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Chapter 79 : Legionnaires' Disease in the United States: Opportunities for Prevention

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Legionnaires' Disease in the United States: Opportunities for Prevention, Page 1 of 2

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Abstract:

Much of what we know about the epidemiology and prevention of Legionnaires' disease (LD) comes from outbreak investigations and special studies. In this chapter the author focuses on three areas where one's knowledge is expanding and where new prevention opportunities have emerged: surveillance for travel-related legionellosis, the use of LD diagnostic tests, and new directions in water disinfection. Detection of travel-related outbreaks offers the potential for providing new prevention opportunities. The European Working Group for Infections conducts surveillance for travel-related LD in Europe. This system has been quite successful at identifying clusters of travel-associated LD. Several studies indicate that the ability to identify outbreaks of LD is inadequate and that the adoption of new diagnostic tests may be further eroding our capacity to identify certain types of infections. To prevent LD in hospitals, Centers for Disease Control and Prevention (CDC) recommends a strategy based on proper maintenance of water systems, universal testing of appropriate patients, and thorough investigations in situations where disease transmission occurs. The shift in diagnostic approach also has imphcations for the ability of the public health community to respond to outbreaks of LD. Monochloramine is currently used by nearly 25% of municipalities as a residual disinfectant in their public water distribution system. In addition to epidemiologic studies supporting the use of monochloramine, laboratory data demonstrate increased efficacy of monochloramine compared with chlorine in eliminating biofilm-associated .

Citation: Besser R. 2002. Legionnaires' Disease in the United States: Opportunities for Prevention, p 391-397. 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.ch79

Key Concept Ranking

Pulsed-Field Gel Electrophoresis
0.49685717
Legionella longbeachae
0.48333335
Legionella pneumophila
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0.49685717
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Figures

Image of FIGURE 1
FIGURE 1

Legionnaires' disease cases reported to Legionnaires' Disease Reporting System, by diagnostic method, United States, 1980 to 1998. Solid line, total number of cases; dotted line, cases diagnosed by culture; dashed line, cases diagnosed by urine antigen.

Citation: Besser R. 2002. Legionnaires' Disease in the United States: Opportunities for Prevention, p 391-397. 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.ch79
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Image of FIGURE 2
FIGURE 2

cases per year reported to Legionnaires' Disease Reporting of LD, they do not provide bacterial isolates, which can be crucial during an investigation. Without a clinical isolate, it can be difficult to definitively implicate a potential source of transmission. During an investigation, multiple strains of often will be isolated from a variety of sources. Molecular epidemiology is used to determine whether strains from the environment are identical to patient isolates ( ).

Citation: Besser R. 2002. Legionnaires' Disease in the United States: Opportunities for Prevention, p 391-397. 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.ch79
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References

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