WHO Watching Legionnaires' Outbreak in Portugal

After 17 cases were identified Nov. 6-7, the Directorate-General for Health of Portugal reported a total of 302 cases of the disease on Nov. 12.

The World Health Organization is tracking a large outreak of Legionnaires' disease in Vila Franca de Xira, a suburban area of Lisbon, after being notified Nov. 9 by the National IHR Focal Point for Portugal. The number of cases rose quickly: After 17 cases were identified Nov. 6-7, the Directorate-General for Health of Portugal reported a total of 302 cases of the disease on Nov. 12, with five deaths confirmed and four additional deaths being investigated.

"All cases have epidemiological links to the outbreak taking place in Vila Franca de Xira," WHO reported. "This is the biggest Legionella disease outbreak detected in Portugal, and it is evolving rapidly; therefore, the outbreak is considered to be a major public health emergency. At present, the regional outbreak investigation team is in place and it is supported by a larger national team of experts in epidemiology, clinical, microbiology and environmental health, with other stakeholders from the municipality following the epidemiological situation and undertaking environmental investigations."

Ornamental fountains in the outbreak area have been closed and the chlorine level of tap water there has been raised; cooling towers of the main industrial facilities in the affected area have been shut down.

The Directorate-General for Health of Portugal has issued these precautionary recommendations to the population until the source of the outbreak has been identified and eliminated:

  • Avoid showers, Jacuzzis, and whirlpools.
  • Disinfect shower heads by immersion in bleach solutions for about 30 minutes once a week.
  • Set the temperature on water heaters above 75ºC if possible.

The Portuguese agency is working closely with the European Centre for Disease Prevention and Control and with WHO on the investigation.

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