An Outbreak of Legionnaires Disease Caused by Long-Distance Spread from an Industrial Air Scrubber in Sarpsborg, Norway

Nygård, Karin; Werner-Johansen, Øyvind; Rønsen, Svein; Caugant, Dominique A.; Simonsen, Øystein; Kanestrøm, Anita; Ask, Eirik; Ringstad, Jetmund; Ødegård, Rune; Jensen, Tore; Krogh, Truls; Høiby, E. Arne; Ragnhildstveit, Eivind; Aaberge, Ingeborg S.; Aavitsland, Preben

doi:10.1086/524016

Cited by 127 publications

(148 citation statements)

References 16 publications

(16 reference statements)

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“…In the last ten years, significant community outbreaks of Legionnaires' disease associated with cooling towers have occurred in the UK and elsewhere in Europe [9]. Other outdoor sources include industrial air scrubbers (Norway) [10], decorative fountains (Wisconsin) [11] and hot water systems (Denmark) [12]. The largest recorded European outbreak was in Murcia, Spain (449 cases) [13] and the largest in England was Barrow in Furness (185 cases) [14].…”

Section: Discussionmentioning

confidence: 99%

Public health response to an outbreak of Legionnaires’ disease in Edinburgh, United Kingdom, June 2012

et al. 2012

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Section: Discussionmentioning

confidence: 99%

Public health response to an outbreak of Legionnaires’ disease in Edinburgh, United Kingdom, June 2012

et al. 2012

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“…The collection of oral fluid facilitates monitoring, surveillance, and detection of viruses in populations 1 , 2 , 4 . Population‐based sampling using oral fluids may result in lower test costs, while increasing the number of pigs monitored and pathogens that can be detected 1 , 14 .…”

Section: Discussionmentioning

confidence: 99%

“…The presence of pathogens and antibodies in saliva from infected humans and animals has been widely studied for diagnostic purposes 4 . In humans, whole saliva or oral fluid specimens have been used to detect antibodies against Helicobacter pylori , Shigella dysenteriae , Taenia Solium , and viral hepatitis, or to detect viral pathogens such as rubella virus and rotavirus in newborn infants 5 , 6 , 7 , 8 , 9 , 10 .…”

Section: Introductionmentioning

confidence: 99%

Sensitivity of oral fluids for detecting influenza A virus in populations of vaccinated and non‐vaccinated pigs

Romagosa

Gramer

Joo

et al. 2011

Influenza Resp Viruses

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Please cite this paper as: Romagosa et al. (2011) Sensitivity of oral fluids for detecting influenza A virus in populations of vaccinated and non‐vaccinated pigs. Influenza and Other Respiratory Viruses. Background/objective We evaluated the sensitivity of PCR on oral fluids in detecting influenza virus in vaccinated and non‐vaccinated pigs. Methods Three‐week‐old influenza‐free pigs were divided into three groups: (i) control, non‐vaccinated, (ii) vaccinated with a commercial, heterologous vaccine, and (iii) vaccinated with an experimental, homologous vaccine. After vaccination, an influenza‐infected pig was placed in contact with each of the groups. Individual nasal swabs and pen oral fluids were collected daily. Viral RNA was tested for the presence of influenza by RRT‐PCR and virus isolation attempted from oral fluids. A pen was considered positive if at least one nasal swab was positive. Results Based on nasal swab results, 43·8% of pens were detected positive but only 35% based on oral fluids. Overall sensitivity of oral fluids was 80%, and virus was isolated from 51% of RRT‐PCR‐positive oral fluids. The kappa coefficient for agreement (ĸ) between oral fluids and nasal swabs was 0·82. Among groups, ĸ was 1 (95% CI, 1–1), 0·74 (95% CI, 0·55–0·92), and 0·76 (95% CI, 0·5–1) for control, heterologous, and homologous‐vaccinated groups, respectively. There was less agreement when within pen prevalence was 10% or less. Probability of detecting influenza virus in oral fluids was 99% when within pen prevalence was higher than 18% and decreased to 69% when prevalence was 9%. Conclusions Results indicated that pen‐based collection of oral fluids is a sensitive method to detect influenza even when within pen prevalence is low and when pigs have been vaccinated and highlight the potential use of oral fluids for influenza surveillance.

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“…Table 2 provides some examples of the use of both approaches together with each study's choice of annuli distances or average population size of the spatial unit considered. A more sophisticated technique is to retrospectively use atmospheric dispersion modelling combined with meteorological data to test whether a potential release location could have resulted in exposure to the pathogen that is consistent with the observed spatial pattern of cases [59,65]. Atmospheric dispersion modelling has similarly been applied in a retrospective manner to the Sverdlovsk inhalational anthrax outbreak to help identify the time and location of the release of the causative pathogen [69].…”

Section: Spatio-temporal Models 41 Retrospective and Prospective Anmentioning

confidence: 99%

A review of back-calculation techniques and their potential to inform mitigation strategies with application to non-transmissible acute infectious diseases

Egan

Hall

2015

J. R. Soc. Interface.

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Back-calculation is a process whereby generally unobservable features of an event leading to a disease outbreak can be inferred either in real-time or shortly after the end of the outbreak. These features might include the time when persons were exposed and the source of the outbreak. Such inferences are important as they can help to guide the targeting of mitigation strategies and to evaluate the potential effectiveness of such strategies. This article reviews the process of back-calculation with a particular emphasis on more recent applications concerning deliberate and naturally occurring aerosolized releases. The techniques can be broadly split into two themes: the simpler temporal models and the more sophisticated spatio-temporal models. The former require input data in the form of cases' symptom onset times, whereas the latter require additional spatial information such as the cases' home and work locations. A key aspect in the back-calculation process is the incubation period distribution, which forms the initial topic for consideration. Links between atmospheric dispersion modelling, within-host dynamics and backcalculation are outlined in detail. An example of how back-calculation can inform mitigation strategies completes the review by providing improved estimates of the duration of antibiotic prophylaxis that would be required in the response to an inhalational anthrax outbreak.

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An Outbreak of Legionnaires Disease Caused by Long-Distance Spread from an Industrial Air Scrubber in Sarpsborg, Norway

Abstract: The high velocity, large drift, and high humidity in the air scrubber may have contributed to the wide spread of Legionella species, probably for >10 km. The risk of Legionella spread from air scrubbers should be assessed.

Cited by 127 publications

References 16 publications

Public health response to an outbreak of Legionnaires’ disease in Edinburgh, United Kingdom, June 2012

Public health response to an outbreak of Legionnaires’ disease in Edinburgh, United Kingdom, June 2012

Sensitivity of oral fluids for detecting influenza A virus in populations of vaccinated and non‐vaccinated pigs

A review of back-calculation techniques and their potential to inform mitigation strategies with application to non-transmissible acute infectious diseases

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