A model for autumn outbreaks of Legionnaires' disease associated with cooling towers, linked to system operation and size.

Cooling towers have been demonstrated to be amplifiers and disseminators of legionella, the causative organism of Legionnaires' disease. Community outbreaks associated with cooling towers have been reported with several common factors. Small towers (< 300 kW) have predominantly been implicated in outbreaks. Cooling tower-associated outbreaks are most frequent in autumn, and frequently implicated systems have been operated after a period of shutdown. This paper reports field study data relating system operation to legionella colonization of systems. Operating systems have been shown to be more frequently colonized by legionella than shutdown systems. In some cases operation of systems after periods of shutdown raised legionella concentrations from below detection limits to between 50 and 950 c.f.u./ml within 10 min. These data and previously reported data relating to biofilm and sediment colonization of the systems, and community outbreaks of Legionnaires' disease, have been used to develop a model explaining the seasonal nature of outbreaks associated with irregularly operated, small cooling tower systems.