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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: Riccò, Matteo, Peruzzi, Simona, Ranzieri, Silvia, Giuri, Pasquale Gianluca
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8624895/
https://www.ncbi.nlm.nih.gov/pubmed/34835307
http://dx.doi.org/10.3390/microorganisms9112180
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author Riccò, Matteo
Peruzzi, Simona
Ranzieri, Silvia
Giuri, Pasquale Gianluca
author_facet Riccò, Matteo
Peruzzi, Simona
Ranzieri, Silvia
Giuri, Pasquale Gianluca
author_sort Riccò, Matteo
collection PubMed
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.
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spelling pubmed-86248952021-11-27 Epidemiology of Legionnaires’ Disease in Italy, 2004–2019: A Summary of Available Evidence Riccò, Matteo Peruzzi, Simona Ranzieri, Silvia Giuri, Pasquale Gianluca Microorganisms Review 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. MDPI 2021-10-20 /pmc/articles/PMC8624895/ /pubmed/34835307 http://dx.doi.org/10.3390/microorganisms9112180 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Riccò, Matteo
Peruzzi, Simona
Ranzieri, Silvia
Giuri, Pasquale Gianluca
Epidemiology of Legionnaires’ Disease in Italy, 2004–2019: A Summary of Available Evidence
title 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_short 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
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8624895/
https://www.ncbi.nlm.nih.gov/pubmed/34835307
http://dx.doi.org/10.3390/microorganisms9112180
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