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1.
Int J Hyg Environ Health ; 237: 113811, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34311418

RESUMO

Legionnaires Disease incidence has risen in the Netherlands in recent years. For the majority of the cases, the source of infection is never identified. Two Dutch wastewater treatment plants (WWTPs) have previously been identified as source of outbreaks of Legionnaires Disease (LD) among local residents. The objective of this study is to examine if LD patients in the Netherlands are more exposed to aerosols originating from WWTPs than controls. METHODS: An atmospheric dispersion model was used to generate nationwide exposure maps of aerosols from 776 WWTPs in the Netherlands. Municipal sewage treatment plants and industrial WWTPs were both included. Exposure of LD cases and controls at the residential address was compared, in a matched case-control design using a conditional logistic regression. Cases were notified LD cases with onset of disease in the period 2013-2018 in the Netherlands (n = 1604). RESULTS: Aerosols dispersed over a large part of the Netherlands, but modelled concentrations are estimated to be elevated in close proximity to WWTPs. A statistically significant association was found between LD and the calculated annual average aerosol concentrations originating from WWTPs (odds-ratio: 1.32 (1.06-1.63)). This association remained significant when the two outbreak-related WWTPs were removed from the analysis (odds-ratio: 1.28 (1.03-1.58)). CONCLUSION: LD cases were more exposed to aerosols from WWTPs than controls. This indicates that exposure to aerosols dispersed from WWTPs caused Legionnaires Disease in residents living near WWTPs in the period 2013-2018. In order to investigate which characteristics of WWTPs are associated with an increased LD risk, the WWTP database should be updated and more data is needed on the presence and survival of aerosolized Legionella bacteria to improve the Legionella dispersion modelling. Furthermore, it is recommended to further investigate how aerosol dispersion of WWTPs can effectively be reduced in order to reduce the potential health risk.


Assuntos
Legionella pneumophila , Legionella , Doença dos Legionários , Purificação da Água , Estudos de Casos e Controles , Surtos de Doenças , Humanos , Doença dos Legionários/epidemiologia
2.
Epidemiol Infect ; 142(11): 2360-71, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24576486

RESUMO

During August and September 2010 an unexpected high number of domestic cases of Legionnaires' disease (LD) were reported in The Netherlands. To examine this increase, patient characteristics and results of source finding and environmental sampling during the summer peak were compared to other domestic cases in 2008-2011. This analysis did not provide an explanation for the rise in cases. A similar increase in LD cases in 2006 was shown to be associated with warm and wet weather conditions, using an extended Poisson regression model with adjustment for long-term trends. This model was optimized with the new data from 2008 to 2011. The increase in 2010 was very accurately described by a model, which included temperature in the preceding 4 weeks, and precipitation in the preceding 2 weeks. These results confirm the strong association of LD incidence with weather conditions, but it remains unclear which environmental sources contributed to the 2010 summer increase.


Assuntos
Doenças Transmissíveis/epidemiologia , Surtos de Doenças , Doença dos Legionários/epidemiologia , Estações do Ano , Temperatura , Adulto , Distribuição por Idade , Idoso , Análise de Variância , Clima , Meio Ambiente , Feminino , Humanos , Incidência , Doença dos Legionários/diagnóstico , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Países Baixos/epidemiologia , Distribuição de Poisson , Estudos Retrospectivos , Fatores de Risco , Distribuição por Sexo
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