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Open Access Research article

Pontiac fever: an operational definition for epidemiological studies

Paul Tossa1, Magali Deloge-Abarkan1, Denis Zmirou-Navier1, Philippe Hartemann1 and Laurence Mathieu2*

Author Affiliations

1 Département Environnement et Santé Publique and INSERM ERI 11, Henri Poincaré University; Nancy, School of Medicine – 9 avenue de la Forêt de Haye, BP 184 – 54 505 Vandoeuvre lès Nancy, France

2 Laboratoire d'Hydroclimatologie Médicale Santé Environnement, Ecole Pratique des Hautes Etudes (EPHE) and INSERM ERI 11; Nancy, School of Medicine – 9 avenue de la Forêt de Haye, BP 184 – 54 505 Vandoeuvre-lès-Nancy, France

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BMC Public Health 2006, 6:112  doi:10.1186/1471-2458-6-112

Published: 28 April 2006

Abstract

Background

Pontiac fever is usually described in epidemic settings. Detection of Pontiac fever is a marker of an environmental contamination by Legionella and should thereby call for prevention measures in order to prevent outbreak of Legionnaire's disease. The objective of this study is to propose an operational definition of Pontiac fever that is amenable to epidemiological surveillance and investigation in a non epidemic setting.

Methods

A population of 560 elderly subjects residing in 25 nursing homes was followed during 4 months in order to assess the daily incidence of symptoms associated, in the literature, with Pontiac fever. The water and aerosol of one to 8 showers by nursing home were characterized combining conventional bacterial culture of Legionella and the Fluorescence In Situ Hybridization (FISH) technique that used oligonucleotides probes specific for Legionellaceae. A definition of Pontiac fever was devised based on clinical symptoms described in epidemic investigations and on their timing after the exposure event. The association between incidence of Pontiac fever and shower contamination levels was evaluated to test the relevance of this definition.

Results

The proposed definition of Pontiac fever associated the following criteria: occurrence of at least one symptom among headache, myalgia, fever and shivers, possibly associated with other 'minor' symptoms, within three days after a shower contaminated by Legionella, during a maximum of 8 days (minimum 2 days). 23 such cases occurred during the study (incidence rate: 0.125 cases per person-year [95% CI: 0.122–0.127]). A concentration of Legionella in water equal to or greater than 104.L-1 (FISH method) was associated with a significant increase of incidence of Pontiac fever (p = 0.04).

Conclusion

Once validated in other settings, the proposed definition of Pontiac fever might be used to develop epidemiological surveillance and help draw attention on sources of Legionella.