{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T03:03:57Z","timestamp":1790651037158,"version":"4.1.0"},"reference-count":18,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2022,1,20]],"date-time":"2022-01-20T00:00:00Z","timestamp":1642636800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>An outbreak of Legionnaires\u2019 disease affected 18 people in Montpellier, a town of the south of France, between December 2016 and July 2017. All cases were diagnosed by a positive urinary antigen test. No deaths were reported. Epidemiological, environmental and genomic investigations (nested Sequence-Based Typing (nSBT) and whole genome sequencing) were undertaken. For the cases for which we had information, four had a new isolate (ST2471), one had a different new isolate (ST2470), one had a genomic pattern compatible with the ST2471 identified by nSBT (flaA = 3), and one had a genomic pattern not compatible with two previous identified STs (pilE = 6). The analysis conducted on the pool of an aquatic therapy center revealed seven isolates of Legionella pneumophila. Whole genome analysis confirmed the link between the environmental and clinical isolates for both ST2470 and ST2471. As the outbreak occurred slowly, with several weeks between new cases, it was not possible to immediately identify a common source. The sixth case was the first to report having aquatic therapy care. Of the 18 cases, eight had attended the aquatic therapy center and the other 10 were inhabitants who lived, worked or walked close to the center. The main cause for this outbreak was the lack of facility maintenance. This investigation highlights the risk to public health of aquatic therapy centers for users and nearby populations, and emphasizes the need for risk reduction measures with specific guidelines to improve health and safety in aquatic facilities.<\/jats:p>","DOI":"10.3390\/ijerph19031119","type":"journal-article","created":{"date-parts":[[2022,1,20]],"date-time":"2022-01-20T22:40:20Z","timestamp":1642718420000},"page":"1119","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["A Community Outbreak of Legionnaires\u2019 Disease with Two Strains of L. pneumophila Serogroup 1 Linked to an Aquatic Therapy Centre"],"prefix":"10.3390","volume":"19","author":[{"given":"Cyril","family":"Rousseau","sequence":"first","affiliation":[{"name":"The French Public Health Agency (Sant\u00e9 Publique France), Region Division\u2014Occitanie, 31050 Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5597-094X","authenticated-orcid":false,"given":"Christophe","family":"Ginevra","sequence":"additional","affiliation":[{"name":"The National Reference Center of <i>Legionella<\/i>, 69317 Lyon, France"},{"name":"CIRI, Centre International de Recherche en Infectiologie, Inserm, U1111, Universit\u00e9 Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Sup\u00e9rieure de Lyon, 69007 Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leslie","family":"Simac","sequence":"additional","affiliation":[{"name":"The French Public Health Agency (Sant\u00e9 Publique France), Region Division\u2014Occitanie, 31050 Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noel","family":"Fiard","sequence":"additional","affiliation":[{"name":"The Regional Health Agency of Occitanie, 34000 Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karine","family":"Vilhes","sequence":"additional","affiliation":[{"name":"The Regional Health Agency of Occitanie, 34000 Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne-Ga\u00eblle","family":"Ranc","sequence":"additional","affiliation":[{"name":"The National Reference Center of <i>Legionella<\/i>, 69317 Lyon, France"},{"name":"CIRI, Centre International de Recherche en Infectiologie, Inserm, U1111, Universit\u00e9 Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Sup\u00e9rieure de Lyon, 69007 Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5750-0215","authenticated-orcid":false,"given":"Sophie","family":"Jarraud","sequence":"additional","affiliation":[{"name":"The National Reference Center of <i>Legionella<\/i>, 69317 Lyon, France"},{"name":"CIRI, Centre International de Recherche en Infectiologie, Inserm, U1111, Universit\u00e9 Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Sup\u00e9rieure de Lyon, 69007 Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Herv\u00e9","family":"Gornes","sequence":"additional","affiliation":[{"name":"The Regional Health Agency of Occitanie, 34000 Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damien","family":"Mouly","sequence":"additional","affiliation":[{"name":"The French Public Health Agency (Sant\u00e9 Publique France), Region Division\u2014Occitanie, 31050 Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Campese","sequence":"additional","affiliation":[{"name":"The French Public Health Agency (Sant\u00e9 Publique France), Infectious Disease Direction, 94415 Saint-Maurice, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1016\/S0140-6736(15)60078-2","article-title":"Legionnaires\u2019 disease","volume":"387","author":"Cunha","year":"2016","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1016\/S1473-3099(14)70713-3","article-title":"Epidemiology and clinical management of Legionnaires\u2019 disease","volume":"14","author":"Phin","year":"2014","journal-title":"Lancet Infect. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1016\/j.ijheh.2018.04.013","article-title":"Environmental sources of community-acquired legionnaires\u2019 disease: A review","volume":"221","author":"Orkis","year":"2018","journal-title":"Int. J. Hyg. Environ. Health"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2644","DOI":"10.1017\/S0950268813000502","article-title":"Legionnaires\u2019 disease in France: Sensitivity of the mandatory notification has improved over the last decade","volume":"141","author":"Campese","year":"2013","journal-title":"Epidemiology Infect."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1086\/663711","article-title":"An Outbreak of Legionnaires Disease Associated with a Decorative Water Wall Fountain in a Hospital","volume":"33","author":"Haupt","year":"2012","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1111\/j.1601-5037.2007.00280.x","article-title":"Legionella pneumophila contamination of a dental unit water line system in a dental teaching centre","volume":"6","author":"Hindiyeh","year":"2008","journal-title":"Int. J. Dent. Hyg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1093\/infdis\/163.3.667","article-title":"Nosocomial Legionnaires\u2019 Disease and Use of Medication Nebulizers","volume":"163","author":"Mastro","year":"1991","journal-title":"J. Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.medmal.2015.01.015","article-title":"Legionnaires\u2019 disease in France","volume":"45","author":"Descours","year":"2015","journal-title":"Med. Mal. Infect."},{"key":"ref_9","first-page":"3063","article-title":"Outbreak of legionellosis suspected to be related to a whirlpool spa display 2006, Lorquin, France","volume":"11","author":"Alsibai","year":"2006","journal-title":"Euro Surveill."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1880","DOI":"10.3201\/eid2311.161390","article-title":"Street Cleaning Trucks as Potential Sources of Legionella pneumophila","volume":"23","author":"Valero","year":"2017","journal-title":"Emerg. Infect. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1016\/j.cmi.2017.01.002","article-title":"A bioinformatics tool for ensuring the backwards compatibility of Legionella pneumophila typing in the genomic era","volume":"23","author":"Gordon","year":"2017","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_12","first-page":"e000166","article-title":"chewBBACA: A complete suite for gene-by-gene schema creation and strain identification","volume":"4","author":"Silva","year":"2018","journal-title":"Microb. Genom."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1128\/JCM.02071-08","article-title":"Evaluation of a Nested-PCR-Derived Sequence-Based Typing Method Applied Directly to Respiratory Samples from Patients with Legionnaires\u2019 Disease","volume":"47","author":"Ginevra","year":"2009","journal-title":"J. Clin. Microbiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"349","DOI":"10.3201\/eid2302.161012","article-title":"Outbreak of Legionnaire\u2019s Disease Caused by Legionella pneumophila Serogroups 1 and 13","volume":"23","author":"Kuroki","year":"2017","journal-title":"Emerg. Infect. Dis."},{"key":"ref_15","first-page":"1556","article-title":"Genomic Investigation of a Legionellosis Outbreak in a Persistently Colonized Hotel","volume":"6","author":"Eguiral","year":"2016","journal-title":"Front. Microbiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1093\/ije\/29.6.1092","article-title":"Outbreak of Legionnaires\u2019 disease associated with a display whirlpool spa","volume":"29","author":"Benkel","year":"2000","journal-title":"Int. J. Epidemiol."},{"key":"ref_17","first-page":"349","article-title":"Outbreak of legionellosis associated with a spa pool, United Kingdom","volume":"23","author":"Foster","year":"2017","journal-title":"Emerg. Infect Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"37","DOI":"10.3201\/eid0801.010176","article-title":"A large outbreak of Legionnaires\u2019 disease at a flower show, the Netherlands, 1999","volume":"8","author":"Yzerman","year":"2002","journal-title":"Emerg. Infect. Dis."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/3\/1119\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:04:27Z","timestamp":1760133867000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/3\/1119"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,20]]},"references-count":18,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,2]]}},"alternative-id":["ijerph19031119"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19031119","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,20]]}}}