Health Secretary Nicola Sturgeon
Scottish Parliament, Edinburgh
June 7, 2012
I am grateful for the opportunity to update Parliament on the current outbreak of Legionnaires disease in south-west Edinburgh.
Members will be aware from media coverage that a number of cases of Legionnaires disease have been identified amongst individuals living or working in the south-west Edinburgh area.
I can advise Parliament that, as of last night, the total number of confirmed cases stood at 24, with a further 27 in the suspected category.
It remains the case that there is no identified link between these cases other than an association with the affected areas in the south-west of Edinburgh.
Of the total 51 cases, 14 are being treated in ITU. 2 have been discharged from hospital and the remainder are being treated in general wards or in the community.
Sadly one person with Legionnaires disease has died and I wish to convey my sincere condolences to the family of the individual involved.
Members will rightly be concerned to know what actions are being taken to investigate the outbreak, to identify and treat those who may be infected, and to minimise the risk of further infection. I will provide an update on each of these points.
Firstly, let me say a word about Legionnaires disease - it is an uncommon but serious form of pneumonia, caused by bacteria that are distributed widely in both natural and artificial water supplies. In most cases, the disease is caused by the inhalation of water containing the bacteria and common sources can be showers, air conditioning, cooling towers, or humidifiers.
In Scotland, we would normally expect to see around 30 to 40 legionella cases each year. Typically around half of these cases are contracted abroad, but we also see indigenous cases, and it is not unusual to see single sporadic cases of community acquired legionella.
Across Europe, outbreaks are not uncommon, with dozens of outbreaks per annum and thousands of cases.
However outbreaks of the size we are currently seeing here in Edinburgh are rare in Scotland – the last time we had an outbreak of this scale was, I understand, in the 1980s in Glasgow.
Let me turn now to action taken.
NHS Lothian was first alerted to a confirmed case of Legionnaires disease on Thursday 31 May and a second case was confirmed on Saturday 2 June. As is standard practice, the Board made arrangements to convene a group to assess these two cases on Sunday.
Over the course of Sunday, two further cases were confirmed and NHS Lothian moved swiftly to set up a multi-agency Incident Management Team.
The IMT is led by NHS Lothian, and involves the Environmental Health Service of Edinburgh City Council, the Health and Safety Executive and Health Protection Scotland. Others are engaged as necessary in the work of the Group, for instance the Met Office regarding weather patterns.
During the group's first meeting on Sunday, possible sources of infection were considered. On the basis of all of the available evidence, it was judged that an indoor source, such as a swimming pool or spa, was unlikely and that the source was likely to be an outdoor community one. Most outdoor outbreaks of Legionella are associated with cooling towers.
Those operating in the south-west of Edinburgh - the area that all patients have an association with - were therefore visited that same evening, samples were taken, and over Sunday night and Monday the cooling towers were ‘shock dosed’ with chemicals to treat any bacterial growth. Over the past two days a further three towers on two sites further out from the site of the outbreak have been tested and treated.
At this point the team investigating the incident proactively briefed the media, to ensure the public was aware.
Clinical services and GPs across NHS Lothian were also notified to ensure that the NHS was ready and able to quickly diagnose and treat potential cases.
Over the course of the period from late Monday to late Tuesday, we saw a sharp rise in the numbers of confirmed and possible cases, with a parallel increase in cases being treated in high dependency and ITU.
Accordingly I took the decision on Tuesday evening to activate the Scottish Government Resilience Room.
I chaired two meetings of the Scottish Government Resilience Committee yesterday, with all of the key agencies in attendance. The Committee will meet again later today.
In addition to the actions already taken and in light of the growing number of cases, the decision was taken yesterday to establish a dedicated NHS 24 public advice line. This went live at 3pm yesterday and can be contacted on 08000 85 85 31.
A public information leaflet has also been produced by NHS Lothian. This was issued electronically to key community contacts yesterday afternoon and is being delivered to all households in the affected areas.
I can also advise parliament that further testing of the treated towers has been carried out. I was advised last night that additional treatment may be appropriate in some of the towers to further increase the levels of chlorine present in them. However, discussions are taking place this morning between the City of Edinburgh Council and the Health & Safety Executive to determine what, if any, further treatment is considered appropriate.
Clearly the numbers of confirmed and possible cases have continued to rise over the course of yesterday. This is not unexpected and we expect to see further cases over the next week. The incubation period for Legionnaires disease can be up to two weeks although it will normally be around five or six days.
It is therefore vital that we ensure that the public are aware of the symptoms, and that the NHS is primed to quickly identify, diagnose and treat cases. I am satisfied that the appropriate steps have been taken to alert the public and prepare our medical services and it is encouraging that a number of the existing cases are responding well to treatment.
Of central priority since Sunday and going forward is the investigation to confirm the source of the outbreak.
I am advised that identifying the source of any outbreak is a complex process. It involves epidemiological analysis, microbiology testing and a Health & Safety inspection process. All of these different, though related, parts of the process are well underway and are making progress. We hope that they will begin to provide more specific answers about the source over the next few days.
However, members should be aware that it is not always possible to conclusively determine the precise source of an outbreak and often conclusions require to be reached on the balance of probabilities in the light of all the available evidence.
However, I am confident that the team managing this incident are deploying their full resources in resolving it and they certainly have – and will continue to have - the full support of the Scottish Government.
Presiding officer, this is clearly a concerning time for anybody who lives in the affected area, or who has recently had reason to visit or pass through the area.
The key message within south-west Edinburgh is that the risk to public health is low. The disease cannot spread from person to person, and I am advised that for people who are generally fit and healthy the risk is very low.
Nevertheless we are seeing a significant number of cases. There are some individuals who are at greater risks of developing the disease and these individuals should be alert for symptoms.
Men are at more risk that women. Most cases are in people aged over 50 or who have a suppressed immune system, or who smoke or have lung problems.
On a precautionary basis, however, other people should not immediately rule themselves out and anybody who thinks they may be unwell should contact their GP or NHS 24. They will be quickly assessed and, if necessary, treated.
As I have said every effort is being made to investigate the potential source of this outbreak. The cooling towers that may be the potential source of the outbreak have been chemically treated and the relevant agencies continue to monitor the situation to ensure that all appropriate action is taken to minimise the risk of further infection.
Until the outbreak is over the incident management team will continue to meet and the relevant experts will continue to assess the information and data that emerges. The Scottish Government Resilience Room will continue to provide support to the investigation, and I will ensure that all that can be done, is being done.
Presiding officer, I am very grateful to all those involved who have and continue to work tirelessly to manage and respond to this outbreak.
I will of course keep Parliament fully updated on developments.