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American Journal of Epidemiology Vol. 125, No. 4: 639-649
Copyright © 1987 by The Johns Hopkins University School of Hygiene and Public Health

research-article

A COMMUNITY HOSPITAL OUTBREAK OF LEGIONELLOSIS

TRANSMISSION BY POTABLE HOT WATER

JOHN P. HANRAHAN1, DALE L. MORSE2,, VIRGINIA B SCHARF3, JOHN G. DEBBIE2, GEORGE P. SCHMID4, ROGER M. McKINNEY4 and MEHDI SHAYEGANI2

1Division of Field Services, Centers for Disease Control, assigned to the New York State Department of Health Albany, NY
2New York State Department of Health Albany, NY
3Alice Hyde Memorial Hospital Malone, NY
4Center for Disease Control Atlanta, GA

Reprint requests to Dr. Dale Morse, Bureau of Communicable Disease Control, New York State Department of Health, Room 651, Mayor E. Corning Tower Building, Empire State Plaza, Albany, NY 12237

Seven cases of nosocomial legionellosis occurred between February and September 1982 in a small community hospital in Upstate New York. All seven were cases of Legionella pneumophila serogroup 1; six were hospital patients and one a hospital employee. None of the cases died. During the peak of the outbreak, the incidence of nosocomial legionellosis was 1.2 cases per 100 patient discharges. An epidemiologic comparison of the six patient cases with 21 matched patient controls suggested that longer hospital stay ({xi}12 = 24.2, p < 0.001) and the proximity of patients' rooms to ward showers ({xi}12 = 4.4, p < 0.04) were significant risk factors for acquiring legionellosis. An environmental investigation demonstrated that the ward showers and the hospital hot water system were contaminated with L. pneumophila serogroup 1. Monoclonal antibody subtyping performed on isolates obtained during the outbreak investigation confirmed that the hot water system and patient isolates had an identical pattern of reactivity. The outbreak demonstrates that legionellosis can be a significant cause of nosocomial pneumonia in a community hospital and that transmission can occur from contaminated potable hot water sources, potentially via shower aerosols.

Legionnaires' disease; Legionella; pneumonia; water pollution; water supply


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