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Chapter 1 : Legionnaires' Disease 25 Years Later: Lessons Learned

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Legionnaires' Disease 25 Years Later: Lessons Learned , Page 1 of 2

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Abstract:

In 1990, epidemic diphtheria began to emerge in the New Independent States of the former Soviet Union; by 1996, approximately 125,000 cases of diphtheria and 4,000 deaths had been reported. Disease outbreaks are yet another stimulus to discovery. Certainly no one wishes for large numbers of people to become ill; however, outbreaks usually are investigated in considerable detail, whereas single cases are much less likely to receive such attention. Certainly this rule of thumb held true with the Legionnaires' disease outbreak in Philadelphia in 1976, the toxic shock syndrome outbreak several years later, and the outbreak of hantavirus pulmonary syndrome in the Four Corners area of the United States in 1993. The response to anomalous laboratory results turned out to be a critical factor during the investigations of Legionnaires' disease and Pontiac fever. Epidemiologic investigations quickly established that the disease was airborne, but there was no evidence of person-to-person spread. The pulmonary manifestations of the Philadelphia patients were considered more typical of viral pneumonia than of bacterial.

Citation: McDade J. 2002. Legionnaires' Disease 25 Years Later: Lessons Learned , p 1-10. In Marre R, Abu Kwaik Y, Bartlett C, Cianciotto N, Fields B, Frosch M, Hacker J, Lück P (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555817985.ch1

Key Concept Ranking

Hepatitis C virus
0.51171356
Toxic Shock Syndrome
0.46212336
Nipah Virus Infection
0.45657814
Rift Valley Fever
0.45641816
0.51171356
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Figures

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FIGURE 1

Outbreak of Legionnaires' disease in Philadelphia, 1976, in association with a meeting of the Pennsylvania unit of the American Legion.

Citation: McDade J. 2002. Legionnaires' Disease 25 Years Later: Lessons Learned , p 1-10. In Marre R, Abu Kwaik Y, Bartlett C, Cianciotto N, Fields B, Frosch M, Hacker J, Lück P (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555817985.ch1
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References

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1. Armstrong, G. L.,, L. A. Conn,, and R. W. Pinner. 1999. Trends in infectious disease mortality in the United States during the 20th century. JAMA 281:6166.
2. Burnet, M. 1962. Natural History of Infectious Disease, 3rd ed., p. 3. Cambridge University Press, Cambridge, United Kingdom.
3.Centers for Disease Control and Prevention. 1995. Update: Vibrio cholerae 01-Western Hemisphere, 1991-1994 and V. cholerae 0139-Asia, 1994. Morb. Mortal. Wkly. Rep. 44:215219.
4. de Melker, H. E.,, M. A. E. Conyn-van Spaendonck,, H. C. Rumke,, J. K. Wijngaarden,, F. R. Mooi,, and J. F. P. Schellekens. 1977. Pertussis in the Netherlands: an outbreak despite high levels of immunization with whole cell vaccine. Emerg. Infect. Dis. 3:175178.
5. Fraser, D. W.,, T. R. Tsai,, W. Orenstein,, H. W. Beecham,, J. Harris,, R. G. Sharrar,, W. Parking,, G. F. Mallison,, S. M. Martin,, J. E. McDade,, C. C. Shepard,, P. S. Brachman, and the Field Investigation Team. 1977. Legionnaires' disease: description of an epidemic of pneumonia. N. Engl. J. Med. 297: 11891197.
6. Glick, T. H.,, M. B. Gregg,, B. Berman,, G. Mallison,, W. W. Rhodes,, and I. Kassanoff. 1978. An epidemic of unknown etiology in a health department. I. Clinical and epidemiologic aspects. Am. J. Epidemiol. 107:149160.
7.Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. National Academy Press, Washington, D.C..
8. Kuhn, T. S. 1996. The Structure of Scientific Revolutions. University of Chicago Press, Chicago, Ill..
9. McDade, J. E.,, C. C. Shepard,, and D. W. Fraser. Legionnaires' disease: isolation of a bacterium and demonstration of its role in other respiratory disease. 1977. N. Engl. J. Med. 297:11971203.
10. Thacker, S. B.,, J. V. Bennett,, T. F. Tsai,, D. W. Fraser,, J. E. McDade,, C. C. Shepard,, H. Williams,, W. H. Stuart,, H. B. Dull,, and T. C. Eickhoff. 1978. An outbreak in 1965 of severe respiratory illness caused by the Legionnaires' disease bacterium. J. Infect. Dis. 138:512519.
11. Vitek, C. R.,, and M. Wharton. 1998. Diptheria in the former Soviet Union: reemergence of a pandemic disease. Emerg. Infect. Dis. 4:539550.

Tables

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TABLE 1

Selected etiologic agents and infectious diseases identified since 1977

Citation: McDade J. 2002. Legionnaires' Disease 25 Years Later: Lessons Learned , p 1-10. In Marre R, Abu Kwaik Y, Bartlett C, Cianciotto N, Fields B, Frosch M, Hacker J, Lück P (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555817985.ch1
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TABLE 2

Results of IFA tests of sera from Legionnaires' disease patients with isolate

Citation: McDade J. 2002. Legionnaires' Disease 25 Years Later: Lessons Learned , p 1-10. In Marre R, Abu Kwaik Y, Bartlett C, Cianciotto N, Fields B, Frosch M, Hacker J, Lück P (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555817985.ch1
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TABLE 3

IFA results with isolate on serum specimens from other outbreaks

Citation: McDade J. 2002. Legionnaires' Disease 25 Years Later: Lessons Learned , p 1-10. In Marre R, Abu Kwaik Y, Bartlett C, Cianciotto N, Fields B, Frosch M, Hacker J, Lück P (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555817985.ch1
Generic image for table
TABLE 4

Isolation of Legionnaires' disease bacterium (LDB) from guinea pigs exposed to air or evaporative condenser water aerosols 6 weeks after outbreak in Pontiac, Mich., 1968

Citation: McDade J. 2002. Legionnaires' Disease 25 Years Later: Lessons Learned , p 1-10. In Marre R, Abu Kwaik Y, Bartlett C, Cianciotto N, Fields B, Frosch M, Hacker J, Lück P (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555817985.ch1

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