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Abstract

In Finland, all microbiology laboratories notify findings and physicians notify Legionnaires’ disease (LD) cases to the National Infectious Disease Register. All cases are interviewed, and water samples obtained from potential places of exposure. isolates from humans and water are compared by whole genome sequencing (WGS). In March 2021, serogroup 1 (Lp 1) pneumonia cases increased in one Finnish city (120,000 inhabitants) where single LD cases are detected annually. We identified 12 LD cases, nine living in different residential buildings and three nosocomial, linked by identical human and/or water isolates. Three of these cases were from January 2020, October 2020 and February 2021 and identified retrospectively. Eleven were diagnosed by urinary antigen test, 10 by PCR and five by culture; age ranged between 52 and 85 years, and 10 had underlying diseases. Nine of 12 homes of LD cases and 15 of 26 water samples from the hospital were positive for Lp 1, with concentrations up to 640,000 cfu/L. Water samples from regional storage tanks were negative. Positivity in homes and the hospital suggested inadequate maintenance measures. Enhanced surveillance combined with WGS was crucial in detecting this unusual LD outbreak related to domestic and hospital water systems.

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/content/10.2807/1560-7917.ES.2023.28.11.2200673
2023-03-16
2024-02-25
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2023.28.11.2200673
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References

  1. Phin N, Parry-Ford F, Harrison T, Stagg HR, Zhang N, Kumar K, et al. Epidemiology and clinical management of Legionnaires’ disease. Lancet Infect Dis. 2014;14(10):1011-21.  https://doi.org/10.1016/S1473-3099(14)70713-3  PMID: 24970283 
  2. European Centre for Disease Prevention and Control (ECDC). Legionnaires’ disease. In: Annual epidemiological report for 2020. Stockholm: ECDC; 2022. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/leggionnaires-disease-annual-epidemiological-report-2020.pdf
  3. Dominguez A, Alvarez J, Sabria M, Carmona G, Torner N, Oviedo M, et al. Factors influencing the case-fatality rate of Legionnaires’ disease. Int J Tuberc Lung Dis. 2009;13(3):407-12. PMID: 19275805 
  4. Sabatini L, Sisti M, Campana R. Isolation and identification of Legionella spp. from non-hospital facilities: a preliminary one-year surveillance study in the urban area of Pesaro-Urbino (Central Italy). Ann Ig. 2022;34(2):177-83.  https://doi.org/10.7416/ai.2022.2477  PMID: 35088824 
  5. Dufresne SF, Locas MC, Duchesne A, Restieri C, Ismaïl J, Lefebvre B, et al. Sporadic Legionnaires’ disease: the role of domestic electric hot-water tanks. Epidemiol Infect. 2012;140(1):172-81.  https://doi.org/10.1017/S0950268811000355  PMID: 21396146 
  6. European Centre for Disease Prevention and Control (ECDC). Surveillance atlas of infectious diseases. Stockholm: ECDC. [Accessed: 3 Aug 2022]. Available from: https://atlas.ecdc.europa.eu/public/index.aspx
  7. Perola O, Kauppinen J, Kusnetsov J, Heikkinen J, Jokinen C, Katila ML. Nosocomial Legionella pneumophila serogroup 5 outbreak associated with persistent colonization of a hospital water system. Acta Pathol Microbiol Scand Suppl. 2002;110(12):863-8.  https://doi.org/10.1034/j.1600-0463.2002.1101204.x  PMID: 12645664 
  8. Kusnetsov J, Neuvonen LK, Korpio T, Uldum SA, Mentula S, Putus T, et al. Two Legionnaires’ disease cases associated with industrial waste water treatment plants: a case report. BMC Infect Dis. 2010;10(1):343.  https://doi.org/10.1186/1471-2334-10-343  PMID: 21126333 
  9. ESCMID study group for Legionella infections. ESGLI European technical guidelines for the prevention, control and investigation, of infections caused by Legionella species. Basel: European Society of Clinical Microbiology and Infectious Diseases; 2017. Available from: https://www.ecdc.europa.eu/en/publications-data/european-technical-guidelines-prevention-control-and-investigation-infections
  10. International Organization for Standardization (ISO). Standard ISO 11731:2017. Water quality – enumeration of Legionella. Geneva: ISO; 2017. Available from: https://www.iso.org/standard/61782.html
  11. Seemann T, Goncalves Da Silva A, Buultjens A, Kwong J. In silico Legionella pneumophila sequence based typing (SBT). [Accessed: 23 Sep 2021]. Available from: https://github.com/tseemann/legsta
  12. Machado JAF, Santos Silva JMC. Quantiles via moments. J Econom. 2019;213(1):145-73.  https://doi.org/10.1016/j.jeconom.2019.04.009 
  13. Ricci ML, Rota MC, Caporali MG, Girolamo A, Scaturro M. A Legionnaires’ disease cluster in a private building in Italy. Int J Environ Res Public Health. 2021;18(13):6922.  https://doi.org/10.3390/ijerph18136922  PMID: 34203343 
  14. Perola O, Kauppinen J, Kusnetsov J, Kärkkäinen UM, Lück PC, Katila ML. Persistent Legionella pneumophila colonization of a hospital water supply: efficacy of control methods and a molecular epidemiological analysis. Acta Pathol Microbiol Scand Suppl. 2005;113(1):45-53.  https://doi.org/10.1111/j.1600-0463.2005.apm1130107.x  PMID: 15676014 
  15. European Parliament and Council of the European Union. Directive (EU) 2020/2184 of the European Parliament and of the Council of 16 December 2020 on the quality of water intended for human consumption. Luxembourg: Official Journal of the European Union. L 435/1. 23 Dec 2020. Available from https://eur-lex.europa.eu/eli/dir/2020/2184/oj
  16. Beauté J, The European Legionnaires’ Disease Surveillance Network. Legionnaires’ disease in Europe, 2011 to 2015. Euro Surveill. 2017;22(27):30566.  https://doi.org/10.2807/1560-7917.ES.2017.22.27.30566  PMID: 28703097 
  17. Borella P, Montagna MT, Romano-Spica V, Stampi S, Stancanelli G, Triassi M, et al. Legionella infection risk from domestic hot water. Emerg Infect Dis. 2004;10(3):457-64.  https://doi.org/10.3201/eid1003.020707  PMID: 15109413 
  18. Arvand M, Jungkind K, Hack A. Contamination of the cold water distribution system of health care facilities by Legionella pneumophila: do we know the true dimension? Euro Surveill. 2011;16(16):19844.  https://doi.org/10.2807/ese.16.16.19844-en  PMID: 21527132 
  19. Oberdorfer K, Müssigbrodt G, Wendt C. Genetic diversity of Legionella pneumophila in hospital water systems. Int J Hyg Environ Health. 2008;211(1-2):172-8.  https://doi.org/10.1016/j.ijheh.2007.04.003  PMID: 17652025 
  20. Sobral D, Le Cann P, Gerard A, Jarraud S, Lebeau B, Loisy-Hamon F, et al. High-throughput typing method to identify a non-outbreak-involved Legionella pneumophila strain colonizing the entire water supply system in the town of Rennes, France. Appl Environ Microbiol. 2011;77(19):6899-907.  https://doi.org/10.1128/AEM.05556-11  PMID: 21821761 
  21. Rangel-Frausto MS, Rhomberg P, Hollis RJ, Pfaller MA, Wenzel RP, Helms CM, et al. Persistence of Legionella pneumophila in a hospital’s water system: a 13-year survey. Infect Control Hosp Epidemiol. 1999;20(12):793-7.  https://doi.org/10.1086/501586  PMID: 10614601 
  22. Darelid J, Bernander S, Jacobson K, Löfgren S. The presence of a specific genotype of Legionella pneumophila serogroup 1 in a hospital and municipal water distribution system over a 12-year period. Scand J Infect Dis. 2004;36(6-7):417-23.  https://doi.org/10.1080/00365540410020749  PMID: 15307560 
  23. Rhoads WJ, Keane T, Spencer MS, Pruden A, Edwards MA. Did municipal water distribution system deficiencies contribute to a Legionnaires’ disease outbreak in Quincy, IL? Environ Sci Technol Lett. 2020;7(12):896-902.  https://doi.org/10.1021/acs.estlett.0c00637 
  24. Rhoads WJ, Garner E, Ji P, Zhu N, Parks J, Schwake DO, et al. Distribution system operational deficiencies coincide with reported Legionnaires’ disease clusters in Flint, Michigan. Environ Sci Technol. 2017;51(20):11986-95.  https://doi.org/10.1021/acs.est.7b01589  PMID: 28849909 
  25. Liang J, Swanson CS, Wang L, He Q. Impact of building closures during the COVID-19 pandemic on Legionella infection risks. Am J Infect Control. 2021;49(12):1564-6.  https://doi.org/10.1016/j.ajic.2021.09.008  PMID: 34537274 
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