Legionnaires' Disease: The Epidemiology of Two Outbreaks in Burlington, Vermont, 1980

Klaucke, Douglas N.; Vogt, Richard L.; LaRue, Denise E; Witherell, Linden E.; Orciari, Lillian A.; Spitalny, Kenneth C.; Pelletier, R.; Cherry, William B.; Novick, Lloyd F.

doi:10.1093/oxfordjournals.aje.a113756

Cited by 53 publications

(24 citation statements)

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“…Twenty-eight subjects (18 %) reported symptoms compatible with legionellosis in the period [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] April (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

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Legionellosis linked with a hotel car park – how many were infected?

Bell

Jorm²,

Williamson³

et al. 1996

Epidemiol. Infect.

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SUMMARYAn outbreak of legionellosis associated with a hotel in Sydney, Australia, and the subsequent epidemiological and environmental investigations are described. Four cases of Legionnaires' disease were notified to the Public Health Unit. A cross-sectional study of 184 people who attended a seminar at the hotel was carried out. Serological and questionnaire data were obtained for 152 (83 %) of these. Twenty-eight (18 %) respondents reported symptoms compatible with legionellosis. Thirty-three subjects (22 %) had indirect fluorescent antibody (IFA) titres to Legionella pneumophila serogroup 1 (Lp-1) of 128 or higher. The only site which those with symptoms of legionellosis and IFA titre > 128 were more likely to have visited than controls was the hotel car park (adjusted odds ratio [OR] 14 7, 95 % confidence interval [CI]: 1 8-123 1). Those with symptoms compatible with legionellosis, but whose IFA titres were < 128 were also more likely to have visited the hotel car park (adjusted OR 4-4, 95 % CI: 1 5-12 9). Seroprevalence of Lp-I antibodies was higher in those who attended the seminar than in a population sample of similar age. Findings suggested that the 4 cases represented a small fraction of all those infected, and highlighted difficulties in defining illness caused by Lp-1 and in interpreting serology.

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“…Twenty-eight subjects (18 %) reported symptoms compatible with legionellosis in the period [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] April (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

“…They include outbreaks associated with a hot spa [6], fountains [7], a grocery mist machine [8], hot water systems [9], whirlpool baths on a cruise ship [10] as well as evaporative condensers and cooling towers [11,12].…”

Section: Introductionmentioning

confidence: 99%

Legionellosis linked with a hotel car park – how many were infected?

Bell

Jorm²,

Williamson³

et al. 1996

Epidemiol. Infect.

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“…As we learn more about supportive and nonsupportive components of plumbing systems, it may be logical to replace those elements that encourage the growth of legionellae. Once treatment is instituted, microbiologic surveillance of the water must be continued, because resurgence of the bacteria is common and clinical disease may once more result (26,120,157). It has been suggested that dead-end loops in the plumbing system may represent sites in which legionellae can survive and later repopulate the system (44,120).…”

Section: Investigation and Control Of Legionnaires Diseasementioning

confidence: 99%

“…(157). Buffered charcoal-yeast extract agar and selective media (202) had just been introduced into the laboratory through the kind help of James Feeley.…”

Section: Introductionmentioning

confidence: 99%

Legionnaires disease: historical perspective

1988

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In the summer of 1976, a mysterious epidemic of fatal respiratory disease in Philadelphia launched an intensive investigation that resulted in the definition of a new family of pathogenic bacteria, the Legionellaceae. In retrospect, members of the family had been isolated from clinical specimens as early as 1943. Unsolved epidemics of acute respiratory disease dating to the 1950s were subsequently attributed to the newly described pathogens. In the intervening years, the Legionellaceae have been firmly established as important causes of sporadic and epidemic respiratory disease. The sources of the infecting bacteria are environmental, and geographic variation in the frequency of infection has been documented. Airborne dissemination of bacteria from cooling towers and evaporative condensers has been responsible for some epidemics, but potable water systems are perhaps more important sources. The mode of transmission from drinking water is unclear. The Legionellaceae are gram-negative, facultative, intracellular pathogens. The resident alveolar macrophage, usually an effective antibacterial defense, is the primary site of growth. Cell-mediated immunity appears to be the most important immunological defense; the role of humoral immunity is less clear. Erythromycin remains the antibiotic of choice for therapy of infected patients, but identification and eradication of environmental sources are also essential for the control of infection.

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“…Widely reported sources linked to outbreaks include cooling towers (CTs) [3][4][5][6][7][8][9][10][11] and other aerosol-producing devices [12][13][14][15][16][17][18]. CTs can give rise to large outbreaks accounting for hundreds of LD cases [10,11], because of their capacity to disperse contaminated aerosols over long distances.…”

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confidence: 99%