29 de jul. de 2012

SETRI - Legionella HACCP - ASHRAE 188P

A SETRI Brasil, já vem trabalhando no processo HACCP para avaliação de Risco da bactéria Legionella.
Com a chegada da ASHRAE 188P, o processo fica ainda mais importante.
O tema é tratado no artigo abaixo:

How to Protect Against Legionella

Is your water safe? A new standard can help safeguard against a Legionella outbreak.
It can lurk in your cooling towers, piping systems, showerheads, hot tubs, sauna rooms, and decorative fountains. It causes flu-like symptoms, hospitalizations, lingering neurological issues, and death. Legionella bacteria begin as a microscopic presence in your water systems and can balloon into a tarnished business image, a CDC investigation, and lengthy lawsuits.
“Though some facilities are proactive with water management, many building teams struggle with documentation or do not have a clearly identified team responsible for the water system,” observe ASHRAE members Bill McCoy of Phigenics and William Pearson of Southeastern Labs. The forthcoming ASHRAE Standard 188, Prevention of Legionellosis Associated with Building Water Systems, is a significant step toward formalized Legionella prevention.
The standard will require a new process to document proactive measures against Legionella with a Hazard Analysis and Critical Control Point (HACCP) risk management plan. The goal is to establish which control and monitoring measures your building has in place.
“We know how to analyze and control this hazard. But we need a standardized practice to specify for facility managers and owners exactly what to do in their facilities to control the hazard in a systematic and scientifically defensible way,” McCoy and Pearson explain. “ASHRAE Standard 188P is intended to fulfill this need.”
Whether you choose to adhere to the standard or not, preventing Legionella from breeding in your water system requires a proactive stance. Remember that building water safety and quality are not within the jurisdiction of the public water utility – the responsibility is yours. Use these three components of the standard to fulfill your General Duty Clause.
KNOW THY ENEMY Legionella is a type of bacteria that causes two forms of pneumonia – Legionnaires’ disease and Pontiac Fever (collectively referred to as Legionellosis). Both conditions develop when the bacteria is inhaled through water droplets or vapor. The disease is not communicable and does not occur if Legionella is ingested.
According the Center for Disease Control (CDC), anywhere from 8,000 to 18,000 cases are reported in the U.S. each year. Because the disease is hard to distinguish from community-acquired pneumonia and the onset of symptoms occurs several days after contact, many more incidences may go unnoticed. The bacteria are most likely to affect those with weakened immune systems, including children, those with diminished lung capacity, the elderly, and people with autoimmune disorders.
The CDC estimates that 5-30% of Legionnaires’ victims perish. Many patients recover with the aid of antibiotics, but some require hospitalization for days. A growing number of reports also show that victims can have lasting neurological damage, largely affecting memory and muscle control.
Along with other waterborne diseases such as giardiasis and cryptosporidiosis, Legionella costs the healthcare system up to $539 million annually, according to CDC research. By using insurance claims, the CDC calculated that Legionnaires’ disease places a $101-321 million burden on patients, insurers, and taxpayers. For example, a single hospitalization for Legionnaires’ averages more than $34,000.

Are You At Risk?

While all commercial buildings are vulnerable to Legionella, the following risk factors can increase the likelihood of contamination
Unlike a slip and fall incident, there’s no specific statute of limitations for Legionella. Time is of the essence for a victim to medically document the disease and connect the source of contamination to a specific location.
But once an incidence has been traced back to your building, many more reports can follow in its wake. It is the likelihood of a severe reaction to Legionella that requires the proactive attention of building managers.
UNDERSTAND THE ROLE OF YOUR WATER SYSTEMSBeyond obvious places like cooling towers and hot tubs, there are many areas in a building vulnerable to Legionella, cautions Simon Turner, president of Healthy Buildings, a consulting firm that specializes in indoor environments. These include drinking water systems, hot water tanks, showers, misters, ice machines, fire sprinklers, and water features such as decorative fountains and water walls. Even respiratory devices and humidifiers in healthcare settings have been called into question.
The likelihood of Legionella doesn’t necessarily depend on the type of water system in question, but the conditions within that water supply. Miniscule amounts of the bacteria won’t make anyone sick, but certain environments will promote Legionella to breed at dangerous levels.
“Legionella will flourish under three conditions,” says Turner. “It needs an optimum growth temperature between 95-115 degrees F., the presence of biofilm to provide a source of nutrients, and an accumulation of sediment or scale that will shield it from chlorination.”
A major source can be dead legs in plumbing lines, which are common in older buildings with renovations or restrooms with waterless urinals. “Water becomes stagnant in these abandoned pipes and can’t be properly sanitized or flushed out, yet it will constantly seed the rest of the plumbing system with Legionella,” Turner explains.
“Owners may not be aware that they need to be prepared to respond to specific events that can push the bacteria into the rest of the water supply or cause it to grow rapidly, like water main breaks or shutdowns,” says Matt Frejie, ASHRAE member and president of HC Info, a consulting firm for Legionella prevention.
DEVELOP A RISK MANAGEMENT PLAN One of the greatest impacts of Standard 188P is the recommendation of a HACCP risk management plan. The HACCP approach was first developed by NASA and then adapted to industries such as food safety, munitions, and automotive manufacturing. Its purpose isn’t to prevent Legionella, but to verify that the control measures to address the bacteria are in place and effective.

Famous Cases of Legionellosis Outbreaks (USA)

Las Vegas (2011-2012) – Over the course of a year, two MGM properties (the ARIA and Luxor resorts) were linked to Legionella cases with one fatality. Both sites had water management programs in place prior to the incidences.
Playboy Mansion (2011) – Close to 200 conference-goers who attended an evening soiree at the Mansion developed Legionnaires’ or Pontiac Fever. Bacteria in the hot tubs were identified as the culprit and a fog machine was also suspected, though never confirmed.
Unidentified Wisconsin Hospital (2010) – Eight people, none of whom were inpatients, became ill from a decorative water feature in the hospital’s lobby. The bacteria were contracted by delivery personnel and visiting family.
Stadium Place (2009) – Legionella struck eight residents at this Baltimore retirement community with one fatality. To remedy the outbreak, the water temperatures were elevated above 130 degrees F.
Bellevue-Stratford Hotel (1976) – First documented outbreak of the disease. Guests at an American Legion convention at the hotel contracted the bacteria – over 200 attendees became ill and 34 perished. The exact source of the contamination was never identified, though the air conditioning system and the cooling tower were likely sites.

28 de jul. de 2012

HSE tells companies to improve their management of legionella risks (UK)

Businesses are being told to do more to protect workers and members of the public from exposure to legionella.
The Health and Safety Executive (HSE) has issued a safety notice after identifying common failings in legionella control from a review of outbreaks of Legionnaires' disease in GB over the past ten years.
HSE's findings confirmed that cooling towers and evaporative condensers are the most common source of significant outbreaks. Ninety per cent of outbreaks stem from failure to recognise potential legionella problems or to adopt effective control measures.
The notice also stresses the need for effective and consistent monitoring of water quality and the importance of responsibilities being assigned to named individuals with proper management oversight.
HSE's legionella expert Paul McDermott said:
"Our research has confirmed the importance of businesses following the well-established and readily available guidance. Through this safety notice we are reiterating what those responsible for the maintenance of water systems should be doing already.
"They have a responsibility to manage the risks they create to protect workers and the wider public. This is a reminder to them of what the law expects. Failure to comply with the law means they may face legal sanctions, including in the most serious cases prosecution through the courts."

26 de jul. de 2012

Legionnaires' disease outbreak leads to lawsuit

The widow of a man who died in October from Legionnaires' disease he contracted while living in a Plant City mobile home park has filed a lawsuit against the park, its management company, general manager and residents association.
Gene Swanson, a 76-year-old retired tool-and-die maker from Michigan, died several days after being diagnosed with the disease. Two other residents contracted the disease and survived.
In November, an independent environmental testing company, working with mobile home park management, found traces of Legionella, the bacteria that causes the disease, in a decorative fountain near the main clubhouse, according to the Hillsborough County Health Department.
In the lawsuit, Swanson's widow, Betty Swanson, says the defendants should have known about possible contamination, failed to prevent it, failed to warn residents and destroyed evidence once investigators arrived.
In a 42-page, 29-count suit, filed in Hillsborough County Circuit Court on July 10, she says MHC The Meadows at Countrywood LLC, which owns the 799-unit park, Equity Lifestyle Properties, which manages it, then-general manager Rick Feathers and the Country Meadows Residents Association were negligent in operating the park.
Betty Swanson is seeking unspecified punitive damages against the defendants, claiming they knew about the presence of Legionella in the park's water systems and "deliberately delayed" correcting the problem and notifying residents "because of the notoriety and bad publicity" that would result.
Officials from MHC, Equity Lifestyle Properties and the residents association did not immediately return calls for comment. Feathers left his job with the park about six months ago, according to a woman who answered the phone there. Efforts to reach him were unsuccessful.
After Swanson and two other park residents were diagnosed with Legionnaires' disease, Hillsborough County officials, seeking the cause of the outbreak, dispatched teams from the Environmental Protection Commission and the Health Department to the park.
Initially, there was some concern about the pool area at the park because an inspection after the disease was discovered showed chlorine levels were below standards, according to the health department. The chlorine level subsequently was increased, making it useless for investigators to sample the water.
Instead, investigators took samples from the decorative fountain, showerheads in the main clubhouse and cabana, the condensate sump tank in the main club house air conditioning system, the entry to the reclaimed water distribution system and untreated well water.
According to the health department report on the incident, no traces of the bacteria causing Legionnaires' was found, but, unexpectedly, chlorine was.
A separate test, by an independent company working with the mobile home park, did find the bacteria in rainwater collected from the decorative fountain, one of 12 spots it checked, according to the report. As a result, the health department concluded that "the likely source of the three cases of Legionnaires' disease was the decorative fountain outside of the main clubhouse."
The lawsuit says that once inspectors arrived at the park on Oct. 14, and the defendants received a notice of potential legal action, they deliberately destroyed evidence by "performing super chlorination on the decorative fountain and other water sources" and added "chlorine to the decorative fountain and other water sources in order to mask the presence" of the bacteria causing the disease and "hinder the investigation of the health department and impeding the determination of the source of the outbreak."

Tampa Bay On line

A Ferramenta de Avaliação de Riscos e o Plano de Segurança no Uso da Água

Vamos apresentar o tema na Conferencia Internacional & Exposição do GBCBrasil no dia 13/09/2012 as 10:50h. O assunto é bem interessante para conhecer mais sobre a Segurança no Uso da Água.
Esperamos você.


21 de jul. de 2012

Legionnaires' disease bacteria at Jersey hospitals

The bacteria which causes Legionnaires' disease has been found in the water at two Jersey hospitals.
Legionella was found in water supplies at the Gwyneth Huelin Wing for outpatients at the General Hospital and in part of St Saviour's Hospital, not used by patients.
The health department said there was a "very low risk" of people getting ill.
It added that the hospitals would be decontaminated over the weekend while services operated as normal.
The legionella bacterium can live in all types of water, natural and artificial.
BBC - 20/07/2012

Grupo francês Accor compra 29 hotéis na América do Sul do mexicano Posadas

PARIS, 16 Jul 2012 (AFP) -O grupo francês de hotelaria Accor anunciou nesta segunda-feira a aquisição de 29 hotéis na América do Sul, 14 deles em projeto, do mexicano Grupo Posadas, por um total de 275 milhões de dólares (225 milhões de euros).
"A aquisição desta carteira permitirá reforçar no curto prazo as marcas Sofitel, Pullman, Novotel e Mercure na região", indicou a Accor em um comunicado.
O grupo será reforçado principalmente no Brasil, onde se encontram 11 dos 15 hotéis adquiridos que já estão em funcionamento, com o foco no Mundial de futebol de 2014 e nos Jogos Olímpicos de 2016.
Com esta operação, que deve ser finalizada antes do fim do ano, a Accor também adquire as marcas Caesar Park e Caesar Business, que estavam nas mãos dos grupo Posadas.
"Em três anos, os pipelines (projetos de hotel) da Accor e de Posadas nos permitirão ter em funcionamento 300 hotéis", disse o diretor-geral de hotelaria para a América Latina da Accor, Roland Bonadona, citado em um comunicado.
Dos 15 hotéis adquiridos e que já estão em funcionamento, 4 estarão em regime de propriedade, 4 em regime de aluguel e 7 funcionarão através do chamado contrato de gestão.
Os 14 hotéis em projeto, cuja data de inauguração ainda não foi definida, também funcionarão com contratos de gestão.
Os estabelecimentos adquiridos pela Accor estão situados, entre outros países, em Brasil (São Paulo e Rio de Janeiro, incluindo um hotel de luxo na praia de Ipanema), Argentina, Buenos Aires e Chile (Santiago).
No mês de maio, o grupo hoteleiro francês anunciou o fechamento de outra operação para comprar por 195 milhões de euros o grupo Mirvac, que tem 48 hotéis a Austrália e na Nova Zelândia.

17 de jul. de 2012

Legionella - Julho de 1976

Artigo da revista Veja em Agosto de 1976, sobre o tema ainda desconhecido da bactéria LEGIONELLA

Climatização de shoppings pode ter vistoria - Porto Alegre (RGS)

Adriana Lampert
Santi critica a falta de fiscais
Santi critica a falta de fiscais
Um grupo de empresários, engenheiros e fiscais da vigilância sanitária irá apresentar hoje à Câmara de Vereadores um anteprojeto de lei municipal para o controle de qualidade do ar em ambientes climatizados não residenciais. O objetivo é fazer valer no município a Portaria 3.523 (de 1998) que remete à Norma (NBR) 13.197 do Ministério da Saúde, que exige que empreendimentos, principalmente os com alto fluxo de pessoas, que se utilizam de sistema de ar-condicionado central implementem o Plano de Manutenção, Operação e Controle (PMOC), criado para monitorar e adequar a qualidade do ar em ambientes de uso coletivo.

Mais do que um simples cuidado com os equipamentos, a existência desse trabalho nos sistemas de climatização é uma obrigação legal sob risco de autuação e multa em caso de fiscalização da vigilância sanitária, mesmo assim, na Capital, as vistorias não alcançam empreendimentos comerciais – apenas os da área de saúde. Organizado pela Associação Sul Brasileira de Refrigeração, Ar-condicionado, Aquecimento e Ventilação (Asbrav), o anteprojeto prevê advertência e multa para todos os estabelecimentos não residenciais que, não estando em dia com a manutenção do sistema de ar central, não cumprirem prazo de adequação à normativa. A entidade ressalta que a medida traz economia e segurança para as empresas, uma vez que são minimizados custos de ações corretivas.

De acordo com o primeiro vice-presidente da entidade, Cesar Augusto De Santi, o texto que será entregue aos vereadores orienta que o plano de uso comercial e industrial sirva de base para uma lei de controle do ar em ambiente climatizado em Porto Alegre. “A vigilância sanitária da Capital está carecendo de pessoal para realizar a fiscalização”, justifica Santi, ao revelar que o anteprojeto inclui um parágrafo que determina que o município deverá angariar recursos para o cumprimento da lei, se aprovada, criando mecanismos de vistorias e ampliação da fiscalização que atualmente é realizada em estabelecimentos da área da saúde, como hospitais e clínicas. “Por enquanto, não há fiscais suficientes, por isso a necessidade de orçamentação para contratar e treinar mais gente”, reforça o dirigente.

Segundo o coordenador da Vigilância da Prefeitura, Anderson Lima, a fiscalização em Porto Alegre ocorre desde 2003 nos serviços hospitalares de média e alta complexidade, como hospitais, clínicas e laboratórios, onde é exigida apresentação do Plano de Manutenção. “Durante a vistoria é verificado o cumprimento do mesmo. No entanto, esta exigência é feita apenas aos estabelecimentos que estão no escopo da vigilância em saúde.” Lima observa que a Anvisa também tem priorizado locais de maior risco e vulnerabilidade associados.

Santi destaca que a boa manutenção do ar traz benefícios para a saúde, além de economias do usuário, que gastará menos energia e evitará paradas acidentais do sistema por desgaste e falta de cuidados do equipamento. Os projetos arquitetônicos futuros já são elaborados baseados nas normas brasileiras de qualidade.

Cientes da importância do serviço, administrações de shoppings da Capital já cumprem a normativa. É o caso do Shopping Total, que há sete anos tem contrato de prestação de serviços com a empresa São Carlos. “Diariamente, dois técnicos permanecem no prédio, desde a abertura até o fechamento das lojas”, diz o gerente de operações do empreendimento, João Gabriel Pretto. 

Fonte: Jornal do Comércio 17/07/2012

16 de jul. de 2012

Legionella - 36 anos em Julho de 2012

Como tudo começou em Julho de 1976

In late July 1976, American Legionnaires returning from a state convention in Philadelphia began to fall ill with mysterious symptoms: pneumonia and fevers topping 107 degrees.

By early August, news organizations across the country were reporting that 6 to 14 of the men in Pennsylvania had died. Others were in hospitals fighting for their lives. No laboratory tests could determine the cause of their illness, which quickly became known as Legionnaires’ disease. No one knew the health status of the 10,000 other convention participants.
As the news began to break, 36 years ago this week, Americans were primed for the threat of an epidemic. The Ford administration was making plans to vaccinate every American against a new strain of influenza, known as swine flu, after repeated warnings from government officials that a devastating epidemic could strike without warning. Michael Crichton’s “Andromeda Strain” had become a best seller. And some scientists were calling for a moratorium on laboratory efforts to genetically engineer microbes for fear they might create a monster germ.
These factors made the unexpected attack on American veterans, which occurred shortly after the country’s bicentennial celebration, front-page news.
When I first heard about the mysterious cases from news agency bulletins on Aug. 2, I initially viewed them with some skepticism. A few months earlier, Dr. Leonard Bachman, the Pennsylvania health secretary, issued a news release saying that a staff member, Dr. Buford S. Washington, had discovered an often fatal new disease, pantosomatitis, that was spreading throughout the eastern United States. Looking into the claim, I found there was no documented case and no such disease.
Disease outbreaks were familiar territory for me. Before coming to The New York Times, I’d been an Epidemic Intelligence Service officer at the Communicable Disease Center, now the Centers for Disease Control and Prevention, in Atlanta. If the Legionnaires’ outbreak had occurred a decade sooner, I might have been one of the investigators sent to Pennsylvania.
Health officials there urged the public not to panic, and some initially denied that the cluster of cases was an outbreak of an infectious disease. But behind the scenes, the same officials were bracing themselves for a medical catastrophe.
“We thought we might be faced with an unprecedented condition in modern medicine, one for which we had no really effective antibiotics, drugs or therapy,” Dr. Bachman told me in 1976. Because there was no way to predict how many more Legionnaires would fall ill, Dr. Bachman said he had contemplated seizing control of all hospitals in the state and imposing quarantines.
It took six months to determine that the illness had been caused by a bacterium, Legionella pneumophilia, which we now know usually succumbs to the timely prescription of proper antibiotics. The bacterium, which in this case was apparently spread from the hotel’s air-conditioning system, is a cause of pneumonia and other illnesses worldwide.
The investigation that solved the mystery took an array of surprising twists and turns. It revealed the strengths and weaknesses of the nation’s health system in response to an outbreak from an unknown agent.
Some lessons learned from the outbreak improved investigations of later outbreaks likeavian fluSARS and the deliberate release of anthrax spores in the postal system shortly after the Sept. 11 attacks. But many authorities have not learned other important lessons, like the need for more effective communication.
Intense news coverage of the Legionnaires’ outbreak continued for weeks, providing one of the rare opportunities for the public to see how medical detectives work and how scientists make discoveries.
The epic challenged the widespread notion that medicine was all-knowing, able to lick almost any problem, and that antibiotics and vaccines had turned once lethal infectious diseases into minor threats.
The news coverage also marked a turning point in journalism’s efforts to hold officials accountable for their response to epidemics that can threaten the lives of thousands of people, as well as tourism, international trade and world economies. News about the outbreak led to the temporary closing of the Bellevue-Stratford Hotel, a Philadelphia landmark that was the headquarters of the American Legion convention and a focus of suspicion about the spread of the bacterium.
The C.D.C. sent 20 epidemiologists — the largest squad of medical detectives to investigate an outbreak in the federal agency’s history — to Pennsylvania where they joined scores of state health workers.
The sleuths fanned across the state to review the medical records of all the ill Legionnaires and to study the autopsy findings in the fatal cases. Epidemiologists also checked every hospital to identify new cases and interview patients’ families and doctors, in part to determine whether one or more Legionnaires might have taken the illness to Philadelphia.
On Aug. 2, when news agencies began issuing dispatches, a quick look convinced me that the Legionnaires’ cases were real, not another false alarm. Late that evening, I finished my first article about the still-unnamed mysterious disease.
Then I drove to Harrisburg, listening to the radio to keep me awake but unable to escape the repetitious news accounts about the outbreak, the speculation that the illness was swine flu and the safety concerns about visiting Philadelphia.
The Times handled the story more cautiously than radio and television. My article, on Page 12, was not even included in the news summary.
Over the next few days, the toll of the illness rose. The final count was 221 cases, including 34 deaths.
As a physician, I wanted to see the patients who were recovering or fighting to stay alive and to learn what leads were being developed from the interviews.
In Chambersburg, Pa., I joined Dr. Stephen B. Thacker, then a rookie in the C.D.C. epidemiology program. We interviewed a Legionnaire, Thomas A. Payne, 48, whose temperature rose to 107.4 degrees before he was put in a cooling blanket.
We felt safe entering his room because we followed standard precautions, wearing yellow masks, white gowns and gloves. In introducing us, Dr. Thacker told Mr. Payne that he “was part of the medical team investigating this weird disease.”
Dr. Thacker, who later became the head of the epidemiology program, asked Mr. Payne a number of questions related to the onset of his illness, how he had felt since, where he had stayed in Philadelphia and what convention events he had attended. Then Dr. Thacker sent the information to colleagues in Harrisburg.
Two weeks later, I interviewed another hospital patient who had driven with four Legionnaires from their home in Saltillo, Pa., to Philadelphia where they had stayed at the same hotel and were together for nearly all the convention events. But no one could figure out why only that patient had developed the disease.
The anecdote illustrates the kinds of dead ends that epidemiologists, like criminal detectives, encounter and that scientific journals rarely publish. They and other factors create a false impression that investigations and discoveries are simpler than they really are.
A week into the investigation, health officials were relieved as a second outbreak failed to develop among those attending an international religious meeting in Philadelphia and no spread of the ailment occurred from Legionnaires’ patients to their families and friends.
Tests also excluded all forms of influenza as a cause of the outbreak. “All of us can breathe a sigh of relief it was not the flu,” said Dr. David J. Sencer, then the C.D.C. director.
If not influenza, what was the illness? Earlier tests had ruled out poisoning from 17 metals. But experts in a variety of specialties who were not connected with the outbreak had called or written to me and health officials to suggest a number of toxins.
Stumped, health officials re-examined the possibility of other toxins or poison gases. One poison, nickel carbonyl, was a long shot that health officials took seriously, only to be embarrassed by flaws in the collection of the tissues for testing. The initial nickel findings were ruled invalid because of probable contamination from the use of metal instruments in autopsies. Pathologists were then ordered to use plastic knives.
Reports of the lapses in investigation technique jarred public confidence about the ability of health departments to detect outbreaks from hazardous chemicals. The flaws also led to a Congressional hearing in the fall on the medical investigation, causing federal and state health officials further embarrassment.
By winter, many of the authorities said the outbreak’s cause was definitely not a bacterium and that it would never be known. But the doubters overlooked the importance that human factors like compulsiveness, embarrassment and public pressure can play in solving scientific riddles and making discoveries.
At Christmastime in 1976, Dr. Joseph McDade, a C.D.C. laboratory scientist who had tested specimens from the outbreak, was harshly criticized at a party for his agency’s failure to solve the mystery.
Dr. McDade said his usual custom at that time of year was to “tidy up loose ends,” so when he went to his laboratory “to put to rest some hunches about something” he had seen in the specimens, the insult lurked in the background.
Within a month, Dr. McDade had identified the culprit and showed that Legionnaires’ was a newly recognized old disease. The bacterium had been isolated at least twice before by different groups of researchers at the Walter Reed Army Institute of Research in Washington starting in 1947. Each group believed it was dealing with a bacterium that affected animals, not humans.
Dr. McDade’s discovery quickly led scientists to document a number of earlier outbreaks in Pontiac, Mich.; Washington; and elsewhere. Legionnaires’ disease now accounts for an estimated 18,000 hospital admissions in this country each year, and C.D.C. scientists have said that doctors miss the diagnosis in many more patients. Most outbreaks and cases have been traced to contaminated water in places like shower heads, air-conditioning systems and medical respiratory devices. The largest outbreak, in Spain in 2001, affected nearly 700 people.
The Legionnaire bacterium can produce two forms of illness that begin with flulike symptoms. One, Legionnaires’ disease, goes on to produce pneumonia and systemic illness. The other, Pontiac fever, produces only a mild illness. Why the same bacterium causes two distinct illness patterns is not known.
Seamless teamwork between epidemiologists and laboratory scientists can be a potent weapon in solving disease outbreaks caused by known and unknown agents. But the teamwork in the Pennsylvania outbreak was porous, as lapses in investigation technique showed.
From the start, the investigation encountered a number of problems, some beyond their control. One was that the American Legion had no registration list of conventioneers, leaving no easy way to contact attendees to check on their health.
In investigating outbreaks, epidemiologists often develop questionnaires, in part to make statistical comparisons between those who become ill and those who do not.
Another aim is to determine the priority in performing laboratory tests to determine the cause of an illness. But the longer the delay in starting this medical sleuthing, the fuzzier people’s recall of events becomes. A problem was that health officials could have learned of the outbreak earlier than they did. For example, a physician in Pennsylvania called health officials on July 30, a Friday afternoon, to report a Legionnaire with possible typhoidfever. It was too late in the day, call back on Monday, a nurse said.
The episode illustrated that many health departments did not provide the type of 24/7 coverage for calls and emergencies that hospitals and doctors did. Now more health departments provide such coverage.
Still another problem was that Philadelphia health officials learned belatedly about an earlier outbreak of 19 cases of an illness similar to Legionnaires’ disease, including three deaths. It affected members of the Independent Order of Odd Fellows in 1974 after they had visited the Bellevue-Stratford. The cluster was not reported until after news of the Legionnaires’ outbreak in 1976.
However, there were widespread complaints about a number of issues over which health officials had some control. One was the lack of coordination between investigators from federal, state and local health departments and determining which was in charge.
Doctors who cooperated in providing information and specimens from Legionnaires’ patients said they had received little feedback from health officials. For example, some doctors said antibiotics were effective in their patients and urged wider use of them in the outbreak. But health officials gave no advice, largely because they could not scientifically evaluate the effectiveness of the antibiotics among the patients quickly enough.
The issue of providing such evaluations of therapy during an outbreak remains an important problem; many doctors and others lodged the same complaint against the C.D.C. in the anthrax outbreak in 2001. Some critics said they learned more about the outbreak from news organizations than from the agency.
In the case of Legionnaires’, persistent pressure from the news media, a number of health officials said later, helped hold them accountable and to spur scientists to do what they rarely had done in other unsolved cases and outbreaks — taking a crucial second look that solved the Legionnaires’ outbreak.

13 de jul. de 2012

Legionella - Hospital Termal em Caldas

Depois de terem sido suspensos os tratamentos no Hospital Termal a 29 de Junho, alegadamente devido a uma avaria num equipamento, tal como a Gazeta das Caldas noticiou na semana passada, a administração do Centro Hospitalar Oeste Norte emitiu a 5 de Julho uma nota de imprensa a anunciar que estes tinham sido parados “pelo facto dos parâmetros microbiológicos da água mineral natural não cumprirem os requisitos legalmente exigidos”. Ou seja, foi detectada a presença de legionella nas análises de rotina que terão sido efectuadas na terça-feira, 3 de Julho, e cujos resultados seriam conhecidos dois dias depois, de acordo com Carlos Sá.
Sem aludir ao facto dos tratamentos já estarem anteriormente parados, o CHON levou ao engano os órgãos de comunicação social nacional que noticiaram que estes tinham sido interrompidos nesse dia.
Esta é a segunda vez este ano que o hospital fecha e em ambos os casos a administração do Centro Hospitalar alude primeiro a uma avaria de equipamento, acabando por anunciar pouco depois que afinal também houve uma contaminação bacteriológica.
No início do ano os tratamentos foram suspensos a 2 de Janeiro, alegadamente por causa da avaria numa bomba, e três dias depois o CHON acabaria por anunciar a detecção da legionnela. Em ambas situações tinha sido dito à Gazeta que não havia problemas com as análises às águas termais.
Carlos Sá garantiu ao nosso jornal que quando nos comunicou a avaria do equipamento, não tinha qualquer suspeita da presença da bactéria na água termal. Para o responsável, contudo, parece haver “uma relação entre avarias nos equipamentos e depois contaminações”.
Tal como é habitual, quando aparece a legionnela, a suspensão envolve apenas a área de hidrobalneoterpia, mantendo-se em funcionamento as restantes actividades, nomeadamente as massagens, bem como o internamento de ortopedia, as consultas de psiquiatria e os tratamentos de medicina física e de reabilitação.Em 2005 e 2009 as termas também estiveram encerradas pelo mesmo motivo, sendo que há dois anos foi detectada também a presença de pseudomonas nalguns pontos do percurso da água. O primeiro problema com contaminações bacteriológicas surgiu em 1997, devido à pseudomona, e levou ao seu encerramento durante três anos.
A legionnela foi encontrada na adução (entre o furo e o hospital termal) e nas canalizações das termas.
Segundo antigos responsáveis do hospital termal que o nosso jornal contactou, nesta altura do ano seria normal serem tomadas medidas adicionais de protecção da qualidade da água uma vez que o calor é propício ao aparecimento de bactérias.
Aos aquistas que estavam em tratamento foi dada a oportunidade de receberem de volta o pagamento que já tinham efectuado e assim poderem voltar quando o hospital reabrir.
O PS das Caldas reagiu ao encerramento do hospital termal, tendo tornado público um comunicado onde exige uma “investigação criteriosa” ao aparecimento da legionnela, o qual motivou uma resposta, também em comunicado por parte da administração do CHON (ver Divulgação Institucional).

12 de jul. de 2012

Edinburgh Legionella outbreak claims 100th victim

The Legionella outbreak has claimed its 100th victim, the Scottish Government revealed.

Health experts said this was the first new case for a week and believe the worst of the outbreak is over.
Three men with Legionnaires’ Disease have already died and two people remain in intensive care.
Health Secretary Nicola Sturgeon said: “The latest case of Legionnaires’ has been ill for some time, and has now been identified as a confirmed case.
“Over recent days as expected, we have not seen as many cases of Legionnaires’ as we did at the peak of the outbreak, and this continues to offer reassurance that the outbreak remains under control.
A total of 52 people are confirmed as having the disease and 48 are suspected to have the bug.
The outbreak began in Edinburgh at the end of May and investigations to locate the source of the disease are on-going.
Health and safety experts still believe the outbreak began in an industrial cooling tower in the south west of the city but experts have warned the exact source of the bug might never traced.
A number of victims have already started legal proceedings to find out how the disease was able to get into the air and why more was not down to prevent the outbreak.
Some have revealed they will seek compensation for their ill-health if and when a company is found to have been responsible for the potentially fatal disease.
All three men who have died were all from the Edinburgh area and health experts said they had underlying health conditions.
Dr Richard Othieno, Consultant in Public Health Medicine, NHS Lothian, said: “While this is the first new case in more than a week, it is not unexpected.
“As the outbreak draws to a close we can expect to see a small number of cases coming forward who have experienced mild symptoms initially and have sought medical attention later in their illness.”

10 de jul. de 2012


(12/P79) TRENTON - Tests conducted this weekend on the air cooling and ventilation system at the Department of Environmental Protection’s 401 East State Street building in Trenton came back negative for signs of legionella bacteria, which had been discovered in a cooling tower atop the building. The cooling tower was “shocked’’ with biocides on Friday to kill the bacteria and continues to be chemically treated to eliminate any potential remnants of legionella.
The building is deemed to be safe and will be open for business as usual on Monday.
“We are absolutely committed to protecting the health and safety of all DEP employees and our visitors,’’ said DEP Commissioner Bob Martin. “We have taken this issue very seriously, and commend the DEP staff, with assistance from the state Department of Treasury and Department of Health, for their efforts this weekend to thoroughly test our systems and deal with this issue. We will continue with a thorough cleansing of the cooling tower and take any steps necessary to ensure that any remnants of the legionella bacteria are eliminated.’’
A pumping system installed on Friday will continue to administer biocide for one week, to be followed by a thorough draining, flushing and cleaning of the entire cooling tower system.
There have been no reports of illness or symptoms of Legionnaire’s disease, the illness which can develop from infection by a certain strain of the legionella bacteria. The presence of the legionella organism in water and cooling systems is not necessarily hazardous if addressed appropriately, as is being done at the DEP in consultation with the State Department of Health.
Sampling for the legionella organism was performed by contractors through the collection of water samples from the cooling tower and the incoming water main.
Surface swab sampling was performed within air handler units on all seven floors. Samples were taken at locations on the cooling tower, including fan exhaust blades and honeycomb cooling tower components, as well as surface samples from the fresh air intake duct louver at the roof level of the air handling system. Surface swabs were collected from interior condensate drip pans from the interior air handling units on all floors. Duplicate swabs were collected at all locations.
Only one sample tested positive for legionella. That sample was taken in the outside cooling tower. Water in that tower was shocked with biocides to kill the bacteria.
The DEP will be working with the state Department of Treasury, which oversees all state government buildings, to ensure follow-up testing is performed and future testing is conducted.
The DEP and Treasury learned Friday that routine tests of the cooling system showed the presence of legionella bacteria. The mere presence of the bacteria does not present a health or safety hazard to employees at this time and, in fact, is not uncommon in building cooling systems, according to the state Department of Health.
The state DOH is routinely contacted by health care facilities and other entities serving the public when they have detected the legionella bacteria in their cooling systems. Neither state nor federal protocol calls for the evacuation of public buildings or health care facilities upon the mere finding of legionella organism.
In fact, standard federal and DOH protocol does not recommend evacuation of health care facilities when the mere presence of legionella is confirmed. Only certain strains of the legionella organism pose a health hazard and create Legionnaire’s disease, a form of pneumonia.
Following normal response protocol, a water treatment contractor was promptly employed by the DEP and Treasury Friday afternoon to "shock'' the water by administering biocide chemicals. A pumping system also was installed to continue to administer the biocides.

6 de jul. de 2012

Calpe's 4 *hotel Diamante Beach Hotel has been closed in second Legionnaires' outbreak this year

05 July 2012 @ 20:55

CALPE’S FOUR-STAR Hotel Diamante Beach was closed on Monday after a second outbreak of Legionnaires’’ Disease this year.

Eleven people have so far been infected with the virulent and potentially fatal form of pneumonia – although health chiefs acknowledge the figure could rise.

Five months ago three British pensioners died after contracting the disease at the hotel and another 15 people were taken ill and treated with antibiotics.

At a press conference on Tuesday, Valencia’s Director of Public Health Manuel Escolano and Calpe Mayor Cesar Sanchez said all those infected with the Legionella bacteria had been hospitalised but none was thought to be “gravely ill”.

The hotel was closed as a precaution and 500 guests moved to alternative accommodation. The source of the outbreak has yet to be confirmed.

And yesterday (Thursday) it was revealed the number infected had risen to 11 – four Belgians, three of them taken ill after returning home, four people from Madrid and three from the Valencian Community. Four, including a Belgian, are being treated Valencia hospitals and making satisfactory progress.

It was believed new outbreak occurred in the third week of June and former guests have been contacted and warned to look out for ‘flu-type symptoms. The first diagnosis was made on 25th June and the Europe-wide notification procedure sprung into action.


Mr Escolano admitted the outbreak came as a “complete surprise” after the Diamante Beach was given the all clear in February following deep and intense cleaning of the water system and “thousands” of tests had been undertaken since the hotel opened again.

“We do expect more cases but it is contained to people staying or working in the hotel. The public has to realise it will not spread in the town because the source is somewhere in the hotel.

“Control that has been taken over all the running water system and it cannot find the presence of Legionella, so we cannot explain the source of the outbreak.”

Mayor Cesar Sanchez pledged the hotel industry in the town would cooperate fully with the health department and said the hotel management had closed the Diamante Beach on its own initiative, alerting guests to the disease and indicating the problem could be with the spa.

However, he admitted the second outbreak “was a blow to the tourism sector of Calpe which makes up 90% of the economy.”

Legionnaires’’ Disease is contracted by breathing in tiny particles of contaminated water; it cannot be passed on human to human. The bug is found in all water but in certain conditions begins to multiply to dangerous levels.

The disease is particularly dangerous to the elderly and to people with low immunity systems. The disease acquired its name in 1976 when an outbreak occurred at a hotel in the United States when members of a convention of the American Legion were infected.

Biossegurança - Classe de Risco - Legionella = Risco 2

O conceito de Biossegurança e sua respectiva aplicação têm como objetivo
principal dotar os profi ssionais e as instituições de ferramentas que
visem desenvolver as atividades com um grau de segurança adequado seja
para o profi ssional de saúde, seja para o meio ambiente ou para a comunidade.
Nesse sentido, podemos defi nir “Biossegurança” como sendo “a
condição de segurança alcançada por um conjunto de ações destinadas
a prevenir, controlar, reduzir ou eliminar riscos inerentes às atividades que
possam comprometer a saúde humana, animal, vegetal e o ambiente”.
A avaliação de risco incorpora ações que objetivam o reconhecimento
ou a identifi cação dos agentes biológicos e a probabilidade do dano proveniente
destes. Tal análise será orientada por vários critérios que dizem
respeito não só ao agente biológico manipulado, mas também ao tipo de
ensaio realizado, ao próprio trabalhador e, quando pertinente, à espécie
animal utilizada no ensaio. Deve contemplar as várias dimensões que envolvem
a questão, sejam elas relativas a procedimentos (boas práticas: padrões
e especiais), a infra-estrutura (desenho, instalações físicas e equipamentos
de proteção) ou informacionais (qualifi cação das equipes). Também
a organização do trabalho e as práticas gerenciais passaram a ser reconhecidas
como importante foco de análise, seja como causadoras de acidentes,
doenças e sofrimento, ou como integrantes fundamentais de um programa
de Biossegurança nas instituições.
Portanto, o estabelecimento de uma relação direta entre a classe de
risco do agente biológico e o nível de biossegurança (NB) é uma dificuldade
habitual no processo de defi nição do nível de contenção. Por exemplo,
estabelecer que para os agentes biológicos de classe de risco 3 deve-se
trabalhar em um ambiente de trabalho NB-3, sem levar em conta a metodologia
diagnóstica que será utilizada. No caso exemplar do diagnóstico da
Mycobacterium tuberculosis, que é de classe de risco 3, a execução de uma
baciloscopia não exige desenvolvê-la numa área de contenção NB-3, e sim
numa área NB-2, utilizando-se uma cabine de segurança biológica. Já se a
atividade diagnóstica exigir a reprodução da bactéria (cultura), bem como

testes de sensibilidade, situação em que o profi ssional estará em contato
com uma concentração aumentada do agente, recomenda-se, aí sim, que
as atividades sejam conduzidas numa área NB-3.
Por outro lado, há situações em que o diagnóstico é de um agente biológico
de classe de risco 2, que deve ser trabalhado em áreas de contenção
NB-2. Porém, se para algum estudo específi co houver a necessidade de um
aumento considerável de sua concentração ou de seu volume, produção em
grande escala, este então deverá ser realizado numa área NB-3.
Os tipos, subtipos e variantes dos agentes biológicos patogênicos envolvendo
vetores diferentes ou raros, a difi culdade de avaliar as medidas
de seu potencial de amplifi cação e as considerações das recombinações
genéticas e dos organismos geneticamente modifi cados (OGMs) são alguns
dos vários desafi os na condução segura de um ensaio. Portanto, para cada
análise ou método diagnóstico exigido, os profi ssionais deverão proceder a
uma avaliação de risco, onde será discutido e defi nido o nível de contenção
adequado para manejar as respectivas amostras. Nesse processo temos que
considerar, também, todos os outros tipos de riscos envolvidos.
Diante de tal complexidade no processo de avaliação de risco para o
trabalho com agentes biológicos, devemos considerar uma série de critérios
Fatores referentes ao trabalhador
São aqueles fatores diretamente ligados as pessoas: idade, sexo, fatores
genéticos, susceptibilidade individual (sensibilidade e resistência com
relação aos agentes biológicos), estado imunológico, exposição prévia, gravidez,
lactação, consumo de álcool, consumo de medicamentos, hábitos
de higiene pessoal (como lavar as mãos) e uso de equipamentos de proteção
individual (como jalecos e luvas). Além do que, devemos levar em
consideração a análise da experiência e da qualifi cação dos profi ssionais
Outros fatores relacionados aos agentes biológicos também devem ser
considerados, tais como as perdas econômicas que possam gerar, sua existência
ou não no país e a sua capacidade de disseminação em novas áreas.
Por esse motivo, as classifi cações existentes em vários países, embora
concordem em relação à grande maioria dos agentes biológicos, apresentam
algumas variações em função de fatores regionais específi cos.
Cabe ressaltar a importância da composição multiprofi ssional e da abordagem
interdisciplinar nas análises de risco. As análises de risco envolvem
não apenas sistemas tecnológicos e agentes biológicos perigosos manipulados
e/ou produzidos, mas também seres humanos, animais, complexos
e ricos em suas naturezas e relações, não apenas biológicas, mas também
sociais, que também se constituem em riscos, e devem ser considerados
durante o processo de avaliação.

Os agentes biológicos que afetam o homem, os animais e as plantas são
distribuídos em classes de risco assim defi nidas:
Classe de risco 1 (baixo risco individual e para a coletividade):
inclui os agentes biológicos conhecidos por não causarem doenças
em pessoas ou animais adultos sadios. Exemplo: Lactobacillus sp.
Classe de risco 2 (moderado risco individual e limitado risco
para a comunidade): inclui os agentes biológicos que provocam
infecções no homem ou nos animais, cujo potencial de propagação
na comunidade e de disseminação no meio ambiente é limitado, e
para os quais existem medidas terapêuticas e profi láticas efi cazes.
Exemplo: Schistosoma mansoni.
Classe de risco 3 (alto risco individual e moderado risco para a
comunidade): inclui os agentes biológicos que possuem capacidade
de transmissão por via respiratória e que causam patologias
humanas ou animais, potencialmente letais, para as quais existem
usualmente medidas de tratamento e/ou de prevenção. Representam
risco se disseminados na comunidade e no meio ambiente, podendo
se propagar de pessoa a pessoa. Exemplo: Bacillus anthracis.
Classe de risco 4 (alto risco individual e para a comunidade):
inclui os agentes biológicos com grande poder de transmissibilidade
por via respiratória ou de transmissão desconhecida. Até o
momento não há nenhuma medida profi lática ou terapêutica efi caz
contra infecções ocasionadas por estes. Causam doenças humanas
e animais de alta gravidade, com alta capacidade de disseminação
na comunidade e no meio ambiente. Esta classe inclui principalmente
os vírus. Exemplo: Vírus Ebola.

                    2.2 Classe de Risco 2
                    AGENTES BACTERIANOS

               Legionella spp, L. pneumophila

Elaboração, distribuição e informações:
Secretaria de Ciência, Tecnologia e Insumos Estratégicos
Departamento de Ciência e Tecnologia
Comissão de Biossegurança em Saúde
Esplanada dos Ministérios, Edifício Sede, bloco G, 8.° andar, sala 848
CEP: 70058-900, Brasília – DF

4 de jul. de 2012

Aparecen cinco casos de legionela en Madrid relacionados con un brote en Calpe

03-07-2012 - MDO/EP - Comunidad de Madrid
La Consejería de Sanidad va a abrir una investigación epidemiológica para determinar si los cinco casos de legionela que han aparecido en Madrid tienen que ver con el brote hallado en un hotel de Calpe.
En concreto, hay tres personas hospitalizadas en el Hospital Universitario Puerta de Hierro de Majadahonda afectadas, una en la Clínica Montepríncipe, en Boadilla del Monte, y otra en la Clínica Quirón, en Pozuelo de Alarcón.

Las autoridades sanitarias madrileñas están haciendo un cuestionario epidemológico para determinar posibles fuentes de exposición de los cinco casos de legionelosis con el fin de confirmar o descartar si están asociados al brote hallado en Calpe. Todos se alojaron la semana pasada en el hotel Diamante Beach de Calpe. Además, resultaron contagiados por la bacteria tres visitantes belgas.

El Diamante Beach ya fue noticia por una situación de características similares. Un foco de legionela afectó a una quincena de personas a principios de año, y aunque permaneció cerrado mientras se hacían las labores de desinfección, fue de nuevo reabierto. Tres británicos fallecieron a causa de esta infección.

Member of sick family diagnosed with Legionnaire's disease

WNEM TV5 has new information about a family who contracted a mystery illness after a family reunion trip up north.
Tonight officials have confirmed at least one person has a case of Legionnaires disease.
Twenty-seven family members went to a private resort in Boyne City, but when they came back last week, four had to be hospitalized, and 10 others have become sick or are taking antibiotics.
Two of them are on life support at the University of Michigan hospital in Ann Arbor.
One family member is so sick, she remains on a respirator and was diagnosed with Legionnaires.
The Saginaw County Health Department worked over the weekend to interview family members in an attempt to piece together any common threads, things like where they ate, where they slept, to figure out exactly where they may have been exposed to the disease.
While family members got together Monday to look at pictures of their trip, they say the most common thread is the lodge itself. TV5 called the lodge several times, but were told no one of authority could talk to us. TV5 has chosen not to identify the lodge until further investigation by authorities is completed.
According to the Mayo Clinic, Legionnaire's disease is described as:
A severe form of pneumonia — lung inflammation usually caused by infection. Legionnaires' disease is caused by a bacterium known as legionella.
You can't catch Legionnaires' disease from person-to-person contact. Instead, most people get Legionnaires' disease from inhaling the bacteria. Older adults, smokers and people with weakened immune systems are particularly susceptible to Legionnaires' disease.
Legionella bacterium also causes Pontiac fever, a milder illness resembling the flu. Separately or together, the two illnesses are sometimes called legionellosis. Pontiac fever usually clears on its own. But untreated Legionnaires' disease can be fatal. Although prompt treatment with antibiotics usually cures Legionnaires' disease, some people continue to experience problems after treatment.
Stay with WNEM.com and TV5 as we learn more about these cases.
Copyright WNEM 2012 (Meredith Corporation). All rights reserved.

Eight sick with Legionnaires' Disease at Spanish hotel

Eight people, including three Belgians, have come down with Legionnaires' disease in a hotel on Spain's Mediterranean coast that was closed after an earlier outbreak killed three Britons this year, officials said Tuesday.
"None of the cases is particularly serious," said the city of Valencia's regional health official Luis Rosado.
But he said the hotel was closed a second time "to avoid new cases and isolate the bacteria."
The nationality of the five other sick people was not immediately known.
The latest outbreak at the Diamante Beach hotel in the resort of Calpe, northeast of Alicante, was detected in the third week of June.
Rosado said the hotel had reopened after the earlier outbreak as experts agreed that "there was reliable evidence that the bacteria were no longer present."
The three Britons, who died between January 26 and February 2, were aged between 73 and 78 years and had been found to have pneumonia caused by Legionnaires'.
Authorities said in February that 15 people aged between 44 and 88 in all were infected -- 11 Britons and four Spaniards -- including the three who died.
The disease, caused by the bacteria Legionella, leads to a severe form of pneumonia which can be fatal.
It is contracted through inhalation of contaminated water droplets and is not known to be transmitted from person to person.


2 de jul. de 2012

5000 breathed in deadly legionella bug

THE NHS has launched a new probe into the hidden victims of the Capital’s legionnaires’ outbreak as it emerged an estimated 5000 people breathed in the potentially deadly bug.

Two people have died and another 94 have been struck down by confirmed or suspected cases of legionnaires’ disease, but one expert today warned that figure was likely to be only the “tip of the iceberg” as hundreds more may have suffered symptoms after becoming infected.
With health chiefs confident that the outbreak is under control, they are now turning their attention to initiating a huge retrospective investigation in an attempt to discover the full scale of infection in communities.
But they have come under fire from people who have suffered with legionellosis infections, who said the risk of developing milder symptoms was not publicised well enough as the crisis unfolded.
Elaine Walker, of Murray- field, has been told by her doctor that she has been ill with Pontiac fever – an illness caused by the legionella bug.
“The public are being misled as to the numbers of people affected,” she said. “I personally know five people who have had Pontiac fever and I know of another ten.”

fonte: NewsScotsman