International investigation of an outbreak of Legionnaires' Disease at a major hotel associated with portable water - Antigua, 1996 -abstract

ABSTRACT

On November 9, 1996, the Caribbean Epidemiology Centre and the UK Public Health Laboratory Service began an investigation of 3 cases of legionnaires' disease (LD) in English tourist staying at an Antiguan hotel in September and October, 1996. The medical records at the two islands hospitals and the hotel's nursing records were reviewed to identify any additional cases. A suspect case was defined as any guest or employee of the hotel since August 1, 1996 with fever and cough, and a confirmed as one with clinical or radiological evidence of pneumonia plus laboratory evidence of recent Legionella pneumophila infection. Two cases were confirmed by high titre to Lp-1, and third by culture of Lp-1 from sputum. Thirteen other suspected cases from four other countries were identified and are being followed up. Chlorine residual levels were satisfactory in the cold water. The hotel's mains supply and hot and cold water distribution system contained L. pneumophila including Lp-1. Concentrations were highest in the hot water system, particularly the solar storeage tanks, and in samples collected from rooms that had not been used for several days. Water samples from the rooms where the cases had stayed contained Lp-1 in high concentration. We concluded that the hotel's hot water supply was the source of the outbreak and recommendations were made to prevent further cases form occurring. This outbreak has important implications for clinical practice and public health in the Caribbean, and for the region's hotel industry. (AU)