S Jarraud, M Reyrolle, S Riffard, F Lo Presti, J Etienne
Centre national de référence des légionelles, Hôpital Edouard Herriot, Lyon.
Bull Soc Pathol Exot. 1998;91(5 Pt 1-2):486-9.
The outbreak of pneumonia involving delegates to the 1976 American Legion convention at a Philadelphia hotel was the first example of travel-associated legionnaires' disease. Travel is now well known as a common risk factor for legionnaires' disease. This travel-associated disease is a preoccupation among European countries because of morbidity among citizens of the European Union. The definition of the case of legionellosis is a patient who presents an acute lower respiratory tract infection with focal signs of pneumonia and/or radiological features, and microbiological evidence of Legionella infection. A case is considered to be travel associated if the patient has spent one or more nights away from home during the ten days before becoming ill. An European Surveillance Scheme for Travel-Associated Legionnaires' Disease was established in 1987 to identify clusters and outbreaks of cases of the disease. This group centralizes the case reports of twenty-nine collaborating centres in twenty-five countries. Outbreaks of legionnaires' disease were described in hotels, camps or cruise ships. In 1996, the number of travel-associated cases of legionnaires' disease represented 16% of the total number cases. The increase of the number of reported cases may reflect improved surveillance and increased ascertainment. In Europe in 1996, the diagnosis of legionellosis was confirmed by detection of Legionella pneumophila sero-group 1 antigen in urine (36%), seroconversion (fourfold rise in antibody titre, 33%) and culture of the organism (16%). Fifteen per cent of legionellosis was diagnosed by the identification of a single high antibody titre. In France a coordination between Public Health Institutions (Réseau National de Santé Public and DDASS), clinicians, laboratories and National Reference Center was established to improve prevention and control of legionnaires' disease outbreaks. Legislation obliges to report each case. When more two cases in the same area are notified an epidemiological investigation must be done. The knowing of the source of the contamination and its eradication allows to prevent new cases and outbreaks. Outbreaks of Legionnaires' disease are even now mediatic and this fact leads to maintain attention for the quality of diagnosis and epidemiology investigation due to touristic and economic consequences for the implicated countries.
1976年在费城一家酒店参加美国退伍军人协会大会的代表中爆发的肺炎，是与旅行相关的军团病的首个案例。如今，旅行已被公认为军团病的常见风险因素。由于欧盟公民中出现发病情况，这种与旅行相关的疾病成为欧洲国家关注的问题。军团病病例的定义是，出现急性下呼吸道感染并伴有肺炎局部体征和/或放射学特征，以及军团菌感染微生物学证据的患者。如果患者在发病前10天内有过一个或多个晚上离家在外的情况，则该病例被视为与旅行相关。1987年建立了欧洲与旅行相关军团病监测计划，以识别该疾病的病例集群和疫情爆发。该组织集中了25个国家29个合作中心的病例报告。军团病疫情爆发情况在酒店、营地或游轮上都有描述。1996年，与旅行相关的军团病病例数占病例总数的16%。报告病例数的增加可能反映了监测的改善和确诊率的提高。1996年在欧洲，军团病的诊断通过检测尿液中的嗜肺军团菌血清1型抗原（36%）、血清转化（抗体滴度四倍升高，33%）以及该微生物的培养（16%）得以确诊。15%的军团病是通过识别单一高抗体滴度来诊断的。在法国，公共卫生机构（国家公共卫生网络和地区卫生与社会事务局）、临床医生、实验室和国家参考中心之间建立了协调机制，以加强军团病疫情爆发的预防和控制。法律规定必须报告每一例病例。当同一地区报告两例以上病例时，必须进行流行病学调查。了解污染源并将其根除有助于预防新病例和疫情爆发。军团病疫情爆发至今仍受到媒体关注，这一事实使得由于对相关国家的旅游和经济造成影响，人们持续关注诊断质量和流行病学调查。
