ECDC Legionnaires’ Disease Report for 2018
In this article we take a look at the European Centre for Disease Prevention and Controls annual report dealing with the prevalence of Legionnaires’ disease across Europe during 2018.
The article considers rates of infection and how they have changed over the last few years, which countries are responsible for the most cases, trends in diagnostic techniques, mortality rates and who is most at risk. It also looks at seasonal trends, and concludes by considering what can be done to control Legionella bacteria and so reduce cases of the disease.
ECDC Legionnaires’ disease report for 2018
The ECDC is the European Centre for Disease Prevention and Control.
Each year, it releases a report containing the latest available data for Legionnaires’ disease across 30 European countries.
The most recent report for 2018 was released in August 2020.
The report confirmed that the trend for rising cases of Legionnaires’ disease has continued. Indeed, 2018 had the most cases ever discovered by the ECDC.
2018 saw a 23% increase in Legionnaires’ disease year-on-year
There are many facts to take away from the latest report.
Most alarming of these is the 23% increase in cases of Legionnaires’ seen in 2018 when compared to the previous year.
23% increase in cases of Legionnaires’ disease seen in 2018
Another of the key facts highlighted at the beginning of the Annual Epidemiological Report for 2018 is that 71% of all notified cases of Legionnaires’ disease came from just four of the 30 countries participating in the data.
These four countries were Germany, Spain, France, and Italy.
in 2018 71% of all cases came from Germany, Spain, France, and Italy
The size of these countries relative to their smaller neighbours could contribute to this percentage.
However, the overall rise is still concerning.
Indeed, when comparing by population, those four countries represent only half the total population across the 30 countries.
Over 11,000 cases of Legionnaires’ reported during 2018
94% of those cases were confirmed as Legionnaires’ disease rather than simply being suspected.
Notifications of any infection are calculated per 100,000 of the population… many are now aware of this due to COVID-19 pandemic.
The same calculation is used for Legionnaires’ and it was confirmed as 2.2 per 100,000 of the population for 2018.
While this may sound low, it is confirmed as the highest percentage since 2013.
The 2.2 rate is 0.4 higher than in 2017.
Meanwhile, the rate was 1.3 in 2014, meaning the notification rate has almost doubled during that period.
Mortality rate lower than the predicted rate for the disease
Legionnaires’ disease is known to have an average mortality rate of 10%.
While 11,343 cases were reported by the ECDC, only 8,974 of them identified an outcome.
The report confirms that 8% of these cases were fatal.
Cases of Legionnaires’ are more prevalent during the summer months
The report contains a very useful graph showing the number of cases that have occurred between January 2014 and the end of 2018.
The overall moving average is increasing, as the data has already shown.
However, the cases peaked in the summer months each year.
The most notable spike was around July 2018.
Research is still ongoing into the cause of these summer spikes, which are not unique to European countries.
The weather is thought to be the main driver of these spikes.
Rising temperatures and increased humidity may lead to preferable conditions for Legionella bacteria to multiply and spread within water systems which can then disperse the bacteria via fine aerosols.
Urine antigen tests are the most popular way of diagnosing Legionnaires’ disease
Cultures are used in some cases to identify Legionnaires’ disease, but these are decreasing in popularity.
In 2014, 12% of cases were confirmed in this way, but the figure has reduced to 10% in 2018.
Meanwhile, 88% of cases were confirmed via urine antigen tests in 2014, rising to 91% in 2018.
Men aged 65 and over are most at risk from the disease
The report goes on to confirm that Legionnaires’ disease is most prevalent among males, especially those aged 65 and over.
We know that age is a significant risk factor for everyone regarding this disease.
However, more than twice the number of males were diagnosed with the disease in 2018 compared with females.
This holds true in the three main age categories affected – 25-44 years, 45-64 years, and 65+ years.
Are some European countries with low rates reporting all cases of Legionnaires’ disease?
The ECDC report suggests it is likely there are countries that are failing to report or recognise all cases of Legionnaires’ disease.
More cases are being reported now than in the past, so a portion of the increase in figures could simply be down to this.
The importance of legionella risk management
However, the report ends by confirming how important it is to perform regular checks to see if raised levels of Legionella bacteria are present in water systems.
It highlights the need to do this in hospital and care settings, along with tourist accommodation such as hotels.
Some of the reported cases for 2018, as in previous years, were acquired by people travelling elsewhere in Europe to go on holiday.
It is likely that some cases are going to go unreported, especially if they are mild and mistaken for something else.
However, nearly all out outbreaks of Legionnaires’ disease are considered to be preventable.
If reliable legionella control measures are put in place in healthcare settings, care homes, hotel accommodation, and business premises, the odds of an outbreak are significantly reduced.
While better reporting accounts for some of the annual rise seen in this ECDC report for 2018, it does not account for it all.
Those in charge of maintaining water systems in all public buildings, hospitals, care settings, hotels and other buildings must ensure they assess the risks from Legionella bacteria, monitor and treat their waters systems to prevent future outbreaks of the disease.
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