Windscreen wiper fluid without added screenwash in motor vehicles: a newly identified risk factor for Legionnaires’ disease
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
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.
- American Public Health Association. Control of communicable diseases manual. In: Heymann DL, editor. 18th ed. Baltimore, Md: United Book Press, Inc; 2004. p. 294.
- Diederen BM. Legionella spp. and Legionnaires’ disease. J Infect. 2008;56(1):1–12.
- Marston BJ, Lipman HB, Breiman RF. Surveillance for Legionnaires’ disease. Risk factors for morbidity and mortality. Arch Intern Med. 1994;154(21):2417–22. CrossRef
- Health Protection Agency. Epidemiological data on Legionnaires’ disease, legionnaires’ disease in residents of England and Wales—nosocomial, travel or community acquired cases, 1980–2008. Available at: http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1195733748327. Accessed 12 Aug 2009.
- Den Boer JW, Nijhof J, Friesema I. Risk factors for sporadic community-acquired Legionnaires’ disease. A 3-year national case-control study. Public Health. 2006;120(6):566–71. CrossRef
- Che D, Campese C, Santa-Olalla P, Jacquier G, Bitar D, Bernillon P, et al. Sporadic community-acquired Legionnaires’ disease in France: a 2-year national matched case-control study. Epidemiol Infect. 2008;136(12):1684–90. CrossRef
- Che D, Decludt B, Campese C, Desenclos JC. Sporadic cases of community acquired legionnaires’ disease: an ecological study to identify new sources of contamination. J Epidemiol Community Health. 2003;57(6):466–9. CrossRef
- Health Protection Agency. National increase in cases of legionnaires’ disease. 2006 Available at: http://www.hpa.org.uk/cdr/archives/archive06/News/news3706.htm. Accessed 22 Oct 2009.
- National Statistics Online. ONS—Labour Force Survey April to June 2007. Available at: http://www.statistics.gov.uk/STATBASE/Product.asp?vlnk=14248. Accessed 12 Aug 2009.
- Polat Y, Ergin C, Kaleli I, Pinar A. Investigation of Legionella pneumophila seropositivity in the professional long distance drivers as a risky occupation. Mikrobiyol Bul. 2007;41(2):211–7.
- Pinar A, Ramirez JA, Schindler LL, Miller RD, Summersgill JT. The use of heteroduplex analysis of polymerase chain reaction products to support the possible transmission of Legionella pneumophila from a malfunctioning automobile air conditioner. Infect Control Hosp Epidemiol. 2002;23(3):145–7. CrossRef
- Armitage P, Berry G. Attributable risk. Statistical methods in medical research. 3rd ed. Oxford: Blackwell Publishers; 1994. p. 519–22.
- Rothman KJ, Greenland S, Lash TL. Design strategies to improve study accuracy. Modern Epidemiology. 3rd ed ed. Philadelphia: Lippincott, Williams and Wilkins; 2008. p. 168–82.
- Sakamoto R, Ohno A, Nakahara T, Satomura K, Iwanaga S, Kouyama Y, et al. Is driving a car a risk for Legionnaires’ disease? Epidemiol Infect. 2009;137(11):1615–22. CrossRef
- Sakamoto R, Ohno A, Nakahara T, Satomura K, Iwanaga S, Kouyama Y, et al. Legionella pneumophila in rainwater on roads. Emerg Infect Dis. 2009;15(8):1295–7. CrossRef
- Windscreen wiper fluid without added screenwash in motor vehicles: a newly identified risk factor for Legionnaires’ disease
European Journal of Epidemiology
Volume 25, Issue 9 , pp 661-665
- Cover Date
- Print ISSN
- Online ISSN
- Springer Netherlands
- Additional Links
- Legionnaires’ disease
- Motor vehicles
- Industry Sectors
- Author Affiliations
- 1. Health Protection Agency, South West, Stonehouse, GL10 3RF, United Kingdom
- 2. European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- 6. Department of Epidemiology, Smittskyddsinstitutet-Swedish Institute for Infectious Disease Control, SE-171 82, Solna, Sweden
- 3. Department of Social Medicine, Bristol University, Bristol, BS8 2PS, United Kingdom
- 4. Centre for Infections, Respiratory Diseases Department, Health Protection Agency, London, NW9 5EQ, United Kingdom
- 5. Centre for Infections, Statistics, Modelling and Bioinformatics Department, Health Protection Agency, London, NW9 5EQ, United Kingdom