TY - JOUR
T1 - Um grande surto da Doença dos Legionários numa cidade industrial em Portugal
AU - George, Francisco
AU - Shivaji, Tara
AU - Pinto, Catia Sousa
AU - Serra, Luis Antonio Oliveira
AU - Valente, João
AU - Albuquerque, Maria João
AU - Vicêncio, Paula Cristina Olivença
AU - San-Bento, Ana
AU - Diegues, Paulo
AU - Nogueira, Paulo Jorge
AU - Marques, Teresa
AU - Rebelo, Helena
AU - Costa, Filipa
AU - Rodrigues, Raquel
AU - Nunes, Alexandra
AU - Borges, Vitor
AU - Gomes, João Paulo
AU - Sampaio, Daniel
AU - Barreiro, Paula
AU - Duarte, Silvia
AU - Carpinteiro, Dina
AU - Mendonça, Joana
AU - Silva, Catarina
AU - Vieira, Luís
AU - Simões, Maria Joao
AU - Gonçalves, Paulo
AU - Nunes, Baltazar
AU - Dias, Carlos
AU - Machado, Jorge
AU - Almeida, Fernando
AU - Goncalves, Elsa A.
AU - Carvalho, Lucilia
AU - Viterbo, Pedro
AU - Jardim, Dilia
AU - Lacasta, Nuno
AU - Boavida, Filomena
AU - Perez, Ana
AU - Santana, Isabel
AU - Matias, Paula
AU - Banza, Nuno
AU - Rabacal, Carlos
PY - 2016/9/1
Y1 - 2016/9/1
N2 - 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.
AB - 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.
KW - Legionella pneumophila fraseri
KW - Legionnaires’ disease
UR - http://www.scopus.com/inward/record.url?scp=85002428359&partnerID=8YFLogxK
U2 - 10.1016/j.rpsp.2016.10.001
DO - 10.1016/j.rpsp.2016.10.001
M3 - Article
AN - SCOPUS:85002428359
SN - 0870-9025
VL - 34
SP - 199
EP - 208
JO - Revista Portuguesa de Saúde Pública
JF - Revista Portuguesa de Saúde Pública
IS - 3
ER -