Legionnaires' disease from a cooling tower in a community outbreak in Lidkoping, Sweden-epidemiological, environmental and microbiological investigation supported by meteorological modelling

Background: An outbreak of Legionnaires' Disease took place in the Swedish town Lidkoping on Lake Vanern in August 2004 and the number of pneumonia cases at the local hospital increased markedly. As soon as the first patients were diagnosed, health care providers were informed and an outbreak investigation was launched. Methods: Classical epidemiological investigation, diagnostic tests, environmental analyses, epidemiological typing and meteorological methods. Results: Thirty-two cases were found. The median age was 62 years (range 36 - 88) and 22 (69%) were males. No common indoor exposure was found. Legionella pneumophila serogroup 1 was found at two industries, each with two cooling towers. In one cooling tower exceptionally high concentrations, 1.2 x 10(9) cfu/L, were found. Smaller amounts were also found in the other tower of the first industry and in one tower of the second plant. Sero-and genotyping of isolated L. pneumophila serogroup 1 from three patients and epidemiologically suspected environmental strains supported the cooling tower with the high concentration as the source. In all, two L. pneumophila strains were isolated from three culture confirmed cases and both these strains were detected in the cooling tower, but one strain in another cooling tower as well. Meteorological modelling demonstrated probable spread from the most suspected cooling tower towards the town centre and the precise location of four cases that were stray visitors to Lidkoping. Conclusions: Classical epidemiological, environmental and microbiological investigation of an LD outbreak can be supported by meteorological modelling methods. The broad competence and cooperation capabilities in the investigation team from different authorities were of paramount importance in stopping this outbreak.