Epidemiology of Legionnaires’ Disease in Italy, 2004–2019: A Summary of Available Evidence

Legionnaires’ disease (LD) incidence has been increasing in several European countries since 2011. Currently, Italy is experiencing high notification rates for LD, whose cause still remains scarcely understood. We sought to summarize the available evidence on the epidemiology of LD in Italy (2004–20...

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Autores principales:	Matteo Riccò, Simona Peruzzi, Silvia Ranzieri, Pasquale Gianluca Giuri
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	<i>Legionella</i> pneumophila typing Legionnaires’ disease cultivation diagnosis epidemiology Biology (General) QH301-705.5
Acceso en línea:	https://doaj.org/article/03a11152fed0460da7c5b0685e1cf24d
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spelling	oai:doaj.org-article:03a11152fed0460da7c5b0685e1cf24d2021-11-25T18:24:02ZEpidemiology of Legionnaires’ Disease in Italy, 2004–2019: A Summary of Available Evidence10.3390/microorganisms91121802076-2607https://doaj.org/article/03a11152fed0460da7c5b0685e1cf24d2021-10-01T00:00:00Zhttps://www.mdpi.com/2076-2607/9/11/2180https://doaj.org/toc/2076-2607Legionnaires’ disease (LD) incidence has been increasing in several European countries since 2011. Currently, Italy is experiencing high notification rates for LD, whose cause still remains scarcely understood. We sought to summarize the available evidence on the epidemiology of LD in Italy (2004–2019), characterizing the risk of LD by region, sex, age group, and settings of the case (i.e., community, healthcare, or travel-associated cases). Environmental factors (e.g., average air temperatures and relative humidity) were also included in a Poisson regression model in order to assess their potential role on the annual incidence of new LD cases. National surveillance data included a total of 23,554 LD cases occurring between 2004 and 2019 (70.4% of them were of male gender, 94.1% were aged 40 years and older), with age-adjusted incidence rates increasing from 1.053 cases per 100,000 in 2004 to 4.559 per 100,000 in 2019. The majority of incident cases came from northern Italy (43.2% from northwestern Italy, 25.6% from northeastern Italy). Of these, 5.9% were healthcare-related, and 21.1% were travel-associated. A case-fatality ratio of 5.2% was calculated for the whole of the assessed timeframe, with a pooled estimate for mortality of 0.122 events per 100,000 population per year. Poisson regression analysis was associated with conflicting results, as any increase in average air temperature resulted in reduced risk for LD cases (Incidence Rate Ratio [IRR] 0.807, 95% Confidence Interval [95% CI] 0.744–0.874), while higher annual income in older individuals was associated with an increased IRR (1.238, 95% CI 1.134–1.351). The relative differences in incidence between Italian regions could not be explained by demographic factors (i.e., age and sex distribution of the population), and also a critical reappraisal of environmental factors failed to substantiate both the varying incidence across the country and the decennial trend we were able to identify.Matteo RiccòSimona PeruzziSilvia RanzieriPasquale Gianluca GiuriMDPI AGarticle<i>Legionella</i> pneumophila typingLegionnaires’ diseasecultivationdiagnosisepidemiologyBiology (General)QH301-705.5ENMicroorganisms, Vol 9, Iss 2180, p 2180 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	<i>Legionella</i> pneumophila typing Legionnaires’ disease cultivation diagnosis epidemiology Biology (General) QH301-705.5
spellingShingle	<i>Legionella</i> pneumophila typing Legionnaires’ disease cultivation diagnosis epidemiology Biology (General) QH301-705.5 Matteo Riccò Simona Peruzzi Silvia Ranzieri Pasquale Gianluca Giuri Epidemiology of Legionnaires’ Disease in Italy, 2004–2019: A Summary of Available Evidence
description	Legionnaires’ disease (LD) incidence has been increasing in several European countries since 2011. Currently, Italy is experiencing high notification rates for LD, whose cause still remains scarcely understood. We sought to summarize the available evidence on the epidemiology of LD in Italy (2004–2019), characterizing the risk of LD by region, sex, age group, and settings of the case (i.e., community, healthcare, or travel-associated cases). Environmental factors (e.g., average air temperatures and relative humidity) were also included in a Poisson regression model in order to assess their potential role on the annual incidence of new LD cases. National surveillance data included a total of 23,554 LD cases occurring between 2004 and 2019 (70.4% of them were of male gender, 94.1% were aged 40 years and older), with age-adjusted incidence rates increasing from 1.053 cases per 100,000 in 2004 to 4.559 per 100,000 in 2019. The majority of incident cases came from northern Italy (43.2% from northwestern Italy, 25.6% from northeastern Italy). Of these, 5.9% were healthcare-related, and 21.1% were travel-associated. A case-fatality ratio of 5.2% was calculated for the whole of the assessed timeframe, with a pooled estimate for mortality of 0.122 events per 100,000 population per year. Poisson regression analysis was associated with conflicting results, as any increase in average air temperature resulted in reduced risk for LD cases (Incidence Rate Ratio [IRR] 0.807, 95% Confidence Interval [95% CI] 0.744–0.874), while higher annual income in older individuals was associated with an increased IRR (1.238, 95% CI 1.134–1.351). The relative differences in incidence between Italian regions could not be explained by demographic factors (i.e., age and sex distribution of the population), and also a critical reappraisal of environmental factors failed to substantiate both the varying incidence across the country and the decennial trend we were able to identify.
format	article
author	Matteo Riccò Simona Peruzzi Silvia Ranzieri Pasquale Gianluca Giuri
author_facet	Matteo Riccò Simona Peruzzi Silvia Ranzieri Pasquale Gianluca Giuri
author_sort	Matteo Riccò
title	Epidemiology of Legionnaires’ Disease in Italy, 2004–2019: A Summary of Available Evidence
title_short	Epidemiology of Legionnaires’ Disease in Italy, 2004–2019: A Summary of Available Evidence
title_full	Epidemiology of Legionnaires’ Disease in Italy, 2004–2019: A Summary of Available Evidence
title_fullStr	Epidemiology of Legionnaires’ Disease in Italy, 2004–2019: A Summary of Available Evidence
title_full_unstemmed	Epidemiology of Legionnaires’ Disease in Italy, 2004–2019: A Summary of Available Evidence
title_sort	epidemiology of legionnaires’ disease in italy, 2004–2019: a summary of available evidence
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/03a11152fed0460da7c5b0685e1cf24d
work_keys_str_mv	AT matteoricco epidemiologyoflegionnairesdiseaseinitaly20042019asummaryofavailableevidence AT simonaperuzzi epidemiologyoflegionnairesdiseaseinitaly20042019asummaryofavailableevidence AT silviaranzieri epidemiologyoflegionnairesdiseaseinitaly20042019asummaryofavailableevidence AT pasqualegianlucagiuri epidemiologyoflegionnairesdiseaseinitaly20042019asummaryofavailableevidence
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Epidemiology of Legionnaires’ Disease in Italy, 2004–2019: A Summary of Available Evidence

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