title: Outbreak investigations and identification of legionella in contaminated water.
abstract: To avoid further cases arising from an infectious source it is essential to ensure the early identification of all potential source(s) within an identified area, or buildings, to determine if they are being managed safely; to take appropriate samples and ensure appropriate remedial actions are taken to remove the risk of further cases. If samples are to give representative results of the system at the time of sampling it is essential to ensure that they are processed appropriately using methods which are both sensitive and specific. It is also imperative that results are interpreted in context and transmitted as soon as possible to the outbreak control team to ensure appropriate and timely action is taken on sites which still pose a risk of infection. A multidisciplinary team approach and forward planning are essential to ensure that there are sufficiently trained and competent personnel and resources. Recognition of sources is dependent on many factors including thorough epidemiological investigations to narrow down the potential geographical area or water system that maybe common to the patients as agreed within the outbreak case definition. qPCR can be useful in both the elimination and identification of suspect systems/sites. However, it requires expert interpretation of results in the context of the sample site and factors which may affect the results such as the use of biocides together with the use of an algorithm for interpretation and actions to be taken to put the results in context.
authors.affiliation: Leegionella Ltd, Ruislip, UK. susannelee@leegionella.co.uk
authors.forename: Susanne
authors.initials: S
authors.lastname: Lee
authors.forename: John
authors.initials: J
authors.lastname: Lee
mesh_terms: D004196:Disease Outbreaks; D004784:Environmental Monitoring / Q000379:methods; D004812:Epidemiologic Methods; D006801:Humans; D007875:Legionella / Q000302:isolation & purification*; D007876:Legionellosis / Q000453:epidemiology*; D018570:Risk Assessment; D013048:Specimen Handling; D014871:Water Microbiology