Legionellosis epidemiology and demographics
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Legionellosis is ubiquitous worldwide, is generally caused by Legionella pneumophila, tends to affect people over the age of 65 who are smokers with lung disease, and occurs after exposure to aquatic settings that promote bacterial growth where three conditions are met:
- The aquatic environment is somewhat stagnant (e.g. water towers)
- The water is warm (77°F–108°F [25°C–42°C]) (e.g. hot tubs), and
- The water must be aerosolized so that the bacteria can be inhaled into the lungs.
These 3 conditions are met almost exclusively in developed or industrialized settings. Legionellosis does not occur in association with natural settings such as waterfalls, lakes, or streams.
Seasonal Variation
Legionellosis tends to occur in the summer and early fall, but it can happen any time of year.
Geographic Considerations
Infection in the U.S.:
Each year, between 8,000 and 18,000 people are hospitalized with Legionnaires' disease in the U.S. Legionellosis is a reportable condition in most states but because of under-diagnosis and under reporting, only 2%-10% of estimated cases are reported. Thus, the number of cases may be much higher than reported.
Worldwide Infection:
Below is a list of Legionnaires' disease outbreaks:
| Suspected Source | Cases | Deaths | Date | Location |
|---|---|---|---|---|
| Cooling Tower | 18 | 2 | July - August 2007 | Benalmadena, Spain |
| Institute of Animal Health | 1+ | 0 | 2007 | Pirbright, Surrey, UK |
| Water supply | 167 | 5 | July - August 2007 | Verkhnyaya Pyshma, Sverdlovsk oblast, Russia [1] |
| Cooling tower | 7 | 0 | 31st Dec 2006 - 1st Jan 2007 | Australia, Sydney [2] |
| Spa Pool | 115 | 0 | August 2006 | Sunderland, UK |
| Cooling tower | 26 | 2 | July - Sept 2006 | Paris, France |
| Cooling tower | 30 | 2 | July 2006 | Amsterdam, Netherlands |
| Cooling towers | 149 | 0 | June 2006 | Pamplona, Spain |
| Cooling tower | 10 | 1 | February 2006 | Sydney, Australia |
| Cooling tower | 20 | 0 | December 2005 | Torrevieja, Spain |
| Cooling tower | 127 | 21 | October 2005 | Toronto, Canada |
| Cooling tower | 21 | 0 | June 2005 | New Rochelle, NY, USA |
| Indoor ornamental fountain | 17 | 1 | Summer 2005 | Rapid City, SD, USA |
| Air scrubber | 52 | 10 | May 2005 | Fredrikstad, Norway |
| Cooling tower | 86 | 21 | 2004 | Pas-de-Calais, France |
| Cooling tower | 172 | 7 | 2002 | Barrow-in-Furness, UK |
| Cooling tower | 28 | 7 | 2001 | Stavanger, Norway |
| Cooling tower | 449 | 6 | July 2001 | Murcia, Spain |
| Whirlpool and humidifier | 200 | 32 | 1999 | Bovenkarspel, Netherlands |
| Hospital | 101 | 28 | 1985 | Stafford, UK |
| Cooling Tower (widely accepted) | 221 | 34 | 1976 | Philadelphia, PA, USA |
Sources
- CDC Legionellosis [2]