Legionnaires’ Disease Outbreak in Murcia, Spain

Abstract

An explosive outbreak of Legionnaires’ disease occurred in Murcia, Spain, in July 2001. More than 800 suspected cases were reported; 449 of these cases were confirmed, which made this the world’s largest outbreak of the disease reported to date. Dates of onset for confirmed cases ranged from June 26 to July 19 , with a case-fatality rate of 1%. The epidemic curve and geographic pattern from the 600 completed epidemiologic questionnaires indicated an outdoor point-source exposure in the northern part of the city. A case-control study matching 85 patients living outside the city of Murcia with two controls each was undertaken to identify the outbreak source; the epidemiologic investigation implicated the cooling towers at a city hospital. An environmental isolate from these towers with an identical molecular pattern as the clinical isolates was subsequently identified and supported that epidemiologic conclusion.

Legionnaires’ disease in Italy: results of the epidemiological surveillance from 2000 to 2011

“…The great majority of the European outbreaks described are related to cooling towers [29][30][31], and also in Italy, the few community outbreaks that occurred were due to this exposure. For this reason, many European countries are implementing new regulations for cooling towers, including their compulsory registration at local and regional level.…”

Public health response to an outbreak of Legionnaires’ disease in Edinburgh, United Kingdom, June 2012

“…Other outdoor sources include industrial air scrubbers (Norway) [10], decorative fountains (Wisconsin) [11] and hot water systems (Denmark) [12]. The largest recorded European outbreak was in Murcia, Spain (449 cases) [13] and the largest in England was Barrow in Furness (185 cases) [14].…”

The risk of contracting infectious diseases in public swimming pools. A review

“…Exposure and establishment of infection does not necessarily mean disease: most people will not develop clinical symptoms even in the evidence of exposure [69]. Due to the intrinsic characteristics of the spread of the legionnaires' disease, it mostly occurs as sporadic cases and small clusters, although large outbreaks also occur -mostly in conjunction with contaminated cooling towers [70].…”