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A Tale of Four Danish Cities: Legionella pneumophila Diversity in Domestic Hot Water and Spatial Variations in Disease Incidence

Author

Listed:
  • Søren A. Uldum

    (Department of Bacteria, Parasites and Fungi, Statens Serum Institut, 2300 Copenhagen S, Denmark)

  • Lars G. Schjoldager

    (CheckPoint World, 8800 Viborg, Denmark)

  • Sharmin Baig

    (Department of Bacteria, Parasites and Fungi, Statens Serum Institut, 2300 Copenhagen S, Denmark)

  • Kelsie Cassell

    (Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, CT 06510, USA)

Abstract

Denmark has one of the highest Legionnaires’ disease notification rates within Europe, averaging 4.7 cases per 100,000 population annually (2017 to 2020). The relatively high incidence of disease is not uniform across the country, and approximately 70% of all domestically acquired cases in Denmark are caused by Legionella pneumophila (LP) strains that are considered less virulent. The aim of this study was to investigate if colonization rates, levels of colonization, and/or types of LP present in hot water systems were associated with geographic differences in Legionnaires’ disease incidence. Domestic water systems from four cities in Denmark were analyzed via culture and qPCR. Serogrouping and sequence typing was performed on randomly selected isolates. Single nucleotide polymorphism was used to identify clonal relationship among isolates from the four cities. The results revealed a high LP colonization rate from 68% to 87.5% among systems, composed primarily of non-serogroup 1. LP serogroup 1 reacting with the monoclonal antibody (MAb) 3/1 was not identified in any of the systems tested, while MAb 3/1 negative serogroup 1 strains were isolated from 10 systems (9.6%). We hypothesize that a combination of factors influences the incidence rate of LD in each city, including sequence type and serogroup distribution, colonization rate, concentration of Legionella in Pre-flush and Flush samples, and potentially building characteristics such as water temperature measured at the point of use.

Suggested Citation

  • Søren A. Uldum & Lars G. Schjoldager & Sharmin Baig & Kelsie Cassell, 2022. "A Tale of Four Danish Cities: Legionella pneumophila Diversity in Domestic Hot Water and Spatial Variations in Disease Incidence," IJERPH, MDPI, vol. 19(5), pages 1-18, February.
    • Handle: RePEc:gam:jijerp:v:19:y:2022:i:5:p:2530-:d:755616
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    References listed on IDEAS

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    1. Michele Totaro & Paola Valentini & Anna Laura Costa & Lorenzo Frendo & Alessia Cappello & Beatrice Casini & Mario Miccoli & Gaetano Privitera & Angelo Baggiani, 2017. "Presence of Legionella spp. in Hot Water Networks of Different Italian Residential Buildings: A Three-Year Survey," IJERPH, MDPI, vol. 14(11), pages 1-9, October.
    2. Maria A. Kyritsi & Varvara A. Mouchtouri & Antonis Katsioulis & Elina Kostara & Vasileios Nakoulas & Marina Hatzinikou & Christos Hadjichristodoulou, 2018. "Legionella Colonization of Hotel Water Systems in Touristic Places of Greece: Association with System Characteristics and Physicochemical Parameters," IJERPH, MDPI, vol. 15(12), pages 1-12, November.
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