Legionnaires' disease in Europe: all quiet on the eastern front?

Beauté, Julien; Robesyn, Emmanuel; Jong, B de

doi:10.1183/09031936.00089113

Cited by 15 publications

(10 citation statements)

References 29 publications

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“…LD is notifiable in all 30 European Union and European Economic Area (EU/EEA) countries, which reported 5,500 to 6,500 LD cases annually between 2005 and 2010 with annual age-standardised rates fluctuating around one LD case per 100,000 inhabitants [3]. This overall rate masked important differences across countries, with rates far below the European average reported by eastern and south-eastern European countries [4]. The notification rate was higher in males and increased with age.…”

Section: Introductionmentioning

confidence: 99%

Legionnaires’ disease in Europe, 2011 to 2015

2017

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Under the coordination of the European Centre for Disease Prevention and Control (ECDC), the European Legionnaires’ disease Surveillance Network (ELDSNet) conducts surveillance of Legionnaires’ disease (LD) in Europe. Between 2011 and 2015, 29 countries reported 30,532 LD cases to ECDC (28,188 (92.3%) confirmed and 2,344 (7.7%) probable). Four countries (France, Germany, Italy and Spain) accounted for 70.3% of all reported cases, although their combined populations represented only 49.9% of the study population. The age-standardised rate of all cases increased from 0.97 cases/100,000 population in 2011 to 1.30 cases/100,000 population in 2015, corresponding to an annual average increase of 0.09 cases/100,000 population (95%CI 0.02–0.14; p = 0.02). Demographics and infection setting remained unchanged with ca 70% of cases being community-acquired and 80% occurring in people aged 50 years and older. Clinical outcome was known for 23,164 cases, of whom 2,161 (9.3%) died. The overall case fatality ratio decreased steadily from 10.5% in 2011 to 8.1% in 2015, probably reflecting improved reporting completeness. Five countries (Austria, Czech Republic, Germany, Italy, and Norway) had increasing age-standardised LD notification rates over the 2011−15 period, but there was no increase in notification rates in countries where the 2011 rate was below 0.5/100,000 population.

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Section: Introductionmentioning

confidence: 99%

Legionnaires’ disease in Europe, 2011 to 2015

2017

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“…The concentrations of Fe and Mn in the biofilm suspensions were measured by inductively coupled plasma mass spectrometry (46) of samples acidified (pH Ͻ 2) with HNO 3 .…”

Section: Methodsmentioning

confidence: 99%

Biofilm Composition and Threshold Concentration for Growth of Legionella pneumophila on Surfaces Exposed to Flowing Warm Tap Water without Disinfectant

Kooij

Bakker²,

Italiaander

et al. 2017

Appl Environ Microbiol

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Legionella pneumophila in potable water installations poses a potential health risk, but quantitative information about its replication in biofilms in relation to water quality is scarce. Therefore, biofilm formation on the surfaces of glass and chlorinated polyvinyl chloride (CPVC) in contact with tap water at 34 to 39°C was investigated under controlled hydraulic conditions in a model system inoculated with biofilm-grown L. pneumophila. The biofilm on glass (average steady-state concentration, 23 Ϯ 9 pg ATP cm Ϫ2 ) exposed to treated aerobic groundwater (0.3 mg C liter Ϫ1 ; 1 g assimilable organic carbon [AOC] liter Ϫ1 ) did not support growth of the organism, which also disappeared from the biofilm on CPVC (49 Ϯ 9 pg ATP cm Ϫ2 ) after initial growth. L. pneumophila attained a level of 4.3 log CFU cm Ϫ2 in the biofilms on glass (1,055 Ϯ 225 pg ATP cm Ϫ2 ) and CPVC (2,755 Ϯ 460 pg ATP cm Ϫ2 ) exposed to treated anaerobic groundwater (7.9 mg C liter Ϫ1 ; 10 g AOC liter Ϫ1 ). An elevated biofilm concentration and growth of L. pneumophila were also observed with tap water from the laboratory. The Betaproteobacteria Piscinibacter and Methyloversatilis and amoeba-resisting Alphaproteobacteria predominated in the clones and isolates retrieved from the biofilms. In the biofilms, the Legionella colony count correlated significantly with the total cell count (TCC), heterotrophic plate count, ATP concentration, and presence of Vermamoeba vermiformis. This amoeba was rarely detected at biofilm concentrations of Ͻ100 pg ATP cm Ϫ2 . A threshold concentration of approximately 50 pg ATP cm Ϫ2 (TCC ϭ 1 ϫ 10 6 to 2 ϫ 10 6 cells cm Ϫ2 ) was derived for growth of L. pneumophila in biofilms.IMPORTANCE Legionella pneumophila is the etiologic agent in more than 10,000 cases of Legionnaires' disease that are reported annually worldwide and in most of the drinking water-associated disease outbreaks reported in the United States. The organism proliferates in biofilms on surfaces exposed to warm water in engineered freshwater installations. An investigation with a test system supplied with different types of warm drinking water without disinfectant under controlled hydraulic conditions showed that treated aerobic groundwater (0.3 mg liter Ϫ1 of organic carbon) induced a low biofilm concentration that supported no or very limited growth of L. pneumophila. Elevated biofilm concentrations and L. pneumophila colony counts were observed on surfaces exposed to two types of extensively treated groundwater, containing 1.8 and 7.9 mg C liter Ϫ1 and complying with the microbial water quality criteria during distribution. Control measures in warm tap water installations are therefore essential for preventing growth of L. pneumophila.

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“…We read with interest the article on legionnaires' disease in Europe by BEAUTÉ et al [1]. As highlighted in that paper, larger outbreaks of legionnaires' disease tend to gain more attention although smaller outbreaks occur, which also have implications on public health.…”

Section: Hot Tub Legionella Pneumonia Outbreakmentioning

confidence: 88%

Hot tub Legionella pneumonia outbreak

Ahmed

Mustfa

2014

Eur Respir J

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provision of affordable anti-inflammatory inhaler therapies and improved care of asthma in general. We are supportive of this categorisation of severe asthma within the WHO definition.The ERS/ATS definition identifies the group of patients encompassed by categories 1 and 3. We see the ERS/ ATS guidelines as entirely complementary to the WHO document focusing on these two categories, particularly treatment-resistant severe asthma, where approaches to phenotyping and targeted novel therapies will be needed, once the issue of untreated asthma at the individual level has been excluded.We thank J. Bousquet and colleagues for giving us the opportunity to clarify these issues.

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Legionnaires' disease in Europe: all quiet on the eastern front?

Cited by 15 publications

References 29 publications

Legionnaires’ disease in Europe, 2011 to 2015

Legionnaires’ disease in Europe, 2011 to 2015

Biofilm Composition and Threshold Concentration for Growth of Legionella pneumophila on Surfaces Exposed to Flowing Warm Tap Water without Disinfectant

Hot tub Legionella pneumonia outbreak

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