Unusual Legionnaires' outbreak in cool, dry Western Canada an investigation using genomic epidemiology

An outbreak of Legionnaires' disease occurred in an inner city district in Calgary, Canada. This outbreak spanned a 3-week period in November–December 2012, and a total of eight cases were identified. Four of these cases were critically ill requiring intensive care admission but there was no as...

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Veröffentlicht in:Epidemiology and infection Jg. 145; H. 2; S. 254 - 265
Hauptverfasser: KNOX, N. C., WEEDMARK, K. A., CONLY, J., ENSMINGER, A. W., HOSEIN, F. S., DREWS, S. J.
Format: Journal Article
Sprache:Englisch
Veröffentlicht: England Cambridge University Press 01.01.2017
Schlagworte:
Aged
Antigens
Antigens, Bacterial - urine
Bacteriological Techniques
Canada - epidemiology
Cooling
Disease Outbreaks
Epidemics
Epidemiology
Female
Genomes
Genomics
Genotype
Humans
Humidity
Hypotheses
Illnesses
Inner city
Intensive care
Legionella pneumophila
Legionella pneumophila - classification
Legionella pneumophila - genetics
Legionella pneumophila - isolation & purification
Legionnaire's disease
Legionnaires' disease
Legionnaires' Disease - epidemiology
Legionnaires' Disease - microbiology
Male
Medicine
Middle Aged
Molecular Epidemiology
Molecular Typing
Original Papers
Outbreaks
Public health
Questionnaires
Respiratory Infections
Seasonal variations
Sputum - microbiology
Surveys and Questionnaires
Urban Population
Weather
Canada
Calgary Alberta Canada
Northern Hemisphere
Toronto Ontario Canada
Alberta Canada
Western Canada
ANW, Canada
Canada, Alberta, Calgary
Legionnaires' disease
Legionella pneumophila
ST222
outbreak
Genomic analysis
Western Canada
ISSN:0950-2688, 1469-4409
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Zusammenfassung:An outbreak of Legionnaires' disease occurred in an inner city district in Calgary, Canada. This outbreak spanned a 3-week period in November–December 2012, and a total of eight cases were identified. Four of these cases were critically ill requiring intensive care admission but there was no associated mortality. All cases tested positive for Legionella pneumophila serogroup 1 (LP1) by urinary antigen testing. Five of the eight patients were culture positive for LP1 from respiratory specimens. These isolates were further identified as Knoxville monoclonal subtype and sequence subtype ST222. Whole-genome sequencing revealed that the isolates differed by no more than a single vertically acquired single nucleotide variant, supporting a single point-source outbreak. Hypothesis-based environmental investigation and sampling was conducted; however, a definitive source was not identified. Geomapping of case movements within the affected urban sector revealed a 1·0 km common area of potential exposure, which coincided with multiple active construction sites that used water spray to minimize transient dust. This community point-source Legionnaires' disease outbreak is unique due to its ST222 subtype and occurrence in a relatively dry and cold weather setting in Western Canada. This report suggests community outbreaks of Legionella should not be overlooked as a possibility during late autumn and winter months in the Northern Hemisphere.
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These authors contributed equally to this work.
Members of the Legionella Outbreak Investigative Team are given in the Appendix.
Findings from this study were presented in part in abstract form at the Annual Scientific Meeting of AMMI Canada – CACMID held in Victoria, Canada, 2–5 April 2014.
ISSN:0950-2688
1469-4409
DOI:10.1017/S0950268816001965