{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T09:57:31Z","timestamp":1784627851794,"version":"3.55.0"},"reference-count":34,"publisher":"IWA Publishing","issue":"9","license":[{"start":{"date-parts":[[2023,8,21]],"date-time":"2023-08-21T00:00:00Z","timestamp":1692576000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100016993","name":"Ministry of Infrastructure and Water Management","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100016993","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["iwaponline.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p\/>\n               <jats:p>Legionnaires\u2019 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.<\/jats:p>","DOI":"10.2166\/wh.2023.164","type":"journal-article","created":{"date-parts":[[2023,8,21]],"date-time":"2023-08-21T13:57:24Z","timestamp":1692626244000},"page":"1291-1302","update-policy":"https:\/\/doi.org\/10.2166\/iwapcrossmarkpolicypage","source":"Crossref","is-referenced-by-count":13,"title":["<i>Legionella<\/i> detection in wastewater treatment plants with increased risk for <i>Legionella<\/i> growth and emission"],"prefix":"10.2166","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7537-9567","authenticated-orcid":false,"given":"Harold","family":"van den Berg","sequence":"first","affiliation":[{"name":"a National Institute for Public Health and The Environment (RIVM), Centre for Infectious Disease Control, Center for Zoonoses and Environmental Microbiology, P.O. Box 1, 3720 BA, Bilthoven, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Willemijn","family":"Lodder","sequence":"additional","affiliation":[{"name":"a National Institute for Public Health and The Environment (RIVM), Centre for Infectious Disease Control, Center for Zoonoses and Environmental Microbiology, P.O. Box 1, 3720 BA, Bilthoven, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alvin","family":"Bartels","sequence":"additional","affiliation":[{"name":"b National Institute for Public Health and The Environment (RIVM), Centre for Infectious Disease Control, National Coordination Centre for Communicable Disease Control, P.O. Box 1, 3720 BA, Bilthoven, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petra","family":"Brandsema","sequence":"additional","affiliation":[{"name":"c National Institute for Public Health and The Environment (RIVM), Centre for Infectious Disease Control, Centre for Infectious Diseases, Epidemiology and Surveillance, P.O. Box 1, 3720 BA, Bilthoven, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucie","family":"Vermeulen","sequence":"additional","affiliation":[{"name":"a National Institute for Public Health and The Environment (RIVM), Centre for Infectious Disease Control, Center for Zoonoses and Environmental Microbiology, P.O. Box 1, 3720 BA, Bilthoven, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gretta","family":"Lynch","sequence":"additional","affiliation":[{"name":"a National Institute for Public Health and The Environment (RIVM), Centre for Infectious Disease Control, Center for Zoonoses and Environmental Microbiology, P.O. Box 1, 3720 BA, Bilthoven, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sjoerd","family":"Euser","sequence":"additional","affiliation":[{"name":"d Regional Public Health Laboratory Kennemerland, Boerhaavelaan 26, 2035 RC, Haarlem, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Maria","family":"de Roda Husman","sequence":"additional","affiliation":[{"name":"a National Institute for Public Health and The Environment (RIVM), Centre for Infectious Disease Control, Center for Zoonoses and Environmental Microbiology, P.O. Box 1, 3720 BA, Bilthoven, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"945","published-online":{"date-parts":[[2023,8,21]]},"reference":[{"key":"2023092719131198500_JWH-D-23-00164C1","first-page":"493","article-title":"Chapter 119: Biological treatment of industrial wastewater: a possible source of Legionella infection","volume-title":"Legionella: State of the Art 30 Years After Its Recognition","year":"2006"},{"key":"2023092719131198500_JWH-D-23-00164C2","unstructured":"Bartels\n            A. A.\n          , van LeerdamR. C., LodderW. J., VermeulenL. C. & van den BergH. H. J. L.2019Inventarisatie van legionellarisico's bij afvalwaterzuiveringsinstallaties. RIVM Report 2019-0061."},{"key":"2023092719131198500_JWH-D-23-00164C3","doi-asserted-by":"crossref","first-page":"7360","DOI":"10.1021\/es800306m","article-title":"Tracking airborne Legionella and Legionella pneumophila at a biological treatment plant","volume":"42","year":"2008","journal-title":"Environmental Science and Technology"},{"key":"2023092719131198500_JWH-D-23-00164C4","doi-asserted-by":"crossref","first-page":"16873","DOI":"10.1007\/s11356-016-7090-6","article-title":"Occurrence of Legionella in wastewater treatment plants linked to wastewater characteristics","volume":"23","year":"2016","journal-title":"Environmental Science and Pollution Research International"},{"key":"2023092719131198500_JWH-D-23-00164C5","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.watres.2018.10.080","article-title":"Legionella occurrence in municipal and industrial wastewater treatment plants and risks of reclaimed wastewater reuse: review","volume":"149","year":"2019","journal-title":"Water Research"},{"key":"2023092719131198500_JWH-D-23-00164C6","first-page":"86","article-title":"Overview of the main disinfection processes for wastewater and drinking water treatment plants","volume":"10","year":"2018","journal-title":"Sustainability"},{"key":"2023092719131198500_JWH-D-23-00164C7","doi-asserted-by":"crossref","first-page":"1167","DOI":"10.3201\/eid2107.141130","article-title":"Results from the National Legionella Outbreak Detection Program, The Netherlands, 2002\u20132012","volume":"21","year":"2015","journal-title":"Emerging Infectious Diseases"},{"key":"2023092719131198500_JWH-D-23-00164C8","volume-title":"Regulation (EU) 2020\/741 of the Parliament and of the Council on Minimum Requirement for Water Reuse","author":"EU","year":"2022"},{"key":"2023092719131198500_JWH-D-23-00164C9","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1007\/s10096-013-1841-9","article-title":"Legionella prevention in the Netherlands: an evaluation using genotype distribution","volume":"32","year":"2013","journal-title":"European Journal of Clinical Microbiology & Infectious Diseases"},{"key":"2023092719131198500_JWH-D-23-00164C10","doi-asserted-by":"crossref","first-page":"373","DOI":"10.3390\/pathogens4020373","article-title":"Opportunistic premise plumbing pathogens: increasingly important pathogens in drinking water","volume":"4","year":"2015","journal-title":"Pathogens"},{"key":"2023092719131198500_JWH-D-23-00164C11","doi-asserted-by":"crossref","first-page":"291","DOI":"10.5271\/sjweh.437","article-title":"Pontiac fever at a sewage treatment plant in the food industry","volume":"25","year":"1999","journal-title":"Scandinavian Journal of Work, Environment & Health"},{"key":"2023092719131198500_JWH-D-23-00164C12","volume-title":"ISO 19458: 2006 Water Quality \u2013 Sampling for Microbiological Analysis","author":"International Organization for Standardization (ISO)","year":"2006"},{"key":"2023092719131198500_JWH-D-23-00164C13","volume-title":"ISO 11731:2017 Water Quality \u2013 Enumeration of Legionella","author":"International Organization for Standardization (ISO)","year":"2017"},{"key":"2023092719131198500_JWH-D-23-00164C14","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1080\/00365540510012143","article-title":"An outbreak of Legionella pneumonia originating from a cooling tower","volume":"37","year":"2005","journal-title":"Scandinavian Journal of Infectious Diseases"},{"key":"2023092719131198500_JWH-D-23-00164C15","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1186\/1471-2334-10-343","article-title":"Two Legionnaires' disease cases associated with industrial wastewater treatment plants: a case report","volume":"10","year":"2010","journal-title":"BMC Infectious Diseases"},{"key":"2023092719131198500_JWH-D-23-00164C16","unstructured":"Lodder\n            W. J.\n          , Van den BergH. H. J. L., Van LeerdamR. C. & De Roda HusmanA. M.2019Potenti\u00eble maatregelen tegen verspreiding van Legionella uit afvalwaterzuiveringsinstallaties RIVM Report 2019-0194."},{"key":"2023092719131198500_JWH-D-23-00164C17","doi-asserted-by":"crossref","first-page":"1914","DOI":"10.3201\/eid2410.180906","article-title":"Two community clusters of Legionnaires\u2019 disease directly linked to a biologic wastewater treatment plant, the Netherlands","volume":"24","year":"2018","journal-title":"Emerging Infectious Diseases"},{"key":"2023092719131198500_JWH-D-23-00164C18","doi-asserted-by":"crossref","first-page":"543","DOI":"10.2166\/wh.2014.063","article-title":"Detection of Legionella by cultivation and quantitative real-time polymerase chain reaction in biological wastewater treatment plants in Norway","volume":"12","year":"2014","journal-title":"Journal of Water and Health"},{"key":"2023092719131198500_JWH-D-23-00164C19","article-title":"Epidemiological investigation and case-control study: a Legionnaires\u2019 disease outbreak associated with cooling towers in Warstein, Germany, August-September 2013","volume":"20","year":"2015","journal-title":"Eurosurveillance"},{"key":"2023092719131198500_JWH-D-23-00164C20","doi-asserted-by":"crossref","first-page":"125","DOI":"10.2166\/ws.2004.0037","article-title":"Risk assessment of Legionella and enteric pathogens in sewage treatment works","volume":"4","year":"2004","journal-title":"Water Science & Technology Water Supply"},{"key":"2023092719131198500_JWH-D-23-00164C21","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1086\/498575","article-title":"A community-wide outbreak of legionnaires disease linked to industrial cooling towers\u2013how far can contaminated aerosols spread?","volume":"193","year":"2006","journal-title":"Journal of Infectious Diseases"},{"key":"2023092719131198500_JWH-D-23-00164C22","doi-asserted-by":"crossref","first-page":"816","DOI":"10.2166\/wst.2016.258","article-title":"Strategies for the reduction of Legionella in biological treatment systems","volume":"74","year":"2016","journal-title":"Water Science and Technology"},{"key":"2023092719131198500_JWH-D-23-00164C23","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1086\/524016","article-title":"An outbreak of Legionnaires disease caused by long-distance spread from an industrial air scrubber in Sarpsborg, Norway","volume":"46","year":"2008","journal-title":"Clinical Infectious Diseases"},{"key":"2023092719131198500_JWH-D-23-00164C24","unstructured":"Oesterholt\n            F.\n           & HollebekkersF.2022Handreiking legionellapreventie in biologische afvalwaterzuiveringsinstallaties (Nieuwegein, KWR)."},{"key":"2023092719131198500_JWH-D-23-00164C25","doi-asserted-by":"crossref","first-page":"8712","DOI":"10.1021\/es1007774","article-title":"Alternative routes for dissemination of Legionella pneumophila causing three outbreaks in Norway","volume":"44","year":"2010","journal-title":"Environmental Science and Technology"},{"key":"2023092719131198500_JWH-D-23-00164C26","unstructured":"Reukers\n            D. F. M.\n          , van AstenL., BrandsemaP. S., DijkstraF., DonkerG. A., van Gageldonk-LafeberA. B., HooiveldM., de LangeM. M. A., MarbusS., TeirlinckA. C., MeijerA. & van der HoekW.2018Annual Report Surveillance of Influenza and Other Respiratory Infections: Winter 2017\/2018 = Surveillance van griep en andere luchtweginfecties: Winter 2017\/2018. RIVM Rapport."},{"key":"2023092719131198500_JWH-D-23-00164C27","unstructured":"Reukers\n            D. F. M.\n          , van AstenL., BrandsemaP. S., DijkstraF., DonkerG. A., van Gageldonk-LafeberA. B., HooiveldM., de LangeM. M. A., MarbusS., TeirlinckA. C., MeijerA. & van der HoekW.2019Annual Report Surveillance of Influenza and Other Respiratory Infections in the Netherlands: Winter 2018\/2019. RIVM Report."},{"key":"2023092719131198500_JWH-D-23-00164C28","doi-asserted-by":"crossref","first-page":"4519","DOI":"10.1128\/AEM.00131-12","article-title":"Isolation of Legionella pneumophila from pluvial floods by amoebal coculture","volume":"78","year":"2012","journal-title":"Applied and Environmental Microbiology"},{"key":"2023092719131198500_JWH-D-23-00164C29","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.ijid.2014.05.009","article-title":"Soil as a source of Legionella pneumophila sequence type 47","volume":"27","year":"2014","journal-title":"International Journal of Infectious Diseases"},{"key":"2023092719131198500_JWH-D-23-00164C30","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1111\/j.1574-6976.2002.tb00607.x","article-title":"Legionella pneumophila: an aquatic microbe goes astray","volume":"26","year":"2002","journal-title":"FEMS Microbiology Reviews"},{"key":"2023092719131198500_JWH-D-23-00164C31","doi-asserted-by":"crossref","first-page":"4797","DOI":"10.1021\/acs.est.5b00142","article-title":"Confirmed and potential sources of Legionella reviewed","volume":"49","year":"2015","journal-title":"Environmental Science and Technology"},{"key":"2023092719131198500_JWH-D-23-00164C32","doi-asserted-by":"crossref","first-page":"113811","DOI":"10.1016\/j.ijheh.2021.113811","article-title":"Atmospheric dispersion and transmission of Legionella from wastewater treatment plants: a 6-year case-control study","volume":"237","year":"2021","journal-title":"International Journal of Hygiene and Environmental Health"},{"key":"2023092719131198500_JWH-D-23-00164C33","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1128\/aem.49.5.1197-1205.1985","article-title":"Effect of temperature, pH, and oxygen level on the multiplication of naturally occurring Legionella pneumophila in potable water","volume":"49","year":"1985","journal-title":"Applied and Environmental Microbiology"},{"key":"2023092719131198500_JWH-D-23-00164C34","doi-asserted-by":"crossref","first-page":"65","DOI":"10.3109\/1040841X.2014.885930","article-title":"Legionella detection by culture and qPCR: comparing apples and oranges","volume":"42","year":"2016","journal-title":"Critical Reviews in Microbiology"}],"container-title":["Journal of Water and Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/iwaponline.com\/jwh\/article-pdf\/21\/9\/1291\/1296646\/jwh0211291.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/iwaponline.com\/jwh\/article-pdf\/21\/9\/1291\/1296646\/jwh0211291.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,27]],"date-time":"2023-09-27T19:24:38Z","timestamp":1695842678000},"score":1,"resource":{"primary":{"URL":"https:\/\/iwaponline.com\/jwh\/article\/21\/9\/1291\/97014\/Legionella-detection-in-wastewater-treatment"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,21]]},"references-count":34,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,8,21]]},"published-print":{"date-parts":[[2023,9,1]]}},"URL":"https:\/\/doi.org\/10.2166\/wh.2023.164","relation":{},"ISSN":["1477-8920","1996-7829"],"issn-type":[{"value":"1477-8920","type":"print"},{"value":"1996-7829","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,21]]}}}