Risk Factors for Domestic Acquisition of Legionnaires Disease

doi:10.1001/archinte.1996.00440140115011

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Vol. 156 No. 15, 12 AUGUST 1996

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Risk Factors for Domestic Acquisition of Legionnaires Disease

Walter L. Straus, MD; Joseph F. Plouffe, MD; Thomas M. File, Jr, MD; Harvey B. Lipman, PhD; Barbara H. Hackman, MPH; Sara-Jane Salstrom; Robert F. Benson, MS; Robert F. Breiman, MD

Arch Intern Med. 1996;156(15):1685-1692.

Abstract

Background
Legionnaires disease is a common cause of adult pneumonia. Outbreaksof legionnaires disease have been well described, but littleis known about sporadically occurring legionnaires disease,which accounts for most infections. Exposure to contaminatedresidential water sources is 1 plausible means of disease acquisition.

Methods
Employing a matched case-control study design in 15 hospitalsin 2 Ohio counties, we prospectively enrolled 146 adults diagnosedas having nonepidemic, community-acquired legionnaires diseaseand compared each with 2 hospital-based control patients, matchedfor age, sex, and underlying illness category. An interviewregarding potential exposures was followed by a home surveythat included sampling residential sources for Legionella. Interviewand home survey data were analyzed to estimate the risk of acquiringlegionnaires disease associated with various exposures.

Results
Multivariate analysis showed that a nonmunicipal water supply(odds ratio [OR], 2.26; 95% confidence interval [CI], 1.17-4.37),recent residential plumbing repair (OR, 2.39; 95% CI, 1.10-5.18),and smoking (OR, 3.48; 95% CI, 2.09-5.79) were independent riskfactors for legionnaires disease. Univariate analysis suggestedthat electric (vs gas) water heaters (OR, 1.97; 95% CI, 1.10-3.52),working more than 40 hours weekly (OR, 2.13; 95% CI, 1.12-4.07),and spending nights away from home before illness (OR, 1.68;95% CI, 1.03-2.74) were additional possible risk factors. Lowerchlorine concentrations in potable water and lower water heatertemperatures were associated with residential Legionella colonization.

Conclusions
A proportion of sporadic cases of legionnaires disease may beresidentially acquired and are associated with domestic potablewater and disruptions in residential plumbing systems. Potentialstrategies to reduce legionnaires disease risk include consistentchlorination of potable water, increasing water heater temperatures,and limiting exposure to aerosols after domestic plumbing repairs.

Arch Intern Med. 1996;156:1685-1692

Author Affiliations

Ohio Legionnaires Disease Group

From the Division of Bacterial and Mycotic Infections, National Center for Infectious Dieseases, Centers for Disease Control and Prevention, Atlanta, Ga (Drs Straus, Lipman, and Breiman and Mr Benson); Department of Medicine, University of North Carolina, Chapel Hill (Dr Straus); Department of Medicine, Ohio State University, Columbus (Dr Plouffe and Ms Hackman); and the Department of Medicine, Northeastern Ohio Universities College of Medicine, Akron (Dr File and Ms Salstrom). Members of the Ohio Legionnaires Disease Group are listed in a box on page 1688.

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