2014 Portugal legionellosis outbreak

The 2014 Portugal legionellosis outbreak was an outbreak caused by Legionella bacteria in multiple cities of Portugal's Lisboa district. It began in November 2014 in Póvoa de Santa Iria, Forte da Casa and Vialonga (Vila Franca de Xira, Lisbon). As of 5 December 2014, 336 people have become infected and eleven have died.[2] Cases in Luanda, Angola and Lima, Peru were suspected to be connected to the outbreak,[3] but were later found to be unrelated.[4] Paulo Macedo, the Health Minister, declared the outbreak over on 21 November. He stated however that, new deaths could be registered.[2]

2014 Legionella outbreak in Portugal
Location of the affected district
Date7 November 2014 - 21 November 2014
Casualties
  • Cases / Deaths (as of 15 December 2014) [1]

Portugal: 375 / 12
Angola: 0 / 0[ibnote 1]
Peru: 0 / 0[ibnote 1]

  1. Two cases had been reported to have been observed abroad, one in Angola and one in Peru, but these were later found out to be unrelated to the outbreak.

Sources

The source of the outbreak is yet to be discovered. Authorities have stated that the source may be a public location such as a water conduct and that more cases are to be expected.[5] The source is being tracked and water sample analysis are to be performed.[5] A total of 20 locations were examined on November 8. Another 5 locations, 4 factories and 1 hotel, have been examined on November 9. No traces so far of the bacteria have been discovered. Up until now, the infected individuals have not been found to have participated in the same events in the last 14 days.[6]

On 11 November, Solvay confirmed that the first results from their factory in Póvoa de Santa Iria came positive for Legionella, but the results of more comprehensive tests, done at Ricardo Jorge National Health Institute (INSA) are not available yet. These tests include samples from other factories in the region, such as Adubos de Portugal (ADP) and Central de Cervejas.[7]

Later on the same day, it was also reported that the ADP factory will be further investigated. It is expected that the new investigation will shed some light on whether there was criminal activity behind the outbreak.[8]

On 21 November, it was confirmed that the ADP factory was the source of the outbreak.[9]

Current status
DateCasesFatalitiesSource
2014-11-07330Público[10]
2014-11-08 12:00590Público[11]
2014-11-08 20:00[12]901[12]Diário de Notícias,[12] Directorate-General of Health (DGS)[13]
2014-11-091203Diário de Notícias[14]
2014-11-09 afternoon1804 (+1)[15]Diário de Notícias,[15] DGS[16]
2014-11-102335DGS[17]
2014-11-112785DGS[18]
2014-11-123027 (+2),[19] 5 (+4)[20]Público,[19] DGS[20]
2014-11-133117 (+1)DGS[4]
2014-11-143167DGS[21]

On 7 November 2014, authorities were alerted about an unusually large number of patients infected with Legionella: in 24 hours, the Vila Franca de Xira hospital received 27 patients with this infection. With six more cases from other hospitals in Lisbon. The municipality promptly asserted that tests carried out by the municipal water and sanitation authority (SMAS) did not find any evidence of Legionella in the tap water.[10]

Patients were from Forte da Casa, Póvoa de Santa Iria, Vialonga, in Vila Franca de Xira, and also Bucelas, Loures and Samora Correia, Benavente.[10]

On the first half of 8 November, there were already 59 known cases.[11] At the end of the same day, there were 90 known cases of Legionella including 1 fatality, with more cases to be expected. Authorities have, however, stated that the first fatality was a 59-year-old male that was a heavy smoker[5] who died 3 hours after arriving at the hospital.[12]

On 9 November, the number of cases was updated to 120.[14] Two more people, a 66-year-old male and an 81-year-old female, both with preexisting conditions, died in the hospital, raising the number of fatalities to 3.[15] 6 more people are in critical condition. In the afternoon, the number of cases was reported to be 180 and 4 fatalities. 24 people are in the intensive care unit. One other fatality is being investigated and was very likely also caused by Legionella.[15]

As of 12 November, there were 302 known cases and 7 fatalities related to this outbreak, with 49 people in intensive care units and two more deaths under investigation.[19]

On 13 November, 311 cases were observed, with 7 fatalities, and the two cases that had been observed abroad were found to be unrelated to this outbreak.[4]

On 17 November, there were 331 cases and 8 fatalities.[22]

On 21 November, there were 336 cases and 10 fatalities. The outbreak was declared to be over.[2]

On 4 December, a 43-year-old man died from Legionella, raising the number of fatalities to 11.

Prevention measures

Authorities recommended people to avoid taking showers and using high-pressure water sources as well as avoiding air-conditioning devices and places where airborne water particles are present. Blood donations in some parts of the affected district were halted.[23]

References
  1. "Legionella: Surto causou 12 mortos e 375 doentes, oito ainda hospitalizados - PÚBLICO". Publico.pt. 2014-12-15. Retrieved 2015-08-29.
  2. "Extinto o surto de legionella". rr.sapo.pt (in Portuguese). November 21, 2014. Retrieved November 23, 2014.
  3. "45 novos casos num dia, são agora 278 os casos de Legionella" (in Portuguese). Observador. Retrieved 12 November 2014.
  4. "Surto de infeção por Legionella — Atualização da situação às 17 horas de 13/11/2014" (in Portuguese). Direcção-Geral da Saúde. 13 November 2014. Retrieved 15 November 2014.
  5. "Médicos de Saúde Pública avisam para risco de mais casos. Origem pode ser espaço público" (in Portuguese). Diário de Notícias. Archived from the original on 9 November 2014. Retrieved 12 November 2014.
  6. "Autoridades continuam no terreno a tentar descobrir foco da infeção de 'legionella'" (in Portuguese). Diário de Notícias. Archived from the original on 9 November 2014. Retrieved 12 November 2014.
  7. "Fábrica de químicos de Vila Franca de Xira com vestígios de Legionella" (in Portuguese). Público. 11 November 2014. Retrieved 12 November 2014.
  8. "Fábrica da Adubos de Portugal vai ser investigada por ser provável foco de Legionella" (in Portuguese). Público. 11 November 2014. Retrieved 12 November 2014.
  9. "Dez mortos, 336 doentes – Torres de refrigeração da ADP na origem do surto de legionela". dn.pt (in Portuguese). November 21, 2014. Archived from the original on November 29, 2014. Retrieved November 23, 2014.
  10. "Surto de legionella em Vila Franca de Xira deixa 33 pessoas internadas" (in Portuguese). Público. 8 November 2014. Retrieved 15 November 2014.
  11. "Sobem para 59 os casos de "legionella" na região de Lisboa" (in Portuguese). Público. 8 November 2014. Retrieved 15 November 2014.
  12. "São já 90 os infetados com 'legionella'. Francisco George admite que possam surgir mais casos" (in Portuguese). Diário de Notícias. Archived from the original on 13 November 2014. Retrieved 12 November 2014.
  13. "Surto de infeção por Legionella" (in Portuguese). Direcção-Geral da Saúde. 8 November 2014. Retrieved 15 November 2014.
  14. "Número de infetados com 'legionella' estará perto dos 120" (in Portuguese). Diário de Notícias. Archived from the original on 9 November 2014. Retrieved 12 November 2014.
  15. "Direção-Geral de Saúde confirma quatro óbitos e 180 casos de pessoas infetadas com 'legionella'" (in Portuguese). Diário de Notícias. Archived from the original on 9 November 2014. Retrieved 12 November 2014.
  16. "Surto de infeção por Legionella" (in Portuguese). Direcção-Geral da Saúde. 9 November 2014. Retrieved 15 November 2014.
  17. "Surto de infeção por Legionella" (in Portuguese). Direcção-Geral da Saúde. 10 November 2014. Retrieved 15 November 2014.
  18. "Surto de infeção por Legionella — Atualização da situação às 15 horas de 11/11/2014" (in Portuguese). Direcção-Geral da Saúde. 11 November 2014. Retrieved 15 November 2014.
  19. "Número de doentes com Legionella ultrapassa os 300" (in Portuguese). Público. 12 November 2014. Retrieved 12 November 2014.
  20. "Surto de infeção por Legionella — Actualização da situação às 15 horas de 12/11/2014" (in Portuguese). Direcção-Geral da Saúde. 12 November 2014. Retrieved 13 November 2014.
  21. "Surto de infeção por Legionella — Atualização da situação às 15 horas de 14/11/2014" (in Portuguese). Direcção-Geral da Saúde. 14 November 2014. Retrieved 15 November 2014.
  22. "Já tiveram alta 87 doentes infetados com Legionella". observador.pt (in Portuguese). November 17, 2014. Retrieved November 23, 2014.
  23. "Suspensa Colheita de Sangue na Póvoa de Santa Iria como precaução devido à 'legionella'" (in Portuguese). Diário de Notícias. Archived from the original on 9 November 2014. Retrieved 12 November 2014.
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