Epidemiology and Infection

Research Article

The Stafford outbreak of Legionnaires’ disease

M. C. O'Mahonya1, R. E. Stanwell-Smitha1, H. E. Tilletta1, D. Harpera1, J. G. P. Hutchisona2, I. D. Farrella2, D. N. Hutchinsona3, J. V. Leea4, P. J. Dennisa4, H. V. Duggala5, J. A. Scullya5 and C. Dennea5

a1 Public Health Laboratory Service Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ.

a2 Birmingham Public Health Laboratory, East Birmingham Hospital, Bordesley Green East, Birmingham B9 5ST.

a3 Preston Public Health Laboratory, Meadow Street, Preston PR1 6PS.

a4 Public Health Laboratory Service Centre for Applied Microbiology and Research, Porton Down, Salisbury SP4 0JG.

a5 Mid–Staffordshire District Health Authority, Corporation Street, Stafford ST16 3SR.

Abstract

A large outbreak of Legionnaires’ disease was associated with Stafford District General Hospital. A total of 68 confirmed cases was treated in hospital and 22 of these patients died. A further 35 patients, 14 of whom were treated at home, were suspected cases of Legionnaires’ disease. All these patients had visited the hospital during April 1985. Epidemiological investigations demonstrated that there had been a high risk of acquiring the disease in the out patient department (OPD), but no risk in other parts of the hospital. The epidemic strain of Legionella pneumophila, serogroup 1, subgroup Pontiac la was isolated from the cooling water system of one of the air conditioning plants. This plant served several departments of the hospital including the OPD. The water in the cooling tower and a chiller unit which cooled the air entering the OPD were contaminated with legionellae. Bacteriological and engineering investigations showed how the chiller unit could have been contaminated and how an aerosol containing legionellae could have been generated in the U–trap below the chiller unit. These results, together with the epidemiological evidence, suggest that the chiller unit was most likely to have been the major source of the outbreak.

Nearly one third of hospital staff had legionella antibodies. These staff were likely to have worked in areas of the hospital ventilated by the contaminated air conditioning plant, but not necessarily the OPD. There was evidence that a small proportion of these staff had a mild legionellosis and that these ‘influenza–like’ illnesses had been spread over a 5–month period. A possible explanation of this finding is that small amounts of aerosol from cooling tower sources could have entered the air–intake and been distributed throughout the areas of the hospital served by this ventilation system. Legionellae, subsequently found to be of the epidemic strain, had been found in the cooling tower pond in November 1984 and thus it is possible that staff were exposed to low doses of contaminated aerosol over several months.

Control measures are described, but it was later apparent that the outbreak had ended before these interventions were introduced. The investigations revealed faults in the design of the ventilation system.

(Received January 01 1990)

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