Jernigan D B, Hofmann J, Cetron M S, Genese C A, Nuorti J P, Fields B S, Benson R F, Carter R J, Edelstein P H, Guerrero I C, Paul S M, Lipman H B, Breiman R
Childhood and Respiratory Diseases Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Lancet. 1996 Feb 24;347(9000):494-9. doi: 10.1016/s0140-6736(96)91137-x.
Outbreaks of travel-related Legionnaires' disease present a public-health challenge since rapid, sensitive, and specific diagnostic tests are not widely used and because detection of clusters of disease among travellers is difficult. We report an outbreak of Legionnaires' disease among cruise ship passengers that occurred in April, 1994, but that went unrecognised until July, 1994.
After rapid diagnosis of Legionnaires' disease in three passengers by urine antigen testing, we searched for additional cases of either confirmed (laboratory evidence of infection) or probable Legionnaires' disease (pneumonia of undetermined cause). A case-control study was conducted to compare exposures and activities on the ship and in ports of call between each case-passenger and two or three matched control-passengers. Water samples from the ship, from sites on Bermuda, and from the ship's water source in New York City were cultured for legionellae and examined with PCR.
50 passengers with Legionnaires' disease (16 confirmed, 34 probable) were identified from nine cruises embarking between April 30 and July 9, 1994. Exposure to whirlpool spas was strongly associated with disease (odds ratio 16.2, 95% Cl 2.8-351:7); risk of acquiring Legionnaires' disease increased by 64% (95% Cl 12-140) for every hour spent in the spa water. Passengers spending time around the whirlpool spas, but not in the water, were also significantly more likely to have acquired infection. Legionella pneumophila serogroup 1 was isolated only from the sand filter in the ship's whirlpool spa. This isolate matched a clinical isolate from the respiratory secretions of a case-passenger as judged by monoclonal antibody subtyping and by arbitrarily primed PCR.
This investigation shows the benefit of obtaining a recent travel history, the usefulness or urine antigen testing for rapid diagnosis of legionella infection, and the need for improved surveillance for travel-related Legionnaires' disease. New strategies for whirlpool spa maintenance and decontamination may help to minimise transmission of legionellae from these aerosol-producing devices.
与旅行相关的军团病暴发带来了公共卫生挑战，这是因为快速、灵敏且特异的诊断检测方法未得到广泛应用，而且难以在旅行者中发现疾病聚集情况。我们报告了1994年4月发生在游轮乘客中的一次军团病暴发，但直到1994年7月才被发现。
通过尿液抗原检测快速诊断出3名乘客患有军团病后，我们寻找其他确诊（感染的实验室证据）或可能的军团病（病因不明的肺炎）病例。开展了一项病例对照研究，比较每位病例乘客与两三名匹配的对照乘客在船上和停靠港口的暴露情况及活动。对来自该船、百慕大各地点以及纽约市该船水源的水样进行军团菌培养并用聚合酶链反应（PCR）检测。
从1994年4月30日至7月9日启航的9次航行中，共识别出50名患有军团病的乘客（16例确诊，34例可能）。接触漩涡浴缸与患病密切相关（比值比16.2，95%可信区间2.8 - 351.7）；在漩涡浴缸水中每多待一小时，感染军团病的风险增加64%（95%可信区间12 - 140）。在漩涡浴缸周围逗留但未接触水的乘客感染的可能性也显著更高。仅从船上漩涡浴缸的砂滤器中分离出嗜肺军团菌血清型1。通过单克隆抗体亚型分析和任意引物PCR判断，该分离株与一名病例乘客呼吸道分泌物中的临床分离株匹配。
这项调查显示了获取近期旅行史的益处、尿液抗原检测对快速诊断军团菌感染的有用性，以及加强对与旅行相关的军团病监测的必要性。漩涡浴缸维护和去污的新策略可能有助于减少这些产生气溶胶设备传播军团菌的情况。
