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Windscreen wiper fluid without added screenwash in motor vehicles: a newly identified risk factor for Legionnaires’ disease

Authors
  • Wallensten, Anders1, 2, 3
  • Oliver, Isabel1, 4
  • Ricketts, Katherine5
  • Kafatos, George6
  • Stuart, James M.4
  • Joseph, Carol5
  • 1 Health Protection Agency, South West, Stonehouse, GL10 3RF, United Kingdom , South West, Stonehouse (United Kingdom)
  • 2 European Centre for Disease Prevention and Control (ECDC), European Programme for Intervention Epidemiology Training (EPIET), Stockholm, Sweden , Stockholm (Sweden)
  • 3 Smittskyddsinstitutet-Swedish Institute for Infectious Disease Control, Department of Epidemiology, Solna, SE-171 82, Sweden , Solna (Sweden)
  • 4 Bristol University, Department of Social Medicine, Bristol, BS8 2PS, United Kingdom , Bristol (United Kingdom)
  • 5 Health Protection Agency, Centre for Infections, Respiratory Diseases Department, London, NW9 5EQ, United Kingdom , London (United Kingdom)
  • 6 Health Protection Agency, Centre for Infections, Statistics, Modelling and Bioinformatics Department, London, NW9 5EQ, United Kingdom , London (United Kingdom)
Type
Published Article
Journal
European Journal of Epidemiology
Publisher
Springer-Verlag
Publication Date
Jun 08, 2010
Volume
25
Issue
9
Pages
661–665
Identifiers
DOI: 10.1007/s10654-010-9471-3
Source
Springer Nature
Keywords
License
Yellow

Abstract

A source of infection is rarely identified for sporadic cases of Legionnaires’ disease. We found that professional drivers are five times more commonly represented among community acquired sporadic cases in England and Wales than expected. We therefore investigated possible risk exposures in relation to driving or spending time in a motor vehicle. A case control study including all surviving community acquired sporadic cases in England and Wales with onset between 12 July 2008 and 9 March 2009 was carried out. Cases were contacted by phone and controls were consecutively recruited by sequential digital dialling matched by area code, sex and age group. Those who consented were sent a questionnaire asking questions on driving habits, potential sources in vehicles and known risk factors. The results were analysed using logistic regression. 75 cases and 67 controls were included in the study. Multivariable analysis identified two exposures linked to vehicle use associated with an increased risk of Legionnaires’ disease: Driving through industrial areas (OR 7.2, 95%CI 1.5–33.7) and driving or being a passenger in a vehicle with windscreen wiper fluid not containing added screenwash (OR 47.2, 95%CI 3.7–603.6). Not adding screenwash to windscreen wiper fluid is a previously unidentified risk factor and appears to be strongly associated with community acquired sporadic cases of Legionnaires’ disease. We estimated that around 20% of community acquired sporadic cases could be attributed to this exposure. A simple recommendation to use screenwash may mitigate transmission of Legionella bacteria to drivers and passengers.

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