How valid is the 2- to 10-day incubation period for cases of Legionnaires' disease?: A reappraisal in the context of the German LeTriWa study; Berlin, 2016-2020.

The evidence for the incubation period of Legionnaires' disease is based on data from a small number of outbreaks. An incubation period of 2-10 days is commonly used for the definition and investigation of cases. In the German LeTriWa study, we collaborated with public health departments to identify evidence-based sources of exposure among cases of Legionnaires' disease within 1-14 days before symptom onset. For each individual, we assigned weights to the numbered days of exposure before symptom onset, giving the highest weight to exposure days of cases with only one possible day of exposure. We then calculated an incubation period distribution where the median was 5 days and the mode was 6 days. The cumulative distribution reached 89% by the 10th day before symptom onset. One case-patient with immunosuppression had a single day of exposure to the likely infection source only 1 day before symptom onset. Overall, our results support the 2- to 10-day incubation period used in case definition, investigation, and surveillance of cases with Legionnaires' disease.