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The first study in New Zealand on the burden of Legionnaires' disease found that the number of cases of this form of pneumonia was three times higher than previously reported.
The study, led by David Murdoch, professor at the University of Otago, Christchurch, has just been published in the Infectious diseases lancet. It provides the first accurate picture of the burden of disease in New Zealand, but has international implications as few sites perform routine tests to detect potentially fatal – and preventable – bacteria.
Researchers have developed a specialized test that allows hospitalized pneumonia patients from nearly all of New Zealand during a calendar year to detect Legionella bacteria. Three times the number of diagnosed cases compared to the average number of confirmed cases in each of the previous three years.
Specifically, the researchers discovered:
- Nearly 60% of patients were older than 65 years old.
- Nearly one third of the confirmed cases lived in socio-economically disadvantaged areas.
- Nearly 80% of patients had been hospitalized in the last five years, but less than half (41%) had been hospitalized for a respiratory illness.
- High rates of the disease in areas that had previously reported a small number of cases. Notably, the Bay of Plenty District Health Board area (more than 8 cases per 100,000 population) and Hawkes and Waitemata Bay (both 6 to 8 per 100,000). Canterbury also had rates between 6 and 8 cases per 100,000 population.
- About two-thirds of the cases were hospitalized in winter and spring.
Professor Murdoch, clinical microbiologist and researcher, says that a special test called polymerase chain reaction (PCR) is the best way to diagnose Legionnaires' disease because chest X-rays or other tests do not do not differentiate this form of pneumonia from other forms. The disease requires different treatments from other types of pneumonia. The sooner the infection is treated with a bacteria-specific medicine, the better the prognosis, he says.
This research shows that the incidence of Legionnaires' disease in New Zealand is much higher than that previously identified. Indeed, our reported incidence is the highest in the world. The research also supports the systematic use of the PCR test to detect and ensure access to appropriate treatments ".
Professor Murdoch
The results are relevant for other countries because the bacterium that causes legionellosis is present internationally, but few countries have routine tests in place, said the Professor Murdoch.
The study identified that the most common form of bacteria at the origin of the disease in New Zealand was Legionella longbeache (in 63% of cases). This strain is found in soil and composted plant material, and those most at risk are those involved in gardening activities.
To get their results, the research team tested all respiratory specimens from pneumonia patients admitted to one of the 20 participating hospitals between May 2015 and May 2016. During the year, A total of 238 cases were identified, or 5.4 cases per 100,000 New Zealanders. This rate was three times higher than expected based on the number of people diagnosed in the previous three years. Of the 238 cases, 15 died within 90 days of diagnosis and 38 required treatment in an intensive care unit.
According to Professor Murdoch, the research was made possible through the participation of staff and laboratories from 20 hospitals and 17 different district health councils. It is unusual for this degree of collaboration on research projects, he said.
The research was funded by the New Zealand Health Research Council (HRC).
Kath McPherson, Executive Director of HRC, said the study demonstrated the vital importance of having accurate data. "Without reliable data, we can completely underestimate the magnitude of a problem and make uninformed decisions, which can have extremely negative health consequences." It's very nice to see this huge effort to reach definitive conclusions that should inform practices and policies in our country and at the international level where such work has not been done. "
Source:
University of Otago
Journal reference:
Murdoch, D.R. et al. (2019) The burden of legionellosis in New Zealand (LegiNZ): a national surveillance study. Infectious diseases lancet. doi.org/10.1016/S1473-3099(19)30113-6.
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