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Andrea L. Benin, Robert F. Benson, Kathryn E. Arnold, Anthony E. Fiore, Patricia G. Cook, L. Keoki Williams, Barry Fields, Richard E. Besser, An Outbreak of Travel-Associated Legionnaires Disease and Pontiac Fever: The Need for Enhanced Surveillance of Travel-Associated Legionellosis in the United States, The Journal of Infectious Diseases, Volume 185, Issue 2, 15 January 2002, Pages 237–243, https://doi.org/10.1086/338060
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Abstract
Travel-associated outbreaks of legionnaires disease (LD) and combined outbreaks of LD and Pontiac fever (PF) are rarely identified. During one travel-associated combined outbreak at a hotel, a cohort study of potentially exposed persons and an environmental investigation were performed. Two LD and 22 PF cases were identified. Legionella pneumophila serogroup 6 (Lp6) isolates from the index patient and the hotel whirlpool spa were found to be identical by amplified fragment–length polymorphism typing. Disease occurred in 10 of 26 guests who were exposed to the spa versus 2 of 29 guests who were exposed only to the pool area (38% vs. 7%; P=.005). Immunoglobulin M (IgM) antibody to the outbreak Lp6 strain was more common among persons with PF (4 of 9) than among non-ill persons (2 of 32) (44% vs. 6%; P=.02). Spa exposure correlated with disease (P=.001) and IgM seropositivity (P=.007). New laboratory techniques facilitate outbreak investigation; to expedite outbreak interruption and measure the impact of travel-associated legionellosis, surveillance must be improved