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An outbreak of LegionnairesÕ disease in an inner city district: importance of the first 24 hours in the investigation

Authors: Jansà J., M.1; Caylà J., A.1; Ferrer, D.1; Gracia, J.2; Pelaz, C.3; Salvador, M.4; Benavides, A.1; Pellicer, T.1; Rodriguez, P.2; Garcés J. Ma.5; Segura, A.6; Guix, J.1; Plasencia, A.1; Barcelona

Source: The International Journal of Tuberculosis and Lung Disease, Volume 6, Number 9, September 2002 , pp. 831-838(8)

Publisher: International Union Against Tuberculosis and Lung Disease

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Abstract:

OBJECTIVE: To present the main results of the investigation of an outbreak of LegionnaireÕs disease that occurred in an inner city district of Barcelona between 15 October and 15 November 2000.

METHODS: Epidemiological surveys of patients and environmental investigations were initiated on the day the first five cases were notified. Water samples and smears from cooling tower trays were taken for microbiological analysis. Maps of the distribution of cases and possible contamination foci were elaborated. Incidences were calculated for each census tract.

RESULTS: A total of 54 patients related to the outbreak were identified, with a case fatality rate of 5.5%. Incidence rate in the area closest to the cooling tower (6.40/1000) was significantly higher than that of the rest of the neighbourhood (2.23/1.000, RR 2.87, 95%CI 1.37–6.12, P = 0.0035). Cultures positive for Legionella pneumophila serogroup 1, subtypes Pontiac, Philadelphia or Allentown, were obtained from eight patients. On the 39th day of the investigation it was found that the strain isolated in one of the cooling towers coincided with the serogroup, subtype and molecular profiles identified in clinical samples.

CONCLUSIONS: Rapid coordination of clinicians, microbiologists, epidemiologists and environmentalists permitted the source of infection and the affected cases to be correlated within a few days.

Keywords: Legionella pneumophila; community outbreak; typing methods

Document Type: Regular Paper

Affiliations: 1: Municipal Institute of Public Health, Barcelona, Spain 2: Directorate of Environmental Surveillance, Barcelona City Council, Barcelona, Spain 3: Legionellosis Reference Laboratory, Health Institute, Carlos III, Health and Consumption Ministry, Madrid, Spain 4: Catalonia Reference Laboratory, Barcelona Municipal Health Institute, Barcelona, Spain 5: Hospital del Mar, Barcelona Municipal Health Institute, Barcelona, Spain 6: Primary Health Centre, Barceloneta, ‘Organització i Salut’, Barcelona, Spain

Publication date: September 1, 2002

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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