Campese, Christine

Cano, Rosa

Jarraud, Sophie

Pardos, Joana

Pelaz, Carmen

Emerging Infectious Diseases

English

PubMed

Rosa Cano

Sophie Jarraud

Joana Pardos

Christine Campese

Carmen Pelaz

Directory of Open Access Journals

Legionnaires’ Disease and Travel in Europe

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Legionnaires' Disease and Travel in Europe

Cano-Portero, Rosa

REPISALUD

LETTERS1606 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 12, No. 10, October 2006Maël Bessaud,* Christophe N. Peyrefitte,*† Boris A.M. Pastorino,* Fabienne Tock,* Olivier Merle,*Jean-Jacques Colpart,‡ Jean-Sébastien Dehecq,§ Romain Girod,* Marie-ChristineJaffar-Bandjee,¶ Pamela J. Glass,#Michael Parker,# Hugues J. Tolou,*and Marc Grandadam**Institut de médecine tropicale du Servicede santé des armées, Marseille, France;†Walter Reed Army Institute of Research,Silver Spring, Maryland, USA; ‡Agence dela biomédecine, Lyon, France; §Directionrégionale des affaires sanitaires etsociales, Saint-Denis, Île de la Réunion,France; ¶Centre hospitalier départementalFélix-Guyon, Saint-Denis, Île de laRéunion, France; and #United States ArmyMedical Research Institute for InfectiousDiseases, Fort Detrick, Maryland, USAReferences1. World Health Organization. Chikungunyain La Reunion Island (France) 2006 Feb 17[cited 2006 Aug 1]. Available from http://www.who.int/csr/don/2006_02_17a/en/2. La Réunion-Mayotte CIRE. Epidémie dechikungunya à la Réunion. Point hebdo-madaire, semaine 13. 2006 Apr 6 [cited2006 Aug 7]. Available from http://www.invs.sante.fr/presse/2006/le_point_sur/chikungunya_reunion_070406/chikungunya_s13.pdf3. Peyrefitte CN, Pastorino BAM, Bessaud M,Gravier P, Tock F, Couissinier-Paris P, et al.Dengue type 3 virus, Saint Martin,2003–2004. Emerg Infect Dis.2005;11:757–61.4. Pastorino B, Muyembe-Tamfum JJ,Bessaud M, Tock F, Tolou H, Durand JP, etal. Epidemic resurgence of chikungunyavirus in Democratic Republic of the Congo:identification of a new Central Africanstrain. J Med Virol. 2004;74:277–82.5. Charrel R, Lamballerie X. Reunionsequence. ProMed. 2006 Mar 23. Availablefrom http://www.promedmail.org, archiveno. 20060323.0896.6. Powers AM, Brault AC, Tesh RB, WeaverSC. Re-emergence of chikungunya ando’nyong-nyong viruses: evidence for dis-tinct geographical lineages and distant evo-lutionary relationships. J Gen Virol.2000;81:471–9.7. Edelman R, Tacket CO, Wasserman SS,Bodinson SA, Perry JG, Mangiafico JA.Phase II safety and immunogenicity studyof live chikungunya virus vaccine TSI-GSD-218. Am J Trop Med Hyg. 2000;62:681–5.8. Vaucel M. Affections dues aux virus:chapitre VII. Affections à virus neu-rotropes. In: Médecine tropicale. Paris:Editions Médicales Flammarion; 1966. p.1111–7.9. Jupp PG, McIntosh BM, dos Santos I,DeMoor P. Laboratory vector studies on sixmosquito and one tick species with chikun-gunya virus. Trans R Soc Trop Med Hyg.1981;75:15–9.10. Pastorino B, Bessaud M, Grandadam M,Murri S, Tolou HJ, Peyrefitte CN.Development of a TaqMan RT-PCR assaywithout RNA extraction step for the detec-tion and quantification of African chikun-gunya viruses. J Virol Methods.2005;124:65–71.Address for correspondence: Marc Grandadam,Unité de Virologie Tropicale, IMTSSA, BP 46,13 998 Marseille Armées, France; email:publi.viro@laposte.netLegionnaires’Disease and Travelin Europe To the Editor: The EuropeanWorking Group for LegionellaInfections (EWGLINET) conductsepidemiologic surveillance ofLegionnaires’ disease cases associat-ed with travel (1) and provides epi-demiologic typing markers ofLegionella pneumophila among refer-ence laboratories in collaboratingcountries. The procedures and criteriaof notification are found in theGuidelines for Control and Preventionof Travel Associated Legionnaires’Disease (2). However, establishingthe association of >1 case of this dis-ease and a specific tourist accommo-dation site is difficult because of lowattack rates and dispersal of peoplefrom the source of infection duringthe incubation period.Collaboration promoted by thisworking group encourages theexchange of data instead of cultures.This distinction is critical whenresearch is conducted on travel-asso-ciated Legionnaires’ disease, in whichstrains from patients and environmen-tal sources of infection studied are indifferent laboratories.The value of such information isshown in a complex case study thatwas recently investigated. During Julyand August 2005, two patients withLegionnaire’s disease living in 2countries in Europe were reported toEWGLINET. Patient 1 was a 45-year-old woman who traveled in Franceand Spain July 1–6, 2005. Her symp-toms started on July 6, 2005, whenshe was in Girona, Spain, where shewas hospitalized. Patient 2 was a 56-year-old woman who traveled inSpain and France August 16–21,2005. Her symptoms started onAugust 8, 2005, when she was inFrance, where she was hospitalized.Both patients tested positive for L.pneumophila serogroup 1 by specificurinary antigen test and culture, butthey recovered and were discharged.After routine notification to EWG-LINET, it was established from thelist of accommodation sites providedby the 2 patients that they each hadstayed for 1 night at the same hotel ina French city within a 45-day interval.This finding led us to identify a clus-ter according to the definition in use(2 cases associated with the sameaccommodation within 2 years) (2).However, patient 2 spent 1 day inAugust in Zaragoza, Spain, duringwhich an outbreak of Legionnaires’disease in the city affected 30 persons.Thus, illness in patient 2 could havebeen associated with the Zaragozaoutbreak. Alternatively, both patientscould have contracted the illness inde-pendently at different sites. Beforeonset, patient 1 stayed 5 days in herprivate residence in Girona andpatient 2 visited 3 other hotels.As soon as cultures from the 2patients were available, the NationalReference Laboratories of France andSpain shared their respective micro-LETTERSEmerging Infectious Diseases • www.cdc.gov/eid • Vol. 12, No. 10, October 2006 1607biologic results. Since both strainswere identified as L. pneumophilaserogroup 1, we performed sequence-based typing (SBT) (3) of 6 genes(flaA, pilE, asd, mip, mompS, andproA) by using the protocol and data-base of EWGLINET. Both isolatesshowed identical SBT patterns(2,3,18,15,2,1).Isolates from 4 patients in theZaragoza outbreak were identified atthe Spanish Reference Laboratory asL. pneumophila serogroup 1(Philadelphia monoclonal antibodytype) and had identical SBT patterns(3,4,1,1,14,9). Collaboration betweenpublic health authorities in France andSpain enabled us to eliminate theassociation of patient 2 with theZaragoza outbreak and establish anassociation of both patients with thesame site in France. Control measureswere taken at the hotel, but we couldnot obtain environmental cultures forcomparison with those of the patients.Lack of environmental data preventedinvestigation of the relationship withthe other accommodation sites visited.The SBT method provides robustgenotyping with high discriminatorypower (index of discrimination >0.94)(3). This method is less effective atdiscriminating between strains thanpulsed-field gel electrophoresis (4),but it shows excellent reproducibilityand may be useful in epidemiologicinvestigation of outbreaks caused byL. pneumophila. The availability of anonline database with accessible infor-mation is key for sharing results anddetermining the geographic distribu-tion of isolates that causeLegionnaires’ disease (4,5).This study demonstrates the criti-cal role of sharing results betweencountries that participate in a network.Agreement is essential on a standard-ized questionnaire that includes moreinformation on the patient’s exposureto a disease. Moreover, despite theperformance of the urine antigen test,cultures of clinical samples should beencouraged by clinicians and microbi-ologists. This step would permit useof techniques, such as SBT, in refer-ence laboratories and sharing ofresults. Our investigation would havebeen more difficult without this tech-nique in identifying the site where theinfection potentially originated.Rosa Cano,* Sophie Jarraud,†Joana Pardos,‡ Christine Campese,§ and Carmen Pelaz**Instituto de Salud Carlos III, Madrid,Spain; †Institut National de la Santé et dela Recherche Médicale E0230, Lyon,France; ‡Public Health Laboratory ofGirona, Catalonia, Spain; and §Institut deVeille Sanitaire, Saint-Maurice, FranceReferences1. Ricketts K, Joseph C. Travel associatedLegionnaires’ disease in Europe: 2003.Euro Surveill. 2004;9:40–3.2. European Working Group for LegionellaInfections. European guidelines for controland prevention of travel associatedLegionnaires’ disease. 2002 [cited 2006 Jul28]. Available from http://www.ewgli.org3. Gaia V, Fry NK, Afshar B, Lück PC,Meugnier H, Etienne J, et al. A consensussequence-based epidemiological typingscheme for clinical and environmental iso-lates of Legionella pneumophila. J ClinMicrobiol. 2005;43:2047–52.4. Aurell H, Farge P, Meugnier H, Gouy M,Forey F, Lina G, et al. Clinical and environ-mental isolates of Legionella pneumophilaserogroup 1 cannot be distinguished bysequence analysis of two surface proteingenes and three housekeeping genes. ApplEnviron Microbiol. 2005;71:282–9.5. Scaturro M, Losardo M, de Ponte G, RicciML. Comparison of three molecular meth-ods used for subtyping of Legionella pneu-mophila strains isolated during an epidemicof legionellosis in Rome. J Clin Microbiol.2005;43:5348–50.Address for correspondence: Carmen Pelaz,Laboratorio de Legionella, Centro Nacional deMicrobiología, Instituto de Salud Carlos III,Majadahonda 28220 Madrid, Spain; email:cpelaz@isciii.esInfluenza A VirusPB1-F2 GeneTo the Editor: Recently, Chen andco-workers described the expressionof an 11th influenza A virus protein,designated PB1-F2 because this pro-tein is encoded in the +1 open readingframe of the segment-2 RNA (1).Later, Chen et al. presented a prelimi-nary analysis of 336 PB1 sequencesfrom GenBank (2). We have extendedthe work on PB1-F2 and analyzed1,864 partial and complete segment-2sequences deposited in GenBank;these sequences belong to 79 influen-za A virus subtypes. In summary, thefollowing 8 observations shouldreceive attention: First, the size of PB1-F2 polypep-tides ranges from 79 to 101 aminoacids (aa); most isolates encode ver-sions of either 87 or 90 aa. Becausepolypeptides of 79 aa are locatedwithin mitochondria, their truncationhas no effect on the protein function.The frequency of the 79-aa PB1-F2 is≈5%.Second, a functional PB1-F2 isexpressed by 92% of all segment-2sequences, i.e., a polypeptide >78 aa.The proportion of intact PB1-F2varies according to host (humans90%, swine 76%, other mammals100%, birds 95%).Third, the H1N1 subtype compris-es 3 genetic lineages. One clade has 2branches: 1 branch includes thehuman viruses, with the pandemic1918 virus at its root; the other branchincludes the classic swine viruses.The third clade represents theEuropean porcine isolates. Althoughall classic swine sequences have atruncated PB1-F2 (in-frame stopcodons after 11, 24, and 35 codons),the early human isolates (H1N1sequences from 1918 through 1947)have an intact PB1-F2. After 1956,however, a mutation became preva-lent such that the recent sequencesstarting from A/Beijing/1/56 termi-nate after 57 codons. An exception toThe opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of theCenters for Disease Control andPrevention or the institutions with which the authors are affiliated.

Legionnaires' disease and travel in Europe

Clinical and environmental isolates of Legionella pneumophila serogroup 1 cannot be distinguished by sequence analysis of two surface protein genes and three housekeeping genes. Appl Environ Microbiol.

Comparison of three molecular methods used for subtyping of Legionella pneumophila strains isolated during an epidemic of legionellosis in

Working Group for Legionella Infections. European guidelines for control and prevention of travel associated Legionnaires’disease.

https://repisalud.isciii.es/bitstream/20.500.12105/6980/1/InfluenzaAVirusPB1_2006.pdf

Legionnaires’ Disease and Travel in Europe

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