{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T04:55:52Z","timestamp":1768798552095,"version":"3.49.0"},"reference-count":21,"publisher":"Cambridge University Press (CUP)","issue":"1","license":[{"start":{"date-parts":[[2009,5,15]],"date-time":"2009-05-15T00:00:00Z","timestamp":1242345600000},"content-version":"unspecified","delay-in-days":6497,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["journals.cambridge.org"],"crossmark-restriction":true},"short-container-title":["Epidemiol. Infect."],"published-print":{"date-parts":[[1991,8]]},"abstract":"<jats:title>SUMMARY<\/jats:title><jats:p>Fourteen people living in or near the city of Gloucester fell ill with Legionnaires' disease caused by <jats:italic>Legionella pneumophila<\/jats:italic> serogroup (SG) 1 between 27 August and 27 October 1986. Another patient had fallen ill on 30 May. Nine of the 15 were diagnosed retrospectively during a case finding exercise. There were three deaths. Three cases of Pontiac fever were also diagnosed.<\/jats:p><jats:p>The source was probably one or more wet cooling towers. Nineteen premises in the city with such towers were identified, and three just outside Gloucester. Samples from 11 of the 22 premises grew <jats:italic>Legionella<\/jats:italic> spp.; from nine of these <jats:italic>L. pneumophila<\/jats:italic> SG 1 (Pontiac) was isolated. The efficacy of regular addition of biocide in addition to hypochlorite added at the time of disinfection in inhibiting the growth of <jats:italic>Legionella<\/jats:italic> spp. was demonstrated.<\/jats:p><jats:p>A survey of patients' movements during their likely incubation period showed that there was no single building that all patients had visited, but there were two areas of the city which nearly all had visited or passed through by car. A case-control study demonstrated an association with one of these areas.<\/jats:p><jats:p>Cooling towers near both areas may have been sources but the evidence is insufficient to incriminate any single one. The unexpected finding of <jats:italic>L. pneumophila<\/jats:italic> SG 1 (Pontiac) in nine towers supports the hypothesis that there may have been multiple sources. Cooling towers may have been contaminated by mains water or by drift from other towers.<\/jats:p>","DOI":"10.1017\/s0950268800048767","type":"journal-article","created":{"date-parts":[[2009,5,15]],"date-time":"2009-05-15T09:13:12Z","timestamp":1242378792000},"page":"133-141","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":19,"title":["An outbreak of Legionnaires' disease in Gloucester"],"prefix":"10.1017","volume":"107","author":[{"given":"D. A.","family":"Hunt","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K. A. V.","family":"Cartwright","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. C.","family":"Smith","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Middleton","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C. L. R.","family":"Bartlett","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. V.","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P. J.","family":"Dennis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D.","family":"Harper","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2009,5,15]]},"reference":[{"key":"S0950268800048767_ref021","doi-asserted-by":"publisher","DOI":"10.1099\/00222615-31-1-45"},{"key":"S0950268800048767_ref020","unstructured":"20. Health and Safety Executive. Legionnaires' disease. Guidance note EH48. January 1987."},{"key":"S0950268800048767_ref019","doi-asserted-by":"publisher","DOI":"10.1017\/S0022172400063580"},{"key":"S0950268800048767_ref017","unstructured":"17. Committee of inquiry. First report of the Committee of Inquiry into the Outbreak of Legionnaires' Disease in Stafford in April, 1985. HMSO. Cmnd 9772"},{"key":"S0950268800048767_ref016","first-page":"630","article-title":"Outbreak of Legionnaires' disease from a cooling water system in a power station","volume":"43","author":"Morton","year":"1986","journal-title":"Br J Indust Med"},{"key":"S0950268800048767_ref015","first-page":"202","article-title":"Woodward M. Legionnaires disease in Reading \u2013 possible association with a cooling tower","volume":"7","author":"Anderson","year":"1985","journal-title":"Community Med"},{"key":"S0950268800048767_ref014","first-page":"64","article-title":"Epidemic legionellosis in England and Wales 1979\u201382","volume":"255","author":"Bartlett","year":"1983","journal-title":"Zentrabl Bacteriol Mikrobiol Hyg Orig A"},{"key":"S0950268800048767_ref013","volume-title":"Minimising the risk of Legionnaires' disease","year":"1987"},{"key":"S0950268800048767_ref010","volume-title":"The control of legionellae in health care premises \u2013 a code of practice","year":"1988"},{"key":"S0950268800048767_ref009","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/15.1.126"},{"key":"S0950268800048767_ref006","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(81)90988-0"},{"key":"S0950268800048767_ref003","doi-asserted-by":"publisher","DOI":"10.1017\/S095026880005932X"},{"key":"S0950268800048767_ref002","unstructured":"2. Public Health Laboratory Service. Communicable Disease Surveillance Centre. CDR 85\/50."},{"key":"S0950268800048767_ref001","first-page":"195","article-title":"Community-acquired pneumonia in adults in British hospitals in 1982\u20131983: a survey of aetiology, mortality, prognostic factors and outcome","volume":"239","year":"1987","journal-title":"Quart J Med"},{"key":"S0950268800048767_ref011","volume-title":"Legionnaires disease and hospital water systems","year":"1980"},{"key":"S0950268800048767_ref012","volume-title":"Legionnaires disease: interim engineering guidance no. 2. Cooling towers and evaporative condensers","year":"1986"},{"key":"S0950268800048767_ref018","first-page":"380","article-title":"Outbreak of legionellosis in a community","volume":"ii","year":"1986","journal-title":"Lancet"},{"key":"S0950268800048767_ref005","doi-asserted-by":"publisher","DOI":"10.1136\/jcp.35.9.1028"},{"key":"S0950268800048767_ref008","doi-asserted-by":"publisher","DOI":"10.1002\/path.1711530310"},{"key":"S0950268800048767_ref004","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268800047385"},{"key":"S0950268800048767_ref007","doi-asserted-by":"publisher","DOI":"10.1017\/S0022172400062641"}],"container-title":["Epidemiology and Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0950268800048767","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,5,17]],"date-time":"2019-05-17T21:02:30Z","timestamp":1558126950000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0950268800048767\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1991,8]]},"references-count":21,"journal-issue":{"issue":"1","published-print":{"date-parts":[[1991,8]]}},"alternative-id":["S0950268800048767"],"URL":"https:\/\/doi.org\/10.1017\/s0950268800048767","relation":{},"ISSN":["0950-2688","1469-4409"],"issn-type":[{"value":"0950-2688","type":"print"},{"value":"1469-4409","type":"electronic"}],"subject":[],"published":{"date-parts":[[1991,8]]},"assertion":[{"value":"Cambridge University Press 1991","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}}]}}