title: Legionnaires' Disease Outbreak at a Long-Term Care Facility Caused by a Cooling Tower Using an Automated Disinfection System--Ohio, 2013.
abstract: On July 9, 2013, an outbreak of Legionnaires' disease (LD) was identified at Long-Term Care Facility A in central Ohio. This article describes the investigation of the outbreak and identification of the outbreak source, a cooling tower using an automated biocide delivery system. In total, 39 outbreak LD cases were identified; among these, six patients died. Water samples from a cooling tower were positive for Legionella pneumophila serogroup 1, reactive to monoclonal antibody 2, with matching sequence type to a patient isolate. An electronic control system turned off cooling tower pumps during low-demand periods, preventing delivery of disinfectant by a timed-release system, and leading to amplification of Legionella in the cooling tower. Guidelines for tower maintenance should address optimal disinfection when using automated systems.
authors.forename: Celia
authors.initials: C
authors.lastname: Quinn
authors.forename: Alicia
authors.initials: A
authors.lastname: Demirjian
authors.forename: Louise Francois
authors.initials: LF
authors.lastname: Watkins
authors.forename: Sara
authors.initials: S
authors.lastname: Tomczyk
authors.forename: Claressa
authors.initials: C
authors.lastname: Lucas
authors.forename: Ellen
authors.initials: E
authors.lastname: Brown
authors.forename: Natalia
authors.initials: N
authors.lastname: Kozak-Muiznieks
authors.forename: Alvaro
authors.initials: A
authors.lastname: Benitez
authors.forename: Laurel E
authors.initials: LE
authors.lastname: Garrison
authors.forename: Jasen
authors.initials: J
authors.lastname: Kunz
authors.forename: Scott
authors.initials: S
authors.lastname: Brewer
authors.forename: Samantha
authors.initials: S
authors.lastname: Eitniear
authors.forename: Mary
authors.initials: M
authors.lastname: DiOrio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000389:Air Conditioning; D004196:Disease Outbreaks; D004202:Disinfectants / Q000008:administration & dosage; D004203:Disinfection / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D016952:Legionella pneumophila / Q000145:classification / Q000302:isolation & purification / Q000502:physiology*; D007877:Legionnaires' Disease / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D009820:Ohio / Q000453:epidemiology; D014871:Water Microbiology
chemical_list: D004202:Disinfectants