Published Date: 2012-06-09 16:21:03
Subject: PRO/EDR> Legionellosis - UK (05): (Scotland) more cases, fatal
Archive Number: 20120609.1162615
LEGIONELLOSIS - UK (05): (SCOTLAND) MORE CASES, FATAL
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Fri 8 Jun 2012
Source: Health Protection Report 2012; 6(23) [edited]
An outbreak of legionellosis in Edinburgh, Scotland, first reported by Health Protection Scotland (HPS) on 3 June, is still under investigation by HPS, the Lothian NHS board, and the Health and Safety Executive (HSE). Between 16 May and 7 June, one death, 46 probable, and 28 confirmed legionnaires' disease cases had been linked to the outbreak. Over 40 cases have been hospitalised.
The majority of cases were resident in the Stenhouse area, south west of the city. An environmental source of infection was suspected of causing the outbreak and, following initial investigations by HSE and Scottish environmental health officers, 16 cooling towers on four sites in the area were inspected and underwent treatment as a precautionary measure.
All the confirmed cases have tested positive for _Legionella pneumophila_ urinary antigen. The first recorded date of onset was 16 May 2012.
The Department of Health for England advised clinicians to consider legionnaires' disease as a possible diagnosis in patients who may present with flu-like symptoms and/or lower respiratory tract symptoms and who have visited Edinburgh in the last two weeks. They should consider arranging urinary antigen testing of suspected cases and are reminded that the infection is a notifiable disease, which must be reported to the local authorities .
1. DH. "Central Alerting System: Legionnaires Disease", 8 June 2012.
Date: Fri 8 Jun 2012
Source: www.metro.co.uk [edited]
Edinburgh legionnaires' disease cases rise to 74
The number of confirmed cases of legionnaires' disease in Edinburgh has climbed to 28, with a further 46 people suspected of having contracted it.
News of the rise came after the Health and Safety Executive (HSE) served an improvement notice on North British Distillery Company for an alleged failure to adequately control the risk of legionellosis in a cooling tower at its Wheatfield Road site. The firm has been given until 29 June  to implement an effective biocide control programme. HSE [Health and Safety Executive] officials said the notice did not mean the tower had been identified as the source of the outbreak and stressed that the investigation was ongoing. North British Distillery had already taken all 3 cooling towers at its Wheatfield Road site offline as a precaution, pending the results of legionella tests conducted earlier in the week, and has temporarily ceased distillation. A spokesman for the company said: "Our thoughts are clearly with the families of those affected by this situation. Ensuring the health and safety of our employees and the local community is our highest priority."
The latest figures from the Scottish government represent a rise of 13 in the number of confirmed and suspected cases. Dr Duncan McCormick, chair of the IMT [incident management team? - Mod.SH] and consultant in public health medicine at NHS Lothian, said the increase had been predicted, given the incubation period of legionnaires' disease. He added: "We expect that the numbers of patients affected will peak over the weekend and then begin to fall as we move into the beginning of next week."
One person has died as a result of the outbreak and 14 more are still in intensive care. Ten others have been discharged, 15 are being looked after in the community, and the rest are being treated in the general wards of hospitals.
ProMED-mail from HealthMap alerts
Date: Sat 9 Jun 2012
Source: BBC [edited]
The number of confirmed and suspected cases of legionnaires' disease in Edinburgh has risen to 80. Figures released on Saturday show 36 confirmed cases, an increase of 8. The number of suspected cases is down by 2 at 44. Health authorities had predicted that the total number of cases would continue to increase.
One man has died in the outbreak. He worked on a construction site in the west of Edinburgh. Of the cases being treated in hospital, 15 are in intensive care and 27 are in general wards. A total of 16 cases are being treated in the community.
Cooling towers have been shut down at a whisky distillery in Edinburgh which is at the centre of an investigation into an outbreak of legionnaires' disease. The Health and Safety Executive has served an improvement notice on the North British Distillery for alleged failures to adequately control the risk of legionella in one of its towers. The company said it had taken its towers offline and halted production at its Gorgie plant as a precaution.
Residents have been leafleted with information on the disease and what they should do if they are worried they could be at risk. GPs have been provided with information on spotting the signs of infection and a dedicated NHS helpline has been set up on 0800 0858 531.
[The number of confirmed and probable cases of legionnaires' disease in Edinburgh has again increased dramatically from 6 to 36 and 4 to 44, respectively, since the 1st ProMED-mail post (Legionellosis - UK (02): (Scotland) 20120605.1156972); there is still only one death from this disease. For a discussion of legionnaires' disease, see ProMED-mail post: Legionellosis - UK (02): (Scotland) 20120605.1156972.
16 cooling towers on 4 sites near Edinburgh were identified as a potential source of the outbreak and were chemically treated about 1 week ago (2-3 Jun 2012). In a prior ProMED-mail post these sites were identified as: North British Distillery, Wheatfield Road, Gorgie; McFarlan Smith (pharmaceuticals), Wheatfield Road, Gorgie; Aegon (insurance), where towers are used to cool servers, in Lochside Crescent, South Gyle; and Burtons Foods, Bankhead Place, Sighthill. However, even if this remediation were effective, cases exposed before the remediation could continue to occur because the incubation period for this disease is 2 to 10 days.
The majority of cases were said to be residents of Stenhouse, which is located west of the center of Edinburgh, between Gorgie and Sighthill. For a map showing these communities, see http://www.maplandia.com/united-kingdom/scotland/scotland/city-of-edinburgh/gorgie/. The effect of the wind direction on plumes from these cooling towers in relation to where these cases occurred will have to be studied.
One news report above also says that the diagnosis of all confirmed cases was made on the basis of a positive test for _Legionella pneumophila_ urinary antigen. Consequently, clinical isolates are not available for genotyping. Genotyping of patient and environmental isolates has become a helpful tool to establish transmission pathways. The predominance of one genotype of legionella isolated from patient specimens would suggest transmission from a common source. Because legionella may be found in environmental samples without linkage to any cases of legionellosis, the actual causative infectious reservoir can be confirmed by matching the genotype of clinical and environmental isolates (see http://www.ncbi.nlm.nih.gov/pmc/articles/PMC86783/ and http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730281/).
Scotland can be located in the interactive HealthMap/ProMED-mail map at http://healthmap.org/r/2wlL. - Mod.ML]