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

Smith, Anya F.; Huss, Anke; Dorevitch, Samuel; Heijnen, Leo; Arntzen, Vera H.; Davies, M. Elizabeth; Holle, Mirna Robert–Du Ry van Beest; Fujita, Yuki; Verschoor, Antonie M.; Raterman, B.W.; Oesterholt, Frank; Heederik, Dick; Medema, Gertjan

doi:10.1289/ehp5663

Cited by 22 publications

(19 citation statements)

References 34 publications

(45 reference statements)

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“…Although the study of Legionella is still very recent (the disease raised up around the last quarter of the 20th century) [22], some aspects seem to consistently characterize and be relevant for Legionella prevalence in water systems and for further infection in human beings [35]. Legionellosis has been linked to different water systems, such as cooling towers (CT) [36,37], hospital [38,39] and hotel [40,41], water supply lines, or whirlpool spas [42,43]. All these systems have some common characteristics that favor Legionella settlement and growth.…”

Section: Common Roots Of Research From Legionella Field-based Studiesmentioning

confidence: 99%

Legionella and Biofilms—Integrated Surveillance to Bridge Science and Real-Field Demands

2021

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Legionella is responsible for the life-threatening pneumonia commonly known as Legionnaires’ disease or legionellosis. Legionellosis is known to be preventable if proper measures are put into practice. Despite the efforts to improve preventive approaches, Legionella control remains one of the most challenging issues in the water treatment industry. Legionellosis incidence is on the rise and is expected to keep increasing as global challenges become a reality. This puts great emphasis on prevention, which must be grounded in strengthened Legionella management practices. Herein, an overview of field-based studies (the system as a test rig) is provided to unravel the common roots of research and the main contributions to Legionella’s understanding. The perpetuation of a water-focused monitoring approach and the importance of protozoa and biofilms will then be discussed as bottom-line questions for reliable Legionella real-field surveillance. Finally, an integrated monitoring model is proposed to study and control Legionella in water systems by combining discrete and continuous information about water and biofilm. Although the successful implementation of such a model requires a broader discussion across the scientific community and practitioners, this might be a starting point to build more consistent Legionella management strategies that can effectively mitigate legionellosis risks by reinforcing a pro-active Legionella prevention philosophy.

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Section: Common Roots Of Research From Legionella Field-based Studiesmentioning

confidence: 99%

Legionella and Biofilms—Integrated Surveillance to Bridge Science and Real-Field Demands

2021

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“…Although the Flint River water was predictably much more corrosive than Detroit water, no federally-mandated corrosion control program was implemented, resulting in rampant corrosion of lead plumbing and iron water mains, low chlorine residuals, elevated bacteria, and high levels of lead [ 1 , 2 , 3 , 4 ]. During the summers of 2014 and 2015, Flint also experienced two outbreaks of Legionnaires’ Disease (LD), with 91 cases and 12 deaths documented in Genesee County (the county which Flint is located), compared to the 6–13 cases per year and no deaths during 2009–2013 while on Detroit water [ 1 , 3 , 5 , 6 ]. The period of Flint River water use was characterized by high levels of LD incidence [ 6 ] and L. pneumophila gene marker levels [ 1 ] associated with large buildings.…”

Section: Introductionmentioning

confidence: 99%

“…During the summers of 2014 and 2015, Flint also experienced two outbreaks of Legionnaires’ Disease (LD), with 91 cases and 12 deaths documented in Genesee County (the county which Flint is located), compared to the 6–13 cases per year and no deaths during 2009–2013 while on Detroit water [ 1 , 3 , 5 , 6 ]. The period of Flint River water use was characterized by high levels of LD incidence [ 6 ] and L. pneumophila gene marker levels [ 1 ] associated with large buildings. However, lower LD incidence associated with residential exposure was noted from August 2015 onwards and our sampling during this period revealed undetectable or very low levels of L. pneumophila in residential plumbing [ 1 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

Interactive Effects of Copper Pipe, Stagnation, Corrosion Control, and Disinfectant Residual Influenced Reduction of Legionella pneumophila during Simulations of the Flint Water Crisis

et al. 2020

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Flint, MI experienced two outbreaks of Legionnaires’ Disease (LD) during the summers of 2014 and 2015, coinciding with use of Flint River as a drinking water source without corrosion control. Using simulated distribution systems (SDSs) followed by stagnant simulated premise (i.e., building) plumbing reactors (SPPRs) containing cross-linked polyethylene (PEX) or copper pipe, we reproduced trends in water chemistry and Legionella proliferation observed in the field when Flint River versus Detroit water were used before, during, and after the outbreak. Specifically, due to high chlorine demand in the SDSs, SPPRs with treated Flint River water were chlorine deficient and had elevated L. pneumophila numbers in the PEX condition. SPPRs with Detroit water, which had lower chlorine demand and higher residual chlorine, lost all culturable L. pneumophila within two months. L. pneumophila also diminished more rapidly with time in Flint River SPPRs with copper pipe, presumably due to the bacteriostatic properties of elevated copper concentrations caused by lack of corrosion control and stagnation. This study confirms hypothesized mechanisms by which the switch in water chemistry, pipe materials, and different flow patterns in Flint premise plumbing may have contributed to observed LD outbreak patterns.

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“…in the environment, soil in particular due to the ubiquitous nature and lack of purification treatment, may also readily contaminate water supplies, cooling towers, and whirlpool spas, leading to more and/or larger-scale outbreaks. Recent examples include the 2019 outbreak in North Carolina that infected 136 individuals and was related to whirlpool spas [47], the 2015 outbreak in New York City that infected 138 and was related to cooling towers [6], and the 2014-2015 outbreak in Michigan that infected 86 and was related to water supply and hospital settings [48]. These outbreaks typify exposure sources and illustrate challenges to prevent them in the wake of new environmental norms of warmer temperature, precipitation surplus, and more bacteria.…”

Section: Plos Onementioning

confidence: 99%

Effects of climate changes and road exposure on the rapidly rising legionellosis incidence rates in the United States

Han

2021

PLoS ONE

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Legionellosis is an infection acquired through inhalation of aerosols that are contaminated with environmental bacteria Legionella spp. The bacteria require warm temperature for proliferation in bodies of water and moist soil. The legionellosis incidence in the United States has been rising rapidly in the past two decades without a clear explanation. In the meantime, the US has recorded consecutive years of above-norm temperature since 1997 and precipitation surplus since 2008. The present study analyzed the legionellosis incidence in the US during the 20-year period of 1999 to 2018 and correlated with concurrent temperature, precipitation, solar ultraviolet B (UVB) radiation, and vehicle mileage data. The age-adjusted legionellosis incidence rates rose exponentially from 0.40/100,000 in 1999 (with 1108 cases) to 2.69/100,000 in 2018 (with 9933 cases) at a calculated annual increase of 110%. In regression analyses, the rise correlated with an increase in vehicle miles driven and with temperature and precipitation levels that have been above the 1901–2000 mean since 1997 and 2008, respectively, suggesting more road exposure to traffic-generated aerosols and promotive effects of anomalous climate. Remarkably, the regressions with cumulative anomalies of temperature and precipitation were robust (R2 ≥ 0.9145, P ≤ 4.7E-11), implying possible changes to microbial ecology in the terrestrial and aquatic environments. An interactive synergy between annual precipitation and vehicle miles was also found in multiple regressions. Meanwhile, the bactericidal UVB radiation has been decreasing, which also contributed to the rising incidence in an inverse correlation. The 2018 legionellosis incidence peak corresponded to cumulative effects of the climate anomalies, vast vehicle miles (3,240 billion miles, 15904 km per capita), record high precipitation (880.1 mm), near record low UVB radiation (7488 kJ/m2), and continued above-norm temperature (11.96°C). These effects were examined and demonstrated in California, Florida, New Jersey, Ohio, and Wisconsin, states that represent diverse incidence rates and climates. The incidence and above-norm temperature both rose most in cold Wisconsin. These results suggest that warming temperature and precipitation surplus have likely elevated the density of Legionella bacteria in the environment, and together with road exposure explain the rapidly rising incidence of legionellosis in the United States. These trends are expected to continue, warranting further research and efforts to prevent infection.

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

Cited by 22 publications

References 34 publications

Legionella and Biofilms—Integrated Surveillance to Bridge Science and Real-Field Demands

Legionella and Biofilms—Integrated Surveillance to Bridge Science and Real-Field Demands

Interactive Effects of Copper Pipe, Stagnation, Corrosion Control, and Disinfectant Residual Influenced Reduction of Legionella pneumophila during Simulations of the Flint Water Crisis

Effects of climate changes and road exposure on the rapidly rising legionellosis incidence rates in the United States

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