Published Date: 2012-07-04 02:46:06
Subject: PRO/EDR> Legionellosis - UK (08): (Scotland) more cases, fatal
Archive Number: 20120704.1189315
LEGIONELLOSIS - UK (08): (SCOTLAND) MORE CASES, FATAL
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Tue 3 Jul 2012
Source: BBC News Edinburg, Fife, & East Scotland [edited]
The Scottish government has said that a 3rd person has died in the legionnaires' disease outbreak in Edinburgh. The man, from southwest Edinburgh, was in his 60s and had been unwell for some time.
The total number of cases now stands at 99, 50 of them confirmed and the remainder suspected. 10 patients are being treated outside the NHS Lothian area and 3 people remain in intensive care.
Investigations into the source and cause of the outbreak are continuing. Although not yet identified, experts believe the source to have been factory cooling towers in the south of the capital.
Lothian and Borders Police and the Health and Safety Executive are jointly investigating the circumstances of the deaths under the direction of the Crown Office and Procurator Fiscal Service (COPFS) Health and Safety Division.
Health secretary Nicola Sturgeon said her thoughts were with the family and friends of the latest person to have died. She added: "Despite this sad and tragic news, is important to stress that strong evidence still suggests that all cases are associated with the suspected period of exposure and that the outbreak has peaked. I repeat the message that anyone in the affected areas suffering from symptoms since the outbreak began should contact their GP or the NHS 24. NHS Lothian are maintaining high quality care for patients who remain unwell and work to identify and deal with the source of the outbreak continues."
Dr Christine Evans, consultant in Public Health Medicine confirmed that a small number of cases or suspected cases were still coming forward. But she said she wanted to reassure the public that such patients had typically been ill for some time and had links to the south west of Edinburgh.
The 1st case of legionnaires' disease emerged on Thu 31 May 2012, after one individual was admitted to hospital the day before. A 2nd case emerged on the Saturday [2 Jun 2012], with an assessment throwing up a close geographical link between the cases. After a 3rd case emerged on Sunday [3 Jun 2012] lunchtime, with another an hour later, outbreak procedures were activated.
ProMED-mail from HealthMap alerts
[The total number of cases of legionnaires' disease in Edinburgh has now risen to 99, with 50 confirmed and 49 suspected cases. There are now 3 fatalities.
For a discussion of legionnaires' disease, see ProMED-mail post Legionellosis - UK (02): (Scotland) 20120605.1156972.
The news release above implies that all cases acquired their infection before remediation on 2-3 Jun 2012 of 16 cooling towers, the suspected sources of the outbreak, located south west of Edinburgh, saying that these late appearing cases had typically been ill for some time and had links to the south west of Edinburgh. The 16 cooling towers on 4 sites 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.
The majority of cases in prior posts 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 previously had been reported to be 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/).
Edinburgh can be located in the interactive HealthMap/ProMED-mail map at http://healthmap.org/r/2wlL. - Mod.ML]