Abstract
During March 12-15, 2001, four cases of Legionnaires' disease (LD) among workers at an automotive engine manufacturing plant (plant X) were reported to the Cuyahoga County Board of Health, Cleveland, Ohio; all four diagnoses were confirmed by Legionella urine antigen. Illness onset among the four workers occurred during March 2-4; two workers died. Beginning March 14, CDC assisted state and local health departments with an investigation to identify new cases and potential sources of Legionella transmission in the plant. This report summarizes the investigation; findings indicate an epidemiologic association with exposure to one of the plant finishing lines but did not identify a specific source.
Highlights
Board of Health, Cleveland, Ohio; all four diagnoses were confirmed by Legionella urine antigen
The plant is divided into four areas: core making, mold production, iron melting, and finishing
Nine workers from plant X were hospitalized during February 14–March 28; four had pneumonia, and all nine had negative Legionella urine antigen tests
Summary
Board of Health, Cleveland, Ohio; all four diagnoses were confirmed by Legionella urine antigen. Beginning March 14, CDC assisted state and local health departments with an investigation to identify new cases and potential sources of Legionella transmission in the plant. Hospital records and plant X employee absentee records were reviewed to identify additional cases. An environmental investigation was conducted to identify aerosol-producing water sources for Legionella transmission, including cooling towers, water hoses, and water heaters. No additional confirmed LD cases were identified among the workers. Nine workers from plant X were hospitalized during February 14–March 28; four had pneumonia, and all nine had negative Legionella urine antigen tests. A possible case-patient of legionellosis was defined as a worker with a titer of anti-legionella IgG antibody $1: 1024 and any two of the following symptoms: cough, shortness of breath, fever, headache, myalgia, or fatigue
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