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- Title
Multiple Sources of the Outbreak of Legionnaires' Disease in Genesee County, Michigan, in 2014 and 2015.
- Authors
Smith, Anya F.; Huss, Anke; Dorevitch, Samuel; Heijnen, Leo; Arntzen, Vera H.; Davies, Megan; Ry van Beest Holle, Mirna Robert-Du; Yuki Fujita; Verschoor, Antonie M.; Raterman, Bernard; Oesterholt, Frank; Heederik, Dick; Medema, Gertjan
- Abstract
BACKGROUND: A community-wide outbreak of Legionnaires’ disease (LD) occurred in Genesee County, Michigan, in 2014 and 2015. Previous reports about the outbreak are conflicting and have associated the outbreak with a change of water source in the city of Flint and, alternatively, to a Flint hospital. OBJECTIVE: The objective of this investigation was to independently identify relevant sources of Legionella pneumophila that likely resulted in the outbreak. METHODS: An independent, retrospective investigation of the outbreak was conducted, making use of public health, health care, and environmental data and whole-genome multilocus sequence typing (wgMLST) of clinical and environmental isolates. RESULTS: Strong evidence was found for a hospital-associated outbreak in both 2014 and 2015: a) 49% of cases had prior exposure to Flint hospital A, significantly higher than expected from Medicare admissions; b) hospital plumbing contained high levels of L. pneumophila; c) Legionella control measures in hospital plumbing aligned with subsidence of hospital A-associated cases; and d) wgMLST showed Legionella isolates from cases exposed to hospital A and from hospital plumbing to be highly similar. Multivariate analysis showed an increased risk of LD in 2014 for people residing in a home that received Flint water or was located in proximity to several Flint cooling towers. DISCUSSION: This is the first LD outbreak in the United States with evidence for three sources (in 2014): a) exposure to hospital A, b) receiving Flint water at home, and c) residential proximity to cooling towers; however, for 2015, evidence points to hospital A only. Each source could be associated with only a proportion of cases. A focus on a single source may have delayed recognition and remediation of other significant sources of L. pneumophila.
- Subjects
MICHIGAN; RISK factors of epidemics; CENTERS for Disease Control &; Prevention (U.S.); CHI-squared test; CONFIDENCE intervals; CROSS infection; LEGIONELLA; LEGIONNAIRES' disease; MULTIVARIATE analysis; QUESTIONNAIRES; RISK assessment; AQUATIC microbiology; WATER supply; GENOMICS; RETROSPECTIVE studies; DISEASE risk factors
- Publication
Environmental Health Perspectives, 2019, Vol 127, Issue 12, p127001-1
- ISSN
0091-6765
- Publication type
Article
- DOI
10.1289/EHP5663