European Journal of Epidemiology

, Volume 25, Issue 9, pp 661–665 | Cite as

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

  • Anders WallenstenEmail author
  • Isabel Oliver
  • Katherine Ricketts
  • George Kafatos
  • James M. Stuart
  • Carol Joseph
Infectious Diseases


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.


Legionnaires’ disease Legionella Driving Motor vehicles Transmission 



The study was funded entirely by the Health Protection Agency. We would like to thank all staff at the Health Protection Agency who assisted in the investigation, in particular: Rebecca Close, Magdalene Mbanefo, Esam Gharish, Falguni Naik, and Anitra Jones. We would also like to thank Nick Phin for his support of the study, and John V Lee and Sandra Lai for carrying out the pilot study into the sampling of windscreen wiper fluid.


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Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  • Anders Wallensten
    • 1
    • 2
    • 6
    Email author
  • Isabel Oliver
    • 1
    • 3
  • Katherine Ricketts
    • 4
  • George Kafatos
    • 5
  • James M. Stuart
    • 3
  • Carol Joseph
    • 4
  1. 1.Health Protection AgencySouth West, StonehouseUnited Kingdom
  2. 2.European Programme for Intervention Epidemiology Training (EPIET)European Centre for Disease Prevention and Control (ECDC)StockholmSweden
  3. 3.Department of Social MedicineBristol UniversityBristolUnited Kingdom
  4. 4.Centre for Infections, Respiratory Diseases DepartmentHealth Protection AgencyLondonUnited Kingdom
  5. 5.Centre for Infections, Statistics, Modelling and Bioinformatics DepartmentHealth Protection AgencyLondonUnited Kingdom
  6. 6.Department of EpidemiologySmittskyddsinstitutet-Swedish Institute for Infectious Disease ControlSolnaSweden

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