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Published on: November 22, 2013
Legionella prevention in the Netherlands: an evaluation using genotype distribution
S M Euser1, J P Bruin, P Brandsema
1Regional Public Health Laboratory Kennemerland, Boerhaavelaan 26, 2035 RC, Haarlem, The Netherlands. s.euser@streeklabhaarlem.nl
Summary
Legionnaires' disease prevention strategies in the Netherlands show limitations. Current primary prevention misses the main bacterial reservoir, while secondary prevention needs improvement to better target Legionella sources.
Area of Science:
- Environmental microbiology
- Public health
- Infectious disease epidemiology
Background:
- Legionnaires' disease (LD) is acute pneumonia caused by Legionella bacteria, often found in water systems.
- Primary prevention of LD relies on drinking water legislation, while secondary prevention uses outbreak detection programs.
- The effectiveness of these two prevention strategies in the Netherlands has not been fully evaluated.
Purpose of the Study:
- To evaluate the effectiveness of primary and secondary prevention strategies for Legionnaires' disease in the Netherlands.
- To compare Legionella pneumophila serogroup 1 genotypes from patient isolates with those identified through prevention actions.
- To identify potential gaps and unknown reservoirs in current LD prevention efforts.
Main Methods:
- Genotyping of Legionella pneumophila serogroup 1 using the HiMLST method with next-generation sequencing.
- Comparison of sequence type profiles from patient isolates (n=179) with those from primary (n=182) and secondary (n=60) prevention actions.
- Analysis of genotype distribution to assess the alignment between prevention efforts and patient exposure sources.
Main Results:
- Genotypes identified during primary prevention efforts showed significant differences from those found in patients.
- Genotypes associated with secondary prevention demonstrated greater similarity to patient isolates but require further refinement.
- A substantial discrepancy suggests that primary prevention may not target the correct environmental reservoir for Legionella.
Conclusions:
- Current primary prevention strategies for Legionnaires' disease may not be effectively targeting the primary bacterial reservoir.
- Secondary prevention efforts show promise but are only partially effective, indicating a need for optimization.
- The findings suggest the existence of an unidentified reservoir contributing to Legionnaires' disease outbreaks.
