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This study examined the impact of meteorological conditions on sporadic, community-acquired cases of Legionnaires' disease in England and Wales (2003–2006), with reference to the 2006 increase in cases. A case-crossover methodology compared each case with self-controlled data using a conditional logistic regression analysis. Effect modification by quarter and year was explored. In total, 674 cases were entered into the dataset and two meteorological variables were selected for study based on preliminary analyses: relative humidity during a case's incubation period, and temperature during the 10–14 weeks preceding onset. For the quarter July–September there was strong evidence to suggest a year, humidity and temperature interaction (Wald χ2=30·59, 3 d.f., P<0·0001). These findings have implications for future case numbers and resource requirements.
Much data has been gathered by the EWGLINET scheme on the distribution of cases of travel-associated Legionnaires' disease (TALD) by country of infection, but less analysis has been carried out on the distribution of these cases within countries. Travel-associated cases with onset in 2002 linked to France, Italy, Spain and Turkey were mapped. Rates of Legionnaires' disease per 100000 tourists were calculated for internal and foreign visitors for the regions of each country, and mapped. Rates of 1·5 cases/100000 and 2 cases/100000 tourists were classified as ‘high’ and ‘very high’ respectively. Cases of TALD were concentrated in certain regions, but when rates were calculated using tourist data, the results were relatively constant throughout each country. Rates were higher among foreign visitors than internal visitors; three of the countries had at least one region with ‘high’ rates, whilst Turkey additionally had three regions with ‘very high’ rates.
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