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Abstract

Background

The detection of a cluster of travel-associated Legionnaires’ disease (TALD) cases in any European Union/European Economic Area (EU/EEA) country prompts action at the accommodation, follow-up by health authorities and reporting of measures taken. Some accommodations incur further cases despite presumed implementation of adequate control measures.

Aim

To identify factors associated with the occurrence of a further TALD case after the implementation of control measures.

Methods

We conducted a retrospective cohort study of hotel and holiday rental accommodations in the EU/EEA associated with two or more TALD cases with onset dates less than 2 years apart (a ‘cluster’) and notification between 1 June 2011−31 December 2016. We fitted Cox regression models to estimate the association between accommodation characteristics and the occurrence of a further case, defined as any case with onset date after the report on measures taken.

Results

Of the 357 accommodations in the analysis, 90 (25%) were associated with at least one further case after the report on measures taken (12.4/100 accommodation-years). Accommodations associated with two or more cases before the cluster notification were more likely to be associated with a further case, compared with those not previously associated with any case (adjusted hazard ratio 1.85; 95% confidence interval: 1.14–3.02). Neither the detection of in the water system nor the type of disinfection were found to be associated with the risk of a further case.

Conclusion

Accommodation size and previous TALD cases were predictive of further Legionnaires’ disease cases after implementation of control measures.

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/content/10.2807/1560-7917.ES.2019.24.20.1800295
2019-05-16
2019-08-23
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2019.24.20.1800295
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