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Volume 24, Number 10—October 2018

Two Community Clusters of Legionnaires’ Disease Directly Linked to a Biologic Wastewater Treatment Plant, the Netherlands

Anna D. LoenenbachComments to Author , Christian Beulens, Sjoerd M. Euser, Jeroen P.G. van Leuken, Ben Bom, Wim van der Hoek, Ana Maria de Roda Husman, Wilhelmina L.M. Ruijs, Alvin A. Bartels, Ariene Rietveld, Jeroen W. den Boer, and Petra S. Brandsema
Author affiliations: European Centre for Disease Prevention and Control, Stockholm, Sweden (A.D. Loenenbach); National Institute for Public Health and the Environment, Bilthoven, the Netherlands (A.D. Loenenbach, J.P.G. van Leuken, B. Bom, W. van der Hoek, A.M. de Roda Husman, W.L.M. Ruijs, A.A. Bartels, P.S. Brandsema); Municipal Health Service Hart voor Brabant, ’s-Hertogenbosch, Tilburg, the Netherlands (C. Beulens, A. Rietveld); Regional Public Health Laboratory Kennemerland, Haarlem, the Netherlands (S.M. Euser, J.W. den Boer); Utrecht University, Utrecht, the Netherlands (A.M. de Roda Husman)

Main Article

Table 1

Characteristics of 14 case-patients in 2 community clusters of Legionnaires’ disease directly linked to a biologic wastewater treatment plant, Boxtel, the Netherlands, October 2016–December 2017*

Characteristic No. (%)
Cluster 1, n = 6 Cluster 2, n = 8 Clusters 1 and 2, N = 14
Patient characteristics
Median age >72 y 5 (35.7)
Sex 8 (57.1)
M 8 (57.1)
F 6 (42.9)
Smoking 7 (50.0)
Co-morbid conditions 11 (78.6)
Hospital admission 14 (100)
ICU admission

Diagnostic results
Legionella culture performed 6 (42.9)
LP sg1 culture positive 5 (35.7)
Urine antigen test positive 14 (100)
LP PCR positive

Typing results
ST1646 2 (33.3) 3 (37.5) 5 (35.7)
Non-ST1646‡ 2 (33.3) 0 2 (14.3)
No isolate 2 (33.3) 5 (62.5) 7 (50.0)

*Sources: National Notification Database Osiris; Database National Reference Laboratory for Legionella, Haarlem, the Netherlands. ICU, intensive-care unit; LP, Legionella pneumophila; ST, sequence type.
†Number of PCR tests performed is not available; only number of tests with positive results known.
‡Obtained through nested PCR with direct sequence–based typing.

Main Article

Page created: September 16, 2018
Page updated: September 16, 2018
Page reviewed: September 16, 2018
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.