Surveillance and outbreak report Epidemiological investigation and case–control study: a Legionnaires’ disease outbreak associated with cooling towers in Warstein, Germany, August–September 2013 A Maisa 1 , A Brockmann 2 , F Renken 2 , C Lück 3 , S Pleischl 4 , M Exner 4 , I Daniels-Haardt 5 , A Jurke 1 1. Department of Infectiology and Hygiene, NRW Centre for Health, Münster, Germany 2. Public Health Department, Soest, Germany 3. Institute for Medical Microbiology and Hygiene, National Consulting Laboratory for Legionella, University of Technology, Dresden, Germany 4. Institute for Hygiene and Public Health, University of Bonn, Bonn, Germany 5. Division Health Protection, Health Promotion, NRW Centre for Health, Münster, Germany Correspondence: Annette Jurke (
[email protected]) Citation style for this article: Maisa A, Brockmann A, Renken F, Lück C, Pleischl S, Exner M, Daniels-Haardt I, Jurke A. Epidemiological investigation and case–control study: a Legionnaires’ disease outbreak associated with cooling towers in Warstein, Germany, August–September 2013. Euro Surveill. 2015;20(46):pii=30064. DOI: http://dx.doi. org/10.2807/1560-7917.ES.2015.20.46.30064 Article submitted on 23 September 2014 / accepted on 13 April 2015 / published on 19 November 2015 Between 1 August and 6 September 2013, an outbreak as Pontiac fever. The bacterium is found ubiquitously of Legionnaires’ disease (LD) with 159 suspected in freshwater environments, but man-made environ- cases occurred in Warstein, North Rhine-Westphalia, ments such as cooling towers provide advantageous Germany. The outbreak consisted of 78 laboratory- conditions for bacterial growth [1]. Advanced age, male confirmed cases of LD, including one fatality, with a sex, heavy smoking and several underlying diseases case fatality rate of 1%.