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The first identified outbreak of Legionnaires' disease occurred in 1976 [1]. Since then
there have been many outbreaks of the disease, each with its own unique properties. Reflections
on these historical outbreaks are useful resources to inform the response to a new outbreak.
For example, Legionella outbreaks can manifest themselves in a range of sizes, from over
one hundred cases; e.g. in Murcia [2], Japanese bath house [3] , Dutch
flower show [4], Barrow [5], Melbourne [6] and Catalonia [7], to less than twenty in Virginia
[8], Victoria [9], Rome [10], Portugal [11] UK [12] and a cruise liner [13]. A
large number of outbreaks occur in an outdoor setting and are the result of
legionella-contaminated aerosol releases by poorly maintained cooling towers [2; 7;
14-18]. It is important that the source of these outbreaks is found quickly and action taken to
remove the bacteria since, given the right meteorological conditions, they have the potential
to infect a large number of people. In the Pas-de-Calais outbreak in 2004, cases were found at
over 6km from the cooling tower responsible [17]. This outbreak highlights the importance of
effectively treating a contaminated system, since a second spike in the epidemic curve
occurred, caused by an inefficient cleaning process which failed to prevent the release of
bacteria into the atmosphere.
As well as these cooling tower releases, other outbreaks have occurred at particular
events [4; 11; 19] or attractions [3; 6] in which the cases were at the source of infection
only once. The types of sources involved can vary e.g. fountains [11], spa pools [4;
13]) and wet air conditioning systems [5; 20], and many of these larger outbreaks are
summarised and analysed in [21].
Legionnaires' disease has also recently been linked to potting compost bought at garden centres
[22] and to manholes [23]. Additionally, outbreaks have been known to occur within, or near,
hospitals [14; 20] which is potentially more of a concern since some of the cases are likely to
be immuno-compromised,making them more susceptible to infection and death.
Outbreak and clusters that have had some epidemiological investigation are listed here and more specfically with geographic information systems
(GIS), either to detect an
outbreak from surveillance data or inform the response, are discussed
here
Report Citation
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Location
|
No. of cases (including possible cases where applicable)
|
Source
|
Serogroup 1 subgroup
|
Edmond-Smith, 2006 [1]
|
Barrow, UK
|
494
|
Air conditioning plant
|
Benidorm
|
Garcia, 2003 [2]
|
Murcia, Spain
|
449
|
Cooling tower
|
Pontiac
|
Sasaki, 2008 [3]
|
Miyazaki, Japan
|
295
|
Public bathhouse
|
|
Den Boer, 1999 [4]
|
Bovenkarspel, Netherlands
|
188
|
Whirlpool spa
|
|
Fraser, 1977 [5]
|
Philadelphia, US
|
182
|
Hotel lobby
|
|
Castilla, 2008 [6]
|
Pamplona, Spain
|
146
|
Cooling tower
|
Pontiac
|
Greig, 2000 [7]
|
Melbourne, Australia
|
125
|
Cooling tower
|
Pontiac
|
Sabria, 2006 [8]
|
Cerdanyola, Spain
|
113
|
Cooling tower
|
|
Castellani, 1997 [9]
|
Genova, Italy
|
98
|
Cooling tower
|
Pontiac
|
De Schrijver, 2003 [10]
|
Kapellen, Belgium
|
93
|
Whirlpool spa
|
|
Nguyen, 2006 [11]
|
Pas-de-Calais, France
|
86
|
Cooling tower
|
Lens
|
Klaucke, 1984 [12]
|
Burlington, USA
|
85
|
Cooling tower
|
|
Henry, 2005 [13]
|
Toronto, Canada
|
82
|
Cooling tower
|
|
O'Mahony, 1990 [14]
|
Stafford, UK
|
68
|
Air conditioning plant
|
Pontiac
|
Von Baum, 2010 [15]
|
Ulm, Germany
|
65
|
Cooling tower
|
Knoxville
|
Nordstrom, 1983 [16]
|
Vasteras, Sweden
|
58
|
Cooling tower
|
|
Nygard, 2008 [17]
|
Sarpsborg, Norway
|
56
|
Air scrubber
|
|
Sala, 2007 [18]
|
Vic-Gurb, Spain
|
55
|
Cooling tower
|
|
Jansa, 2002 [19]
|
Barcelona, Spain
|
54
|
Cooling tower
|
Pontiac
|
Dondero, 1980 [20]
|
Memphis, USA
|
47
|
Cooling tower
|
|
Watson, 1994 [21]
|
London, UK
|
43
|
Cooling tower
|
Benidorm
|
Garcia de Olalla, 2008[22]
|
Barcelona, Spain
|
33
|
Cooling tower
|
Pontiac
|
Mahoney, 1992 [23]
|
Bogalusa, USA
|
33
|
Mist machine
|
Philadelphia
|
Glasgow, 1986 [24]
|
Glasgow, UK
|
33
|
Cooling tower
|
|
Darelid, 1994 [25]
|
Varnamo, Sweden
|
31
|
Shower nozzels
|
Benidorm
|
Sonder, 2008 [26]
|
Amsterdam, Netherlands
|
31
|
Cooling tower
|
|
Alonso, 2004 [27]
|
Zaragoza, Spain
|
30
|
Cooling tower
|
Pontiac
|
Hugosson, 2007 [28]
|
Lidkoping, Sweden
|
30
|
Cooling tower
|
Benidorm
|
Brown, 1999 [29]
|
Delaware, US
|
29
|
Cooling tower
|
Philadelphia
|
Addiss, 1989 [30]
|
Sheboygan, US
|
29
|
Cooling tower
|
Philadelphia
|
Luna, 2005 [31]
|
Torrevieja, Spain
|
28
|
Cooling tower
|
|
Blystad, 2001 [32]
|
Stavangar, Norway
|
28
|
Cooling tower
|
|
Kirrage, 2007 [33]
|
Hereford, UK
|
28
|
Cooling tower
|
|
Benkel, 2000 [34]
|
Christiansburg, US
|
23
|
Whirpool spa
|
Philadelphia
|
Fiore, 1998 [35]
|
Franklin County, US
|
22
|
Cooling tower
|
Philadelphia
|
Formica, 2000 [36]
|
Thomastown, Australia
|
18
|
Cooling tower
|
|
O'Loughlin, 2007 [37]
|
Rapid City, US
|
18
|
Decorative fountain
|
Benidorm
|
Garbe, 1985 [38]
|
Rhode Island, US
|
15
|
Cooling tower
|
Philadelphia
|
Rota, 2005 [39]
|
Rome, Italy
|
15
|
Cooling tower
|
Philadelphia
|
Hunt, 1991 [40]
|
Gloucester, UK
|
14
|
Cooling tower
|
Pontiac
|
Correia, 2001 [41]
|
Braga, Portugal
|
11
|
Decorative fountain
|
|
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- JANSÀ, J.M., CAYLÀ, J.A., FERRER D., GRACIA J., PELAZ C., SALVADOR M., BENAVIDES
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