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Chapter 9 : A Question of Time: A Short Review of Data on the Incubation Period Between Exposure and Symptom Onset for Legionnaires’ Disease

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A Question of Time: A Short Review of Data on the Incubation Period Between Exposure and Symptom Onset for Legionnaires’ Disease, Page 1 of 2

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Abstract:

The literature on Legionnaires’ disease (LD) widely cites 2 to 10 days (less frequently to 14 days) as the incubation period for the disease. This chapter summarizes the findings of reports with data adequate to examine the potential for incubation periods longer than 10 to 14 days. These findings suggest that while the majority of cases will develop by 14 days, 19 days may be the upper end of the incubation period. The scientific literature was searched, primarily via PubMed and Scirus, for reports on outbreaks of LD. The recovered reports were reviewed for information on the incubation period considered for case inclusion and for data on the actual periods between exposure and symptom onset for the cases. Investigators of outbreaks with well-defined sources and exposure windows should consider a longer case inclusion period from 14 to perhaps as long as 21 days to ensure good data capture and to help better define the latency period between exposure and symptoms for LD.

Citation: Armstrong T. 2006. A Question of Time: A Short Review of Data on the Incubation Period Between Exposure and Symptom Onset for Legionnaires’ Disease, p 37-39. In Cianciotto N, Kwaik Y, Edelstein P, Fields B, Geary D, Harrison T, Joseph C, Ratcliff R, Stout J, Swanson M (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555815660.ch09

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Figures

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FIGURE 1

The cumulative percent of cases accrued reaches 50% at day 10, 90% at day 14, and 95% at day 16. A 10-day cutoff could miss 50% of cases. Note that exposure may have occurred as late as 28 February.

Citation: Armstrong T. 2006. A Question of Time: A Short Review of Data on the Incubation Period Between Exposure and Symptom Onset for Legionnaires’ Disease, p 37-39. In Cianciotto N, Kwaik Y, Edelstein P, Fields B, Geary D, Harrison T, Joseph C, Ratcliff R, Stout J, Swanson M (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555815660.ch09
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References

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1. Centers for Disease Control. 1994. Legionnaires’ disease associated with cooling towers— Massachusetts, Michigan, and Rhode Island, 1993. Morb. Mortal.Wkly. Rep. 43:491493.
2. De Schrijver, K.,, K. Dirven,, K. Van Bouwel,, L. Mortelmans,, P. Van Rossom,, T. De Beukelaar,, C. Vael,, M. Fajo,, O. Ronveaux,, M. F. Peeters,, Z. A. van der,, A. Bergmans,, M. Leven, and, H. Goossens. 2003. An outbreak of Legionnaire’s disease among visitors to a fair in Belgium in 1999. Public Health 117:117124.
3. den Boer, J. W.,, E. P. Yzerman,, J. Schellekens,, K. D. Lettinga,, H. C. Boshuizen,, J. E. Van Steenbergen,, A. Bosnian,, H. S. Van den,, H. A. Van Vliet, M. F. Peeters,, R. J. van Ketel,, P. Speelman,, J. L. Kool, and, M. A. Conyn-van Spaendonck. 2002. A large outbreak of Legionnaires’ disease at a flower show, the Netherlands, 1999. Emerg. Infect. Dis. 8:3743.
4. Edelstein, P. H. 11 August 2005 accession date. Legionnaires’ Disease Database. [Online.] Available at: http://www.uphs.upenn.edu/bugdrug/legionella/ldrefman.html.
5. Fraser, D. W.,, T. R. Tsai,, W. Orenstein,, W. E. Parkin,, H. J. Beecham,, R. G. Sharrar,, J. Harris,, G. F. Mallison,, S. M. Martin,, J. E. Mc-Dade,, C. C. Shepard, and, P. S. Brachman. 1977. Legionnaires’ disease: description of an epidemic of pneumonia. N. Engl.J. Med. 297:11891197.
6. Green, D. 11 August 2005 accession date. Legionnaires’ Disease. [Online.] Available at: http://www.q-net.net.au/~legion/
7. Jernigan, D. B.,, J. Hofmann,, M. S. Cetron,, C. A. Genese,, J. P. Nuorti,, B. S. Fields,, R. F. Benson,, R. J. Carter,, P. H. Edelstein,, I. C. Guerrero,, S. M. Paul,, H. B. Lipman, and, R. Breiman. 1996. Outbreak of Legionnaires’ disease among cruise ship passengers exposed to a contaminated whirlpool spa. Lancet 347:494499.

Tables

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TABLE 1

Summary of published data relevant to the incubation period for legionnaires’ disease

Citation: Armstrong T. 2006. A Question of Time: A Short Review of Data on the Incubation Period Between Exposure and Symptom Onset for Legionnaires’ Disease, p 37-39. In Cianciotto N, Kwaik Y, Edelstein P, Fields B, Geary D, Harrison T, Joseph C, Ratcliff R, Stout J, Swanson M (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555815660.ch09

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