Large community-acquired Legionnaires’ disease outbreak caused by Legionella pneumophila serogroup 1, Italy, July to August 2018

Author:

Faccini Marino12,Russo Antonio Giampiero12,Bonini Maira12,Tunesi Sara2,Murtas Rossella2,Sandrini Monica2,Senatore Sabrina2,Lamberti Anna2,Ciconali Giorgio2,Cammarata Serafina2,Barrese Eros2,Ceriotti Valentina2,Vitaliti Sonia2,Foti Marina2,Gentili Gabriella2,Graziano Elisabetta2,Panciroli Emerico2,Bosio Marco2,Gramegna Maria3,Cereda Danilo3,Perno Carlo Federico4,Mazzola Ester4,Campisi Daniela4,Aulicino Gianuario5,Castaldi Silvana65,Girolamo Antonietta7,Caporali Maria Grazia7,Scaturro Maria7,Rota Maria Cristina7,Ricci Maria Luisa7

Affiliation:

1. These authors contributed equally to this article and share first authorship

2. Agency for Health Protection of Metropolitan Area of Milan (ATS), Milan, Italy

3. Direzione Generale Welfare, Unità Organizzativa Prevenzione, Lombardy Region, Milan, Italy

4. Department of Laboratory Medicine, Hospital Niguarda, Milan, Italy

5. Department of Biomedical Sciences for Health, Post Graduate School in Public Health, University of Milan, Milan, Italy

6. Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

7. Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy

Abstract

In July 2018, a large outbreak of Legionnaires’ disease (LD) caused by Legionella pneumophila serogroup 1 (Lp1) occurred in Bresso, Italy. Fifty-two cases were diagnosed, including five deaths. We performed an epidemiological investigation and prepared a map of the places cases visited during the incubation period. All sites identified as potential sources were investigated and sampled. Association between heavy rainfall and LD cases was evaluated in a case-crossover study. We also performed a case–control study and an aerosol dispersion investigation model. Lp1 was isolated from 22 of 598 analysed water samples; four clinical isolates were typed using monoclonal antibodies and sequence-based typing. Four Lp1 human strains were ST23, of which two were Philadelphia and two were France-Allentown subgroup. Lp1 ST23 France-Allentown was isolated only from a public fountain. In the case-crossover study, extreme precipitation 5–6 days before symptom onset was associated with increased LD risk. The aerosol dispersion model showed that the fountain matched the case distribution best. The case–control study demonstrated a significant eightfold increase in risk for cases residing near the public fountain. The three studies and the matching of clinical and environmental Lp1 strains identified the fountain as the source responsible for the epidemic.

Publisher

European Centre for Disease Control and Prevention (ECDC)

Subject

Virology,Public Health, Environmental and Occupational Health,Epidemiology

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