title: Legionnaires' Disease Outbreak at a Resort in Cozumel, Mexico.
abstract: Background.A Legionnaires' disease (LD) outbreak at a resort on Cozumel Island in Mexico was investigated by a joint Mexico-United States team in 2010. This is the first reported LD outbreak in Mexico, where LD is not a reportable disease.Methods.Reports of LD among travelers were solicited from US health departments and the European Working Group forLegionellaInfections. Records from the resort and Cozumel Island health facilities were searched for possible LD cases. In April 2010, the resort was searched for possibleLegionellaexposure sources. The temperature and total chlorine of the water at 38 sites in the resort were measured, and samples from those sites were tested forLegionella.Results.Nine travelers became ill with laboratory-confirmed LD within 2 weeks of staying at the resort between May 2008 and April 2010. The resort and its potable water system were the only common exposures. No possible LD cases were identified among resort workers.Legionellaewere found to have extensively colonized the resort's potable water system.Legionellaematching a case isolate were found in the resort's potable water system.Conclusions.Medical providers should test for LD when treating community-acquired pneumonia that is severe or affecting patients who traveled in the 2 weeks before the onset of symptoms. When an LD outbreak is detected, the source should be identified and then aggressively remediated. Because LD can occur in tropical and temperate areas, all countries should consider making LD a reportable disease if they have not already done so.
authors.affiliation: Epidemic Intelligence Service, Scientific Education and Professional Development Program Office; Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases.
authors.forename: Lee M
authors.initials: LM
authors.lastname: Hampton
authors.affiliation: Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases.
authors.forename: Laurel
authors.initials: L
authors.lastname: Garrison
authors.affiliation: Epidemic Intelligence Service, Scientific Education and Professional Development Program Office; Connecticut Department of Public Health, Hartford.
authors.forename: Jessica
authors.initials: J
authors.lastname: Kattan
authors.affiliation: Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases.
authors.forename: Ellen
authors.initials: E
authors.lastname: Brown
authors.affiliation: Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases.
authors.forename: Natalia A
authors.initials: NA
authors.lastname: Kozak-Muiznieks
authors.affiliation: Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases.
authors.forename: Claressa
authors.initials: C
authors.lastname: Lucas
authors.affiliation: Division of Global Health Protection, Center for Global Health.
authors.forename: Barry
authors.initials: B
authors.lastname: Fields
authors.affiliation: Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases , Centers for Disease Control and Prevention , Atlanta, Georgia.
authors.forename: Nicole
authors.initials: N
authors.lastname: Fitzpatrick
authors.affiliation: Instituto de Diagnóstico y Referencia Epidemiologicos , Ciudad de Mexico, Distrito Federal.
authors.forename: Luis
authors.initials: L
authors.lastname: Sapian
authors.affiliation: Laboratorio Estatal de Salud Publica de Quintana Roo , Chetumal.
authors.forename: Teresa
authors.initials: T
authors.lastname: Martin-Escobar
authors.affiliation: Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases , Centers for Disease Control and Prevention , Atlanta, Georgia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Waterman
authors.affiliation: Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases.
authors.forename: Lauri A
authors.initials: LA
authors.lastname: Hicks
authors.affiliation: Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública , Cuernavaca, Morelos , Mexico.
authors.forename: Celia
authors.initials: C
authors.lastname: Alpuche-Aranda
authors.affiliation: Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública , Cuernavaca, Morelos , Mexico.
authors.forename: Hugo
authors.initials: H
authors.lastname: Lopez-Gatell
keywords: Legionnaires' disease; community-acquired pneumonia; legionellosis