Legionnaires’ disease in Italy: results of the epidemiological surveillance from 2000 to 2011

Rota, Maria Cristina; Caporali, Maurizio; Bella, Antonino; Ricci, Maria Luisa; Napoli, Christian

doi:10.2807/ese.18.23.20497-en

Cited by 23 publications

(36 citation statements)

References 22 publications

(26 reference statements)

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“…Such improvement has already been reported in Italy over the 2000−11 period [15]. In other countries with stable ASR, the increasing number of LD cases would be compatible with an effect of demographic change with increasing numbers of at-risk older people.…”

Section: Discussionsupporting

confidence: 65%

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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: Discussionsupporting

confidence: 65%

“…This has been documented in Italy where a study has suggested higher under-reporting in central and southern regions compared with northern regions [15]. This analysis could not capture such heterogeneity, but these findings could be highly valuable for informing national policies.…”

Section: Discussionmentioning

confidence: 96%

Legionnaires’ disease in Europe, 2011 to 2015

2017

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“…Contrastingly, no shift was observed with hyperthermia, which is in line with its ineffectiveness at reducing Legionella colonization. The continuous injection of chlorine-based biocides evidently selects the most resistant Legionella spp., in our experience L. pneumophila serogroup 1, which is also the most virulent (1). In order to support this hypothesis, other authors reported the persistence of serogroup 1 in hospital water systems despite the adoption of chlorine-based disinfection strategies (53,54).…”

Section: Discussionsupporting

confidence: 64%

“…he number of cases of Legionnaires' disease has increased steadily over the years, especially in Italy and Europe (1,2). In 2013 in Italy, most cases were community acquired (83.4%), followed by travel-associated (9.8%) and health care-associated (4.6%) (3) cases.…”

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confidence: 99%

Control of Legionella Contamination and Risk of Corrosion in Hospital Water Networks following Various Disinfection Procedures

Marchesi

Mansi

Marcelloni

et al. 2016

Appl Environ Microbiol

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bPhysical and chemical disinfection methods have been proposed with the aim of controlling Legionella water contamination. To date, the most effective procedures for reducing bacterial contamination have not yet been defined. The aim of this study was to assess the long-term effectiveness of various disinfection procedures in order to reduce both culturable and nonculturable (NC) legionellae in different hospital water networks treated with heat, chlorine dioxide, monochloramine, and hydrogen peroxide. The temperature levels and biocide concentrations that proved to give reliable results were analyzed. In order to study the possible effects on the water pipes, we verified the extent of corrosion on experimental coupons after applying each method for 6 months. The percentage of positive points was at its lowest after treatment with monochloramine, followed by chlorine dioxide, hydrogen peroxide, and hyperthermia. Different selections of Legionella spp. were observed, as networks treated with chlorinebased disinfectants were contaminated mainly by Legionella pneumophila serogroup 1, hyperthermia was associated with serogroups 2 to 14, and hydrogen peroxide treatment was associated mainly with non-pneumophila species. NC cells were detected only in heat-treated waters, and also when the temperature was approximately 60°C. The corrosion rates of the coupons were within a satisfactory limit for water networks, but the morphologies differed. We confirm here that chemical disinfection controls Legionella colonization more effectively than hyperthermia does. Monochloramine was the most effective treatment, while hydrogen peroxide may be a promising alternative to chlorine-based disinfectants due to its ability to select for other, less virulent or nonpathogenic species.

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“…Improved surveillance has been noted as a potential reason for the continued increase of legionellosis incidence across Europe [19,36]. The Australian Department of Health has documented a sharp increase in reported legionellosis cases, from 122 to 382, between 1991 and 2012 [6].…”

Section: Discussionmentioning

confidence: 99%

The shift in seasonality of legionellosis in the USA

2018

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According to the Centers for Disease Control and Prevention (CDC), from 2000 to 2014, reported cases of legionellosis per 100 000 population increased by 300% in the USA, although reports on disease seasonality are inconsistent. Using two national databases, we assessed seasonal patterns of legionellosis in the USA. We created a monthly time series from 1993 to 2015 of reported cases of legionellosis from the CDC, and from 1997 to 2006 of medical claims of legionellosis-related hospitalisation in older adults from the Centers for Medicaid and Medicare Services (CMS). We split the study time interval into two segments (before and after 2003), and applied a Poisson harmonic regression model to each dataset and each segment. The time series of monthly counts exhibited a significant shift of seasonal peaks from mid-September (9.676 ± 0.164 months) before 2003 to mid-August (8.452 ± 0.042 months) after 2003, along with an alarming increase in the amplitude of seasonal peaks in both CDC and CMS data. The lowest monthly reported cases of legionellosis in 2015 (281) exceed the maximum value reported before 2003 (206). We also observed a discrepancy between CDC and CMS data, suggesting that not all cases of legionellosis diagnosed by hospital-based laboratories were reported to the CDC. Improved reporting of legionellosis is required to better inform the public and organise disease prevention.

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Legionnaires’ disease in Italy: results of the epidemiological surveillance from 2000 to 2011

Abstract: Binary file ES_Abstracts_Final_ECDC.txt matches

Cited by 23 publications

References 22 publications

Legionnaires’ disease in Europe, 2011 to 2015

Legionnaires’ disease in Europe, 2011 to 2015

Control of Legionella Contamination and Risk of Corrosion in Hospital Water Networks following Various Disinfection Procedures

The shift in seasonality of legionellosis in the USA

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