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Estimating the True Burden of Legionnaires' Disease.

Authors
  • Cassell, Kelsie1
  • Gacek, Paul2
  • Rabatsky-Ehr, Therese2
  • Petit, Susan2
  • Cartter, Matthew2
  • Weinberger, Daniel M1
  • 1 Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut.
  • 2 Connecticut Department of Public Health, Hartford, Connecticut.
Type
Published Article
Journal
American journal of epidemiology
Publication Date
Sep 01, 2019
Volume
188
Issue
9
Pages
1686–1694
Identifiers
DOI: 10.1093/aje/kwz142
PMID: 31225857
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Over the past decade, the reported incidence of Legionnaires' disease (LD) in the northeastern United States has increased, reaching 1-3 cases per 100,000 population. There is reason to suspect that this is an underestimate of the true burden, since LD cases may be underdiagnosed. In this analysis of pneumonia and influenza (P&I) hospitalizations, we estimated the percentages of cases due to Legionella, influenza, and respiratory syncytial virus (RSV) by age group. We fitted mixed-effects models to estimate attributable percents using weekly time series data on P&I hospitalizations in Connecticut from 2000 to 2014. Model-fitted values were used to calculate estimates of numbers of P&I hospitalizations attributable to Legionella (and influenza and RSV) by age group, season, and year. Our models estimated that 1.9%, 8.8%, and 5.1% of total (all-ages) inpatient P&I hospitalizations could be attributed to Legionella, influenza, and RSV, respectively. Only 10.6% of total predicted LD cases had been clinically diagnosed as LD during the study period. The observed incidence rate of 1.2 cases per 100,000 population was substantially lower than our estimated rate of 11.6 cases per 100,000 population. Our estimates of numbers of P&I hospitalizations attributable to Legionella are comparable to those provided by etiological studies of community-acquired pneumonia and emphasize the potential for underdiagnosis of LD in clinical settings. © The Author(s) 2019. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: [email protected]

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