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An Outbreak of Legionnaires' Disease Associated with a Contaminated Air-Conditioning Cooling Tower

List of authors.
  • Timothy J. Dondero, Jr., M.D.,
  • Robert C. Rendtorff, M.D.,
  • George F. Mallison, M.P.H.,
  • R. Mark Weeks, M.P.H.,
  • Joe S. Levy, M.D.,
  • Edward W. Wong, M.D.,
  • and William Schaffner, M.D.

Abstract

In August and September 1978, an outbreak of Legionnaires' disease occurred in Memphis, Tennessee. Of the 44 ill, 39 had been either patients, employees, visitors, or passers-by at one Memphis hospital (Hospital A) during the 10 days before. Assuming an incubation period of between two and 10 days, the onset of cases correlated precisely with the use of Hospital A's auxiliary air-conditioning cooling tower. L. pneumophila was recovered from two samples of water from the tower.

Infection appeared to have occurred both outside and within the hospital. A significant association was demonstrated between acquisition of Legionnaires' disease and prior hospitalizaron in those areas of Hospital A that received ventilating air from air intakes near the auxiliary cooling tower. Tracer-smoke studies indicated that contaminated aerosols from the tower could easily reach these air intakes, as well as the street below, where four passers-by had been before they contracted Legionnaires' disease.

This represents a common-source outbreak in which the source of L. pneumophila infection and airborne transmission were identified. (N Engl J Med 302:365–370, 1980)

Funding and Disclosures

This manuscript shared the 1979 Alexander D. Langmuir Prize for epidemiology, which is awarded annually by the Epidemic Intelligence Service Alumni Association of the Center for Disease Control.

Many persons participated and assisted in the investigation. We acknowledge the contributions of R. T. Kelly, W. A. Rightsel, F. H. Portera, K. F. Hood, T. P. Smith, C. N. Lee, B. J. Thomas, S. Sturdevant, and the medical, nursing, serology, microbiology, engineering and medical-records staffs, and administration of the Baptist Memorial Hospital, Memphis; the infection-control personnel at the Methodist Hospitals, the City of Memphis Hospital, the St. Joseph's Hospitals, and the Veterans Administration Hospital, Memphis; G. S. Lovejoy, Z. Boyle, and the Environmental Section, Memphis-Shelby County Health Department; S. Eakin, J. H. Grayson, and the Serology Laboratory, Tennessee Department of Public Health; G. K. Morris, P. Skaliy, and the Epidemiological Investigations Laboratory Branch Bacterial Diseases Division, Bureau of Epidemiology, Center for Disease Control, Atlanta, Ga. Finally, we wish to thank R. H. Hutcheson, Jr., of the Tennessee Department of Public Health, and the following persons from the Center for Disease Control, for their help: A. W. Hightower, S. M. Martin, J. R. Allen, R. E. Dixon, C. V. Broome, S. I. Music, J. L. Conrad, and D. W. Fraser.

Author Affiliations

From the Field Services Division and the Bacterial Diseases Division, Bureau of Epidemiology, Center for Disease Control, Atlanta; the Department of Preventive Medicine, University of Tennessee School of Medicine, Memphis; the Tennessee Department of Public Health; the Memphis-Shelby County Health Department; and the Vanderbilt University School of Medicine, Nashville (address reprint requests to Dr. Dondero at the Bureau of Epidemiology, Center for Disease Control, Atlanta, GA 30333).

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