A whirlpool associated outbreak of Pontiac fever at a hotel in Northern Sweden

In April 1999, an outbreak of Pontiac fryer occurred at a hotel in Northern Sweden. A retrospective cohort study to find the source and define the extent of the outbreak was carried out among 530 Swedish and Norwegian guests. Twenty-nine epidemiological cases (8 % of 378 responders) aged 21-57 years were identified. Antibodies against Legionella micdadei were detected in 17 of 27 tested cases and 3 other symptomatic persons. Visiting the whirlpool area was identified as the sole risk factor (RR 86; 95% CI 21-352) and infected cases were confined to visitors to this area over three successive days. The attack rate was 71% (27/38) and 24 cases (83 %) used the whirlpool. Environmental sampling was negative for Legionella sp. But epidemiological investigation strongly suggests that the whirlpool was the source of the outbreak. The possibility of serious legionella infections underlines the importance of strict maintenance practices to maintain hygiene of whirlpools.