Abstract
BackgroundDuring 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.MethodsSurvey 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.ResultsEight 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.ConclusionsManagers 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.
Highlights
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
Few published reports have described LD outbreaks in apartment buildings and other residential facilities designed for seniors who live independently, even though these facilities are increasingly common in the United States [10,11]
Epidemiological and environmental investigations were conducted at the apartment complex, which consisted of four adjacent buildings
Summary
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. In the United States, ~8,000-18,000 persons with community-acquired LD are hospitalized common in the elderly, further increase the risk of lung inoculation through aspiration. LD outbreaks among residents of long-term care facilities and nursing homes have been publicized and described elsewhere [9]. Few published reports have described LD outbreaks in apartment buildings and other residential facilities designed for seniors who live independently, even though these facilities are increasingly common in the United States [10,11]
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