H5N1

Health officials link four pneumonia deaths in Tucumán to Legionnaires' disease

Via the Buenos Aires Times: Health officials link four pneumonia deaths in Tucumán to Legionnaires' disease. Excerpt:

Tucumán health officials said Saturday that four people in a clinic in northwestern province had died of Legionnaires' disease, a relatively rare bacterial affliction of the lungs.  

Health Minister Carla Vizzotti told reporters that Legionnaires' had been identified as the underlying cause of double pneumonia in the four, who had suffered high fevers, body aches and trouble breathing.   

The deaths, all since Monday, occurred in a single clinic in the city of San Miguel de Tucumán.  

The latest, on Saturday morning, was that of a 48-year-old man with underlying health problems. A 70-year-old woman who had undergone surgery in the clinic was also a victim.

Seven other non-fatal cases have been identified, all in the same establishment and nearly all involving clinic personnel, provincial officials said.  

The disease, which first appeared at a 1976 meeting of the American Legion veterans group in the US city of Philadelphia, has been linked to contaminated water or unclean air-conditioning systems.  

When the outbreak in Tucumán was first detected, doctors tested the afflicted for Covid-19, flu and the hantavirus, but ruled all of them out.   

Samples were then sent to the prestigious ANLIS-Malbran Institute in Buenos Aires. Tests at the research body pointed to Legionnaires'.

Cluster of legionnaires' disease cases found in downtown New Westminster, BC

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We've just seen our highest daily COVID-19 count of the pandemic (121), and now this. Via CBC News: Cluster of legionnaires' disease cases found in downtown New Westminster, B.C. Except:

The Fraser Health authority says it has detected a cluster of cases of legionnaires' disease in central New Westminster. B.C..  

Six cases have been discovered since June, with the most recent found last week. Two people are currently in hospital, but the health authority did not release their status.   

The source of the bacteria is still unknown, but Fraser Health says the exposure is around the downtown quay area.  

"It's unusual to be seeing a number of cases concentrated like this, and that's really the reason why we're investigating and also wanted to notify the public," said Dr. Aamir Bharmal, a Fraser Health medical health officer.  

Bacteria found in the environment 

Legionnaires' disease is caused by a bacterium called Legionella pneumophila that is commonly found in freshwater, groundwater and soil. It can grow and spread in building water systems like cooling towers, hot tubs that aren't drained, large plumbing systems and decorative fountains.  

People can get the disease when they breathe in small droplets of water in the air that contain the bacterium.    

Fraser Health says while most healthy people won't get sick if exposed to Legionella, the elderly, smokers, people with chronic lung conditions and the immunocompromised are at high risk of becoming ill.  

"We really are seeing people who are between the ages of 50 to 70, and many of them have underlying medical conditions," said Bharmal.  

Infected people may develop pneumonia and symptoms like fever, shortness of breath, severe fatigue, abdominal pain and diarrhea.  

The risk of death for people who develop legionnaires' disease pneumonia ranges between 10 to 25 per cent, according to Fraser Health.

The burden of Legionnaires' disease in New Zealand (LegiNZ)

Via The Lancet Infectious Diseases: The burden of Legionnaires' disease in New Zealand (LegiNZ): a national surveillance study. The summary:

Background 

Legionnaires' disease is under-diagnosed because of inconsistent use of diagnostic tests and uncertainty about whom to test. We assessed the increase in case detection following large-scale introduction of routine PCR testing of respiratory specimens in New Zealand. 

Methods 

LegiNZ was a national surveillance study done over 1-year in which active case-finding was used to maximise the identification of cases of Legionnaires' disease in hospitals. Respiratory specimens from patients of any age with pneumonia, who could provide an eligible lower respiratory specimen, admitted to one of 20 participating hospitals, covering a catchment area of 96% of New Zealand's population, were routinely tested for legionella by PCR. Additional cases of Legionnaires' disease in hospital were identified through mandatory notification. 

Findings 

Between May 21, 2015, and May 20, 2016, 5622 eligible specimens from 4862 patients were tested by PCR. From these, 197 cases of Legionnaires' disease were detected. An additional 41 cases were identified from notification data, giving 238 cases requiring hospitalisation. The overall incidence of Legionnaires' disease cases in hospital in the study area was 5·4 per 100 000 people per year, and Legionella longbeachae was the predominant cause, found in 150 (63%) of 238 cases. 

Interpretation 

The rate of notified disease during the study period was three-times the average over the preceding 3 years. Active case-finding through systematic PCR testing better clarified the regional epidemiology of Legionnaires' disease and uncovered an otherwise hidden burden of disease. These data inform local Legionnaires' disease testing strategies, allow targeted antibiotic therapy, and help identify outbreaks and effective prevention strategies. The same approach might have similar benefits if applied elsewhere in the world.

ECDC: CDTR, week 23

ECDC has published Communicable Disease Threats Report, 2 - 8 June 2019, Week 23.

The ECDC Communicable Disease Threats Report (CDTR) is a weekly bulletin for epidemiologists and health professionals on active public health threats. This issue covers the period from 2-8 June 2019 and includes updates on poliomyelitis, Middle East respiratory syndrome coronavirus (MERS-CoV), dengue, Ebola virus disease, Legionnaires' disease and West Nile virus infection.

ECDC: CDTR, May 17

ECDC has published Communicable disease threats report, 12-18 May 2019, week 20. The summary: 

The ECDC Communicable Disease Threats Report (CDTR) is a weekly bulletin for epidemiologists and health professionals on active public health threats. This issue covers the period from 12-18 May 2019 and includes updates on poliomyelitis, chikungunya virus disease and dengue, measles, monkeypox, dengue, Ebola virus disease, influenza, Rift Valley fever, Crimean-Congo haemmorhagic fever and Legionnaires' disease.

Eurosurveillance: Special issue on advanced diagnostics to inform public health policy

An editorial in this week's Eurosurveillance: Note from the editors: Special issue on advanced diagnostics to inform public health policy.

This issue features the first three articles of the Eurosurveillance special issue on advanced diagnostics to inform public health policy. The second set of articles for the special issue will follow in mid-January.  

Acknowledging the impact of advances in laboratory technology—including the application of qualitative and quantitative molecular diagnostics, proteomics (e.g. MALDI-TOF MS) and genomics, particularly whole genome sequencing (WGS) and metagenomics—on clinical and public health microbiology and consequently on public health, we issued a call for contributions for this special issue in late 2017. 

Here we present the first part of the special issue, with three articles that exemplify proof of concepts and novel applications of laboratory methods that have potential to impact public health and surveillance. In their study, van der Veer et al. applied Neisseria gonorrhoeae multi-antigen sequence typing (Ng-MAST) directly to urogenital and extra-genital samples, allowing for diagnosis of N. gonorrhoeae even in cases where culture failed, thus overcoming an important limitation of culture-dependent approaches. Moreover, the authors were able to detect concurrent infections with distinct strains in the same patient, which would have been missed if they had followed the resistance surveillance guidelines that recommend culture of only one anatomical site.  

An article on diagnostics of Legionnaires’ disease (LD) by researchers from Italy also demonstrates the advantages of a molecular, culture-independent method over the more time-intensive diagnostic approaches based on culture. In this paper, Ricci et al. applied real-time PCR directly on respiratory specimens for the detection of LD and, based on their experiences, propose the adoption of PCR as routine laboratory testing to diagnose LD, as well as to consider the inclusion of PCR positivity in the case definition of a confirmed LD case. 

In a proof of concept, Kafetzopoulou et al. demonstrate that metagenomic sequencing using Illumina MiSeq and the portable Oxford Nanopore MinION was able to recover whole genome sequences of chikungunya and dengue viruses directly from serum or plasma samples. Authors inferred that the applied technique may also be used to detect other RNA viruses, thereby supporting front-line public health investigations during outbreak situations.  

The research in these three articles provides novel ideas and opens new public health perspectives. We are confident that our readers will find them interesting and we look forward to presenting the second part of the special issue in mid-January 2019.

Legionella: Now it's chaos. Paper mill is cleared

The outbreak of Legionnaire's in Italy continues to grow, but its source remains unclear. Via Giornale di Brescia: Legionella, now it's chaos. The paper mill is cleared. Excerpt from the Google translation:

«14 days after the outbreak of the epidemic we returned to the starting point ». These are the words to love those with which the mayor of Montichiari, Mario Fraccaro, has communicated via Facebook the results of the investigations conducted by ATS that exclude the presence of legionella in the waters of the cooling tower west of the Montichiari paper mill. 

One of the three in which the first findings of the same ATS had identified the bacterium, so as to indicate by the regional health authorities that precisely in the towers of three companies was to identify the cause of the epidemic. And if the Montichiari paper mill is so cleared in full, the similar insights on the other two companies involved - respectively in Calvisano and Carpenedolo - will arrive on Monday.  

Even if they were negative, it would be really all have to be redone. The question remains: what is the cause of the epidemic , which has 468 cases of pneumonia, an out-of-scale figure for the period, with 45 positivities ascertained to legionella?  

Not the Chiese for the same ATS, which also in the sampling of the waters of the river that flows along many of the countries at the center of the contagion has found traces: "The bacterium is present in nature, especially in water, but the human contagion occurs through nebulized droplets, while also for irrigation purposes, the waters of the Chiese are used only for flow, not for sprinkling ».

ECDC: CDTR, week 38

ECDC has published Communicable disease threats report, 16-22 September 2018, week 38. The summary:

The ECDC Communicable Disease Threats Report (CDTR) is a weekly bulletin for epidemiologists and health professionals on active public health threats. This issue covers the period 16-22 September 2018 and includes updates on West Nile virus, Ebola virus disease, cholera, monkeypox and Legionnaires' disease.

Pneumonia epidemic: New case in Calcinato

Via Brescia Settegiorni, a September 16 report: Pneumonia epidemic new case in Calcinato. The Google translation, edited, and then a comment:

The news coming from the Region seemed reassuring but instead, today it took a step back: a man of 30 has presented the symptoms of pneumonia and is now hospitalized for suspected legionella.  

The new case 

So far, Calcinato had been out of the red zone of the pneumonia epidemic that hit the Bassa in the last ten days. Today, however, a the 30-year-old, after a few days of fever, showed up at the Montichiari First Aid. High fever and the classic symptoms of pneumonia then persuaded the doctors to put him in a protected room because the suspicion of the doctors is that it could be legionella. 

The contacts with the outside and with the relatives were kept to a minimum, the doctors questioned the man, asking him where he lives and works, and his habits. Samples were also taken, then sent to ATS for the necessary investigations.  

This latest case arrives a few hours after the last medical bulletin was issued yesterday evening by the Lombardy Region in which the Welfare Councilor Giulio Gallera professed optimism for the end of the outbreak.

This outbreak is surprisingly large, but you'd never know it from the Italian media; longtime Flublogian ironorehopper has been following it as closely as possible.

Italy: Technicians seeking origin of legionella in pulp mills

Via Corriere della Sera: Pneumonia: Technicians seeking legionella in the Chiese pulp mills. The Google translation, slightly edited:

The hunt for the possible causes of the contagion of pneumonia continues and the research, as anticipated by Corriere, is concentrating along the axis of the Chiese as explained by the director general of ATC of Brescia on Tuesday. 

So the technicians of the Health Protection Agency, with the help of firefighters, on Tuesday, sieved, for a whole day, the Chiese Pulp Mill in Montichiari, carrying out a total of 23 samples, especially on the cooling towers of the production cycles. 

Yesterday, however, it was the turn of other companies and the hospital of Montichiari. 

The hypothesis, to be verified, is that in these large radiators may have nested the legionella bacteria, which is airborne through the water vapor and then dispersed in the atmosphere by the wind, in a sort of gigantic aerosol that could have infected the inhabitants of Montichiari but also of some neighboring country (Ats has asked Arpa to model the winds of the first week of September). 

Let's be clear, the water used by the paper mill for its production cycles and drawn not from the Chiese but from two artesian wells a few meters from its bed, reaches very high temperatures, such as not to allow the survival of the bacterium. Nor could they survive the sulfuric acid used for cleaning and macerating recycled paper. 

However, the vapors may have intercepted the bacteria present in the cooling system. How could they have arrived there? This is a beautiful mystery. For the infectious diseases of the public hospitals, the legionella has developed in the warm pools of the river, impoverished by drought, irrigation and hydroelectric plants. 

And since the paper mill does not use water directly from the Chiese river but some wells made a few meters from its bed, it is assumed that legionella may have affected the first stratum. 

Logically if this were the true Cartiera would be indirect victim of the epidemic. But in the company, which has dozens of employees, is there anyone who has pneumonia? 

"We have several employees at home in sickness," confirms Alberto Piovani, responsible for security, "but for privacy reasons we can not even know what diseases they suffer from. We have provided their names to the Ats staff who will contact their family doctors." 

Meanwhile, production in the paper mill continues. The results of the sampling, which will tell if the legionella bacteria (or others) have been found, will be ready in ten days, or 21 September.