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

Published online by Cambridge University Press:  15 May 2009

R. S. Bhopal  and
R. J. Fallon
R. S. Bhopal
Affiliation:
Division of Epidemiology and Public Health, School of Health Care Sciences, The University of Newcastle upon Tyne, The Medical School, Framlington Place, Newcastle upon Tyne NE2 4HH
R. J. Fallon
Affiliation:
Department of Laboratory Medicine, Ruchill Hospital, Bilsland Drive, Glasgow G20 9NB
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Summary

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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 socio–economic 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 spacetime variations in incidence support the hypothesis that cooling towers were an important source of infection for not–nravel, non-outbreak cases. If so such infection is potentially preventable.

Type
Research Article
Information
Epidemiology & Infection , Volume 106 , Issue 1 , February 1991 , pp. 45 - 61
Copyright
Copyright © Cambridge University Press 1991

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