Surveillance Report 2016-2017
- Figure 1. Crude incidence rates of reported confirmed cases of Legionnaires’ disease by year—NNDSS, United States, 2000–2017.
- Figure 2. Number of reported confirmed cases of Legionnaires’ disease by month and year—NNDSS, United States, 2016 and 2017.
- Figure 3a. Crude incidence rates of reported confirmed cases of Legionnaires’ disease by jurisdiction of residence—NNDSS, United States, 2016.
- Figure 3b. Crude incidence rates of reported confirmed cases of Legionnaires’ disease by jurisdiction of residence—NNDSS, United States, 2017.
- Table 1. Number of reported confirmed cases of Legionnaires’ disease by jurisdiction of residence and year—NNDSS, United States, 2016 and 2017.
- Table 2. Number, percent, and crude incidence rates of reported confirmed cases of Legionnaires’ disease by demographic characteristics and year—NNDSS, United States, 2016 and 2017.
- Figure 4a. Percent of reported confirmed cases of Legionnaires’ disease by age group and year—NNDSS and SLDSS, United States, 2016 and 2017.
- Figure 4b. Percent of reported confirmed cases of Legionnaires’ disease by sex and year—NNDSS and SLDSS, United States, 2016 and 2017.
- Figure 4c. Percent of reported confirmed cases of Legionnaires’ disease by race and year—NNDSS and SLDSS, United States, 2016 and 2017.
- Figure 4d. Percent of reported confirmed cases of Legionnaires’ disease by ethnicity and year—NNDSS and SLDSS, United States, 2016 and 2017.
- Figure 5a. Reported confirmed cases of legionellosis by syndrome and completeness of jurisdictional reporting—SLDSS, United States, 2016.
- Figure 5b. Reported confirmed cases of legionellosis by syndrome and completeness of jurisdictional reporting—SLDSS, United States, 2017.
- Figure 6a. Number of reported confirmed cases and deaths of Legionnaires’ disease by exposure category—SLDSS, complete reporting jurisdictions, 2016.
- Figure 6b. Number of reported confirmed cases and deaths of Legionnaires’ disease by exposure category—SLDSS, complete reporting jurisdictions, 2017.
- Table 3. Number of reported confirmed cases of Legionnaires’ disease by exposure category and year—SLDSS, complete reporting jurisdictions, 2016 and 2017.
- Table 4a. Number of reported confirmed cases of Legionnaires’ disease by demographic characteristics and exposure category—SLDSS, complete reporting jurisdictions, 2016.
- Table 4b. Number of reported confirmed cases of Legionnaires’ disease by demographic characteristics and exposure category—SLDSS, complete reporting jurisdictions, 2017.
- Table 5a. Number of reported confirmed cases of healthcare-associated Legionnaires’ disease by healthcare facility type and healthcare exposure certainty—SLDSS, complete reporting jurisdictions, 2016.
- Table 5b. Number of reported confirmed cases of healthcare-associated Legionnaires’ disease by healthcare facility type and healthcare exposure certainty—SLDSS, complete reporting jurisdictions, 2017.
- Table 6a. Number of reported confirmed cases of Legionnaires’ disease by hospitalization, outcome, and exposure category—SLDSS, complete reporting jurisdictions, 2016.
- Table 6b. Number of reported confirmed cases of Legionnaires’ disease by hospitalization, outcome, and exposure category—SLDSS, complete reporting jurisdictions, 2017.
- Figure 7. Percent of reported confirmed cases of Legionnaires’ disease that were treated in hospital by age group and year—SLDSS, complete reporting jurisdictions, 2016 and 2017.
- Figure 8. Percent of reported confirmed cases of Legionnaires’ disease resulting in death by age group and year—SLDSS, complete reporting jurisdictions, 2016 and 2017.
- Table 7. Number of reported confirmed cases of Legionnaires’ disease by diagnostic testing method and year—SLDSS, United States, 2016 and 2017.
Figure 1. Crude incidencea rates of reported confirmed cases of Legionnaires’ diseaseb by yearc—NNDSS,d,e United States, 2000–2017.
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 extrapulmonary legionellosis, but are referred to as Legionnaires’ disease in this figure (because almost all legionellosis cases reported in the United States are due to Legionnaires’ disease).
cBased on year the case was reported to CDC.
dNational Notifiable Diseases Surveillance System (NNDSS).
eJurisdictions may report cases of any case status to NNDSS, but only confirmed cases of Legionnaires’ disease from the 50 U.S. states, the District of Columbia, and New York City are included in this figure, with the exceptions noted below. National case counts published in the MMWR use the same criteria and exceptions.
2001: Legionnaires’ disease cases with probable and unknown case status were also included.
2000–2001: Legionnaires’ disease cases were not reportable in Oregon and West Virginia.
2004–2012: Legionnaires’ disease cases with unknown case status reported from California were also included.
2011–2012: Legionnaires’ disease cases were not reportable in the District of Columbia.
Figure 2. Number of reported confirmed cases of Legionnaires’ diseasea by monthb and yearc—NNDSS,d United States, 2016 and 2017.
aCases of disease due to Legionella are reported to NNDSS as legionellosis, which includes Legionnaires’ disease, Pontiac fever, and extrapulmonary legionellosis, but are referred to as Legionnaires’ disease in this figure (because almost all legionellosis cases reported in the United States are due to Legionnaires’ disease).
bMonth is based upon Morbidity and Mortality Weekly Report year and week (available at https://ndc.services.cdc.gov/wp-content/uploads/2021/02/MMWR_Week_overview.pdf [2 pages]).
cBased on year the case was reported to CDC.
dNational Notifiable Diseases Surveillance System (NNDSS).
Figure 3a. Crude incidencea rates of reported confirmed cases of Legionnaires’ diseaseb by jurisdiction of residencec—NNDSS,d United States, 2016.e,f
aCrude incidence of cases per 100,000 population (number of confirmed Legionnaires’ disease cases reported that year divided by postcensal resident jurisdiction 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 extrapulmonary legionellosis, but are referred to as Legionnaires’ disease in this figure (because almost all legionellosis cases reported in the United States are due to Legionnaires’ disease).
cJurisdiction of the patient’s “usual residence” at the time of disease onset.
dNational Notifiable Diseases Surveillance System (NNDSS).
eBased on year the case was reported to CDC.
fShading represents quintiles of incidence rates.
Figure 3b. Crude incidencea rates of reported confirmed cases of Legionnaires’ diseaseb by jurisdiction of residencec—NNDSS,d United States, 2017.e,f
aCrude incidence of cases per 100,000 population (number of confirmed Legionnaires’ disease cases reported that year divided by postcensal resident jurisdiction 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 extrapulmonary legionellosis, but are referred to as Legionnaires’ disease in this figure (because almost all legionellosis cases reported in the United States are due to Legionnaires’ disease).
cJurisdiction of the patient’s “usual residence” at the time of disease onset.
dNational Notifiable Diseases Surveillance System (NNDSS).
eBased on year the case was reported to CDC.
fShading represents quintiles of incidence rates.
Table 1. Number of reported confirmed cases of Legionnaires’ diseasea by jurisdiction of residenceb and yearc—NNDSS,d United States, 2016 and 2017.
| 2016 (Total=6,141) |
2017 (Total=7,458) |
|||
|---|---|---|---|---|
| Jurisdiction | N | % | N | % |
| ALABAMA | 63 | 1.0 | 66 | 0.9 |
| ALASKA | 1 | 0.0 | 6 | 0.1 |
| ARIZONA | 76 | 1.2 | 74 | 1.0 |
| ARKANSAS | 48 | 0.8 | 56 | 0.8 |
| CALIFORNIA | 586 | 9.5 | 535 | 7.2 |
| COLORADO | 57 | 0.9 | 82 | 1.1 |
| CONNECTICUT | 78 | 1.3 | 120 | 1.6 |
| DELAWARE | 26 | 0.4 | 34 | 0.5 |
| D.C. | 12 | 0.2 | 46 | 0.6 |
| FLORIDA | 328 | 5.3 | 435 | 5.8 |
| GEORGIA | 118 | 1.9 | 159 | 2.1 |
| HAWAII | 7 | 0.1 | 8 | 0.1 |
| IDAHO | 10 | 0.2 | 12 | 0.2 |
| ILLINOIS | 318 | 5.2 | 332 | 4.5 |
| INDIANA | 172 | 2.8 | 198 | 2.7 |
| IOWA | 33 | 0.5 | 35 | 0.5 |
| KANSAS | 32 | 0.5 | 34 | 0.5 |
| KENTUCKY | 102 | 1.7 | 116 | 1.6 |
| LOUISIANA | 33 | 0.5 | 49 | 0.7 |
| MAINE | 16 | 0.3 | 16 | 0.2 |
| MARYLAND | 142 | 2.3 | 187 | 2.5 |
| MASSACHUSETTS | 141 | 2.3 | 201 | 2.7 |
| MICHIGAN | 294 | 4.8 | 347 | 4.7 |
| MINNESOTA | 115 | 1.9 | 98 | 1.3 |
| MISSISSIPPI | 32 | 0.5 | 52 | 0.7 |
| MISSOURI | 159 | 2.6 | 138 | 1.9 |
| MONTANA | 10 | 0.2 | 17 | 0.2 |
| NEBRASKA | 17 | 0.3 | 29 | 0.4 |
| NEVADA | 26 | 0.4 | 14 | 0.2 |
| NEW HAMPSHIRE | 28 | 0.5 | 63 | 0.8 |
| NEW JERSEY | 199 | 3.2 | 249 | 3.3 |
| NEW MEXICO | 22 | 0.4 | 13 | 0.2 |
| NEW YORK CITY | 268 | 4.4 | 435 | 5.8 |
| NEW YORK | 463 | 7.5 | 587 | 7.9 |
| NORTH CAROLINA | 232 | 3.8 | 212 | 2.8 |
| NORTH DAKOTA | 5 | 0.1 | 7 | 0.1 |
| OHIO | 503 | 8.2 | 601 | 8.1 |
| OKLAHOMA | 60 | 1.0 | 65 | 0.9 |
| OREGON | 36 | 0.6 | 37 | 0.5 |
| PENNSYLVANIA | 371 | 6.0 | 500 | 6.7 |
| RHODE ISLAND | 37 | 0.6 | 50 | 0.7 |
| SOUTH CAROLINA | 62 | 1.0 | 55 | 0.7 |
| SOUTH DAKOTA | 9 | 0.2 | 15 | 0.2 |
| TENNESSEE | 126 | 2.1 | 207 | 2.8 |
| TEXAS | 270 | 4.4 | 327 | 4.4 |
| UTAH | 30 | 0.5 | 32 | 0.4 |
| VERMONT | 10 | 0.2 | 22 | 0.3 |
| VIRGINIA | 144 | 2.3 | 197 | 2.6 |
| WASHINGTON | 67 | 1.1 | 56 | 0.8 |
| WEST VIRGINIA | 30 | 0.5 | 49 | 0.7 |
| WISCONSIN | 114 | 1.9 | 176 | 2.4 |
| WYOMING | 3 | 0.1 | 7 | 0.1 |
| Total | 6,141 | 100.0 | 7,458 | 100.0 |
aCases of disease due to Legionella are reported to NNDSS as legionellosis, which includes Legionnaires’ disease, Pontiac fever, and extrapulmonary legionellosis, but are referred to as Legionnaires’ disease in this figure (because almost all legionellosis cases reported in the United States are Legionnaires’ disease cases).
bJurisdiction of the patient’s “usual residence” at the time of disease onset.
cBased on year the case was reported to CDC.
dNational Notifiable Diseases Surveillance System (NNDSS).
Table 2. Number, percent, and crude incidencea rates of reported confirmed cases of Legionnaires’ diseaseb by demographic characteristics and yearc—NNDSS,d United States, 2016 and 2017.
| 2016 | 2017 | |||||
|---|---|---|---|---|---|---|
| Characteristic | N | % | Ratea | N | % | Ratea |
| Age | ||||||
| 0–9 | 8 | 0.1 | 0.02 | 5 | 0.1 | 0.01 |
| 10–19 | 19 | 0.3 | 0.05 | 11 | 0.2 | 0.03 |
| 20–29 | 112 | 1.8 | 0.25 | 154 | 2.1 | 0.34 |
| 30–39 | 330 | 5.4 | 0.78 | 421 | 5.6 | 0.97 |
| 40–49 | 675 | 11.0 | 1.66 | 789 | 10.6 | 1.94 |
| 50–59 | 1,433 | 23.3 | 3.27 | 1,683 | 22.6 | 3.88 |
| 60–69 | 1,584 | 25.8 | 4.36 | 1,919 | 25.7 | 5.21 |
| 70–79 | 1057 | 17.2 | 5.24 | 1,418 | 19.0 | 6.57 |
| 80–84 | 388 | 6.3 | 6.61 | 459 | 6.2 | 7.69 |
| 85+ | 534 | 8.7 | 8.37 | 598 | 8.0 | 9.24 |
| Not stated | 1 | 0.0 | N/A | 1 | 0.0 | N/A |
| Sex | ||||||
| Female | 2,458 | 40.0 | 1.50 | 2,865 | 38.4 | 1.73 |
| Male | 3,679 | 59.9 | 2.31 | 4,589 | 61.5 | 2.86 |
| Not stated | 4 | 0.1 | N/A | 4 | 0.1 | N/A |
| Race | ||||||
| American Indian/Alaska Native | 26 | 0.4 | 0.56 | 28 | 0.4 | 0.60 |
| Asian/Pacific Islander | 99 | 1.6 | 0.48 | 103 | 1.4 | 0.49 |
| African American/Black | 1068 | 17.4 | 2.36 | 1,579 | 21.2 | 3.44 |
| White | 3,891 | 63.4 | 1.54 | 4,706 | 63.1 | 1.85 |
| Othere | 242 | 3.9 | N/A | 215 | 2.9 | N/A |
| Not stated | 815 | 13.3 | N/A | 827 | 11.1 | N/A |
| Ethnicity | ||||||
| Hispanic | 397 | 6.5 | 0.69 | 435 | 5.8 | 0.74 |
| Non-Hispanic | 4,506 | 73.4 | 1.70 | 5,500 | 73.8 | 2.06 |
| Not stated | 1,238 | 20.2 | N/A | 1,523 | 20.4 | N/A |
| Total | 6,141 | 100.0 | 1.90 | 7,458 | 100.0 | 2.29 |
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 extrapulmonary legionellosis, but are referred to as Legionnaires’ disease in this figure (because almost all legionellosis cases reported in the United States are Legionnaires’ disease cases).
cBased on year the case was reported to CDC.
dNational Notifiable Diseases Surveillance System (NNDSS).
eOther race includes individuals that did not identify with races listed.
Figure 4a. Percent of reported confirmed cases of Legionnaires’ diseasea by age group and yearb—NNDSSc and SLDSS,d United States, 2016 and 2017.
aCases of disease due to Legionella are reported to NNDSS as legionellosis, which includes Legionnaires’ disease, Pontiac fever, and extrapulmonary legionellosis, but are referred to as Legionnaires’ disease in this figure (because almost all legionellosis cases reported in the United States are Legionnaires’ disease cases). SLDSS data are limited to cases of Legionnaires’ disease in this figure.
bBased on year the case was reported to CDC in NNDSS and 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 titer 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.
cNational Notifiable Diseases Surveillance System (NNDSS).
dSupplemental Legionnaires’ Disease Surveillance System (SLDSS).
Figure 4b. Percent of reported confirmed cases of Legionnaires’ diseasea by sex and yearb—NNDSSc and SLDSS,d United States, 2016 and 2017.
aCases of disease due to Legionella are reported to NNDSS as legionellosis, which includes Legionnaires’ disease, Pontiac fever, and extrapulmonary legionellosis, but are referred to as Legionnaires’ disease in this figure (because almost all legionellosis cases reported in the United States are Legionnaires’ disease cases). SLDSS data are limited to cases of Legionnaires’ disease in this figure.
bBased on year the case was reported to CDC in NNDSS and 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 titer 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.
cNational Notifiable Diseases Surveillance System (NNDSS).
dSupplemental Legionnaires’ Disease Surveillance System (SLDSS).
Figure 4c. Percent of reported confirmed cases of Legionnaires’ diseasea by raceb and yearc—NNDSSd and SLDSS,e United States, 2016 and 2017.
aCases of disease due to Legionella are reported to NNDSS as legionellosis, which includes Legionnaires’ disease, Pontiac fever, and extrapulmonary legionellosis, but are referred to as Legionnaires’ disease in this figure (because almost all legionellosis cases reported in the United States are Legionnaires’ disease cases). SLDSS data are limited to cases of Legionnaires’ disease in this figure.
bIn NNDSS, Other includes American Indian/Alaska Native, Asian/Pacific Islander, and individuals that did not identify with either race in NNDSS. In SLDSS, Other includes American Indian/Alaska Native, Asian, Hawaii/Pacific Islander, and individuals that identified with multiple races.
cBased on year the case was reported to CDC in NNDSS and 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 titer 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.
dNational Notifiable Diseases Surveillance System (NNDSS).
eSupplemental Legionnaires’ Disease Surveillance System (SLDSS).
Figure 4d. Percent of reported confirmed cases of Legionnaires’ diseasea by ethnicity and yearb—NNDSSc and SLDSS,d United States, 2016 and 2017.
aCases of disease due to Legionella are reported to NNDSS as legionellosis, which includes Legionnaires’ disease, Pontiac fever, and extrapulmonary legionellosis, but are referred to as Legionnaires’ disease in this figure (because almost all legionellosis cases reported in the United States are Legionnaires’ disease cases). SLDSS data are limited to cases of Legionnaires’ disease in this figure.
bBased on year the case was reported to CDC in NNDSS and 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 titer 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.
cNational Notifiable Diseases Surveillance System (NNDSS).
dSupplemental Legionnaires’ Disease Surveillance System (SLDSS).
Figure 5a. Reported confirmed cases of legionellosisa by syndrome and completeness of jurisdictional reportingb—SLDSS,c United States, 2016.d
aLegionellosis includes Legionnaires’ disease, Pontiac fever, and extrapulmonary legionellosis.
b35 complete reporting jurisdictions reported at least 90% of confirmed NNDSS cases to SLDSS in 2016: Alabama, Alaska, Arkansas, Arizona, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Iowa, Illinois, Kansas, Kentucky, Maine, Michigan, Minnesota, Mississippi, Missouri, Montana, New Hampshire, New Jersey, New York City, New York (state), Ohio, Pennsylvania, Rhode Island, South Carolina, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.
cSupplemental Legionnaires’ Disease Surveillance System (SLDSS).
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 titer 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.
eLegionnaires’ disease.
fCFR: Case fatality rate calculated as the number of reported confirmed case deaths divided by the number of patients with the same legionellosis syndrome.
gPontiac fever.
hExtrapulmonary legionellosis.
iWhile legionellosis consists of Legionnaires’ disease, Pontiac fever, and extrapulmonary legionellosis, syndrome was not specified for some cases.
jComplete reporting.
Figure 5b. Reported confirmed cases of legionellosisa by syndrome and completeness of jurisdictional reportingb—SLDSS,c United States, 2017.d
aLegionellosis includes Legionnaires’ disease, Pontiac fever, and extrapulmonary legionellosis.
b39 complete reporting jurisdictions reported at least 90% of confirmed NNDSS cases to SLDSS in 2017: Alabama, Alaska, Arkansas, Colorado, Connecticut, Florida, Georgia, Iowa, Illinois, Kansas, Kentucky, Maryland, Maine, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New York City, New York (state), North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Washington, West Virginia, Wisconsin, and Wyoming.
cSupplemental Legionnaires’ Disease Surveillance System (SLDSS).
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 titer 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.
eLegionnaires’ disease.
fCFR: Case fatality rate calculated as the number of reported confirmed case deaths divided by the number of patients with the same legionellosis syndrome.
gPontiac fever.
hExtrapulmonary legionellosis.
iWhile legionellosis consists of Legionnaires’ disease, Pontiac fever, and extrapulmonary legionellosis, syndrome was not specified for some cases.
jComplete reporting.
Figure 6a. Number of reported confirmed cases and deaths of Legionnaires’ disease by exposure categorya—SLDSS,b complete reporting jurisdictions,c 2016.d
| Cases (Total = 4,150) |
Deaths (Total= 276) |
|||
|---|---|---|---|---|
| Exposure category | N | % | N | CFRe |
| Any healthcare | 835 | 20.1 | 87 | 10.4 |
| Definite healthcare | 178 | 4.3 | 30 | 16.9 |
| Possible healthcare | 657 | 15.8 | 57 | 8.7 |
| Any travel | 616 | 14.8 | 30 | 4.9 |
| Any assisted or senior living | 152 | 3.7 | 14 | 9.2 |
| None of these | 2,693 | 64.9 | 160 | 5.9 |
aExposure categories are not mutually exclusive. A patient may report multiple exposures in the 10 days before date of symptom onset. Exposure categories:
Travel: A patient with a history of spending at least one night away from home (in the state of residence, another state, or another country) in the 10 days before date of symptom onset, not including nights spent in a healthcare facility.
Assisted or senior living: A patient who visited, worked, or stayed in a senior or assisted living facility in the 10 days before date of symptom onset.
None of these: A patient without reported healthcare setting, travel, or senior or assisted living facility exposure in the 10 days before date of symptom onset.
bSupplemental Legionnaires’ Disease Surveillance System (SLDSS).
cComplete reporting jurisdictions in 2016: 35 complete reporting jurisdictions reported at least 90% of confirmed NNDSS cases to SLDSS: Alabama, Alaska, Arkansas, Arizona, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Iowa, Illinois, Kansas, Kentucky, Maine, Michigan, Minnesota, Mississippi, Missouri, Montana, New Hampshire, New Jersey, New York City, New York (state), Ohio, Pennsylvania, Rhode Island, South Carolina, 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 titer 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.
Figure 6b. Number of reported confirmed cases and deaths of Legionnaires’ disease by exposure categorya—SLDSS,b complete reporting jurisdictions,c 2017.d
| Cases (Total = 5,898) |
Deaths (Total= 438) |
|||
|---|---|---|---|---|
| Exposure category | N | % | N | CFRe |
| Any healthcare | 1255 | 21.3 | 142 | 11.3 |
| Definite healthcare | 232 | 3.9 | 47 | 20.3 |
| Possible healthcare | 1023 | 17.3 | 95 | 9.3 |
| Any travel | 931 | 15.8 | 30 | 3.2 |
| Any assisted or senior living | 211 | 3.6 | 22 | 10.4 |
| None of these | 3,733 | 63.3 | 260 | 7.0 |
aExposure categories are not mutually exclusive. A patient may report multiple exposures in the 10 days before date of symptom onset. Exposure categories:
Healthcare: A patient who visited, worked, or stayed in a healthcare setting in the 10 days before date of symptom onset.
Travel: A patient with a history of spending at least one night away from home (in the state of residence, another state, or another country) in the 10 days before date of symptom onset, not including nights spent in a healthcare facility.
Assisted or senior living: A patient who visited, worked, or stayed in a senior or assisted living facility in the 10 days before date of symptom onset.
None of these: A patient without reported healthcare setting, travel, or senior or assisted living facility exposure in the 10 days before date of symptom onset.
bSupplemental Legionnaires’ Disease Surveillance System (SLDSS).
cComplete reporting jurisdictions for 2017: 39 complete reporting jurisdictions reported at least 90% of confirmed NNDSS cases to SLDSS in 2017: Alabama, Alaska, Arkansas, Colorado, Connecticut, Florida, Georgia, Iowa, Illinois, Kansas, Kentucky, Maryland, Maine, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New York City, New York (state), North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, 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 titer 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.
Table 3. Number of reported confirmed cases of Legionnaires’ disease by exposure categorya and yearb—SLDSS,c complete reporting jurisdictions,d 2016 and 2017.
| 2016 (Total = 4,150) |
2017 (Total = 5,898) |
|||
|---|---|---|---|---|
| Exposure category | N | % | N | % |
| Healthcare | 835 | 20.1 | 1255 | 21.3 |
| Healthcare facility type | ||||
| Hospital | 325 | 38.9 | 443 | 35.3 |
| Long-term care facility | 197 | 23.6 | 282 | 22.5 |
| Clinic | 196 | 23.5 | 335 | 26.7 |
| Multiple | 89 | 10.7 | 125 | 10.0 |
| Other | 1 | 0.1 | 0 | 0.0 |
| Not stated | 27 | 3.2 | 70 | 5.6 |
| Healthcare exposure type | ||||
| Inpatient | 317 | 38.0 | 430 | 34.3 |
| Outpatient | 292 | 35.0 | 460 | 36.7 |
| Visitor | 74 | 8.9 | 143 | 11.4 |
| Employee | 70 | 8.4 | 89 | 7.1 |
| Multiple | 50 | 6.0 | 61 | 4.9 |
| Not stated | 32 | 3.8 | 72 | 5.7 |
| Travel | 616 | 14.8 | 931 | 15.8 |
| Any public accommodation | 417 | 67.7 | 585 | 62.8 |
| Hotel/motel/resort | 412 | 576 | ||
| Cruise ship | 11 | 18 | ||
| All private accommodations | 181 | 29.4 | 239 | 25.7 |
| Unknown travel accommodation type | 18 | 2.9 | 107 | 11.5 |
| Assisted or senior living | 152 | 3.7 | 211 | 3.6 |
| Assisted or senior living facility type | ||||
| Assisted living facility | 90 | 59.2 | 121 | 57.3 |
| Senior living facility | 48 | 31.6 | 64 | 30.3 |
| Both | 1 | 0.7 | 1 | 0.5 |
| Not stated | 13 | 8.6 | 25 | 11.8 |
| Assisted or senior living exposure type | ||||
| Resident | 99 | 65.1 | 137 | 64.9 |
| Visitor | 25 | 16.4 | 41 | 19.4 |
| Employee | 11 | 7.2 | 9 | 4.3 |
| Not stated | 17 | 11.2 | 24 | 11.4 |
| None of these | 2,693 | 64.9 | 3,733 | 63.3 |
aExposure categories (categories are not mutually exclusive):
Healthcare: A patient who visited, worked, or stayed in a healthcare setting in the 10 days before date of symptom onset.
Travel: A patient with a history of spending at least one night away from home (in the state of residence, another state, or another country) in the 10 days before date of symptom onset, not including nights spent in a healthcare facility. Cases may occur in patients with multiple travel locations during the exposure period. If any exposure to a public accommodation occurs, the case is categorized as public travel. Private travel represents exposure to private accommodations only. If a patient has exposure to both private and unknown accommodations, the case is categorized as unknown travel.
Assisted or senior living: A patient who visited, worked, or stayed in a senior or assisted living facility in the 10 days before date of symptom onset.
None of these: A patient without reported healthcare setting, travel, or senior or assisted living facility exposure in the 10 days before date of symptom onset.
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 titer 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 2016: 35 complete reporting jurisdictions reported at least 90% of confirmed NNDSS cases to SLDSS: Alabama, Alaska, Arkansas, Arizona, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Iowa, Illinois, Kansas, Kentucky, Maine, Michigan, Minnesota, Mississippi, Missouri, Montana, New Hampshire, New Jersey, New York City, New York (state), Ohio, Pennsylvania, Rhode Island, South Carolina, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.
Complete reporting jurisdictions for 2017: 39 complete reporting jurisdictions reported at least 90% of confirmed NNDSS cases to SLDSS in 2017: Alabama, Alaska, Arkansas, Colorado, Connecticut, Florida, Georgia, Iowa, Illinois, Kansas, Kentucky, Maryland, Maine, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New York City, New York (state), North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Washington, West Virginia, Wisconsin, and Wyoming.
Table 4a. Number of reported confirmed cases of Legionnaires’ disease by demographic characteristics and exposure categorya—SLDSS,b complete reporting jurisdictions,c 2016.d
| Exposure category | ||||||||
|---|---|---|---|---|---|---|---|---|
| Healthcare (Total = 835) |
Travel (Total = 616) |
Assisted or senior living (Total = 152) |
None of these (Total = 2,693) |
|||||
| Characteristic | N | % | N | % | N | % | N | % |
| Median Age (years) | 65 | 61 | 78 | 61 | ||||
| Age | ||||||||
| 0–9 | 3 | 0.4 | 1 | 0.2 | 0 | 0.0 | 3 | 0.1 |
| 10–19 | 3 | 0.4 | 2 | 0.3 | 0 | 0.0 | 5 | 0.2 |
| 20–29 | 12 | 1.4 | 13 | 2.1 | 0 | 0.0 | 59 | 2.2 |
| 30–39 | 40 | 4.8 | 35 | 5.7 | 6 | 3.9 | 164 | 6.1 |
| 40–49 | 60 | 7.2 | 80 | 13.0 | 7 | 4.6 | 303 | 11.3 |
| 50–59 | 167 | 20.0 | 144 | 23.4 | 15 | 9.9 | 673 | 25.0 |
| 60–69 | 212 | 25.4 | 203 | 33.0 | 28 | 18.4 | 715 | 26.6 |
| 70–79 | 160 | 19.2 | 87 | 14.1 | 25 | 16.4 | 441 | 16.4 |
| 80–84 | 63 | 7.5 | 28 | 4.5 | 24 | 15.8 | 153 | 5.7 |
| 85+ | 114 | 13.7 | 21 | 3.4 | 47 | 30.9 | 175 | 6.5 |
| Not stated | 1 | 0.1 | 2 | 0.3 | 0 | 0.0 | 2 | 0.1 |
| Sex | ||||||||
| Female | 413 | 49.5 | 242 | 39.3 | 88 | 57.9 | 964 | 35.8 |
| Male | 418 | 50.1 | 370 | 60.1 | 64 | 42.1 | 1,712 | 63.6 |
| Not stated | 4 | 0.5 | 4 | 0.6 | 0 | 0.0 | 17 | 0.6 |
| Race | ||||||||
| American Indian/Alaska Native | 4 | 0.5 | 5 | 0.8 | 0 | 0.0 | 7 | 0.3 |
| Asian | 14 | 1.7 | 8 | 1.3 | 3 | 2.0 | 27 | 1.0 |
| Black or African American | 142 | 17.0 | 86 | 14.0 | 23 | 15.1 | 558 | 20.7 |
| Native Hawaiian/Other Pacific Islander | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 | 6 | 0.2 |
| White | 519 | 62.2 | 397 | 64.4 | 87 | 57.2 | 1,590 | 59.0 |
| Multiple | 1 | 0.1 | 0 | 0.0 | 0 | 0.0 | 6 | 0.2 |
| Not stated | 155 | 18.6 | 120 | 19.5 | 39 | 25.7 | 499 | 18.5 |
| Ethnicity | ||||||||
| Hispanic | 31 | 3.7 | 22 | 3.6 | 5 | 3.3 | 132 | 4.9 |
| Non-Hispanic | 651 | 78.0 | 460 | 74.7 | 115 | 75.7 | 2,039 | 75.7 |
| Not stated | 153 | 18.3 | 134 | 21.8 | 32 | 21.1 | 522 | 19.4 |
aExposure categories (categories are not mutually exclusive):
Healthcare: A patient who visited, worked, or stayed in a healthcare setting in the 10 days before date of symptom onset.
Travel: A patient with a history of spending at least one night away from home (in the state of residence, another state, or another country) in the 10 days before date of symptom onset, not including nights spent in a healthcare facility.
Assisted or senior living: A patient who visited, worked, or stayed in a senior or assisted living facility in the 10 days before date of symptom onset.
None of these: A patient without reported healthcare setting, travel, or senior or assisted living facility exposure in the 10 days before date of symptom onset.
bSupplemental Legionnaires’ Disease Surveillance System (SLDSS).
cComplete reporting jurisdictions in 2016: 35 complete reporting jurisdictions reported at least 90% of confirmed NNDSS cases to SLDSS in 2016: Alabama, Alaska, Arkansas, Arizona, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Iowa, Illinois, Kansas, Kentucky, Maine, Michigan, Minnesota, Mississippi, Missouri, Montana, New Hampshire, New Jersey, New York City, New York (state), Ohio, Pennsylvania, Rhode Island, South Carolina, 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 titer 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 categorya—SLDSS,b complete reporting jurisdictions,c 2017.d
| Exposure category | ||||||||
|---|---|---|---|---|---|---|---|---|
| Healthcare (Total = 1,255) |
Travel (Total = 931) |
Assisted or senior living (Total = 211) |
None of these (Total = 3,733) |
|||||
| Characteristic | N | % | N | % | N | % | N | % |
| Median Age (years) | 66 | 61 | 74 | 61 | ||||
| Age | ||||||||
| 0–9 | 1 | 0.1 | 0 | 0.0 | 0 | 0.0 | 1 | 0.0 |
| 10–19 | 3 | 0.2 | 0 | 0.0 | 0 | 0.0 | 5 | 0.1 |
| 20–29 | 21 | 1.7 | 21 | 2.3 | 6 | 2.8 | 85 | 2.3 |
| 30–39 | 48 | 3.8 | 71 | 7.6 | 7 | 3.3 | 228 | 6.1 |
| 40–49 | 110 | 8.8 | 110 | 11.8 | 8 | 3.8 | 442 | 11.8 |
| 50–59 | 250 | 19.9 | 211 | 22.7 | 29 | 13.7 | 922 | 24.7 |
| 60–69 | 295 | 23.5 | 285 | 30.6 | 39 | 18.5 | 941 | 25.2 |
| 70–79 | 279 | 22.2 | 152 | 16.3 | 40 | 19.0 | 665 | 17.8 |
| 80–84 | 96 | 7.6 | 49 | 5.3 | 24 | 11.4 | 206 | 5.5 |
| 85+ | 151 | 12.0 | 29 | 3.1 | 58 | 27.5 | 234 | 6.3 |
| Not stated | 1 | 0.1 | 3 | 0.3 | 0 | 0.0 | 4 | 0.1 |
| Sex | ||||||||
| Female | 563 | 44.9 | 360 | 38.7 | 98 | 46.4 | 1301 | 34.9 |
| Male | 682 | 54.3 | 564 | 60.6 | 111 | 52.6 | 2,409 | 64.5 |
| Not stated | 10 | 0.8 | 7 | 0.8 | 2 | 0.9 | 23 | 0.6 |
| Race | ||||||||
| American Indian/Alaska Native | 5 | 0.4 | 4 | 0.4 | 1 | 0.5 | 8 | 0.2 |
| Asian | 12 | 1.0 | 6 | 0.6 | 1 | 0.5 | 33 | 0.9 |
| Black or African American | 251 | 20.0 | 157 | 16.9 | 41 | 19.4 | 860 | 23.0 |
| Native Hawaiian/Other Pacific Islander | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 | 2 | 0.1 |
| White | 846 | 67.4 | 636 | 68.3 | 149 | 70.6 | 2,296 | 61.5 |
| Multiple | 3 | 0.2 | 1 | 0.1 | 0 | 0.0 | 10 | 0.3 |
| Not stated | 138 | 11.0 | 127 | 13.6 | 19 | 9.0 | 524 | 14.0 |
| Ethnicity | ||||||||
| Hispanic | 54 | 4.3 | 41 | 4.4 | 4 | 1.9 | 207 | 5.5 |
| Non-Hispanic | 968 | 77.1 | 692 | 74.3 | 166 | 78.7 | 2,821 | 75.6 |
| Not stated | 233 | 18.6 | 198 | 21.3 | 41 | 19.4 | 705 | 18.9 |
aExposure categories (categories are not mutually exclusive):
Healthcare: A patient who visited, worked, or stayed in a healthcare setting in the 10 days before date of symptom onset.
Travel: A patient with a history of spending at least one night away from home (in the state of residence, another state, or another country) in the 10 days before date of symptom onset, not including nights spent in a healthcare facility.
Assisted or senior living: A patient who visited, worked, or stayed in a senior or assisted living facility in the 10 days before date of symptom onset.
None of these: A patient without reported healthcare setting, travel, or senior or assisted living facility exposure in the 10 days before date of symptom onset.
bSupplemental Legionnaires’ Disease Surveillance System (SLDSS).
cComplete reporting jurisdictions for 2017: 39 complete reporting jurisdictions reported at least 90% of confirmed NNDSS cases to SLDSS in 2017: Alabama, Alaska, Arkansas, Colorado, Connecticut, Florida, Georgia, Iowa, Illinois, Kansas, Kentucky, Maryland, Maine, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New York City, New York (state), North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, 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 titer 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-associateda Legionnaires’ disease by healthcare facility type and healthcare exposure certaintyb—SLDSS,c complete reporting jurisdictionsd, 2016.e
| Healthcare exposure certainty | ||||||
|---|---|---|---|---|---|---|
| Definite | Possible | Total | ||||
| Facility type | N | % | N | % | N | % |
| Hospital | 31 | 17.4 | 294 | 44.7 | 325 | 38.9 |
| Long-term care facility | 110 | 61.8 | 87 | 13.2 | 197 | 23.6 |
| Clinic | 0 | 0.0 | 196 | 29.8 | 196 | 23.5 |
| Multiplef | 31 | 17.4 | 58 | 8.8 | 89 | 10.7 |
| Otherg | 0 | 0.0 | 1 | 0.2 | 1 | 0.1 |
| Not stated | 6 | 3.4 | 21 | 3.2 | 27 | 3.2 |
| Total | 178 | 100 | 657 | 100 | 835 | 100 |
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:
Definite case of healthcare–associated Legionnaires’ disease was defined as laboratory-confirmed legionellosis in a patient with exposure to a hospital or long-term–care facility for the entire 10 days preceding symptom onset.
Possible case of healthcare–associated Legionnaires’ disease was defined as laboratory-confirmed legionellosis in a patient with exposure to a healthcare facility for a portion of the 10 days preceding symptom onset.
cSupplemental Legionnaires’ Disease Surveillance System (SLDSS).
dComplete reporting jurisdictions in 2016: 35 complete reporting jurisdictions reported at least 90% of confirmed NNDSS cases to SLDSS in 2016: Alabama, Alaska, Arkansas, Arizona, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Iowa, Illinois, Kansas, Kentucky, Maine, Michigan, Minnesota, Mississippi, Missouri, Montana, New Hampshire, New Jersey, New York City, New York (state), Ohio, Pennsylvania, Rhode Island, South Carolina, 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 titer 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 more than one type of healthcare facility.
gOther facility includes locations such as outpatient laboratories and pharmacies.
Table 5b. Number of reported confirmed cases of healthcare-associateda Legionnaires’ disease by healthcare facility type and healthcare exposure certaintyb—SLDSS,c complete reporting jurisdictions,d 2017.e
| Healthcare exposure certainty | ||||||||
|---|---|---|---|---|---|---|---|---|
| Definite | Possible | Total | ||||||
| Facility type | N | % | N | % | N | % | ||
| Hospital | 43 | 18.5 | 400 | 39.1 | 443 | 35.3 | ||
| Long-term care facility | 137 | 59.1 | 145 | 14.2 | 282 | 22.5 | ||
| Clinic | 0 | 0.0 | 335 | 32.7 | 335 | 26.7 | ||
| Multiplef | 43 | 18.5 | 82 | 8.0 | 125 | 10.0 | ||
| Otherg | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 | ||
| Not stated | 9 | 3.9 | 61 | 6.0 | 70 | 5.6 | ||
| Total | 232 | 100 | 1023 | 100 | 1255 | 100 | ||
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:
Definite case of healthcare–associated Legionnaires’ disease was defined as laboratory-confirmed legionellosis in a patient with exposure to a hospital or long-term–care facility for the entire 10 days preceding symptom onset.
Possible case of healthcare–associated Legionnaires’ disease was defined as laboratory-confirmed legionellosis in a patient with exposure to a healthcare facility for a portion of the 10 days preceding symptom onset.
cSupplemental Legionnaires’ Disease Surveillance System (SLDSS).
dComplete reporting jurisdictions for 2017: 39 complete reporting jurisdictions reported at least 90% of confirmed NNDSS cases to SLDSS in 2017: Alabama, Alaska, Arkansas, Colorado, Connecticut, Florida, Georgia, Iowa, Illinois, Kansas, Kentucky, Maryland, Maine, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New York City, New York (state), North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, 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 titer 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 more than one type of healthcare facility.
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 categoryc—SLDSS,d complete reporting jurisdictions,e 2016.f
| Exposure category | ||||||||
|---|---|---|---|---|---|---|---|---|
| Healthcare (Total = 835) |
Travel (Total = 616) |
Assisted or senior living (Total = 152) |
None of these (Total = 2,693) |
|||||
| N | % | N | % | N | % | N | % | |
| Hospitalization | ||||||||
| Yes | 777 | 93.1 | 579 | 94.0 | 139 | 91.4 | 2,588 | 96.1 |
| No | 52 | 6.2 | 27 | 4.4 | 10 | 6.6 | 76 | 2.8 |
| Not stated | 6 | 0.7 | 10 | 1.6 | 3 | 2.0 | 29 | 1.1 |
| Outcome | ||||||||
| Death | 87 | 10.4 | 30 | 4.9 | 14 | 9.2 | 160 | 5.9 |
| Still ill | 105 | 12.6 | 56 | 9.1 | 17 | 11.2 | 228 | 8.5 |
| Survived | 608 | 72.8 | 476 | 77.3 | 99 | 65.1 | 1,868 | 69.4 |
| Not stated | 35 | 4.2 | 54 | 8.8 | 22 | 14.5 | 437 | 16.2 |
aHospitalization for treatment of Legionnaires’ disease.
bOutcome at time of case reporting.
cExposure categories (categories are not mutually exclusive):
Healthcare: Legionnaires’ disease in a patient who visited, worked, or stayed in a healthcare setting in the 10 days before date of symptom onset.
Travel: Legionnaires’ disease in a patient with a history of spending at least one night away from home (in the state of residence, another state, or another country) in the 10 days before date of symptom onset, not including nights spent in a healthcare facility.
Assisted or senior living: Legionnaires’ disease in a patient who visited, worked, or stayed in a senior or assisted living facility in the 10 days before date of symptom onset.
None of these: A patient without reported healthcare setting, travel, or senior or assisted living facility exposure in the 10 days before date of symptom onset.
dSupplemental Legionnaires’ Disease Surveillance System (SLDSS).
eComplete reporting jurisdictions in 2016: 35 complete reporting jurisdictions reported at least 90% of confirmed NNDSS cases to SLDSS in 2016: Alabama, Alaska, Arkansas, Arizona, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Iowa, Illinois, Kansas, Kentucky, Maine, Michigan, Minnesota, Mississippi, Missouri, Montana, New Hampshire, New Jersey, New York City, New York (state), Ohio, Pennsylvania, Rhode Island, South Carolina, 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 titer 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 categoryc—SLDSS,d complete reporting jurisdictions,e 2017.f
| Exposure category | ||||||||
|---|---|---|---|---|---|---|---|---|
| Healthcare (Total = 1,255) |
Travel (Total = 931) |
Assisted or senior living (Total = 211) |
None of these (Total = 3,733) |
|||||
| N | % | N | % | N | % | N | % | |
| Hospitalization | ||||||||
| Yes | 1193 | 95.1 | 886 | 95.2 | 201 | 95.3 | 3,613 | 96.8 |
| No | 55 | 4.4 | 18 | 1.9 | 9 | 4.3 | 79 | 2.1 |
| Not stated | 7 | 0.6 | 27 | 2.9 | 1 | 0.5 | 41 | 1.1 |
| Outcome | ||||||||
| Death | 142 | 11.3 | 30 | 3.2 | 22 | 10.4 | 260 | 7.0 |
| Still ill | 133 | 10.6 | 95 | 10.2 | 15 | 7.1 | 310 | 8.3 |
| Survived | 860 | 68.5 | 701 | 75.3 | 152 | 72.0 | 2,653 | 71.1 |
| Not stated | 120 | 9.6 | 105 | 11.3 | 22 | 10.4 | 510 | 13.7 |
aHospitalization for treatment of Legionnaires’ disease.
bOutcome at time of case reporting.
cExposure categories (categories are not mutually exclusive):
Healthcare: Legionnaires’ disease in a patient who visited, worked, or stayed in a healthcare setting in the 10 days before date of symptom onset.
Travel: Legionnaires’ disease in a patient with a history of spending at least one night away from home (in the state of residence, another state, or another country) in the 10 days before date of symptom onset, not including nights spent in a healthcare facility.
Assisted or senior living: Legionnaires’ disease in a patient who visited, worked, or stayed in a senior or assisted living facility in the 10 days before date of symptom onset.
None of these: A patient without reported healthcare setting, travel, or senior or assisted living facility exposure in the 10 days before date of symptom onset.
dSupplemental Legionnaires’ Disease Surveillance System (SLDSS).
eComplete reporting jurisdictions for 2017: 39 complete reporting jurisdictions reported at least 90% of confirmed NNDSS cases to SLDSS in 2017: Alabama, Alaska, Arkansas, Colorado, Connecticut, Florida, Georgia, Iowa, Illinois, Kansas, Kentucky, Maryland, Maine, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New York City, New York (state), North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, 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 urine antigen testing, culture, or fourfold rise of antibody titer 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.
Figure 7. Percent of reported confirmed cases of Legionnaires’ disease that were treated in hospitala by age group and yearb—SLDSS,c complete reporting jurisdictions,d 2016 and 2017.
aHospitalization for treatment of Legionnaires’ disease.
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 titer 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 for 2016: 35 complete reporting jurisdictions reported at least 90% of confirmed NNDSS cases to SLDSS in 2016: Alabama, Alaska, Arkansas, Arizona, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Iowa, Illinois, Kansas, Kentucky, Maine, Michigan, Minnesota, Mississippi, Missouri, Montana, New Hampshire, New Jersey, New York City, New York (state), Ohio, Pennsylvania, Rhode Island, South Carolina, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.
Complete reporting jurisdictions for 2017: 39 complete reporting jurisdictions reported at least 90% of confirmed NNDSS cases to SLDSS in 2017: Alabama, Alaska, Arkansas, Colorado, Connecticut, Florida, Georgia, Iowa, Illinois, Kansas, Kentucky, Maryland, Maine, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New York City, New York (state), North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Washington, West Virginia, Wisconsin, and Wyoming.
Figure 8. Percent of reported confirmed cases of Legionnaires’ disease resulting in deatha by age group and yearb—SLDSS,c complete reporting jurisdictions,d 2016 and 2017.
aBased on outcome at time of case reporting.
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 titer 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 for 2016: 35 complete reporting jurisdictions reported at least 90% of confirmed NNDSS cases to SLDSS in 2016: Alabama, Alaska, Arkansas, Arizona, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Iowa, Illinois, Kansas, Kentucky, Maine, Michigan, Minnesota, Mississippi, Missouri, Montana, New Hampshire, New Jersey, New York City, New York (state), Ohio, Pennsylvania, Rhode Island, South Carolina, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.
Complete reporting jurisdictions for 2017: 39 complete reporting jurisdictions reported at least 90% of confirmed NNDSS cases to SLDSS in 2017: Alabama, Alaska, Arkansas, Colorado, Connecticut, Florida, Georgia, Iowa, Illinois, Kansas, Kentucky, Maryland, Maine, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New York City, New York (state), North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Washington, West Virginia, Wisconsin, and Wyoming.
Table 7. Number of reported confirmed cases of Legionnaires’ disease by diagnostic testing methoda and yearb—SLDSS,c United States, 2016 and 2017.
| 2016 | 2017 | Total | ||||
|---|---|---|---|---|---|---|
| N | % | N | % | N | % | |
| Diagnostic testing method | ||||||
| Urinary antigen test | 4,674 | 97.8 | 6,103 | 98.1 | 10,777 | 98.0 |
| Serology | 6 | 0.1 | 3 | 0.0 | 9 | 0.1 |
| Culture | 173 | 3.6 | 209 | 3.4 | 382 | 3.5 |
| Culture site | ||||||
| Respiratory secretiond | 149 | 86.1 | 180 | 86.1 | 329 | 86.1 |
| Blood | 5 | 2.9 | 6 | 2.9 | 11 | 2.9 |
| Lung biopsy | 5 | 2.9 | 5 | 2.4 | 10 | 2.6 |
| Pleural fluid | 3 | 1.7 | 1 | 0.5 | 4 | 1.0 |
| Other | 1 | 0.6 | 1 | 0.5 | 2 | 0.5 |
| Not stated | 10 | 5.8 | 16 | 7.7 | 26 | 6.8 |
| Culture species | ||||||
| L. pneumophila | 115 | 66.5 | 115 | 55.0 | 230 | 60.2 |
| Serogroup 1 | 51 | 60 | 111 | |||
| Serogroup 2 | 0 | 1 | 1 | |||
| Serogroup 4 | 2 | 0 | 2 | |||
| Serogroup 5 | 1 | 3 | 4 | |||
| Serogroup 6 | 1 | 1 | 2 | |||
| Serogroup 9 | 6 | 0 | 6 | |||
| Serogroup 10 | 0 | 1 | 1 | |||
| Serogroup 12 | 0 | 2 | 2 | |||
| L. micdadei | 4 | 2.3 | 3 | 1.4 | 7 | 1.8 |
| L. bozemanii | 2 | 1.2 | 0 | 0.0 | 2 | 0.5 |
| L. gormanii | 2 | 1.2 | 0 | 0.0 | 2 | 0.5 |
| L. donaldsonii | 0 | 0.0 | 1 | 0.5 | 1 | 0.3 |
| L. feeleii | 0 | 0.0 | 1 | 0.5 | 1 | 0.3 |
| L. longbeachae | 1 | 0.6 | 0 | 0.0 | 1 | 0.3 |
| L. parisiensis | 0 | 0.0 | 1 | 0.5 | 1 | 0.3 |
| Other or not stated | 49 | 28.3 | 88 | 42.1 | 137 | 35.9 |
aMore than one type of test might apply. Laboratory criteria for diagnosis include the following for confirmed cases:
Urinary antigen test: detection of Legionella pneumophila serogroup 1 antigen in urine using validated reagents.
Culture: isolation of any Legionella organism from respiratory secretions, lung tissue, pleural fluid, or other normally sterile site.
Serology: fourfold or greater rise in specific serum antibody titer to L. pneumophila serogroup 1 using validated reagents detected 3–6 weeks apart.
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 titer 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.