PDF(Pubmed)
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.
摘要：
废水处理厂（WWTP）越来越被认为是军团病（LD）源。2022年9月在Houten报告了5例LD病例后，展开了疫情调查，荷兰。病例识别基于欧洲LD病例定义，自2022年9月1日起出现症状，居住在Houten5公里内或附近，或在潜伏期内拜访Houten,没有其他可能的来源。我们对潜在来源进行了采样，并对环境和临床分离株进行了基因分型。我们确定了15例LD病例，发病时间为2022年9月13日至10月23日。空间源识别和风向模型建议工业（iWWTP）和市政WWTP（mWWTP）作为潜在源，第一个将水排入后者。两者均对具有多种序列类型（ST）的嗜肺军团菌血清组1和6检测为阳性。我们在mWWTP中检测到嗜肺乳杆菌sg1ST42，与三个可用的临床分离株之一相匹配。在污水处理厂采取控制措施后，没有观察到更多的病例。这次爆发突显出市政和工业污水处理厂可以在社区LD病例和爆发中发挥重要作用，特别是那些有利于军团菌生长和传播的条件，甚至是不利于生长的条件，但随着污染水的涌入。
