Community Legionella outbreak linked to a cooling tower, 2022.

Background: Thirty-five laboratory-confirmed legionellosis cases were reported to the Simcoe Muskoka District Health Unit (Ontario, Canada) between September 27, 2022, and October 15, 2022, resulting in one death and 29 hospitalizations. This article describes the Legionella outbreak and highlights activities for managing the outbreak, including various environmental and infrastructural controls associated with the public health response and some of the unique challenges and potential solutions to mitigate future outbreaks. Methods: All cases of legionellosis were reported to and investigated by the local provincial health unit. Within a 6 km radius around the community, 27 cooling towers (CTs) were identified as potential sources of Legionella. Environmental samples were collected from 19 CTs and a long-term care home. Outcome: Of the 35 cases, 29 (83%) were hospitalized (including three long-term care residents) with two requiring intubation/ventilation. Of the five sputa (clinical isolates) collected from confirmed cases, four tested positive for Legionella pneumophila (one was positive for L. pneumophila serogroup 1-with the same sequence type as one of the CT isolates). Education and recommendations were provided by the local provincial health unit to operators to improve CT operation. Conclusion: Detection and management of community legionellosis outbreaks associated with CTs involve resources and time to properly identify and control risks. Measures for community risk mitigation included coordinating with provincial and community partners, developing methods to rapidly identify CTs as a likely source of infection and applying operational/maintenance/testing standards for CTs to control bacterial growth and minimize the dispersion of contaminated aerosols.

Risk communication and risk perception: lessons from the 2011 floods in Brisbane, Australia.

Risk communication and risk perception are critical factors in disaster management. Governments at all levels play a part in communicating risk, whereas the perception of risk entails active roles by community participants, including potential and actual victims of disasters. This paper discusses these matters in relation to the floods in Brisbane, Australia, in 2011. The findings are based on interviews with representatives of households whose dwellings or business premises were fully or partially inundated by the waters. The research shows how important it is to recognise the problems of institutional fragmentation in terms of communication and the active engagement of recipients in understanding and interpreting flood risk information (especially for slow-onset riverine flooding, such as that suffered by Brisbane). Locally targeted information on risk is of vital importance in avoiding the misinterpretation of warning information in relation to environmental cues and in promoting adequate responses. The paper concludes with some recommendations.

Arsenic from community water fluoridation: quantifying the effect.

Community water fluoridation is a WHO recommended strategy to prevent dental carries. One debated concern is that hydrofluorosilicic acid, used to fluoridate water, contains arsenic and poses a health risk. This study was undertaken to determine if fluoridation contributes to arsenic in drinking water, to estimate the amount of additional arsenic associated with fluoridation, and compare this to the National Sanitation Foundation/American National Standards Institute (NSF/ANSI) standard and estimates from other researchers. Using surveillance data from Ontario drinking water systems, mixed effects linear regression was performed to examine the effect of fluoridation status on the difference in arsenic concentration between raw water and treated water samples. On average, drinking water treatment was found to reduce arsenic levels in water in both fluoridated and non-fluoridated systems by 0.2 µg/L. However, fluoridated systems were associated with an additional 0.078 µg/L (95% CI 0.021, 0.136) of arsenic in water when compared to non-fluoridated systems (P = 0.008) while controlling for raw water arsenic concentrations, types of treatment processes, and source water type. Our estimate is consistent with concentrations expected from other research and is less than 10% of the NSF/ANSI standard of 1 µg/L arsenic in water. This study provides further information to inform decision-making regarding community water fluoridation.

Healthy places, active transport and path dependence: a review of the literature.

Children walking to school, people cycling to the shops or work and neighbours chatting in the street, these are some of the gauges of an active and healthy community that can be achieved through utilising good design principles. But are these principles being applied in urban developments or are policy-makers following a 'path dependent' trajectory that severely limits the best practice outcomes sought? This review examines current research on path dependence to determine how this concept advances our understanding of barriers to change in the built environment, active transport and healthy communities. An online database search of scholarly bibliographic records identified 22 relevant articles for a critical review of studies that evaluated path dependence in the urban and built environment literature with a focus on transport, urban planning and health. A thematic analysis of the articles showed that different types of path dependence have contributed to the dominance of policies and designs supporting car-based transport to the detriment of public transport and active transport modes, leading to sub-optimal development patterns becoming 'locked-in'. However, the outcomes for active transport and physical activity are not all dire, and path dependence theory does provide some guidance on changing policy to achieve better outcomes. This review suggests that path dependence is one of the best theoretical frameworks to help health promoters understand barriers to change and can provide insights into developing future successful public health interventions. Future studies could focus further on active transport, local neighbourhood development and physical activity.

Sensitivity analysis of the pressure-based direct integrity test for membranes used in drinking water treatment.

We conducted a sensitivity analysis of the commonly employed pressure-based direct integrity test (DIT), the most sensitive test for defects in low-pressure hollow fiber (LPHF) microfiltration and ultrafiltration systems used in drinking water treatment. Incorporating uncertainty to assess the practice of DIT, we find the resolution in some tests may be insufficient to verify the presence of a barrier to oocysts of Cryptosporidium. Applying distributions and boundaries derived from literature and practice, we solved for the defect size resolution (DSR) using Monte Carlo and Probability Bounds Analysis for five commercial membrane designs. Surface tension was modeled using annual temperature profiles from three rivers. Contact angle measurement error and variability were derived from literature, respectively, as a standard deviation of 5.7 degrees and +/- 9.6 degrees median change due to natural organic matter (NOM) fouling. These measures of contact angle uncertainty and variability were combined in a normal distribution with the discrete values currently applied. Additionally we considered model uncertainty, applying the maximum bubble pressure method, an established method of surface tension measurement in liquids in which the maximum air pressure in a submerged capillary is developed after the contact angle becomes zero prior to bubble formation. Where the DSR exceeds 3 microm the test design is not compliant with applicable drinking water regulations. Implications include uncertain and variable log-removal values (LRV) as determined by DIT due to the possible emergence of defects large enough to allow oocysts to pass without detection by the DIT. Specifically, we found the DSR may exceed 3 microm and may be as large as 8 microm. With the variable contact angle model, all lower bound possibilities are compliant, whereas the upper bound is over 80% noncompliant for three of five commercial designs. Using the Maximum Bubble Pressure Method, the lower bounds in three designs start to exceed 3 microm for between 50 and 100% of the produced water, whereas the upper bounds of the DSR completely exceed 3 microm for four of five commercial designs examined.