Carol Joseph (carol.joseph@hpa.org.uk), European Surveillance Scheme for travel associated legionnaires' disease project coordinator (http://www.ewgli.org/), Health Protection Agency Communicable Disease Surveillance Centre, London, England, and Konrad Beyrer, State Health Authority of Lower Saxony, Germany.

The number of cases of legionnaires’ disease in passengers who traveled on the Ocean Monarch cruise ship from 6-23 August is still three (1). One case has been confirmed by culture of the organism and the others by urinary antigen detection.
The ship remained berthed at Harwich (England) for one week where it underwent extensive environmental investigations and implementation of control measures. Hot and cold water samples were taken for analysis and have yielded isolates of Legionella pneumophila serogroups 1 and 2-14. These isolates as well as those of the German case will be sent to the reference laboratory at the University of Dren for further investigation. The ship left for Dover (England) on 30 August after all the control measures had been reviewed by marine and port health staff, and staff from England and Wales’ Health Protection Agency. Further water sampling was carried out in Dover before the ship sailed on its next cruise the following day.

In Germany, passengers associated with the cruise outbreak are being followed up to assist with identification of the source of infection and to assess the full extent of associated illness. Further information about the cluster can be obtained from the State Health Authority of Lower Saxony, Germany at the following address by contacting Adolf Windorfer via email (Adolf.Windorfer@nlga.niedersachsen.de), telephone (+49 (0) 511 4505 500), or fax (+49 (0) 511 4505 502).

References:
Joseph C. Legionnaires' disease associated with a cruise liner – Germany. Eurosurveillance Weekly 2003; 7 (35): 28/08/2003. (http://www.eurosurveillance.org/ew/2003/030828.asp)

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