Legionnaires’ Disease Incidence and Risk Factors, New York, New York, USA, 2002–2011 - Volume 20, Number 11—November 2014 - Emerging Infectious Disease journal - CDC

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Legionnaires’ Disease Incidence and Risk Factors, New York, New York, USA, 2002–2011 - Volume 20, Number 11—November 2014 - Emerging Infectious Disease journal - CDC

Volume 20, Number 11—November 2014

CME ACTIVITY - Synopsis

Legionnaires’ Disease Incidence and Risk Factors, New York, New York, USA, 2002–2011

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• Medscape CME Activity
• Materials and Methods
• Results
• Discussion
• Suggested Citation

Figures

• Figure 1
• Figure 2

Tables

• Table 1
• Table 2
• Table 3
• Table 4

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Andrea Farnham1 , Lisa Alleyne, Daniel Cimini, and Sharon Balter

Author affiliations: New York City Department of Health and Mental Hygiene, New York, New York, USA;1Current affiliation: University of Zurich, Zurich, Switzerland.

Suggested citation for this article

Abstract

Incidence of Legionnaires’ disease in the United States is increasing. We reviewed case records to determine the the epidemiology of and risk factors for the 1,449 cases reported to the New York City Department of Health and Mental Hygiene, New York, New York, USA, during 2002–2011. The highest incidence (2.74 cases/100,000 population) occurred in 2009; this incidence was higher than national incidence for that year (1.15 cases/100,000 population). Overall, incidence of Legionnaires’ disease in the city of New York increased 230% from 2002 to 2009 and followed a socioeconomic gradient, with highest incidence occurring in the highest poverty areas. Among patients with community-acquired cases, the probability of working in transportation, repair, protective services, cleaning, or construction was significantly higher for those with Legionnaires’ disease than for the general working population. Further studies are required to clarify whether neighborhood-level poverty and work in some occupations represent risk factors for this disease.

Legionnaires’ disease, a bacterial infection caused primarily by the species Legionella pneumophila, was initially recognized as the cause of a 1976 outbreak of respiratory disease that resulted in 221 cases of illness, primarily among attendees of an American Legion convention in Philadelphia (1). In that outbreak, 34 people died, catapulting the previously unidentified disease to national attention (1–4). Infection with Legionella spp. is now classified into 2 clinically distinct diseases, Pontiac fever and Legionnaires’ disease; Pontiac fever is a milder illness that does not involve pneumonia (2).

An estimated 8,000–18,000 persons are hospitalized for legionellosis each year in the United States; ≈5%–30% of case-patients die (2,5). During the 2000s, cases of legionellosis in the United States reported to the Centers for Disease Control and Prevention increased 279%, from 1,110 in 2000 to 4,202 in 2011. During the same period, the national incidence of legionellosis increased 249%, from 0.39 per 100,000 persons in 2000 to 1.36 per 100,000 persons in 2011 (6,7).

Most Legionella species live in water, and transmission to humans occurs through inhalation of small water droplets in which the pathogen is aerosolized or by aspiration of contaminated water into the lungs (2,8). Known host risk factors for legionellosis are smoking, chronic obstructive pulmonary disease, diabetes, immune system compromise, older age (>50 years), and receipt of a transplant or chemotherapy (9). Environmental risk factors associated with legionellosis outbreaks are travel, residence in a health care facility, and proximity to cooling towers, whirlpool spas, decorative fountains, and grocery produce misters (2,6,10,11). However, only limited studies have been done regarding socioeconomic and occupational risk factors for community-acquired cases; some studies have identified driving as a potential occupational risk factor (12,13).

To describe the epidemiology of Legionnaires’ disease in New York, New York, we analyzed surveillance data for 2002–2011. In addition to overall incidence, we measured the associations between acquisition of Legionella infection and socioeconomic and occupational groups.

Ms Farnham is a research scientist with the Immunization Surveillance Team at the New York City Department of Health and Mental Hygiene. Her research interests include the epidemiology of infectious disease and socioeconomic health disparities.

Acknowledgment

This publication was supported by Epidemiology and Laboratory Capacity for Infectious Diseases Cooperative Agreement Number 3U50CI000899-02S3 and the Public Health Emergency Preparedness grant award no. 5U90TP000546-02 from CDC. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC.

References

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Figures

• Figure 1. Annual number and incidence (no. cases/100,000 population) of Legionnaires’ disease cases, New York, New York, USA, 2002–2011.
• Figure 2. Legionnaires’ disease incidence (no. cases/100,000 population) by sex and age group, New York, New York, USA, 2002–2011.

Tables

• Table 1. Most common underlying medical conditions among Legionnaires’ disease case-patients, New York, New York, USA, 2002–2011
• Table 2. Rates of community-acquired Legionnaires’ disease by census tract poverty level, New York, New York, USA, 2002–2011
• Table 3. Sociodemographic characteristics of persons with community-acquired Legionnaires’ disease, New York, New York, USA, 2002–2011
• Table 4. Incidence of and risk for Legionnaires’ disease by case-patient occupation, New York, New York, USA, 2002–2011

Suggested citation for this article: Farnham A, Alleyne L, Cimini D, Balter S. Legionnaires’ disease incidence and risk factors, New York, New York, USA, 2002–2011. Emerg Infect Dis [Internet]. 2014 Nov [date cited]. http://dx.doi.org/10.3201/eid2011.131872

DOI: 10.3201/eid2011.131872