Saudi MOH: 3 More MERS Cases In Riyadh

 

 

#10,394

 

While it has yet to be posted on their English language website, we know that yesterday one MERS case was reported in Riyadh.  Today, 3 more cases have been reported – bringing the number of new Saudi MERS cases reported over the past five days to eleven.

One of today’s cases is listed as in `home isolation’, and is likely part of the family cluster I wrote about last night (see Saudi MOH Statement On MERS Family Cluster). 

 

Two of today’s cases are obviously part of a cluster, while the exposure for the third case is still under review.

 

 

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Eurosurveillance: B/Victoria Prevalence In Early New South Wales Flu Season

Photo Credit - CDC PHIL

 

#10,393

 

Because of the six months lead time required to produce and distribute a flu vaccine, twice each year the World Health Organization gathers together global influenza experts to decide on what stains to include in the next vaccine. Decisions on the vaccine being used right now in the Southern Hemisphere were made at the end of September 2014, while the Northern Hemisphere’s fall vaccine were decided upon last February.

 

It is always a little dicey trying to predict what flu strains will be dominate 6 to 12 months in the future, and last year we saw a big `mismatch’ with the H3N2 component  (see MMWR: Reduced Protection From This Year’s Flu Vaccine).

 

The formulation for both of those vaccines this year is identical, with (for the 6th year running) the 2009 H1H1 strain, a revamped H3N2 component, and a Yamagata lineage B/Phuket/3073/2013-like virus

 

Recommended composition of influenza virus vaccines for use in the 2015 southern hemisphere influenza season

25 September 2014

It is recommended that trivalent vaccines for use in the 2015 influenza season (southern hemisphere winter) contain the following:

• an A/California/7/2009 (H1N1)pdm09-like virus;
• an A/Switzerland/9715293/2013 (H3N2)-like virus^a;
• a B/Phuket/3073/2013-like virus.

It is recommended that quadrivalent vaccines containing two influenza B viruses contain the above three viruses and a B/Brisbane/60/2008-like virus.

 

In addition to picking which H1 and and H3 strain to include, experts must decide which of the two lineages of influenza B (Yamagata or Victoria) will dominate the next flu season. Influenza B often becomes the predominant strain late in the flu season, after influenza A has peaked, which puts even more time between the decision of what lineage to use, and its arrival. 

 

Over the first decade of the 21st century, the trivalent vaccine matched the dominant B strain only about 50% of the time. In 2012, the FDA approved the first Quadrivalent Flu vaccine, containing both Victoria and Yamagata lineage B strains (see Two B's Or Not Two B's? That Is the Question).

 

Being relatively stable, influenza B viruses don’t get as much respect as the highly mutable influenza A’s, even though they are quite capable of producing large epidemics with significant morbidity and mortality.  

This graphic from  CDC’s  2014-15 FluView shows Influenza B (green) dominating last spring.

 

With influenza activity in full swing in the Southern Hemisphere, we usually look at Australia and New Zealand around this time of year for clues as to what we might expect in the Northern Hemisphere this fall and winter.  

 

Yesterday Eurosurveillance published a Rapid Communications indicating that New South Wales (NSW) is reporting unusually heavy influenza B activity, and that a substantial portion of their cases are due to the Victoria lineage, which is not included in this year’s standard trivalent flu vaccine.

 

A bit of a surprise as the most recent WHO Influenza Surveillance Report (July 27th) found globally that detections of the B-Yamagata lineage continue to outnumber B-Victoria by nearly 20 to 1. ( `Of the characterized B viruses, 89 (94.7%) belonged to the B-Yamagata lineage and 5 (5.3%) to the B-Victoria lineage.’).

 

 

Eurosurveillance, Volume 20, Issue 31, 06 August 2015

Rapid communications

Increased prevalence of influenza B/Victoria lineage viruses during early stages of the 2015 influenza season in New South Wales, Australia: implications for vaccination and planning

Z Jennings¹, I Carter¹, K McPhie¹, J Kok ()^1,2,3, D E Dwyer^1,2,3

During the early weeks of the 2015 Australian influenza season, influenza B accounted for 67% (821/1,234) of all positive influenza tests in New South Wales. Of 81 successive influenza B viruses characterised, 33 (41%) were from children aged < 16 years; 23/81 (28%) belonged to the B/Victoria lineage. This lineage is not contained in the southern hemisphere's 2015 trivalent influenza vaccine. The significant B/Victoria lineage activity in the southern hemisphere suggests that the quadrivalent vaccine should be considered for the northern hemisphere.

 

The first four weeks of the 2015 influenza season in New South Wales, Australia (15 June to 12 July) have shown substantial early influenza B activity, with frequent detection of influenza B/Victoria lineage viruses, including in children (aged under 16 years). This lineage is not contained in the southern hemisphere’s 2015 [1] or the northern hemisphere’s 2015/16 trivalent influenza vaccine [2].

(Continue . . . )

 

Whether this activity in NSW is an outlier or a harbinger is far too soon to say.  The authors do, however, suggest this uncertainty may make the quadrivalent vaccine a better choice for the Northern Hemisphere this fall.

They conclude by writing:

 

Although the sample size of the present study is small, our preliminary data suggest early and significant B/Victoria lineage virus activity in children and adults in New South Wales. The recommended influenza B component of the 2015/16 northern hemisphere’s trivalent influenza vaccine is the B/Phuket/3073/2013-like virus (B/Yamagata lineage). As there may be incomplete protection against B/Victoria lineage infection for those receiving the trivalent vaccine, our early data would suggest that a quadrivalent vaccine should be considered for the upcoming northern hemisphere influenza season (and for travellers to the southern hemisphere). This will be especially relevant if the northern hemisphere experiences early and widespread influenza B/Victoria activity similar to that being observed in the current southern hemisphere winter.

 

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RESEP PUDING SUSU MOZAIK NUTRIJELL WARNA WARNI

Resep puding susu mozaik nutrijell. Tampilan warna-warni dari puding susu yang enak dan sederhana kali ini tidak hanya enak disantap tetapi juga membuatnya cukup menarik. Secara praktis dalam membuat puding mozaik adalah dengan membagi adonan menjadi pecahan atau potongan yang berwarna-warni lalu digabungkan dalam sebuah puding. Sedangkan untuk variasi dan kreasinya bisa menggunakan berbagai macam bahan puding seperti halnya puding susu sederhana dari agar-agar nutrijell.

Berikut ini adalah cara membuat puding susu mozaik dengan cita rasa susu sebagai bahan dasar adonannya beserta puding nutrijell susu aneka rasa sebagai variasi warnanya. Rasa manis yang segar membuatnya bisa menjadi menu makanan penutup yang tepat.

RESEP PUDING SUSU MOZAIK

Agar potongan puding nutrijell bisa penuh menutupi keseluruhan puding utama bisa mengikuti resep di bawah ini, sedangkan kita bisa menggunakan takaran setengah puding nutrijell supaya tidak beresiko potongan puding nutrijell yang berlebih.

Bahan puding susu :

• 1 bungkus agar-agar putih
• 800 ml susu cair ultra
• 100 gram gula pasir

Bahan puding nutrijell :

• 4 bungkus nutrijell (jelly powder) aneka rasa masing-masing 10 gram
• 1600 ml susu cair (tiap rasa 400 ml) atau bisa ganti air biasa
• 400 gram gula pasir (masing-masing 100 gram)
• 4 macam pewarna makanan sesuai selera supaya tampilan warnanya lebih ngejreng

CARA MEMBUAT PUDING SUSU MOZAIK NUTRIJELL

1. Campur 1 bungkus nutrijell rasa melon dengan 100 gram gula pasir, 400 ml susu cair dan pewarna hijau. Aduk rata lalu masak sambil sesekali diaduk hingga mendidih, matikan api lalu tuang dalam wadah.
2. Lakukan hal yang sama untuk tiap bungkus nutrijell lainnya, misalkan warna merah untuk nutrijell rasa strawberry, kuning untuk rasa mango dan orange untuk rasa jeruk. Setelah dingin atau beku kemudian potong-potong puding berbentuk dadu.
3. Campurkan 1 bungkus agar-agar putih dengan gula pasir dan susu cair, aduk rata kemudian didihkan sambil sesekali diaduk lalu matikan api dan biarkan uap panasnya hilang.
4. Siapkan cetakan puding dan basahi dengan air, susun secara acak potongan puding nutrijel dalam cetakan puding tersebut kemudian tuang atau sirami dengan puding susu. Biarkan beku atau simpan dalam lemari es lalu siap untuk dipotong-potong dan disajikan.

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Saudi MOH Statement On MERS Family Cluster

 

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For the past couple of weeks we’ve been following an extended outbreak of MERS in and around the Capital city of Riyadh. As of today, at least 13 cases have been confirmed by the Saudi Ministry of Health. 

 

Although the information provided on the MOH website is fairly cryptic, it has been apparent that contacts of family members, and nosocomial contacts, have been infected.  Additionally, some cases have no known risk exposures listed.

 

Today the Ministry of Health has posted a long statement regarding a family cluster, apparently in response to criticisms lodged by family members to the media.   First, a (translated) excerpt from one of the media sources of the accusations, then the MOH response.

 

Health" Saudi Arabia responded to the accusations of family infected with Corona

Riyadh Khalid Al Shaya

August 6, 2015

 

Saudi Ministry of Health and health affairs at the Ministry of National Guard issued a joint statement on Thursday, made it clear the recording of cases of HIV Middle East respiratory syndrome Coruna central Saudi family in Riyadh region. The family has accused the Ministry of Health of causing the injury of six members with the virus, the lack of follow-up to one of its members who was formerly the disease and neglect checking the rest.

The tired-Harbi, a family member, said on Wednesday that four of his family contracted the disease, including his mother, who died, and three of his uncles. He said, adding: "My father virus wounded first, but in spite of it remains in intensive care for five days, but the hospital is directed, declaring that he is no longer suffering from it, which is what caused the transmission of the virus to my mother, who died outcome, and after the virus has moved to my brother, who is currently lying in Prince Mohammad Bin Abdulaziz Hospital with three of my uncles because of the virus. "

He continued, "I attended a medical committee of the Ministry of Health to our house after Thbot injury and my father HIV and conducted tests for a limited number of the family, and they told us that the results were negative. and asked them to check the rest, but they refused, knowing that the effects of the disease were visible on my mother. "

(Continue . . . )

 

The index case (the father) who remains hospitalized, appears to have had recent camel (“beauty”) contact. Subsequently his wife has succumbed, and two sons have been hospitalized.  At least one other family member is isolated at home.

 

Apparently these charges have induced the MOH to take the unusual step of publishing a formal response (see below), where they acknowledge the family cluster, but do not directly address the family’s allegations.

 

As machine translations often lose some context and flavor along the way, if and when an English language statement is published, we may be able to glean more from it.   

 

Health and the Ministry of National Guard issue joint registration virus cases (Corona) to the family of Saudi Arabia in Riyadh

21 October 1436

A desire to shed light on more information on registered cases of HIV (La Coruna), Ministry of Health and Health Affairs at the Ministry of National Guard has issued a joint statement, which made clear recording cases of HIV Middle East respiratory syndrome (Corona) amid a Saudi family in the Riyadh region, including two cases Mnomtan Hospital King Abdulaziz Medical City, National Guard, and the state of hypnotic Hospital, Prince Mohammed bin Abdul Aziz, and the case moved to the mercy of God.

Symptoms and signs have emerged the first case (the father) and who suffer from chronic diseases, and underwent the process of eradication of college previously, and hypnotic currently at King Abdulaziz Medical City, National Guard, and receive the necessary medical care, ask God cure him.

And it has been shown through epidemiological investigation of the case that the patient Mkhalt to beauty, was immediately conduct epidemiological investigation and debate all contacts, and a sampling of those who showed symptoms of the disease, and in accordance with the directives issued by the command and control center at the Ministry of Health and the World Health Organization Scientific Committee.  

As for the second case (mother), the wife of the first patient case; it has been discovered through follow-up to household contacts of the first case, he has died, ask God have mercy and forgiveness.

The third case, the son of the first and the second case, he is hypnotized Hospital, Prince Mohammed bin Abdulaziz, and receive necessary medical care, God's lips.

For the fourth case is the brother of the first case, and hypnotized at King Abdulaziz Medical City, National Guard, and receive necessary medical care, God's lips.

It should be noted that a family member was found positivity when the virus check, which is isolated now at home, and is a carrier of the virus only, and does not apply it your disease virus case definition (Corona) in accordance with the Guidelines approved by the Scientific Committee and the center of command and control at the Ministry of Health and the World Health Organization and the control center and control diseases in the United States of America, and place a stable home, thankfully.

For its part, the Ministry of Health made it clear that this is not the first time that an outbreak occur amid members of one family, there have been outbreaks earlier, also in Al-Ahsa province to the family of one of the seven members, also occurred in the province of Taif and Riyadh region, all outbreaks of the center of a Saudi family link among them is communion friction and beauty products.

The Ministry of Health also confirmed that it already noted for all in more than one occasion through the media channels and various means of social communication through the campaign (appreciate plugged) health awareness, and calls upon the ministry now valued citizens need to take the necessary precautions when dealing with beauty, from the coverage of the mouth, face and follow health habits for example, washing of hands.

The ministry also Taml the integrative role with our partners from government agencies in the Ministry of Agriculture and the Ministry of Municipal and Rural Affairs and valued citizens who trust in the health and awareness.

We ask God for this family urgently healing, and that the ruthless dead

 

While large family clusters of MERS have been reported before, they are uncommon enough to warrant additional investigation and scientific scrutiny.   Hopefully whatever is learned will be shared – sooner rather than later – by  the Saudi Authorities.

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Eurosurveillance: Parotitis Associated With A Drifted A/H3N2 Infection

Credit Wikipedia

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Last February, amid concerns that the dominant seasonal H3N2 virus had drifted away from last winter’s vaccine (see CDC HAN Advisory On `Drifted’ H3N2 Seasonal Flu Virus), we began to hear of cases of Unusual Presentation Of Parotitis With Seasonal Influenza.

 

The classic cause of parotid swelling is the mumps virus, but other viruses (EBV & HIV), along with acute bacterial parotitis or Extrapulmonary Tuberculosis can cause inflammation of these glands, as well as some autoimmune diseases. And sometimes, the etiology is unknown.

 

In January, the Chicago Department of Public Health issued an alert to local doctors to test for both influenza, and mumps, when diagnosing parotitis, as several unusual influenza-related cases had surfaced.

 

The following month,  the CDC published an overview of the 2014-15 flu season, with the following comment on these parotitis cases.

What You Should Know for the 2014-2015 Influenza Season

(excerpt)

Is there any unusual disease activity going on this season?

Since December 2014, multiple states have notified CDC of laboratory-confirmed influenza infections in persons who have swelling of their salivary glands (a condition called ‘parotitis’). Of the cases of influenza infection with parotitis that have been reported to CDC, the majority have occurred in children with influenza A (H3) infection, and have resulted in mild illness. No deaths have been reported. CDC is currently investigating  the situation in order to understand the characteristics of patients and the occurrence of parotitis.

Parotitis is not a common symptom of influenza infection, although cases of parotitis with influenza infection have been reported in the past. Parotitis is much more commonly seen following infection with other pathogens such as the mumps virus. Symptoms of influenza infection include fever, chills, cough, sore throat, runny or stuffy nose, muscle or body aches, headache, fatigue (tiredness), and sometimes vomiting and  diarrhea (more common in children than adults).

 

Fast forward to today, and we have a report in today’s Eurosurveillance Journal of A/H3N2 detected last winter in children being tested for mumps in the England.

 

Eurosurveillance, Volume 20, Issue 31, 06 August 2015

Rapid communications

Detection of influenza A(H3N2) virus in children with suspected mumps during winter 2014/15 in England

C I Thompson ()¹, J Ellis¹, M Galiano¹, M Ramsay², K E Brown¹, M Zambon¹

Influenza A(H3N2) virus was detected in oral fluid from 16/107 children (aged 2 to 12 years) with a clinical diagnosis of mumps, who were sampled between December 2014 and February 2015 in England, during the peak of the 2014/15 influenza season. Sequence analysis of an A(H3N2) virus from a child with suspected mumps showed the virus was similar to other circulating A(H3N2) viruses detected in winter 2014/15, which were antigenically drifted from the A(H3N2) vaccine strain.

During winter 2014/15, clinical parotitis in children with confirmed influenza A(H3) infection was reported in North America [1]. In contrast, however, neither clinical nor virological surveillance for influenza-like illness (ILI) through sentinel general practitioners (GPs) in England detected an association between parotitis and influenza virus infection in the 2014/15 winter. In light of the observations from North America, gingival crevicular fluid (oral fluids) submitted for mumps surveillance in England were examined for influenza virus. Analysis of samples from 107 children (aged 2 to 12 years) with a clinical diagnosis of mumps but negative for mumps virus, sampled between December 2014 and February 2015, during the peak of the 2014/15 influenza season, showed that 16 (15%) were infected with influenza A(H3N2) virus.

(SNIP)

Influenza virus as an atypical cause of acute viral parotitis should be considered especially during epidemic seasons with drifted A(H3N2) strains, such as in 2014/15, or when zoonotic exposure has occurred.

Influenza A(H3N2) viruses from the 3C.2a clade that have predominantly circulated in the UK during winter 2014/15 show reduced agglutination of red blood cells used in laboratory tests suggestive of a change in binding specificity or avidity for sialic acid receptors [20]. Both mumps and influenza viruses bind sialic acid receptors on cells in the upper respiratory tract [21]. The unusual clinical presentation of parotitis during the 2014/15 season in conjunction with a change in virus receptor binding properties warrants further investigation.

(Continue . . . )

 

The idea that a sufficiently `drifted’ or zoonotic H3N2 virus might cause an atypical presentation like parotitis isn’t without precedent.  While rare, it has been documented before, as in this April of 2009 edition of the Journal of Clinical Microbiology.

 

Parotitis in a Child Infected with Triple-Reassortant Influenza A Virus in Canada in 2007

Nathalie Bastien1,Donalda Bowness1,  Laura Burton2, Erika Bontovics2,  Anne-Luise Winter2,  Graham Tipples1, Debby Minielly2,  Betty Gregg2,  Christine Cramer2,  Christine Schincariol2 and  Yan Li1,*

ABSTRACT

Swine H3N2 influenza virus designated A/Ontario/1252/2007 was isolated from a child with parotitis. Diagnosis was confirmed by viral isolation and serological assays. A/Ontario/1252/2007 was related to H3N2 triple reassortants that emerged in swine in the United States in 1998. Three of five tested household members were also seropositive for A/Ontario/1252/2007.

(Continue . . . )

 

Going even further back in the literature, in 1977 the NEJM reported on Acute Parotitis Associated with Influenza Type a — A Report of Twelve Cases, which occurred during the last year that A/H3N2 ruled the influenza court alone (H1N1 reemerged in May of 1977 after a 20 year absence).

Although there is always a degree of diversity in the flu strains circulating around the globe, the most recent ECDC  Influenza Virus Characterization Report describes an increasingly complex H3N2 viral field.

Since 2009, seven genetic groups based on the HA gene have been defined for A(H3N2) viruses.

The HA genes fall within genetic group 3C. This group has three subdivisions: 3C.1 (to which the recommended vaccine virus for the 2014–15 northern hemisphere season, A/Texas/50/2012, belongs), 3C.2 and 3C.3. Viruses in these three subdivisions have been antigenically similar.

However, in 2014 three new genetic subgroups emerged, one in subdivision 3C.2, 3C.2a, and two in 3C.3, 3C.3a and 3C.3b (Figure 2). While viruses in genetic subgroups 3C.2a and 3C.3a are antigenic drift variants, those in 3C.3b have remained antigenically similar to previously circulating viruses in the 3C.3 subdivision. Amino acid substitutions that define these subdivisions and subgroups compared with A/Texas/50/2012 are:

• (3C.2) N145S and V186G5 in HA1, and D160N in HA2, e.g. A/Hong Kong/146/2013
• (3C.2a) Those in 3C.2 plus L3I, N144S (resulting in the loss of a potential glycosylation site), F159Y, K160T (in the majority of viruses, resulting in the gain of a potential glycosylation site), N225D and Q311H in HA1, e.g. A/Hong Kong/5738/2014
• (3C.3) T128A (resulting in the loss of a potential glycosylation site), R142G, N145S and V186G in HA1, e.g. A/Samara/73/2013
• (3C.3a) those in 3C.3 plus A138S, F159S and N225D in HA1, many with K326R, e.g. A/Switzerland/9715293/2013
• (3C.3b) those in 3C.3 plus E62K, K83R, N122D (resulting in the loss of a potential glycosylation site), L157S and R261Q in HA1 with M18K in HA2, e.g. A/Newcastle/22/2014.

 

Whether this growing diversity portends more atypical flu presentations is far from certain.  It does, however, make selecting the right vaccine strain for future flu seasons a lot more complicated.

 

The authors of today’s Eurosurveillance Journal report conclude by saying:

 

The specific detection of influenza A(H3N2), and not influenza B or A(H1N1)pdm09 in this sample set, in combination with the clinical syndrome reporting from North America, suggests that influenza should be considered as part of the differential diagnosis for parotitis at the time when influenza virus is circulating, but this conclusion requires evaluation with different circulating influenza virus strains.

The question of whether 3C.2a A(H3N2) influenza virus strains have an unusual tissue distribution compared with other A(H3N2) viruses or whether a subset of children infected with any influenza strain experience parotitis remains to be determined. Our conclusions would be strengthened by evaluation of further studies during future influenza seasons where oral fluids are taken in parallel with nasal swabs from children with influenza, with and without parotitis.

Nevertheless, greater awareness of influenza virus as a potential cause of parotitis especially during epidemic periods associated with a drifted A(H3N2) strain is an important clinical and public health message.

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August Tropical Climatology & The Latest CSU Hurricane Forecast

 

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As a resident of Florida for nearly 50 of my 61 years, I’m pretty used to casting a weather eye towards the tropics six months out of every year.  But while hurricane season runs from June 1st through the end of November, as the chart above illustrates, most of our tropical activity takes place between August 20th and October 20th.

 

As the summer progresses the spawning grounds for Hurricanes expands greatly, moving further east into the warming Atlantic ocean.  It is usually  August and September when the Cape Verde basin begins to produce what often turn into the largest and most persistent storms.

 

July & August Tropical Climatology

You can find much more on Hurricane Climatology at NOAA’s  Tropical Cyclone Climatology page.

This being a strong El Niño year, we would expect tropical activity in the Eastern Pacific to be enhanced, while tropical development in the Atlantic is suppressed. 

 

But there is a great deal more to long range tropical forecasting, which is why we eagerly await the forecasts each spring and summer by Philip J. Klotzbach and William M. Gray who run Colorado State University’s Tropical Meteorology Project.

 

Starting in April, they begin producing regular forecasts for the upcoming season, adjusting and fine tuning their projections throughout the season.  Their initial forecast (April 9th) anticipated that `the 2015 Atlantic basin hurricane season will be one of the least active seasons since the middle of the 20th century’.

Their latest update (August 4th) continues to predict a below-average Atlantic tropical season.

 

FORECAST OF ATLANTIC SEASONAL HURRICANE ACTIVITY AND LANDFALL STRIKE PROBABILITY FOR 2015

We continue to foresee a well below-average 2015 Atlantic hurricane season. A strong El Niño event is already underway. Conditions in the tropical Atlantic remain unfavorable for hurricane formation. We continue to call for a below-average probability of United States and Caribbean major hurricane landfall.

(Continue . .. )

 

Of course, even a slow hurricane season doesn’t preclude seeing one or more potentially deadly storms affect the United States coastline.   The chart below from the latest forecast still gives Florida 1 in 5 chance of seeing a hurricane yet this year, and a 13% probability for Texas.

 

So, if you haven’t already downloaded the updated Tropical Cyclone Preparedness Guide, now would be an excellent time to do so.

When it comes to getting the latest information on hurricanes, your first stop should always be the National Hurricane Center in Miami, Florida. These are the real experts, and the only ones you should rely on to track and forecast the storm.

 

And if you are on Twitter, you should also follow @FEMA, @CraigatFEMA, @NHC_Atlantic, @NHC_Pacific and @ReadyGov.

 

For more on preparedness, you may wish to revisit some of these recent blogs:

•  Appreciating The Nature Of The Threat
• When Evacuation Is The Better Part Of Valor
• When 72 Hours Isn’t Enough

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Updating NYC’s Legionnaire’s Outbreak

Legionella Bacteria - Photo Credit CDC PHIL

 

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In a story we’ve been following for more than a week (see Monday’s Updating The NYC Legionella Outbreak), the number of Legionella infections reported in the South Bronx continues to rise, with the total nearing 100. As many people who contract this type of bacterial infection experience only minor symptoms, this is likely an undercount.

 

Those who are susceptible (often smokers, the elderly, immunocompromised, etc.) can develop serious – even life threatening – pneumonia.

 

The Legionella bacteria thrives in warm water, such as is commonly found in air-conditioning cooling towers, hot tubs, and even ornamental water fountains. When water is sprayed into the air the bacteria can become aerosolized and inhaled.

 

The CDC estimates that between 8,000 and 18,000 Americans are hospitalized with Legionnaire's Disease each year. While large outbreaks of Legionella are often traced to specific causes, quite often the source of the infection for individual cases remains unknown.  

 

Overnight NYC.gov posted the following update.

 

NYC.gov

Bronx Legionnaires' Disease Cluster Updated Fact-Sheet 8/5/15

Cases

• Individuals with Legionnaires' deceased: 8
• All deceased individuals were older adults and had additional underlying medical problems.
• These patients are connected to the current cluster.
• Reported individuals with Legionnaires': 97
• Individuals with Legionnaires' hospitalized: 92
• Of the 92, the number of individuals with Legionnaires' treated and discharged: 48

FAQ

• New York City's drinking water supply and other water features, like fountains, shower heads and pools, are safe throughout New York City and are unaffected by legionella
• Water towers are unaffected by legionella
• Home air conditioner units are unaffected and walking into air conditioned environments is safe, as well.

Locations and Remediation

• 17 cooling towers were tested
• 5 locations tested positive, and all have been remediated. Health officials are confident that one or more of the five locations that tested positive was the source of the outbreak, and the risk has been removed through disinfection.
• All sites will submit long-term plans as to how they will maintain the cooling towers to protect against any future growth of legionella – those plans are due Friday.
• The Health Department convened a panel of experts in the field of infectious disease to discuss the work the City has done so far and to ensure that all the appropriate steps are being taken to find and eliminate the source of the outbreak.

Ongoing DOHMH Actions

• Continued monitoring for new cases
• Close collaboration with area hospitals
• Disease detectives conducting epidemiological investigation
• Interviews with all individuals reported with Legionnaires' to support source identification
• Providing updates to elected officials and Bronx residents
• Outreach to vulnerable populations – senior centers, homeless shelters, and other locations
• Monitoring of disinfection of affected cooling towers

 

For more information on the disease, the CDC maintains a fact sheet at Patient Facts: Learn More about Legionnaires' disease.

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