American Journal of Epidemiology Vol. 119, No. 1: 124-134
Copyright © 1984 by The Johns Hopkins University School of Hygiene and Public Health
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FEBRILE ILLNESS IN SUCCESSIVE COHORTS OF TOURISTS AT A HOTEL ON THE ITALIAN ADRIATIC COAST: EVIDENCE FOR A PERSISTENT FOCUS OF LEGIONELLA INFECTION
1Laboratory of Epidemiology and Biostatistics, Is-tituto Superiore di Sanita, Rome, Italy
2Laboratory of Medical Bacteriology and Mycology, Istituto Superiore di Sanita, Rome, Italy
3Local Health Unit Number 11, Como, Italy
4Max von Pettenkofer Institute for Hygiene and Medical Microbiology, Ludwig-Maximilians University, Munich, Federal Republic of Germany
5Local Health Unit Number 35, Ravenna, Italy
6Epidemiology Program Office, Centers for Disease Control, Atlanta, GA
7Departments of Internal Medicine and Microbiology, The University of Texas Health Science Center at Dallas, Dallas, TX
Reprint requests to Dr. William B. Baine, Epidemiology Program Office, Centers for Disease Control, Atlanta, GA 30333.
Rosmini, F., M. Castellani-Pastorls, M. F. Mazzotti, F. Forastiere, A. Gavaz-zonl, D. Greco, G. Ruckdeschel, E. Tartagni, A. Zampierl and W. B. Baine (Epidemiology Program Office, CDC, Atlanta, GA 30333). Febrile illness in successive cohorts of tourists at a hotel on the italian Adriatic coast: evidence for a persistent focus of Leglonella infection. Am J Epidemiol 1984; 117: 124-34.
Outbreaks of febrile illness consistent with legionellosis occurred in successive groups of vacationers at an Adriatic resort in 1980. illness was associated with one of two hotels used by the groups. A cohort study of guests of the suspect hotel revealed 23 cases of febrile illness with pulmonary symptoms, significant antibody titers to Leglonella pneumophlia, or both, among 291 persons at risk. Two patients died. Attack rates ranged from 0–19% in the nine cohorts of vacationers and were highest among the most elderly. Febrile illness in the last two cohorts of the season was associated with an antibody titer 
128. L. pneumophlia was isolated from shower heads in the suspect hotel, but no association was found between showering and illness or sero-positlvlty. Bacteria identified as L. pneumophlia by direct immunofluorescence were also found in water from an adjacent hotel and from the outflow from a common well. No cases were associated with the adjacent hotel.
Legionella; Legionnaires' disease; water supply
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