Windscreen wiper fluid without added screenwash in motor vehicles: a newly identified risk factor for Legionnaires' disease.

A source of infection is rarely identified for sporadic cases of Legionnaires' disease. We found that professional drivers are five times more commonly represented among community acquired sporadic cases in England and Wales than expected. We therefore investigated possible risk exposures in relation to driving or spending time in a motor vehicle. A case control study including all surviving community acquired sporadic cases in England and Wales with onset between 12 July 2008 and 9 March 2009 was carried out. Cases were contacted by phone and controls were consecutively recruited by sequential digital dialling matched by area code, sex and age group. Those who consented were sent a questionnaire asking questions on driving habits, potential sources in vehicles and known risk factors. The results were analysed using logistic regression. 75 cases and 67 controls were included in the study. Multivariable analysis identified two exposures linked to vehicle use associated with an increased risk of Legionnaires' disease: Driving through industrial areas (OR 7.2, 95%CI 1.5-33.7) and driving or being a passenger in a vehicle with windscreen wiper fluid not containing added screenwash (OR 47.2, 95%CI 3.7-603.6). Not adding screenwash to windscreen wiper fluid is a previously unidentified risk factor and appears to be strongly associated with community acquired sporadic cases of Legionnaires' disease. We estimated that around 20% of community acquired sporadic cases could be attributed to this exposure. A simple recommendation to use screenwash may mitigate transmission of Legionella bacteria to drivers and passengers.

From development to success: the European surveillance scheme for travel associated Legionnaires' disease.

BACKGROUND: EWGLINET, the European surveillance scheme for travel associated Legionnaires' disease, was established in 1987 following the identification of the disease in 1976. In 1998, the European Commission's Decision 2119/98/EC provided a legal framework for EWGLINET's operation, and its aims and objectives were formalised. Since its inception, the scheme has encountered a number of challenges which have influenced its development as a Disease Specific Network. The solutions to these challenges, and their successes, may be of interest to similar schemes. AIM: This article traces the development of the scheme and its responses to the challenges it has encountered. RESULTS: One especially significant document developed by the scheme is the European Guidelines for Control and Prevention of Travel Associated Legionnaires' Disease;(1) its history is explored. In addition, EWGLINET's relationship with collaborating centres and other groups such as tour operators is highlighted. CONCLUSIONS: Despite changing over time, the collaborations and partnerships have been maintained and continue to ensure a close cooperation, maximizing public health effects.

The impact of new guidelines in Europe for the control and prevention of travel-associated Legionnaires' disease.

On 1 July 2002, EWGLINET introduced European guidelines for the control and prevention of travel-associated legionnaires' disease. This paper presents the results gathered by the surveillance scheme during the first two and a half years of the operation of the guidelines (to the end of 2004). Two hundred and thirty-seven new clusters and 70 cluster updates were identified. Investigations at 146 sites returned positive samples for legionella, and the proportion of positive sites reached over 60% in 2004. Thirty-four cluster sites were reported to have been investigated satisfactorily, but have gone on to be associated with subsequent cases ('repeater sites'). Fifty-one sites were published on the European Working Group for Legionella Infections (EWGLI) website; the publication states that EWGLINET cannot be confident that the sites have adequate control measures in place. The operation of the guidelines is discussed, and the situation in Turkey highlighted as a particular success.