Epidemiology and Infection

Research Article

Legionellosis linked with a hotel car park – how many were infected?

J. C. Bella1a2, L. R. Jorma1, M. Williamsona1, N. H. Shawa1, D. L. J. Kazandjiana3, R. Chiewa3 and A. G. Capona1

a1 Western Sector Public Health Unit, 13 New Street, North Parramatta NSW 2151, Australia

a2 National Centre for Epidemiology and Population Health, Australian National University, Canberra ACT 0200, Australia

a3 Department of Clinical Microbiology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead NSW 2145, Australia

SUMMARY

An outbreak of legionellosis associated with a hotel in Sydney, Australia, and the subsequent epidemiological and environmental investigations are described. Four cases of Legionnaires' disease were notified to the Public Health Unit. A cross-sectional study of 184 people who attended a seminar at the hotel was carried out. Serological and questionnaire data were obtained for 152 (83%) of these. Twenty-eight (18%) respondents reported symptoms compatible with legionellosis. Thirty-three subjects (22%) had indirect fluorescent antibody (IFA) titres to Legionella pneumophila serogroup 1 (Lp-1) of 128 or higher. The only site which those with symptoms of legionellosis and IFA titre ≥128 were more likely to have visited than controls was the hotel car park (adjusted odds ratio [OR] 14·7, 95% confidence interval [CI]: 1·8–123·1). Those with symptoms compatible with legionellosis, but whose IFA titres were < 128 were also more likely to have visited the hotel car park (adjusted OR 4·4, 95% CI: 1·5–12·9). Seroprevalence of Lp-1 antibodies was higher in those who attended the seminar than in a population sample of similar age. Findings suggested that the 4 cases represented a small fraction of all those infected, and highlighted difficulties in defining illness caused by Lp-1 and in interpreting serology.

(Accepted October 26 1995)

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