1. Kool JL, Bergmire-Sweat D, Butler JC, et al. Hospital characteristics associated with colonization of water systems by Legionella and risk of nosocomial Legionnaires' disease: A cohort study of 15 hospitals. Infect. Control Hosp. Epidemiol. 1999;20:798-805.
  2. State of Maryland, Department of Health and Human and Mental Hygiene. Report of the Maryland scientific working group to study Legionella in water systems in healthcare institutions. MD: State of Maryland Department of Health and Mental Hygiene. 2000:1-26.
  3. McDade JE, Sheppard CC, Fraser DW, et al. Legionnaires' disease: isolation of a bacterium and demonstration of its role in other respiratory diseases. N. Engl. J. Med. 1977;287:1197-1203.
  4. Winn Jr. WC. Legionella. In Manual of Clinical Microbiology, 7th Ed. Murray PR, Barron EJ, Pfaller MA, Tenover FC and Yolken RH Eds. Washington, D.C., American Society for Microbiology 1999:573-585.
  5. Parry MF, Stampleman L, Hutchinson JH, et al. Waterborne Legionella bozemanii and nosocomial pneumonia in immunosuppressed patients. Ann. Intern. Med. 1985;103:205-210.
  6. Doebbeling BN, Ishak MA, Wade BH, et al. Nosocomial Legionella micdadei pneumonia: 10 years experience and case-control study. J. Hosp. Infect. 1989;13:289-298.
  7. Reingold AL, Thomason BM, Brake BJ. Legionella pneumonia in the United States: the distribution of serogroups and species causing human illness. J. Infect. Dis. 1984;149:819.
  8. Girod JC, Reichman WC, Winn Jr, DN, et al. Pneumonic and nonpneumonic forms of legionellosis. The result of a common source exposure to Legionella pneumophila. Arch. Intern. Med. 1982;142:545-547.
  9. Stout JE, Yu VL. Legionellosis. N. Engl. J. Med. 1997;337:682-687.
  10. Marston BJ, Plouffe JF, File, TM, et al. Incidence of community-acquired pneumonia requiring hospitalization: results of a population-based surveillance study in Ohio. Arch. Intern. Med. 1997;157:1709-1718.
  11. Breiman RF, Butler JC. Legionnaires' disease: clinical, epidemiological, and public health perspectives. Semin. Respir. Infect. 1998;13:84-89.
  12. Straus WL, Plouffe JF, File, TM, et al. Risk factors for domestic acquisition of Legionnaires' disease. Arch. Intern. Med. 1996;156:1685-1692.
  13. Marston BJ, Lipman HB, Breimen RF. Surveillance for Legionnaires' disease: risk factors for morbidity and mortality. Arch. Intern. Med. 1994;154:2417-2422.
  14. Centers for Disease Control and Prevention. Guidelines for Prevention of Nosocomial Pneumonia. Morbid. Mortal. Weekly Rep. 1997;46 (RR-1):1-79.
  15. Hospital Infection Control Program Advisory Committee. Legionnaires' Disease: Recommendations for the prevention of nosocomial Legionnaires' Disease. March 26, 1996.
  16. American Academy of Pediatrics. "Immunization in Special Clinical Circumstances." In: Pickering LK, ed. 2000 Red Book: Report of the Committee on Infectious Diseases. 25th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2000, page 61.
  17. Buesching WJ. Enhanced primary isolation of Legionella pneumophila from clinical specimens by low pH treatment. J. Clin. Microbiol. 1983;17:1153-1155.
  18. Lepine L, Jernigan DB, Butler JC, et al. A recurrent outbreak of nosocomial Legionnaires' disease detected by urinary antigen testing: evidence for long-term colonization of a hospital plumbing system. Infect. Control Hosp. Epidemiol. 1998;19:905-910.
  19. Kazandjian D, Chiew R, Gilbert GL. Rapid diagnosis of Legionella pneumophila serogroup 1 infection with the Binax enzyme immunoassay urinary antigen test. J. Clin. Microbiol. 1997;35:954-956.
  20. Stout JE. Laboratory diagnosis of Legionnaires' disease: the expanding role of the Legionella urinary antigen test. Clin. Microbiol. Newsletter 2000;22:62-64.
  21. Kool JL, Fiore AE, Kioski CM, et al. More than 10 years of unrecognized nosocomial transmission of Legionnaires' disease among transplant patients. Infect. Control Hosp. Epidemiol. 1998;19:898-904.
  22. Fiore AE, Butler JC, Emori TG, Gaynes RP. A survey of methods used to detect nosocomial legionellosis among participants in the National Nosocomial Infections Surveillance System. Infect. Control Hosp. Epidemiol. 1999;20:412-416.
  23. Centers for Disease Control and Prevention. Case definitions for infectious conditions under public health surveillance. Morbid. Mortal. Weekly Rep. 1997;46 (RR-10).
  24. Stout JE, Best MG, Yu VL. Susceptibility of Members of the family Legionellaceae to thermal stress: Implications for heat eradication methods in water distribution systems. Appl. Environ. Microbiol. 1986;52:396-399.
  25. Stout JE, Yu VL, Best MG. Ecology of Legionella pneumophila within water distribution systems. Appl. Eviron. Microbiol. 1985;49:221-228.
  26. Blatt SP, Parkinson MD, Pace E, et al. Nosocomial Legionnaires' disease: aspiration as a primary mode of disease acquisition. Am. J. Med. 1993;95:16-22.
  27. Venzia RA, Agresta MD, Hanley EM, et al. Nosocomial legionellosis associated with aspiration of nasogastric feedings diluted in tap water. Infect. Control Hosp. Epidemiol. 1994;15:529-533.
  28. Hanrahan JP, Morse DL, Scharf VB, et al. A community hospital outbreak of legionellosis: transmission by potable hot water. Am. J. Epidemiol. 10987;125:639-649.
  29. Arnow PM, Chou T, Shapiro EN, Kretzschmar C. Nosocomial Legionnaires' disease caused by aerosolized tap water from respiratory devices. J. Infect. Dis. 1982;146:460-467.
  30. Breiman RF, Fields BS, Sanden GN, et al. Association of shower use with Legionnaires' disease. JAMA 1990;263:2924-2926.
  31. Brown CM, Nuorti, PJ, Breiman RF, et al. A community outbreak of Legionnaires' disease linked to hospital cooling towers: an epidemiological method to calculate dose of exposure. Int. J. Epidemiol. 1999;28:353-359.
  32. Keller DW, Hajjeh R, DeMaria A, et al. Community outbreak of Legionnaires' disease: an investigation confirming the potential for cooling towers to transmit Legionella species. Clin. Infect. Dis. 1996;22:257-261.
  33. Fiore AE, Nuorti JP, Levine OS, et al. Epidemic Legionnaires' disease two decades later: old sources, new diagnostic methods. Clin. Infect. Dis. 1998;26:426-433.
  34. Stone M, Ahmed J, Evans J. The continuing risk of domestic hot water scalds to the elderly. Burns 2000;26:347-50.
  35. Yu VL. Resolving the controversy on environmental cultures for Legionella: A modest proposal. Infect. Control Hosp. Epidemiol. 1998;19:893-7.
  36. Second Report of the Committee of Inquiry into the Outbreak of Legionnaires' Disease in Stafford in April 1985, London, England. Her Majesty's Stationary Office (HMSO) 1987.
  37. Alary M, Joly JR. Factors contributing to the contamination of hospital water distribution systems. J. Infect. Dis. 1992;165:565-9.
  38. Vickers RM, Yu VL, Hanna SS, et al. Determinants of Legionella pneumophila contamination of water distribution systems: 15-hospital prospective study. Infect. Control 1987;8:357-363.
  39. Patterson WJ, Hay J, Seal DV, McLuckie JC. Colonization of transplant unit water supplies with Legionella and protozoa: precautions required to reduce the risk of legionellosis. J. Hosp. Infect. 1997;37:7-17.
  40. Marrie TJ, Green T, Burbridge S. Legionellaceae in the potable water of Nova Scotia hospital and Halifax residences. Epidemiol. Infect. 1994;112:143-150.
  41. Liu WK, Yu VL, McClure J, Kominos S. Nosocomial Legionnaires' disease uncovered in a prospective pneumonia study: implications for underdiagnosis. JAMA 1983;249:3184-8.
  42. Best MG, Goetz A, Yu VL. Heat eradication measures for control of nosocomial Legionnaires' disease: implementation, education, and cost analysis. Am J Infect Control. 1984;12:26-30.
  43. Heimberger T, Birkhead G, Bornstein D, et al. Control of nosocomial Legionnaires' disease through hot water flushing and supplemental chlorination of potable water. J. Infect. Dis. 1991;163:413.
  44. Synder MB, Siwicki M, Wireman J, et al. Reduction in Legionella pneumophila through heat flushing followed by continuous supplemental chlorination of hospital hot water. J. Infect. Dis. 1990;162:127-132.
  45. Grosserode M, Wenzel R, Pfaller M, Helms C. Continuous hyperchlorination for control of nosocomial Legionella pneumophila: a ten year follow-up of efficacy, environmental effects, and costs. In: Legionella-Current Status and Emerging Perspectives. Barbaree, J.M., Breiman, R.F. and Dufour, A.P., Eds. Washington, D.C. American Society for Microbiology; 1993.
  46. Landeen LK, Yahya MT, Gerba CP. Efficacy of copper and silver ions and reduced levels of free chlorine in inactivation of Legionella pneumophila. Appl. Environ. Microbiol. 1989;55:3045-3050.
  47. Liu Z, Stout JL, Tedesco L, et al. Controlled evaluation of copper-silver ionization in eradicating Legionella pneumophila from a hospital water distribution system. J. Infect. Dis. 1994;169:919-922.
  48. Liu Z, Stout JE, Boldin M, et al. Intermittent use of copper-silver ionization for Legionella control in water distribution systems: a potential option in buildings housing individuals at low risk of infection. Clin. Infect. Dis. 1998;26:138-140.
  49. Stout JE, Lin YE, Goetz AM, Muder RR. Controlling Legionella in hospital water systems: experience with the superheat-and-flush method and copper-silver ionization. Infect. Control Hosp. Epidemiol. 1998;19:911-914.
  50. Mietzner S, Schwille RC, Farley A, et al. Efficacy of thermal treatment and copper-silver ionization for controlling Legionella pneumophila in high-volume hot water plumbing systems in hospitals. Am. J. Infect. Control 1997;25:452-457.
  51. Biurrun A, Caballero L, Pelaz C, et al. Treatment of a Legionella pneumophila-colonized water distribution system using copper-silver ionization and continuous chlorination. Infect. Control Hosp. Epidemiol. 1999;20:426-428.
  52. Rohr U, Senger M, Selenda F, Turley R, Wilhelm M. Four years of experience with silver-copper ionization for control of Legionella in a German university hospital hot water plumbing system. Clin. Infect. Dis. 1999;29:1507-11.
  53. Muraca P, Stout JE, Yu VL. Comparative assessment of chlorine, heat, ozone, and UV light for killing Legionella pneumophila within a model plumbing system. Appl. Environ. Microbiol. 1987;53:447-453.
  54. Farr, B.M., et al. Evaluation of UV light for disinfection of hospital works contaminated with Legionella. Lancet 1988;2:669.
  55. Personal communication, Barry Farr, MD
  56. Cunliffe DA. Inactivation of Legionella pneumophila by monochloramine. J. Appl. Bacteriol. 1990;68:453-459.
  57. Kool JL, Carpenter JC, Fields BS. Effect of monochloramine disinfection of municipal drinking water on risk of nosocomial Legionnaires' disease. Lancet 1999;353:272-277.
  58. Pic-Albas L, Donegan NE, Witherell LE, et al. Short trial of monochloramine for Legionella disinfection in a hospital setting. Abstract, 4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections. Atlanta, GA, March 5-9, 2000.
  59. ASHRAE Guideline 12-2000. Minimizing the risk of legionellosis associated with building water systems. American Society of Heating, Refrigerating and Air-Conditioning Engineers, Atlanta, GA., 1999. (available through the ASHRAE web site:
  60. Best M, Yu VL, Stout JE, et al. Legionellaceae in the hospital water supply- epidemiological link with disease and evaluation of a method of control of nosocomial Legionnaires' disease and Pittsburgh pneumonia. Lancet 1983;2:307-310.
  61. Allegheny County Health Department. Approaches to prevention and control of Legionella infection in Allegheny county health care facilities. 2nd ed. Pittsburgh, PA: Allegheny County Health Department. 1997:1-15.
  62. Dixon Bruce. Statement to Time/CNN, broadcast Nov. 21, 1999
  63. Stout JE, Yu VL. Nosocomial Legionella infection. In: Mayhall CG, ed. Hospital epidemiology and infection control, 2nd Ed. Philadelphia: Lippincott Williams and Wilkins, 1999:453-465.
  64. Hart CA, Makin T. Legionella in hospitals: a review. J Hosp Infect 1991;18(Suppl A):481-489.
  65. Benin AL, Benson RF, Arnold KE, Fiore AE, Cook PG, Williams LK, et al. An outbreak of travel-associated Legionnaires disease and Pontiac fever: The need for enhanced surveillance of travel-associated legionellosis in the United States. J Infect. Dis. 2002;185:237-243.
  66. Bergmire-Sweat D. Legionellosis in Texas. Dis Prev News. 1995;55:1-2.
  67. Ta AC, Stout JE, Yu VL, Wagener ML. Comparison of culture methods for monitoring Legionella species in hospital potable water systems and recommendations for standardization of such methods. J. Clin. Microbiol. 1995;33:118-212.