257. Rapid Detection of a Winter Outbreak of Legionellosis New York City, 20142015
Session: Poster Abstract Session: Diagnostics: Typing and Sequencing
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • Benowitz Legionella PCR (IDweek poster) 10 06 15 legal color.pdf (288.4 kB)
  • Background: Legionella bacteria, found in soil and water, infect humans by airborne transmission; outbreaks have been linked to cooling towers and building water systems. Environmental source investigations typically rely on culture, which can take two weeks to grow. We investigated a legionellosis outbreak in a 60,000-resident housing complex (HC) in New York City in 2014–2015.

    Methods: A case was defined as legionellosis in a resident of HC, diagnosed by urine antigen test (UAT) or sputum culture during November 2014–January 2015. A structured patient interview was used to determine risk factors. Environmental samples from residential water systems and nearby cooling towers were cultured. Because of concern for an on-going hazard, we used a previously field-tested polymerase chain reaction (PCR) method to ascertain the presence of Legionella pneumophila serogroup 1 (LP1). Clinical and environmental isolates were compared by pulsed-field gel electrophoresis (PFGE).

    Results: Eight cases were identified by UAT; no patients died. LP1 was isolated from sputum. All cases resided in HC (42 apartment buildings). Two patients lived in the same building. PCR identified LP1 in samples from a large cooling tower 2 days later. No LP1 was identified in other cooling towers or at residential sites. Remediation began the following day. Results were confirmed by culture 5 days later. Clinical and environmental isolates were indistinguishable by PFGE. Repeat environmental sampling found no LP1. No further cases were identified. Changes in water disinfection contributed to Legionella overgrowth.

    Conclusion: We linked a legionellosis outbreak to a cooling tower. Use of PCR in addition to culture allowed action to prevent further illness 5 days earlier than using culture alone. Adequate water disinfection may help prevent legionellosis outbreaks.

    Isaac Benowitz, MD1,2, Robert Fitzhenry, PhD2, Christopher Boyd, BA3, Michelle Dickinson, MPH4, Michael Levi, ScD, (D) ABMM5, Ying Lin, PhD6, Elizabeth Nazarian, MT (ASCP)4, Belinda Ostrowsky, MD, MPH, FIDSA, FSHEA7, Teresa Passaretti, BS8, Jennifer Rakeman, PhD6, Elena Shamoonian, BS9, Amy Saylors, MLT(ASCP)4, Sharon Balter, MD2 and Terry-Ann Smith, MS6, (1)Epidemic Intelligence Service, US Centers for Disease Control and Prevention, Atlanta, GA, (2)Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, Long Island City, NY, (3)Public Health Engineering, New York City Department of Health and Mental Hygiene, Long Island City, NY, (4)Wadsworth Center, New York State Department of Health, Albany, NY, (5)Pathology, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, (6)Public Health Laboratory, New York City Department of Health and Mental Hygiene, New York, NY, (7)Department of Medicine, Division of Infectious Diseases, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, (8)Division of Infectious Diseases, New York State Department of Health, Wadsworth Center, Albany, NY, (9)Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY

    Disclosures:

    I. Benowitz, None

    R. Fitzhenry, None

    C. Boyd, None

    M. Dickinson, None

    M. Levi, None

    Y. Lin, None

    E. Nazarian, None

    B. Ostrowsky, None

    T. Passaretti, None

    J. Rakeman, None

    E. Shamoonian, None

    A. Saylors, None

    S. Balter, None

    T. A. Smith, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.