Increasing incidence of legionellosis in the United States, 1990-2005: Changing epidemiologic trends

Background. An abrupt increase in the incidence of legionellosis in the United States has been noted since 2003. Whether the recent increase is associated with shifting epidemiologic trends has not been well characterized. Methods. We analyzed all cases of legionellosis reported to the Centers for Disease Control and Prevention through the National Notifiable Disease Surveillance System from 1990 through 2005. Results. A total of 23,076 cases of legionellosis were reported to the Centers for Disease Control and Prevention from 1990 through 2005. The number of reported cases increased by 70% from 1310 cases in 2002 to 2223 cases in 2003, with a sustained increase to 12000 cases per year from 2003 through 2005. The eastern United States showed most of the increases in age-adjusted incidence rates after 2002, with the mean rate in the Middle Atlantic states during 2003-2005 exceeding that during 1990-2002 by 96%. During 2000-2005, legionellosis cases were most commonly reported in persons aged 45-64 years. Persons aged <65 years comprised 63% of total cases in 2000-2005. Age-adjusted incidence rates in males exceeded those in females for all age groups and years. Legionellosis incidence showed marked seasonality in eastern states, with most cases reported in the summer or fall. Conclusions. Reported legionellosis cases have increased substantially in recent years, particularly in the eastern United States and among middle-aged adults. Legionella infection should be considered in the differential diagnosis of any patient with pneumonia. Public health professionals should focus increased attention on detection and prevention of this important and increasing public health problem.