Abstract
Legionnaires' disease (LD) is a severe pneumonia mainly caused by the bacterium Legionella pneumophila. Although many environmental sources of LD have been described, the sources of the majority of non-outbreak LD cases have not been identified. In several outbreaks in the Netherlands, wastewater treatment plants (WWTPs) were identified as the most likely source of infection. In this study, four criteria for Legionella growth and emission to air and surface waters were selected based on the literature and a risk matrix was drafted. An inventory was made of all WWTPs and their characteristics in the Netherlands. The risk matrix was applied to identify WWTPs at risk for Legionella growth and emission. Wastewater was collected at WWTPs with moderate to high risk for Legionella growth and emission. In 18% of the sampled WWTPs, Legionella spp. was detected using culture methods. The presented risk matrix can be used to assess the risks of Legionella growth and emission for WWTPs and support surveillance by prioritizing WWTPs. When Legionella is detected in the wastewater, it is recommended to take action to prevent emission to air or discharge on surface waters and, if possible, reduce the Legionella concentration.
Original language | English |
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Pages (from-to) | 1291-1302 |
Number of pages | 12 |
Journal | Journal of Water and Health |
Volume | 21 |
Issue number | 9 |
DOIs | |
Publication status | Published - 1 Aug 2023 |
Externally published | Yes |
Bibliographical note
Funding Information:This study was funded by the Dutch Ministry of Infrastructure and Water Management and the Association of Environmental Agencies in the Netherlands (ODNL). The authors are grateful to environmental agencies for both carrying out the inventory and contacting the iWWTPs to sample, especially Diany Stoel and Mark van Rijn (OD Brabant Noord) for their coordinating with all environmental agencies. The authors like to thank Imke Leenen and Cora Uijterlinde (STOWA) for organizing the inventory at the cWWTPs. We thank Omegam for sampling the selected iWWTPs. Finally, the authors would like to thank Robin van Leerdam, Melissa Stunnenberg and Ingmar Janse (RIVM) and Femke van den Berg for reviewing the manuscript.
Publisher Copyright:
© 2023 The Authors.
Keywords
- Legionnaires' disease
- aerosol
- airborne
- emission
- industrial wastewater
- sewage