Publicação
A large outbreak of Legionnaires' Disease in an industrial town in Portugal
| Resumo: | 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. |
|---|---|
| Autores principais: | George,Francisco |
| Outros Autores: | Shivaji,Tara; Pinto,Catia Sousa; Serra,Luis Antonio Oliveira; Valente,João; Albuquerque,Maria João; Vicêncio,Paula Cristina Olivença; San-Bento,Ana; Diegues,Paulo; Nogueira,Paulo Jorge; Marques,Teresa; Rebelo,Helena; Costa,Filipa; Rodrigues,Raquel; Nunes,Alexandra; Borges,Vitor; Gomes,João Paulo; Sampaio,Daniel; Barreiro,Paula; Duarte,Silvia; Carpinteiro,Dina; Mendonça,Joana; Silva,Catarina; Vieira,Luís; Simões,Maria Joao; Gonçalves,Paulo; Nunes,Baltazar; Dias,Carlos; Machado,Jorge; Almeida,Fernando; Goncalves,Elsa A; Carvalho,Lucilia; Viterbo,Pedro; Jardim,Dilia; Lacasta,Nuno; Boavida,Filomena; Perez,Ana; Santana,Isabel; Matias,Paula; Banza,Nuno; Rabacal,Carlos |
| Assunto: | Legionnaires' disease Legionella pneumophila fraseri |
| Ano: | 2016 |
| País: | Portugal |
| Tipo de documento: | artigo |
| Tipo de acesso: | acesso aberto |
| Instituição associada: | Fundação para a Ciência e Tecnologia |
| Idioma: | inglês |
| Origem: | SciELO Portugal |
| _version_ | 1877791968346505216 |
|---|---|
| author | George,Francisco |
| author2 | Shivaji,Tara Pinto,Catia Sousa Serra,Luis Antonio Oliveira Valente,João Albuquerque,Maria João Vicêncio,Paula Cristina Olivença San-Bento,Ana Diegues,Paulo Nogueira,Paulo Jorge Marques,Teresa Rebelo,Helena Costa,Filipa Rodrigues,Raquel Nunes,Alexandra Borges,Vitor Gomes,João Paulo Sampaio,Daniel Barreiro,Paula Duarte,Silvia Carpinteiro,Dina Mendonça,Joana Silva,Catarina Vieira,Luís Simões,Maria Joao Gonçalves,Paulo Nunes,Baltazar Dias,Carlos Machado,Jorge Almeida,Fernando Goncalves,Elsa A Carvalho,Lucilia Viterbo,Pedro Jardim,Dilia Lacasta,Nuno Boavida,Filomena Perez,Ana Santana,Isabel Matias,Paula Banza,Nuno Rabacal,Carlos |
| author2_role | author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author |
| author_facet | George,Francisco Shivaji,Tara Pinto,Catia Sousa Serra,Luis Antonio Oliveira Valente,João Albuquerque,Maria João Vicêncio,Paula Cristina Olivença San-Bento,Ana Diegues,Paulo Nogueira,Paulo Jorge Marques,Teresa Rebelo,Helena Costa,Filipa Rodrigues,Raquel Nunes,Alexandra Borges,Vitor Gomes,João Paulo Sampaio,Daniel Barreiro,Paula Duarte,Silvia Carpinteiro,Dina Mendonça,Joana Silva,Catarina Vieira,Luís Simões,Maria Joao Gonçalves,Paulo Nunes,Baltazar Dias,Carlos Machado,Jorge Almeida,Fernando Goncalves,Elsa A Carvalho,Lucilia Viterbo,Pedro Jardim,Dilia Lacasta,Nuno Boavida,Filomena Perez,Ana Santana,Isabel Matias,Paula Banza,Nuno Rabacal,Carlos |
| author_role | author |
| country_str | PT |
| creators_json_txt | [{\"Person.name\":\"George,Francisco\"},{\"Person.name\":\"Shivaji,Tara\"},{\"Person.name\":\"Pinto,Catia Sousa\"},{\"Person.name\":\"Serra,Luis Antonio Oliveira\"},{\"Person.name\":\"Valente,João\"},{\"Person.name\":\"Albuquerque,Maria João\"},{\"Person.name\":\"Vicêncio,Paula Cristina Olivença\"},{\"Person.name\":\"San-Bento,Ana\"},{\"Person.name\":\"Diegues,Paulo\"},{\"Person.name\":\"Nogueira,Paulo Jorge\"},{\"Person.name\":\"Marques,Teresa\"},{\"Person.name\":\"Rebelo,Helena\"},{\"Person.name\":\"Costa,Filipa\"},{\"Person.name\":\"Rodrigues,Raquel\"},{\"Person.name\":\"Nunes,Alexandra\"},{\"Person.name\":\"Borges,Vitor\"},{\"Person.name\":\"Gomes,João Paulo\"},{\"Person.name\":\"Sampaio,Daniel\"},{\"Person.name\":\"Barreiro,Paula\"},{\"Person.name\":\"Duarte,Silvia\"},{\"Person.name\":\"Carpinteiro,Dina\"},{\"Person.name\":\"Mendonça,Joana\"},{\"Person.name\":\"Silva,Catarina\"},{\"Person.name\":\"Vieira,Luís\"},{\"Person.name\":\"Simões,Maria Joao\"},{\"Person.name\":\"Gonçalves,Paulo\"},{\"Person.name\":\"Nunes,Baltazar\"},{\"Person.name\":\"Dias,Carlos\"},{\"Person.name\":\"Machado,Jorge\"},{\"Person.name\":\"Almeida,Fernando\"},{\"Person.name\":\"Goncalves,Elsa A\"},{\"Person.name\":\"Carvalho,Lucilia\"},{\"Person.name\":\"Viterbo,Pedro\"},{\"Person.name\":\"Jardim,Dilia\"},{\"Person.name\":\"Lacasta,Nuno\"},{\"Person.name\":\"Boavida,Filomena\"},{\"Person.name\":\"Perez,Ana\"},{\"Person.name\":\"Santana,Isabel\"},{\"Person.name\":\"Matias,Paula\"},{\"Person.name\":\"Banza,Nuno\"},{\"Person.name\":\"Rabacal,Carlos\"}] |
| datacite.creators.creator.creatorName.fl_str_mv | George,Francisco Shivaji,Tara Pinto,Catia Sousa Serra,Luis Antonio Oliveira Valente,João Albuquerque,Maria João Vicêncio,Paula Cristina Olivença San-Bento,Ana Diegues,Paulo Nogueira,Paulo Jorge Marques,Teresa Rebelo,Helena Costa,Filipa Rodrigues,Raquel Nunes,Alexandra Borges,Vitor Gomes,João Paulo Sampaio,Daniel Barreiro,Paula Duarte,Silvia Carpinteiro,Dina Mendonça,Joana Silva,Catarina Vieira,Luís Simões,Maria Joao Gonçalves,Paulo Nunes,Baltazar Dias,Carlos Machado,Jorge Almeida,Fernando Goncalves,Elsa A Carvalho,Lucilia Viterbo,Pedro Jardim,Dilia Lacasta,Nuno Boavida,Filomena Perez,Ana Santana,Isabel Matias,Paula Banza,Nuno Rabacal,Carlos |
| datacite.rights.fl_str_mv | http://purl.org/coar/access_right/c_abf2 |
| datacite.subjects.subject.fl_str_mv | Legionnaires' disease Legionella pneumophila fraseri |
| datacite.titles.title.fl_str_mv | A large outbreak of Legionnaires' Disease in an industrial town in Portugal |
| dc.creator.none.fl_str_mv | George,Francisco Shivaji,Tara Pinto,Catia Sousa Serra,Luis Antonio Oliveira Valente,João Albuquerque,Maria João Vicêncio,Paula Cristina Olivença San-Bento,Ana Diegues,Paulo Nogueira,Paulo Jorge Marques,Teresa Rebelo,Helena Costa,Filipa Rodrigues,Raquel Nunes,Alexandra Borges,Vitor Gomes,João Paulo Sampaio,Daniel Barreiro,Paula Duarte,Silvia Carpinteiro,Dina Mendonça,Joana Silva,Catarina Vieira,Luís Simões,Maria Joao Gonçalves,Paulo Nunes,Baltazar Dias,Carlos Machado,Jorge Almeida,Fernando Goncalves,Elsa A Carvalho,Lucilia Viterbo,Pedro Jardim,Dilia Lacasta,Nuno Boavida,Filomena Perez,Ana Santana,Isabel Matias,Paula Banza,Nuno Rabacal,Carlos |
| dc.format.none.fl_str_mv | text/html |
| dc.identifier.none.fl_str_mv | http://scielo.pt/scielo.php?script=sci_arttext&pid=S0870-90252016000300002 |
| dc.language.none.fl_str_mv | eng |
| dc.publisher.none.fl_str_mv | Escola Nacional de Saúde Pública |
| dc.rights.none.fl_str_mv | http://purl.org/coar/access_right/c_abf2 |
| dc.source.none.fl_str_mv | Revista Portuguesa de Saúde Pública v.34 n.3 2016 |
| dc.subject.none.fl_str_mv | Legionnaires' disease Legionella pneumophila fraseri |
| dc.title.fl_str_mv | A large outbreak of Legionnaires' Disease in an industrial town in Portugal |
| dc.type.none.fl_str_mv | http://purl.org/coar/resource_type/c_6501 |
| description | 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. |
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| eu_rights_str_mv | openAccess |
| format | article |
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| inst_facet_str | urn:organizationAcronym:scielo{{{_:::_}}}Fundação para a Ciência e Tecnologia |
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| language | eng |
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| person_str_mv | George,Francisco Shivaji,Tara Pinto,Catia Sousa Serra,Luis Antonio Oliveira Valente,João Albuquerque,Maria João Vicêncio,Paula Cristina Olivença San-Bento,Ana Diegues,Paulo Nogueira,Paulo Jorge Marques,Teresa Rebelo,Helena Costa,Filipa Rodrigues,Raquel Nunes,Alexandra Borges,Vitor Gomes,João Paulo Sampaio,Daniel Barreiro,Paula Duarte,Silvia Carpinteiro,Dina Mendonça,Joana Silva,Catarina Vieira,Luís Simões,Maria Joao Gonçalves,Paulo Nunes,Baltazar Dias,Carlos Machado,Jorge Almeida,Fernando Goncalves,Elsa A Carvalho,Lucilia Viterbo,Pedro Jardim,Dilia Lacasta,Nuno Boavida,Filomena Perez,Ana Santana,Isabel Matias,Paula Banza,Nuno Rabacal,Carlos |
| publishDate | 2016 |
| publisher.none.fl_str_mv | Escola Nacional de Saúde Pública |
| repo_facet_str | urn:repositoryAcronym:scielopt{{{_:::_}}}SciELO Portugal |
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| spelling | A large outbreak of Legionnaires' Disease in an industrial town in PortugalGeorge,FranciscoShivaji,TaraPinto,Catia SousaSerra,Luis Antonio OliveiraValente,JoãoAlbuquerque,Maria JoãoVicêncio,Paula Cristina OlivençaSan-Bento,AnaDiegues,PauloNogueira,Paulo JorgeMarques,TeresaRebelo,HelenaCosta,FilipaRodrigues,RaquelNunes,AlexandraBorges,VitorGomes,João PauloSampaio,DanielBarreiro,PaulaDuarte,SilviaCarpinteiro,DinaMendonça,JoanaSilva,CatarinaVieira,LuísSimões,Maria JoaoGonçalves,PauloNunes,BaltazarDias,CarlosMachado,JorgeAlmeida,FernandoGoncalves,Elsa ACarvalho,LuciliaViterbo,PedroJardim,DiliaLacasta,NunoBoavida,FilomenaPerez,AnaSantana,IsabelMatias,PaulaBanza,NunoRabacal,CarlosLegionnaires' diseaseLegionella pneumophila fraseriopen accesshttp://purl.org/coar/access_right/c_abf2http://scielo.pt/scielo.php?script=sci_arttext&pid=S0870-90252016000300002URLhttp://scielo.pt/scielo.php?script=sci_arttext&pid=S0870-90252016000300002URLHasVersion2016-10-01Background 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.Escola Nacional de Saúde PúblicaRevista Portuguesa de Saúde Pública v.34 n.3 2016text/htmlengjournal articlehttp://purl.org/coar/resource_type/c_6501literature |
| spellingShingle | A large outbreak of Legionnaires' Disease in an industrial town in Portugal George,Francisco Legionnaires' disease Legionella pneumophila fraseri |
| status | SINGLETON |
| subject.fl_str_mv | Legionnaires' disease Legionella pneumophila fraseri |
| title | A large outbreak of Legionnaires' Disease in an industrial town in Portugal |
| title_full | A large outbreak of Legionnaires' Disease in an industrial town in Portugal |
| title_fullStr | A large outbreak of Legionnaires' Disease in an industrial town in Portugal |
| title_full_unstemmed | A large outbreak of Legionnaires' Disease in an industrial town in Portugal |
| title_short | A large outbreak of Legionnaires' Disease in an industrial town in Portugal |
| title_sort | A large outbreak of Legionnaires' Disease in an industrial town in Portugal |
| topic | Legionnaires' disease Legionella pneumophila fraseri |
| topic_facet | Legionnaires' disease Legionella pneumophila fraseri |
| url | http://scielo.pt/scielo.php?script=sci_arttext&pid=S0870-90252016000300002 |
| visible | 1 |
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