A large Legionnaires' disease outbreak in Pamplona, Spain: early detection, rapid control and no case fatality

Abstract

An outbreak of Legionnaire's disease was detected in Pamplona, Spain, on 1 June 2006. Patients with pneumonia were tested to detect Legionella pneumophila antigen in urine (Binax Now; Binax Inc., Scarborough, ME, USA), and all 146 confirmed cases were interviewed. The outbreak was related to district 2 (22 012 inhabitants), where 45% of the cases lived and 50% had visited; 5% lived in neighbouring districts. The highest incidence was found in the resident population of district 2 (3/1000 inhabitants), section 2 (14/1000). All 31 cooling towers of district 2 were analysed. L. pneumophila antigen (Binax Now) was detected in four towers, which were closed on 2 June. Only the strain isolated in a tower situated in section 2 of district 2 matched all five clinical isolates, as assessed by mAb and two genotyping methods, AFLP and PFGE. Eight days after closing the towers, new cases ceased appearing. Early detection and rapid coordinated medical and environmental actions permitted immediate control of the outbreak and probably contributed to the null case fatality.

Fig. 1

Number of Legionnaires' disease cases by date of onset of illness and date of diagnosis in the outbreak of Pamplona, Spain, 2006. Black triangles indicate visits to district 2 of Pamplona by persons visiting the area a single time during the incubation period.

Fig. 2

Sex- and age-adjusted Legionnaires' disease incidence rates in Pamplona, Spain, by sections. White square represents the cooling tower related to the outbreak.

Fig. 3

Amplified fragment length polymorphism gel containing human and environmental L. pneumophila sg 1 (Allentown/France, mAb type) isolates. M, Molecular weight marker (Ladder Mix, MBI Fermentas, Vilnius, Lithuania). Lanes 1–4, patients 1–4, respectively. Lanes 5 and 6, patient 5. Lanes 7 and 8, two colonies from cooling tower 4 (probably responsible for the outbreak).