1
|
Glažar Ivče D, Rončević D, Šantić M, Cenov A, Tomić Linšak D, Mićović V, Lušić D, Glad M, Ljubas D, Vukić Lušić D. Is a Proactive Approach to Controlling Legionella in the Environment Justified? Food Technol Biotechnol 2021; 59:314-324. [PMID: 34759763 PMCID: PMC8542184 DOI: 10.17113/ftb.59.03.21.7016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 06/24/2021] [Indexed: 11/29/2022] Open
Abstract
Research background Legionella are Gram-negative bacteria that are ubiquitous in the natural environment. Contaminated water in man-made water systems is a potential source of transmission of legionnaires’ disease. The aim of this study is to explore the prevalence of Legionella pneumophila in the drinking water distribution system (DWDS) of Primorje-Gorski Kotar (PGK) County, Croatia, for the period 2013-2019, coupled with the incidence of legionnaires’ disease. A number of L. pneumophila-positive samples (>100 CFU/L), serogroup distribution and the degree of contamination of specific facilities (health and aged care, tourism, and sports) were assessed. Based on the obtained results, the reasoning for the implementation of a mandatory Legionella environmental surveillance program was assessed. Experimental approach Sample testing for Legionella was carried out according to the standard method for enumeration of this bacterium. A heterotrophic plate count (HPC) and Pseudomonas aeruginosa number were analysed along with the basic physicochemical indicators of drinking water quality. The research period was divided into two parts, namely, the 2013-2018 period (before implementation of the prevention program, after the outbreak of legionnaires’ disease), and the year 2019 (proactive approach, no disease cases recorded). Results and conclusion During the 7-year observation period in PGK County, an increase in the number of samples tested for Legionella was found. An increase in Legionella-positive samples (particularly pronounced during the warmer part of the year) was recorded, along with a growing trend in the number of reported legionnaires’ disease cases. In addition to hot water systems, the risk of Legionella colonisation also applies to cold water systems. Health and aged care facilities appear to be at highest risk. In addition to the higher proportion of positive samples and a higher degree of microbiological load in these facilities, the highest proportion of L. pneumophila SGs 2-14 was identified. Due to the diagnostic limitations of the applied tests, the number of legionnaires’ disease cases is underdiagnosed. Novelty and scientific contribution The introduction of a mandatory preventive approach to monitoring Legionella in DWDS water samples, along with the definition of national criteria for the interpretation of the results will create the preconditions for diagnosis and adequate treatment of larger numbers of legionnaires’ disease cases.
Collapse
Affiliation(s)
- Daniela Glažar Ivče
- Teaching Institute of Public Health of Primorje-Gorski Kotar County, Krešimirova 52a, 51000 Rijeka, Croatia
| | - Dobrica Rončević
- Teaching Institute of Public Health of Primorje-Gorski Kotar County, Krešimirova 52a, 51000 Rijeka, Croatia.,Faculty of Health Studies, Viktora cara Emina 5, 51000 Rijeka, Croatia
| | - Marina Šantić
- Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia
| | - Arijana Cenov
- Teaching Institute of Public Health of Primorje-Gorski Kotar County, Krešimirova 52a, 51000 Rijeka, Croatia
| | - Dijana Tomić Linšak
- Teaching Institute of Public Health of Primorje-Gorski Kotar County, Krešimirova 52a, 51000 Rijeka, Croatia.,Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia
| | - Vladimir Mićović
- Teaching Institute of Public Health of Primorje-Gorski Kotar County, Krešimirova 52a, 51000 Rijeka, Croatia.,Faculty of Health Studies, Viktora cara Emina 5, 51000 Rijeka, Croatia.,Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia
| | - Dražen Lušić
- Faculty of Health Studies, Viktora cara Emina 5, 51000 Rijeka, Croatia.,Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia.,Center for Advanced Computing and Modelling, University of Rijeka, Radmile Matejčić 2, 51000 Rijeka, Croatia
| | - Marin Glad
- Teaching Institute of Public Health of Primorje-Gorski Kotar County, Krešimirova 52a, 51000 Rijeka, Croatia
| | - Davor Ljubas
- Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Ivana Lučića 5, Zagreb, Croatia
| | - Darija Vukić Lušić
- Teaching Institute of Public Health of Primorje-Gorski Kotar County, Krešimirova 52a, 51000 Rijeka, Croatia.,Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia.,Center for Advanced Computing and Modelling, University of Rijeka, Radmile Matejčić 2, 51000 Rijeka, Croatia
| |
Collapse
|
2
|
Whitney EA, Blake S, Berkelman RL. Implementation of a Legionella Ordinance for Multifamily Housing, Garland, Texas. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 23:601-607. [PMID: 28141673 PMCID: PMC5636053 DOI: 10.1097/phh.0000000000000518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT The incidence of legionellosis has sharply increased in the United States as a result of contaminated water systems. Jurisdictions across the country are considering whether to develop and implement regulations to protect individuals against Legionnaires' disease with its associated high morbidity and mortality. OBJECTIVE This article sheds light on the implementation and effectiveness of a 2005 citywide Legionella testing mandate of multifamily housing cooling towers in Garland, Texas. This ordinance has been in place for more than 10 years and represents the first of its kind in the United States to mandate routine testing of cooling towers for Legionella in multifamily housing. DESIGN, SETTING, AND POPULATION We utilized a mix of both qualitative and quantitative methods to explore the development, adoption, and implementation of the ordinance. Phone interviews were conducted with individuals from the City of Garland Health Department and apartment managers. Quantitative data included public health surveillance data on legionellosis. MAIN OUTCOME MEASURES Barriers and facilitators of implementation, number and percentage of cooling towers from multifamily housing units that tested positive for Legionella by year, and number of legionellosis cases by year in Garland, Texas. RESULTS Study outcomes highlight key themes that facilitated the successful implementation of the Legionella testing mandate, including the importance of timing, leadership support, stakeholder engagement, and education and outreach. The number of contaminated cooling towers was reduced over time. CONCLUSION Mandatory monitoring for legionella in a local jurisdiction may result in reduced risk of legionellosis from cooling towers through raising awareness and education of building owners and managers about the need to prevent, detect, and remediate legionella contamination in their building water systems. Garland, Texas, broke new ground in the United States in moving toward primary prevention of legionellosis. The ordinance may be useful both in serving to educate and increase awareness about the need for Legionella prevention and to monitor effectiveness of maintenance procedures.
Collapse
Affiliation(s)
- Ellen A. Whitney
- International Association of National Public Health Institutes, Global Health Institute (Ms Whitney), Department of Health Policy and Management, Rollins School of Public Health (Dr Blake), and Center for Public Health Preparedness and Research, Rollins School of Public Health (Dr Berkelman), Emory University, Atlanta, Georgia
| | - Sarah Blake
- International Association of National Public Health Institutes, Global Health Institute (Ms Whitney), Department of Health Policy and Management, Rollins School of Public Health (Dr Blake), and Center for Public Health Preparedness and Research, Rollins School of Public Health (Dr Berkelman), Emory University, Atlanta, Georgia
| | - Ruth L. Berkelman
- International Association of National Public Health Institutes, Global Health Institute (Ms Whitney), Department of Health Policy and Management, Rollins School of Public Health (Dr Blake), and Center for Public Health Preparedness and Research, Rollins School of Public Health (Dr Berkelman), Emory University, Atlanta, Georgia
| |
Collapse
|
3
|
Parr A, Whitney EA, Berkelman RL. Legionellosis on the Rise: A Review of Guidelines for Prevention in the United States. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2015; 21:E17-26. [PMID: 25203696 PMCID: PMC4519350 DOI: 10.1097/phh.0000000000000123] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
CONTEXT Reported cases of legionellosis more than tripled between 2001 and 2012 in the United States. The disease results primarily from exposure to aerosolized water contaminated with Legionella. OBJECTIVE To identify and describe policies and guidelines for the primary prevention of legionellosis in the US. DESIGN An Internet search for Legionella prevention guidelines in the United States at the federal and state levels was conducted from March to June 2012. Local government agency guidelines and guidelines from professional organizations that were identified in the initial search were also included. SETTING Federal, state, and local governing bodies and professional organizations. RESULTS Guidelines and regulations for the primary prevention of legionellosis (ie, Legionnaires' disease and Pontiac fever) have been developed by various public health and other government agencies at the federal, state, and local levels as well as by professional organizations. These guidelines are similar in recommending maintenance of building water systems; federal and other guidelines differ in the population/institutions targeted, the extent of technical detail, and support of monitoring water systems for levels of Legionella contamination. CONCLUSIONS Legionellosis deserves a higher public health priority for research and policy development. Guidance across public health agencies for the primary prevention of legionellosis requires strengthening as this disease escalates in importance as a cause of severe morbidity and mortality. We recommend a formal and comprehensive review of national public health guidelines for prevention of legionellosis.
Collapse
Affiliation(s)
- Alyssa Parr
- Center for Public Health Preparedness and Research, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | | |
Collapse
|