Dispersion of Legionella bacteria in atmosphere: A practical source location estimation method

Autoři: Steven Dyke aff001;  Iain Barrass aff001;  Kevin Pollock aff002;  Ian M. Hall aff001
Působiště autorů: Emergency Response Department Science and Technology (ERD S&T), Public Health England, Porton Down, Wiltshire, United Kingdom, SP4 0JG aff001;  Health Protection Scotland, Glasgow, United Kingdom aff002;  School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom aff003
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224144


Legionnaires’ disease, a form of pneumonia which can be fatal, is transmitted via the inhalation of water droplets containing Legionella bacteria. These droplets can be dispersed in the atmosphere several kilometers from their source. The most common such sources are contaminated water within cooling towers and other air-conditioning systems but other sources such as ornamental fountains and spa pools have also caused outbreaks of the disease in the past. There is an obvious need to locate and eliminate any such sources as quickly as possible. Here a maximum likelihood model estimating the source of an outbreak from case location data has been developed and implemented. Unlike previous models, the average dose exposure sub-model is formulated using a atmospheric dispersion model. How the uncertainty in inferred parameters can be estimated is discussed. The model is applied to the 2012 Edinburgh Legionnaires’ disease outbreak.

Klíčová slova:

Aerosols – Bacterial pathogens – Data visualization – Epidemiology – Inhalation – Statistical models – Legionellosis – Legionella


1. Legionnaires’ disease. ECDC, Stockholm: European Centre for Disease Prevention and Control (ECDC); 2019.

2. Naik FC, Dabrera G. Legionnaires’ Disease in England and Wales 2014. Public Health England; 2015.

3. Currie SL, Beattie TK. Compost and Legionella longbeachae: an emerging infection? Perspectives in Public Health. 2015;135(6):309–315. doi: 10.1177/1757913915611162 26543151

4. Addiss DG, Davis JP, Wand PJ, McKinney RM, Gradus MS, Martins RR. Two Cases of Community-Acquired Legionnaires’ Disease: Evidence for Association with a Cooling Tower. The Journal of Infectious Diseases. 1989;159(3):572–575. doi: 10.1093/infdis/159.3.572 2915170

5. Bennett E, Ashton M, Calvert N, Chaloner J, Cheesbrough J, Egan J, et al. Barrow-in-Furness: a large community legionellosis outbreak in the UK. Epidemiology and Infection. 2014;142(8):1763–1777. doi: 10.1017/S0950268813002483 24112310

6. Brown CM, Nuorti PJ, Breiman RF, Hathcock AL, Fields BS, Lipman HB, et al. A community outbreak of Legionnaires’ disease linked to hospital cooling towers: an epidemiological method to calculate dose of exposure. International Journal of Epidemiology. 1999;28(2):353–359. doi: 10.1093/ije/28.2.353 10342703

7. Brown J, Hort K, Bouwman R, Capon A, Bansal N, Goldthorpe I, et al. Investigation and control of a cluster of cases of Legionnaires disease in western Sydney. Communicable Diseases Intelligence. 2001;25(2):63–66. 11432530

8. Pastoris MC, Ciceroni L, Monaco RL, Goldoni P, Mentore B, Flego G, et al. Molecular Epidemiology of an Outbreak of Legionnaires’ Disease Associated with a Cooling Tower in Genova-Sestri Ponente, Italy. European Journal of Clinical Microbiology & Infectious Diseasese. 1997;16(12):883–892. doi: 10.1007/BF01700554

9. García-Fulgueiras A, Navarro C, Fenoll D, García J, González-Diego P, Jiménez-Buñuales T, et al. Legionnaires’ Disease Outbreak in Murcia, Spain. Emerging Infectious Diseases. 2003;9(8):915–921. doi: 10.3201/eid0908.030337 12967487

10. Jansà JM, Caylà JA, Ferrer D, Gracia J, Pelaz C, Salvador M, et al. An outbreak of Legionnaires disease in an inner city district: importance of the first 24 hours in the investigation. The International Journal of Tuberculosis and Lung Disease. 2002;6(9):831–838. 12234140

11. Keramarou M, Evans MR, Team SWLDOC. A community outbreak of Legionnaires’ disease in South Wales, August-September 2010. Eurosurveillance. 2010;15(42):pii = 19691. doi: 10.2807/ese.15.42.19691-en 21034723

12. Kirrage D, Reynolds G, Smith GE, Olowokure B, Herford Legionnaires Outbreak Control Team. Investigation of an outbreak of Legionnaires’ disease: Herford, UK 2003. Respiratory Medicine. 2007;101(8):1639–1644. doi: 10.1016/j.rmed.2006.11.026 17513103

13. Nguyen TMN, Ilef D, Jarraud S, Rouil L, Campese C, Che D, et al. A Community-Wide Outbreak of Legionnaires Disease Linked to Industrial Cooling Towers—How Far Can Contaminated Aerosols Spread? The Journal of Infectious Diseases. 2006;193(1):102–111. doi: 10.1086/498575 16323138

14. Coscollá M, Fenollar J, Escribano I, González-Candelas F. Legionellosis Outbreak Associated with Asphalt Paving Machine, Spain, 2009. Emerging Infectious Diseases. 2010;16(9):1381–1387. doi: 10.3201/eid1609.100248 20735921

15. Nygård K, Werner-Johansen Ø, Rønsen S, Caugant DA, Simonsen Ø, Kanestrøm A, et al. An Outbreak of Legionnaires Disease Caused by Long-Distance Spread from an Industrial Air Scrubber in Sarpsborg, Norway. Clinical Infectious Diseases. 2008;46(1):61–69. doi: 10.1086/524016 18171215

16. Coetzee N, Duggal H, Hawker J, Ibbotson S, Harrison TG, Phin N, et al. An outbreak of Legionnaires’ disease associated with a display spa in retail premises, Stoke-on-Trent, United Kingdom, July 2012. Eurosurveillance. 2012;17(37):pii = 20271. 22995431

17. Correia AM, Gonçalves G, Reis J, Cruz JM, e Freitas JAC. An outbreak of Legionnaires’ disease in a municipality in northern Portugal. Eurosurveillance. 2001;6(7):pii = 228. doi: 10.2807/esm.06.07.00228-en

18. Egan JR, Hall IM, Lemon DJ, Leach S. Modeling Legionnaires’ Disease Outbreaks: Estimating the Timing of an Aerosolized Release Using Symptom-onset Dates. Epidemiology. 2011;22(2):188–198. doi: 10.1097/EDE.0b013e31820937c6 21242803

19. Armstrong TW, Naas CN. A Quantitative Microbial Risk Assessment Model for Legionnaires’ Disease: Animal Model Selection and Dose-Response Modeling. Risk Analysis. 2007;27(6):1581–1596. doi: 10.1111/j.1539-6924.2007.00990.x 18093054

20. Prasad B, Hamilton KA, Haas CN. Incorporating Time-Dose-Response into Legionella Outbreak Models. Risk Analysis. 2017;37(2):291–304. doi: 10.1111/risa.12630 27228068

21. Martínez-Beneito MA, Abellán JJ, López-Quílez A, Vanaclocha H, Óscar Zurriaga, Jorques G, et al. Source Detection in an Outbreak of Legionnaire’s Disease. In: Baddeley A, Gregori P, Mateu J, Stoica R, Stoyan D, editors. Case Studies in Spatial Point Process Modeling. vol. 185 of Lecture Notes in Statistics. New York: Springer; 2006. p. 169–182.

22. Bull M, Hall IM, Leach S, Robesyn E. The application of geographic information systems and spatial data during Legionnaires’ disease outbreak responses. Eurosurveillance. 2012;17(49):pii = 20331. doi: 10.2807/ese.17.49.20331-en 23231895

23. Sansom P, Copley VR, Naik FC, Leach S, Hall IM. A case-association cluster detection and visualisation tool with an application to Legionnaires’ disease. Statistics in Medicine. 2013;32(20):3522–3538. doi: 10.1002/sim.5765 23483594

24. Legrand J, Egan JR, Hall IM, Cauchemez S, Leach S, Ferguson NM. Estimating the Location and Spatial Extent of a Covert Anthrax Release. PLoS Computational Biology. 2009;5(1):e1000356. doi: 10.1371/journal.pcbi.1000356 19360099

25. Hancock PA, Rehman Y, Hall IM, Edeghere O, Danon L, House TA, et al. Strategies for Controlling Non-Transmissible Infection Outbreaks Using a Large Human Movement Data Set. PLoS Computational Biology. 2014;10(9):e1003809. doi: 10.1371/journal.pcbi.1003809 25211122

26. van Leuken JPG, Havelaar AH, van der Hoek W, Ladbury GAF, Hackert VH, Swart AN. A Model for the Early Identification of Sources of Airborne Pathogens in an Outdoor Environment. PLoS One. 2013;8(12):e80412. doi: 10.1371/journal.pone.0080412 24324598

27. Hambleton P, Broster MG, Dennis PJ, Henstridge R, Fitzgeorge R, Conlan JW. Survival of virulent Legionella pneumophila in aerosols. The Journal of Hygiene. 1983;90(3):451–460. doi: 10.1017/s0022172400029090 6863914

28. Pourchez J, Leclerc L, Girardot F, Riffard S, Prevot N, Allegra S. Experimental human-like model to assess the part of viable Legionella reaching the thoracic region after nebulization. PLoS ONE. 2017;12(10):e0186042. doi: 10.1371/journal.pone.0186042 28982141

29. Stockie JM. The Mathematics of Atmospheric Dispersion Modeling. SIAM Review. 2011;53(2):349–372. doi: 10.1137/10080991X

30. Irons JF, Dunn MJG, Kefala K, Thorn S, Lakha F, Caesar D, et al. The effect of a large Legionnaires’ disease outbreak in Southwest Edinburgh on acute and critical care services. QJM. 2013;106(12):1087–1094. doi: 10.1093/qjmed/hct167 23970183

31. Hanna SR, Briggs GA, Hosker RP Jr. Handbook of Atmospheric Diffusion. U.S. Dept. of Energy; 1982.

32. Burnham KP, Anderson DR. Multimodel Inference: Understanding AIC and BIC in Model Selection. Sociological Methods and Research. 2004;33(2):261–304. doi: 10.1177/0049124104268644

33. Legionnaires’ Disease Outbreak in South West Edinburgh June to July 2012. NHS Lothian; 2015.

34. McCormick D, Thorn S, Milne D, Evans C, Stevenson J, Llano M, et al. Public health response to an outbreak of Legionnaires’ disease in Edinburgh, United Kingdom, June 2012. Eurosurveillance. 2012;17(28):pii = 20216. doi: 10.2807/ese.17.28.20216-en 22835439

Článek vyšel v časopise


2019 Číslo 11