{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T17:29:01Z","timestamp":1790184541108,"version":"4.1.0"},"reference-count":32,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2017,1,31]],"date-time":"2017-01-31T00:00:00Z","timestamp":1485820800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Public Health Rep"],"published-print":{"date-parts":[[2017,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>Infections caused by Legionella are the leading cause of waterborne disease outbreaks in the United States. We investigated a large outbreak of Legionnaires\u2019 disease in New York City in summer 2015 to characterize patients, risk factors for mortality, and environmental exposures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We defined cases as patients with pneumonia and laboratory evidence of Legionella infection from July 2 through August 3, 2015, and with a history of residing in or visiting 1 of several South Bronx neighborhoods of New York City. We describe the epidemiologic, environmental, and laboratory investigation that identified the source of the outbreak.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>We identified 138 patients with outbreak-related Legionnaires\u2019 disease, 16 of whom died. The median age of patients was 55. A total of 107 patients had a chronic health condition, including 43 with diabetes, 40 with alcoholism, and 24 with HIV infection. We tested 55 cooling towers for Legionella, and 2 had a strain indistinguishable by pulsed-field gel electrophoresis from 26 patient isolates. Whole-genome sequencing and epidemiologic evidence implicated 1 cooling tower as the source of the outbreak.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>A large outbreak of Legionnaires\u2019 disease caused by a cooling tower occurred in a medically vulnerable community. The outbreak prompted enactment of a new city law on the operation and maintenance of cooling towers. Ongoing surveillance and evaluation of cooling tower process controls will determine if the new law reduces the incidence of Legionnaires\u2019 disease in New York City.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0033354916689620","type":"journal-article","created":{"date-parts":[[2017,1,31]],"date-time":"2017-01-31T18:51:43Z","timestamp":1485888703000},"page":"241-250","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":71,"title":["A Large Community Outbreak of Legionnaires\u2019 Disease Associated With a Cooling Tower in New York City, 2015"],"prefix":"10.1177","volume":"132","author":[{"given":"Don","family":"Weiss","sequence":"first","affiliation":[{"name":"New York City Department of Health and Mental Hygiene, Queens, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Boyd","sequence":"additional","affiliation":[{"name":"New York City Department of Health and Mental Hygiene, Queens, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Rakeman","sequence":"additional","affiliation":[{"name":"New York City Department of Health and Mental Hygiene, Queens, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon K.","family":"Greene","sequence":"additional","affiliation":[{"name":"New York City Department of Health and Mental Hygiene, Queens, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Fitzhenry","sequence":"additional","affiliation":[{"name":"New York City Department of Health and Mental Hygiene, Queens, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trevor","family":"McProud","sequence":"additional","affiliation":[{"name":"New York City Department of Health and Mental Hygiene, Queens, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberlee","family":"Musser","sequence":"additional","affiliation":[{"name":"The Wadsworth Center, New York State Department of Health, Albany, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Huang","sequence":"additional","affiliation":[{"name":"New York City Department of Health and Mental Hygiene, Queens, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Kornblum","sequence":"additional","affiliation":[{"name":"New York City Department of Health and Mental Hygiene, Queens, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth J.","family":"Nazarian","sequence":"additional","affiliation":[{"name":"The Wadsworth Center, New York State Department of Health, Albany, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annie D.","family":"Fine","sequence":"additional","affiliation":[{"name":"New York City Department of Health and Mental Hygiene, Queens, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah L.","family":"Braunstein","sequence":"additional","affiliation":[{"name":"New York City Department of Health and Mental Hygiene, Queens, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Kass","sequence":"additional","affiliation":[{"name":"New York City Department of Health and Mental Hygiene, Queens, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keren","family":"Landman","sequence":"additional","affiliation":[{"name":"New York City Department of Health and Mental Hygiene, Queens, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal","family":"Lapierre","sequence":"additional","affiliation":[{"name":"The Wadsworth Center, New York State Department of Health, Albany, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Hughes","sequence":"additional","affiliation":[{"name":"New York City Department of Health and Mental Hygiene, Queens, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Tran","sequence":"additional","affiliation":[{"name":"New York City Department of Health and Mental Hygiene, Queens, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jill","family":"Taylor","sequence":"additional","affiliation":[{"name":"The Wadsworth Center, New York State Department of Health, Albany, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Baker","sequence":"additional","affiliation":[{"name":"The Wadsworth Center, New York State Department of Health, Albany, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucretia","family":"Jones","sequence":"additional","affiliation":[{"name":"New York City Department of Health and Mental Hygiene, Queens, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Kornstein","sequence":"additional","affiliation":[{"name":"New York City Department of Health and Mental Hygiene, Queens, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boning","family":"Liu","sequence":"additional","affiliation":[{"name":"New York City Department of Health and Mental Hygiene, Queens, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodolfo","family":"Perez","sequence":"additional","affiliation":[{"name":"New York City Department of Health and Mental Hygiene, Queens, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David E.","family":"Lucero","sequence":"additional","affiliation":[{"name":"New York City Department of Health and Mental Hygiene, Queens, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Peterson","sequence":"additional","affiliation":[{"name":"New York City Department of Health and Mental Hygiene, Queens, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isaac","family":"Benowitz","sequence":"additional","affiliation":[{"name":"New York City Department of Health and Mental Hygiene, Queens, NY, USA"},{"name":"Centers for Disease Control and Prevention, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen F.","family":"Lee","sequence":"additional","affiliation":[{"name":"New York City Department of Health and Mental Hygiene, Queens, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Ngai","sequence":"additional","affiliation":[{"name":"New York City Department of Health and Mental Hygiene, Queens, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitch","family":"Stripling","sequence":"additional","affiliation":[{"name":"New York City Department of Health and Mental Hygiene, Queens, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay K.","family":"Varma","sequence":"additional","affiliation":[{"name":"New York City Department of Health and Mental Hygiene, Queens, NY, USA"},{"name":"Centers for Disease Control and Prevention, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2017,1,31]]},"reference":[{"key":"bibr1-0033354916689620","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)60078-2"},{"key":"bibr2-0033354916689620","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6522e1"},{"key":"bibr3-0033354916689620","unstructured":"City of New York. Epiquery: New York City interactive health data. http:\/\/nyc.gov\/health\/epiquery. Accessed December 12, 2016."},{"key":"bibr4-0033354916689620","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2014.00501"},{"key":"bibr5-0033354916689620","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc1505356"},{"key":"bibr6-0033354916689620","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00029-14"},{"key":"bibr7-0033354916689620","unstructured":"Council of State and Territorial Epidemiologists. Public health reporting and national notification for legionellosis. http:\/\/c.ymcdn.com\/sites\/www.cste.org\/resource\/resmgr\/PS\/09-ID-45.pdf. Position statement 09-ID-45. Published 2010. Accessed April 20, 2016."},{"key":"bibr8-0033354916689620","doi-asserted-by":"publisher","DOI":"10.3201\/eid2102.140098"},{"key":"bibr9-0033354916689620","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.0020059"},{"key":"bibr10-0033354916689620","doi-asserted-by":"publisher","DOI":"10.3201\/eid2210.160097"},{"key":"bibr11-0033354916689620","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2015.03.037"},{"key":"bibr12-0033354916689620","unstructured":"Kulldorff M. Focused cluster tests. In: SaTScan User Guide for Version 9.4. http:\/\/www.satscan.org\/techdoc.html. Accessed July 30, 2015."},{"key":"bibr13-0033354916689620","first-page":"23","volume":"53","author":"Heffernan R","year":"2004","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"bibr14-0033354916689620","unstructured":"New York City Department of Health and Mental Hygiene. 2015 alert 21: increase in Legionnaires\u2019 disease in the Bronx. https:\/\/a816-health30ssl.nyc.gov\/sites\/NYCHAN\/Lists\/AlertUpdateAdvisoryDocuments\/HAN_LegionellaSouthBronx.pdf. Published July 29, 2015. Accessed April 20, 2016."},{"key":"bibr15-0033354916689620","unstructured":"New York City Department of Health and Mental Hygiene. 2015 alert 24: update. Clinical management of respiratory illness in the South Bronx. https:\/\/a816-health30ssl.nyc.gov\/sites\/NYCHAN\/Lists\/AlertUpdateAdvisoryDocuments\/HAN%20-%20LegClinical.pdf. Published August 2, 2015. Accessed April 20, 2016."},{"key":"bibr16-0033354916689620","doi-asserted-by":"publisher","DOI":"10.1002\/sim.738"},{"key":"bibr17-0033354916689620","volume-title":"SAS\/STAT Version 9.4","author":"SAS Institute Inc","year":"2012"},{"key":"bibr18-0033354916689620","doi-asserted-by":"publisher","DOI":"10.1016\/j.diagmicrobio.2008.05.004"},{"key":"bibr19-0033354916689620","doi-asserted-by":"publisher","DOI":"10.1128\/AEM.02261-10"},{"key":"bibr20-0033354916689620","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.01280-15"},{"key":"bibr21-0033354916689620","doi-asserted-by":"publisher","DOI":"10.1086\/501843"},{"key":"bibr22-0033354916689620","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES2014.19.50.20991"},{"key":"bibr23-0033354916689620","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hct167"},{"issue":"9","key":"bibr24-0033354916689620","first-page":"831","volume":"6","author":"Jans\u00e0 JM","year":"2002","journal-title":"Int J Tuberc Lung Dis"},{"key":"bibr25-0033354916689620","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-008-0603-6"},{"issue":"38","key":"bibr26-0033354916689620","doi-asserted-by":"crossref","first-page":"pii18983","DOI":"10.2807\/ese.13.38.18983-en","volume":"13","author":"Sonder GJ","year":"2008","journal-title":"Euro Surveill"},{"key":"bibr27-0033354916689620","doi-asserted-by":"publisher","DOI":"10.1080\/00365540601001930"},{"key":"bibr28-0033354916689620","unstructured":"US Census Bureau. American Community Survey 5-year dataset, 2010-2014. http:\/\/www.census.gov\/programs-surveys\/acs\/news\/data-releases\/2014\/release.html#par_textimage_9. Accessed April 20, 2016."},{"key":"bibr29-0033354916689620","unstructured":"New York City Department of Health and Mental Hygiene. New York Community Health Survey, 2012-2014. https:\/\/www1.nyc.gov\/site\/doh\/data\/data-sets\/community-health-survey-public-use-data.page. Accessed April 20, 2016."},{"key":"bibr30-0033354916689620","volume-title":"HIV Surveillance Annual Report, 2014","author":"HIV Epidemiology and Field Services Program","year":"2015"},{"key":"bibr31-0033354916689620","unstructured":"New York City Office of City Planning. Current population estimates. http:\/\/www1.nyc.gov\/site\/planning\/data-maps\/nyc-population\/current-future-populations.page. Accessed December 7, 2015."},{"key":"bibr32-0033354916689620","unstructured":"New York City Rules. Cooling towers\u2014new Chapter 8 in Title 24 of the rules of the City of New York to establish rules for maintenance of cooling towers. http:\/\/rules.cityofnewyork.us\/content\/cooling-towers-new-chapter-8-title-24-rules-city-new-york-establish-rules-maintenance. Accessed April 20, 2016."}],"container-title":["Public Health Reports\u00ae"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0033354916689620","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/0033354916689620","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0033354916689620","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T09:33:39Z","timestamp":1777628019000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0033354916689620"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,1,31]]},"references-count":32,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2017,3]]}},"alternative-id":["10.1177\/0033354916689620"],"URL":"https:\/\/doi.org\/10.1177\/0033354916689620","relation":{},"ISSN":["0033-3549","1468-2877"],"issn-type":[{"value":"0033-3549","type":"print"},{"value":"1468-2877","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,1,31]]}}}