Scotland:
Twenty-four cases of legionnaires’ disease in residents of Scotland were reported to the Scottish Centre for Infection and Environmental Health (SCIEH) by the Scottish Legionella Reference Laboratory in 1996 1 14 fewer than in 1995 2 .
Three quarters of the cases were male. The age distribution of cases was as expected, with 12 being men over 50 years of age. Four cases were known to have died. Thirteen cases were associated with foreign travel to destinations in Spain (5 cases), France (2), Turkey (2), the US (2), Italy(1), and Mexico(1). Two additional cases were linked to travel within the UK. Scottish cases diagnosed in 1996 were associated with the identification of three clusters and two linked groups (cases linked to the same accommodation but who became ill more than six months apart 3 ) in the European surveillance scheme.
No cases in 1996 were thought likely to have acquired infection in hospital, and there were no community outbreaks. Two cases may have been associated with exposure in the workplace, including the first documented seroconversion to L. feeleii in Scotland reported from a mining engineer with pneumonia. No environmental source for this infection was identified, despite intensive sampling. The remaining seven cases were presumed to have been acquired in the community.
1. Christie P, Abraham W,
Lindsay DSJ, Girdwood RWA.
Legionella infections in Scotland, 1996.
SCIEH Weekly Report 1997; 31: 210-2.
2. Christie P, Abraham W,
Lindsay DSJ, Girdwood RWA.
Legionella infections in Scotland, 1995.
SCIEH Weekly Report 1996; 30: 262-4.
3. Hutchinson EJ, Joseph
CA, Bartlett CLR. EWGLI:
a European surveillance scheme for travel associated legionnaires' disease.
Eurosurveillance 1996; 1: 37-9.
1973 Scotland
The first known cases of Legionnaires disease
in Scotland occurred in 1973 in a group of tourists who had been on holiday
in Benidorm in Spain, Three tourists died from that unknown outbreak. A
further case was noted in 1976 and a further two cases in 1977, These cases
were not realised until several years later
(Fallon RJ, Journal Hygine Cambridge 1882 89 439-448)
1978 Glasgow
POSSIBLE PERSON TO PERSON TRANSMISSION OF LEGIONNAIRES
DISEASE.
A general practitioner was treated for pneumonia
in 1974, The clinical features suggested infection with Mycoplasma pneumoniae,chlamydia
B or Coxiella burnetii, but the serlogy was negative, The doctor himself
was positive that he had contacted the infection from a patient whom he
had attended 2 weeks before and had sent to hospital with sever pneumonia
which had developed during a holiday in Benidorm, Sera taken from the patient
during his illness have proved, retrospect, that he had Legionnaires disease.
No acute-phase serum was available from the general practitioner, but a
sample taken more than three years later had an antibody of 1:512 This
is a strong circumstantial evidence of a case-to-case transmission.
(W Campbell Love, The Lancet, December 9 1978)
1984 Glasgow
An outbreak of legionellosis in Glasgow, Scotland
in 1984, 33 people caught the disease and one died, 26 of the patients
lived in Dennistown district. Cases occurred downwind of the cooling tower
up to a distance of 1700 metres
(AD-HOC COMMITTEE, The Lancet August 16 1986)
1985 Glasgow
An outbreak of Legionnaires disease at the
Royal Infirmary in Glasgow in November 1985, 15 patients and one staff
member in the phase 1 block developed the disease, The source on the infection
was traced to contamination of a cooling tower from which a plune of spray
discharged into the intake vents of the two ventilation systems.
(Timbury MC, Journal Hygiene Cambridge 1986 97 393-403)
1987 Lochgoilhead
Between December 31 1987 and January 4 1988,
about 200 hundred people visited a hotel and leisure complex in Lochgoilhead,
a village on the west coast of Scotland 187 people who had visited the
complex had had an acute illness.. Legionella micdadei was isolated from
the leisure whirlpool spa. This outbreak is thought to be the first of
a Pontiac fever like illness ascribed to L. micdadei and the first large
scale outbreak of its kind to have occurred outside North America.
(Goldberg DJ, The Lancet 1989 Febraury 11 )
1990 Glasgow
A survey to assess the maintainance of cooling
towers in Glasgow was held after two Legionnaires disease outbreaks, Information
was obtained from 76 of 81 premises and a maintainance score was calculated
for each of the 174 towers, Low maintainance scores were associated with
no log book, no guidelines, no change in procedures in the last five years,
solitary cooling towers and towers on industrial premises. Despite intense
publicity the standard of cooling tower maintainance in Glasgow remains
a concern
(Bhopal RS, Epidemiology and Infection, 1990 104 29-38)
Fatal nosocomial Legionnaires' disease:
The investigation, epidemiology, and effectiveness
of control procedures during an outbreak of Legionnaires' disease involving
three immunosuppressed patients are described.
The source of infection appeared to be a network of fire hydrant spurs
connected directly to the incoming hospital mains water supply.
Removal of these hydrants considerably reduced, but failed to eliminate,
contamination of water storage facilities. As an emergency control procedure
the incoming mains water was chlorinated continuously. Additional modifications
to improve temperature regulation and reduce stagnation also failed to
eliminate the legionellae. A perspex test-rig was constructed to model
the pre-existing hospital water supply and storage system. This showed
that through the hydraulic mechanism known as 'temperature buoyancy', contaminated
water could be efficiently and quickly exchanged between a stagnant spur
pipe and its mains supply.
Contamination of hospital storage tanks from such sources has not previously
been considered a risk factor for Legionnaires' disease. We recommend that
hospital water storage tanks are supplied by a dedicated mains pipe without
spurs.
(Patterson WJ; Seal DV; Curran E; Sinclair TM; McLuckie JC Address Glasgow
Royal Infirmary, Edinburgh. Source Epidemiol Infect, 1994 Jun, 112:3, 513-25)
Denis
legion@q-net.net.au