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. 2019 May;24(20):1800295.
doi: 10.2807/1560-7917.ES.2019.24.20.1800295.

Factors associated with Legionnaires' disease recurrence in hotel and holiday rental accommodation sites

Julien Beauté  1   2 , Sven Sandin  2   3   4 , Birgitta de Jong  1 , Lara Payne Hallström  1 , Emmanuel Robesyn  1   5 , Johan Giesecke  2 , Pär Sparén  2 ; European Legionnaires’ Disease Surveillance Network  6
Affiliations

Factors associated with Legionnaires' disease recurrence in hotel and holiday rental accommodation sites

Julien Beauté et al. Euro Surveill. 2019 May.

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.

Keywords: Europe; Legionella; Legionnaires’ disease; bacterial infections; epidemiology; surveillance; travel; waterborne infections.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Schema of the six scenarios considered in the analysis of factors associated with Legionnaires’ disease recurrence in hotel and holiday rental accommodation sites, EU/EEA, 2011–2016
Figure 2
Figure 2
Smoothed hazard function of occurrence of further TALD cases after control measures in hotel and holiday rental accommodation sites, EU/EEA, 1 June 2011–31 December 2016
Figure 3
Figure 3
Cumulative incidence of hotel and holiday rental accommodations sites associated with a further TALD case after control measures, by previous report status, EU/EEA, 1 June 2011–31 December 2016
See this image and copyright information in PMC

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