Skip to main content
PMC home page
Epidemiology and Infection logoLink to Epidemiology and Infection
. 1991 Feb;106(1):45–61. doi: 10.1017/s0950268800056430

Variation in time and space of non-outbreak Legionnaires' disease in Scotland.

R S Bhopal 1, R J Fallon 1
PMCID: PMC2271845  PMID: 1993452

Abstract

The main aim of this study was to measure and explain geographic variations in the incidence of Legionnaires' disease in Scotland, particularly to help understand the source of non-outbreak infection. Between 1978 and 1986 the overall mean annual incidence rate was 7.9 per million (range 3.1-20.2), and for non-outbreak, non-travel cases it was 5.6. There were geographical variations by health board, by city and within cities, e.g. the mean annual incidence rate per million for non-travel, non-outbreak disease was 1.2 in Tayside Health Board, 3.7 in Lanarkshire, 5.6 in Lothian and 14.4 in Greater Glasgow. In Greater Glasgow Health Board non-travel cases lived in and around the city centre and in some postcode sectors there, the mean annual incidence rate exceeded 100. Travel-related cases lived in peripheral areas. These variations could not be explained by differences in access to and use of diagnostic services, surveillance, or host susceptibility (as reflected by socioeconomic status and frequency of other respiratory disease). The explanation probably lay in environmental factors, though differences in agent virulence were not excluded. The two main conclusions are, that non-outbreak cases were not truly sporadic, and that the space-time variations in incidence support the hypothesis that cooling towers were an important source of infection for non-travel, non-outbreak cases. If so such infection is potentially preventable.

Full text

PDF
45

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Addiss D. G., Davis J. P., Wand P. J., McKinney R. M., Gradus M. S., Martins R. R. Two cases of community-acquired Legionnaires' disease: evidence for association with a cooling tower. J Infect Dis. 1989 Mar;159(3):572–575. doi: 10.1093/infdis/159.3.572. [DOI] [PubMed] [Google Scholar]
  2. England A. C., 3rd, Fraser D. W., Plikaytis B. D., Tsai T. F., Storch G., Broome C. V. Sporadic legionellosis in the United States: the first thousand cases. Ann Intern Med. 1981 Feb;94(2):164–170. doi: 10.7326/0003-4819-94-2-164. [DOI] [PubMed] [Google Scholar]
  3. Fallon R. J., Abraham W. H. Polyvalent heat-killed antigen for the diagnosis of infection with Legionella pneumophila. J Clin Pathol. 1982 Apr;35(4):434–438. doi: 10.1136/jcp.35.4.434. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Fallon R. J. Legionella infections in Scotland. J Hyg (Lond) 1982 Dec;89(3):439–448. doi: 10.1017/s002217240007100x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Grist N. R., Reid D., Najera R. Legionnaires' disease and the traveller. Ann Intern Med. 1979 Apr;90(4):563–564. doi: 10.7326/0003-4819-90-4-563. [DOI] [PubMed] [Google Scholar]
  6. Macfarlane J. T., Finch R. G., Ward M. J., Macrae A. D. Hospital study of adult community-acquired pneumonia. Lancet. 1982 Jul 31;2(8292):255–258. doi: 10.1016/s0140-6736(82)90334-8. [DOI] [PubMed] [Google Scholar]
  7. McNabb W. R., Shanson D. C., Williams T. D., Lant A. F. Adult community-acquired pneumonia in central London. J R Soc Med. 1984 Jul;77(7):550–555. doi: 10.1177/014107688407700705. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Nimmo A. W., Innes G., Paterson J. G. Computerized mapping of health data. Health Bull (Edinb) 1984 Jul;42(4):199–208. [PubMed] [Google Scholar]
  9. Stout J. E., Yu V. L., Muraca P. Legionnaires' disease acquired within the homes of two patients. Link to the home water supply. JAMA. 1987 Mar 6;257(9):1215–1217. [PubMed] [Google Scholar]
  10. Timbury M. C., Donaldson J. R., McCartney A. C., Fallon R. J., Sleigh J. D., Lyon D., Orange G. V., Baird D. R., Winter J., Wilson T. S. Outbreak of Legionnaires' disease in Glasgow Royal Infirmary: microbiological aspects. J Hyg (Lond) 1986 Dec;97(3):393–403. doi: 10.1017/s0022172400063580. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. White R. J., Blainey A. D., Harrison K. J., Clarke S. K. Causes of pneumonia presenting to a district general hospital. Thorax. 1981 Aug;36(8):566–570. doi: 10.1136/thx.36.8.566. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Woodhead M. A., Macfarlane J. T., Macrae A. D., Pugh S. F. The rise and fall of Legionnaires' disease in Nottingham. J Infect. 1986 Nov;13(3):293–296. doi: 10.1016/s0163-4453(86)91421-0. [DOI] [PubMed] [Google Scholar]

Articles from Epidemiology and Infection are provided here courtesy of Cambridge University Press

RESOURCES