title: Community outbreak of legionellosis and an environmental investigation into a community water system.
abstract: During two legionellosis outbreak investigations, one at a geriatric centre and the other in high-rise housing for seniors, it was observed that additional cases of legionellosis occurred in nearby smaller residential settings. This apparent geographical cluster of legionellosis occurred in the same general area of a community water storage tank. No potential airborne sources in or near the area could be identified, but a community water system storage tank that was centrally located among case residences spurred an investigation of water-quality factors in the identified investigation area. Conditions conducive for Legionella growth, particularly low chlorine residuals, were found. The rate of legionellosis among residents aged ⩾50 years in the investigation areas (61·0 and 64·1/100 000) was eight times higher than in the rest of the service area (9·0/100 000) and almost 20 times higher than the statewide annual average incidence rate (3·2/100 000). A water mains flushing programme in the area was launched by the water utility, and water samples taken before and during flushing found L. pneumophila.
authors.affiliation: Consumer, Environmental and Occupational Health Service, New Jersey Department of Health, Trenton, NJ,USA.
authors.forename: P D
authors.initials: PD
authors.lastname: Cohn
authors.affiliation: Consumer, Environmental and Occupational Health Service, New Jersey Department of Health, Trenton, NJ,USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Gleason
authors.affiliation: Communicable Disease Service, New Jersey Department of Health, Trenton, NJ,USA.
authors.forename: E
authors.initials: E
authors.lastname: Rudowski
authors.affiliation: Communicable Disease Service, New Jersey Department of Health, Trenton, NJ,USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Tsai
authors.affiliation: Communicable Disease Service, New Jersey Department of Health, Trenton, NJ,USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Genese
authors.affiliation: Consumer, Environmental and Occupational Health Service, New Jersey Department of Health, Trenton, NJ,USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Fagliano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000209:etiology; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D004777:Environment; D005260:Female; D016852:Housing for the Elderly; D006801:Humans; D007876:Legionellosis / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009515:New Jersey / Q000453:epidemiology; D014871:Water Microbiology; D014881:Water Supply; D055815:Young Adult
keywords: water (quality)
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