Rapid Identification of a Cooling Tower-Associated Legionnaires’ Disease Outbreak Supported by Polymerase Chain Reaction Testing of Environmental Samples, New York City, 2014–2015
We investigated an outbreak of eight Legionnaires' disease cases among persons living in an urban residential community of 60,000 people. Possible environmental sources included two active cooling towers (air-conditioning units for large buildings) <1 km from patient residences, a market misting system, a community-wide water system used for heating and cooling, and potable water. To support a timely public health response, we used real-time polymerase chain reaction (PCR) to identify Legionella DNA in environmental samples within hours of specimen collection. We detected L.pneumophila serogroup 1 DNA only at a power plant cooling tower, supporting the decision to order remediation before culture results were available. An isolate from a power plant cooling tower sample was indistinguishable from a patient isolate by pulsed-field gel electrophoresis, suggesting the cooling tower was the outbreak source. PCR results were available <1 day after sample collection, and culture results were available as early as 5 days after plating. PCR is a valuable tool for identifying Legionella DNA in environmental samples in outbreak settings.
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Speaker / Author:
Isaac Benowitz, MD, Epidemic Intelligence Service, Centers for Disease Control and Prevention
Robert Fitzhenry, PhD, New York City Department of Health and Mental Hygiene
Christopher Boyd, New York City Department of Health and Mental Hygiene
Michelle Dickinson, MPH, New York State Department of Health
Michael Levy, ScD, Montefiore Medical Center
Ying Lin, New York City Department of Health and Mental Hygiene
Elizabeth Nazarian, MT (ASCP), New York State Department of Health
Belinda Ostrowsky, MPH, MD, Montefiore Medical Center
Teresa Passaretti, New York State Department of Health
Jennifer Rakeman, PhD; Amy Saylors; Elena Shamoonian; Terry-Ann Smith, MS; and Sharon Balter, MD