Health Advisory December 21, 2018 FROM: RANDALL W. WILLIAMS, MD, FACOG DIRECTOR 

 The St. Louis Marriott West hotel in St. Louis County, Missouri is under investigation following two Legionnaire’s disease case reports of individuals that stayed at the hotel. Public information released on December 14th and 18th, 2018 directs individuals with symptoms of Legionnaire’s disease that have stayed at the hotel within 14 days of illness onset to seek medical care. This health alert provides general guidance for healthcare providers that may see patients who fit these criteria. Most people with Legionnaires' disease will have pneumonia since the Legionella bacteria grow and thrive in the lungs. Legionellosis is not spread from person to person. Legionella grow best in warm water sources, such as hot tubs or hot water tanks. The infection is primarily acquired through inhalation of mist or vapor containing the bacteria, or by aspiration of contaminated water into the lungs. Environmental risk factors associated with legionellosis outbreaks are travel, residence in a health care facility, and proximity to cooling towers, whirlpool spas, decorative fountains, and grocery produce misters. Though most individuals exposed to Legionella will not get sick, some persons have an elevated risk of acquiring legionellosis. Such individuals include those with the following risk factors: • Age of 50 years or older • Diabetes • Current or former smoker • Chronic lung disease • Weakened immune system, including recipients of a transplant or chemotherapy The most commonly used laboratory test for diagnosis of Legionnaires’ disease is the urinary antigen test, which detects a molecule of the L. pneumophila serogroup 1 in urine. L. pneumophila serogroup 1 is the serogroup that most commonly causes disease. Along with the urinary antigen test, isolation of the bacteria via culture of respiratory secretions, lung tissue, pleural fluid, or a normally sterile site is highly recommended since culture is a preferred diagnostic modality. Sputum should ideally be obtained prior to antibiotic administration, but antibiotic treatment should not be delayed. The Infectious Disease Society of America (IDSA) guidelines recommend fluoroquinolone or azithromycin, as preferred, and doxycycline as an alternative treatment. Legionellosis is a reportable disease in Missouri. All known or suspected cases should be reported to the local public health agency, or to DHSS at 573/751-6113 or 800/392-0272 (24/7). Questions should be directed to DHSS’ Bureau of Communicable Disease Control and Prevention at 573/751- 6113. To view the press releases regarding this current investigation, please see the following links: • December 14, 2018: https://health.mo.gov/information/news/2018/dhss_121418 • December 19, 2018: https://health.mo.gov/information/news/2018/dhss_121918

HIDDEN IN PLAIN VIEW

An Initiative to Help Parents Spot Signs of Risky Behavior

Tuesday, January 22, 2019     

DuBourg Centre                                                                                                                                                

305 Merchant Street, Ste. Genevieve, MO

Exhibit open 6:00-8:00 pm, Presentation at 6:30pm

Sponsored by the Ste Genevieve County Memorial Hospital and Ste. Genevieve Health Department. This event is for adults only.

Explore an interactive display of a teenager’s bedroom containing over 70 items that could signal that a young person is involved in risky activities. Learn how to spot warning signs and get tips for talking with kids about the dangers of alcohol and drug use.

Remember: Talking with your kids early and often about the dangers of drug use is the most effective tool to prevent youth substance use. For tips on starting these conversations go to www.addictionisreal.org