scholarly journals Legionnaires' Disease Outbreak at a Resort in Cozumel, Mexico

2016 ◽  
Vol 3 (3) ◽  
Author(s):  
Lee M. Hampton ◽  
Laurel Garrison ◽  
Jessica Kattan ◽  
Ellen Brown ◽  
Natalia A. Kozak-Muiznieks ◽  
...  
Keyword(s):  
United States ◽  
Potable Water ◽  
Water System ◽  
Disease Outbreak ◽  
Community Acquired Pneumonia ◽  
Health Departments ◽  
Medical Providers ◽  
Cozumel Island ◽  
European Working ◽  
Legionnaires Disease

Abstract Background.  A Legionnaires' disease (LD) outbreak at a resort on Cozumel Island in Mexico was investigated by a joint Mexico-United States team in 2010. This is the first reported LD outbreak in Mexico, where LD is not a reportable disease. Methods.  Reports of LD among travelers were solicited from US health departments and the European Working Group for Legionella Infections. Records from the resort and Cozumel Island health facilities were searched for possible LD cases. In April 2010, the resort was searched for possible Legionella exposure sources. The temperature and total chlorine of the water at 38 sites in the resort were measured, and samples from those sites were tested for Legionella. Results.  Nine travelers became ill with laboratory-confirmed LD within 2 weeks of staying at the resort between May 2008 and April 2010. The resort and its potable water system were the only common exposures. No possible LD cases were identified among resort workers. Legionellae were found to have extensively colonized the resort's potable water system. Legionellae matching a case isolate were found in the resort's potable water system. Conclusions.  Medical providers should test for LD when treating community-acquired pneumonia that is severe or affecting patients who traveled in the 2 weeks before the onset of symptoms. When an LD outbreak is detected, the source should be identified and then aggressively remediated. Because LD can occur in tropical and temperate areas, all countries should consider making LD a reportable disease if they have not already done so.

scholarly journals Lessons From an Outbreak of Legionnaires’ Disease on a Hematology-Oncology Unit

2016 ◽  
Vol 38 (3) ◽  
pp. 306-313 ◽  
Author(s):  
Louise K. Francois Watkins ◽  
Karrie-Ann E. Toews ◽  
Aaron M. Harris ◽  
Sherri Davidson ◽  
Stephanie Ayers-Millsap ◽  
...  
Keyword(s):  
Legionella Pneumophila ◽  
Potable Water ◽  
Single Case ◽  
Healthcare Providers ◽  
Water System ◽  
Positive Sequence ◽  
Environmental Isolates ◽  
Legionnaires Disease ◽  
Oncology Unit ◽  
Healthcare Associated

OBJECTIVESTo define the scope of an outbreak of Legionnaires’ disease (LD), to identify the source, and to stop transmission.DESIGN AND SETTINGEpidemiologic investigation of an LD outbreak among patients and a visitor exposed to a newly constructed hematology-oncology unit.METHODSAn LD case was defined as radiographically confirmed pneumonia in a person with positive urinary antigen testing and/or respiratory culture forLegionellaand exposure to the hematology-oncology unit after February 20, 2014. Cases were classified as definitely or probably healthcare-associated based on whether they were exposed to the unit for all or part of the incubation period (2–10 days). We conducted an environmental assessment and collected water samples for culture. Clinical and environmental isolates were compared by monoclonal antibody (MAb) and sequence-based typing.RESULTSOver a 12-week period, 10 cases were identified, including 6 definite and 4 probable cases. Environmental sampling revealedLegionella pneumophilaserogroup 1 (Lp1) in the potable water at 9 of 10 unit sites (90%), including all patient rooms tested. The 3 clinical isolates were identical to environmental isolates from the unit (MAb2-positive, sequence type ST36). No cases occurred with exposure after the implementation of water restrictions followed by point-of-use filters.CONCLUSIONSContamination of the unit’s potable water system with Lp1 strain ST36 was the likely source of this outbreak. Healthcare providers should routinely test patients who develop pneumonia at least 2 days after hospital admission for LD. A single case of LD that is definitely healthcare associated should prompt a full investigation.Infect Control Hosp Epidemiol2017;38:306–313

scholarly journals Assessment of the Legionnaires’ disease outbreak in Flint, Michigan

2018 ◽  
Vol 115 (8) ◽  
pp. E1730-E1739 ◽  
Author(s):  
Sammy Zahran ◽  
Shawn P. McElmurry ◽  
Paul E. Kilgore ◽  
David Mushinski ◽  
Jack Press ◽  
...  
Keyword(s):  
Drinking Water ◽  
Water Supply ◽  
Census Tract ◽  
Water System ◽  
Disease Outbreak ◽  
Free Chlorine ◽  
Legionnaires Disease ◽  
Genesee County ◽  
Flint River ◽  
Boil Water Advisories

The 2014–2015 Legionnaires’ disease (LD) outbreak in Genesee County, MI, and the outbreak resolution in 2016 coincided with changes in the source of drinking water to Flint’s municipal water system. Following the switch in water supply from Detroit to Flint River water, the odds of a Flint resident presenting with LD increased 6.3-fold (95% CI: 2.5, 14.0). This risk subsided following boil water advisories, likely due to residents avoiding water, and returned to historically normal levels with the switch back in water supply. During the crisis, as the concentration of free chlorine in water delivered to Flint residents decreased, their risk of acquiring LD increased. When the average weekly chlorine level in a census tract was <0.5 mg/L or <0.2 mg/L, the odds of an LD case presenting from a Flint neighborhood increased by a factor of 2.9 (95% CI: 1.4, 6.3) or 3.9 (95% CI: 1.8, 8.7), respectively. During the switch, the risk of a Flint neighborhood having a case of LD increased by 80% per 1 mg/L decrease in free chlorine, as calculated from the extensive variation in chlorine observed. In communities adjacent to Flint, the probability of LD occurring increased with the flow of commuters into Flint. Together, the results support the hypothesis that a system-wide proliferation of legionellae was responsible for the LD outbreak in Genesee County, MI.

Nosocomial Outbreak of Legionnaires' Disease: Molecular Epidemiology and Disease Control Measures

1987 ◽  
Vol 8 (2) ◽  
pp. 53-58 ◽  
Author(s):  
Jeffrey M. Johnston ◽  
Robert H. Latham ◽  
Frederick A. Meier ◽  
Jon A. Green ◽  
Rebecca Boshard ◽  
...  
Keyword(s):  
Legionella Pneumophila ◽  
Potable Water ◽  
Cooling Tower ◽  
Water System ◽  
Hot Water ◽  
Control Measures ◽  
Laboratory Techniques ◽  
Legionnaires Disease ◽  
Water Holding ◽  
Methods Of Control

AbstractMolecular laboratory techniques were used to study the epidemiology of an outbreak of nosocomial Legionnaires' disease. All patient isolates were Legionella pneumophila serogroup 1 and showed identical plasmid profiles and reactions with serogroup-specific monoclonal antibodies. L pneumophila was also cultured from four of five cooling tower water samples; however, the isolate from only one tower was serogroup 1 of the same sub-type as patient isolates. Since the cases were temporally clustered and epidemiologically associated with exposure to cooling tower aerosols, the single cooling tower implicated by molecular analysis was the most likely source of the outbreak. Chlorination of cooling tower ponds has eradicated the epidemic strain. Since potable water also harbored the infecting organism and was the probable source for cooling tower contamination, decontamination of the hospital water system was also undertaken. Superchlorination of hot water holding tanks to 17 ppm on a weekly basis has effectively eradicated L pneumophila from the potable water system and appears to be a reasonable, simple, and relatively inexpensive alternative to previously described methods of control.

scholarly journals Trends in Legionnaires’ Disease-Associated Hospitalizations, United States, 2006–2010

2020 ◽  
Vol 7 (8) ◽  
Author(s):  
Gayathri Mudali ◽  
Paul E Kilgore ◽  
Abdulbaset Salim ◽  
Shawn P McElmurry ◽  
Marcus Zervos
Keyword(s):  
United States ◽  
Legionella Pneumophila ◽  
Disease Burden ◽  
International Classification Of Diseases ◽  
The United States ◽  
Community Acquired Pneumonia ◽  
Annual Incidence ◽  
Diagnostic Code ◽  
National Hospital Discharge Survey ◽  
Legionnaires Disease

Abstract Background Legionella pneumophila is a waterborne cause of both healthcare-associated and community-acquired pneumonia. Legionella pneumophila serogroup 1 is responsible for 80% of infections. There is currently limited published disease burden data on Legionnaires’ disease-associated hospitalization in the United States. Methods In this study, we estimated the annual incidence of Legionnaires’ disease-associated hospitalizations in United States and identified demographic, temporal, and regional characteristics of individuals hospitalized for Legionnaires’ disease. A retrospective study was conducted using the National Hospital Discharge Survey (NHDS) data from 2006 to 2010. The NHDS is a nationally representative US survey, which includes estimates of inpatient stays in short-stay hospitals in the United States, excluding federal, military, and Veterans Administration hospitals. All discharges assigned with the Legionnaires’ disease International Classification of Diseases 9th Clinical Modification discharge diagnostic code (482.84) were included in this study. Results We observed the annual incidence and number of Legionnaires’ disease-associated hospitalizations (per 100 000 population) in the United States by year, age, sex, race, and region. Over a 5-year period, 14 574 individuals experienced Legionnaires’ disease-associated hospitalizations in the United States The annual population-adjusted incidence (per 100 000 population) of Legionnaires’ disease-associated hospitalizations was 5.37 (95% confidence interval [CI], 5.12–5.64) in 2006, 7.06 (95% CI, 6.80–7.40) in 2007, 8.77 (95% CI, 8.44–9.11) in 2008, 17.07 (95% CI, 16.62–17.54) in 2009, and 9.66 (95% CI, 9.32–10.01) in 2010. A summer peak of Legionnaires’ disease-associated hospitalizations occurred from June through September in 2006, 2007, 2008, and 2010. Conclusions Legionnaires’ disease-associated hospitalizations significantly increased over the 5-year study period. The increasing disease burden of Legionnaires’ disease suggests that large segments of the US population are at risk for exposure to this waterborne pathogen.

Sporadic Legionnaires' disease: the role of domestic electric hot-water tanks

2011 ◽  
Vol 140 (1) ◽  
pp. 172-181 ◽  
Author(s):  
S. F. DUFRESNE ◽  
M. C. LOCAS ◽  
A. DUCHESNE ◽  
C. RESTIERI ◽  
J. ISMAÏL ◽  
...  
Keyword(s):  
Potable Water ◽  
Water System ◽  
Water Systems ◽  
Pulsed Field Gel Electrophoresis ◽  
Hot Water ◽  
Clinical Isolates ◽  
Domestic Hot Water ◽  
Legionnaires Disease ◽  
Water Tanks

SUMMARYSporadic community-acquired legionellosis (SCAL) can be acquired through contaminated aerosols from residential potable water. Electricity-dependent hot-water tanks are widely used in the province of Quebec (Canada) and have been shown to be frequently contaminated withLegionellaspp. We prospectively investigated the homes of culture-proven SCAL patients from Quebec in order to establish the proportion of patients whose domestic potable hot-water system was contaminated with the sameLegionellaisolate that caused their pneumonia. Water samples were collected in each patient's home. Environmental and clinical isolates were compared using pulsed-field gel electrophoresis. Thirty-six patients were enrolled into the study.Legionellawas recovered in 12/36 (33%) homes. The residential and clinical isolates were found to be microbiologically related in 5/36 (14%) patients. Contaminated electricity-heated domestic hot-water systems contribute to the acquisition of SCAL. The proportion is similar to previous reports, but may be underestimated.

Building America

2019 ◽  
Author(s):  
Jean H. Baker
Keyword(s):  
United States ◽  
Early Republic ◽  
Critical Role ◽  
Water System ◽  
The United States ◽  
Primary Sources ◽  
Early American ◽  
Transatlantic Exchange ◽  
The Us ◽  
Private Homes

Building America: The Life of Benjamin Henry Latrobe is a biography of America’s first professionally trained architect and engineer. Born in 1764, Latrobe was raised in Moravian communities in England and Germany. His parents expected him to follow his father and brother into the ministry, but he rebelled against the church. Moved to London, he studied architecture and engineering. In 1795 he emigrated to the United States and became part of the period’s Transatlantic Exchange. Latrobe soon was famous for his neoclassical architecture, designing important buildings, including the US Capitol and Baltimore Basilica as well as private homes. Carpenters and millwrights who built structures more cheaply and less permanently than Latrobe challenged his efforts to establish architecture as a profession. Rarely during his twenty-five years in the United States was he financially secure, and when he was, he speculated on risky ventures that lost money. He declared bankruptcy in 1817 and moved to New Orleans, the sixth American city that he lived in, hoping to recoup his finances by installing a municipal water system. He died there of yellow fever in 1820. The themes that emerge in this biography are the critical role Latrobe played in the culture of the early republic through his buildings and his genius in neoclassical design. Like the nation’s political founders, Latrobe was committed to creating an exceptional nation, expressed in his case by buildings and internal improvements. Additionally, given the extensive primary sources available for this biography, an examination of his life reveals early American attitudes toward class, family, and religion.

Potable water as a source of legionnaires' disease

1985 ◽  
Vol 13 (6) ◽  
pp. 286 ◽  
Author(s):  
K.N. Shands ◽  
J.L. Ho ◽  
R.D. Meyer ◽  
G.W. Gorman
Keyword(s):  
Potable Water ◽  
Legionnaires Disease

scholarly journals Human Health Impact of Cross-Connections in Non-Potable Reuse Systems

Water ◽  
2018 ◽  
Vol 10 (10) ◽  
pp. 1352 ◽  
Author(s):  
Mary Schoen ◽  
Michael Jahne ◽  
Jay Garland
Keyword(s):  
Potable Water ◽  
Reclaimed Water ◽  
Water System ◽  
Health Impact ◽  
Quantitative Microbial Risk Assessment ◽  
Pathogen Inactivation ◽  
Microbial Infection ◽  
Microbial Risk Assessment ◽  
Potable Reuse ◽  
Contamination Event

We used quantitative microbial risk assessment (QMRA) to estimate the microbial risks from two contamination pathways in onsite non-potable water systems (ONWS): contamination of potable water by (treated) reclaimed, non-potable water and contamination of reclaimed, non-potable water by wastewater or greywater. A range of system sizes, event durations, fraction of users exposed, and intrusion dilutions were considered (chlorine residual disinfection was not included). The predicted annual microbial infection risk from domestic, non-potable reuse remained below the selected benchmark given isolated, short-duration intrusion (i.e., 5-day) events of reclaimed water in potable water. Whereas, intrusions of wastewater into reclaimed, non-potable water resulted in unacceptable annual risk without large dilutions or pathogen inactivation. We predicted that 1 user out of 10,000 could be exposed to a 5-day contamination event of undiluted wastewater in the reclaimed, non-potable water system each year to meet the annual benchmark risk of 10−4 infections per person per year; whereas, 1 user out of 1000 could be exposed to a 5-day contamination event of undiluted reclaimed water in the potable water each year. Overall, the predicted annual risks support the use of previously derived non-potable reuse treatment requirements for a variety of ONWS sizes and support the prioritization of protective measures to prevent the intrusion of wastewater into domestic ONWS.

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