{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T06:42:15Z","timestamp":1791182535433,"version":"4.1.0"},"reference-count":33,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2012,10,18]],"date-time":"2012-10-18T00:00:00Z","timestamp":1350518400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Risk Analysis"],"published-print":{"date-parts":[[2013,7]]},"abstract":"<jats:p>Quantitative microbiological risk assessment was used to quantify the risk associated with the exposure to <jats:italic>Legionella pneumophila<\/jats:italic> in a whirlpool. Conceptually, air bubbles ascend to the surface, intercepting <jats:italic>Legionella<\/jats:italic> from the traversed water. At the surface the bubble bursts into dominantly noninhalable jet drops and inhalable film drops. Assuming that film drops carry half of the intercepted <jats:italic>Legionella<\/jats:italic>, a total of four (95% interval: 1\u20139) and 4.5\u00d710<jats:sup>4<\/jats:sup> (4.4\u00d710<jats:sup>4<\/jats:sup> \u2013 4.7\u00d710<jats:sup>4<\/jats:sup>) cfu\/min were estimated to be aerosolized for concentrations of 1 and 1,000 legionellas per liter, respectively. Using a dose\u2010response model for guinea pigs to represent humans, infection risks for active whirlpool use with 100 cfu\/L water for 15 minutes were 0.29 (\u223c0.11\u20130.48) for susceptible males and 0.22 (\u223c0.06\u20130.42) for susceptible females. A <jats:italic>L. pneumophila<\/jats:italic> concentration of \u22651,000 cfu\/L water was estimated to nearly always cause an infection (mean: 0.95; 95% interval: 0.9\u2013\u223c1). Estimated infection risks were time\u2010dependent, ranging from 0.02 (0\u20130.11) for 1\u2010minute exposures to 0.93 (0.86\u20130.97) for 2\u2010hour exposures when the <jats:italic>L. pneumophila<\/jats:italic> concentration was 100 cfu\/L water. Pool water in Dutch bathing establishments should contain &lt;100 cfu <jats:italic>Legionella<\/jats:italic>\/L water. This study suggests that stricter provisions might be required to assure adequate public health protection.<\/jats:p>","DOI":"10.1111\/j.1539-6924.2012.01909.x","type":"journal-article","created":{"date-parts":[[2012,10,19]],"date-time":"2012-10-19T00:29:38Z","timestamp":1350606578000},"page":"1228-1236","source":"Crossref","is-referenced-by-count":21,"title":["Quantitative Risk Estimation for a <i>Legionella pneumophila<\/i> Infection Due to Whirlpool Use"],"prefix":"10.1111","volume":"33","author":[{"given":"Martijn","family":"Bouwknegt","sequence":"first","affiliation":[{"name":"Laboratory for Zoonoses and Environmental Microbiology Centre for Infectious Disease Control Netherlands National Institute for Public Health and the Environment  Bilthoven The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack F.","family":"Schijven","sequence":"additional","affiliation":[{"name":"Expert Centre for Methodology and Information Services National Institute for Public Health and the Environment  Bilthoven The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna A.C.","family":"Schalk","sequence":"additional","affiliation":[{"name":"Laboratory for Zoonoses and Environmental Microbiology Centre for Infectious Disease Control Netherlands National Institute for Public Health and the Environment  Bilthoven The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Maria","family":"de Roda Husman","sequence":"additional","affiliation":[{"name":"Laboratory for Zoonoses and Environmental Microbiology Centre for Infectious Disease Control Netherlands National Institute for Public Health and the Environment  Bilthoven The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2012,10,18]]},"reference":[{"key":"e_1_2_7_2_1","volume-title":"Legionella and the Prevention of Legionellosis","author":"Hornei B","year":"2007"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.15.3.506-526.2002"},{"issue":"36","key":"e_1_2_7_4_1","first-page":"1973","article-title":"Three patients with pneumonia due to Legionella associated with a sauna, a cooling tower and a caravan in the Netherlands","volume":"149","author":"Bencini MA","year":"2005","journal-title":"Ned Tijdschr Geneeskd"},{"issue":"4","key":"e_1_2_7_5_1","first-page":"114","article-title":"Occurrence of Legionella in beach shower facilities","volume":"48","author":"Delia S","year":"2007","journal-title":"Journal of Preventive Medicine and Hygiene"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid0801.010176"},{"issue":"3","key":"e_1_2_7_7_1","first-page":"259","article-title":"Detection of Legionella pneumophila at thermal spas","volume":"24","author":"Martinelli F","year":"2001","journal-title":"New Microbiology"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1128\/AEM.00944-10"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1539-6924.2007.00990.x"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/29.6.1092"},{"issue":"26","key":"e_1_2_7_11_1","article-title":"Cluster of Legionnaires\u2019 disease associated with a public whirlpool spa, France, April\u2013May 2010","volume":"15","author":"Campese C","year":"2010","journal-title":"Euro Surveillance"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.3109\/00365548.2010.509331"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.2166\/wh.2008.026"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.4319\/lo.1983.28.1.0101"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1128\/aem.43.5.1001-1005.1982"},{"issue":"2","key":"e_1_2_7_16_1","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1128\/aem.39.2.335-338.1980","article-title":"Water\u2010to\u2010air fractionation of bacteria","volume":"39","author":"Hejkal TW","year":"1980","journal-title":"Applied and Environmental Microbiology"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0013-9351(86)80003-2"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1029\/JC086iC09p08085"},{"key":"e_1_2_7_19_1","volume-title":"Human Respiratory Tract Model for Radiological Protection","author":"Anonymous","year":"1994"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1080\/15459620701487539"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01089056"},{"key":"e_1_2_7_22_1","unstructured":"Anonymous.The engineering toolbox. 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