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Nosocomial Legionnaires' disease in England and Wales, 1980–92

Published online by Cambridge University Press:  15 May 2009

C. A. Joseph ,
J. M. Watson ,
T. G. Harrison  and
C. L. R. Bartlett
C. A. Joseph
Affiliation:
PHLS Communicable Disease Surveillance Centre and PHLS Laboratory of Microbiological Reagents, Central Public Health Laboratory, 61 Colindale Avenue, London NW9 5EQ, UK
J. M. Watson
Affiliation:
PHLS Communicable Disease Surveillance Centre and PHLS Laboratory of Microbiological Reagents, Central Public Health Laboratory, 61 Colindale Avenue, London NW9 5EQ, UK
T. G. Harrison
Affiliation:
PHLS Laboratory of Microbiological Reagents, Central Public Health Laboratory, 61 Colindale Avenue, London NW9 5EQ, UK
C. L. R. Bartlett
Affiliation:
PHLS Communicable Disease Surveillance Centre and PHLS Laboratory of Microbiological Reagents, Central Public Health Laboratory, 61 Colindale Avenue, London NW9 5EQ, UK
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Summary

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Two hundred and eighteen nosocomial cases of Legionnaires' disease with 68 deaths were reported to the National Surveillance Scheme for Legionnaires Disease between 1980 and 1992, representing 15% of the reported infections acquired in England and Wales. Twenty–two nosocomial outbreaks accounted for 135 (62%) of these cases, the remainder occurring as single cases either in hospitals where other single cases or outbreaks had been reported in different years or as ‘sporadic’ cases in hospitals from which no other cases were reported. A clinical history prior to onset of Legionnaires' disease was available for 124 patients, 61 of whom had undergone recent transplant therapy or were immunosuppressed for other reasons.

Sixty cases (27%) were diagnosed by culture of the organism and isolates from 56 patients were typed; 25 (42%) were non L. pneumophila serogroup 1 infections.

Methods for prevention and control of nosocomial outbreaks are discussed, in particular the susceptibility to Legionnaires' disease of certain groups of hospital patients.

Type
Research Article
Information
Epidemiology & Infection , Volume 112 , Issue 2 , April 1994 , pp. 329 - 346
Copyright
Copyright © Cambridge University Press 1994

References

REFERENCES

Osterholm, MT, Chin, TDY, Osborne, DO et al. , A 1957 outbreak of legionnaires' disease associated with a meat packing plant. Am J Epidemiol 1983; 117: 60–7.CrossRefGoogle ScholarPubMed
Thacker, SB, Bennet, JV, Tsai, TF et al. , An outbreak in 1965 of severe respiratory illness caused by the legionnaires' disease bacterium. J Infect Dis 1978; 138: 512–9.CrossRefGoogle ScholarPubMed
Hutchinson, DN. Nosocomial legionellosis. Rev Med Microbiol 1990; 1: 108–15.Google Scholar
Harrison, TG, Taylor, AG, eds. A laboratory manual for legionella. Chichester: John Wiley and Sons, 1988.Google Scholar
Birtles, RJ, Harrison, TG, Samuel, D, Taylor, AG. Evaluation of urinary antigen ELISA for diagnosing Legionella pneumophila serogroup 1 infection. J Clin Pathol 1990; 43: 685–90.CrossRefGoogle ScholarPubMed
Joly, JR, McKinney, RM, Tobin, JO, Bibb, WF, Watkins, ID, Ramsay, D. Development of a standardized subgrouping scheme for Legionella pneumophila serogroup 1 using monoclonal antibodies. J Clin Microbiol 1986; 23: 768–71.CrossRefGoogle ScholarPubMed
Saunders, NA, Harrison, TG, Haththotuwu, A, Kachwalla, N, Taylor, AG. A method for typing strains of Legionella pneumophila serogroup 1 by analysis of restriction fragment length polymorphisms. J Med Microbiol 1990; 31: 45–55.CrossRefGoogle ScholarPubMed
Swinburn, CR, Gould, FK, Corris, PA et al. , Opportunist pulmonary infection with Legionella bozemanii. Thorax 1989; 44: 434–5.CrossRefGoogle ScholarPubMed
Palmer, SR, Zamiri, I, Ribeiro, CD, Gajewska, A. Legionnaires' disease cluster and reduction in hospital hot water temperatures. BMJ 1986; 292: 1494–5.CrossRefGoogle ScholarPubMed
Meigh, RE, Makin, T, Scott, MH, Hart, CA. Legionella pneumophila serogroup 12 pneumonia in a renal transplant recipient: case report and environmental observations. J Hosp Infect 1989; 13: 315–19.CrossRefGoogle Scholar
Harrison, TG, Saunders, NA, Haththotuwa, A, Doshi, N, Taylor, AG. Further evidence that genotypically closely related strains of Legionella pneumophila can express different serogroup specific antigens. J Med Microbiol 1992; 37: 155–61.CrossRefGoogle ScholarPubMed
Fischer-Hoch, SP, Bartlett, CLR, Tobin, Jo'h et al. , Investigation and control of an outbreak of legionnaires' disease in a district general hospital. Lancet 1981; i: 932–7.CrossRefGoogle Scholar
Colbourne, JS, Pratt, DJ, Smith, MG, Fischer-Hoch, SP, Harper, D. Water fittings as sources of Legionella pneumophila in a hospital plumbing system. Lancet 1984; 28: 210–13.CrossRefGoogle Scholar
O'mahony, MC, Stanwell-Smith, RE, Tillett, HE et al. , The Stafford outbreak of Legionnaires' disease. Epidemiol Infect 1990; 104: 361–80.CrossRefGoogle ScholarPubMed
Colville, A, Crowley, J, Dearden, D, Slack, RCB, Lee, JV. Outbreak of Legionnaires' disease at University Hospital, Nottingham. Epidemiology, microbiology and control. Epidemiol Infect 1993; 110: 105–16.CrossRefGoogle ScholarPubMed
Nazareth, B, Smith, GW. Legionella: a case for culture. Lancet 1993; ii: 113.Google Scholar
Humphreys, H, Marshall, RJ, Mackay, I, Caul, EO. Pneumonia due to Legionella bozemanii and Chlamydia psittaci/TWAR following renal transplantation. J Infect 1992; 25: 67–71.CrossRefGoogle ScholarPubMed
Brundrett, GW. Legionella and building services. Oxford: Butterworth Heinemann, 1992.Google Scholar
Ruf, B, Schurmann, D, Horbach, I, Seidel, K, Pohle, HD. Nosocomial legionella pneumonia: demonstration of potable water as the source of infection. Epidemiol Infect 1988; 101: 647–54.CrossRefGoogle ScholarPubMed
Verissimo, A, Vesey, G, Rocha, GM et al. , A hot water supply as the source of Legionella pneumophila in incubators of a neonatology unit. J Hosp Infect 1990; 15: 255–63.CrossRefGoogle ScholarPubMed
Kaan, JA, Simoons-Smit, AM, MacLaren, DM. Another source of aerosol causing nosocomial legionnaires' disease. J Infect 1985; 11: 145–8.CrossRefGoogle ScholarPubMed
Zuravleff, JJ, Yu, VL, Shonnard, JW, Rihs, JD, Best, M. Legionella pneumophila contamination of a hospital humidifier: demonstration of aerosol transmission and subsequent subclinical infection in exposed guinea pigs. Am Rev Respir Dis 1983; 128: 657–61.Google ScholarPubMed
Anonymous. Legionella linked to tap water used in respiratory equipment. Hosp Infect Control 1989: 149–150.Google Scholar
Mastro, TD, Fields, BS, Breiman, RF, Campbell, J, Plikaytis, BD, Spika, JS. Nosocomial legionnaires' disease and use of medication nebulizers. J Infect Dis 1991; 163: 667–71.CrossRefGoogle ScholarPubMed
Anonymous. An outbreak of Legionnaires' disease associated with a whirlpool. Communicable Disease Report 1985 (50): 3–4. Internal publication of the Public Health Laboratory Service, London.Google Scholar
Tobin, Jo'h, Beare, J, Dunnill, MS et al. , Legionnaires' disease in a transplant unit: isolation of the causative agent from shower baths. Lancet 1980: 118–21.CrossRefGoogle Scholar
27. Committee of Inquiry. First report of the Committee of Inquiry into the outbreak of legionnaires' disease in Stafford in April 1985. London: HMSO, 1986.Google Scholar
28. Committee of Inquiry. Second report of the Committee of Inquiry into the outbreak of legionnaires' disease in Stafford in April 1985. London: HMSO, 1987.Google Scholar
29. Public Health Laboratory Service. Collaborative study of legionella species in water systems. Heat Air Cond 1985; 55: 25–7.Google Scholar
Edelstein, PH. Nosocomial legionnaires' disease: a global perspective. J Hosp Infect 1988; 11 (Supplement A): 182–8.CrossRefGoogle ScholarPubMed
Redd, SC, Schuster, DM, Quan, J, Plikaytis, BD, Spika, JS, Cohen, ML. Legionellosis in cardiac transplant recipients: results of a nationwide survey. J Infect Dis 1988; 158: 651–3.CrossRefGoogle ScholarPubMed
Wilczek, H, Kallings, I, Nystrom, B, Hoffner, S. Nosocomial legionnaires' disease following renal transplantation. Transplantation 1987; 43: 847–51.CrossRefGoogle ScholarPubMed
Edelstein, PH. Control of legionella in hospitals. J Hosp Infect 1986; 8: 109–15.CrossRefGoogle ScholarPubMed
Vickers, RM, Yu, VL, Hanna, S et al. , Determinants of Legionella pneumophila contamination of water distribution systems: 15-hospital prospective study. Infect Control 1987; 8: 357–63.CrossRefGoogle ScholarPubMed
Ribeiro, CD, Burge, SH, Palmer, SR, Tobin, Jo'h, Watkins, ID. Legionella pneumophila in a hospital water system following a nosocomial outbreak: prevalence, monoclonal antibody subgrouping and effect of control measures. Epidemiol Infect 1987; 98: 253–62.CrossRefGoogle Scholar
Marrie, TJ, MacDonald, S, Clarke, K, Haldane, D. Nosocomial legionnaires' disease: Lessons from a four-year prospective study. Am J Infect Control 1991; 19: 79–85.CrossRefGoogle ScholarPubMed
Goetz, A, Yu, VL. Screening for nosocomial legionellosis by culture of the water supply and targeting of high-risk patients for specialised laboratory testing. Am J Infect Control 1991; 19: 79–85.CrossRefGoogle ScholarPubMed
Vereerstraeten, P, Stolear, J-C, Schoutens-Serruys, E et al. , Erythromycin prophylaxis for legionnaires' disease in immunosuppressed patients in a contaminated hospital environment. Transplantation 1986; 41: 52–4.CrossRefGoogle Scholar
39. Health and Safety Executive. The control of legionellosis including legionnaires' disease. London: HMSO, 1991.Google Scholar
Ampel, NM, Wing, EJ. Legionella infection in transplant patients. Semin Respir Infect 1990; 5: 30–7.Google ScholarPubMed
Dournon, E, Bibb, WF, Rajagopalan, P, Desplaces, N, McKinney, RM. Monoclonal antibody reactivity as a virulence marker for Legionella pneumophila serogroup 1 strains. J Infect Dis 1988; 157: 496–501.CrossRefGoogle ScholarPubMed
Bhopal, RS, Fallon, RJ. Seasonal variation of legionnaires' disease in Scotland. J Infect 1990; 22: 153–60.CrossRefGoogle Scholar
Franzin, L, Castellani, Pastoris M, Gioannini, P, Villani, G. Endemicity of Legionella pneumophila serogroup 3 in a hospital water supply. J Hosp Infect 1989; 13: 281–8.CrossRefGoogle Scholar
Moiraghi, Ruggenini A, Castellani, Pastoris M, Dennis, PJ et al. , Legionella pneumophila in a hospital in Torino, Italy. A retrospective one-year study. Epidemiol Infect 1989; 102: 21–9.Google Scholar
Guiguet, M, Pierre, J, Brun, P et al. , Epidemiological survey of a major outbreak of nosocomial legionellosis. Int J Epidemiol 1987; 16: 466–71.CrossRefGoogle Scholar
England, AC, Fraser, DW. Sporadic and epidemic nosocomial legionellosis in the United States. Am J Med 1981; 70: 707–11.CrossRefGoogle ScholarPubMed
Helms, CM, Viner, JP, Weisenburger, DD, Chiu, LC, Renner, ED, Johnson, W. Sporadic legionnaires' disease: clinical observations on 87 nosocomial and community–acquired cases. Am J Med Sci 1984; 288: 2–12.CrossRefGoogle ScholarPubMed
Breiman, RF, Fields, BS, Sanden, GN, Volmer, LaJ, Meier, A, Spika, JS. Association of shower use with legionnaires' disease: possible role of amoebae. JAMA 1990; 263: 2924–6.CrossRefGoogle ScholarPubMed
49. Department of Health and Social Security and the Welsh Office. The control of legionellae in health care premises: a code of practice. London: HMSO, 1988.Google Scholar
50. Health and Safety Commission. The prevention or control of legionellosis (including legionnaires' disease): approved code of practice. London: HMSO, 1991.Google Scholar