A large outbreak of Legionnaires’ Disease in an industrial town in Portugal

George, Francisco; Shivaji, Tara; Pinto, Cátia Sousa; Serra, Luis Antonio Oliveira; Valente, João; Albuquerque, Maria João; Vicêncio, Paula Cristina Olivença; San-Bento, Ana; Diegues, Paulo; Nogueira, Paulo; Marques, Teresa; Rebelo, Helena; Costa, Filipa Alves da; Rodrigues, Raquel; Nunes, Alexandra; Borges, Vítor; Gomes, João Paulo; Sampaio, Daniel A.; Barreiro, Paula; Duarte, Sílvia; Carpinteiro, Dina; Mendonça, Joana; Silva, Catarina; Vieira, Luı́s; Simões, Maria João; Gonçalves, Paulo; Nunes, Baltazar; Dias, Carlos Alberto; Machado, Jorge; Almeida, Fernando Antônio de; Goncalves, Elsa A; Carvalho, Lucília; Viterbo, Pedro; Jardim, Dilia; Lacasta, Nuno; Boavida, Filomena; Pérez, Antonio Martín; Santana, Isabel; Matias, Paula; Banza, Nuno; Rabaçal, Carlos

doi:10.1016/j.rpsp.2016.10.001

Cited by 16 publications

(17 citation statements)

References 22 publications

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“…Previous LD outbreaks have been associated with a single source by a single ST (Phin et al 2014;George et al 2016;David et al 2017;Weiss et al 2017). Spatial and geographical clusters of otherwise unrelated LD outbreaks have been reported in New York City, USA, and Sydney, Australia (MacIntyre et al 2018).…”

Section: Aerosolmentioning

confidence: 99%

Multiple Sources of the Outbreak of Legionnaires’ Disease in Genesee County, Michigan, in 2014 and 2015

Smith

Huss

Dorevitch

et al. 2019

Environ Health Perspect

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BACKGROUND: A community-wide outbreak of Legionnaires' disease (LD) occurred in Genesee County, Michigan, in 2014 and 2015. Previous reports about the outbreak are conflicting and have associated the outbreak with a change of water source in the city of Flint and, alternatively, to a Flint hospital. OBJECTIVE: The objective of this investigation was to independently identify relevant sources of Legionella pneumophila that likely resulted in the outbreak. METHODS: An independent, retrospective investigation of the outbreak was conducted, making use of public health, health care, and environmental data and whole-genome multilocus sequence typing (wgMLST) of clinical and environmental isolates. RESULTS: Strong evidence was found for a hospital-associated outbreak in both 2014 and 2015: a) 49% of cases had prior exposure to Flint hospital A, significantly higher than expected from Medicare admissions; b) hospital plumbing contained high levels of L. pneumophila; c) Legionella control measures in hospital plumbing aligned with subsidence of hospital A-associated cases; and d) wgMLST showed Legionella isolates from cases exposed to hospital A and from hospital plumbing to be highly similar. Multivariate analysis showed an increased risk of LD in 2014 for people residing in a home that received Flint water or was located in proximity to several Flint cooling towers. DISCUSSION: This is the first LD outbreak in the United States with evidence for three sources (in 2014): a) exposure to hospital A, b) receiving Flint water at home, and c) residential proximity to cooling towers; however, for 2015, evidence points to hospital A only. Each source could be associated with only a proportion of cases. A focus on a single source may have delayed recognition and remediation of other significant sources of L. pneumophila.

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Section: Aerosolmentioning

confidence: 99%

Multiple Sources of the Outbreak of Legionnaires’ Disease in Genesee County, Michigan, in 2014 and 2015

Smith

Huss

Dorevitch

et al. 2019

Environ Health Perspect

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“…Therefore, MF is intimately associated with epidemiological surveys, allowing studying and following disease outbreak dynamics, mainly concerning the identification of the agent or toxin, origin and natural reservoirs, genetic diversity and evolution, and possible transmission routes. Some well-known cases of the epidemiological studies are the swine-origin influenza A virus (H1N1; 2009) [ 175 ], the Haitian cholera (2010) [ 176 ], the haemolytic-uremic syndrome ( Escherichia coli O104:H4; 2011) [ 177 ], the Coronavirus Middle East respiratory syndrome (2012) [ 178 ], the avian-origin Influenza A virus (H7N9; 2013) [ 179 ], the West African Ebola virus (2013/2015) [ 180 ], the Middle Eastern poliomyelitis (2014) [ 181 ], the Portuguese Legionnaires’ disease (2014) [ 182 ], and the Zika virus outbreaks [ 183 ]. Note that most of the cases indicated above applied NGS approaches to identify and study the different biological agents.…”

Section: Microbiologymentioning

confidence: 99%

Forensic genetics and genomics: Much more than just a human affair

et al. 2017

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While traditional forensic genetics has been oriented towards using human DNA in criminal investigation and civil court cases, it currently presents a much wider application range, including not only legal situations sensu stricto but also and, increasingly often, to preemptively avoid judicial processes. Despite some difficulties, current forensic genetics is progressively incorporating the analysis of nonhuman genetic material to a greater extent. The analysis of this material—including other animal species, plants, or microorganisms—is now broadly used, providing ancillary evidence in criminalistics in cases such as animal attacks, trafficking of species, bioterrorism and biocrimes, and identification of fraudulent food composition, among many others. Here, we explore how nonhuman forensic genetics is being revolutionized by the increasing variety of genetic markers, the establishment of faster, less error-burdened and cheaper sequencing technologies, and the emergence and improvement of models, methods, and bioinformatics facilities.

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“…The proven Legionella positivity, before and during the cluster, in samples of CT3, in combination with the plausible evolution of case risk around the tower, suggested CT3 as the most likely source. CTs are known to be high risk installations and can cause outbreaks at a distance [26, 27]. Around CT3, the attack rate decreased with increasing distance from the tower, with most cases living north-east of the tower which coincided with predominant south-west wind direction.…”

Section: Discussionmentioning

confidence: 99%

A cluster of Legionnaires' disease in Belgium linked to a cooling tower, August–September 2016: practical approach and challenges

et al. 2019

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A cluster of Legionnaires' disease (LD) with 10 confirmed, three probable and four possible cases occurred in August and September 2016 in Dendermonde, Belgium. The incidence in the district was 7 cases/100 000 population, exceeding the maximum annual incidence in the previous 5 years of 1.5/100 000. Epidemiological, environmental and geographical investigations identified a cooling tower (CT) as the most likely source. The case risk around the tower decreased with increasing distance and was highest within 5 km. Legionella pneumophila serogroup 1, ST48, was identified in a human respiratory sample but could not be matched with the environmental results. Public health authorities imposed measures to control the contamination of the CT and organised follow-up sampling. We identified obstacles encountered during the cluster investigation and formulated recommendations for improved LD cluster management, including faster coordination of teams through the outbreak control team, improved communication about clinical and environmental sample analysis, more detailed documentation of potential exposures obtained through the case questionnaire and earlier use of a geographical information tool to compare potential sources and for hypothesis generation.

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A large outbreak of Legionnaires’ Disease in an industrial town in Portugal

Cited by 16 publications

References 22 publications

Multiple Sources of the Outbreak of Legionnaires’ Disease in Genesee County, Michigan, in 2014 and 2015

Multiple Sources of the Outbreak of Legionnaires’ Disease in Genesee County, Michigan, in 2014 and 2015

Forensic genetics and genomics: Much more than just a human affair

A cluster of Legionnaires' disease in Belgium linked to a cooling tower, August–September 2016: practical approach and challenges

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