title: Legionnaires' disease outbreak associated with a cruise liner, August 2003: epidemiological and microbiological findings.
abstract: Eight cases of Legionnaires' disease were identified among the 215 German passengers after a cruise to the Nordic Sea in August 2003. An unmatched case-control study was conducted to identify risk factors and the source of infection. In total, eight passengers fulfilled the case definition, one of these died. Forty-two passengers served as controls. The attack rate was 4%. The mean age was 60 years for cases and 62 years for controls. Prolonged exposure to the spa pool seemed to be a risk factor of infection (OR 4.85, P=0.09). Legionella pneumophila serogroup 1, monoclonal antibody (mAb) subgroup 'Knoxville' was isolated from clinical and environmental samples. DNA sequence-based typing revealed that these isolates were indistinguishable from each other. The investigation showed the importance of an interdisciplinary approach of microbiology and epidemiology as not all sites on the ship that tested positive for L. pneumophila actually posed a relevant risk for the passengers.
authors.affiliation: Governmental Institute of Public Health of Lower Saxony, Hannover, Germany. konrad.beyrer@nlga.niedersachsen.de
authors.forename: K
authors.initials: K
authors.lastname: Beyrer
authors.forename: S
authors.initials: S
authors.lastname: Lai
authors.forename: J
authors.initials: J
authors.lastname: Dreesman
authors.forename: J V
authors.initials: JV
authors.lastname: Lee
authors.forename: C
authors.initials: C
authors.lastname: Joseph
authors.forename: T
authors.initials: T
authors.lastname: Harrison
authors.forename: S
authors.initials: S
authors.lastname: Surman-Lee
authors.forename: C
authors.initials: C
authors.lastname: Lück
authors.forename: B
authors.initials: B
authors.lastname: Brodhun
authors.forename: U
authors.initials: U
authors.lastname: Buchholz
authors.forename: A
authors.initials: A
authors.lastname: Windorfer
mesh_terms: D000328:Adult; D000368:Aged; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D016952:Legionella pneumophila / Q000302:isolation & purification; D007877:Legionnaires' Disease / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D014195:Travel; D014871:Water Microbiology