No 37 - 2022

Ordering influenza, COVID-19 and pneumococcal vaccines for general practice and private pharmacies

The responsibility for ordering of vaccines for the upcoming autumn vaccination efforts against influenza, COVID-19 and pneumococci will pass to the regions as from 15 September 2022.

General practitioners and private pharmacies should therefore contact their region to place orders for the above-mentioned vaccines. The Order Office of Statens Serum Institut cannot assist with orders or changes to orders already made through your region.

(Statens Serum Institut)

Legionnaires' disease in Denmark 2021

2021 a total of 276 cases of legionnaires' disease (LD) were recorded among persons with residence in Denmark, including 168 men (range 29-96 years, median age 72 years) and 108 women (range 29-97 years, median age 75 years). A total of 260 cases were presumably infected in Denmark (94.2%). This is on par with the number recorded in 2020 (n = 263) which recorded the highest number of domestic LD cases dto date, EPI-NEWS 18, 2021. As in 2020, the overall mortality was slightly higher (14%) than normal (10%), which may be explained by the very low number of travel-associated LD cases as this group typically records a very low mortality. For a detailed epidemiological description of the 2021 incidence, please see the 2021 Annual Report on Legionnaires’ Disease.

Some changes were recorded in the incidence in the various areas compared with previous years, please see Table 1. No obvious general explanations have been found for these changes. One contributory cause for the low incidence observed in East Jutland may be that no cases were detected in the town of Randers in 2021, even though Randers has generally recorded one of the highest incidences seen in Denmark. In 2021, the area Copenhagen Subs. recorded the highest incidence in the country with 7.1 cases per 100,000 inhabitants after experiencing a steeply increasing incidence as from 2017. In the Copenhagen City area, which has otherwise typically recorded some of the lowest incidences in Denmark, 2021 saw 2-4 times more cases than has previously been the case, see Table 1 .

In 2021, a long-term cross-ministry study of causes for the increasing LD incidence concluded (BOU, General Part - 2020-21 - Appendix 174: Memo on reporting from the cross-ministry work on transmission of Legionella by the Danish Minister of the Interior and Housing/Danish Parliament (Folketinget) (ft.dk)). The individual projects have contributed to provide explanations, but more systematic and prolonged analyses are needed to elucidate all problems related to testing and preventing Legionella in water installations. Overall, the projects concluded that improved monitoring based on data from the Danish Microbiology Database and intensified testing activity have contributed to enhanced diagnosing and recording of LD.

However, these causes cannot explain all of the increase observed. In particular, they cannot explain the steep increase observed from 2016 to 2017 (EPI-NEWS no. 45, 2018), after which the general level has remained stable compared with previous years though a decline has been observed in the number of travel-associated cases and an increase has been observed in the number of infections in Denmark. Other conditions, including climate change, an ageing population and energy- and water-saving measures, may also have contributed. One important factor in controlling Legionella in hot-water systems is constantly maintaining the temperature at a minimum of 50 °C, which is often not achieved. As increasing requirements are introduced for energy-saving measures in heated water systems like heat pumps and future increased requirements for monitoring of Legionella in water systems in pursuance of the novel EU Drinking Water Directive, the future holds various and partly contradictive challenges for LD prevention. Therefore, prevention of LD is a highly cross-disciplinary task, and the cross-ministry work on Legionella has been extended in the form of a collaborative network at a sub-ministry level counting municipalities and regions as relevant.

(S. A. Uldum, Department of Bacteria, Parasites & Fungi. C. Kjelsø, Department of Infectious Disease Epidemiology and Infection)

14 September 2022