{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T09:17:13Z","timestamp":1768468633807,"version":"3.49.0"},"reference-count":46,"publisher":"Cambridge University Press (CUP)","issue":"2","license":[{"start":{"date-parts":[[2016,10,20]],"date-time":"2016-10-20T00:00:00Z","timestamp":1476921600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["journals.cambridge.org"],"crossmark-restriction":true},"short-container-title":["Epidemiol. Infect."],"published-print":{"date-parts":[[2017,1]]},"abstract":"<jats:title>SUMMARY<\/jats:title><jats:p>An outbreak of Legionnaires' disease occurred in an inner city district in Calgary, Canada. This outbreak spanned a 3-week period in November\u2013December 2012, and a total of eight cases were identified. Four of these cases were critically ill requiring intensive care admission but there was no associated mortality. All cases tested positive for<jats:italic>Legionella pneumophila<\/jats:italic>serogroup 1 (LP1) by urinary antigen testing. Five of the eight patients were culture positive for LP1 from respiratory specimens. These isolates were further identified as Knoxville monoclonal subtype and sequence subtype ST222. Whole-genome sequencing revealed that the isolates differed by no more than a single vertically acquired single nucleotide variant, supporting a single point-source outbreak. Hypothesis-based environmental investigation and sampling was conducted; however, a definitive source was not identified. Geomapping of case movements within the affected urban sector revealed a 1\u00b70 km common area of potential exposure, which coincided with multiple active construction sites that used water spray to minimize transient dust. This community point-source Legionnaires' disease outbreak is unique due to its ST222 subtype and occurrence in a relatively dry and cold weather setting in Western Canada. This report suggests community outbreaks of<jats:italic>Legionella<\/jats:italic>should not be overlooked as a possibility during late autumn and winter months in the Northern Hemisphere.<\/jats:p>","DOI":"10.1017\/s0950268816001965","type":"journal-article","created":{"date-parts":[[2016,10,20]],"date-time":"2016-10-20T08:57:56Z","timestamp":1476953876000},"page":"254-265","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":7,"title":["Unusual Legionnaires' outbreak in cool, dry Western Canada: an investigation using genomic epidemiology"],"prefix":"10.1017","volume":"145","author":[{"given":"N. C.","family":"KNOX","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K. A.","family":"WEEDMARK","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"CONLY","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. W.","family":"ENSMINGER","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F. S.","family":"HOSEIN","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S. J.","family":"DREWS","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"the Legionella Outbreak Investigative Team","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2016,10,20]]},"reference":[{"key":"S0950268816001965_ref39","doi-asserted-by":"publisher","DOI":"10.1128\/mBio.01091-14"},{"key":"S0950268816001965_ref13","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1128\/AEM.49.5.1197-1205.1985","article-title":"Effect of temperature, pH, and oxygen level on the multiplication of naturally occurring Legionella pneumophila in potable water","volume":"49","author":"Wadowsky","year":"1985","journal-title":"Applied and Environmental Microbiology"},{"key":"S0950268816001965_ref32","unstructured":"FigTree (http:\/\/tree.bio.ed.ac.uk\/software\/figtree). Accessed 13 November 2015."},{"key":"S0950268816001965_ref22","volume-title":"Manual of Clinical Microbiology","author":"Edelstein","year":"2011"},{"key":"S0950268816001965_ref21","first-page":"9","volume-title":"Standard Methods for the Examination of Water and Wastewater","author":"Rice","year":"2005"},{"key":"S0950268816001965_ref24","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 Diseases"},{"key":"S0950268816001965_ref10","doi-asserted-by":"publisher","DOI":"10.3201\/eid1603.081689"},{"key":"S0950268816001965_ref29","doi-asserted-by":"publisher","DOI":"10.1093\/nar\/gkt394"},{"key":"S0950268816001965_ref20","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/165.4.xxxx"},{"key":"S0950268816001965_ref28","doi-asserted-by":"publisher","DOI":"10.1186\/gb-2004-5-2-r12"},{"key":"S0950268816001965_ref5","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-12-313"},{"key":"S0950268816001965_ref25","doi-asserted-by":"crossref","unstructured":"Petkau A . SNVPhyl: Whole Genome SNV Phylogenomics Pipeline, 2015; e554b40 (https:\/\/github.com\/apetkau\/snvphyl-galaxy. Accessed 3 June 2016.","DOI":"10.1099\/mgen.0.000116"},{"key":"S0950268816001965_ref19","doi-asserted-by":"publisher","DOI":"10.3390\/v4112754"},{"key":"S0950268816001965_ref42","first-page":"63","article-title":"Notes from the field: increase in reported legionellosis \u2013 Milwaukee, Wisconsin, June-September 2013","volume":"63","author":"Biedrzycki","year":"2014","journal-title":"Morbidity and Mortality Weekly Report"},{"key":"S0950268816001965_ref15","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/141.5.689"},{"key":"S0950268816001965_ref40","doi-asserted-by":"publisher","DOI":"10.1128\/JB.01739-12"},{"key":"S0950268816001965_ref43","doi-asserted-by":"publisher","DOI":"10.1086\/590557"},{"key":"S0950268816001965_ref46","doi-asserted-by":"crossref","first-page":"19844","DOI":"10.2807\/ese.16.16.19844-en","article-title":"Contamination of the cold water distribution system of health care facilities by Legionella pneumophila: do we know the true dimension?","volume":"16","author":"Arvand","year":"2011","journal-title":"Eurosurveillance"},{"key":"S0950268816001965_ref9","doi-asserted-by":"publisher","DOI":"10.1007\/s10393-009-0218-0"},{"key":"S0950268816001965_ref6","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-9-68"},{"key":"S0950268816001965_ref26","doi-asserted-by":"publisher","DOI":"10.1111\/cmi.12586"},{"key":"S0950268816001965_ref35","doi-asserted-by":"publisher","DOI":"10.1093\/bioinformatics\/btu153"},{"key":"S0950268816001965_ref36","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0011147"},{"key":"S0950268816001965_ref41","doi-asserted-by":"publisher","DOI":"10.3201\/eid2011.131872"},{"key":"S0950268816001965_ref11","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.01973-13"},{"key":"S0950268816001965_ref34","doi-asserted-by":"publisher","DOI":"10.1089\/cmb.2012.0021"},{"key":"S0950268816001965_ref8","doi-asserted-by":"publisher","DOI":"10.1099\/jmm.0.46738-0"},{"key":"S0950268816001965_ref1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)60078-2"},{"key":"S0950268816001965_ref17","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1111\/j.1600-6143.2011.03938.x","article-title":"Legionellosis \u2013 United States, 2000\u20132009","volume":"12","author":"Hicks","year":"2012","journal-title":"American Journal of Transplantation"},{"key":"S0950268816001965_ref12","doi-asserted-by":"publisher","DOI":"10.1016\/0966-842X(96)10041-X"},{"key":"S0950268816001965_ref16","doi-asserted-by":"publisher","DOI":"10.1017\/S0022172400029090"},{"key":"S0950268816001965_ref30","doi-asserted-by":"publisher","DOI":"10.1093\/sysbio\/syq010"},{"key":"S0950268816001965_ref45","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.1999.tb02568.x"},{"key":"S0950268816001965_ref31","doi-asserted-by":"publisher","DOI":"10.1080\/10635150600755453"},{"key":"S0950268816001965_ref18","unstructured":"United States Centers for Disease Control and Prevention. Legionellosis Hypothesis-Generating Questionnaire (http:\/\/www.cdc.gov\/legionella\/downloads\/hypothesis-generating-questionnaire.pdf). Accessed 3 June 2016 (http:\/\/www.cdc.gov\/legionella\/health-depts\/inv-tools-single\/index.html)."},{"key":"S0950268816001965_ref37","doi-asserted-by":"publisher","DOI":"10.1093\/bioinformatics\/btq588"},{"key":"S0950268816001965_ref44","first-page":"145","article-title":"Investigation of an outbreak of Legionnaires' disease in a hospital under construction: Ontario, September-October 2002","volume":"29","author":"Abbas","year":"2003","journal-title":"Canada Communicable Disease Report"},{"key":"S0950268816001965_ref27","doi-asserted-by":"publisher","DOI":"10.1093\/nar\/gkr485"},{"key":"S0950268816001965_ref3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198002143020703"},{"key":"S0950268816001965_ref23","doi-asserted-by":"publisher","DOI":"10.1111\/1469-0691.12459"},{"key":"S0950268816001965_ref14","doi-asserted-by":"publisher","DOI":"10.1086\/498248"},{"key":"S0950268816001965_ref38","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2958.1999.01642.x"},{"key":"S0950268816001965_ref2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-90-4-699"},{"key":"S0950268816001965_ref33","doi-asserted-by":"publisher","DOI":"10.1093\/bioinformatics\/btr507"},{"key":"S0950268816001965_ref4","doi-asserted-by":"publisher","DOI":"10.1086\/498575"},{"key":"S0950268816001965_ref7","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0103852"}],"container-title":["Epidemiology and Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0950268816001965","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,10]],"date-time":"2022-07-10T20:38:28Z","timestamp":1657485508000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0950268816001965\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,10,20]]},"references-count":46,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2017,1]]}},"alternative-id":["S0950268816001965"],"URL":"https:\/\/doi.org\/10.1017\/s0950268816001965","relation":{},"ISSN":["0950-2688","1469-4409"],"issn-type":[{"value":"0950-2688","type":"print"},{"value":"1469-4409","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,10,20]]},"assertion":[{"value":"Copyright \u00a9 Cambridge University Press 2016\u00a0This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}}]}}