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Legionnaire’s Disease HPA Surveillance & Outbreak Management

Comprehensive information on Legionnaires’ disease, including clinical features, microbiological investigation, epidemiology, surveillance, prevention, and outbreak management. Learn about the West Yorkshire Health Protection Unit's role in monitoring and controlling the disease.

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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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