{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:03:27Z","timestamp":1785888207806,"version":"3.56.0"},"reference-count":26,"publisher":"Cambridge University Press (CUP)","issue":"10","license":[{"start":{"date-parts":[[2007,12,19]],"date-time":"2007-12-19T00:00:00Z","timestamp":1198022400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Epidemiol. Infect."],"published-print":{"date-parts":[[2008,10]]},"abstract":"<jats:title>SUMMARY<\/jats:title><jats:p>This paper provides one of the first assessments of the burden of both the public health investigation and the economic costs associated with an apparent outbreak of Legionnaires' disease (LD) in South East London. In addition to epidemiological, microbiological and environmental investigations, we collected data on the staff time and resources committed by the 11 main organizations responsible for managing the outbreak. Of the overall estimated costs of \u00a3455 856, only 14% (\u00a364 264) was spent on investigation and control of the outbreak compared with 86% (\u00a3391 592) spent on the hospital treatment of the patients. The time and money spent on public health services in this investigation appear to represent good value for money considering the potential costs of a major outbreak, including the high case-fatality rate in LD generally and the high health-care costs. Further research is needed to determine optimum strategies for the cost-effective use of health system resources in investigations of LD. Whether the threshold for investigation of cases should be based on observed incidence rates or the cost-effectiveness of investigations, or both, should be debated further.<\/jats:p>","DOI":"10.1017\/s0950268807000076","type":"journal-article","created":{"date-parts":[[2007,12,19]],"date-time":"2007-12-19T10:06:53Z","timestamp":1198058813000},"page":"1306-1314","source":"Crossref","is-referenced-by-count":16,"title":["Public health and economic costs of investigating a suspected outbreak of Legionnaires' disease"],"prefix":"10.1017","volume":"136","author":[{"given":"K.","family":"LOCK","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"MILLETT","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"HEATHCOCK","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.\u00a0A.","family":"JOSEPH","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.\u00a0G.","family":"HARRISON","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.\u00a0V.","family":"LEE","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"RAO","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"SURMAN-LEE","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the Outbreak Control Team","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2007,12,19]]},"reference":[{"key":"S0950268807000076_ref011","unstructured":"11.\u00a0Health Protection Agency. Epidemiological data. Legionella (case definitions) (http:\/\/www.hpa.org.uk\/infections\/topics_az\/legionella\/data.htm). Accessed 26 October 2007."},{"key":"S0950268807000076_ref012","unstructured":"12.\u00a0Health and Safety Executive\/Local Authorities Enforcement Liaison Committee (HELA). Investigation of outbreaks (and single cases) of legionellosis from water systems incorporating cooling towers and evaporative condensers. Health and Safety Executive: London, 2002."},{"key":"S0950268807000076_ref015","unstructured":"15.\u00a0European Working Group for Legionella Infections. European surveillance scheme for travel associated Legionnaires' disease (https:\/\/http:\/\/www.ewgli.org\/). Accessed 26 October 2007."},{"key":"S0950268807000076_ref002","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijheh.2006.05.003"},{"key":"S0950268807000076_ref025","unstructured":"25.\u00a0Health and Safety Executive. Legionnaires' disease: The control of legionella in water systems. Approved Code of Practice and Guidance, 2004. London: Health and Safety Executive."},{"key":"S0950268807000076_ref013","first-page":"157","article-title":"Guidelines for investigating a single case of Legionnaires' disease","volume":"5","author":"Lee","year":"2002","journal-title":"Communicable Disease and Public Health"},{"key":"S0950268807000076_ref007","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(96)91137-X"},{"key":"S0950268807000076_ref021","unstructured":"21.\u00a0 Lee JV , Surman SB. Sampling of households for Legionella species, 2002 (www.hpa.org.uk\/infections\/topics_az\/legionella\/sampling.pdf.). Accessed 26 October 2007."},{"key":"S0950268807000076_ref014","unstructured":"14.\u00a0Health and Safety Executive\/Local Authorities Enforcement Liaison Committee (HELA). Control of Legionella: revised approved code of practice. Health and Safety Executive: London, 2001."},{"key":"S0950268807000076_ref023","first-page":"36","article-title":"Legionnaires' disease associated with south London","volume":"15","author":"Joseph","year":"2005","journal-title":"Communicable Disease Report Weekly"},{"key":"S0950268807000076_ref009","doi-asserted-by":"publisher","DOI":"10.1136\/jech.2005.037127"},{"key":"S0950268807000076_ref004","doi-asserted-by":"publisher","DOI":"10.1086\/516309"},{"key":"S0950268807000076_ref008","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a116895"},{"key":"S0950268807000076_ref020","volume-title":"Legionella: State of the Art 30 Years after Its Recognition","author":"Fry","year":"2006"},{"key":"S0950268807000076_ref001","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268804002018"},{"key":"S0950268807000076_ref022","unstructured":"22.\u00a0British Standards Institution. BS 6068-ISO 11731, Water quality\u00a0\u2013\u00a0Part 4: Microbiological methods. Section 4.12:1998. Detection and enumeration of Legionella. London: British Standards Institution, 1998."},{"key":"S0950268807000076_ref005","doi-asserted-by":"publisher","DOI":"10.1086\/498575"},{"key":"S0950268807000076_ref018","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1007\/s10096-002-0820-3","article-title":"Pan-European study on culture-proven Legionnaires' disease: distribution of Legionella pneumophila serogroups and monoclonal subgroups","volume":"21","author":"Helbig","year":"2002","journal-title":"European Journal of Clinical Microbiology and Infectious Disease"},{"key":"S0950268807000076_ref016","doi-asserted-by":"publisher","DOI":"10.1136\/jcp.43.8.685"},{"key":"S0950268807000076_ref006","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/165.4.xxxx"},{"key":"S0950268807000076_ref019","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.43.5.2047-2052.2005"},{"key":"S0950268807000076_ref003","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1985.03360040075028"},{"key":"S0950268807000076_ref017","volume-title":"A Laboratory Manual for Legionella","author":"Harrison","year":"1988"},{"key":"S0950268807000076_ref026","doi-asserted-by":"publisher","DOI":"10.1086\/340738"},{"key":"S0950268807000076_ref024","unstructured":"24.\u00a0Health Protection Agency. Legionnaires' disease in residents of England and Wales\u00a0\u2013\u00a0Nosocomial, travel or community acquired cases, 1980\u20132005 (http:\/\/www.hpa.org.uk\/infections\/topics_az\/legionella\/data_travel_comm_new.htm). 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