A Large Community Outbreak of Legionnaires' Disease Associated With a Cooling Tower in New York City, 2015.

Weiss D1, Boyd C1, Rakeman JL1, Greene SK1, Fitzhenry R1, McProud T1, Musser K2, Huang L1, Kornblum J1, Nazarian EJ2, Fine AD1, Braunstein SL1, Kass D1, Landman K1, Lapierre P2, Hughes S1, Tran A1, Taylor J2, Baker D2, Jones L1, Kornstein L1, Liu B1, Perez R1, Lucero DE1, Peterson E1, Benowitz I1,3, Lee KF1, Ngai S1, Stripling M1, Varma JK1,3; South Bronx Legionnaires’ Disease Investigation Team.

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Abstract

OBJECTIVES:

Infections caused by Legionella are the leading cause of waterborne disease outbreaks in the United States. We investigated a large outbreak of Legionnaires' disease in New York City in summer 2015 to characterize patients, risk factors for mortality, and environmental exposures.

METHODS:

We defined cases as patients with pneumonia and laboratory evidence of Legionella infection from July 2 through August 3, 2015, and with a history of residing in or visiting 1 of several South Bronx neighborhoods of New York City. We describe the epidemiologic, environmental, and laboratory investigation that identified the source of the outbreak.

RESULTS:

We identified 138 patients with outbreak-related Legionnaires' disease, 16 of whom died. The median age of patients was 55. A total of 107 patients had a chronic health condition, including 43 with diabetes, 40 with alcoholism, and 24 with HIV infection. We tested 55 cooling towers for Legionella, and 2 had a strain indistinguishable by pulsed-field gel electrophoresis from 26 patient isolates. Whole-genome sequencing and epidemiologic evidence implicated 1 cooling tower as the source of the outbreak.

CONCLUSIONS:

A large outbreak of Legionnaires' disease caused by a cooling tower occurred in a medically vulnerable community. The outbreak prompted enactment of a new city law on the operation and maintenance of cooling towers. Ongoing surveillance and evaluation of cooling tower process controls will determine if the new law reduces the incidence of Legionnaires' disease in New York City.

KEYWORDS:

Legionnaires’ disease; cooling tower; outbreak

PMID:: 28141970
DOI:: 10.1177/0033354916689620

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