{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T05:23:14Z","timestamp":1768800194742,"version":"3.49.0"},"reference-count":22,"publisher":"Cambridge University Press (CUP)","issue":"3","license":[{"start":{"date-parts":[[2018,2,1]],"date-time":"2018-02-01T00:00:00Z","timestamp":1517443200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["www.cambridge.org"],"crossmark-restriction":true},"short-container-title":["Epidemiol. Infect."],"published-print":{"date-parts":[[2018,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>A large outbreak of Legionnaires\u2019 disease occurred at a California state prison in August 2015. We conducted environmental and epidemiological investigations to identify the most likely source of exposure and characterise morbidity. Sixty-four inmates had probable Legionnaires\u2019 disease; 14 had laboratory-confirmed legionellosis. Thirteen (17%) inmates were hospitalised; there were no deaths. Ill inmates were more likely to be \u2a7e65 years old (<jats:italic>P<\/jats:italic> &lt; 0.01), have the chronic obstructive pulmonary disease (<jats:italic>P<\/jats:italic> &lt; 0.01), diabetes mellitus (<jats:italic>P<\/jats:italic> = 0.02), hepatitis C infection (<jats:italic>P<\/jats:italic> &lt; 0.01), or end-stage liver disease (<jats:italic>P<\/jats:italic> &lt; 0.01). The case-patients were in ten housing units throughout the prison grounds. All either resided in or were near the central clinical building (for appointments or yard time) during their incubation periods. <jats:italic>Legionella pneumophila<\/jats:italic> serogroup 1 was cultured from three cooling towers on top of the central medical clinic (range, 880\u20131200 cfu\/ml). An inadequate water management program, dense biofilm within the cooling towers, and high ambient temperatures preceding the outbreak created an ideal environment for <jats:italic>Legionella<\/jats:italic> sp. proliferation. All state prisons were directed to develop local operating procedures for maintaining their cooling towers and the state health department added a review of the maintenance plans to their environmental inspection protocol.<\/jats:p>","DOI":"10.1017\/s0950268818000110","type":"journal-article","created":{"date-parts":[[2018,2,1]],"date-time":"2018-02-01T07:04:11Z","timestamp":1517468651000},"page":"297-302","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":7,"title":["Outbreak of Legionnaires\u2019 disease associated with cooling towers at a California state prison, 2015"],"prefix":"10.1017","volume":"146","author":[{"given":"K. D.","family":"Lucas","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.","family":"Wheeler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P.","family":"McLendon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B. N.","family":"Leistikow","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. C.","family":"Mohle-Boetani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2018,2,1]]},"reference":[{"key":"S0950268818000110_ref21","unstructured":"Occupational Safety and Health Administration (1991) OSHA Technical Manual. Section III: Chapter 7. Legionnaires\u2019 disease. Available at https:\/\/www.osha.gov\/dts\/osta\/otm\/otm_iii\/otm_iii_7.html#app_iii:7_3 (Accessed October 13, 2017)."},{"key":"S0950268818000110_ref18","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-62703-161-5_2"},{"key":"S0950268818000110_ref17","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.40.9.3232-3236.2002"},{"key":"S0950268818000110_ref16","doi-asserted-by":"publisher","DOI":"10.1136\/jcp.43.8.685"},{"key":"S0950268818000110_ref15","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)60078-2"},{"key":"S0950268818000110_ref13","doi-asserted-by":"publisher","DOI":"10.1189\/jlb.4MR0816-340R"},{"key":"S0950268818000110_ref12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2014.06.035"},{"key":"S0950268818000110_ref11","doi-asserted-by":"publisher","DOI":"10.1111\/imm.12394"},{"key":"S0950268818000110_ref10","volume-title":"Principles and Practice of Infectious Diseases","author":"Mandell","year":"2010"},{"key":"S0950268818000110_ref8","unstructured":"Occupational Safety and Health Administration (2003) Legionnaires\u2019 disease eTool: Section II:A. Cooling Towers, Evaporative Condensers, and Fluid Coolers. Available at https:\/\/www.osha.gov\/dts\/osta\/otm\/legionnaires\/pdf.html (Accessed 2 February 2017)."},{"key":"S0950268818000110_ref7","unstructured":"Accuweather, Inc. San Quentin, CA local weather. August 2015. Available at http:\/\/www.accuweather.com\/en\/us\/san-quentin-ca\/94964\/august-weather\/2142313 (Accessed 23 November 2015)."},{"key":"S0950268818000110_ref6","unstructured":"Centers for Disease Control and Prevention (2017) Legionella (Legionnaires\u2019 Disease and Pontiac Fever). Available at https:\/\/www.cdc.gov\/legionella\/clinicians\/clinical-features.html (Accessed 12 October 2017)."},{"key":"S0950268818000110_ref4","doi-asserted-by":"publisher","DOI":"10.1093\/clind\/16.6.741"},{"key":"S0950268818000110_ref1","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.15.3.506-526.2002"},{"key":"S0950268818000110_ref3","unstructured":"Centers for Disease Control and Prevention (2005) National Notifiable Disease Surveillance System. Legionellosis\/Legionnaires\u2019 disease or Pontiac Fever (Legionella pneumophila). Case Definition. Available at http:\/\/wwwn.cdc.gov\/nndss\/conditions\/legionellosis\/case-definition\/2005\/ (Accessed 23 November 2015)."},{"key":"S0950268818000110_ref19","doi-asserted-by":"publisher","DOI":"10.1021\/acs.est.5b00142"},{"key":"S0950268818000110_ref5","unstructured":"Centers for Disease Control and Prevention. Quick Learn Lessons. Using an epi curve to determine most likely period of exposure. Available at http:\/\/www.cdc.gov\/training\/QuickLearns\/exposure\/index.html (Accessed 23 November 2015)."},{"key":"S0950268818000110_ref22","unstructured":"Kutty PK (2015) What everyone needs to know about Legionnaires\u2019 disease. Medscape. 26 October 2015. Available at http:\/\/www.medscape.com\/viewarticle\/852874?nlid=90227_436&src=wnl_edit_medp_publ&uac=137154MJ&spon=42&impID=875278&faf=1 (Accessed 5 November 2016)."},{"key":"S0950268818000110_ref9","doi-asserted-by":"publisher","DOI":"10.3810\/pgm.2001.05.933"},{"key":"S0950268818000110_ref2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6522e1"},{"key":"S0950268818000110_ref20","unstructured":"ASHRAE (2016) Legionellosis risk management for building water systems. ANSI\/ASHRAE Standard 188-2015. Atlanta, GA, USA. Available at https:\/\/ashrae.iwrapper.com\/ViewOnline\/Standard_188-2015 (Accessed 2 February 2016)."},{"key":"S0950268818000110_ref14","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00029-14"}],"container-title":["Epidemiology and Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0950268818000110","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,19]],"date-time":"2023-01-19T04:36:03Z","timestamp":1674102963000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0950268818000110\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,2]]},"references-count":22,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2018,2]]}},"alternative-id":["S0950268818000110"],"URL":"https:\/\/doi.org\/10.1017\/s0950268818000110","relation":{},"ISSN":["0950-2688","1469-4409"],"issn-type":[{"value":"0950-2688","type":"print"},{"value":"1469-4409","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,2]]},"assertion":[{"value":"Copyright \u00a9 Cambridge University Press 2018\u00a0","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}}]}}