Published Date: 2010-07-08 16:00:03
Subject: PRO/EDR> Legionellosis - Spain (02): (AN)
Archive Number: 20100708.2279

LEGIONELLOSIS - SPAIN (02): (ALICANTE)
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Date: Fri 2 Jul 2010
Source: Laverdad.es [in Spanish, trans. Mod.JG, edited]
<http://www.laverdad.es/alicante/v/20100702/provincia/sanidad-localiza-autolavado-coches-20100702.html>


The Public Health Council has identified the source of the most
recent _Legionella_ outbreak occurring in Alcoy, which has already
affected 9 persons, as a car-washing machine located in the Ensanche
neighborhood. The machine, reported to be colonized by the
aforementioned microorganism, even after complying with the current
regulations, was sealed off yesterday [1 Jul 2010]. Only 2 of the
last 4 patients who acquired the disease are still hospitalized in
the Virgen de los Lirios Hospital. According to health authorities,
these patients are doing well.

Since the 1st reported outbreak of legionellosis back in 1999, it was
always thought that the source of the infection was refrigeration
towers; nonetheless, the Public Health Council declared last year
[2009] for the 1st time that the origin of the case clusters recorded
during August and October [2009] was in asphalt spreading machines.
Now, as confirmed in a municipal report, technicians traced the
source of the most recent outbreak in June 2010, which affected 9
persons, to a car-washing machine located in the Ensanche
neighborhood.

The epidemiological surveillance network from the Public Health
Council reported 5 cases of legionellosis during the 1st half of June
[2010]. Some of the actions undertaken included taking samples from
different facilities and, even though 3 samples were reported as
positive for _Legionella_, no definitive association with the cases
could be established. However, last Wednesday [30 Jun 2010] a new
cluster including 4 cases of legionellosis was reported; and, also, a
new sample was reported as positive; which may "most likely" explain
the origin of the 9 cases reported until now.

[Byline: Bea Navarrete]

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Communicated by:
ProMED-mail
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[Dr. Steve Berger has noted that rates of legionellosis have been
increasing in Spain
(<http://www.gideononline.com/2010/06/12/legionellosis-in-spain/>).
It is unknown if this is due to increased reporting or an actual
increase in acquisition of this infection.

A car washing facility has been linked to an outbreak of
legionellosis in the past: 7 cases of Legionnaires' disease were
linked to a car wash in the state of Victoria, Australia in 2008
(<http://www.health.vic.gov.au/environment/legionella/car_washes.htm>).

Legionnaires' disease, the acute pneumonic form of legionellosis, is
usually acquired by inhalation by a susceptible person of an
infectious dose of aerosolized _Legionella pneumophila_. Water
temperatures of 25-40 deg C (77-104 deg F) support the highest
concentrations of the organism in water storage tanks of plumbing
systems. Aerosolization of the contaminated warm water can occur in
showers, spa pools, sprays in groceries, fountains, and cooling
towers. It appears that most car wash premises have at least some
part of their process that involves the heating water to 40 deg C
(104 deg F) and storage of the warm water; aerosolization of the
contaminated warm water can then occur during the car washing process.

The Victoria Department of Human Services Public Health Branch has
issued instructions to car wash owners in an effort to prevent
legionellosis
(<http://www.health.vic.gov.au/environment/downloads/carwash_letter.pdf>).

Genotyping _Legionella_ has become a helpful tool to establish
transmission pathways. The predominance of one genotype in patient
specimens suggests transmission from a common source. Because _L.
pneumophila_ may be found in water supplies without linkage to any
cases of legionellosis, the actual causative infectious reservoir
should be demonstrated by means of genotyping methods
(<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC86783/>; and
<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730281/>).

The news release above does not specify if the link of cases of
legionellosis to car washing facilities was confirmed by genotyping.

Alcoy is an inland industrial city, with a population of about 61
000, located in the province of Alicante, along the eastern coast
(Costa Blanca) of Spain
(<http://en.wikipedia.org/wiki/Alcoy_(Spain)>).
The HealthMap/ProMED-mail interactive map of Spain can be accessed at
<http://healthmap.org/r/01Dt>. - Mod.ML]

See Also

Legionellosis - Spain: (AN) 20100612.1973
Legionellosis, nosocomial - USA: (WI) 20100315.0834
Legionellosis, fatal - Germany: (BY, BW) 20100129.0314
Legionellosis - France: (AM) 20100115.0185
2006
----
Legionellosis - Spain (Pamplona) (03) 20060609.1611
Legionellosis - Spain (Pamplona) (02) 20060605.1565
Legionellosis - Spain (Pamplona) 20060604.1558
2005
----
Legionellosis - Spain (Barcelona) 20051103.3210
Legionellosis, nosocomial - Spain (Barcelona) 20050302.0646
2004
----
Legionellosis - Spain (Barcelona) (02) 20040820.2305
Legionellosis - Spain (Barcelona) 20040816.2271
Legionellosis, hospital - Spain (Zaragoza) (02) 20040630.1743
Legionellosis, hospital - Spain (Zaragoza) 20040621.1651

2003
----
Legionellosis - Spain (Valencia) 20030611.1439
Legionellosis, spa outbreak - Spain (Canary Islands) (02) 20030603.1352
Legionellosis, spa outbreak - Spain (Canary Islands) 20030530.1320
2002
----
Legionellosis update: 2002 (03) 20020828.5173
Legionellosis - Spain (Barcelona, Valencia) 20020812.5029
2001
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Legionellosis - Spain (Murcia) (08) 20011017.2555
Legionellosis - Spain (Pamplona) (02) 20010822.1979
Legionellosis - Spain (Pamplona) 20010815.1929
Legionellosis - Spain (Murcia) 20010710.1331
2000
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Legionellosis - Spain: 2000 20001209.2163
Legionellosis - Spain (Vigo, Arbizu) (02) 20001026.1860
1998
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Legionellosis - Spain (Zaragoza) 19981130.2302
...................................ml/mj/lm

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