Schoonmaker-Bopp Dianna, Nazarian Elizabeth, Dziewulski David, Clement Ernest, Baker Deborah J, Dickinson Michelle C, Saylors Amy, Codru Neculai, Thompson Lisa, Lapierre Pascal, Dumas Nellie, Limberger Ronald, Musser Kimberlee A
Wadsworth Center, New York State Department of Health, Albany, New York, USA.
Bureau of Water Supply Protection, New York State Department of Health, Albany, New York, USA.
Appl Environ Microbiol. 2021 Jul 27;87(16):e0058021. doi: 10.1128/AEM.00580-21.
Since 1978, the New York State Department of Health's public health laboratory, Wadsworth Center (WC), in collaboration with epidemiology and environmental partners, has been committed to providing comprehensive public health testing for Legionella in New York. Statewide, clinical case counts have been increasing over time, with the highest numbers identified in 2017 and 2018 (1,022 and 1,426, respectively). Over the course of more than 40 years, the WC Legionella testing program has continuously implemented improved testing methods. The methods utilized have transitioned from solely culture-based methods for organism recovery to development of a suite of reference testing services, including identification and characterization by PCR and pulsed-field gel electrophoresis (PFGE). In the last decade, whole-genome sequencing (WGS) has further refined the ability to link outbreak strains between clinical specimens and environmental samples. Here, we review Legionnaires' disease outbreak investigations during this time period, including comprehensive testing of both clinical and environmental samples. Between 1978 and 2017, 60 outbreaks involving clinical and environmental isolates with matching PFGE patterns were detected in 49 facilities from the 157 investigations at 146 facilities. However, 97 investigations were not solved due to the lack of clinical or environmental isolates or PFGE matches. We found 69% of patient specimens from New York State (NYS) were outbreak associated, a much higher rate than observed in other published reports. The consistent application of new cutting-edge technologies and environmental regulations has resulted in successful investigations resulting in remediation efforts. Legionella, the causative agent of Legionnaires' disease (LD), can cause severe respiratory illness. In 2018, there were nearly 10,000 cases of LD reported in the United States (https://www.cdc.gov/legionella/fastfacts.html; https://wonder.cdc.gov/nndss/static/2018/annual/2018-table2h.html), with actual incidence believed to be much higher. About 10% of patients with LD will die, and as high as 90% of patients diagnosed will be hospitalized. As Legionella is spread predominantly through engineered building water systems, identifying sources of outbreaks by assessing environmental sources is key to preventing further cases LD.
自1978年以来，纽约州卫生部的公共卫生实验室沃兹沃思中心（WC）与流行病学及环境领域的合作伙伴协作，一直致力于为纽约州提供针对军团菌的全面公共卫生检测。在全州范围内，临床病例数随时间不断增加，2017年和2018年的病例数最多（分别为1022例和1426例）。在40多年的时间里，WC军团菌检测项目不断采用改进的检测方法。所使用的方法已从单纯基于培养的生物体回收方法转变为开发一套参考检测服务，包括通过聚合酶链反应（PCR）和脉冲场凝胶电泳（PFGE）进行鉴定和特征分析。在过去十年中，全基因组测序（WGS）进一步提升了将临床标本与环境样本中的暴发菌株进行关联的能力。在此，我们回顾这一时期军团病暴发调查情况，包括对临床和环境样本的全面检测。1978年至2017年期间，在146家机构的157次调查中，有49家机构检测到60起涉及临床和环境分离株且PFGE模式匹配的暴发。然而，由于缺乏临床或环境分离株或PFGE匹配，97次调查未得到解决。我们发现纽约州（NYS）69%的患者标本与暴发相关，这一比例远高于其他已发表报告中的观察值。新前沿技术和环境法规的持续应用使得调查取得成功，并促成了补救措施。军团菌是军团病（LD）的病原体，可引发严重的呼吸道疾病。2018年，美国报告了近10000例军团病病例（https://www.cdc.gov/legionella/fastfacts.html；https://wonder.cdc.gov/nndss/static/2018/annual/2018-table2h.html），实际发病率据信要高得多。约10%的军团病患者会死亡，高达90%的确诊患者会住院治疗。由于军团菌主要通过工程建筑供水系统传播，通过评估环境来源来确定暴发源头是预防更多军团病病例的关键。
