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Legionnaire’s Disease HPA Surveillance & Outbreak Management Rebecca Ingham Health Protection Practitioner West Yorkshire Health Protection Unit.

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Presentation on theme: "Legionnaire’s Disease HPA Surveillance & Outbreak Management Rebecca Ingham Health Protection Practitioner West Yorkshire Health Protection Unit."— Presentation transcript:

1 Legionnaire’s Disease HPA Surveillance & Outbreak Management Rebecca Ingham Health Protection Practitioner West Yorkshire Health Protection Unit

2 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

3 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

4 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

5 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

6 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

7 YearTotal CasesMale Cases Female CasesDeaths Travel Associated (Abroad & UK) 19972261656128114 19982271626525115 1999200150502891 20001801433725101 20011821424026100 200238725613133154 20033142387635174 20043182397938173 20053552718330179 200655143311853213 200744232811453199 2008#3592817834152

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9 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

10 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)

11 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

12 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

13 Clusters, Outbreaks & Travel Associated Clusters Cluster Outbreak Travel Associated Cluster Strength of evidence for outbreaks High Low

14 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

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18 Legionella

19 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

20 Managing Outbreaks Requires All of us Working Together

21 How to reach us: West Yorkshire HPU 6th floor South East Quarry House Quarry Hill LEEDS LS2 7UE Telephone: 0113 386 0300 Duty desk: option 1 Email: westyorksdutypro@hpa.org.uk rebecca.ingham@hpa.org.uk 1 st April 2013: rebecca.ingham@phe.gov.uk NB soon to be Public Health England HPA website: www.hpa.org.uk 1 st April 2013 www.phe.gov.uk


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