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Medscape Medical News 2004. © 2004 Medscape
(Boston) — The incidence of legionellosis appears to increase during wet
weather, suggesting that clinicians and public health officials need to be
on the lookout for signs of the infection and possible methods for reducing
environmental exposures during the rainy season, researchers from the
Centers for Disease Control and Prevention (CDC) and public health officials
Legionellosis includes both Pontiac
fever, a self-limited flu-like illness, and Legionnaire's disease (LD), a
severe pneumonia responsible for an estimated 8,000 to 18,000
hospitalizations in the U.S. each year, according to CDC data.
causative pathogen, Legionella pneumophila, is a waterborne
organism, so it is not surprising that the bug would flourish under wet
conditions, according to Lauri Hicks, DO, a medical epidemiologist in the
division of respiratory disease at the CDC in Atlanta, Georgia. But little
is known about risk factors or transmission of sporadic LD, which accounts
for about 80% of all cases.
sporadic outbreak of legionellosis infection occurred after record rainfall
in the mid-Atlantic states in 2003, Dr. Hicks and colleagues in the state
health departments of North
Maryland, and Virginia wanted to know why.
investigators used data reported to the CDC along with annual Census Bureau
population estimates to calculate monthly LD incidence in five mid-Atlantic
Maryland, North Carolina, Pennsylvania, and Virginia. They also obtained
meteorologic data, including rainfall and temperature information for each
state, from the National
Climatic Data Center. The investigators evaluated the relationship between
legionellosis rates and climatic variables using Pearson's correlation
coefficient (r) and a Poisson regression model.
found that from January to August 2003, there were 374 reported sporadic
cases in the five states compared with an average of 161 cases (range,
107-225) during the same months over the previous 13 years. The correlations
for legionellosis were 0.40 for rainfall, 0.39 for temperature, and 0.53 for
the combination of temperature and rain (P < .01 for all). Using the
Poisson model, they found a linear relationship between rainfall and
relative risk for legionellosis. The model showed that an increase of 2.6
inches in the monthly average rainfall from May to September 2003
corresponded to a 24% increased risk of legionellosis. The results held up
even when they controlled for variables such as changes in surveillance
practices or in the urine antigen test now widely used to screen for
investigators speculated that the increase in legionellosis could be due to
a temporary compromise of public water supplies.
we found is consistent with the ecology of the organism. We know that
Legionella is a waterborne organism and we know that it grows fast in
warm temperatures, so it makes sense that if water quality changes, perhaps
related to disinfectants in the water supply or an increase in particulate
matter that supports growth of Legionella, that legionellosis cases
may increase," Dr. Hicks told Medscape.
cannot say that there is absolutely a causal relationship at this point, and
heavy rainfall does not lead directly to an increase in legionellosis cases,
but we can see that it may lead to some sort of change in conditions that
would lead to legionellosis," she said.
epidemiologist from a notoriously soggy state told Medscape that larger
climatic factors than rainfall alone may be at work.
think it's very interesting the way that rates [of legionellosis] do seem to
change in certain situations, and I think it probably is multifactorial and
may be related to actual change in climate than to the rainfall itself,
because you would expect that in western Washington, where we have a much
higher average rainfall than they do in say, Pennsylvania, that we would
have lots of cases of Legionella, said Jo Hofmann, MD, an
epidemiologist for communicable diseases for the state of Washington. "It's
interesting, but it would be more interesting to follow it for a longer
period of time as climate changes throughout the world." Dr. Hofmann
attended the presentation and commented on it for Medscape. She was not
involved in the study.
Hicks and colleagues recommend increased vigilance for legionellosis during
times of abnormally high rainfall and suggest that "identification of the
specific environmental sources that support transmission during heavy
rainfall may lead to opportunities for prevention," according to their
2004 Annual Meeting: Abstract 751. Presented Oct. 2, 2004.
Reviewed by Gary D. Vogin, MD
Phillip Fry and Divine Montero to find
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