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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


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


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

Andrea Farnham1Comments to Author , 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.


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 (14). 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.


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.


  1. Fraser DWTsai TROrenstein WParkin WEBeecham HJSharrar RGLegionnaires’ disease: description of an epidemic of pneumonia. N Engl J Med1977;297:118997 . DOIPubMed
  2. Legionellosis and nonpneumonic legionellosis. In: Heymann D, editor. Control of communicable diseases manual. Washington (DC): American Public Health Association; 2008. p. 337–40.
  3. Association of Water Technologies. Legionella 2003: an update and statement by the Association of Water Technologies. Rockville (MD); The Association; 2003.
  4. Fraser DWThe challenges were legion. Lancet Infect Dis2005;5:23741DOIPubMed
  5. Centers for Disease Control and PreventionLegionella (Legionnaires’ disease and Pontiac fever). 2013 [cited 2013 Mar 14].
  6. Legionellosis—United States2000–2009. MMWR Morb Mortal Wkly Rep2011;60:10836 .PubMed
  7. Adams DAGallagher KMJajosky RAKriseman JSharp PAnderson WJSummary of notifiable diseases—United States, 2011. MMWR Morb Mortal Wkly Rep2013;60:1117 .PubMed
  8. Fields BSBenson RFBesser RELegionella and Legionnaires’ disease: 25 years of investigation. Clin Microbiol Rev2002;15:50626.DOIPubMed
  9. Mandell GLBennett JEDolin R. Principles and practice of infectious diseases, 7th ed. Philadelphia (PA): Churchill Livingston Elsevier; 2010.
  10. Greig JECarnie JATallis GFRyan NJTan AGGordon IRAn outbreak of Legionnaires’ disease at the Melbourne Aquarium, April 2000: investigation and case–control studies. Med J Aust2004;180:56672 .PubMed
  11. Beauté JZucs Pde Jong BLegionnaires disease in Europe, 2009–2010. Euro Surveill2013;18:20417 .PubMed
  12. Wallensten AOliver IRicketts KKafatos GStuart JMJoseph CWindscreen wiper fluid without added screenwash in motor vehicles: a newly identified risk factor for Legionnaires’ disease. Eur J Epidemiol2010;25:6615DOIPubMed
  13. Sakamoto ROhno ANakahara TSatomura KIwanaga SKouyama YIs driving a car a risk for Legionnaires’ disease? Epidemiol Infect.2009;137:161522DOIPubMed
  14. Council of State and Territorial Epidemiologists. Strengthening surveillance for travel-associated legionellosis and revised case definitions for legionellosis. 2005 [cited 2013 Jul 1].
  15. Epiquery: NYC Interactive Health Data System. [cited 2013 Jul 1].
  16. United States Census Bureau. Summary file. 2013 [cited 2013 Jan 1].
  17. Neil KBerkelman RIncreasing incidence of legionellosis in the United States, 1990–2005: changing epidemiologic trends. Clin Infect Dis.2008;47:5919DOIPubMed
  18. Rota MCCaporali MGBella ARicci MLNapoli CLegionnaires’ disease in Italy: results of the epidemiological surveillance from 2000 to 2011. Euro Surveill2013;18:20497 .PubMed
  19. Campese CBitar DJarraud SMaine CForey FEtienne JProgress in the surveillance and control of Legionella infection in France, 1998–2008. Int J Infect Dis2011;15:e307DOIPubMed
  20. Krieger NWaterman PDChen JTSoobader MJSubramanian SVMonitoring socioeconomic inequalities in sexually transmitted infections, tuberculosis, and violence: geocoding and choice of area-based socioeconomic measures—the public health disparities geocoding project (US). Public Health Rep2003;118:24060 .PubMed
  21. Krieger NChen JTWaterman PDRehkopf DHSubramanian SVPainting a truer picture of US socioeconomic and racial/ethnic health inequalities: the Public Health Disparities Geocoding Project. Am J Public Health2005;95:31223DOIPubMed
  22. Den Boer JWNijhof JFriesema IRisk factors for sporadic community-acquired Legionnaires’ disease. A 3-year national case–control study. Public Health2006;120:56671DOIPubMed
  23. Suzuki KTachibana AHatakeyama SYamaguchi KTateda KClinical characteristics in 8 sporadic cases of community-acquired Legionellapneumonia [in Japanese]Nihon Kokyuki Gakkai Zasshi2002;40:2826 .PubMed
  24. Yu VLStout JECommunity-acquired legionnaires disease: implications for underdiagnosis and laboratory testing. Clin Infect Dis2008;46:13657.DOIPubMed



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].
DOI: 10.3201/eid2011.131872

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