The burden of Legionnaires' disease in New Zealand (LegiNZ): a national surveillance study.

Autor:	Priest PC; Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand., Slow S; Department of Pathology and Biomedical Science, University of Otago Christchurch, Christchurch, New Zealand., Chambers ST; Department of Pathology and Biomedical Science, University of Otago Christchurch, Christchurch, New Zealand., Cameron CM; Deans Office, Dunedin School of Medicine, University of Otago, Dunedin New Zealand., Balm MN; Wellington Southern Community Laboratories, Wellington Hospital, Wellington, New Zealand., Beale MW; Palmerston North Hospital, Palmerston North, New Zealand., Blackmore TK; Wellington Southern Community Laboratories, Wellington Hospital, Wellington, New Zealand., Burns AD; Hawke's Bay Hospital, Hastings, New Zealand., Drinković D; North Shore Hospital, Takapuna, Auckland, New Zealand., Elvy JA; Nelson Hospital, Nelson, New Zealand., Everts RJ; Nelson Hospital, Nelson, New Zealand., Hammer DA; Whangarei Hospital, Whangarei, New Zealand., Huggan PJ; Waikato Hospital, Hamilton, New Zealand., Mansell CJ; Waikato Hospital, Hamilton, New Zealand., Raeder VM; Grey Base Hospital, Greymouth, New Zealand., Roberts SA; Auckland City Hospital, Auckland, New Zealand., Robinson MC; PathLab, Tauranga, New Zealand., Sathyendran V; PathLab, Tauranga, New Zealand., Taylor SL; Middlemore Hospital, Otahuhu, Auckland, New Zealand., Thompson AW; Gisborne Hospital, Gisborne, New Zealand., Ussher JE; Southern Community Laboratories, Dunedin Hospital, Dunedin, New Zealand., van der Linden AJ; Southern Community Laboratories, Dunedin Hospital, Dunedin, New Zealand., Williams MJ; Taranaki Base Hospital, New Plymouth, New Zealand., Podmore RG; Canterbury Health Laboratories, Christchurch, New Zealand., Anderson TP; Canterbury Health Laboratories, Christchurch, New Zealand., Barratt K; Canterbury Health Laboratories, Christchurch, New Zealand., Mitchell JL; Canterbury Health Laboratories, Christchurch, New Zealand., Harte DJ; Legionella Reference Laboratory, Institute of Environmental Science and Research, Porirua, New Zealand., Hope VT; Health Programme, Institute of Environmental Science and Research, Upper Hutt, New Zealand., Murdoch DR; Department of Pathology and Biomedical Science, University of Otago Christchurch, Christchurch, New Zealand. Electronic address: david.murdoch@otago.ac.nz.
Jazyk:	angličtina
Zdroj:	The Lancet. Infectious diseases [Lancet Infect Dis] 2019 Jul; Vol. 19 (7), pp. 770-777. Date of Electronic Publication: 2019 Jun 10.
DOI:	10.1016/S1473-3099(19)30113-6
Abstrakt:	Background: Legionnaires' disease is under-diagnosed because of inconsistent use of diagnostic tests and uncertainty about whom to test. We assessed the increase in case detection following large-scale introduction of routine PCR testing of respiratory specimens in New Zealand. Methods: LegiNZ was a national surveillance study done over 1-year in which active case-finding was used to maximise the identification of cases of Legionnaires' disease in hospitals. Respiratory specimens from patients of any age with pneumonia, who could provide an eligible lower respiratory specimen, admitted to one of 20 participating hospitals, covering a catchment area of 96% of New Zealand's population, were routinely tested for legionella by PCR. Additional cases of Legionnaires' disease in hospital were identified through mandatory notification. Findings: Between May 21, 2015, and May 20, 2016, 5622 eligible specimens from 4862 patients were tested by PCR. From these, 197 cases of Legionnaires' disease were detected. An additional 41 cases were identified from notification data, giving 238 cases requiring hospitalisation. The overall incidence of Legionnaires' disease cases in hospital in the study area was 5·4 per 100 000 people per year, and Legionella longbeachae was the predominant cause, found in 150 (63%) of 238 cases. Interpretation: The rate of notified disease during the study period was three-times the average over the preceding 3 years. Active case-finding through systematic PCR testing better clarified the regional epidemiology of Legionnaires' disease and uncovered an otherwise hidden burden of disease. These data inform local Legionnaires' disease testing strategies, allow targeted antibiotic therapy, and help identify outbreaks and effective prevention strategies. The same approach might have similar benefits if applied elsewhere in the world. Funding: Health Research Council of New Zealand. (Copyright © 2019 Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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