Surveillance Report 2014-2015

Table 1. Number of reported confirmed cases of Legionnaires’ disease^a by jurisdiction of residence^b and year^c—NNDSS,^d United States, 2014 and 2015.

^aCases of disease due to Legionella are reported to NNDSS as legionellosis, which includes Legionnaires’ disease, Pontiac fever, and disease due to Legionella infection at extrapulmonary sites, but is referred to as Legionnaires’ disease in this figure (almost all legionellosis cases reported in the United States are due to Legionnaires’ disease).
^bJurisdiction of the patient’s “usual residence” at the time of disease onset.
^cBased on year case was reported to CDC.
^dNational Notifiable Diseases Surveillance System (NNDSS).

Table 2. Number, percent, and crude incidence^a rates of reported confirmed cases of Legionnaires’ disease^b by demographic characteristics and year^c—NNDSS,^d United States, 2014 and 2015.

^aCrude incidence of cases per 100,000 population (number of confirmed Legionnaires’ disease cases reported that year divided by postcensal population estimate for that year times 100,000 population).
^bCases of disease due to Legionella are reported to NNDSS as legionellosis, which includes Legionnaires’ disease, Pontiac fever, and disease due to Legionella infection at extrapulmonary sites, but is referred to as Legionnaires’ disease in this figure (almost all legionellosis cases reported in the United States are due to Legionnaires’ disease).
^cBased on year case was reported to CDC.
^dNational Notifiable Diseases Surveillance System (NNDSS).
^eOther race includes individuals that did not identify with races listed.
^fDue to significant proportion of missing ethnicity data reported, incidence rates by ethnicity are not presented.

Figure 6a. Number of reported confirmed cases and deaths of Legionnaires’ disease by exposure category^a—SLDSS,^b complete reporting jurisdictions,^c 2014.^d

^aExposure categories are not mutually exclusive. A patient may report multiple exposures in the 10 days before date of symptom onset. Exposure categories:

^bSupplemental Legionnaires’ Disease Surveillance System (SLDSS).
^cComplete reporting jurisdictions in 2014: 31 complete reporting jurisdictions reported at least 90% of confirmed NNDSS cases to SLDSS: Alabama, Alaska, Colorado, Connecticut, Florida, Georgia, Iowa, Kansas, Kentucky, Maine, Maryland, Michigan, Minnesota, Mississippi, Missouri, New Hampshire, New York City, New York State, North Dakota, Ohio, Pennsylvania, Rhode Island, South Carolina, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.
^dBased on year of symptom onset in SLDSS. If onset date was not stated in SLDSS, case year for confirmed cases was determined by the following dates (in order of reporting): positive laboratory date (by either urinary antigen testing, culture, or fourfold rise of antibody against Legionella pneumophila serogroup 1); date patient was hospitalized during treatment for Legionnaires’ disease; or date case was first reported to public health at any level.
^eCFR: Case fatality rate calculated as the number of reported confirmed Legionnaires’ disease case deaths divided by the number of patients with Legionnaires’ disease and the same exposure history.
^fDiagram illustrates overlap of reported exposures. The numbers in each segment are mutually exclusive.

Figure 6b. Number of reported confirmed cases and deaths of Legionnaires’ disease by exposure category^a—SLDSS,^b complete reporting jurisdictions,^c 2015.^d

^aExposure categories are not mutually exclusive. A patient may report multiple exposures in the 10 days before date of symptom onset. Exposure categories:

^bSupplemental Legionnaires’ Disease Surveillance System (SLDSS).
^cComplete reporting jurisdictions in 2015: 31 complete reporting jurisdictions reported at least 90% of confirmed NNDSS cases to SLDSS: Alabama, Colorado, Connecticut, Florida, Georgia, Hawaii, Iowa, Kansas, Kentucky, Maine, Maryland, Michigan, Minnesota, Mississippi, Missouri, New Hampshire, New Mexico, New York City, New York State, North Dakota, Ohio, Pennsylvania, Rhode Island, South Carolina, Texas, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.
^dBased on year of symptom onset in SLDSS. If onset date was not stated in SLDSS, case year for confirmed cases was determined by the following dates (by either urinary antigen testing, culture, or fourfold rise of antibody against Legionella pneumophila serogroup 1); date patient was hospitalized during treatment for Legionnaires’ disease; or date case was first reported to public health at any level.
^eCFR: Case fatality rate calculated as the number of reported confirmed Legionnaires’ disease case deaths divided by the number of patients with Legionnaires’ disease and the same exposure history.
^fDiagram illustrates overlap of reported exposures. The numbers in each segment are mutually exclusive.

Table 3. Number of reported confirmed cases of Legionnaires’ disease by exposure category^a and year^b—SLDSS,^c complete reporting jurisdictions,^d 2014 and 2015.

^aExposure categories (categories are not mutually exclusive):

^bBased on year of symptom onset in SLDSS. If onset date was not stated in SLDSS, case year for confirmed cases was determined by the following dates (in order of reporting): positive laboratory date (by either urinary antigen testing, culture, or fourfold rise of antibody against Legionella pneumophila serogroup 1; date patient was hospitalized during treatment for Legionnaires’ disease; or date case was first reported to public health at any level.
^cSupplemental Legionnaires’ Disease Surveillance System (SLDSS).
^dComplete reporting jurisdictions in 2014: 31 complete reporting jurisdictions reported at least 90% of confirmed NNDSS cases to SLDSS: Alabama, Alaska, Colorado, Connecticut, Florida, Georgia, Iowa, Kansas, Kentucky, Maine, Maryland, Michigan, Minnesota, Mississippi, Missouri, New Hampshire, New York City, New York State, North Dakota, Ohio, Pennsylvania, Rhode Island, South Carolina, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.
Complete reporting jurisdictions in 2015: 31 complete reporting jurisdictions reported at least 90% of confirmed NNDSS cases to SLDSS: Alabama, Colorado, Connecticut, Florida, Georgia, Hawaii, Iowa, Kansas, Kentucky, Maine, Maryland, Michigan, Minnesota, Mississippi, Missouri, New Hampshire, New Mexico, New York City, New York State, North Dakota, Ohio, Pennsylvania, Rhode Island, South Carolina, Texas, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

Table 4a. Number of reported confirmed cases of Legionnaires’ disease by demographic characteristics and exposure category^a—SLDSS,^b complete reporting jurisdictions,^c 2014.^d

^aExposure categories (categories are not mutually exclusive):

^bSupplemental Legionnaires’ Disease Surveillance System (SLDSS).
^cComplete reporting jurisdictions in 2014: 31 complete reporting jurisdictions reported at least 90% of confirmed NNDSS cases to SLDSS: Alabama, Alaska, Colorado, Connecticut, Florida, Georgia, Iowa, Kansas, Kentucky, Maine, Maryland, Michigan, Minnesota, Mississippi, Missouri, New Hampshire, New York City, New York State, North Dakota, Ohio, Pennsylvania, Rhode Island, South Carolina, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.
^dBased on year of symptom onset in SLDSS. If onset date was not stated in SLDSS, case year for confirmed cases was determined by the following dates (in order of reporting): positive laboratory date (by either urinary antigen testing, culture, or fourfold rise of antibody against Legionella pneumophila serogroup 1); date patient was hospitalized during treatment for Legionnaires’ disease; or date case was first reported to public health at any level.

Table 4b. Number of reported confirmed cases of Legionnaires’ disease by demographic characteristics and exposure category^a—SLDSS,^b complete reporting jurisdictions,^c 2015.^d

^aExposure categories (categories are not mutually exclusive):

^bSupplemental Legionnaires’ Disease Surveillance System (SLDSS)
^cComplete reporting jurisdictions in 2015: 31 complete reporting jurisdictions reported at least 90% of confirmed NNDSS cases to SLDSS: Alabama, Colorado, Connecticut, Florida, Georgia, Hawaii, Iowa, Kansas, Kentucky, Maine, Maryland, Michigan, Minnesota, Mississippi, Missouri, New Hampshire, New Mexico, New York City, New York State, North Dakota, Ohio, Pennsylvania, Rhode Island, South Carolina, Texas, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.
^dBased on year of symptom onset in SLDSS. If onset date was not stated in SLDSS, case year for confirmed cases was determined by the following dates (in order of reporting): positive laboratory date (by either urinary antigen testing, culture, or fourfold rise of antibody against Legionella pneumophila serogroup 1); date patient was hospitalized during treatment for Legionnaires’ disease; or date case was first reported to public health at any level.

Table 5a. Number of reported confirmed cases of healthcare-associated^a Legionnaires’ disease by healthcare facility type and healthcare exposure certainty^b—SLDSS,^c complete reporting jurisdictions^d, 2014.^e

^aHealthcare–associated Legionnaires’ disease includes both definite and possible cases in patients who worked, visited, or stayed in a healthcare setting for any amount of time in the 10 days preceding symptom onset.
^bHealthcare exposure certainty defined as:

^cSupplemental Legionnaires’ Disease Surveillance System (SLDSS).
^dComplete reporting jurisdictions in 2014: 31 complete reporting jurisdictions reported at least 90% of confirmed NNDSS cases to SLDSS in 2014: Alabama, Alaska, Colorado, Connecticut, Florida, Georgia, Iowa, Kansas, Kentucky, Maine, Maryland, Michigan, Minnesota, Mississippi, Missouri, New Hampshire, New York City, New York State, North Dakota, Ohio, Pennsylvania, Rhode Island, South Carolina, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.
^eBased on year of symptom onset in SLDSS. If onset date was not stated in SLDSS, case year for confirmed cases was determined by the following dates (in order of reporting): positive laboratory date (by either urinary antigen testing, culture, or fourfold rise of antibody against Legionella pneumophila serogroup 1); date patient was hospitalized during treatment for Legionnaires’ disease; or date case was first reported to public health at any level.
^fMultiple indicates two or more healthcare facilities.
^gOther facility includes locations such as outpatient laboratories and pharmacies.

Table 5b. Number of reported confirmed cases of healthcare-associated^a Legionnaires’ disease by healthcare facility type and healthcare exposure certainty^b—SLDSS,^c complete reporting jurisdictions,^d 2015.^e

^aHealthcare–associated Legionnaires’ disease includes both definite and possible cases in patients who worked, visited, or stayed in a healthcare setting for any amount of time in the 10 days preceding symptom onset.
^bHealthcare exposure certainty defined as:

^cSupplemental Legionnaires’ Disease Surveillance System (SLDSS).
^dComplete reporting jurisdictions in 2015: 31 complete reporting jurisdictions reported at least 90% of confirmed NNDSS cases to SLDSS: Alabama, Colorado, Connecticut, Florida, Georgia, Hawaii, Iowa, Kansas, Kentucky, Maine, Maryland, Michigan, Minnesota, Mississippi, Missouri, New Hampshire, New Mexico, New York City, New York State, North Dakota, Ohio, Pennsylvania, Rhode Island, South Carolina, Texas, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.
^eBased on year of symptom onset in SLDSS. If onset date was not stated in SLDSS, case year for confirmed cases was determined by the following dates (in order of reporting): positive laboratory date (by either urinary antigen testing, culture, or fourfold rise of antibody against Legionella pneumophila serogroup 1); date patient was hospitalized during treatment for Legionnaires’ disease; or date case was first reported to public health at any level.
^fMultiple indicates two or more healthcare facilities.
^gOther facility includes locations such as outpatient laboratories and pharmacies.

Table 6a. Number of reported confirmed cases of Legionnaires’ disease by hospitalization,^a outcome,^b and exposure category^c—SLDSS,^d complete reporting jurisdictions,^e 2014.^f

^aHospitalization for treatment of Legionnaires’ disease.
^bOutcome at time of case reporting.
^cExposure categories (categories are not mutually exclusive):

^dSupplemental Legionnaires’ Disease Surveillance System (SLDSS).
^eComplete reporting jurisdictions in 2014: 31 complete reporting jurisdictions reported at least 90% of confirmed NNDSS cases to SLDSS: Alabama, Alaska, Colorado, Connecticut, Florida, Georgia, Iowa, Kansas, Kentucky, Maine, Maryland, Michigan, Minnesota, Mississippi, Missouri, New Hampshire, New York City, New York State, North Dakota, Ohio, Pennsylvania, Rhode Island, South Carolina, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.
^fBased on year of symptom onset in SLDSS. If onset date was not stated in SLDSS, case year for confirmed cases was determined by the following dates (in order of reporting): positive laboratory date (by either urinary antigen testing, culture, or fourfold rise of antibody against Legionella pneumophila serogroup 1); date patient was hospitalized during treatment for Legionnaires’ disease; or date case was first reported to public health at any level.

Table 6b. Number of reported confirmed cases of Legionnaires’ disease by hospitalization,^a outcome,^b and exposure category^c—SLDSS,^d complete reporting jurisdictions,^e 2015.^f

^aHospitalization for treatment of Legionnaires’ disease.
^bOutcome at time of case reporting.
^cExposure categories (categories are not mutually exclusive):

^cSupplemental Legionnaires’ Disease Surveillance System (SLDSS).
^dComplete reporting jurisdictions for 2015: 31 complete reporting jurisdictions reported at least 90% of confirmed NNDSS cases to SLDSS: Alabama, Colorado, Connecticut, Florida, Georgia, Hawaii, Iowa, Kansas, Kentucky, Maine, Maryland, Michigan, Minnesota, Mississippi, Missouri, New Hampshire, New Mexico, New York City, New York State, North Dakota, Ohio, Pennsylvania, Rhode Island, South Carolina, Texas, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.
^eBased on year of symptom onset in SLDSS. If onset date was not stated in SLDSS, case year for confirmed cases was determined by the following dates (in order of reporting): positive laboratory date (by either urinary antigen testing, culture, or fourfold rise of antibody against Legionella pneumophila serogroup 1); date patient was hospitalized during treatment for Legionnaires’ disease; or date case was first reported to public health at any level.

Table 7. Number of reported confirmed cases of Legionnaires’ disease by diagnostic testing method^a and year^b—SLDSS,^c United States, 2014 and 2015.

^aMore than one type of test might apply. Laboratory criteria for diagnosis include the following for confirmed cases:

^bBased on year of symptom onset in SLDSS. If onset date was not stated in SLDSS, case year for confirmed cases was determined by the following dates (in order of reporting): positive laboratory date (by either urinary antigen testing, culture, or fourfold rise of antibody against Legionella pneumophila serogroup 1); date patient was hospitalized during treatment for Legionnaires’ disease; or date case was first reported to public health at any level.
^cSupplemental Legionnaires’ Disease Surveillance System (SLDSS).
^dRespiratory secretions include sputum, bronchial wash, bronchoalveolar lavage.