title: Community outbreak of Legionnaires' disease: an investigation confirming the potential for cooling towers to transmit Legionella species.
abstract: In August and September 1993, we investigated an outbreak of legionnaires' disease in Fall River, Massachusetts, that involved 11 persons; the attack rate was highest in Flint, a community of Fall River. All cases were infected with Legionella pneumophila serogroup 1 (Lp-1). A case-control study revealed that cases were more likely than matched controls to have visited sites in neighborhood A of Flint. Environmental sampling in Flint found that four of nine aerosol-producing devices sampled contained legionellae; only two, conjoined cooling towers on building A, contained Lp-1. Three independent methods of subtyping--monoclonal antibody subtyping, arbitrary primer polymerase chain reaction, and pulsed-field gel electrophoresis--revealed that Lp-1 isolates from three cases with culture-positive legionnaires' disease matched those from the cooling towers on building A. Water samples from the homes of cases with culture-positive legionnaires' disease contained no legionellae. The results of this epidemiologic and laboratory investigation indicate that the cooling towers on building A were the source of the outbreak of legionnaires' disease and confirm the importance of cooling towers in the transmission of legionnaires' disease.
authors.affiliation: Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
authors.forename: D W
authors.initials: DW
authors.lastname: Keller
authors.forename: R
authors.initials: R
authors.lastname: Hajjeh
authors.forename: A
authors.initials: A
authors.lastname: DeMaria
authors.forename: B S
authors.initials: BS
authors.lastname: Fields
authors.forename: J M
authors.initials: JM
authors.lastname: Pruckler
authors.forename: R S
authors.initials: RS
authors.lastname: Benson
authors.forename: S M
authors.initials: SM
authors.lastname: Kludt PE Lett
authors.forename: L A
authors.initials: LA
authors.lastname: Mermel
authors.forename: C
authors.initials: C
authors.lastname: Giorgio
authors.forename: R F
authors.initials: RF
authors.lastname: Breiman
mesh_terms: D000328:Adult; D000336:Aerosols; D000368:Aged; D016022:Case-Control Studies; D004269:DNA, Bacterial / Q000032:analysis; D004196:Disease Outbreaks; D004197:Disease Reservoirs; D004783:Environmental Microbiology; D005260:Female; D006801:Humans; D016952:Legionella pneumophila / Q000302:isolation & purification; D007877:Legionnaires' Disease / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged
chemical_list: D000336:Aerosols; D004269:DNA, Bacterial