Epidemiological investigation of a Legionnaires' disease outbreak in Christchurch, New Zealand: the value of spatial methods for practical public health

White, Paul S.; Graham, Frances F.; Harte, David; Baker, Michael G; Ambrose, Chris; Humphrey, Alistair

doi:10.1017/s0950268812000994

Cited by 21 publications

(13 citation statements)

References 20 publications

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“…Different molecular markers have been used to characterize Legionella populations in previous genetic studies (6), but sequence-based typing (SBT) has become the current gold-standard typing tool (7,8). Apart from its utility in epidemiological investigations of LD outbreaks (9)(10)(11), SBT provides nucleotide sequence data that can be used for further analyses of genetic variability and population structure (12,13). A recent study has shown that even though undetected genomic variability within sequence types (ST) could mislead the identification of Legionella reservoirs during outbreak investigations, genetic distances determined by using SBT data correlate significantly with genome-wide estimates (14).…”

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confidence: 99%

Geographical and Temporal Structures of Legionella pneumophila Sequence Types in Comunitat Valenciana (Spain), 1998 to 2013

Sánchez-Busó

Coscollá

Palero

et al. 2015

Appl Environ Microbiol

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Legionella pneumophila is an accidental human pathogen associated with aerosol formation in water-related sources. High recombination rates make Legionella populations genetically diverse, and nearly 2,000 different sequence types (STs) have been described to date for this environmental pathogen. The spatial distribution of STs is extremely heterogeneous, with some variants being present worldwide and others being detected at only a local scale. Similarly, some STs have been associated with disease outbreaks, such as ST578 or ST23. Spain is among the European countries with the highest incidences of reported legionellosis cases, and specifically, Comunitat Valenciana (CV) is the second most affected area in the country. In this work, we aimed at studying the overall diversity of Legionella pneumophila populations found in the period from 1998 to 2013 in 79 localities encompassing 23 regions within CV. To do so, we performed sequence-based typing (SBT) on 1,088 L. pneumophila strains detected in the area from both environmental and clinical sources. A comparison with the genetic structuring detected in a global data set that included 20 European and 7 non-European countries was performed. Our results reveal a level of diversity in CV that can be considered representative of the diversity found in other countries worldwide.

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confidence: 99%

Geographical and Temporal Structures of Legionella pneumophila Sequence Types in Comunitat Valenciana (Spain), 1998 to 2013

Sánchez-Busó

Coscollá

Palero

et al. 2015

Appl Environ Microbiol

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“…For example, in an outbreak of Legionnaires' disease in Christchurch, New Zealand, cases were identified at a distance of 12 km from the implicated cooling tower [38]. White and colleagues therefore proposed updates to World Health Organization guidelines which at the time placed the area at risk from such sources at 3.2 km.…”

Section: Comparing Results With Established Factsmentioning

confidence: 99%

“…Although the simple dot map was the most commonly used method, a wide range of techniques were applied, including more sophisticated data visualisations and analytic tools. Across the range of studies, there were examples of spatial tools being usefully applied throughout the course of an outbreak investigation; from initial confirmation of the outbreak to describing and analysing [11,18-28,30-36,38,40-50,55,56,58-60, 63,67-69,71-76,80,82-85,87-93,96-105] Thematic map 25 [18,19,[21][22][23]28,29,38,41,42,45,46,50,60,68,70,74,80,82,89,91,[93][94][95]103] Rate map 14 [20,30,44,45,49,50,57,63,70,76,79,81,90,101] Smoothed incidence map 13 [11,31,[48][49][50]73,…”

Section: Discussionmentioning

confidence: 99%

“…Several studies also highlighted the usefulness of maps in reports or Reports by continent presentations to communicate results to health officials [29,47], policymakers [49,50] and the public [38]. Sarkar and colleagues, for example, presented dot maps of cases of acute diarrhoeal disease in a village in southern India to the local community and health authorities [46].…”

Section: Communicating Findingsmentioning

confidence: 99%

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Spatial methods for infectious disease outbreak investigations: systematic literature review

et al. 2015

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Investigations of infectious disease outbreaks are conventionally framed in terms of person, time and place. Although geographic information systems have increased the range of tools available, spatial analyses are used relatively infrequently. We conducted a systematic review of published reports of outbreak investigations worldwide to estimate the prevalence of spatial methods, describe the techniques applied and explore their utility. We identified 80 reports using spatial methods published between 1979 and 2013, ca 0.4% of the total number of published outbreaks. Environmental or waterborne infections were the most commonly investigated, and most reports were from the United Kingdom. A range of techniques were used, including simple dot maps, cluster analyses and modelling approaches. Spatial tools were usefully applied throughout investigations, from initial confirmation of the outbreak to describing and analysing cases and communicating findings. They provided valuable insights that led to public health actions, but there is scope for much wider implementation and development of new methods.

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“…Legionella detection in sputum as well as in water samples plays a critical role in public health. Thus, identifying Legionella as the causative agent of infection is crucial for disease treatment and outbreak prevention3351.…”

Section: Discussionmentioning

confidence: 99%

Comparison of sputum microbiome of legionellosis-associated patients and other pneumonia patients: indications for polybacterial infections

Mizrahi

Peretz

Lesnik

et al. 2017

Sci Rep

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Bacteria of the genus Legionella cause water-based infections resulting in severe pneumonia. Here we analyze and compare the bacterial microbiome of sputum samples from pneumonia patients in relation to the presence and abundance of the genus Legionella. The prevalence of Legionella species was determined by culture, PCR, and Next Generation Sequencing (NGS). Nine sputum samples out of the 133 analyzed were PCR-positive using Legionella genus-specific primers. Only one sample was positive by culture. Illumina MiSeq 16S rRNA gene sequencing analyses of Legionella-positive and Legionella-negative sputum samples, confirmed that indeed, Legionella was present in the PCR-positive sputum samples. This approach allowed the identification of the sputum microbiome at the genus level, and for Legionella genus at the species and sub-species level. 42% of the sputum samples were dominated by Streptococcus. Legionella was never the dominating genus and was always accompanied by other respiratory pathogens. Interestingly, sputum samples that were Legionella positive were inhabited by aquatic bacteria that have been observed in an association with amoeba, indicating that amoeba might have transferred Legionella from the drinking water together with its microbiome. This is the first study that demonstrates the sputum major bacterial commensals and pathogens profiles with regard to Legionella presence.

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Epidemiological investigation of a Legionnaires' disease outbreak in Christchurch, New Zealand: the value of spatial methods for practical public health

Cited by 21 publications

References 20 publications

Geographical and Temporal Structures of Legionella pneumophila Sequence Types in Comunitat Valenciana (Spain), 1998 to 2013

Geographical and Temporal Structures of Legionella pneumophila Sequence Types in Comunitat Valenciana (Spain), 1998 to 2013

Spatial methods for infectious disease outbreak investigations: systematic literature review

Comparison of sputum microbiome of legionellosis-associated patients and other pneumonia patients: indications for polybacterial infections

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