Abstract
BackgroundAn explosive outbreak of Legionnaires’ disease (LD) was identified on 11 December 2015 in Manzanares, Ciudad Real, Spain, and was declared closed by 03 February 2016. The number of declared cases was 593 with 277 confirmed cases so that it can be considered as one of the outbreaks with highest attack rate. This rate could be attributed to the ageing of the population, among others, in addition to various risk factors and habits, and the meteorological conditions (thermal inversion) maintained in this municipality at the time. The Public Health Services succeeded in breaking the bacterial transmission. Several facilities were early identified by microbiological analysis, including a cooling tower and a decorative fountain, as possible infectious sources. Rapid analytical techniques for rapid Legionella detection and the shutdown and preventative closure of positive installations have been considered key elements in the control of this outbreak.ResultsRapid microbiological analysis helped to the early identification of potential risk sources in a Legionnaires´ disease outbreak, reducing decision-making processes according to the actual needs of the intervention in public health and shortening the exposure of the population.ConclusionsProtocolized and immediate intervention in an outbreak is a crucial issue to reduce their effects on public health. For this, identification and control of the suspicious sources able to disseminate the bacteria and cause the illness is required. Rapid analytical techniques like immunomagnetic separation (IMS) method based on the whole bacterial cell detection are shown as excellent tools to investigate all the potential sources of risk.
Highlights
An explosive outbreak of Legionnaires’ disease (LD) was identified on 11 December 2015 in Manzanares, Ciudad Real, Spain, and was declared closed by 03 February 2016
This paper describes the environmental and analytical investigation made within the global investigation of an explosive outbreak occurred in December 2015 in Manzanares (Ciudad Real, Spain), on the basis of the information available in the report prepared by General Directorate of Public Health and Consumer Affairs of the Castilla-La Mancha Community Council [17]
Case definition was based on the following criteria: i) Living in or visiting Manzanares in the 10 days preceding the development of community-acquired pneumonia (CAP), ii) Pneumonia confirmed by radiology, iii) A positive result in at least one of the following assays: culture, antigen in urine, nested Sequence-Based Typing (SBT) PCR, seroconversion, iv) A PCR positive result
Summary
An explosive outbreak of Legionnaires’ disease (LD) was identified on 11 December 2015 in Manzanares, Ciudad Real, Spain, and was declared closed by 03 February 2016. The number of declared cases was 593 with 277 confirmed cases so that it can be considered as one of the outbreaks with highest attack rate This rate could be attributed to the ageing of the population, among others, in addition to various risk factors and habits, and the meteorological conditions (thermal inversion) maintained in this municipality at the time. Biofilms are promoted by a poor state, inappropriate design, or the absence of proper maintenance of these systems, providing nutrients for Legionella, including organic matter, sludge, corrosion materials and protozoa. These systems can act as transmission devices becoming potential sources of infection when they are contaminated and produce aerosols. Several human risk factors and lifestyle habits can lead to this illness, which is presented as isolated cases or outbreaks in both nosocomial and community-acquired pneumonia scenarios [7]
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