionnaires' disease.

Health officials are investigating if there is a link between the men, who all lived within a mile-and-a-half of each other near Rotherham, Yorkshire.

Experts originally suspected that the dead man, aged 67, had picked up the illness during a holiday in Turkey.

A 42-year-old man was being treated at the Bassetlaw Hospital but is now recovering at home.

Dr Kevin Perrett, public health consultant for Rotherham Health Authority, said: "We now have to carry out a detective job to find out the possible source or sources for these cases

"It could be that each person contracted the illness from a separate source and that it is a coincidence."

The first man died of the illness on 10 June while the second case was diagnosed on 9 July.

Dr Perrett said: "The first man had recently been on holiday and we thought that he may have picked up the disease while abroad.

"One of the other men affected had also been on holiday abroad and the other man works in a factory which can also be a source."

Officials from Rotherham Council's environmental health department will now interview the men and their families to see if there is a common link between the cases.

Eurosurveillance Weekly has previously reported a community outbreak of legionnaires' disease in Norway, in the city of Stavanger, on the west coast of the country

(1). Twenty-six confirmed cases and two probable cases were identified in this first reported outbreak of legionellosis in Norway.

The first patient presented with symptoms on 18 July, the last on 7 September. All confirmed cases had urinary antigen detected. In addition, Legionella pneumophila serogroup 1 was cultured from nine patients. Of the 28 patients (both confirmed and probable cases), 21 were local residents in Stavanger and surrounding municipalities, and five were residents of other parts of Norway travelling through the city. In addition two foreign nationals staying in the city were diagnosed with legionnaires’ disease, a businessman and a tourist. The tourist was identified through the reporting system of the European Working Group for Legionella Infections (EWGLI, <http://www.ewgli.org/>). Seven of the 28 patients died, including one of the probable cases. The age range of the cases was from 16 to 94 years (mean age 54). The mean age of those who died was 81 years (range 43-94). Twenty-one of the patients were men.

Investigation carried out by local health authorities showed that all the patients had been in the same area in the city centre within 10 days before the onset of illness. Three of the patients had been staying in a hotel in the same area. Water samples taken from the cooling tower of this hotel subsequently showed presence of L. pneumophila serogroup 1. The air outlet of the cooling tower was situated five metres above ground level, close to a bus terminal. Nine isolates from patients and five isolates from the cooling tower were genetically compared at Statens Serum Institute in Copenhagen, Denmark, and Statens institutt for folkehelse (National Institute of Public Health, NIPH) in Oslo and showed similarities and were different from other known Norwegian legionella isolates.

The onset of symptoms of the last reported case occurred nine days after the cooling tower in the hotel was taken out of service and disinfected on 29 August (figure).

Outbreak of legionnaires’ disease in Stavanger, Norway 2001. Epidemic curve by onset of symptoms

Close cooperation between local health authorities, the local microbiological laboratory, and NIPH was essential in this successful investigation. To prevent further outbreaks, an information programme aimed at hotels, engineering consultants, and health professionals will be implemented. Current Norwegian prevention guidelines will be updated in accordance with the forthcoming European prevention guidelines produced by members of EWGLI.

The first known case of the disease discovered in Norway happened in 2001. 28 people were infected in the city of Stavanger, and seven people died. At first the authorities were puzzled as several of the victims lived all around the country, including one in Germany and another in England. After a massive hunt the source of the outbreak turned out to be the small lake of Breiavatnet, which has a fountain in the middle of it. The fountain had sprayed the bacteria into the air, in turn getting picked up by a cooling system at a Stavanger hotel close by. Only three of the infected had stayed at the hotel but it turned out the exit shaft of the cooling tower was right next to a public bus stop, explaining the other victims.

The Council of Health of the Meeting investigates three at the moment cases of pneumonía by legionella detected in three patients whom they remain entered in the Virgin Hospital Macarena of Seville.

According to the Provincial Delegation informed into Health in Seville, entered people present/display pneumonía by legionella of type communitarian, that is to say, that has contracted the disease outside hospitable scope.

According to the data of the health administration, two of patients are entered the Unit of Intensive Cares: one woman of 74 years, resident in a municipality of the province of
Seville, and whose prognosis is serious; and a man, of 50 years of age, that it evolves of favourable form, reason why is anticipated that it can to happen next to plant. The third patient is another man, of 55 years, that also evolve of favourable form.

Previously, according to the spokesmen of the Delegation explain of Health, registered another communitarian case of legionella in a woman of 38 years, that passed away the 17th of October, as a result of a failure respiratory, and that resided in the environs of one of patients at the moment entered. For this reason, the technicians of Public health, in collaboration with the local authorities, is carrying out the corresponding measures of monitoring and control in the surroundings of both people.

The health administration insists, in relation to the patients hospitalized, in which one is " isolated cases " that they do not have no relation to each other and the opportune ones are being made studies to determine which is the origin of the disease in each one of the patients, so and as establishes the protocols of performance in case of legionellosis.

The doctors of the hospitable center have maintained informed to families of the patients, as much on the made tests as on the diagnosis of pneumonía by legionella and the processing anticipated the patients.

HEALTH officials are advising Mitcham residents and workers to be on alert for signs of legionella after three men caught the disease.

The men, aged 39, 48 and 52, all either live or work in Thornton Crescent, Mitcham.

Department of Human Services yesterday sent letters to hundreds of houses and workplaces nearby to be on the lookout for symptoms.

Victorian chief health officer Dr John Catford said authorities were concerned other people might fall ill when there was a cluster of victims.

Cooling towers at three workplaces have been tested and decontaminated, with results of the tests expected to take about a week.

"We've screened and rendered safe all the relevant towers and we'll be waiting for results of the tests which, because we have to wait for this bacteria to grow, does take some days and it will be some days therefore before we can pinpoint the cause of the cluster," he said.

All the towers had been registered in compliance with Victoria's new legionella laws.

The three men had all been treated at hospital: two were discharged and the other is due to go home in the next few days.

There have been 98 cases of legionella, including seven deaths, in Victoria this year.

The Department of Health of the Catalan Government confirmed yesterday the existence of three cases of infection by legionella in Tarrasa (Barcelona) and also warned of the " suspicion " that it can have a outbreak of this disease in the city. In a notification directed to the Consistorio of the city, the Generalitat informed on the detection of the three infected people, one of who was registered whereas the other two evolve favourably, but emphasizes that these cases suppose a " suspicion of outbreak " of legionella.

According to the official notice, although the three affected people reside closely together, " the infections have not agreed in the time and one of them, for work reasons, visits different points from the regions of Barcelona ". For this reason, the Department of Health has requested to the City council of Tarrassa that facilitates information to him about the state of the cooling towers located in the South-eastern zone of the city, where reside the three people affected by the infection.

On the other hand, the Consistorio, that recently made a census of the towers, has put to disposition of the Generalitat all the information that it has and it has impelled an operative one of pursuit of the evolution of the detected cases of legionella.

They detect two suspicious cases of legionella in the Hospital Juan Ramon Jiménez de Huelva

The Council of Health of the Meeting of Andalusia has detected two cases of legionella in the Hospital Juan Ramon Jiménez de Huelva that affect two women, " middle-aged and the other greater one ", according to the accidental delegate of Health, Mountain Antonio.
The two affected women were entered in the Unit of Oncología of the hospitable center, where they stay in a state that, according to Serrano.
The direction of the Hospital has opened an investigation to verify the state of the conductions of water and air of the center, although any similar measured protocol of isolation nor of the zone has at the moment not been carried out where the cases were detected.

LINARES (JAÉN)
the direction medical of the Hospital Saint Agustín of Linares (Jaén) recognize yesterday the existence of two case suspicious of legionella in two old people in the center with pneumonia, although reject the hypothesis of that have infect in the same hospital because not be enter in the center in the last month.

The manager of the hospital, Antonio Resola, said both patients had entered the hospital from last Monday in the Unit of Care Intensive have 72 and 80 year of age, both neighbour of Linares, that find at the moment enter in state serious in the Unit of Care Intensive with a diagnosis of pneumonia communitarian or extra hospitable with suspicion of legionella " in a 99.9 percent of probability ". Both patients began to feel ill the 18th of August, reason why they decided to go to the emurgencies of San Agustín de Linares Monday, once verified that they felt worse. In this unit pneumonia was diagnosed to them extra hospitable and were entered.

The sources added that in the day the state of both people worsened yesterday, reason why entered the Unit of Intensive Cares, where they are being put under a specific processing, and bacteriological analyses were asked for to determine the causes of this ailment, including a study on legionella pneumophila. These analyses will be known in a maximum term of 72 hours. The direction of the hospital remembered that these patients were not admitted the hospital in the last months, reason why discarded that in principle they could have been infected in the hospitable enclosure. For that reason, the manager discarded that some type of risk for the rest of patients exists.
The relatives of one of the old ones who could be infected of legionella in the hospital san Agustín de Linares assured that " nobody in the hospital has informed to us into which the possibility that exists it has been able to contract legionella, to only have spoken us of pneumonia extra hospitable ".

A person died the week last as a result of " legionella pneumophilia " in the Hospital Marquess of Valdecilla of Santander, after contracting this disease outside the hospitable center.

Three patients contract legionella in the own Hospital of the Baja Fertile valley

The Hospital of the Low Fertile valley, in a has decided to superchlorinate the water

Public health affirms that the rooms have been closed, have taken environmental samples and it is going away to superchlorinate the water

The Hospital Low Fertile valley of Orihuela has communicated to the Conselleria of Health which three cases of pneumonia by legionella of nosocomial origin have been diagnosed in this center Disinfection acquired in the own center hospital and considered other like of probable, informed yesterday sources into the main directorate of Public Health. The patients are three men of 58, 74 and 69 years, first of which she has been registered, whereas the other two evolve favourably, according to the same sources. The mentioned hospital has adopted the preventive hygienic measures and has summoned to the meeting of personnel with the purpose of giving to the pertinent information on the situation and the taken decisions.

In this sense, the hospital has evacuated the affected rooms, that are in the first plant, has taken environmental samples from the same ones and has disinfected all its devices.

Also it will be made a hypercorrection of the water and ample a taking of random samples in all the hospitable center, besides to continue the active search of new cases of possible nosocomial origin.

However, during the last year the Hospital Low Fertile valley of Orihuela has adopted a series of measures of control in relation to the contamination by legionella.

Between these they appear three superchlorinate of the water systems, the disinfection of the conditioned air and the substitution of the manual system of chlorine of the water, including the cooling towers, by another automatic with frequent controls and adaptation to the necessities of the network.

Also the disassembling and meticulous disinfection of the cooling towers have been carried out, the substitution of the systems of fixed showers by systems of telephone in all the hospital, the disinfection with chlorine of the faucets of all the rooms and a monitoring epidemiologist of all the cases of pneumonias that they have been diagnosed in the hospitable center.

In addition, the hospital is coming to the installation of metallic ionisastion in cold the health water systems and warms up.

LEGIONELLA-FALLECIMIENTO TOURIST BRITISH THAT SPENT THE SUMMER IN SALOU DIES BY LEGIONELLA

A British tourist of 63 years the past passed away Friday in the Sant Hospital Joan de Reus (Tarragona) as a result of one pneumonía by legionella, according to has confirmed today the Delegation of the Department of Health of the Generalitat in Tarragona. The same sources have indicated that the deceased, that was spending days of vacations in a hotel of Salou, had pathological antecedents of isquémica cardiopathy and chronic respiratory insufficiency by silicosis.

The man entered the 11 of August in the Surgical Medical Center of Reus by acute respiratory affection and two days later Joan de Reus by agravamiento of the clinical panel with complications by her pathologies of base was transferred to the UCI of the Sant hospital.

During the past weekend the Delegation of the Department of Health in Tarragona initiated the habitual performances derived from the notification of a case of legionella.

Delegation of Health, that it investigates if the disease contracted it in Spain or it already brought it incubated, it stands out that it is an isolated case with fatal consequences, due to the antecedents of the patient, and adds that another case of legionellosis related to this episode has not communicated.

A old one the past entered 14th of July in the Hospital of Crossings of aquejado Bizkaia of legionellosis the past passed away Monday at night, according to confirmed sources of the Delegation vizcaína. The man slept habitually in the Attended Residence of Leioa, pertaining to the Leasehold Delegation of Bizkaia, accompanied by his woman.

After entering the old one in the hospitable center in the middle of the last month, the Delegation prohibited to use the water network of the Residence like preventive measure, while the conduits were examined. To the delay of the results, from the leasehold institution they discarded that the premises were an infection center.

At first, the man presented/displayed influenza symptoms, and since its state of health did not improve he was entered the 14 of July in the Hospital of Crossings. It was here where a possible panel of legionella was diagnosed to him, that, later, the test was confirmed when making to it and to give him positive.

This same week, the past Tuesday, vizcaíno of Getxo also passed away in the Hospital of Crossings a neighbor of the municipality, of 48 years, due to one neumonía caused by the bacterium legionella. After knowing the first case the week, the advisor of Health of the Government of Lakua, Gabriel Inclán, denied the existence of a outbreak of legionella in Bizkaia, although he recognized that there have been several " isolated cases ". Yesterday, the health authorities continued speaking of isolated cases.

This year 22 cases of legionella have been detected in Plowed, Bizkaia and Gipuzkoa,

A neighbor of Getxo of 48 years dies of legionella in the hospital of Crossings

A neighbor of Getxo passed away Tuesday in the hospital of Crossings of one neumonía caused by legionella. Technicians of Public Health have met with relatives and fellow workers of the victim to determine the places that month frequented in the last Miguel Angel C., and to try to locate the infectious center.
The specialists will review the conditioned air systems and the network of water conduction of the places in which it was possible to be produced I infect.

The man, who resided in a floor of Algorta next to his family, is the third person who dies of one pneumonía caused by legionella in which she goes of year in Euskadi, where all the mortal cases concentrate itself in Biscay.

The other two victims of the east disease year have been two old ones of more than eighty years, without no relation among them nor with the deceased the past Tuesday. One of the pensioners lived completely isolated in a small village.

He is habitual which the disease has a greater index of mortality between the people of more age, when having less defenseto fight the effects of the bacterium. On the contrary, Miguel Angel C. was a relatively young man and " totally healthy ", according to their fellow workers confirmed.

The statistics mainly show that every year tens of affected and several deads in the community by legionella take place, between July and November, since the heat and the humidity favour the proliferation of the bacterium in the facilities that use water. During year 2000 80 affected in the community were registered and four deaths.

The past July, Health also investigated the origin of the infection contracted by other two people in Biscay, a man who lived in a residence of old on Leioa and a foreign tourist. Nevertheless, the results of them inspection are only made public in case an outbreak exists: that more than two people they have been infected in a same installation, to the supposition already a risk for the public health.

The Cabinet the past approved Friday a real decree in which the hygienic and health criteria for the prevention and control of legionella settle down. The holders of the facilities will be the people in charge to guarantee the correct operation of the facilities able to produce the disease, between which are hydric cooling towers and other systems.

In the Basque Country 80 cases of legionella took place the last year recognized by Health of the Basque Government and four mortal victims registered themselves.
During this year the affected ones have been 27, of which three have passed away. The greater outbreak in Spain has been registered in Murcia, where already four people have passed away.

A man committed in the Hospital the Flat one of Vila-real is affected of pneumonía caused by legionella . The Conselleria of Health confirmed yesterday to the Mediterranean the existence of this case of legionella pneumophila in the province of Castellón, infected outside the hospitable center. Apparently, they indicated the sources, the man became infected in Santander during its vacations, of which it finishes returning.

The patient, boarding school days ago in the vila-realense health center, was put under diverse tests and analysis before the clinical panel that presented/displayed. Yesterday, Thursday, it was practiced him antigen tests, and its result was positive to legionella pneumophila , according to the sources.

The affected one, of which single one knows that it is 64 years old since its identification has not become public, is in the Unit of Intensive Cares.

This it is the second case of legionella in humans that is detected in Castellón, although unlike first -- a nurse that worked in the Provincial Hospital the --, center finds outside the province.

A patient is admitted the Hospital of the Coast of the Sun because of a legionellosis. The patient evolves favourably. This case is sporadic and it does not bear any relation to the factors from risk of I infect of legionella, according to showed yesterday to this newspaper the provincial delegate of Health, Jose Luis Marcos. To the patient one was diagnosed to him pneumonia in the urgencies of the Hospital of the Coast of the Sun, caused by the bacterium of legionella.

The delegate of Health indicated that the patient is stabilized and its evolution is good from the clinical point of view.

The legionellosis that that person suffers does not keep relation from any type with the channels of I infect of legionella in establishments or places public, reason why there is no possibility that it appears a outbreak.

Marks indicated that annually they take place in the province of Malaga between six and seven cases of legionellosis, of approximately the 40 that are registered in Andalusia. The delegate specified that those cases are not related either to the risk factors of contracting legionella in a public place (hospitals, hotels, commercial establishments), reason why does not exist danger of a outbreak or an epidemic.

Legionella is a bacterium that affects the respiratory system and whose manifestation usually is one pneumonia. The people who have losses the defences of the immune system are more prone to be attacked by the bacterium, commented Jose Luis Marcos.

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The first ever outbreak of legionellosis reported in Norway has beendetected in the city of Stavanger, which is on the west coast and has apopulation of 100 000. As of 29th Aug 2001, 14 cases had been reported, withthe first case on 2th July2001. All cases have had a clinical presentationcompatible with legionellosis.

A total of 13 cases have been confirmed by legionella antigen test in urineby culture of respiratorysecretions (11 men and 3 women, aged 20-94 years).

Nine of the patients are residents of Stavanger but live far apart. Theothers have visited Stavanger since mid-July.

The local health authoritiesare investigating the outbreak in collaboration with Statens institutt for folkehelse (National Institute of Public Health, NIPH) in Oslo.

Stavanger is the land base for the offshore oil industry in Norway and alsoreceives large numbers of tourists in the summer. NIPH would like toreceive immediate reports of cases who have visited Stavanger this summer.

[Byline: Preben Aavitsland (<preben.aavitsland@folkehelsa.no>), Statensinstitutt for folkehelse, Oslo, Norway]

As of 4th Sep 2001 the National Institute of Public Health (NIPH) Oslo,Norway has reported a total of 19 cases (17 confirmed by urinary antigendetection and 2 probable cases) including 2 deaths in Stavanger on the westcoast of Norway.

The first patient presented with symptoms on 26th Jul 2001, while the latestcase presented with symptoms on 1st Sep 2001. All the patients had visited alimited area of the center of Stavanger within 10 days of the onset ofsymptoms.

Local health authorities in collaboration with NIPH have identified several possible sources of legionellosis within this area, including a waterfountain situated in a park and several cooling towers. Results fromsamples taken from these possible sources are pending.
The fountain inquestion has been closed down and all cooling towers in the vicinity havebeen disinfected.

WHO encourages those who have information regarding possible cases inpersons who may have been in Stavanger during this period to contactdirectly one of the following:

Last week, Eurosurveillance Weekly reported a community outbreak of legionnaire¹s disease in Norway, in the city of Stavanger, on the west coastof the country (1). As of 4 September 2001, a total of 17 confirmed cases and two probable cases of legionellosis had been identified in thisoutbreak.
The age range of the cases is from 30 to 94 years. Sixteen of the patients are men. The first patient presented with symptoms on 26 July, the latest on1 September. All confirmed cases had urinary antigen detected.
In addition,a number of samples for cultures have been taken.
Of the 19 patients (both confirmed and probable cases), nine are local residents, 10 are residents of other municipalities in Norway, and one is a foreignbusinessman who was travelling through the city. All the patients had visited a limited area of the centre of Stavanger within 10 days of onset of symptoms. One confirmed and one probable case have died. Local health authorities in collaboration with Statens institutt for folkehelse (National Institute of Public Health, NIPH) in Oslo have identified several possible sources within that area,
including a water fountain situated in a park and several cooling towers.
Samples from these possible sources have been taken. No results are available so far. Any environmental isolate will be compared with patient isolates by genetic methods.
Measures have been taken in relation to possible sources of the outbreak.
The fountain in question has been closed down, and all cooling towers in the vicinity have been disinfected.

Reference:
1. Aavitsland P. Outbreak of legionellosis in Stavanger, Norway.
Eurosurveillance Weekly 2001; 5: 010830.

- 12/05/2001

BARCELONA

a case of legionella has been diagnosed in a prisoner of penitenciaría of Dog Brians, in Sant Esteve Sesrovires. The man, of 37 years, began to be bad and the past entered day 10 in the penitentiary hospitable pavilion of Terrassa, where legionella was diagnosed to him yesterday, the Departament of Justíce informs. The internal one (a prisoner of module 4, of ordinary fulfillment) evolves favorably, but the case has caused alarm by the fear to that an infectious outbreak in the prison takes place and can infect to more prisoners and civil employees

The direction of Dog Brians informed into the case to the representatives of the workers. Union the UGT insisted yesterday to adopt of immediate way all pertinent the health measures in these situations to avoid possible new internal or working contagios of in the penitentiary center. A spokesman of the union indicated that she did not have myself more information but than trusted that measures would be taken to avoid a outbreak.

The chief of a main directorate of Public Salut of the Generalitat, Lluís Salleras, explained that Justícia communicated yesterday to Sanitat the case - legionella of is forced declaration so that it consists in the health registries and immediately an investigation was started epidemiologist - the experts of Sanitat collaborate with the doctors of penitenciaría- to see which could have been the focus of infection of the patient. In addition, samples began to take themselves from the possible centers and the habitual measures of disinfection, environmental character and even in the showers. According to Salleras, until the moment one has not detected that other prisoners of the jail present/display symptoms of the infection. " There are indications of a no outbreak and, so far, everything aims at an isolated case ", assured.

This is the first occasion in which a case of legionella in Dog Brians is detected, although in the last months several outbreaks of this infection, caused by a bacterium have been registered in Catalonia that nests in humid places. The most common centers are the cooling towers of conditioned air systems, for that reason after the outbreak registered in autumn in the Barceloneta, that affected almost half hundred of people, it was approved a norm for the cleaning and periodic disinfection of these facilities. Legionella, ailment that is looked like an influenza, is not infected of person to person and most of the times it is cured with relative rapidity.

12 of May of 2001\

First case of legionella in a Catalan jail

BARCELONA. An internal one of the prison of Brians, in Sant Esteve Sesrovires, has been the first Catalan inmate affected by legionella. But, apparently, the panic in the prison does not have to spread. Department of Justícia of the Generalitat assured yesterday that it is a " isolated case " and completely discarded the risk of an epidemic.The doctors suspected this case five days ago, when they transferred to the internal one to the penitentiary hospital of Terrassa. The analyses confirmed yesterday that the prisoner undergoes one pneumonía caused by legionella, whose origin is not known at the moment. On the other hand, the person in charge of prisons of the UGT, Antonio Benedicto, indicated yesterday that the affected one is an inmate classified in second penitentiary degree - with right to some permissions of exit -, committed in the fourth module of the prison of Brians - of ordinary regime and is seropositivo, which him made more prone to infect itself of legionella.

The Main directorate of Prisons of the Generalitat, according to a spokesman of Justícia, already has adopted the opportune health measures to avoid that legionella propagates and becomes an epidemic. The prison authorities have discarded completely that can be produced this possibility. \

Between the adopted measures of " prophylaxis " it appears the disinfection with lye of the considered zones of risk, like for example the common showers, the communitarian washbasins or office of the dining rooms, points where the humidity is concentrated and where it thinks that the bacterium of legionella can have been incubated. On the matter, Antonio Benedicto explained that neither in the prison of Brians nor in its environs there are cooling towers, facilities in which also the bacterium is developed

Since the 7th July, incidence has declined rapidly and there have been no new cases reported since 14 July.
The epidemiological investigation and surveillance are continuing.
The most likely source of the outbreak is a cooling tower in the city centre. The cooling tower has now been disinfected.

Information received after this posting indicates that several cooling towers in the area were positive for Legionella by the polymerase chain reaction (PCR), but the organism has not been isolated thus far. Control measures have focused on all cooling towers which may be involved, as well as other potential sources.

There has been another outbreak of legionnaire's disease at European hospital Georges-Pompidou. Between 29th Jun 2001 and 9th Jul 2001,

3 new cases of the disease were diagnosed at the hospital, 2 of which have proved fatal.

After the epidemic which spread between November 2000 and January 2001, the new outbreak has brought the total number of cases in the hospital to12, including 6 fatalities.

In March [2001] it was thought that the danger was over after a series of changes were made to the hot water system. The hospital will not be closed, but a number of new measures will be put in place to combat the problem.

the epidemic of legionella untied the last week in Murcia has affected until the moment to 670 people, of whom nine remain entered in units of intensive cares with favourable evolution, informed the advisor into Health, Francisco Marquess, whom it emphasized that the episode tends to send. Marquess, who made these declarations during his visit to the services of urgencies of the Hospital Morales Meseguer of Murcia, advanced that this noon the cabinet of crisis will meet constituted in the occasion of the epidemic and integrated by people in charge of the Council of Health, the Presidency and the City council, for " adopting measures of homogenous character " in all the facilities of air

The advisor of Health and Consumption of the Region of Murcia, Francisco Marquess, showed today that, according to data of the 18,00 hours, the number of patients by legionella in Murcia already promotes to 228 confirmed cases, whereas the number of possible patients of pneumonía is of 575, " of which the 71.8 percent have been entered ".

Marquess indicated that of the 228 confirmed cases the 74.6 percent is men, and the 25.4 percent is women, to the time that indicated that " there are 12 people in the Units of Intensive Cares of the different hospitals from the Region, one of them, of 31 years, in very serious state ".

Also, the advisor today presented the facilities where the DNA tests have been positive, to the time that needed that " 14 facilities have given positive in 6 great continents, that are: the building of old the Appraised Galleries, the English Court of the Avenue of the Freedom, the Palace of San Esteban, the council of Agriculture, the council of Health, and the central offices of Cajamurcia ".

Marquess affirmed that in the samples taken in the facilities of these places " rest of DNA exist ", to the time that it asserted that " in agreement they have been arriving the results from the laboratory of these places have gone away systematically cleaning, disinfecting or stopping, and all absolute and they are totally verified, so that we can guarantee, to date of today, that no of them constitutes no risk for the public health ".

In this respect, it added that in the building of Galleries, the cooling tower, the intervention measures have been made, is to say closing, cleaning and disinfection, as well as that is open; in the conditioned air raft of the building of Galleries everything is made and also he is open; and the general depot of the same building has a hipercloración order and is closed.

On the Palace of San Esteban, it declared that " it has a closed circuit and does not exist cooling tower, reason why is impossible that it is emitting center, as much within the own Palace as outside, and one is open ". In the English Court of Great Via, in the department deposit three of the cooling tower " all the operations have been made and it is open with all the guarantees, and in the cleanliness of ladies of the third plant, a washbasin has hipercloración order, that is made but he remains closed ".

Also, Marquess indicated that in the council of Agriculture, Agua and Medio.ambiente " a purge in the cooling tower has become and all the operations are concluded, with which has opened itself ", whereas " in the central offices of Cajamurcia in Great via, in the cooling tower the operation has been made and is open ". Finally, he affirmed that " in the council of Health, in the cooling tower number one, all the operations have become and it has opened itself ".

Marquess also explained the reasons by that these data have not been facilitated before, indicating that the council of Health " at no moment desveló no name before he appeared in mass media, because the facilities can have or not the character of potentially infectante center ".

Uncontrollable " and irresponsible alarm "
In addition, according to the advisor " mentioning four facilities was assumption, in the later days, an inevitable dripping of new facilities that had been able to lodge DNA of legionella, and hubiesemos generated uncontrollable and irresponsible an alarm, and under my only responsibility those data have not been facilitated ".

Marquess stood out that the situation in the doors of emergency of the hospitals and in the services of urgency of the centers of Primary Attention of the city is of " total and absolute normality during last the 48 hours, and is the most important descente tonic ".

" Situation in hospitals is good, is taking care of patients of way suitable and has beds free in case new income take place, that are foreseeable in the next hours ", added.

They continue them inspection
As far as health them inspection, Marquess aimed that " they follow cultivated the samples that have been obtained and that are continued obtaining in the systematic hairdo that is being made, fundamentalmante, in District 1 of Murcia, as well as in the adjacent zones, although not yet we have the news ".

Thus, Marquess explained that they continue sending the samples taken to the laboratories for the fast determination from the DNA of legionella, to the time that he reiterated that this test " is not feaciente that they are centers of infection, because only determines the existence of legionella at one or another moment, without the necessity that now the bacterium is there ".

and 80 years and more, the 5.9 percent.
As far as the locality of residence of the confirmed cases of legionella, the 68 percent of the affected ones belongs to Murcia-centre,
17.7 percent to pedanías and the 14.3 percent to other municipalities of the Region.
Also, it detailed that the cases of suspicion of pneumonía per date of hospitable attendance, until the 18,00 hours of today, are the following one:

The advisor of Health also talked about to the number of discharges given until today, that ascends to 150, the time that he reiterated that " only a death by pneumonía with suspicion has taken place ". " This makes us say that foreseeable and with all the prudence, the legionellosis epidemic that has affected Murcia is in the declining phase of a form definitive, and probably absolute, although despite they will continue entering patient the hospitals and will be diagnosed of pneumonía by legionella, given the period of time of incubation that this germ causes when producing the pathology ", it asserted.

Finally, Marquess assured that the president of the Independent Community, Ramon Luis Valcárcel, " has been in all and in each one of the moments of this process, total and occupied and absolutely worried about this subject ".

The advisor of Health and Consumption of the Region of Murcia, Francisco Marquess, today showed that the number of patients by legionella in Murcia ascends to 178 cases, to the time that indicated that the number of possible patients of pneumonía is of 470.

Marquess indicated that " the number of cases no longer is going to vary significantly ", to which he added that " there are 10 people in Unit of Intensive Cares, concretely 5 in the Morales hospital Meseguer, one in the Arrixaca, 2 in the Fertile valley, and other 2 in San Carlos, all with stable prognosis and well ".

The outbreak of legionella that affects Murcia is generating the alarm between the citizens. At the moment already a person of pneumonía has died, and they remain hospitalised six more in intensive cares affected by the bacterium. Of the 253 patients, to 86 already it has been confirmed to them who have legionella. And what is worse, still the infected center has not been located.
The urgencies, meanwhile, colpasadas

The number of patients by legionella in extreme Murcia and follows. Up to 253 cases of pneumonía they have been taken care of already in the different hospitable centers from the region. 175 samples have been analysed and of them, 86 have given positive by legionellosis. Six people are entered in Units of Intensive Cares.

They are fulfilled therefore the worse prognoses, because in addition one to the affected people, a man of 65 years, passed away at dawn of yesterday. The results of the autopsy will clarify if its death could have relation with legionella, had admitted the aquejado hospital of one pneumonía.

And while, practically all the region lives to the doors of the hospitals. Some wait for the news about the state of their relatives and they complain the saturation of the centers. But the majority goes when verifying that it suffers the symptoms of the disease.

What still one looks for without rest is the center of this epidemic. All the cooling towers located in roofs of the zone have been inspected already center and they are continued taking samples from the refrigeration apparatuses. The alarm or is untied because this epidemic of legionella, in total phase of incubation, is or most virulent of the last years

The epidemic of legionella of Murcia registers one dead and 210 patients by pneumonía
The number of affected is doubled less in than 24 hours and is predicted that it continues raising

Although the analyses have still not confirmed it, everything aims at that a people of the Murcian district of Santa Maria de Gracia - the zone where it suspects that it is the infection center is the first mortal victim of the epidemic of legionella that is doing damage in the capital of the Region.
Therefore it at least assured yesterday the advisor Health, Francisco Marquess, who for the second time in less than 24 hours admitted that the Community and the City council of Murcia face a problem of public health of unpredictable consequences.
The number of affected increases as spend the hours: if Sunday there were 117 patients, to the closing of this editing they were already the 210 patients with pneumonía, of which more than 140 have admitted the hospitals, and two are in the UCI.
Antonio Ródenas, of 64 years, died Sunday in the hospital as a result of one serious pulmonary infection.

The death of a person of the center of Murcia, almost with complete certainty by the devastating effect of the bacterium, ratifies the thesis of the Council of Health on the place where the center of the epidemic resides.
Every time it seems clearer that the cooling tower by water where legionella lodges finds installed in the district of Santa Maria de Gracia or in its environs.
The patient of pneumonía that died last Friday, also in the UCI of Morales Meseguer, lived in the street Smaller Sea on the mentioned Murcian district, the same direction in which resided Antonio Ródenas.

The dripping of cases follows in increase. Throughout the day of yesterday they continued arriving at the doors of urgencies of the citizen hospitals that presented/displayed the symptoms characteristic of the legionellosis: strong headaches, dry cough, very high fever, vomits and in some cases diarrea. To last hour of last night, the Council of Health had registered a total of 210 cases of pneumonía - the majority men -, and the existence of the bacterium in 57 of than one hundred tests the more made to patients had been confirmed.

Wrapped by the heads on watch of Public Health and Epidemiology and by the mayor of Murcia, Miguel Angel Camera, the advisor of Health appeared yesterday before mass media to facilitate what takes way to become the childbirth of the day. The fatigue and the preoccupation were let notice in the faces of Francisco Marquess and Camera.

The Maxima health authority of the Region explained that, in accordance with the data received in the council throughout the dawn of Monday and during the day of yesterday, " it is possible to be affirmed that the situation is slightly better than the one of Saturday and Sunday ".

However, Marquess clarified that " the positively of the antigen with respect to legionella is being determined in more cases, which on the other hand is normal that it happens when epidemics like the present occur ". The advisor insisted on which " we are in a better situation, from the health epidemiologist and point of view ".

The percentage of people entered in hospitable centers with respect to the total of affected is almost of 80%.
The rest of patients receives processing in their addresses and they recover without problems. Most of patients with pneumonía susceptible to be caused by legionella they are bed-ridden in Morales Meseguer, which had mainly to that this hospital is the center of reference for the zone of Murcia where more cases of pneumonía are arising: Santa Maria de Gracia, goes up to around North and part of the avenue Juan Carlos I.

In spite of the important affected increase of the number of, the advisor of Health guarantees that in the hospitals there is site to take care of the alluvium of patients very well. According to Marquess, at noon of yesterday they were left 118 free beds in the health centers, that can be destined people who enter with symptoms of respiratory infections by pneumonía. Colapsada Sala of income in the door of Urgencies of the Hospital Morales Meseguer, of Murcia.

The epidemic of pneumonía caused apparently by legionella untied in Murcia from the past Friday has affected to the moment to 151 people, of whom 120 remain entered in hospitable centers, two of them in the unit of intensive cares, today informed the advisor into Health, Francisco Marquess.

The advisor confirmed, also, who this dawn has passed away a person of 65 years in a hospital of Murcia affected by pneumonía, but has needed that the same one began to be treated day 15th of June and that until they do not know themselves the results of the autopsy will not know if the death has relation with the epidemic of legionella.

The tests made to the 151 people affected by pneumonía have confirmed that in 53 cases the origin of the disease was legionella.

Marquess again requested " tranquillity to the population " because " it is not possible to be done more of those than he is being done ", and assured that " there is no collapse in the urgencies of the hospitals ", although yes great affluence of patients, and that all the centers have free beds to take care of possible new patients.

To last hour of, Marquess he explained yesterday that one was 117 patients and only 10 confirmed cases. Affected health does not discard that it can follow increased the number of, since the period of incubation is of between two and ten days, and has qualified two telephone numbers to inform to the Murcian:

The advisor indicated that, apparently, the epidemic began Friday the past and the center is located in the center of Murcia, where a numerous group of technicians, helped by a helicopter of Civil Protection, worked yesterday in the evening in the inspection of several cooling towers and public source to detect the origin.

Marquess asked the citizens who do not fall " in the alarmism " because he is working in the detection of the center and advanced that the Murcian can drink " with guarantee " water of the provision network because has been verified that is not contaminated.

The affected ones, all adults, are in their majority (60%) of the district of Santa Maria de Gracia, located in downtown, and people of North Ronda, one of the main road arteries of Murcia.

87% of the patients are men (97 people) and 13% women (20 people). Most of the patients they are mayores of 50 years, of which 10% are mayores of 80 years.
Minors of 20 years 1.5% of the cases have been only registered until the moment.
The person who remains entered in a the UCI in the Hospital of the Fertile valley is 50 years old.

The advisor indicated that 11.1% of the affected ones reside in pedanías of Murcia, and 25.7% come from other municipalities of the Region, although it emphasized that " with all probability, the contagious have taken place in the capital ". Marquess explained that from afternoon of Friday, technicians of the City council of Murcia and the Council of Health work in the collection of samples in cooling towers to locate the center.

The advisor insisted on which " there are 117 people who have pneumonía, which does not mean that all of them undergo legionellosis, but that has the pathological process, but it is not necessary to hide that there are 10 cases in which the test of the antigen has given positive, and therefore we must think that the cause of most of these pneumonía is legionella ".

Of these 117 people, 80 are hospitalised, in the Virgin hospital of the Arrixaca (28 people), the one of the Red Cross (4 people), the one of the Fertile valley (15 people), the one of the Arcs (12), the one of the Consolation of Molina (10), Morales Meseguer (44) and the one of San Carlos (3). In addition, Marquess indicated that there is a man of 50 years who is hospitalised in the Unit of Intensive Cares of the Fertile valley.

The ages of these people are outposts " fundamentally ". " a 80% of the people would have of 50 years in ahead, and of these 83% would be men and the 17 women ", clarified.
The advisor also indicated that the disease has affected fundamentally people who live in " Murcia helmet ". " 60% of the patients have their residence in Murcia helmet, and specially the technicians have determined that he is the area of Santa Maria de Gracia and all the street North Round ", he said, to the time that affirmed that " this makes suppose that in this zone it is where is the emitting center, that still it is without determining ".

Also, it indicated that a 11.1% of affected people come from pedanías, and a 25.7% come from other municipalities. " one occurs of very dispersed form, all of them have come to Murcia during the last days and we suppose that they have contracted the disease in Murcia ", it added.

The independent community has put in alert all its services, and Marquess declared that during the day samples of all the cooling towers took shelter yesterday of Murcia center, with the purpose of finding the center emitting. Thus, he added that 8 cooling towers in the palace of San Esteban have paralysed, regional seat of the government; in the leisure center Zigzag; in the English Court; and in the old building of Appraised Galleries, with the purpose of gathering samples.

In this respect, it indicated that a helicopter of Civil Protection flew over the city of Murcia " with the purpose of photographing all the cooling towers that the inspectors cannot see at first, simultaneously that other inspectors cross the streets of the city to find all the evaporators that are to the height of the street ".

Marquess explained that the legionellosis is a form of pneumonía produced by the denominated bacterium legionella, whose symptoms are high fever, between 39 and 40.5 degrees, dry cough, abdominal and sometimes diarrea pain, as well as that " I infect is exclusively by aerogenea channel, and in no case by digestive tract nor of person to person ".

The advisor emphasized that " it has been possible to determine that the potable water network of Murcia does not have abs

Note this outbreak now stands at 805 cases, five deaths

Disease Outbreaks
Reported

Legionellosis in Spain - Update 1

Spain

117 people are affected by an epidemic from legionella in Murcia

8^th July 2001

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