Transcript Title of presentation

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
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
Legionella pneumophilia
• 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
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
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
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
Travel
Associated
Year
Total Cases
Male Cases
Female
Cases
Deaths
(Abroad &
UK)
1997
226
165
61
28
114
1998
227
162
65
25
115
1999
200
150
50
28
91
2000
180
143
37
25
101
2001
182
142
40
26
100
2002
387
256
131
33
154
2003
314
238
76
35
174
2004
318
239
79
38
173
2005
355
271
83
30
179
2006
551
433
118
53
213
2007
442
328
114
53
199
2008#
359
281
78
34
152
Legionella cases Eng and Wales
160
1997
140
1998
Number of Cases
120
1999
2000
100
2001
80
2002
60
2003
2004
40
2005
20
2006
0
2007
Jan Feb Mar
Apr May Jun
Jul
Month
Aug Sep Oct
Nov Dec
2008#
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
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)
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
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
Clusters, Outbreaks & Travel
Associated Clusters
• Cluster
• Outbreak
• Travel Associated Cluster
Strength of evidence for outbreaks
• High
• Low
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
Legionella
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
Managing Outbreaks Requires All of
us Working Together
How to reach us:
West Yorkshire HPU
6th floor South East
Quarry House
Quarry Hill
LEEDS LS2 7UE
Telephone:
NB soon to be Public Health
England
HPA website:
www.hpa.org.uk
0113 386 0300
Duty desk: option 1
1st April 2013
Email:
[email protected]
[email protected]
1st April 2013:
[email protected]
www.phe.gov.uk