Published Date: 2012-08-27 20:05:26
Subject: PRO/EDR> Legionellosis - Canada (04): (QC) fatal, more cases, RFI
Archive Number: 20120827.1266801
LEGIONELLOSIS - CANADA (04): (QUEBEC), FATAL, MORE CASES, REQUEST FOR INFORMATION
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Sun 26 Aug 2012
Source: CBC.ca [edited]
More cooling towers should be inspected on Monday [27 Aug 2012] to try to control the Legionnaires' disease outbreak. Quebec's public health authority announced that Legionnaires' disease had caused 2 more deaths and infected 2 other people since Saturday [25 Aug 2012]. To date, 104 people have contracted the disease in Quebec City since 31 Jul 2012. So far, 8 people have died from complications related to the illness.
The bacteria tend to grow in stagnant water and can be found in cooling towers and fountains.
On Saturday [25 Aug 2012], regional director of public health Francois Desbiens said 89 cooling towers have been inspected and disinfected in Quebec's Lower Town, an area considered at high risk. It is the oldest part of the city, a long swathe of historic buildings below the famed Chateau Frontenac hotel.
He announced more cooling towers, including the ones that were already cleared, would be inspected and cleaned out on Monday and Tuesday [27-28 Aug 2012]. Authorities have expanded the perimeter and will investigate units outside of the Lower Town.
The crisis was discussed on Saturday during the Liberal Party and the Parti Quebecois's [PQ] daily campaign stops. Both parties mentioned a report that was filed in 1997 that offered a series of recommendations to the Quebec government after a Legionnaires' [disease] outbreak that took place a year earlier. The Liberals blamed the PQ, which was in power at the time, for failing to follow the report's guidelines.
On Friday [24 Aug 2012], Quebec Mayor Regis Labeaume said Quebec's provincial government had not introduced adequate measures to take care of the outbreak. Labeaume said rules would be tightened to prevent such situations in the future and that a registry of cooling towers would be kept from now on. The new rules, expected to be enacted this fall , will also require more maintenance of cooling towers.
ProMED-mail Rapporteur Mary Marshall
[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 (03): (Quebec) fatal, cooling tower susp, RFI 20120825.1262366), there were a total of 65 cases, including 6 fatalities, of Legionnaires' disease. Now, there are a total of 104 cases, including 8 fatalities. We are again not told of the species of _Legionella_ involved in the outbreak nor whether 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. For example, do they work or live in the same locality where there are cooling towers? Other sources for _Legionella_-contaminated aerosols that have been implicated in other legionellosis community outbreaks, in addition to cooling towers, include public fountains, hot tub store demonstrations, misting machines that keep vegetables fresh in grocery stores, and car washing facilities. A description of the microbiology and the epidemiology of the outbreak would be helpful.
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]