ArticleEcoHealth2008
Going with the flow: legionellosis risk in Toronto, Canada is strongly associated with local watershed hydrology.
Article in EcoHealth, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
25 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Association of climatic factors with infectious diseases in the Arctic and subarctic region--a systematic review.Global health action · 2014Pooled it
- Impact of Climate Change on Legionnaire's Disease: A Systematic Review.In vivo (Athens, Greece)Pooled it
- A community Legionnaires' disease outbreak linked to a collective biomass condensing boiler, France, 2019.Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin · 2025Article
- The effect of seasonal and extreme floods on hospitalizations for Legionnaires' disease in the United States, 2000-2011.BMC infectious diseases · 2022Article
- Legionella pneumophila Risk from Cooling Tower Systems in China.Applied and environmental microbiology · 2022Article
- Association of Natural Waterways andJournal of patient-centered research and reviews · 2022Article
- Effects of climate changes and road exposure on the rapidly rising legionellosis incidence rates in the United States.PloS one · 2021Article
- Article
- The association between sporadic Legionnaires' disease and weather and environmental factors, Minnesota, 2011-2018.Epidemiology and infection · 2020Article
- Optimising the case-crossover design for use in shared exposure settings.Epidemiology and infection · 2020Article
- Short-term associations between Legionnaires' disease incidence and meteorological variables in Belgium, 2011-2019.Epidemiology and infection · 2020Article
- Solar and Climate Effects Explain the Wide Variation in Legionellosis Incidence Rates in the United States.Applied and environmental microbiology · 2019Article
- Article
- Outbreaks of Legionnaires' Disease and Pontiac Fever 2006-2017.Current environmental health reports · 2018Review
- Association Between Sporadic Legionellosis and River Systems in Connecticut.The Journal of infectious diseases · 2018Article
- Ten Questions Concerning the Aerosolization and Transmission of Legionella in the Built Environment.Building and environment · 2017Article
- Unusual Legionnaires' outbreak in cool, dry Western Canada: an investigation using genomic epidemiology.Epidemiology and infection · 2017Article
- Article
- A case-association cluster detection and visualisation tool with an application to Legionnaires' disease.Statistics in medicine · 2013Article
- Meteorological conditions and incidence of Legionnaires' disease in Glasgow, Scotland: application of statistical modelling.Epidemiology and infection · 2013Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Legionella species are increasingly recognized as a cause of both healthcare- and community-acquired pneumonia (so-called "Legionnaire's disease"). These pathogens are ubiquitous in the environment, but environmental factors in the occurrence of sporadic legionellosis remain poorly understood. We analyzed all legionellosis cases identified in the Greater Toronto Area of Ontario from 1978 to 2006, and evaluated seasonal and environmental patterns in legionellosis case occurrence by using both negative binomial models and case-crossover analysis. A total of 837 cases were reported during the study period. After adjusting for seasonal effects, changes in the local watershed, rather than weather, were the strongest contributors to legionellosis risk. A 3.6-fold increase (95% confidence interval (CI), 2.4-5.3) in odds of disease was identified with decreasing watershed levels approximately 4 weeks before case-occurrence. We also found a 33% increase (95% CI, 8-64%) in odds of disease with decreasing lake temperature during the same period and a 34% increase (95% CI, 14-57%) with increasing humidity 5 weeks before case-occurrence. We conclude that local watershed ecology influences the risk of legionellosis, notwithstanding the availability of advanced water treatment capacity in Toronto. Enhancement of risk might occur through direct contamination of water sources or via introduction of micronutrients or commensal organisms into residential and hospital water supplies. These observations suggest testable hypotheses for future empiric studies.
Indexed as
Identifiers
19370300What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.