A large outbreak of Legionnaires’ Disease in an industrial town in Portugal

Detalhes bibliográficos
Autor(a) principal: George, Francisco
Data de Publicação: 2016
Outros Autores: Shivaji, Tara, Pinto, Catia Sousa, Serra, Luis Antonio Oliveira, Valente, João, Albuquerque, Maria João, Vicêncio, Paula Cristina Olivença, San-Bento, Ana, Diegues, Paulo, Nogueira, Paulo Jorge, Marques, Teresa, Rebelo, Helena, Costa, Filipa, Rodrigues, Raquel, Nunes, Alexandra, Borges, Vitor, Gomes, João Paulo, Sampaio, Daniel, Barreiro, Paula, Duarte, Silvia, Carpinteiro, Dina, Mendonça, Joana, Silva, Catarina, Vieira, Luís, Simões, Maria Joao, Gonçalves, Paulo, Nunes, Baltazar, Dias, Carlos, Machado, Jorge, Almeida, Fernando, Gonçalves, Elsa A., Carvalho, Lucilia, Viterbo, Pedro, Jardim, Dilia, Lacasta, Nuno, Boavida, Filomena, Perez, Ana, Santana, Isabel, Matias, Paula, Banza, Nuno, Rabacal, Carlos
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://hdl.handle.net/10362/22882
Resumo: A B S T R A C T - Background: We describe the investigation and control of an outbreak of Legionnaires’ disease in Portugal in October, November and December 2014. Methods: Confirmed cases were individuals with pneumonia, laboratory evidence of Legionella pneumophila serogroup 1 and exposure, by residence, occupational or leisure to the affected municipalities. 49 possible sources were reduced to four potential sources, all industries with wet cooling system, following risk assessment. We geo-referenced cases’ residences and the location of cooling towers defining four study areas 10 km buffer centered on each cooling tower system. We compared the number of cases with expected numbers, calculated from the outbreak’s attack rates applied to 2011 census population. Using Stones’ Test, we tested observed to expected ratios for decline in risk, with distance up to 10 km four directions. Isolates of Legionella pneumophila were compared using molecular methods. Results: We identified 403 cases, 377 of which were confirmed, 14 patients died. Patients became ill between 14 October and 2 December. A NE wind and thermal inversion were recorded during the estimated period of exposure. Disease risk was highest in people living south west from all of the industries identified and decreased with distance (p < 0.001). 71 clinical isolates demonstrated an identical SBT profile to an isolate from a cooling tower. Whole genome sequencing identified an unusual L. pneumophila subsp. fraseri serogroup 1 as the outbreak causative strain, and confirmed isolates’ relatedness. Conclusions: Industrial wet cooling systems, bacteria with enhanced survival characteristics and a combination of climatic conditions contributed to the second largest outbreak of Legionnaires’ disease recorded internationally.
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spelling A large outbreak of Legionnaires’ Disease in an industrial town in PortugalUm grande surto da Doença dos Legionários numa cidade industrial em PortugalLegionnaires’ diseaseLegionella pneumophila fraseriDoença dos LegionáriosLegionella pneumophila fraseriA B S T R A C T - Background: We describe the investigation and control of an outbreak of Legionnaires’ disease in Portugal in October, November and December 2014. Methods: Confirmed cases were individuals with pneumonia, laboratory evidence of Legionella pneumophila serogroup 1 and exposure, by residence, occupational or leisure to the affected municipalities. 49 possible sources were reduced to four potential sources, all industries with wet cooling system, following risk assessment. We geo-referenced cases’ residences and the location of cooling towers defining four study areas 10 km buffer centered on each cooling tower system. We compared the number of cases with expected numbers, calculated from the outbreak’s attack rates applied to 2011 census population. Using Stones’ Test, we tested observed to expected ratios for decline in risk, with distance up to 10 km four directions. Isolates of Legionella pneumophila were compared using molecular methods. Results: We identified 403 cases, 377 of which were confirmed, 14 patients died. Patients became ill between 14 October and 2 December. A NE wind and thermal inversion were recorded during the estimated period of exposure. Disease risk was highest in people living south west from all of the industries identified and decreased with distance (p < 0.001). 71 clinical isolates demonstrated an identical SBT profile to an isolate from a cooling tower. Whole genome sequencing identified an unusual L. pneumophila subsp. fraseri serogroup 1 as the outbreak causative strain, and confirmed isolates’ relatedness. Conclusions: Industrial wet cooling systems, bacteria with enhanced survival characteristics and a combination of climatic conditions contributed to the second largest outbreak of Legionnaires’ disease recorded internationally.R E S U M O Contexto: Descrevemos a investigação epidemiológica e medidas de controlo de um surto de doença dos Legionários, ocorrido em Portugal em outubro, novembro e dezembro de 2014. Métodos: A definição de caso englobou doentes com critérios clínicos de pneumonia aguda, com provas imagiológicas compatíveis e confirmação laboratorial para a identificação de Legionella pneumophila (L. pneumophila) serogrupo 1, para além do critério epidemiológico de exposição, quer por motivos de residência, ocupacional ou lazer nas freguesias suspeitas. Quarenta e nove possíveis fontes de infeção foram reduzidas a 4 potenciais fontes, após avaliação de risco, todas as indústrias com sistema de torres de arrefecimento. A georreferenciação por residência dos casos e localização de torres permitiu definir 4 áreas de investigação num perímetro de 10 km centrado em cada uma daquelas 4 torres. Comparouse o número de casos observados com o número de casos esperados, calculados a partir de taxas de ataque do surto aplicadas à população. Usando o teste de Stones, testou-se a razão entre casos observados e casos esperados e declínio do risco em relação à distância de até 10 km em 4 direções. As amostras de L. pneumophila foram comparadas utilizando métodos moleculares. Resultados: Foram identificados 403 casos, dos quais 377 foram confirmados, tendo ocorrido 14 óbitos. Os doentes apresentaram sintomas entre 14 de outubro e 2 de dezembro. Em termos meteorológicos, foram registados ventos NE e inversão térmica durante o período estimado de exposição. O risco de doença foi maior em pessoas que vivem a sudoeste de todas as indústrias identificadas, diminuindo com o aumento da distância (p < 0,001). Amostras de 71 dos casos clínicos demonstraram um perfil SBT idêntico às amostras isoladas a partir de uma torre de arrefecimento. A sequência de genoma de L. pneumophila fraseri serogrupo 1 pouco comum como a estirpe causadora do surto confirmou a relação das amostras isoladas. Conclusões: Torres de arrefecimento industriais, agentes bacterianos com características mais desenvolvidas para elevada sobrevivência e uma rara combinação de condições climáticas, contribuíram para o segundo maior surto de doença dos Legionários registado na literatura.Universidade Nova de Lisboa, Escola Nacional de Saúde PúblicaRUNGeorge, FranciscoShivaji, TaraPinto, Catia SousaSerra, Luis Antonio OliveiraValente, JoãoAlbuquerque, Maria JoãoVicêncio, Paula Cristina OlivençaSan-Bento, AnaDiegues, PauloNogueira, Paulo JorgeMarques, TeresaRebelo, HelenaCosta, FilipaRodrigues, RaquelNunes, AlexandraBorges, VitorGomes, João PauloSampaio, DanielBarreiro, PaulaDuarte, SilviaCarpinteiro, DinaMendonça, JoanaSilva, CatarinaVieira, LuísSimões, Maria JoaoGonçalves, PauloNunes, BaltazarDias, CarlosMachado, JorgeAlmeida, FernandoGonçalves, Elsa A.Carvalho, LuciliaViterbo, PedroJardim, DiliaLacasta, NunoBoavida, FilomenaPerez, AnaSantana, IsabelMatias, PaulaBanza, NunoRabacal, Carlos2017-08-22T15:10:24Z2016-092016-09-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10362/22882eng0870-9025info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2024-03-11T04:10:51Zoai:run.unl.pt:10362/22882Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T03:27:33.153204Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv A large outbreak of Legionnaires’ Disease in an industrial town in Portugal
Um grande surto da Doença dos Legionários numa cidade industrial em Portugal
title A large outbreak of Legionnaires’ Disease in an industrial town in Portugal
spellingShingle A large outbreak of Legionnaires’ Disease in an industrial town in Portugal
George, Francisco
Legionnaires’ disease
Legionella pneumophila fraseri
Doença dos Legionários
Legionella pneumophila fraseri
title_short A large outbreak of Legionnaires’ Disease in an industrial town in Portugal
title_full A large outbreak of Legionnaires’ Disease in an industrial town in Portugal
title_fullStr A large outbreak of Legionnaires’ Disease in an industrial town in Portugal
title_full_unstemmed A large outbreak of Legionnaires’ Disease in an industrial town in Portugal
title_sort A large outbreak of Legionnaires’ Disease in an industrial town in Portugal
author George, Francisco
author_facet George, Francisco
Shivaji, Tara
Pinto, Catia Sousa
Serra, Luis Antonio Oliveira
Valente, João
Albuquerque, Maria João
Vicêncio, Paula Cristina Olivença
San-Bento, Ana
Diegues, Paulo
Nogueira, Paulo Jorge
Marques, Teresa
Rebelo, Helena
Costa, Filipa
Rodrigues, Raquel
Nunes, Alexandra
Borges, Vitor
Gomes, João Paulo
Sampaio, Daniel
Barreiro, Paula
Duarte, Silvia
Carpinteiro, Dina
Mendonça, Joana
Silva, Catarina
Vieira, Luís
Simões, Maria Joao
Gonçalves, Paulo
Nunes, Baltazar
Dias, Carlos
Machado, Jorge
Almeida, Fernando
Gonçalves, Elsa A.
Carvalho, Lucilia
Viterbo, Pedro
Jardim, Dilia
Lacasta, Nuno
Boavida, Filomena
Perez, Ana
Santana, Isabel
Matias, Paula
Banza, Nuno
Rabacal, Carlos
author_role author
author2 Shivaji, Tara
Pinto, Catia Sousa
Serra, Luis Antonio Oliveira
Valente, João
Albuquerque, Maria João
Vicêncio, Paula Cristina Olivença
San-Bento, Ana
Diegues, Paulo
Nogueira, Paulo Jorge
Marques, Teresa
Rebelo, Helena
Costa, Filipa
Rodrigues, Raquel
Nunes, Alexandra
Borges, Vitor
Gomes, João Paulo
Sampaio, Daniel
Barreiro, Paula
Duarte, Silvia
Carpinteiro, Dina
Mendonça, Joana
Silva, Catarina
Vieira, Luís
Simões, Maria Joao
Gonçalves, Paulo
Nunes, Baltazar
Dias, Carlos
Machado, Jorge
Almeida, Fernando
Gonçalves, Elsa A.
Carvalho, Lucilia
Viterbo, Pedro
Jardim, Dilia
Lacasta, Nuno
Boavida, Filomena
Perez, Ana
Santana, Isabel
Matias, Paula
Banza, Nuno
Rabacal, Carlos
author2_role author
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author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
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author
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author
author
dc.contributor.none.fl_str_mv RUN
dc.contributor.author.fl_str_mv George, Francisco
Shivaji, Tara
Pinto, Catia Sousa
Serra, Luis Antonio Oliveira
Valente, João
Albuquerque, Maria João
Vicêncio, Paula Cristina Olivença
San-Bento, Ana
Diegues, Paulo
Nogueira, Paulo Jorge
Marques, Teresa
Rebelo, Helena
Costa, Filipa
Rodrigues, Raquel
Nunes, Alexandra
Borges, Vitor
Gomes, João Paulo
Sampaio, Daniel
Barreiro, Paula
Duarte, Silvia
Carpinteiro, Dina
Mendonça, Joana
Silva, Catarina
Vieira, Luís
Simões, Maria Joao
Gonçalves, Paulo
Nunes, Baltazar
Dias, Carlos
Machado, Jorge
Almeida, Fernando
Gonçalves, Elsa A.
Carvalho, Lucilia
Viterbo, Pedro
Jardim, Dilia
Lacasta, Nuno
Boavida, Filomena
Perez, Ana
Santana, Isabel
Matias, Paula
Banza, Nuno
Rabacal, Carlos
dc.subject.por.fl_str_mv Legionnaires’ disease
Legionella pneumophila fraseri
Doença dos Legionários
Legionella pneumophila fraseri
topic Legionnaires’ disease
Legionella pneumophila fraseri
Doença dos Legionários
Legionella pneumophila fraseri
description A B S T R A C T - Background: We describe the investigation and control of an outbreak of Legionnaires’ disease in Portugal in October, November and December 2014. Methods: Confirmed cases were individuals with pneumonia, laboratory evidence of Legionella pneumophila serogroup 1 and exposure, by residence, occupational or leisure to the affected municipalities. 49 possible sources were reduced to four potential sources, all industries with wet cooling system, following risk assessment. We geo-referenced cases’ residences and the location of cooling towers defining four study areas 10 km buffer centered on each cooling tower system. We compared the number of cases with expected numbers, calculated from the outbreak’s attack rates applied to 2011 census population. Using Stones’ Test, we tested observed to expected ratios for decline in risk, with distance up to 10 km four directions. Isolates of Legionella pneumophila were compared using molecular methods. Results: We identified 403 cases, 377 of which were confirmed, 14 patients died. Patients became ill between 14 October and 2 December. A NE wind and thermal inversion were recorded during the estimated period of exposure. Disease risk was highest in people living south west from all of the industries identified and decreased with distance (p < 0.001). 71 clinical isolates demonstrated an identical SBT profile to an isolate from a cooling tower. Whole genome sequencing identified an unusual L. pneumophila subsp. fraseri serogroup 1 as the outbreak causative strain, and confirmed isolates’ relatedness. Conclusions: Industrial wet cooling systems, bacteria with enhanced survival characteristics and a combination of climatic conditions contributed to the second largest outbreak of Legionnaires’ disease recorded internationally.
publishDate 2016
dc.date.none.fl_str_mv 2016-09
2016-09-01T00:00:00Z
2017-08-22T15:10:24Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
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dc.identifier.uri.fl_str_mv http://hdl.handle.net/10362/22882
url http://hdl.handle.net/10362/22882
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv 0870-9025
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Universidade Nova de Lisboa, Escola Nacional de Saúde Pública
publisher.none.fl_str_mv Universidade Nova de Lisboa, Escola Nacional de Saúde Pública
dc.source.none.fl_str_mv reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
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reponame_str Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
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