Kool J L, Carpenter J C, Fields B S
Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Lancet. 1999 Jan 23;353(9149):272-7. doi: 10.1016/S0140-6736(98)06394-6.
Many Legionella infections are acquired through inhalation or aspiration of drinking water. Although about 25% of municipalities in the USA use monochloramine for disinfection of drinking water, the effect of monochloramine on the occurrence of Legionnaires' disease has never been studied.
We used a case-control study to compare disinfection methods for drinking water supplied to 32 hospitals that had had outbreaks of Legionnaires' disease with the disinfection method for water supplied to 48 control-hospitals, with control for selected hospital characteristics and water treatment factors.
Hospitals supplied with drinking water containing free chlorine as a residual disinfectant were more likely to have a reported outbreak of Legionnaires' disease than those that used water with monochloramine as a residual disinfectant (odds ratio 10.2 [95% CI 1.4-460]). This result suggests that 90% of outbreaks associated with drinking water might not have occurred if monochloramine had been used instead of free chlorine for residual disinfection (attributable proportion 0.90 [0.29-1.00]).
The protective effect of monochloramine against legionella should be confirmed by other studies. Chloramination of drinking water may be a cost-effective method for control of Legionnaires' disease at the municipal level or in individual hospitals, and widespread implementation could prevent thousands of cases.
许多军团菌感染是通过吸入或误吸饮用水而获得的。尽管美国约25%的市政当局使用一氯胺对饮用水进行消毒，但一氯胺对军团病发生的影响从未得到研究。
我们采用病例对照研究，将32家曾爆发军团病的医院的饮用水消毒方法与48家对照医院的饮用水消毒方法进行比较，并对选定的医院特征和水处理因素进行控制。
供应含有游离氯作为残留消毒剂的饮用水的医院，比那些使用含有一氯胺作为残留消毒剂的水的医院，报告军团病爆发病例的可能性更高（比值比10.2 [95%可信区间1.4 - 460]）。这一结果表明，如果使用一氯胺而非游离氯进行残留消毒，90%与饮用水相关的爆发可能不会发生（归因比例0.90 [0.29 - 1.00]）。
一氯胺对军团菌的保护作用应由其他研究予以证实。饮用水加氯胺消毒可能是在市政层面或个别医院控制军团病的一种具有成本效益的方法，广泛实施可能预防数千例病例。
