An outbreak of Legionnaires’ disease linked to a municipal and industrial wastewater treatment plant, The Netherlands, September–October 2022

Author:

Pijnacker Roan12,Brandsema Petra2,Euser Sjoerd3,Vahidnia Ali3,Kuiter Arnold4,Limaheluw Jesse2,Schout Christine1,Haj Mohammad Gaaled1,Raven Stijn1

Affiliation:

1. Department of Infectious Diseases, Public Health Service region Utrecht (GGD), Zeist, the Netherlands

2. Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands

3. Regional Public Health Laboratory Kennemerland, Haarlem, the Netherlands

4. Environmental Services Regarding Authorization and Enforcement (RUD Utrecht), Utrecht, the Netherlands

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 Legionella pneumophila serogroups 1 and 6 with multiple sequence types (ST). We detected L. pneumophila 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 Legionella growth and dissemination, or even non-favourable conditions for growth but with the influx of contaminated water.

Publisher

European Centre for Disease Control and Prevention (ECDC)

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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

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