2017年6月至9月，瑞士日内瓦发生军团病社区疫情。

A community outbreak of Legionnaires' disease in Geneva, Switzerland, June to September 2017.

作者信息

Zanella Marie-Céline, Yerly Sabine, Cherkaoui Abdessalam, Renzi Gesuele, Mamin Aline, Lourenço Cordes Laura, Delaporte Elisabeth, Baranczuk-Turska Zofia, Keiser Olivia, Schrenzel Jacques, Harbarth Stephan, Gaia Valeria, Kaiser Laurent

机构信息

Laboratory of Virology, Division of Laboratory Medicine and Division of Infectious Diseases, University of Geneva Hospitals, Switzerland; University of Geneva Medical School, Switzerland.

Laboratory of Bacteriology, Division of Laboratory Medicine and Division of Infectious Diseases, Geneva University Hospitals, Switzerland; University of Geneva Medical School, Switzerland.

出版信息

Swiss Med Wkly. 2018 Dec 2;148:w14687. doi: 10.4414/smw.2018.14687. eCollection 2018 Nov 19.

DOI:10.4414/smw.2018.14687

PMID:30552854

Abstract

PURPOSE

Eight confirmed cases of Legionnaires’ disease were identified at the Geneva University Hospitals between 28 July 2017 and 02 August 2017, leading to a detailed outbreak investigation.

METHODS

Legionnaires’ disease cases were defined according to Swiss and European (ELDSNet) consensus guidelines. An outbreak investigation task force was put in place. Patients were interviewed, when feasible, with a standard questionnaire. A Legionella pneumophila urinary antigen test was performed in all cases. Lower respiratory tract (LRT) specimens were collected for culture, polymerase chain-reaction (PCR) assay, monoclonal antibody subtyping and sequenced-based typing (SBT). Multiple environmental samples were collected. Case geographical mapping was performed and local meteorological data were obtained.

RESULTS

Thirty-four confirmed cases of Legionnaires’ disease were identified between 20 June 2017 and 16 September 2017, including 28 patients living in the Canton of Geneva and 6 cases in neighbouring cantons and France. The case fatality rate was 8.8%. The urinary antigen test was positive in 32/34 (94.1%) cases. Among the 17/34 (50%) cases with available LRT specimens, 8 (47.1%) were culture/PCR positive, 5 (29.4%) were PCR positive only, and 4 (23.5%) were culture/PCR negative. Monoclonal antibody subtyping and SBT on 12 samples allowed subtype identification of 8 samples, with a predominance of L. pneumophila serogroup-1 subtype-France/Allentown ST23 among clinical isolates. A specific city area was identified as a possible outbreak epicentre in 25/34 (73.5%) cases, although molecular analysis of clinical and environmental specimens revealed heterogeneous subtypes of L. pneumophila.

CONCLUSIONS

In this largest documented outbreak of Legionnaires’ disease in Switzerland, we report prompt outbreak identification, leading to timely initiation of a detailed, well-orchestrated clinical and epidemiological investigation.

摘要

目的

2017年7月28日至2017年8月2日期间，日内瓦大学医院确诊8例军团病病例，从而开展了详细的疫情调查。

方法

根据瑞士和欧洲（ELDSNet）共识指南定义军团病病例。成立了疫情调查特别工作组。在可行的情况下，使用标准问卷对患者进行访谈。对所有病例均进行嗜肺军团菌尿抗原检测。采集下呼吸道（LRT）标本进行培养、聚合酶链反应（PCR）检测、单克隆抗体分型和基于测序的分型（SBT）。采集多个环境样本。进行病例地理定位并获取当地气象数据。

结果

2017年6月20日至2017年9月16日期间，共确诊34例军团病病例，其中28例患者居住在日内瓦州，6例在邻近州和法国。病死率为8.8%。尿抗原检测在32/34（94.1%）的病例中呈阳性。在17/34（50%）有可用LRT标本的病例中，8例（47.1%）培养/PCR呈阳性，5例（29.4%）仅PCR呈阳性，4例（23.5%）培养/PCR呈阴性。对12份样本进行单克隆抗体分型和SBT，可对8份样本进行亚型鉴定，临床分离株中嗜肺军团菌血清1型法国/阿伦敦ST23占优势。在25/34（73.5%）的病例中，确定了一个特定的城市区域为可能的疫情中心，尽管对临床和环境标本的分子分析显示嗜肺军团菌存在异质亚型。