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Abstract

Between 1 November and 12 December 2019, a Legionnaires’ disease (LD) outbreak occurred in the Strasbourg metropolitan area, France. Epidemiological, environmental and genomic investigations (nested sequence-based typing and whole genome sequencing (WGS)) were undertaken to locate the outbreak source, characterise the causal strain, and understand its spread. Through a positive urinary antigen test, 28 cases (14 male; 14 female) with 70 years median age (range: 42–88 years) were diagnosed. Two died. For nine cases, typing revealed serogroup 1 (Lp 1) sequence type (ST) 62 infection. Mapping where cases were during their incubation period pointed to a place south-west of Strasbourg city as the outbreak epicentre. There, in the biomass condensing boiler of a heating plant, high Lp 1 contamination levels (105–106 CFU/L) were discovered. Eight environmental Lp 1 isolates from inside the plant were ST62. Analysing WGS data from these isolates and the nine Lp 1 ST62 clinical isolates, found their sequences clustering with zero to two single nt polymorphisms. Sub-optimal maintenance and warm weather before the boiler started operating may have allowed Lp 1 proliferation within, with boiler fumes subsequently disseminating Lp 1, thereby exposing people. This outbreak highlights potential LD risks arising from innovative energy-saving heat production processes designed to reduce greenhouse gas emissions.

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2025-10-16
2025-11-11
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A community Legionnaires’ disease outbreak linked to a collective biomass condensing boiler, France, 2019
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Sophie+Raguet&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Raguet Sophie</a>, <a href="/search?value1=Christophe+Ginevra&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Ginevra Christophe</a>, <a href="/search?value1=Ghislaine+Descours&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Descours Ghislaine</a>, <a href="/search?value1=Cl%C3%A9mence+Augustin&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Augustin Clémence</a>, <a href="/search?value1=Astrid+Rebert-Placide&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Rebert-Placide Astrid</a>, <a href="/search?value1=Michel+Vernay&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Vernay Michel</a>, <a href="/search?value1=Sophie+Jarraud&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Jarraud Sophie</a>, <a href="/search?value1=Christine+Camp%C3%A8se&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Campèse Christine</a></span>. A community Legionnaires’ disease outbreak linked to a collective biomass condensing boiler, France, 2019. <a href="/content/ecdc">Euro Surveill.</a> 2025;30(41):pii=2400804. <a href="https://doi.org/10.2807/1560-7917.ES.2025.30.41.2400804" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2025.30.41.2400804</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 05 Dec 2024;&nbsp;&nbsp; <span class="generated">Accepted</span>: 07 Apr 2025 </span> </p>
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