Tags

Type your tag names separated by a space and hit enter

Outbreak of Legionnaires' disease among cruise ship passengers exposed to a contaminated whirlpool spa.
Lancet. 1996 Feb 24; 347(9000):494-9.Lct

Abstract

BACKGROUND

Outbreaks of travel-related Legionnaires' disease present a public-health challenge since rapid, sensitive, and specific diagnostic tests are not widely used and because detection of clusters of disease among travellers is difficult. We report an outbreak of Legionnaires' disease among cruise ship passengers that occurred in April, 1994, but that went unrecognised until July, 1994.

METHODS

After rapid diagnosis of Legionnaires' disease in three passengers by urine antigen testing, we searched for additional cases of either confirmed (laboratory evidence of infection) or probable Legionnaires' disease (pneumonia of undetermined cause). A case-control study was conducted to compare exposures and activities on the ship and in ports of call between each case-passenger and two or three matched control-passengers. Water samples from the ship, from sites on Bermuda, and from the ship's water source in New York City were cultured for legionellae and examined with PCR.

FINDINGS

50 passengers with Legionnaires' disease (16 confirmed, 34 probable) were identified from nine cruises embarking between April 30 and July 9, 1994. Exposure to whirlpool spas was strongly associated with disease (odds ratio 16.2, 95% Cl 2.8-351:7); risk of acquiring Legionnaires' disease increased by 64% (95% Cl 12-140) for every hour spent in the spa water. Passengers spending time around the whirlpool spas, but not in the water, were also significantly more likely to have acquired infection. Legionella pneumophila serogroup 1 was isolated only from the sand filter in the ship's whirlpool spa. This isolate matched a clinical isolate from the respiratory secretions of a case-passenger as judged by monoclonal antibody subtyping and by arbitrarily primed PCR.

INTERPRETATION

This investigation shows the benefit of obtaining a recent travel history, the usefulness or urine antigen testing for rapid diagnosis of legionella infection, and the need for improved surveillance for travel-related Legionnaires' disease. New strategies for whirlpool spa maintenance and decontamination may help to minimise transmission of legionellae from these aerosol-producing devices.

Authors+Show Affiliations

Childhood and Respiratory Diseases Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

8596266

Citation

Jernigan, D B., et al. "Outbreak of Legionnaires' Disease Among Cruise Ship Passengers Exposed to a Contaminated Whirlpool Spa." Lancet (London, England), vol. 347, no. 9000, 1996, pp. 494-9.
Jernigan DB, Hofmann J, Cetron MS, et al. Outbreak of Legionnaires' disease among cruise ship passengers exposed to a contaminated whirlpool spa. Lancet. 1996;347(9000):494-9.
Jernigan, D. B., Hofmann, J., Cetron, M. S., Genese, C. A., Nuorti, J. P., Fields, B. S., Benson, R. F., Carter, R. J., Edelstein, P. H., Guerrero, I. C., Paul, S. M., Lipman, H. B., & Breiman, R. (1996). Outbreak of Legionnaires' disease among cruise ship passengers exposed to a contaminated whirlpool spa. Lancet (London, England), 347(9000), 494-9.
Jernigan DB, et al. Outbreak of Legionnaires' Disease Among Cruise Ship Passengers Exposed to a Contaminated Whirlpool Spa. Lancet. 1996 Feb 24;347(9000):494-9. PubMed PMID: 8596266.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outbreak of Legionnaires' disease among cruise ship passengers exposed to a contaminated whirlpool spa. AU - Jernigan,D B, AU - Hofmann,J, AU - Cetron,M S, AU - Genese,C A, AU - Nuorti,J P, AU - Fields,B S, AU - Benson,R F, AU - Carter,R J, AU - Edelstein,P H, AU - Guerrero,I C, AU - Paul,S M, AU - Lipman,H B, AU - Breiman,R, PY - 1996/2/24/pubmed PY - 1996/2/24/medline PY - 1996/2/24/entrez SP - 494 EP - 9 JF - Lancet (London, England) JO - Lancet VL - 347 IS - 9000 N2 - BACKGROUND: Outbreaks of travel-related Legionnaires' disease present a public-health challenge since rapid, sensitive, and specific diagnostic tests are not widely used and because detection of clusters of disease among travellers is difficult. We report an outbreak of Legionnaires' disease among cruise ship passengers that occurred in April, 1994, but that went unrecognised until July, 1994. METHODS: After rapid diagnosis of Legionnaires' disease in three passengers by urine antigen testing, we searched for additional cases of either confirmed (laboratory evidence of infection) or probable Legionnaires' disease (pneumonia of undetermined cause). A case-control study was conducted to compare exposures and activities on the ship and in ports of call between each case-passenger and two or three matched control-passengers. Water samples from the ship, from sites on Bermuda, and from the ship's water source in New York City were cultured for legionellae and examined with PCR. FINDINGS: 50 passengers with Legionnaires' disease (16 confirmed, 34 probable) were identified from nine cruises embarking between April 30 and July 9, 1994. Exposure to whirlpool spas was strongly associated with disease (odds ratio 16.2, 95% Cl 2.8-351:7); risk of acquiring Legionnaires' disease increased by 64% (95% Cl 12-140) for every hour spent in the spa water. Passengers spending time around the whirlpool spas, but not in the water, were also significantly more likely to have acquired infection. Legionella pneumophila serogroup 1 was isolated only from the sand filter in the ship's whirlpool spa. This isolate matched a clinical isolate from the respiratory secretions of a case-passenger as judged by monoclonal antibody subtyping and by arbitrarily primed PCR. INTERPRETATION: This investigation shows the benefit of obtaining a recent travel history, the usefulness or urine antigen testing for rapid diagnosis of legionella infection, and the need for improved surveillance for travel-related Legionnaires' disease. New strategies for whirlpool spa maintenance and decontamination may help to minimise transmission of legionellae from these aerosol-producing devices. SN - 0140-6736 UR - https://www.unboundmedicine.com/medline/citation/8596266/Outbreak_of_Legionnaires'_disease_among_cruise_ship_passengers_exposed_to_a_contaminated_whirlpool_spa_ DB - PRIME DP - Unbound Medicine ER -