Legionnaires' disease outbreak investigation toolbox
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Developing Understanding
Data Collection
Data Management
Data Analysis
Decision Support
Developing Communications
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Developing Understanding
Literature review
Legionnaires' Disease background
How the environment might be contaminated and managed
Potential Sources
How the environment might be contaminated and managed
How human infections arise, the effects on humans and diagnosis challenges
Infectiousness of aerosolised organisms
Incubation period
Immune response to a Legionella infection
Diagnosis of Legionnaires' disease - Under-reporting and Under-diagnosis
Experimental studies in animals exposed to aerosolised Legionella
Background immunity/antibody level in population
Past outbreaks
Outbreak preparedness
Indicative pre-departure equipment and materials checklist
Training and safety considerations
Environmental sampling in an outbreak situation
Examples of environmental sites for sampling for legionellae
Sampling methodologies
Specimen engineering designs for cooling towers and condensers
Specimen engineering designs for spa pools and associated water systems
Extract from Sampling of households for legionella species
Legal context for outbreaks
International implications of outbreaks
Risk Management
Information for Owners and Managers of Hotels and Other Accommodation Sites: Minimising the Risk
Legionella outbreak control team membership
Data Collection
Legionnaires' disease outbreak case definitions
Definition of Legionellosis
Definition of a standard case
Outbreak and cluster definitions
Outbreak case definitions
Examples of case definitions used in previous outbreak investigations
Flowchart for classifying potential Legionnaires' Disease cases
Surveillance questionnaire
Creating a trawling questionnaire for a Legionnaires' disease outbreak
Trawling interview questionnaire for a Legionnaires' Disease outbreak
Interview logistics and guide
Creating a Line listing
Template line listing for a Legionnaires' Disease outbreak
Data Formats
Case finding
Environmental Investigation
Microbiology: Legionella laboratory diagnosis and detection
Environmental Samples
Clinical Samples
Data Management
Data Analysis
Why investigate an outbreak?
Descriptive epidemiology
The use of GIS in Legionnaires' disease outbreak investigations
Analytical methods for LD outbreak investigation
Data Visualisation
Outbreak Detection
Comparing potential outbreak sources
Inferring an outbreak source location
Airborne dispersion modelling
GIS Software
Data requirements and considerations
Case Data
Potential outbreak source locations
Demographic Data
Meteorological Data
Spatial data structure and interoperability
INSPIRE
Data requirements and considerations
Literature review: Legionnaires' disease outbreak response
Literature review: Legionnaires' disease outbreak detection
APPENDIX 1: Scopus literature search results
APPENDIX 2: Additional literature sourced
Design of a cohort study
Design of a case-control study
Special types of case-control studies
Summary of advantages and disadvantages of the main analytical epidemiological studies
Published epidemiological analytical studies
Legionnaires' Disease Outbreak Study protocol
Analytical study EpiInfo data entry screens
Hypothesis testing questionnaire script
Study questionnaire analysis template
Decision Support
Types of evidence
Examples of weighting evidence from various sources
Level of assurance linking source of exposure to cases
Developing communications
Lessons Identified
Message: Initial identification of an outbreak
Message: Continuing updates
Message: Identify cause of potential source
Message: Cruise ship identified as source
Message: Hotel identified as source
Message: Cessation of the outbreak control team investigation
Letter: Template letter to inform individuals of risk of exposure
FAQ: Typical questions and answers regarding Legionnaires' disease
