Scottish Govt. Statement: Confirmed Ebola Case Arrived In Glasgow

Credit CDC PHIL

 

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The news is just coming across the wires, apparently based on the following statement posted on the Scottish Government website roughly 40 minutes ago.  The case involves a medical worker who just returned last evening from West Africa, who reported feeling unwell this morning, and has now tested positive for the virus.

 

 

 29/12/2014 18:35

 

Confirmed case in Glasgow

A confirmed case of Ebola has been diagnosed in Glasgow.

NHS Scotland infectious diseases procedures have now been put into effect and the patient has been isolated and is receiving treatment in the specialist Brownlee Unit for Infectious Diseases on the Gartnavel Hospital campus.

The patient is a health care worker who was helping to combat the disease in west Africa. They returned to Scotland from Sierra Leone late last night via Casablanca and London Heathrow, arriving into Glasgow Airport on a British Airways flight at around 11.30pm.

The patient was admitted to hospital early in the morning after feeling unwell and was placed into isolation at 7.50am. All possible contacts with the patient are now being investigated and anyone deemed to be at risk will be contacted and closely monitored. However, having been diagnosed in the very early stages of the illness, the risk to others is considered extremely low.

First Minister Nicola Sturgeon has chaired a meeting of the Scottish Government Resilience Committee (SGoRR) to ensure all necessary steps are being taken, and has also spoken to Prime Minister David Cameron.

According to UK and Scottish protocol for anyone diagnosed with Ebola, the patient will be transferred to the high level isolation unit in the Royal Free hospital, London, as soon as possible. This is where the facilities, staff and systems are in place to ensure the best quality and safest care.

While public health experts have emphasised that the risks are negligible, a telephone helpline has been set up for anyone who was on the Heathrow to Glasgow flight last night.

The number is: 08000 858531

First Minister Nicola Sturgeon said:

“Our first thoughts at this time must be with the patient diagnosed with Ebola and their friends and family. I wish them a speedy recovery.

“Scotland has been preparing for this possibility from the beginning of the outbreak in West Africa and I am confident that we are well prepared.

“We have the robust procedures in place to identify cases rapidly. Our health service also has the expertise and facilities to ensure that confirmed Ebola cases such as this are contained and isolated effectively minimising any potential spread of the disease.

“Scotland’s NHS has proved it is well able to cope with infectious diseases in the past, such as swine flu, and I am confident we will be able to respond effectively again.”

 

Update: CCHF Patient In Scotland Dies

 

Global Distribution of CCHF – Credit WHO

 

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News this morning from the UK press that the 38-year old man who flew into Glasgow, Scotland earlier this week from the Middle East infected with CCHF (see Crimean-Congo Hemorrhagic Fever Patient Isolated In Glasgow) has died overnight.

 

This report from the Independent, after which, I’ll have more.

 

Patient with rare fever dies in UK hospital

Lucinda Cameron  - Saturday 06 October 2012

A man being treated for Crimean-Congo haemorrhagic fever after returning to the UK from Afghanistan has died.

 

It is the first laboratory-confirmed case of CCHF in the UK, according to the Health Protection Agency (HPA).

 

Other passengers who sat close to him on an aircraft are undergoing daily health checks.

(Continue . . . )

 

 

Although originally hospitalized at Gartnavel General Hospital's Brownlee Centre, the unidentified patient was transferred yesterday to a high bio-security unit at London's Royal Free Hospital yesterday.

 

The following statement from the HPA was released yesterday, before the patient’s death.

 

Confirmed case of Crimean Congo Haemorrhagic Fever in the UK

5 October 2012

The Health Protection Agency (HPA) is aware of a laboratory confirmed case of Crimean-Congo Haemorrhagic Fever (CCHF) in a UK traveller who has recently returned from Afghanistan. The patient has been transferred from Glasgow, Scotland to the high security infectious diseases unit at the Royal Free hospital in London using specialist air transport.

CCHF is a serious viral disease which infects a range of domestic and wild animals. Humans are usually infected directly from the blood or body fluids of infected animals or via tick bites. The disease is endemic in many countries in Africa, parts of Europe, the Middle East and Asia.

CCHF can be acquired from an infected patient, but this requires direct contact with their blood or body fluids Therefore, there is no risk to the general population. As a precautionary measure, close contacts of the patient including hospital staff involved in the patient’s care have been contacted and will be monitored.

The HPA is providing public health, diagnostic and other support to the teams currently handling this incident.

This is the first laboratory-confirmed case of CCHF in the United Kingdom.

Information about the Crimean-Congo Haemorrhagic Fever is available on the HPA website. 

Information about the geographical distribution of CCHF is available on the HPA website.

Further information about the transmission of CCHF is available on the HPA website.

Information on CCHF is available from the World Health Organization (WHO) website [external link].

Visit the Royal Free Hospital website [external link].

 

While the risk that this virus has been spread to others is considered low, the HPA will monitor close contacts of this patient for the next two weeks looking for any signs of infection.

ECDC: Risk Assessment On Edinburgh Legionella Outbreak

 

 

# 6386

 

 

This morning the ECDC published a brief Rapid Risk Assessment on the Legionella outbreak in Scotland that has been ongoing for about two weeks (for earlier reports see here, and here).

 

According to NHS Lothian, which is the local public health authority running point on the investigation, the number of cases has remained steady over the past couple of days at 88 (see Update - 13/06/2012).  

 

Yesterday Health Secretary Nicola Sturgeon was quoted as saying:

 

“These numbers today again offer reassurance that the worst of the outbreak is over. The increase of confirmed cases and reduction in the suspected cases is in line with our expectations. However, there is no room for complacency and we will continue to monitor the situation very closely over the coming days.

 

A link to the 4-page ECDC risk assessment, and a few excerpts, follows:

 

Rapid risk assessment: A community outbreak of Legionnaires' disease in Edinburgh, Scotland

Technical reports - 14 Jun 2012

Available as PDF in the following languages:

 

This document is free of charge.

ABSTRACT

ECDC assessed the risk to the EU related to the community outbreak of Legionnaires' disease in Edinburgh, Scotland.

In the absence of an identified and controlled source of Legionella, there may be an ongoing risk of exposure for persons living or visiting the area, although the risk is assessed to be low for the general public due to implemented control measures.

 

Main conclusions and recommendations

Eighty-eight cases of Legionnaires’ disease, of which one was fatal, have occurred in the south-western part of Edinburgh since 24 May 2012 when the first case was reported to have fallen ill.

Although the exact source of the outbreak has not yet been identified, the clustering of cases in the south-western part of Edinburgh and the evolving number of cases suggests an ongoing source in this part of the city. Environmental investigations to confirm the source and treatment of local cooling towers in the area are ongoing. The  implementation of precautionary control measures at any identified suspected  risk installations
are of utmost importance to decrease the risk of exposure.

 

In the absence of an identified and controlled source of Legionella, there may be an ongoing risk of exposure to  Legionella  for persons living or visiting the area, although the risk is assessed to be low for the general public due to implemented control measures.

 

The risk for Legionnaires’ disease should be considered higher for persons above 40 years of age, smokers and immune-compromised persons. For this group, timely diagnosis and appropriate treatment will be particularly important.

 

 

As Legionnaires’ disease cannot be transmitted from human to human, the risk for the EU remains very limited apart from susceptible people visiting the affected areas.

 

The information given  to members of the public about their potential exposure is important to ensure timely diagnosis and appropriate treatment. This has been addressed by the Scottish authorities by  setting up a telephone hotline.

 

 

 

For a brief history of the discovery of Legionnaires disease you may wish to revisit my blog from last week called The Legionella Outbreak in South West Edinburgh. You’ll also find more information on Legionella on the NHS website:

 

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.

(Continue . . . )

Updating Edinburgh’s Legionnaires Outbreak

 

 

# 6372

 

 

Since yesterday, an additional 10 cases of Legionella have been identified in Edinburgh, Scotland bring the total to 61 in a week. It is considered likely that more people are affected, albeit mildly and are not seeking medical care.

 

While no environmental source has been identified, HVAC cooling towers (the most common point of origin) in the south western part of the city have been treated, and it is hoped that this will result in a drop in cases.

 

For more on the origins of this outbreak, and a brief history of Legionnaires diseases, you may wish to revisit (The Legionella Outbreak in South West Edinburgh).

 

You’ll also find a very instructive PDF file available from the ECDC website called:

 

Legionella Pneumonia Geographic Information System: a helpful tool in cluster detection

 

This presentation was made by Sjoerd M. Euser, PhD at the 2010 European Scientific Conference on Applied Infectious Disease Epidemiology (ESCAIDE) in Lisbon in 2010.

 

 

We’ve the latest statement from NHS Lothian, the public health authority in charge of the Edinburgh area.

 

 

Outbreak of Legionella in South West Edinburgh

Update - 07/06/2012 17:30

Legionnaires’ outbreak update - number of cases stands at 61

 

The latest reports from the Scottish Government Resilience Room (SGoRR) on the Edinburgh Legionnaires’ disease outbreak show that there are now 24 confirmed cases and 37 suspected cases.

 

As at 12pm today, of those cases being treated in hospital, 12 were in intensive care and 28 are on general wards.

 

A total of 13 cases are being treated in the community, five have been discharged from hospital and one person has sadly died.

 

Two cases are being treated outwith the NHS Lothian area – one in Highland and one in the north of England. Both of these cases are being treated as part of the south west Edinburgh outbreak and have connections to the area.

 

People that are being admitted to hospital with symptoms are now generally speaking in a better state of health than has previously been the case. The ages of those affected now ranges between 19 and 88, with more males than females affected.

 

As of yesterday, NHS 24 had received 48 calls to the dedicated helpline. However, there was a 20 per cent increase in the number of calls to their regular number about Legionnaire’s disease.

 

The investigation into the source of the outbreak is continuing, with all 16 cooling towers in the affected area now having been inspected.

 

Those cooling towers which were considered to possibly require re-treating are now undergoing this process.

 

Health Secretary Nicola Sturgeon said: “It is a positive sign that those people being admitted to hospital are, generally speaking, less ill than had been the case at the start of the outbreak and we are seeing an increase in the numbers of people well enough to be treated in the community.

 

“NHS Lothian services are busy but coping and I would like to pay tribute to NHS staff who are coping extremely well with this situation.

 

“It remains the case that the risk to the general public remains low but anyone with concerns should contact their GP or NHS 24’s dedicated hotline on 0800 0858 531.

 

“I want to stress that this bacteria is not passed on person to person or by drinking water.

 

“Investigations into the source of this outbreak, which are primarily led by the City of Edinburgh Council and the Health and Safety Executive and supported by Health Protection Scotland, are making good progress. I would hope that over the next few days this investigation will start to deliver answers about where the source of the outbreak might be. However, it is important to note that sometimes it is not possible to conclusively identify a source.

 

The Legionella Outbreak in South West Edinburgh

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.

(Continue . . . )

 

 

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.

(Continue . . . )

 

 

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.