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VIRTUAL MEETING September 9, 2022 They analyzed the evolution of the Legionella outbreak in Tucumán
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National and provincial health authorities together with national and international experts are working on the investigation and control of the outbreak. In the ANLIS-Malbrán laboratories, the diagnostic evaluation of the samples of the suspected cases included was extended.
The meeting, chaired by the Nation's Minister of Health, Dr. Carla Vizzotti , together with the representative of the Pan American Health Organization (PAHO), Dr. Eva Jané Llopis , was attended by the Minister of Public Health, Dr. Luis Medina Ruiz , the medical executive secretary, doctor Miguel Ferre Contreras , the undersecretaries of Health, doctors Eliana Molina and Cristina Majul, Environmental Health authorities, Epidemiology, among others. The press conference was to report on the evolution of the Legionella outbreak in Tucumán and the actions that are being developed to respond in an articulated effort between the Nation, the jurisdiction and local and international experts.
Medina Ruiz said that what was done these days was discussed: “First of all, we ratify that the outbreak was generated in the private clinic, and it is an outbreak limited to the clinic that generated contagion to the people who circulated within it. . This disease does not spread from person to person, now we have to wait 14 to 16 days from the last contact of those who have passed through that institution to assess whether symptoms appear or not.
On the other hand, he said that they sent water samples and swabs from different parts of the clinic to evaluate if legionella is found. "We are waiting for the results that have already begun processing at the Malbrán Institute," he added, while congratulating the health team that was treating the patients and following them by phone, carrying out epidemiological surveillance in the laboratories, sending the samples, making a survey of the infrastructure and carrying out interrelation with the different institutions of the country.
On the occasion, Vizzotti highlighted "the support from the first day of the Pan American Health Organization through its representative in the country and with the arrival this week of an expert and advisory team for the environmental study of the building." And he clarified that “in this bacterium the source of infection is by inhalation when it is in the air conditioning tabulators and the pipes. So, the situation is absolutely localized in a health center, which is what usually happens with outbreaks of this bacterium."
On the other hand, the minister listed the steps to follow that include the search for more cases among the people who may have been exposed; complete laboratory studies of all detected cases; clinical follow-up of exposed cases; and the final classification of all cases to assess the final determination of the magnitude of the outbreak. On the other hand, the clinic facilities will also be disinfected to evaluate their rehabilitation and the strengthening of the infection control and facility inspection committees will continue.
In her turn, the PAHO representative in Argentina, Eva Jané Llopis, highlighted “the rapid action of the national authorities and the province of Tucumán to detect, evaluate, and respond to this outbreak; as well as the very rapid notification made to the WHO through the necessary channels and complying with all health regulations. And she remarked that "this action demonstrates Argentina's commitment to international public health."
According to the epidemiological investigation, as of September 8, 22 suspected cases of Legionella disease (6 people deceased) have been identified, of which 4 results are compatible with Legionella pneumophila and one with Legionella spp. Epidemiological investigation continues (monitoring, evaluation, and classification of cases, monitoring of exposed persons), laboratory surveillance, and environmental surveillance, to finally determine the magnitude of the outbreak.
Legionella is a bacteria that is found in water and multiplies more easily in buildings with high volume water systems.
The most common form of transmission is inhalation of contaminated aerosols produced in conjunction with sprays, jets, or mists of water. Sources of these aerosols include cooling towers for air conditioning, hot and cold water systems, humidifiers, and whirlpool installations. It is important to mention that it is not transmitted from person to person.
Illness caused by this bacterium has an incubation period of 2 to 10 days and people may develop mild self-limited illness (Pontiac Fever) or more severe illness with pneumonia known as Legionnaire's disease. People over 50 years of age, those who smoke or have smoked, those who are immunocompromised, and those with chronic diseases are at increased risk of severe disease.
Evolution of the outbreak and actions taken
In a chronology on the origin of the outbreak and the work carried out, the minister explained that on August 29, the Epidemiology Directorate of Tucumán notified the national health portfolio about the detection of a conglomerate of two cases of bilateral pneumonia without identification of the cause and related to the same private sanatorium.
Since then, they have worked together on the investigation. The first step was to verify the existence of a possible outbreak and preventive isolation was carried out so that no new patients were admitted to the institution. In addition, a case definition was agreed upon to search for new cases and a protocol was drawn up to determine the possible origin.
Thus, new cases were identified and samples were taken that were analyzed at the Tucumán Public Health Laboratory for respiratory viruses, other viral, bacterial and fungal agents, all with negative results.
In turn, the samples were sent to laboratories of the National Administration of Laboratories and Health Institutes (ANLIS) “Dr. Carlos Malbrán” to expand the diagnostic analysis. They were studied for legionellosis, hantavirus, panel of 12 respiratory viruses and pancoronavirus, histoplasmosis and panfungal, leptospirosis, Q fever, mycoplasma and psittacosis.
All patients were transferred to another hospital and there are no workers in the institution, so there are no people who could be in contact with the source of transmission.
Finally, last Saturday, ANLIS-Malbrán reported that a viral genome was detected through PCR, sequencing and metagenomic analysis, compatible with legionella pneumophila in 4 patients and with legionella sp in 1 case.
In relation to environmental surveillance in the sanatorium, 59 samples were taken from 27 different sites, of cold and hot water and swabs from taps and showers. The samples will be derived for analysis at ANLIS-Malbrán. Additionally, the disinfection process of the facilities will begin.
Case update on the pneumonia outbreak.