Legionella Bacteria - Photo Credit CDC PHIL
# 6370
There’s a rapidly spreading outbreak of Legionella in Scotland this week, and I’ve details from the NHS and HSE.
But first . . . a little background and history.
In July of 1976, while many of us in the health care field were waiting for the expected arrival of a swine flu pandemic (see Deja Flu, All Over Again), another medical crisis was brewing at the Bellevue Stratford Hotel in Philadelphia.
This was the scene of the gathering of hundreds of veterans belonging to the American Legion, celebrating this country’s bicentennial. Within a couple of days of their arrival, scores fell ill with a serious flu-like illness.
At first, many believed this was the first arrival of the expected flu pandemic, but soon it became evident that this was something else entirely. But exactly what it was would take months to determine.
During this outbreak, 221 people were treated and 34 died.
But it wouldn’t be until early in 1977 that a definitive cause would be isolated by the CDC – a Gram negative, aerobic bacteria found growing in the hotel’s air-conditioning cooling tower – that provoked a serious form of pneumonia.
Dubbed `Legionnaire's Disease’ by the press, this bacterium was named Legionella, and the pneumonia it produces Legionellosis.
While `discovered’ in 1976 and identified the following year, Legionella had been with us, and causing serious illness, for a long time. It had caused earlier outbreaks, including one in Austin, Minnesota in 1957 (Osterholm et al., 1983) and at Saint Elizabeth’s Hospital in Washington, D.C. in 1965.
The cause of these outbreaks wasn’t identified, however, until retrospective studies were conducted after the Philadelphia outbreak.
We now know Legionella to be a major cause of infectious pneumonia, and that it sometimes sparks large outbreaks of illness. According to the CDC between 8,000 and 18,000 Americans are hospitalized with Legionnaire's Disease each year, although the actual number of infected is likely higher.
All of which serves as prelude to the following report on the rising number of Legionella cases being diagnosed this week in Edinburgh Scotland.
As of today, the Associated Press is reporting 51 confirmed cases (link), one death, and more cases are expected to turn up.
So far, the source of this environmental pneumonia has not been identified.
Running point in the investigation is NHS Lothian, which is the public health authority for the Edinburgh area.
The first press release on this outbreak came 4 days ago with the announcement of the first four cases. The next day there were six, and the day after that . . . thirteen.
Now the number stands at 51, and at least 10 more suspected cases are being tested.
You can read the progression of daily reports by the NHS at the link below, with the last update from yesterday.
Outbreak of Legionella in South West Edinburgh - Last updated 07/06/2012 AM
Update - 07/06/2012 AM
The Cabinet Secretary for Health & Wellbeing made a statement on the Legionella Outbreak at the Scottish Parliament this morning. You can watch it online at
http://www.scottish.parliament.uk/newsandmediacentre/30912.aspx
Update - 06/06/2012
Resilience team report on outbreak latest
The latest reports from the Scottish Government Resilience Room (SGoRR) on the Edinburgh Legionnaires’ outbreak show that there are now 21 confirmed cases and 19 suspected cases.
One of the confirmed cases has died, two have been discharged from hospital and 12 are being treated in intensive care.
An emergency information leaflet will be delivered to all homes and businesses in affected areas tomorrow. GPs have also been provided with information on spotting the signs of infection.
A dedicated NHS helpline has been set up for anyone concerned and can be reached on 0800 0858 531.
Health Secretary Nicola Sturgeon said:
“The fact remains that the risk to the general public is low – however, due to the incubation period of the infection we are still expecting to see an increase in cases over the next couple of days.
Obviously these numbers continue to rise, and press reports now differ from the numbers posted above.
The NHS maintains the following website with more information on Legionella:
Legionnaires' disease
Introduction
Legionnaires’ disease is a potentially fatal lung infection (pneumonia) that is caused by the legionella bacteria. Legionnaires’ disease is caught by breathing in small droplets of contaminated water. It is not contagious and cannot be spread directly from person to person.
Initial symptoms include a high fever and muscle pain. Once the bacteria begin to infect your lungs, you may also develop a persistent cough (see Legionnaires disease - symptoms). Prompt treatment using antibiotics is essential to reduce the risk of death. See Legionnaires’ disease - treatment for more information.
To put this in context, the largest outbreak of Legionnaires disease in recent years in the UK occurred a decade ago, in the town center of Barrow-in-Furness, Cumbria which ultimately produced 180 known infections, and 7 deaths.
The following 62-page report on that outbreak is available on the HSE website:
Report of the public meetings into the legionella outbreak in Barrow-in-Furness, August 2002
While doctors struggle to treat those infected, disease detectives in Scotland are working to find the environmental source of this virulent bacteria, in order to stop the outbreak.
I’ll update this story when new details emerge.
