European Journal of Epidemiology

, Volume 25, Issue 9, pp 661–665

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

Authors

    • Health Protection Agency
    • European Programme for Intervention Epidemiology Training (EPIET)European Centre for Disease Prevention and Control (ECDC)
    • Department of EpidemiologySmittskyddsinstitutet-Swedish Institute for Infectious Disease Control
  • Isabel Oliver
    • Health Protection Agency
    • Department of Social MedicineBristol University
  • Katherine Ricketts
    • Centre for Infections, Respiratory Diseases DepartmentHealth Protection Agency
  • George Kafatos
    • Centre for Infections, Statistics, Modelling and Bioinformatics DepartmentHealth Protection Agency
  • James M. Stuart
    • Department of Social MedicineBristol University
  • Carol Joseph
    • Centre for Infections, Respiratory Diseases DepartmentHealth Protection Agency
Infectious Diseases

DOI: 10.1007/s10654-010-9471-3

Cite this article as:
Wallensten, A., Oliver, I., Ricketts, K. et al. Eur J Epidemiol (2010) 25: 661. doi:10.1007/s10654-010-9471-3

Abstract

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.

Keywords

Legionnaires’ diseaseLegionellaDrivingMotor vehiclesTransmission

Copyright information

© Springer Science+Business Media B.V. 2010