Letter of Invitation Legionella_MO 2015

	Missouri Department of Health and Senior Services Eastern District 220 South Jefferson Street, St. Louis MO 63103 Phone: 314-877-2800 FAX: 314-877-0203 RELAY MISSOURI for Hearing and Speech Impaired 1-800-735-2966 VOICE 1-800-735-2466
	Peter Lyskowski Acting Director	Jeremiah W. (Jay) Nixon Governor

November 6, 2015

To: Dr. Rana Hajjeh

Director, Division of Bacterial Diseases

National Center for Immunizations and Respiratory Diseases

Centers for Disease Control and Prevention, Atlanta, GA

Dear Dr Hajjeh,

In June, 2015, the Missouri Department of Health and Senior Services (MDHSS) was notified by the CDC that travel surveillance system detected two initial laboratory-confirmed cases of legionellosis (onsets of illness March 7, 2015 and June 7, 2015). Investigation revealed that both individuals reported staying in Hotel A within their incubation period. Since then, an additional case of legionellosis has been reported.  This individual also reported staying at Hotel A and had an onset of illness of October 12, 2015. The third patient died from his illness.  At present, the source of this outbreak remains unknown. Upon the identification of two initial cases, an environmental assessment was completed without any sampling. With the third case, the whirlpool spa was disinfected and five environmental samples were collected. All environmental samples are negative to date. Autopsy of lung tissue from deceased case demonstrated Legionella pneumophila serogroup 1 growth on culture. Sequence-based type testing is pending.

Given heightened concern regarding the undetermined source of transmission and need for environmental capacity building within local and state health departments, we are requesting an Epi-Aid. The objectives of this Epi-Aid will include environmental assessment and sampling of the hotel, training of local and state environmental and epidemiology staff, education of hotel management on maintenance and Legionella prevention, and capacity building within state and local health departments.

Considering the fatal outcome of the last case and the ongoing nature of the outbreak, the DHSS is requesting help on an urgent basis so that outbreak of legionellosis could be halted timely and additional death prevented.

Sincerely,

George Turabelidze, MD, PhD

Missouri State Epidemiologist

www.health.mo.gov

Healthy Missourians for life.

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