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Abstract

Wastewater treatment plants (WWTPs) are increasingly identified as Legionnaires’ disease (LD) sources. An outbreak investigation was initiated following five LD cases reported in September 2022 in Houten, the Netherlands. Case identification was based on the European LD case definition, with symptom onset from 1 September 2022, residence in or within 5 km of Houten, or visit to Houten within the incubation period, without other likely sources. We sampled potential sources and genotyped environmental and clinical isolates. We identified 15 LD cases with onset between 13 September and 23 October 2022. A spatial source identification and wind direction model suggested an industrial (iWWTP) and a municipal WWTP (mWWTP) as potential sources, with the first discharging water into the latter. Both tested positive for serogroups 1 and 6 with multiple sequence types (ST). We detected sg1 ST42 in the mWWTP, matching with one of three available clinical isolates. Following control measures at the WWTPs, no further cases were observed. This outbreak underlines that municipal and industrial WWTPs can play an important role in community LD cases and outbreaks, especially those with favourable conditions for growth and dissemination, or even non-favourable conditions for growth but with the influx of contaminated water.

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2024-05-16
2024-11-25
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2024.29.20.2300506
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References

  1. Cunha BA, Burillo A, Bouza E. Legionnaires’ disease. Lancet. 2016;387(10016):376-85.  https://doi.org/10.1016/S0140-6736(15)60078-2  PMID: 26231463 
  2. Reukers DFM, Van Asten L, Brandsema PS, Dijkstra F, Hendriksen JMT, Hooiveld M, et al. Annual report. Surveillance of COVID-19, influenza and other respiratory infections in the Netherlands: winter 2021/2022. Bilthoven: National Institute for Public Health and the Environment (RIVM); 2022. Available from: https://www.rivm.nl/publicaties/annual-report-surveillance-of-covid-19-influenza-and-other-respiratory-infections-in-0
  3. European Centre for Disease Prevention and Control (ECDC). External quality assessment schemes to support European surveillance of Legionnaires’ disease in EU/EEA countries, 2021-2022. Stockholm: ECDC; 2022. Available from: https://www.ecdc.europa.eu/en/publications-data/external-quality-assessment-schemes-support-european-surveillance-legionnaires-0
  4. Hamilton KA, Prussin AJ 2nd, Ahmed W, Haas CN. Outbreaks of Legionnaires’ disease and Pontiac fever 2006-2017. Curr Environ Health Rep. 2018;5(2):263-71.  https://doi.org/10.1007/s40572-018-0201-4  PMID: 29744757 
  5. Kanarek P, Bogiel T, Breza-Boruta B. Legionellosis risk-an overview of Legionella spp. habitats in Europe. Environ Sci Pollut Res Int. 2022;29(51):76532-42.  https://doi.org/10.1007/s11356-022-22950-9  PMID: 36161570 
  6. Caicedo C, Rosenwinkel KH, Exner M, Verstraete W, Suchenwirth R, Hartemann P, et al. Legionella occurrence in municipal and industrial wastewater treatment plants and risks of reclaimed wastewater reuse: Review. Water Res. 2019;149:21-34.  https://doi.org/10.1016/j.watres.2018.10.080  PMID: 30445393 
  7. Huang SW, Hsu BM, Ma PH, Chien KT. Legionella prevalence in wastewater treatment plants of Taiwan. Water Sci Technol. 2009;60(5):1303-10.  https://doi.org/10.2166/wst.2009.410  PMID: 19717918 
  8. Lund V, Fonahn W, Pettersen JE, Caugant DA, Ask E, Nysaeter A. Detection of Legionella by cultivation and quantitative real-time polymerase chain reaction in biological waste water treatment plants in Norway. J Water Health. 2014;12(3):543-54.  https://doi.org/10.2166/wh.2014.063  PMID: 25252358 
  9. Caicedo C, Beutel S, Scheper T, Rosenwinkel KH, Nogueira R. Occurrence of Legionella in wastewater treatment plants linked to wastewater characteristics. Environ Sci Pollut Res Int. 2016;23(16):16873-81.  https://doi.org/10.1007/s11356-016-7090-6  PMID: 27376367 
  10. Loenenbach AD, Beulens C, Euser SM, van Leuken JPG, Bom B, van der Hoek W, et al. Two community clusters of Legionnaires’ disease directly linked to a biologic wastewater treatment plant, the Netherlands. Emerg Infect Dis. 2018;24(10):1914-8.  https://doi.org/10.3201/eid2410.180906  PMID: 30226165 
  11. Vermeulen LC, Brandsema PS, van de Kassteele J, Bom BCJ, Sterk HAM, Sauter FJ, et al. Atmospheric dispersion and transmission of Legionella from wastewater treatment plants: A 6-year case-control study. Int J Hyg Environ Health. 2021;237:113811.  https://doi.org/10.1016/j.ijheh.2021.113811  PMID: 34311418 
  12. Reukers DFM, Van Asten L, Brandsema PS, Dijkstra F, Donker GA, Van Gageldonk-Lafeber AB, et al. Annual report. Surveillance of influenza and other respiratory infections in the Netherlands: winter 2018/2019. Bilthoven: National Institute for Public Health and the Environment (RIVM); 2019. Available from: https://rivm.openrepository.com/handle/10029/623227
  13. Reukers DFM, Van Asten L, Brandsema PS, Dijkstra F, Hendriksen JMT, Van der Hoek W, et al. Annual report. Surveillance of influenza and other respiratory infections in the Netherlands: winter 2019/2020. Bilthoven: National Institute for Public Health and the Environment (RIVM); 2020. Available from: https://rivm.openrepository.com/handle/10029/624659
  14. Den Boer JW, Euser SM, Brandsema P, Reijnen L, Bruin JP. Results from the National Legionella Outbreak Detection Program, the Netherlands, 2002-2012. Emerg Infect Dis. 2015;21(7):1167-73.  https://doi.org/10.3201/eid2107.141130  PMID: 26079594 
  15. European Commission. Commission Implementing Decision (EU) 2018/945 of 22 June 2018 on the communicable diseases and related special health issues to be covered by epidemiological surveillance as well as relevant case definitions. Brussels: Official Journal of the European Union. 6 Jul 2018. L 170/26. Available from: https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32018D0945&from=EN#page=26
  16. European Centre for Disease Prevention and Control (ECDC). Legionnaires' Disease GIS tool. Stockholm: ECDC. [Accessed: 2 Oct 2022]. Available from: https://legionnaires.ecdc.europa.eu/gistool
  17. Atlas Leefomging. Natte koeltorens. [Wet cooling towers]. Bilthoven: National Institute for Public Health and the Environment (RIVM). [Accessed: 1 Oct 2022]. Dutch. Available from: https://www.atlasleefomgeving.nl/thema/veilige-omgeving/nattekoeltorens
  18. Gaia V, Fry NK, Afshar B, Lück PC, Meugnier H, Etienne J, et al. Consensus sequence-based scheme for epidemiological typing of clinical and environmental isolates of Legionella pneumophila. J Clin Microbiol. 2005;43(5):2047-52.  https://doi.org/10.1128/JCM.43.5.2047-2052.2005  PMID: 15872220 
  19. Jünemann S, Sedlazeck FJ, Prior K, Albersmeier A, John U, Kalinowski J, et al. Updating benchtop sequencing performance comparison. Nat Biotechnol. 2013;31(4):294-6.  https://doi.org/10.1038/nbt.2522  PMID: 23563421 
  20. Moran-Gilad J, Prior K, Yakunin E, Harrison TG, Underwood A, Lazarovitch T, et al. Design and application of a core genome multilocus sequence typing scheme for investigation of Legionnaires’ disease incidents. Euro Surveill. 2015;20(28):21186.  https://doi.org/10.2807/1560-7917.ES2015.20.28.21186  PMID: 26212142 
  21. Walser SM, Gerstner DG, Brenner B, Höller C, Liebl B, Herr CE. Assessing the environmental health relevance of cooling towers--a systematic review of legionellosis outbreaks. Int J Hyg Environ Health. 2014;217(2-3):145-54.  https://doi.org/10.1016/j.ijheh.2013.08.002  PMID: 24100053 
  22. Vermeulen L, Brandsema P, Kassteele J, Bom B, Van den Berg H, De Roda Husman M. Mogelijke luchtverspreiding van Legionella door afvalwaterzuiveringsinstallaties: een patiënt-controle onderzoek. [Potential spread of legionella bacteria by air from wastewater treatment plants: a case-control study]. Bilthoven: RIVM; 2019. Dutch. Available from: https://www.rivm.nl/publicaties/mogelijke-luchtverspreiding-van-legionella-door-afvalwaterzuiveringsinstallaties
  23. Klous G, Smit LAM, Freidl GS, Borlée F, van der Hoek W, IJzermans CJ, et al. Pneumonia risk of people living close to goat and poultry farms - Taking GPS derived mobility patterns into account. Environ Int. 2018;115:150-60.  https://doi.org/10.1016/j.envint.2018.03.020  PMID: 29573654 
  24. van Leuken JP, Havelaar AH, van der Hoek W, Ladbury GA, Hackert VH, Swart AN. A model for the early identification of sources of airborne pathogens in an outdoor environment. PLoS One. 2013;8(12):e80412.  https://doi.org/10.1371/journal.pone.0080412  PMID: 24324598 
  25. Bays D, Bennett E, Finnie T. Applying probability-weighted incubation period distributions to traditional wind rose methodology to improve public health investigations of Legionnaires’ disease outbreaks. Epidemiol Infect. 2020;148:e33.  https://doi.org/10.1017/S0950268820000230  PMID: 32070446 
  26. Greig JE, Carnie JA, Tallis GF, Ryan NJ, Tan AG, Gordon IR, et al. An outbreak of Legionnaires’ disease at the Melbourne Aquarium, April 2000: investigation and case-control studies. Med J Aust. 2004;180(11):566-72.  https://doi.org/10.5694/j.1326-5377.2004.tb06093.x  PMID: 15174987 
  27. Petzold M, Prior K, Moran-Gilad J, Harmsen D, Lück C. Epidemiological information is key when interpreting whole genome sequence data - lessons learned from a large Legionella pneumophila outbreak in Warstein, Germany, 2013. Euro Surveill. 2017;22(45):17-00137.  https://doi.org/10.2807/1560-7917.ES.2017.22.45.17-00137  PMID: 29162202 
  28. Nakanishi N, Komatsu S, Tanaka S, Mukai K, Nomoto R. Investigation of a Legionella pneumophila outbreak at a bath facility in Japan using whole-genome sequencing of isolates from clinical and environmental samples. Microorganisms. 2022;11(1):28.  https://doi.org/10.3390/microorganisms11010028  PMID: 36677320 
  29. Timms VJ, Rockett R, Bachmann NL, Martinez E, Wang Q, Chen SC, et al. Genome sequencing links persistent outbreak of legionellosis in Sydney (New South Wales, Australia) to an emerging clone of Legionella pneumophila sequence type 211. Appl Environ Microbiol. 2018;84(5):e02020-17.  https://doi.org/10.1128/AEM.02020-17  PMID: 29247056 
  30. Smith AF, Huss A, Dorevitch S, Heijnen L, Arntzen VH, Davies M, et al. Multiple sources of the outbreak of Legionnaires’ disease in Genesee County, Michigan, in 2014 and 2015. Environ Health Perspect. 2019;127(12):127001.  https://doi.org/10.1289/EHP5663  PMID: 31799878 
  31. Petzold M, Ehricht R, Slickers P, Pleischl S, Brockmann A, Exner M, et al. Rapid genotyping of Legionella pneumophila serogroup 1 strains by a novel DNA microarray-based assay during the outbreak investigation in Warstein, Germany 2013. Int J Hyg Environ Health. 2017;220(4):673-8.  https://doi.org/10.1016/j.ijheh.2016.02.004  PMID: 28501485 
  32. Quero S, Párraga-Niño N, Barrabeig I, Sala MR, Pedro-Botet ML, Monsó E, et al. Population structure of environmental and clinical Legionella pneumophila isolates in Catalonia. Sci Rep. 2018;8(1):6241.  https://doi.org/10.1038/s41598-018-24708-1  PMID: 29674708 
  33. David S, Mentasti M, Tewolde R, Aslett M, Harris SR, Afshar B, et al. Evaluation of an optimal epidemiological typing scheme for Legionella pneumophila with whole-genome sequence data using validation guidelines. J Clin Microbiol. 2016;54(8):2135-48.  https://doi.org/10.1128/JCM.00432-16  PMID: 27280420 
  34. Schjørring S, Stegger M, Kjelsø C, Lilje B, Bangsborg JM, Petersen RF, et al. Genomic investigation of a suspected outbreak of Legionella pneumophila ST82 reveals undetected heterogeneity by the present gold-standard methods, Denmark, July to November 2014. Euro Surveill. 2017;22(25):30558.  https://doi.org/10.2807/1560-7917.ES.2017.22.25.30558  PMID: 28662761 
  35. Falkinham JO 3rd, Pruden A, Edwards M. Opportunistic premise plumbing pathogens: increasingly important pathogens in drinking water. Pathogens. 2015;4(2):373-86.  https://doi.org/10.3390/pathogens4020373  PMID: 26066311 
  36. Wadowsky RM, Wolford R, McNamara AM, Yee RB. Effect of temperature, pH, and oxygen level on the multiplication of naturally occurring Legionella pneumophila in potable water. Appl Environ Microbiol. 1985;49(5):1197-205.  https://doi.org/10.1128/aem.49.5.1197-1205.1985  PMID: 4004233 
  37. Diederen BM. Legionella spp. and Legionnaires’ disease. J Infect. 2008;56(1):1-12.  https://doi.org/10.1016/j.jinf.2007.09.010  PMID: 17980914 
An outbreak of Legionnaires’ disease linked to a municipal and industrial wastewater treatment plant, The Netherlands, September–October 2022
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Roan+Pijnacker&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Pijnacker Roan</a>, <a href="/search?value1=Petra+Brandsema&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Brandsema Petra</a>, <a href="/search?value1=Sjoerd+Euser&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Euser Sjoerd</a>, <a href="/search?value1=Ali+Vahidnia&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Vahidnia Ali</a>, <a href="/search?value1=Arnold+Kuiter&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kuiter Arnold</a>, <a href="/search?value1=Jesse+Limaheluw&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Limaheluw Jesse</a>, <a href="/search?value1=Christine+Schout&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Schout Christine</a>, <a href="/search?value1=Gaaled+Haj+Mohammad&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Haj Mohammad Gaaled</a>, <a href="/search?value1=Stijn+Raven&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Raven Stijn</a></span>. An outbreak of Legionnaires’ disease linked to a municipal and industrial wastewater treatment plant, The Netherlands, September–October 2022 . <a href="/content/ecdc">Euro Surveill.</a> 2024;29(20):pii=2300506. <a href="https://doi.org/10.2807/1560-7917.ES.2024.29.20.2300506" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2024.29.20.2300506</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 19 Sept 2023;&nbsp;&nbsp; <span class="generated">Accepted</span>: 19 Feb 2024 </span> </p>
/content/10.2807/1560-7917.ES.2024.29.20.2300506
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