Current Epidemiology Reports

, Volume 6, Issue 3, pp 310–320 | Cite as

Legionella Epidemiologic and Environmental Risks

  • Alexander T. YuEmail author
  • Amanda Kamali
  • Duc J. Vugia
Infectious Disease Epidemiology (A Reingold, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Infectious Disease Epidemiology


Purpose of Review

Legionella bacteria cause Legionnaires’ disease (LD), a severe and potentially fatal pneumonia. Legionellosis has been increasing in the USA and in Europe. We reviewed the literature to describe host factors predisposing to LD, environmental factors facilitating Legionella proliferation, and transmission modes leading to legionellosis cases and outbreaks.


Men, smokers, and persons 50 years and older, or with chronic pulmonary or immunocompromising conditions, are at risk for LD. Stagnated water and warm water temperature promote Legionella growth. Most legionellosis cases result from exposure to aerosolized contaminated water from man-made water systems, including hot tubs and whirlpool spas; hot water systems in large buildings, hotels, and hospitals; and cooling towers.


Water management plans for hot water systems at hospitals, long-term care facilities, and large buildings are important to help prevent LD, and careful epidemiologic investigations remain essential in controlling and preventing legionellosis outbreaks.


Legionellosis Legionnaires’ disease Legionella Pontiac fever Cooling towers 



We thank Allyx Nicolici and Seema Jain of the CDPH Infectious Diseases Branch, for the illustrative figure and for review of the manuscript, respectively.

Compliance with Ethical Standards

Conflict of Interest

Alexander Yu, Amanda Kamali, and Duc Vugia each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by the author.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Alexander T. Yu
    • 1
    Email author
  • Amanda Kamali
    • 1
  • Duc J. Vugia
    • 1
  1. 1.Infectious Diseases Branch, Division of Communicable Disease ControlCalifornia Department of Public HealthRichmondUSA

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