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Legionnaire’s Disease HPA Surveillance & Outbreak Management

Legionnaire’s Disease HPA Surveillance & Outbreak Management. Rebecca Ingham Health Protection Practitioner West Yorkshire Health Protection Unit. The West Yorkshire HPU. West Yorkshire HPU: 5 CCDC’s ( Consultant in Communicable Disease Control ): All CCDC’s are Dr’s in our Unit

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Legionnaire’s Disease HPA Surveillance & Outbreak Management

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  1. Legionnaire’s DiseaseHPA Surveillance & Outbreak Management Rebecca Ingham Health Protection Practitioner West Yorkshire Health Protection Unit

  2. The West Yorkshire HPU • West Yorkshire HPU: • 5 CCDC’s (Consultant in Communicable Disease Control): • All CCDC’s are Dr’s in our Unit • Patch work – 1 CCDC to each patch • Duty CCDC - on daily basis • 9 Health Protection Specialists: • 8 HP Nurses + 1 HP Practitioner • Patch work – 2 HPS to each patch • Duty Professional – approx 1 or 2 days/ week • Surveillance team • PA support/ Administration Team • Trainees • Specialist Registrars (medic trained) & Specialist Trainees (non medic)/ FY2’s – Junior Dr’s

  3. Ubiquitous: Aquatic: lakes and streams 46 species including L. pneumophilia (serogroup 1 causes most LD) Spread through aerosols Cooling towers, spas, shower heads, taps, humidifiers No person-to-person transmission Legionella pneumophilia

  4. Clinical features • Legionnaires’ disease: Incubation Period 2-10 days • Non specific flu like illness: fever, malaise, myalgia, headache, dry cough, anorexia often with diarrhoea and confusion • Difficult to differentiate clinically from other atypical pneumonias • Become ill quickly • Complications: • resp failure, pericarditis, acute renal failure • Treatment: • Erythromycin • 5-15% mortality • Pontiac fever: self limiting, Incubation Period 5-66hrs

  5. Microbiological Investigation • Culture: need special media • Antibody detection: takes 3-6 weeks to rise to diagnostic levels • Serogroup 1 urinary antigen: early diagnosis – fast and dirty testing of urine • Usual to also get sputum or other respiratory samples (bronchial washings) for testing • Genotyping available to support epidemiological investigations • i.e. human and env samples ‘fingerprint’ the same • Environmental sampling to investigate suspected sources. Routine sampling not worthwhile

  6. Epidemiology • Incidence ?? Over 200 cases a year in the UK • 70% in Males • 90% in the over 30’s • Travel associated accounts for about 50% of cases • Spain, Turkey, France, Italy, Greece • 15% associated with outbreaks • 2% hospital acquired • Risk factors: • Age, smoking, lung and kidney disease, immunosuppression, alcohol • Incidence appears to be rising, probably due to better awareness and testing

  7. Surveillance: Why? • See trends: descriptive epidemiology, at risk populations – age, travel • Detect outbreaks • New infections: seasonal flu virus, pandemic virus • Implement interventions to prevent spread of disease • Monitor effectiveness of interventions

  8. Dissemination of Surveillance Data • Health Protection Report and HPA website • European Legionnaires’ disease Surveillance Network (ELDSNet ) • European Centre for Disease Prevention and Control (ECDC) • World Health Organisation (WHO)

  9. Investigation of a Case • Confirm case: Test validated at CfI • Notifiable in Eng&Wales (since 2010) • Risk factor history for previous 2 weeks • Travel, place of work, hospital acquired? • Other cases? (diagnosed, undiagnosed?) • Inform LA H&S and HSE • LA holds a database of cooling towers (is it up to date?) Check out sampling records

  10. Surveillance Data Set: • Patients demographics: • Age/ DoB/ Gender/ Home & Work Address/ Occupation • Clinical History: • Onset/ Relevant med history/ Hospital admission/ Outcome • Exposure history: • ? hospital acquired • Community acquired (known exposure to cooling towers, whirlpool spas, showers) • Travel associated Country (s) visited, dates of stay, name & address of accommodation, room number, tour operator, use of showers, spa pools • Household acquired - Use of household water system during incubation period, in absence of other exposures

  11. Clusters, Outbreaks & Travel Associated Clusters • Cluster • Outbreak • Travel Associated Cluster • Strength of evidence for outbreaks • High • Low

  12. Outbreaks • Active case finding • Detailed analysis of movements • Mapping • Identify potential sources: inspections and detailed look at records • Hospital acquired: check all sources • Engineer’s advice • Typing results

  13. Legionella

  14. Prevention and Control • Health and Safety • Employers should identify, assess and manage risks • Cooling towers notified and maintained • Testing and addition of biocides to limit growth • Reporting of cases: locally and nationally • Investigation of cases • Increasing awareness • Professionals: thinks of Legionella and if you find it report it • Employers aware of risks and duties • Public beware of the risks

  15. Managing Outbreaks Requires All of us Working Together

  16. How to reach us: • West Yorkshire HPU • 6th floor South EastQuarry HouseQuarry HillLEEDS LS2 7UE • Telephone: • 0113 386 0300 • Duty desk: option 1 • Email: • westyorksdutypro@hpa.org.uk • rebecca.ingham@hpa.org.uk • 1st April 2013: • rebecca.ingham@phe.gov.uk • NB soon to be Public Health England • HPA website: • www.hpa.org.uk • 1st April 2013 • www.phe.gov.uk

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