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Legionnaires' disease case-finding algorithm, attack rates, and risk factors during a residential outbreak among older adults: an environmental and cohort study.
BMC Infect Dis. 2013 Jun 27; 13:291.BI

Abstract

BACKGROUND

During a Legionnaires' disease (LD) outbreak, combined epidemiological and environmental investigations were conducted to identify prevention recommendations for facilities where elderly residents live independently but have an increased risk of legionellosis.

METHODS

Survey responses (n = 143) were used to calculate attack rates and describe transmission routes by estimating relative risk (RR) and 95% confidence intervals (95% CI). Potable water collected from five apartments of LD patients and three randomly-selected apartments of residents without LD (n = 103 samples) was cultured for Legionella.

RESULTS

Eight confirmed LD cases occurred among 171 residents (attack rate = 4.7%); two visitors also developed LD. One case was fatal. The average age of patients was 70 years (range: 62-77). LD risk was lower among residents who reported tub bathing instead of showering (RR = 0.13, 95% CI: 0.02-1.09, P = 0.03). Two respiratory cultures were characterized as L. pneumophila serogroup 1, monoclonal antibody type Knoxville (1,2,3), sequence type 222. An indistinguishable strain was detected in 31 (74%) of 42 potable water samples.

CONCLUSIONS

Managers of elderly-housing facilities and local public health officials should consider developing a Legionella prevention plan. When Legionella colonization of potable water is detected in these facilities, remediation is indicated to protect residents at higher risk. If LD occurs among residents, exposure reduction, heightened awareness, and clinical surveillance activities should be coordinated among stakeholders. For prompt diagnosis and effective treatment, clinicians should recognize the increased risk and atypical presentation of LD in older adults.

Authors

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Pub Type(s)

Journal Article

Language

eng

PubMed ID

23806063

Citation

Silk, Benjamin J., et al. "Legionnaires' Disease Case-finding Algorithm, Attack Rates, and Risk Factors During a Residential Outbreak Among Older Adults: an Environmental and Cohort Study." BMC Infectious Diseases, vol. 13, 2013, p. 291.
Silk BJ, Foltz JL, Ngamsnga K, et al. Legionnaires' disease case-finding algorithm, attack rates, and risk factors during a residential outbreak among older adults: an environmental and cohort study. BMC Infect Dis. 2013;13:291.
Silk, B. J., Foltz, J. L., Ngamsnga, K., Brown, E., Muñoz, M. G., Hampton, L. M., Jacobs-Slifka, K., Kozak, N. A., Underwood, J. M., Krick, J., Travis, T., Farrow, O., Fields, B. S., Blythe, D., & Hicks, L. A. (2013). Legionnaires' disease case-finding algorithm, attack rates, and risk factors during a residential outbreak among older adults: an environmental and cohort study. BMC Infectious Diseases, 13, 291. https://doi.org/10.1186/1471-2334-13-291
Silk BJ, et al. Legionnaires' Disease Case-finding Algorithm, Attack Rates, and Risk Factors During a Residential Outbreak Among Older Adults: an Environmental and Cohort Study. BMC Infect Dis. 2013 Jun 27;13:291. PubMed PMID: 23806063.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Legionnaires' disease case-finding algorithm, attack rates, and risk factors during a residential outbreak among older adults: an environmental and cohort study. AU - Silk,Benjamin J, AU - Foltz,Jennifer L, AU - Ngamsnga,Kompan, AU - Brown,Ellen, AU - Muñoz,Mary Grace, AU - Hampton,Lee M, AU - Jacobs-Slifka,Kara, AU - Kozak,Natalia A, AU - Underwood,J Michael, AU - Krick,John, AU - Travis,Tatiana, AU - Farrow,Olivia, AU - Fields,Barry S, AU - Blythe,David, AU - Hicks,Lauri A, Y1 - 2013/06/27/ PY - 2012/12/22/received PY - 2013/06/20/accepted PY - 2013/6/29/entrez PY - 2013/6/29/pubmed PY - 2014/11/14/medline SP - 291 EP - 291 JF - BMC infectious diseases JO - BMC Infect Dis VL - 13 N2 - BACKGROUND: During a Legionnaires' disease (LD) outbreak, combined epidemiological and environmental investigations were conducted to identify prevention recommendations for facilities where elderly residents live independently but have an increased risk of legionellosis. METHODS: Survey responses (n = 143) were used to calculate attack rates and describe transmission routes by estimating relative risk (RR) and 95% confidence intervals (95% CI). Potable water collected from five apartments of LD patients and three randomly-selected apartments of residents without LD (n = 103 samples) was cultured for Legionella. RESULTS: Eight confirmed LD cases occurred among 171 residents (attack rate = 4.7%); two visitors also developed LD. One case was fatal. The average age of patients was 70 years (range: 62-77). LD risk was lower among residents who reported tub bathing instead of showering (RR = 0.13, 95% CI: 0.02-1.09, P = 0.03). Two respiratory cultures were characterized as L. pneumophila serogroup 1, monoclonal antibody type Knoxville (1,2,3), sequence type 222. An indistinguishable strain was detected in 31 (74%) of 42 potable water samples. CONCLUSIONS: Managers of elderly-housing facilities and local public health officials should consider developing a Legionella prevention plan. When Legionella colonization of potable water is detected in these facilities, remediation is indicated to protect residents at higher risk. If LD occurs among residents, exposure reduction, heightened awareness, and clinical surveillance activities should be coordinated among stakeholders. For prompt diagnosis and effective treatment, clinicians should recognize the increased risk and atypical presentation of LD in older adults. SN - 1471-2334 UR - https://www.unboundmedicine.com/medline/citation/23806063/Legionnaires'_disease_case_finding_algorithm_attack_rates_and_risk_factors_during_a_residential_outbreak_among_older_adults:_an_environmental_and_cohort_study_ L2 - https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-13-291 DB - PRIME DP - Unbound Medicine ER -