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Legionnaires’ Disease on the Rise in Switzerland: A Denominator-Based Analysis of National Diagnostic Data, 2007–2016

1
Swiss Tropical and Public Health Institute, 4001 Basel, Switzerland
2
Faculty of Science, University of Basel, 4002 Basel, Switzerland
3
National Reference Center for Legionella, Service of Microbiology, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2020, 17(19), 7343; https://doi.org/10.3390/ijerph17197343
Received: 14 September 2020 / Revised: 2 October 2020 / Accepted: 3 October 2020 / Published: 8 October 2020
(This article belongs to the Section Infectious Disease Epidemiology)
The risk of falling ill with Legionnaires’ disease (LD) is suggested to increase, but the global burden of disease is unknown due to a lack of appropriate diagnosis and surveillance systems. In Switzerland, the number of LD cases, captured by the National Notification System for Infectious Diseases, has more than doubled since 2008. This study aims to investigate this increase, contextualizing disease surveillance data with denominator data, which is not routinely available, i.e., the number of tests performed for Legionella spp. We collected the testing data for Legionella spp. of 14 Swiss diagnostic laboratories and calculated the positivity, defined as the proportion of the number of positive tests to the number of tests performed. The number of positive tests increased proportionally to the number of tests performed; hence, the positivity remained stable. However, the cause of the increase in test volume is unclear and has a large impact on the interpretation of the positivity curve. Further, the test outcome was found to be dependent on regional determinants, and the diagnostic method applied. The lack of understanding if and at which stage LD is considered in current case management of pneumonia patients limits the interpretation of observed heterogeneities in incidence or underestimation of LD in Switzerland. The absence of (or non-adherence to) existing guidelines and the heterogeneity in diagnostic testing hampers the comparison of data in the Swiss public health context. Therefore, diagnostic procedures should be harmonised across Switzerland and adherence to national LD management guidelines supported. View Full-Text
Keywords: Legionella spp.; disease surveillance; underestimation; Legionnaires’ disease; diagnostics; denominator data Legionella spp.; disease surveillance; underestimation; Legionnaires’ disease; diagnostics; denominator data
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MDPI and ACS Style

Fischer, F.B.; Schmutz, C.; Gaia, V.; Mäusezahl, D. Legionnaires’ Disease on the Rise in Switzerland: A Denominator-Based Analysis of National Diagnostic Data, 2007–2016. Int. J. Environ. Res. Public Health 2020, 17, 7343. https://doi.org/10.3390/ijerph17197343

AMA Style

Fischer FB, Schmutz C, Gaia V, Mäusezahl D. Legionnaires’ Disease on the Rise in Switzerland: A Denominator-Based Analysis of National Diagnostic Data, 2007–2016. International Journal of Environmental Research and Public Health. 2020; 17(19):7343. https://doi.org/10.3390/ijerph17197343

Chicago/Turabian Style

Fischer, Fabienne B., Claudia Schmutz, Valeria Gaia, and Daniel Mäusezahl. 2020. "Legionnaires’ Disease on the Rise in Switzerland: A Denominator-Based Analysis of National Diagnostic Data, 2007–2016" International Journal of Environmental Research and Public Health 17, no. 19: 7343. https://doi.org/10.3390/ijerph17197343

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