- Anna Maisa1, Ansgar Brockmann2, Frank Renken2, Christian Lück3, Stefan Pleischl4, Martin Exner4, Inka Daniels-Haardt5, Annette Jurke1
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View Affiliations Hide AffiliationsAffiliations: 1 Department of Infectiology and Hygiene, NRW Centre for Health, Münster, Germany 2 Public Health Department, Soest, Germany 3 Institute for Medical Microbiology and Hygiene, National Consulting Laboratory for Legionella, University of Technology, Dresden, Germany 4 Institute for Hygiene and Public Health, University of Bonn, Bonn, Germany 5 Division Health Protection, Health Promotion, NRW Centre for Health, Münster, GermanyAnnette JurkeAnnette.Jurke lzg.nrw.de
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Citation style for this article: Maisa Anna, Brockmann Ansgar, Renken Frank, Lück Christian, Pleischl Stefan, Exner Martin, Daniels-Haardt Inka, Jurke Annette. Epidemiological investigation and case–control study: a Legionnaires’ disease outbreak associated with cooling towers in Warstein, Germany, August–September 2013. Euro Surveill. 2015;20(46):pii=30064. https://doi.org/10.2807/1560-7917.ES.2015.20.46.30064 Received: 23 Sep 2014; Accepted: 13 Apr 2015
Epidemiological investigation and case–control study: a Legionnaires’ disease outbreak associated with cooling towers in Warstein, Germany, August–September 2013
Abstract
Between 1 August and 6 September 2013, an outbreak of Legionnaires’ disease (LD) with 159 suspected cases occurred in Warstein, North Rhine-Westphalia, Germany. The outbreak consisted of 78 laboratory-confirmed cases of LD, including one fatality, with a case fatality rate of 1%. Legionella pneumophila, serogroup 1, subtype Knoxville, sequence type 345, was identified as the epidemic strain. A case–control study was conducted to identify possible sources of infection. In univariable analysis, cases were almost five times more likely to smoke than controls (odds ratio (OR): 4.81; 95% confidence interval (CI): 2.33–9.93; p < 0.0001). Furthermore, cases were twice as likely to live within a 3 km distance from one identified infection source as controls (OR: 2.14; 95% CI: 1.09–4.20; p < 0.027). This is the largest outbreak of LD in Germany to date. Due to a series of uncommon events, this outbreak was most likely caused by multiple sources involving industrial cooling towers. Quick epidemiological assessment, source tracing and shutting down of potential sources as well as rapid laboratory testing and early treatment are necessary to reduce morbidity and mortality. Maintenance of cooling towers must be carried out according to specification to prevent similar LD outbreaks in the future.

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