Published Date: 2012-06-12 21:44:01
Subject: PRO/EDR> Legionellosis - UK (07): (Scotland)
Archive Number: 20120612.1166013
LEGIONELLOSIS - UK (07): (SCOTLAND)
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Mon 11 Jun 2012
Source: news.stv.tv [edited]
Inspectors investigating the Legionnaires' disease outbreak in Edinburgh have served an improvement notice on a 2nd cooling tower. The Scottish Government confirmed the number of people infected had risen again from 82 to 88, with 39 confirmed cases and 49 suspected cases on Monday afternoon [11 Jun 2012].
Chemical company Macfarlan Smith Ltd was contacted by the Health and Safety Executive on Monday. 2 improvement notices were served ordering the firm to carry out "thorough cleaning" of one its cooling towers and improve "provision of access for inspection and maintenance" of the heat removal device.
Last Friday [8 Jun 2012], the executive served a similar notice on North British Distillery Company Ltd for a failure to devise and implement a sustained and effective biocide control programme in one cooling tower at its site, which is also on Wheatfield Road, in the Gorgie area of the city.
As of noon on Monday, 14 of those suffering from the disease were in intensive care and 26 were on general wards. A total of 18 cases were being treated in the community; 22 had been discharged from hospital. A man, 56 years old, is the only fatality linked to the outbreak at this stage. The government also confirmed 7 cases were being treated outwith the NHS Lothian area, while the victims' ages range from 33 and 76 years old, with men predominantly affected.
A Health and Safety Executive spokeswoman said: "The improvement notices require the company to take steps to improve its management systems and do not mean that this cooling tower has been identified as the source of the outbreak. HSE said the source of the outbreak may never be conclusively identified, based on experience from previous outbreaks. The improvement notices have been served because the company has allegedly failed to maintain their control measures for the safe operation of the cooling tower to the required standard. It does not indicate an immediate risk from legionellosis, as this was being controlled by the emergency dosing of chemicals and the company's subsequent voluntary shutdown of the cooling tower." The opiates and controlled drug manufacturer has 21 days to appeal the notice and have until 9 Jul 2012 to comply with it.
ProMED-mail from HealthMap alerts
[The number of confirmed and probable cases of Legionnaires' disease in Edinburgh has risen from 82 (Legionellosis - UK (06): (Scotland) 20120612.1164841) to now 88; there is still only one death from this disease. It is about one week after 16 cooling towers on 4 sites near Edinburgh that were identified as a potential source of the outbreak were chemically treated. More cases may continue to be reported, even if the source were eliminated, considering that the incubation period for Legionnaires' disease is about 2 to 10 days. The 16 cooling towers on 4 sites near Edinburgh that were identified as a potential source of the outbreak and were chemically treated about 1 week ago (2-3 Jun 2012) are: the North British Distillery, Wheatfield Road, Gorgie; Macfarlan 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. For a discussion of Legionnaires' disease, see ProMED-mail post Legionellosis - UK (02): (Scotland) 20120605.1156972.
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.
The diagnosis of all confirmed cases was reported to have been 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]