Impact of the Legionella urinary antigen test on epidemiological trends in community outbreaks of legionellosis in Catalonia, Spain, 1990-2004

Josep Alvarez, Angela Domínguez, Miquel Sabrià, Laura Ruiz, Nuria Torner, Joan Cayla, Irene Barrabeig, M. Rosa Sala, Pere Godoy, Neus Camps, Sofia Minguell

Research output: Contribution to journalArticle

Abstract

Objectives: To describe the characteristics of community outbreaks of legionellosis in Catalonia, Spain from 1990 to 2004, to compare two time periods (1990-1996 and 1997-2004), and to assess the influence of outbreak characteristics on the case fatality rate (CFR). Methods: This is a descriptive analysis of the outbreaks detected by epidemiological surveillance units in Catalonia. Variables potentially related to the CFR were analyzed by logistic regression. Results: Of the 118 outbreaks involving 690 patients (overall CFR 4.5%), the urinary antigen test (UAT) was used for first case diagnosis in 80.5%. The origin of the outbreak was identified as a cooling tower in 35.6%, as a water distribution system in a public building in 14.4%, and a water distribution system at other sites in 7.6%. Statistically significant differences were found in the CFR (12.2% vs. 3.9%; p = 0.018) and detection of the first case by UAT (0.0% vs. 87.2%; p <0.001) between the two time periods investigated. Logistic regression showed an increase in the CFR according to outbreak size (adjusted odds ratio (aOR) 1.18; 95% confidence interval (CI) 1.05-1.33) that was significantly lower in the second period (aOR 0.09; 95% CI 0.04-0.20). Conclusions: Since the UAT was introduced, early diagnosis and treatment has helped to improve the outcomes and CFR of cases involved in outbreaks of legionellosis.

Original languageEnglish (US)
JournalInternational Journal of Infectious Diseases
Volume13
Issue number6
DOIs
StatePublished - Nov 2009
Externally publishedYes

Fingerprint

Legionellosis
Legionella
Spain
Disease Outbreaks
Antigens
Mortality
Logistic Models
Odds Ratio
Confidence Intervals
Water
Early Diagnosis

Keywords

  • Case fatality rate
  • Community outbreak
  • Laboratory diagnosis
  • Legionellosis
  • Urinary antigen test

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Impact of the Legionella urinary antigen test on epidemiological trends in community outbreaks of legionellosis in Catalonia, Spain, 1990-2004. / Alvarez, Josep; Domínguez, Angela; Sabrià, Miquel; Ruiz, Laura; Torner, Nuria; Cayla, Joan; Barrabeig, Irene; Sala, M. Rosa; Godoy, Pere; Camps, Neus; Minguell, Sofia.

In: International Journal of Infectious Diseases, Vol. 13, No. 6, 11.2009.

Research output: Contribution to journalArticle

Alvarez, J, Domínguez, A, Sabrià, M, Ruiz, L, Torner, N, Cayla, J, Barrabeig, I, Sala, MR, Godoy, P, Camps, N & Minguell, S 2009, 'Impact of the Legionella urinary antigen test on epidemiological trends in community outbreaks of legionellosis in Catalonia, Spain, 1990-2004', International Journal of Infectious Diseases, vol. 13, no. 6. https://doi.org/10.1016/j.ijid.2009.01.004
Alvarez, Josep ; Domínguez, Angela ; Sabrià, Miquel ; Ruiz, Laura ; Torner, Nuria ; Cayla, Joan ; Barrabeig, Irene ; Sala, M. Rosa ; Godoy, Pere ; Camps, Neus ; Minguell, Sofia. / Impact of the Legionella urinary antigen test on epidemiological trends in community outbreaks of legionellosis in Catalonia, Spain, 1990-2004. In: International Journal of Infectious Diseases. 2009 ; Vol. 13, No. 6.
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abstract = "Objectives: To describe the characteristics of community outbreaks of legionellosis in Catalonia, Spain from 1990 to 2004, to compare two time periods (1990-1996 and 1997-2004), and to assess the influence of outbreak characteristics on the case fatality rate (CFR). Methods: This is a descriptive analysis of the outbreaks detected by epidemiological surveillance units in Catalonia. Variables potentially related to the CFR were analyzed by logistic regression. Results: Of the 118 outbreaks involving 690 patients (overall CFR 4.5{\%}), the urinary antigen test (UAT) was used for first case diagnosis in 80.5{\%}. The origin of the outbreak was identified as a cooling tower in 35.6{\%}, as a water distribution system in a public building in 14.4{\%}, and a water distribution system at other sites in 7.6{\%}. Statistically significant differences were found in the CFR (12.2{\%} vs. 3.9{\%}; p = 0.018) and detection of the first case by UAT (0.0{\%} vs. 87.2{\%}; p <0.001) between the two time periods investigated. Logistic regression showed an increase in the CFR according to outbreak size (adjusted odds ratio (aOR) 1.18; 95{\%} confidence interval (CI) 1.05-1.33) that was significantly lower in the second period (aOR 0.09; 95{\%} CI 0.04-0.20). Conclusions: Since the UAT was introduced, early diagnosis and treatment has helped to improve the outcomes and CFR of cases involved in outbreaks of legionellosis.",
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AU - Ruiz, Laura

AU - Torner, Nuria

AU - Cayla, Joan

AU - Barrabeig, Irene

AU - Sala, M. Rosa

AU - Godoy, Pere

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AU - Minguell, Sofia

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N2 - Objectives: To describe the characteristics of community outbreaks of legionellosis in Catalonia, Spain from 1990 to 2004, to compare two time periods (1990-1996 and 1997-2004), and to assess the influence of outbreak characteristics on the case fatality rate (CFR). Methods: This is a descriptive analysis of the outbreaks detected by epidemiological surveillance units in Catalonia. Variables potentially related to the CFR were analyzed by logistic regression. Results: Of the 118 outbreaks involving 690 patients (overall CFR 4.5%), the urinary antigen test (UAT) was used for first case diagnosis in 80.5%. The origin of the outbreak was identified as a cooling tower in 35.6%, as a water distribution system in a public building in 14.4%, and a water distribution system at other sites in 7.6%. Statistically significant differences were found in the CFR (12.2% vs. 3.9%; p = 0.018) and detection of the first case by UAT (0.0% vs. 87.2%; p <0.001) between the two time periods investigated. Logistic regression showed an increase in the CFR according to outbreak size (adjusted odds ratio (aOR) 1.18; 95% confidence interval (CI) 1.05-1.33) that was significantly lower in the second period (aOR 0.09; 95% CI 0.04-0.20). Conclusions: Since the UAT was introduced, early diagnosis and treatment has helped to improve the outcomes and CFR of cases involved in outbreaks of legionellosis.

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