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Legionnaires’ disease in transportation, construction and other occupations in 39 US jurisdictions, 2014–2016
  1. Laurel Harduar Morano1,2,
  2. Bozena M Morawski3,4,
  3. Carolyn T A Herzig5,6,
  4. Chris Edens7,
  5. Albert E Barskey7,
  6. Sara E Luckhaupt2
  1. 1Division of Occupational and Environmental Medicine, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
  2. 2Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
  3. 3Idaho Hospital Association, Boise, Idaho, USA
  4. 4CDC assignee to the Idaho Department of Health and Welfare, Boise, Idaho, USA
  5. 5National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia, USA
  6. 6CDC assignee to the Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina, USA
  7. 7Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  1. Correspondence to Dr Laurel Harduar Morano, Division of Occupational and Environmental Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan, USA; harduarm{at}msu.edu

Abstract

Background Certain workers are at increased risk for acquiring Legionnaires’ disease compared with other workers. This study aims to identify occupations at increased risk for acquiring Legionnaires’ disease.

Methods Using data from the US Centers for Disease Control and Prevention’s Supplemental Legionnaires’ Disease Surveillance System, this study identified Legionnaires’ disease confirmed patients ≥16 years of age in 39 states with reported symptom onset during 2014–2016. Age-adjusted and sex-adjusted incidence rate ratios (IRR) stratified by occupation group were calculated by comparing Legionnaires’ disease patients in an occupation group (eg, transportation) to those in all other occupation groups (eg, non-transportation).

Results A total of 2553 patients had a known occupation group. The two occupations with the highest burden were transportation (N=287; IRR=2.11) and construction (N=269; IRR=1.82). Truck drivers comprised the majority (69.7%) of the transportation occupation group and construction labourers comprised almost half (49%) of the construction occupation group. The healthcare support occupation had the highest IRR (N=75; IRR=2.16).

Conclusion Transportation and construction workers, who are generally not covered by guidance related to building water systems, have increased risk of Legionnaires’ disease compared with other workers. One hypothesised risk factor for truck drivers is the use of non-genuine windshield cleaner in their vehicles. A simple intervention is to use genuine windshield cleaner with bactericidal properties (ie, includes isopropanol/methanol) which can reduce the risk of Legionella growth and transmission. To improve surveillance of Legionnaires’ disease and identification of similar exposures, the authors encourage the collection of occupation and industry information for all patients with Legionnaires’ disease.

  • Transportation
  • Epidemiology
  • Occupational Health
  • Public Health Surveillance
  • Construction Industry

Data availability statement

Data are available on reasonable request. A deidentified dataset can be made available on request. However, due to confidentiality, a data use agreement may be required depending on requested data elements. Data requests can be made to travellegionella@cdc.gov.

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Data availability statement

Data are available on reasonable request. A deidentified dataset can be made available on request. However, due to confidentiality, a data use agreement may be required depending on requested data elements. Data requests can be made to travellegionella@cdc.gov.

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Footnotes

  • Contributors LHM, CTAH and BMM conceived of and designed the project. BMM, CE and SEL critically reviewed and approved the project design. BMM and CE acquired the data. LHM analysed the data and wrote the draft paper. All authors contributed to the interpretation of the data, provided critical review of the paper contents, agreed to the final version. LHM is responsible for the overall content and is accountable for the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

  • Competing interests The primary author reports 2023 travel support in the form of a registration fee scholarship from the Council of State and Territorial Epidemiologists (CSTE) to attend their annual conference.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.