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O: Public Health
Abstract Submission
Jared R. Rispens, MD, REHS/RS
Epidemic Intelligence Service Officer
Centers for Disease Control and Prevention
Atlanta, GA
Disclosure: Nothing to disclose
Chris Edens, PhD
Epidemiologist
Centers for Disease Control and Prevention
Atlanta, GA
Disclosure: Nothing to disclose
Albert Barskey, MPH
Epidemiologist
Centers for Disease Control and Prevention
Atlanta, CA
Disclosure: Nothing to disclose
Jeffrey Mercante, PhD
Research Microbiologist
Centers for Disease Control and Prevention
Atlanta, GA
Disclosure: Nothing to disclose
Troy Ritter, PhD
Commander
United States Public Health Service
Atlanta, GA
Disclosure: Nothing to disclose
Stephen B. Martin, PhD
Captain
United States Public Health Service
Morgantown, WV
Disclosure: Nothing to disclose
Marisa Hast, PhD
Epidemic Intelligence Service Officer
Centers for Disease Control and Prevention
Atlanta, GA
Disclosure: Nothing to disclose
Miriam Siegel, DrPH, MPH
Epidemic Intelligence Service Officer
National Institute for Occupational Safety and Health, CDC
Cincinnati, OH
Disclosure: Nothing to disclose
Erica Thomasson, PhD
Chief Science Officer
West Virginia Bureau for Public Health
Charleston, WV
Disclosure: Nothing to disclose
Jackie L. Huff, BS
Administrator
Hancock County Health Department
Chester, WV
Disclosure: Nothing to disclose
Carolyne A. Baker, BS, REHS/RS
Registered Santarian, Registered Environmental Health Specialist
West Virginia Bureau of Public Health Sanitation
Weirton, WV
Disclosure: Nothing to disclose
Chelsea Everly, Bachelor of Science in Public Health
Environmental Sanitarian
Hancock County Health Department
New Cumberland, WV
Disclosure: Nothing to disclose
Background : In October 2018, the West Virginia Bureau for Public Health (BPH) notified CDC of one Legionella urinary antigen test (UAT) positive case of Legionnaires’ disease (LD) in a worker at a racetrack facility. Following investigation by BPH and the county health department, five additional LD cases were identified among facility workers within a one-month period. Our objective was to determine the extent of the outbreak and identify potential sources of exposure.
Methods : We interviewed the previously identified patients and conducted case-finding among racetrack workers. Our case definitions included confirmed LD (pneumonia with a positive UAT), suspected LD (pneumonia without a UAT completed), and Pontiac fever (PF) (self-limited, non-specific flu-like symptoms) among employees with exposure to the facility within 14 days prior to symptom onset. We conducted an environmental assessment of the facility and the surrounding area for sources of potential Legionella exposure.
Results : We identified 17 cases (71% in men, 35% in current smokers, median age 55 years): six confirmed LD, four suspected LD, and seven suspected PF cases. Our environmental assessment revealed a poorly maintained hot tub in the 1st floor jockey area. All samples collected from the hot tub (which was chlorinated before our arrival) tested negative for Legionella. Two employees with confirmed LD (33%), three with suspected LD (75%), and six with suspected PF (86%) had direct exposure to the hot tub or adjacent hallway; the remaining six were exposed only to a 2nd floor office suite. Further investigation identified deficiencies in the facility’s ventilation systems and a crack in the floor between the hot tub and office areas. These factors created a pathway for Legionella-containing aerosols from the hot tub to pass into the 2nd floor office space and air-handling unit for recirculation to occupied areas.
Conclusion :
Our investigation suggests that both direct and indirect exposure to a Legionella reservoir can cause illness. This finding supports analysis of ventilation systems and airflow dynamics in future LD outbreak investigations. Clinicians should consider LD in pneumonia patients with direct or indirect exposure to suspected Legionella sources to ensure appropriate testing and treatment.