Is there a relationship between monthly rainfall and the isolation of Legionella in potable water systems in Spanish healthcare facilities?

Under the Weather: Legionellosis and Meteorological Factors

The incidence of legionellosis, caused by the bacteria Legionella which are commonly found in the environment, has been increasing in New Jersey (NJ) over the last decade. The majority of cases are sporadic with no known source of exposure. Meteorological factors may be associated with increases in legionellosis. Time series and case-crossover study designs were used to evaluate associations of legionellosis and meteorological factors (temperature (daily minimum, maximum, and mean), precipitation, dew point, relative humidity, sea level pressure, wind speed (daily maximum and mean), gust, and visibility). Time series analyses of multi-factor models indicated increases in monthly relative humidity and precipitation were positively associated with monthly legionellosis rate, while maximum temperature and visibility were inversely associated. Case-crossover analyses of multi-factor models indicated increases in relative humidity occurring likely before incubation period was positively associated, while sea level pressure and visibility, also likely preceding incubation period, were inversely associated. It is possible that meteorological factors, such as wet, humid weather with low barometric pressure, allow proliferation of Legionella in natural environments, increasing the rate of legionellosis.

Precipitation increases the occurrence of sporadic legionnaires' disease in Taiwan

Legionnaires' disease (LD) is an acute form of pneumonia, and changing weather is considered a plausible risk factor. Yet, the relationship between weather and LD has rarely been investigated, especially using long-term daily data. In this study, daily data was used to evaluate the impacts of precipitation, temperature, and relative humidity on LD occurrence in Taiwan from 1995-2011. A time-stratified 2:1 matched-period case-crossover design was used to compare each case with self-controlled data using a conditional logistic regression analysis, and odds ratios (ORs) for LD occurrence was estimated. The city, gender and age were defined as a stratum for each matched set to modify the effects. For lag day- 0 to 15, the precipitation at lag day-11 significantly affected LD occurrence (p<0.05), and a 2.5% (95% CIs = 0.3-4.7%) increased risk of LD occurrence was associated with every 5-mm increase in precipitation. In addition, stratified analyses further showed that positive associations of precipitation with LD incidence were only significant in male and elderly groups and during the warm season ORs = 1.023-1.029). However, such an effect was not completely linear. Only precipitations at 21-40 (OR = 1.643 (95% CIs = 1.074-2.513)) and 61-80 mm (OR = 2.572 (1.106-5.978)) significantly increased the risk of LD occurrence. Moreover, a negative correlation between mean temperature at an 11-day lag and LD occurrence was also found (OR = 0.975 (0.953-0.996)). No significant association between relative humidity and LD occurrence was identified (p>0.05). In conclusion, in warm, humid regions, an increase of daily precipitation is likely to be a critical weather factor triggering LD occurrence where the risk is found particularly significant at an 11-day lag. Additionally, precipitation at 21-40 and 61-80 mm might make LD occurrence more likely.

Analysis of the impact of a new electro-chemical activation system for potable water disinfection on the Legionella pneumophila isolation rate in a Spanish hospital

In a field study comparing isolation rates pre- and post-installation of an electro-chemical activation system for Legionella pneumophila disinfection of potable hot water in a Spanish hospital, a total of 250 tap samples pre-installation and 113 post-installation were collected. Chlorine levels were higher ( p < 0.001) post-installation (0.55 ± 0.41 vs. 1.19 ± 0.44 ppm). Of 38.0% (138/363) samples positive for L. pneumophila, 111 (80.4%) were serogroups 2—14. Post-installation, the isolation rate was lower (46.8% vs. 18.6%; p < 0.001, odds ratio (OR) 0.26, 95% confidence interval (CI) 0.15—0.44) due to significant ( p < 0.001; OR 0.25, 95% CI 0.14—0.45) reduction in L. pneumophila serogroups 2—14 from 38.4% to 13.3%. Post-installation, isolation rates were lower in spring (44.4% vs. 0.0%; p < 0.001), summer (80.0% vs. 25.0%; p = 0.003) and autumn (72.0% vs. 28.9%; p = 0.018), but not in winter (18.5% vs. 11.8%; p = 0.688). The seasonal wave constructed with pre-installation data significantly decreased post-installation by decreasing isolation rates in summer and autumn to rates similar to those found in winter pre-installation.