A Community Outbreak of Legionnaires’ Disease with Two Strains of L. pneumophila Serogroup 1 Linked to an Aquatic Therapy Centre

Cyril Rousseau, Christophe Ginevra, Leslie Simac, Noel Fiard, Karine Vilhes, Anne-Gaëlle Ranc, Sophie Jarraud, Hervé Gornes, Damien Mouly and Christine Campese
Additional contact information
Cyril Rousseau: The French Public Health Agency (Santé Publique France), Region Division—Occitanie, 31050 Toulouse, France
Christophe Ginevra: The National Reference Center of Legionella , 69317 Lyon, France
Leslie Simac: The French Public Health Agency (Santé Publique France), Region Division—Occitanie, 31050 Toulouse, France
Noel Fiard: The Regional Health Agency of Occitanie, 34000 Montpellier, France
Karine Vilhes: The Regional Health Agency of Occitanie, 34000 Montpellier, France
Anne-Gaëlle Ranc: The National Reference Center of Legionella , 69317 Lyon, France
Sophie Jarraud: The National Reference Center of Legionella , 69317 Lyon, France
Hervé Gornes: The Regional Health Agency of Occitanie, 34000 Montpellier, France
Damien Mouly: The French Public Health Agency (Santé Publique France), Region Division—Occitanie, 31050 Toulouse, France
Christine Campese: The French Public Health Agency (Santé Publique France), Infectious Disease Direction, 94415 Saint-Maurice, France

IJERPH, 2022, vol. 19, issue 3, 1-9

Abstract: An outbreak of Legionnaires’ disease affected 18 people in Montpellier, a town of the south of France, between December 2016 and July 2017. All cases were diagnosed by a positive urinary antigen test. No deaths were reported. Epidemiological, environmental and genomic investigations (nested Sequence-Based Typing (nSBT) and whole genome sequencing) were undertaken. For the cases for which we had information, four had a new isolate (ST2471), one had a different new isolate (ST2470), one had a genomic pattern compatible with the ST2471 identified by nSBT ( fla A = 3), and one had a genomic pattern not compatible with two previous identified STs ( pil E = 6). The analysis conducted on the pool of an aquatic therapy center revealed seven isolates of Legionella pneumophila . Whole genome analysis confirmed the link between the environmental and clinical isolates for both ST2470 and ST2471. As the outbreak occurred slowly, with several weeks between new cases, it was not possible to immediately identify a common source. The sixth case was the first to report having aquatic therapy care. Of the 18 cases, eight had attended the aquatic therapy center and the other 10 were inhabitants who lived, worked or walked close to the center. The main cause for this outbreak was the lack of facility maintenance. This investigation highlights the risk to public health of aquatic therapy centers for users and nearby populations, and emphasizes the need for risk reduction measures with specific guidelines to improve health and safety in aquatic facilities.

Keywords: Legionella pneumophila; outbreak; aquatic therapy centre; sequence typing (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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