Published Date: 2002-07-05 23:50:00
Subject: PRO/EDR> Legionellosis, pilgrims - Italy (Puglia)
Archive Number: 20020705.4674

LEGIONELLOSIS, PILGRIMS - ITALY (PUGLIA)
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Date: 4 Jul 2002
From: ProMED-mail <promed@promedmail.org>
Source: Eurosurveillance Weekly 2002; 6(27): 020704 [edited]
<http://www.eurosurv.org/2002/020704.html>

Community cluster of legionnaires' disease among pilgrims to San Giovanni
Rotondo, Puglia, Italy
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At the end of May 2002, 6 cases of legionnaires' disease were notified to
the national legionellosis surveillance scheme at the Istituto Superiore di
Sanita within a few days. All cases became ill between 14 and 19 May 2002.
The 4 cases (3 women and a man) aged between 66 and 79 years were members
of a group who went on pilgrimage from Vercelli, in the Piemonte region, to
San Giovanni Rotondo, in the Puglia region, from 7 to 12 May 2002. All 4
cases were diagnosed by urinary antigen detection. The patients had
travelled by bus to San Giovanni Rotondo, where they stayed in a hotel
previously notified to the European Working Group for Legionella Infections
(EWGLI <http://www.ewgli.org/>) as associated with a cluster and where
control measures had recently been implemented. The travel itinerary
included a one-night stay at a hotel in Pompei, and visits to shrines and
domes in the towns of Pietrelcina, Benevento, San Giovanni Rotondo, and
Monte Sant'Angelo. The group had lunch at different restaurants.
The fifth case was a woman of 78, who went on pilgrimage with another group
from 7 to 9 May, travelling by bus from Grosseto, in the Toscana region, to
San Giovanni Rotondo. This group had a slightly different itinerary, but
also visited San Giovanni Rotondo and Monte Sant'Angelo. The group stayed
at the same hotel in San Giovanni Rotondo as the first 4 patients. This
fifth patient has since died. Her urinary antigen test was negative, but
presumptive diagnosis of legionnaires' disease was made after tests by
polymerase chain reaction and direct immunofluorescence on a lung specimen
taken postmortem.
A sixth case was another elderly woman who travelled to San Giovanni
Rotondo with a third group of pilgrims who departed from Albinia, Toscana
region, to San Giovanni Rotondo, between 13 and 15 May 2002. The diagnosis
was confirmed by urinary antigen detection. This last group stayed at a
different hotel in San Giovanni Rotondo, sharing with the other 2 groups
the visit to the shrine of San Michele at Monte Sant'Angelo and lunch at
the same restaurant in Pietrelcina.
Epidemiological and environmental investigations were immediately
undertaken by local and regional authorities in collaboration with the
Istituto Superiore di Sanita. The hotel, which had previously been involved
in a cluster, was immediately suspected to be one of the possible sources
of infection and therefore sampled, but no legionellas were isolated. All
the different sites visited and the buses used by the 3 groups of pilgrims
were investigated. A questionnaire aimed at gathering further information
about possible exposures has been given to all the participants in the 3
groups, and responses are awaited.
This cluster highlights the difficulties in identifying the source of
Legionella infection when package tours include common sites.
(Reported by Maddalena Castellani Pastoris(maddalena.castellani@iss.it) and
Maria Luisa Ricci, Laboratorio di Batteriologia e Micologia Medica, and
Maria Cristina Rota, Laboratorio di Epidemiologia e Biostatistica, Istituto
Superiore di Sanita, Rome, Italy.)
--
ProMED-mail
<promed@promedmail.org>
[In the same issue of Eurosurveillance Weekly
<http://www.eurosurv.org/2002/020704.html>, the European Working Group for
Legionella Infections (EWGLI) released new European guidelines for control
and prevention of travel associated legionnaires' disease. These guidelines
will make it easier to obtain information related to European travellers
with legionellosis. The EWGLI website is currently under
development and will contain further information about the surveillance
scheme and the guidelines. - Mod. LL]

See Also

Legionellosis, nursing home - USA (Pennsylvania) 20020615.4507
Legionellosis - update 20020517.4237
Legionellosis - Australia (Melbourne): alert 20020417.3977
2001
---
Legionellosis - Spain (Murcia) (08) 20011017.2555
Legionellosis - Norway (02) 20010906.2123
Legionellosis - Norway 20010831.2076
Legionellosis - Spain (Pamplona) (02) 20010822.1979
Legionellosis - Spain (Pamplona) 20010822.1979
Legionellosis - France (Paris) 20010717.1379
Legionellosis - Spain (Murcia) 20010711.1340
Legionellosis - UK (London): alert 20010630.1249
Legionellosis, automobile plant - USA (Ohio) 20010315.0531
Legionellosis, hospital - Australia (Melbourne) 20010108.0059
2000
---
Legionellosis - Australia (Melbourne) (09) 20000525.0833
Legionellosis - New Zealand, UK, ex Australia 20000503.0673
Legionellosis - Australia (Melbourne) 20000328.0451
1999
---
Legionellosis - trade fair - Belgium: alert 19991114.2028
Legionellosis - prisoners - Germany (02) 19991017.1851
Legionellosis - prisoners - Germany 19990925.1705
Legionellosis - USA (Pennsylvania) 19990918.1675
Legionellosis - Australia (Victoria) 19990801.1310
Legionellosis - Australia 19990801.1309
Legionellosis - flower show - Netherlands (09) 19990404.0545
Legionellosis - flower show - Netherlands:RFI 19990315.0384
1998
---
Legionellosis - Australia (Melbourne) (04) 19981224.2437
Legionellosis - Australia (Melbourne) 19981031.2131
Legionellosis - Australia (Victoria) (03) 19980722.1388
Legionellosis - Australia (Victoria) 19980714.1325
Legionellosis, cruise ship - UK (Scotland) 19980629.1206
Legionellosis, lorry drivers - Europe 19980413.0677
..........................mpp/ll/pg/sh
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