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Factors associated with Legionnaires' disease recurrence in hotel and holiday rental accommodation sites.
Euro Surveill. 2019 May; 24(20)ES

Abstract

BackgroundThe 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.AimTo identify factors associated with the occurrence of a further TALD case after the implementation of control measures.MethodsWe 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.ResultsOf 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 Legionella in the water system nor the type of disinfection were found to be associated with the risk of a further case.ConclusionAccommodation size and previous TALD cases were predictive of further Legionnaires' disease cases after implementation of control measures.

Authors+Show Affiliations

European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, United States. Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, United States.European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden. Department of Public Health Sciences, Karolinska Institutet, Sweden.Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.Members of the European Legionnaires' Disease Surveillance Network are acknowledged at the end of the article.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31115313

Citation

Beauté, Julien, et al. "Factors Associated With Legionnaires' Disease Recurrence in Hotel and Holiday Rental Accommodation Sites." Euro Surveillance : Bulletin Europeen Sur Les Maladies Transmissibles = European Communicable Disease Bulletin, vol. 24, no. 20, 2019.
Beauté J, Sandin S, de Jong B, et al. Factors associated with Legionnaires' disease recurrence in hotel and holiday rental accommodation sites. Euro Surveill. 2019;24(20).
Beauté, J., Sandin, S., de Jong, B., Hallström, L. P., Robesyn, E., Giesecke, J., & Sparén, P. (2019). Factors associated with Legionnaires' disease recurrence in hotel and holiday rental accommodation sites. Euro Surveillance : Bulletin Europeen Sur Les Maladies Transmissibles = European Communicable Disease Bulletin, 24(20). https://doi.org/10.2807/1560-7917.ES.2019.24.20.1800295
Beauté J, et al. Factors Associated With Legionnaires' Disease Recurrence in Hotel and Holiday Rental Accommodation Sites. Euro Surveill. 2019;24(20) PubMed PMID: 31115313.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Factors associated with Legionnaires' disease recurrence in hotel and holiday rental accommodation sites. AU - Beauté,Julien, AU - Sandin,Sven, AU - de Jong,Birgitta, AU - Hallström,Lara Payne, AU - Robesyn,Emmanuel, AU - Giesecke,Johan, AU - Sparén,Pär, AU - ,, PY - 2019/5/23/entrez PY - 2019/5/23/pubmed PY - 2020/7/24/medline KW - Europe KW - Legionella KW - Legionnaires’ disease KW - bacterial infections KW - epidemiology KW - surveillance KW - travel KW - waterborne infections JF - Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin JO - Euro Surveill VL - 24 IS - 20 N2 - BackgroundThe 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.AimTo identify factors associated with the occurrence of a further TALD case after the implementation of control measures.MethodsWe 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.ResultsOf 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 Legionella in the water system nor the type of disinfection were found to be associated with the risk of a further case.ConclusionAccommodation size and previous TALD cases were predictive of further Legionnaires' disease cases after implementation of control measures. SN - 1560-7917 UR - https://www.unboundmedicine.com/medline/citation/31115313/Factors_associated_with_Legionnaires'_disease_recurrence_in_hotel_and_holiday_rental_accommodation_sites_ L2 - http://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2019.24.20.1800295 DB - PRIME DP - Unbound Medicine ER -