Outbreak of legionnaires' disease in the United Kingdom

doi:10.1136/bmj.325.7371.1033/a

BMJ 2002;325:1033 ( 2 November )

Letters

Outbreak of legionnaires' disease in the United Kingdom

Vigilance must be eternal but balanced

Official cleaning and disinfection procedures must be adhered to

Extracorporeal membrane oxygenation should be considered in severe cases

Vigilance must be eternal but balanced

The first 150 words of the full text of this article appear below.

EDITOR $---$ Joseph underlines the paradox of larger outbreaks of legionnaires' disease when understanding of causality is greaterthan ever.¹ She gives four explanations $---$ loss of vigilance inmaintenance of water systems, greater clinical awareness, bettersurveillance, and easier diagnosis. She calls for enhanced surveillanceof both sporadic disease and outbreaks and for greater vigilancein control. Some lessons from studies of legionnaires' diseasein Scotland are pertinent to concerns fuelled by outbreaks inEngland thissummer.

In Glasgow a survey conducted after two outbreaks, including the largest in the United Kingdom up to 1984, showed up difficultiesin maintaining an accurate register of cooling towers, poor understandingamong some managers of premises about the nature and locationof cooling towers and evaporative condensers, and breaches ofguidelines, usually on structural issues $---$ for example, controlof the drift of cooling towers rather than non-use of chemicals.²The problems would have been . . . [Full text of this article]