Published Date: 2012-08-21 17:21:23
Subject: PRO/EDR> Legionellosis - Canada (02): (Quebec) fatal, cooling tower susp, RFI
Archive Number: 20120821.1255310
LEGIONELLOSIS - CANADA (02): (QUEBEC) FATAL, COOLING TOWER SUSPECTED, REQUEST FOR INFORMATION
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Date: Mon 20 Aug 2012
Source: CBC News/Montreal [edited]
http://www.cbc.ca/news/canada/montreal/story/2012/08/20/montreal-quebec-city-legionnaires-disease.html
Amid of a total of 40 infections, 2 more people are dead in an outbreak of Legionnaires' disease in Quebec City, public health officials said Monday [20 Aug 2012]. That's more than twice the number of cases that had previously been disclosed, and surpasses the last outbreak in the city, in 1995, when 12 people fell ill and one died. Officials didn't name or provide details about the 2 new fatalities, which bring the death toll to 3. The 1st to die was an 88-year-old Quebec City woman.
Dr. Francois Desbiens, the director of public health for the Quebec City region, said authorities have begun inspecting downtown buildings that use a cooling tower as part of their ventilation. Public-health officials had already sent 2700 letters to building owners in the downtown core asking them to clean their cooling systems, but the emergence of new cases -- a dozen since Friday afternoon -- is prompting the inspections.
"We're still seeing cases despite the fact that we've asked building owners to take steps," Desbiens said. "So we've decided to go further and investigate every tower again, and for those that haven't had maintenance, to identify them, to inspect them to take a water sample. And to order a disinfection."
Legionnaires' disease, also known as legion fever, is a flu-like pneumonia that affects people with lung problems or weak immune systems. It is caused by bacteria that thrive in warm temperatures and can breed in the stagnant water of cooling towers, before spreading in the mist released by those systems.
It's not contagious and presents no risk to people in good health. The disease got its name in the 1970s [in 1976] after an outbreak of pneumonia among people attending a convention of the American Legion [in Philadelphia, Pennsylvania].
Earlier this month, Desbiens guessed there were about 200 cooling towers in the area where people became sick that could be the source of the infection, but officials said Monday they've narrowed their area of concern down to 22 cooling towers in a core area that will be inspected by the end of the week, and 19 more in a different area that will be inspected after.
Tests on the water in those towers will take 2 to 3 days to get results confirming an infection [contamination] with _Legionella_ bacteria.
There are normally 2 to 3 isolated cases of Legionnaires' disease a year in the Quebec City region.
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[For a discussion of Legionnaires' disease, see ProMED-mail post Legionellosis - UK (02): (Scotland) 20120605.1156972.
In the previous ProMED-mail post of this outbreak in Quebec City (Legionellosis - Canada: (Quebec) fatal, cooling tower susp. 20120805.1228680), there were a total of 15 cases, including one fatality, of Legionnaires' disease. Now there are a total of 40 cases, including 3 fatalities. We are not told of the species of _Legionella_ involved in the outbreak or if genotyping of the clinical isolates has been done. We are also not told of the timeline over which the cases have occurred or any commonality linking the cases. A description of the microbiology and the epidemiology of the outbreak would be helpful.
Legionnaires' disease attacks more frequently and is more severe in individuals who are elderly, are smokers or alcoholic, have an underlying illness, such as chronic obstructive pulmonary disease (COPD) or have a weakened immune system as a result of, for example, organ transplant or taking immunosuppressive drugs (e.g., corticosteroid therapy) for other reasons. However, it is important to emphasize that relatively healthy individuals can also be at risk of contracting the disease.
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/).
However, clinical isolates are often not available because the diagnosis of Legionnaires' disease is commonly made on the basis of serology or the _Legionella_ urinary antigen test, and not by culture of patient specimens.
A map of the affected area can be accessed at http://healthmap.org/r/2Z0O. - Mod.ML]
See Also
Legionellosis - Canada: (Quebec) fatal, cooling tower susp. 20120805.1228680Legionellosis - UK (12): (England) fatal, hot tub implicated 20120802.1225198
Legionellosis - UK (11): (England) more cases, fatal, RFI 20120728.1218773
Legionellosis - UK (10): (England) RFI 20120725.1213968
Legionellosis - UK (09): (Scotland) more cases, fatal 20120713.1200937
Legionellosis - Spain (05): (MD) restaurant 20120706.1192385
Legionellosis - UK (08): (Scotland) more cases, fatal 20120704.1189315
Legionellosis - USA (02): (Maryland) 20120622.1178048
Legionellosis - UK (07): (Scotland) 20120612.1166013
Legionellosis - UK (06): (Scotland) 20120612.1164841
Legionellosis - UK (05): (Scotland) more cases, fatal 20120609.1162615
Legionellosis - UK (04): (Scotland) more cases, fatal 20120607.1159816
Legionellosis - UK (03): (Scotland) fatal 20120606.1157653
Legionellosis - UK (02): (Scotland) 20120605.1156972
Legionellosis - UK: (Scotland) L. longbeachae, compost, fatal 20120529.1148827
Legionellosis - New Zealand (04): (AU) fatal 20120525.1144719
Legionellosis - New Zealand (03): (AU) fatal 20120425.1113122
Legionellosis - New Zealand (02): (AU) fatal 20120405.1091797
Legionellosis - New Zealand: (Auckland) 20120404.1090247
Legionellosis - Italy: (Rome) dental exposure 20120218.1045716
Legionellosis - Spain (04): (AN), hotel 20120211.1038953
Legionellosis - Spain (03): (AN) hotel 20120210.1037995
Legionellosis - USA: (NY) hotel 20120205.1033536
Legionellosis - Spain (02): (AN) hotel 20120203.1031069
Legionellosis - Spain: (AN) hotel 20120122.1018077
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