Mixed community and nosocomial outbreak of Legionella pneumophila in Montréal, Québec, 2019
Objectives: To describe the investigation of a community-based outbreak of Legionella pneumophila serogroup 1, with retirement home and acute care hospital sub-clusters in Montréal, QC, and the key challenges encountered. Methods: There were 14 cases of L. pneumophila serogroup 1 infection with an o...
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| Veröffentlicht in: | Canada communicable disease report 2020-07, Vol.46 (7/8) |
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| creator | Cadieux, Geneviève Brodeur, Julie Lamothe, Félix Lalancette, Cindy Pilon, Pierre A Kaiser, David Litvak, Éric |
| description | Objectives: To describe the investigation of a community-based outbreak of Legionella pneumophila serogroup 1, with retirement home and acute care hospital sub-clusters in Montréal, QC, and the key challenges encountered. Methods: There were 14 cases of L. pneumophila serogroup 1 infection with an onset date between June 7 and August 21, 2019. The environmental investigation included sampling of water cooling towers (WCTs) and other potential sources. Sequence-based typing of clinical and environmental isolates was performed. Public health interventions included WCT decontamination orders and communication with clinicians. Results: Eleven (79%) of the 14 cases were immunosuppressed or immunocompromised. Most (13; 93%) were diagnosed using a urinary antigen test, and five (36%) had a culture. Two sub-clusters were identified: three cases in a retirement home and four cases on an acute care hospital floor. Typing results suggested that the same L. pneumophila serogroup 1 may have caused the community outbreak and the two sub-clusters. A matching environmental source was not identified. Conclusion: Whereas typing of clinical isolates suggested a common environmental source, our investigation failed to identify this source. Future outbreak investigations could benefit from more clinical isolates for typing, local registries of water aerosolization sources other than WCTs, and ongoing access to all WCT routine monitoring results and L. pneumophila isolates for typing. |
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Methods: There were 14 cases of L. pneumophila serogroup 1 infection with an onset date between June 7 and August 21, 2019. The environmental investigation included sampling of water cooling towers (WCTs) and other potential sources. Sequence-based typing of clinical and environmental isolates was performed. Public health interventions included WCT decontamination orders and communication with clinicians. Results: Eleven (79%) of the 14 cases were immunosuppressed or immunocompromised. Most (13; 93%) were diagnosed using a urinary antigen test, and five (36%) had a culture. Two sub-clusters were identified: three cases in a retirement home and four cases on an acute care hospital floor. Typing results suggested that the same L. pneumophila serogroup 1 may have caused the community outbreak and the two sub-clusters. A matching environmental source was not identified. Conclusion: Whereas typing of clinical isolates suggested a common environmental source, our investigation failed to identify this source. Future outbreak investigations could benefit from more clinical isolates for typing, local registries of water aerosolization sources other than WCTs, and ongoing access to all WCT routine monitoring results and L. pneumophila isolates for typing.</description><identifier>ISSN: 1188-4169</identifier><identifier>EISSN: 1481-8531</identifier><language>eng</language><publisher>Ottawa: Public Health Agency of Canada</publisher><subject>Antigens ; Biofilms ; Clinical isolates ; Cluster analysis ; Clusters ; Cooling towers ; Decontamination ; Drinking water ; Epidemics ; Health promotion ; Hospitals ; Infections ; Investigations ; Laboratories ; Legionella pneumophila ; Legionnaires' disease bacterium ; Liquid cooling ; Nosocomial infection ; Outbreaks ; Public health ; Retirement ; Typing</subject><ispartof>Canada communicable disease report, 2020-07, Vol.46 (7/8)</ispartof><rights>2020. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,778,782</link.rule.ids></links><search><creatorcontrib>Cadieux, Geneviève</creatorcontrib><creatorcontrib>Brodeur, Julie</creatorcontrib><creatorcontrib>Lamothe, Félix</creatorcontrib><creatorcontrib>Lalancette, Cindy</creatorcontrib><creatorcontrib>Pilon, Pierre A</creatorcontrib><creatorcontrib>Kaiser, David</creatorcontrib><creatorcontrib>Litvak, Éric</creatorcontrib><title>Mixed community and nosocomial outbreak of Legionella pneumophila in Montréal, Québec, 2019</title><title>Canada communicable disease report</title><description>Objectives: To describe the investigation of a community-based outbreak of Legionella pneumophila serogroup 1, with retirement home and acute care hospital sub-clusters in Montréal, QC, and the key challenges encountered. Methods: There were 14 cases of L. pneumophila serogroup 1 infection with an onset date between June 7 and August 21, 2019. The environmental investigation included sampling of water cooling towers (WCTs) and other potential sources. Sequence-based typing of clinical and environmental isolates was performed. Public health interventions included WCT decontamination orders and communication with clinicians. Results: Eleven (79%) of the 14 cases were immunosuppressed or immunocompromised. Most (13; 93%) were diagnosed using a urinary antigen test, and five (36%) had a culture. Two sub-clusters were identified: three cases in a retirement home and four cases on an acute care hospital floor. Typing results suggested that the same L. pneumophila serogroup 1 may have caused the community outbreak and the two sub-clusters. A matching environmental source was not identified. Conclusion: Whereas typing of clinical isolates suggested a common environmental source, our investigation failed to identify this source. Future outbreak investigations could benefit from more clinical isolates for typing, local registries of water aerosolization sources other than WCTs, and ongoing access to all WCT routine monitoring results and L. pneumophila isolates for typing.</description><subject>Antigens</subject><subject>Biofilms</subject><subject>Clinical isolates</subject><subject>Cluster analysis</subject><subject>Clusters</subject><subject>Cooling towers</subject><subject>Decontamination</subject><subject>Drinking water</subject><subject>Epidemics</subject><subject>Health promotion</subject><subject>Hospitals</subject><subject>Infections</subject><subject>Investigations</subject><subject>Laboratories</subject><subject>Legionella pneumophila</subject><subject>Legionnaires' disease bacterium</subject><subject>Liquid cooling</subject><subject>Nosocomial infection</subject><subject>Outbreaks</subject><subject>Public health</subject><subject>Retirement</subject><subject>Typing</subject><issn>1188-4169</issn><issn>1481-8531</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNqNjksKwjAURYMo-N3DA6cWmn5iOxbFgQ4Ep1LSNmo0zatNA7qkrqMbMwMX4Oge7rmDOyATGiXUS-KQDh3TJPEiytIxmRrz8P2AxSyckMtRvkUJBVaV1bL9ANclaDToGskVoG3zRvAn4BUO4iZRC6U41FrYCuu7dCw1HFG3Td9xtYKT7btcFCsIfJrOyejKlRGLX87Icrc9b_Ze3eDLCtNmD7SNdioL3J11ymKfhf-tvolERaI</recordid><startdate>20200702</startdate><enddate>20200702</enddate><creator>Cadieux, Geneviève</creator><creator>Brodeur, Julie</creator><creator>Lamothe, Félix</creator><creator>Lalancette, Cindy</creator><creator>Pilon, Pierre A</creator><creator>Kaiser, David</creator><creator>Litvak, Éric</creator><general>Public Health Agency of Canada</general><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8FQ</scope><scope>8FV</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M3G</scope><scope>NAPCQ</scope><scope>PATMY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PYCSY</scope><scope>Q9U</scope></search><sort><creationdate>20200702</creationdate><title>Mixed community and nosocomial outbreak of Legionella pneumophila in Montréal, Québec, 2019</title><author>Cadieux, Geneviève ; 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Methods: There were 14 cases of L. pneumophila serogroup 1 infection with an onset date between June 7 and August 21, 2019. The environmental investigation included sampling of water cooling towers (WCTs) and other potential sources. Sequence-based typing of clinical and environmental isolates was performed. Public health interventions included WCT decontamination orders and communication with clinicians. Results: Eleven (79%) of the 14 cases were immunosuppressed or immunocompromised. Most (13; 93%) were diagnosed using a urinary antigen test, and five (36%) had a culture. Two sub-clusters were identified: three cases in a retirement home and four cases on an acute care hospital floor. Typing results suggested that the same L. pneumophila serogroup 1 may have caused the community outbreak and the two sub-clusters. A matching environmental source was not identified. Conclusion: Whereas typing of clinical isolates suggested a common environmental source, our investigation failed to identify this source. Future outbreak investigations could benefit from more clinical isolates for typing, local registries of water aerosolization sources other than WCTs, and ongoing access to all WCT routine monitoring results and L. pneumophila isolates for typing.</abstract><cop>Ottawa</cop><pub>Public Health Agency of Canada</pub></addata></record> |
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| subjects | Antigens Biofilms Clinical isolates Cluster analysis Clusters Cooling towers Decontamination Drinking water Epidemics Health promotion Hospitals Infections Investigations Laboratories Legionella pneumophila Legionnaires' disease bacterium Liquid cooling Nosocomial infection Outbreaks Public health Retirement Typing |
| title | Mixed community and nosocomial outbreak of Legionella pneumophila in Montréal, Québec, 2019 |
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