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An outbreak of Legionnaires' disease in Gloucester

Published online by Cambridge University Press:  15 May 2009

D. A. Hunt ,
K. A. V. Cartwright ,
M. C. Smith ,
J. Middleton ,
C. L. R. Bartlett ,
J. V. Lee ,
P. J. Dennis  and
D. Harper
D. A. Hunt*
Affiliation:
Gloucester Health Authority, Gloucester GL1 1LY
K. A. V. Cartwright
Affiliation:
Public Health Laboratory, Gloucester GL1 3NN
M. C. Smith
Affiliation:
City Environmental Services Department, Gloucester GL1 2EQ
J. Middleton
Affiliation:
Communicable Disease Surveillance Centre, London NW9 5EQ
C. L. R. Bartlett
Affiliation:
Communicable Disease Surveillance Centre, London NW9 5EQ
J. V. Lee
Affiliation:
Centre for Applied Microbiology and Research, Porton Down, Wiltshire SP4 0JG
P. J. Dennis
Affiliation:
Centre for Applied Microbiology and Research, Porton Down, Wiltshire SP4 0JG
D. Harper
Affiliation:
Winton Applied Occupational Hygiene Ltd, Worcester Park, Surrey KT4 8RH
*
D. A. Hunt, Consultant in Public Health Medicine, Cheltenham and District Health Authority, Burlington House, Lypiatt Road, Cheltenham, Glos GL50 2QN
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Summary

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Fourteen people living in or near the city of Gloucester fell ill with Legionnaires' disease caused by Legionella pneumophila serogroup (SG) 1 between 27 August and 27 October 1986. Another patient had fallen ill on 30 May. Nine of the 15 were diagnosed retrospectively during a case finding exercise. There were three deaths. Three cases of Pontiac fever were also diagnosed.

The source was probably one or more wet cooling towers. Nineteen premises in the city with such towers were identified, and three just outside Gloucester. Samples from 11 of the 22 premises grew Legionella spp.; from nine of these L. pneumophila SG 1 (Pontiac) was isolated. The efficacy of regular addition of biocide in addition to hypochlorite added at the time of disinfection in inhibiting the growth of Legionella spp. was demonstrated.

A survey of patients' movements during their likely incubation period showed that there was no single building that all patients had visited, but there were two areas of the city which nearly all had visited or passed through by car. A case-control study demonstrated an association with one of these areas.

Cooling towers near both areas may have been sources but the evidence is insufficient to incriminate any single one. The unexpected finding of L. pneumophila SG 1 (Pontiac) in nine towers supports the hypothesis that there may have been multiple sources. Cooling towers may have been contaminated by mains water or by drift from other towers.

Type
Research Article
Information
Epidemiology & Infection , Volume 107 , Issue 1 , August 1991 , pp. 133 - 141
Copyright
Copyright © Cambridge University Press 1991

References

REFERENCES

1.Sub-committee of the Research Committee of the British Thoracic Society and the Public Health Laboratory Service. Community-acquired pneumonia in adults in British hospitals in 1982–1983: a survey of aetiology, mortality, prognostic factors and outcome. Quart J Med 1987; new series 62, 239: 195–220.Google Scholar
2. Public Health Laboratory Service. Communicable Disease Surveillance Centre. CDR 85/50.Google Scholar
3.Mitchell, E, O'mahoney, M, Watson, JM, et al. Two outbreaks of Legionnaires' disease in Bolton Health District. Epidemiol Infect 1990; 104: 159–70.CrossRefGoogle ScholarPubMed
4.O'mahoney, MC, Stanwell-Smith, RE, Tillett, HE, et al. The Stafford outbreak of Legionnaires' disease. Epidemiol Infect 1990; 104: 361–80.CrossRefGoogle Scholar
5.Harrison, TG, Taylor, AG. A rapid microagglutination test for the diagnosis of Legionella pneumophila (serogroup 1) infection. J Clin Pathol 1982; 35: 1028–31.CrossRefGoogle ScholarPubMed
6.Taylor, AG, Harrison, TG. Formolised yolk sac antigen in early diagnosis of Legionnaires' disease caused by Legionella pneumophila serogroup 1. Lancet 1981; ii: 591–2.CrossRefGoogle Scholar
7.Watkins, ID, Tobin, Jo'h, Dennis, PJ, et al. Legionella pneumophila serogroup 1 subgrouping by monoclonal antibodies – an epidemiological tool. J Hyg 1985; 95: 211–6.CrossRefGoogle ScholarPubMed
8.Williams, A, Baskerville, A, Dowsett, AB, Conlan, JW. Immunocytochemical demonstration of the association between Legionella pneumophila, its tissue-destructive protease and pulmonary lesions in experimental Legionnaires' disease. J Path 1987; 153: 257–64.CrossRefGoogle ScholarPubMed
9.Tillett, HE. Statistical analysis of case-control studies of communicable diseases. Int J Epidemiol 1986; 15: 126–33.CrossRefGoogle Scholar
10. Department of Health. The control of legionellae in health care premises – a code of practice. London: HMSO 1988.Google Scholar
11. Department of Health and Social Security. Health Services Management. Legionnaires disease and hospital water systems. London: Department of Health and Social Security, 1980. (HN(80)39).Google Scholar
12. Department of Health and Social Security. Health Services Management. Legionnaires disease: interim engineering guidance no. 2. Cooling towers and evaporative condensers. London: Department of Health and Social Security, 1986. (HN(Hazard)(86)1).Google Scholar
13.Chartered Institution of Building Services Engineers. Technical Memorandum (TM) 13. Minimising the risk of Legionnaires' disease. London: Chartered Institution of Building Services Engineers, 1987.Google Scholar
14.Bartlett, CLR, Bibby, LF. Epidemic legionellosis in England and Wales 1979–82. Zentrabl Bacteriol Mikrobiol Hyg Orig A (1983); 255: 64–70.Google Scholar
15.Anderson, P, Bartlett, C, Cook, G, Woodward M. Legionnaires disease in Reading – possible association with a cooling tower. Community Med 1985; 7: 202–7.Google ScholarPubMed
16.Morton, S, Bartlett, CLR, Bibby, LF, et al. Outbreak of Legionnaires' disease from a cooling water system in a power station. Br J Indust Med 1986; 43: 630–5.Google Scholar
17. Committee of inquiry. First report of the Committee of Inquiry into the Outbreak of Legionnaires' Disease in Stafford in April, 1985. HMSO. Cmnd 9772Google Scholar
18.Ad-hoc committee. Outbreak of legionellosis in a community. Lancet 1986; ii: 380–3.Google Scholar
19.Timbury, MC, Donaldson, JR, McCartney, AC, et al. Outbreak of Legionnaires' disease in Glasgow Royal Infirmary: microbiological aspects. J Hyg 1986; 97: 393–403.CrossRefGoogle Scholar
20. Health and Safety Executive. Legionnaires' disease. Guidance note EH48. January 1987.Google Scholar
21.Saunders, NA, Harrison, TG, Haththotuwa, A, et al. A method for typing strains of Legionella pneumophila serogroup 1 by analysis of restriction fragment length polymorphisms. J Med Microbiol 1990; 31: 45–55.CrossRefGoogle ScholarPubMed