{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T10:00:00Z","timestamp":1792404000637,"version":"4.4.0"},"reference-count":43,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2024,1,11]],"date-time":"2024-01-11T00:00:00Z","timestamp":1704931200000},"content-version":"unspecified","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Epidemiol. Infect."],"published-print":{"date-parts":[[2024]]},"abstract":"<jats:title>Abstract<\/jats:title>\n\t  <jats:p>Legionellosis is a disease caused by the bacterium <jats:italic>Legionella<\/jats:italic> that most commonly presents as Legionnaires\u2019 disease (LD), a severe form of pneumonia. From 2015 to 2019, an average of 438 LD cases per year were reported in Canada. However, it is believed that the actual number of cases is much higher, since LD may be underdiagnosed and underreported. The purpose of this study was to develop an estimate of the true incidence of illnesses, hospitalizations, and deaths associated with LD in Canada. Values were derived using a stochastic model, based on Canadian surveillance data from 2015 to 2019, which were scaled up to account for underdiagnosis and underreporting. Overall, there were an estimated 1,113 (90% CrI: 737\u20131,730) illnesses, 1,008 (90% CrI: 271\u20132,244) hospitalizations, and 34 (90% CrI: 4\u201386) deaths due to domestically acquired waterborne LD annually in Canada from 2015 to 2019. It was further estimated that only 36% of illnesses and 39% of hospitalizations and deaths were captured in surveillance, and that 22% of illnesses were caused by <jats:italic>Legionella<\/jats:italic> serogroups and species other than <jats:italic>Legionella pneumophila<\/jats:italic> serogroup 1 (non-Lp1). This study highlights the true burden and areas for improvement in Canada\u2019s surveillance and detection of LD.<\/jats:p>","DOI":"10.1017\/s0950268824000013","type":"journal-article","created":{"date-parts":[[2024,1,11]],"date-time":"2024-01-11T07:56:41Z","timestamp":1704959801000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":9,"title":["Estimating the burden of illness caused by domestic waterborne Legionnaires\u2019 disease in Canada: 2015\u20132019"],"prefix":"10.1017","volume":"152","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1141-3217","authenticated-orcid":false,"given":"Carrie K. 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Kate","family":"Thomas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2024,1,11]]},"reference":[{"key":"S0950268824000013_r9","doi-asserted-by":"crossref","first-page":"30566","DOI":"10.2807\/1560-7917.ES.2017.22.27.30566","article-title":"Legionnaires\u2019 disease in Europe, 2011 to 2015","volume":"22","author":"Beaut\u00e9","year":"2017","journal-title":"Eurosurveillance"},{"key":"S0950268824000013_r35","first-page":"62","volume-title":"CIHI Data Quality Study of the 2009\u20132010 Discharge Abstract Database","year":"2012"},{"key":"S0950268824000013_r7","volume-title":"Management of Legionella in Water Systems","year":"2020"},{"key":"S0950268824000013_r6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1017\/S0950268820000631","article-title":"Estimates of healthcare utilisation and deaths from waterborne pathogen exposure in Ontario, Canada","volume":"148","author":"Greco","year":"2020","journal-title":"Epidemiology and Infection"},{"key":"S0950268824000013_r13","volume-title":"Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention","author":"Shah","year":"2019"},{"key":"S0950268824000013_r3","doi-asserted-by":"crossref","first-page":"373","DOI":"10.3390\/pathogens4020373","article-title":"Opportunistic premise plumbing pathogens: Increasingly important pathogens in drinking water","volume":"4","author":"Falkinham","year":"2015b","journal-title":"Pathogens"},{"key":"S0950268824000013_r4","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.3390\/w14071129","article-title":"The presence of opportunistic premise plumbing pathogens in residential buildings: A literature review","volume":"14","author":"Hayward","year":"2022","journal-title":"Water"},{"key":"S0950268824000013_r43","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1186\/s13690-020-00470-7","article-title":"The burden of legionnaires\u2019 disease in Belgium, 2013 to 2017","volume":"78","author":"Fastl","year":"2020","journal-title":"Archives of Public Health"},{"key":"S0950268824000013_r40","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1017\/S0950268803008616","article-title":"Repeat capture-recapture studies as part of the evaluation of the surveillance of legionnaires\u2019 disease in France","volume":"131","author":"Nardone","year":"2003","journal-title":"Epidemiology and Infection"},{"key":"S0950268824000013_r27","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.1513\/AnnalsATS.201510-715BC","article-title":"Improving the diagnosis of Legionella pneumonia within a healthcare system through a systematic consultation and testing program","volume":"13","author":"Decker","year":"2016","journal-title":"Annals of the American Thoracic Society"},{"key":"S0950268824000013_r2","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1289\/ehp.1408692","article-title":"Epidemiology and ecology of opportunistic premise plumbing pathogens: Legionella pneumophila, Mycobacterium avium, and Pseudomonas aeruginosa","volume":"123","author":"Falkinham","year":"2015a","journal-title":"Environmental Health Perspectives"},{"key":"S0950268824000013_r39","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1128\/CMR.00029-14","article-title":"Current and emerging Legionella diagnostics for laboratory and outbreak investigations","volume":"28","author":"Mercante","year":"2015","journal-title":"Clinical Microbiology Reviews"},{"key":"S0950268824000013_r1","doi-asserted-by":"crossref","first-page":"4533","DOI":"10.3390\/ijerph120504533","article-title":"Common features of opportunistic premise plumbing pathogens","volume":"12","author":"Falkinham","year":"2015","journal-title":"International Journal of Environmental Research and Public Health"},{"key":"S0950268824000013_r5","doi-asserted-by":"crossref","first-page":"140","DOI":"10.3201\/eid2701.190676","article-title":"Estimate of burden and direct healthcare cost of infectious waterborne disease in the United States","volume":"27","author":"Collier","year":"2021","journal-title":"Emerging Infectious Diseases"},{"key":"S0950268824000013_r10","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1016\/S0140-6736(15)60078-2","article-title":"Legionnaires\u2019 disease","volume":"387","author":"Cunha","year":"2016","journal-title":"The Lancet"},{"key":"S0950268824000013_r11","unstructured":"[11] National Collaborating Centre for Environmental Health (2022) Legionella. National Collaborating Centre for Environmental Health: Vancouver, Canada. 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The Canadian community-acquired pneumonia working group","volume":"31","author":"Mandell","year":"2000","journal-title":"Clinical Infectious Diseases"},{"key":"S0950268824000013_r32","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1099\/jmm.0.000454","article-title":"Accuracy of diagnostic tests for legionnaires\u2019 disease: A systematic review","volume":"66","author":"Cristovam","year":"2017","journal-title":"Journal of Medical Microbiology"},{"key":"S0950268824000013_r42","first-page":"e0153106","article-title":"Disease burden of 32 infectious diseases in the Netherlands, 2007-2011","volume":"11","author":"van Lier","year":"2016","journal-title":"Public Library of Science One"},{"key":"S0950268824000013_r14","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1086\/586742","article-title":"Community-acquired legionnaires disease: Implications for underdiagnosis and laboratory testing","volume":"46","author":"Yu","year":"2008","journal-title":"Clinical Infectious Diseases"},{"key":"S0950268824000013_r41","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1017\/S0950268807008977","article-title":"Incidence and completeness of notification of legionnaires\u2019 disease in the Netherlands: Covariate capture-recapture analysis acknowledging regional differences","volume":"136","author":"van Hest","year":"2008","journal-title":"Epidemiology and Infection"}],"container-title":["Epidemiology and Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0950268824000013","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,2]],"date-time":"2024-02-02T10:35:28Z","timestamp":1706870128000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0950268824000013\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024]]},"references-count":43,"alternative-id":["S0950268824000013"],"URL":"https:\/\/doi.org\/10.1017\/s0950268824000013","relation":{},"ISSN":["0950-2688","1469-4409"],"issn-type":[{"value":"0950-2688","type":"print"},{"value":"1469-4409","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024]]},"assertion":[{"value":"\u00a9 Crown Copyright - His Majesty the King in Right of Canada as represented by the Minister of Health, 2024. Published by Cambridge University Press","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0), which permits non-commercial re-use, distribution, and reproduction in any medium, provided that no alterations are made and the original article is properly cited. The written permission of Cambridge University Press must be obtained prior to any commercial use and\/or adaptation of the article.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e18"}}