View source for Medicine:1999 Bovenkarspel legionellosis outbreak

{{Short description|Outbreak of legionellosis in Bovenkarspel, the Netherlands}}
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{{Infobox event
| title                    = 1999 Bovenkarspel legionellosis outbreak
| image                    = Legionella pneumophila 01.jpg

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| caption                  = ''[[Biology:Legionella pneumophila|Legionella pneumophila]]'' bacterium

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| date                     = {{start date|1999|02|25}}
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| location                 = Bovenkarspel, the Netherlands
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| reported deaths          = at least 32
| reported injuries        = 206
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The '''Bovenkarspel legionellosis outbreak''' ({{lang-nl|Legionellaramp}}; Legionella disaster) began on 25 February 1999 in Bovenkarspel, the Netherlands, and was one of the largest outbreaks of legionellosis in history.<ref>{{cite news |language=nl |url=http://www.volkskrant.nl/vk/nl/2844/Archief/archief/article/detail/525339/1999/03/18/Een-van-de-grootste-uitbraken-in-de-geschiedenis.dhtml |title=Een van de grootste uitbraken in de geschiedenis |trans-title=One of the largest outbreaks in history |first=Gerbrand |last=Feenstra |work=De Volkskrant |date=18 March 1999 |url-status=dead |archive-url=https://web.archive.org/web/20140819084648/https://www.volkskrant.nl/vk/nl/2844/Archief/archief/article/detail/525339/1999/03/18/Een-van-de-grootste-uitbraken-in-de-geschiedenis.dhtml |archive-date=19 August 2014}}</ref> With at least 32 dead and 206 severe infections, it was the deadliest legionellosis outbreak since the original 1976 outbreak in Philadelphia, United States.

Between 19 and 28 February 1999, the Westfriese Flora took place in Bovenkarspel, one of the largest indoor flower exhibitions in the world (later the Holland Flowers Festival). A vendor had several recreational hot tubs on display, with one of them filled from a long-inactive firehose and heated to 37 degrees Celsius (98.6 degrees Fahrenheit). In the water that had previously stagnated inside the hose, a very aggressive type of ''[[Biology:Legionella pneumophila|legionella pneumophila]]'' bacterium had developed.<ref>{{cite book|last1=Mahon|first1=Connie|title=Textbook of Diagnostic Microbiology|date=2014|publisher=Elsevier Health Sciences|isbn=9780323292610|page=416|url=https://books.google.com/books?id=rdDsAwAAQBAJ&pg=PA416}}</ref><ref name=Cun2016>{{cite journal|last1=Cunha|first1=BA|last2=Burillo|first2=A|last3=Bouza|first3=E|title=Legionnaires' disease.|journal=Lancet|date=23 January 2016|volume=387|issue=10016|pages=376–85|pmid=26231463|doi=10.1016/s0140-6736(15)60078-2|s2cid=28047369}}</ref> The vendor did not add [[Chemistry:Chlorine|chlorine]] to the tubs, since customers were not permitted in them.{{cn|date=February 2023}}

From 7 March, 13 patients were admitted to the Westfries Gasthuis in Hoorn.  Unable to diagnose the patients, hospital staff called the Academic Medical Center (AMC) in [[Place:Amsterdam|Amsterdam]]. The AMC initially diagnosed six patients with legionellosis and a link with the Westfriese Flora was soon made. On 12 March, the Netherlands National Institute for Public Health and the Environment (RIVM) issued an epidemic warning to all doctors and hospitals, alerting them to Flora visitors and people with pneumonia-like symptoms. In the following weeks, 318 cases throughout the Netherlands were reported to the RIVM. All patients had visited the Westfriese Flora after 22 February and had become ill between 25 February and 16 March. It is known that 32 people died of the infection, one of them in 2001 after prolonged illness. A further 206 people became severely ill and many developed permanent health problems after visiting the Flora.{{cn|date=February 2023}}

The 318 cases exceeds the 221 in the 1976 Philadelphia outbreak.  While the Philadelphia outbreak had two more fatalities (34 versus 32), there is a possibility that others died in the 1999 Bovenkarspel outbreak, but were interred before the infection was recognized.{{cn|date=February 2023}}

==References==
{{Reflist}}

==External links==
*[http://wwwnc.cdc.gov/eid/article/8/1/01-0176_article.htm A Large Outbreak of Legionnaires’ Disease at a Flower Show, the Netherlands, 1999], Jeroen W. Den Boer, Ed P.F. Yzerman, Joop Schellekens et al., [[Biology:Emerging Infectious Diseases|Emerging Infectious Diseases]], Volume 8, Number 1—January 2002 
*[http://www.q-net.net.au/~legion/Legionnaires`_Disease_Netherlands_1999.htm The Westfriese Flora flower exhibition and fair], Legionnaires` Disease website
*{{in lang|nl}} [https://web.archive.org/web/20071215060654/http://www.zero-meridean.nl/c_bovenkarspel_250299.html 25 februari 1999: Legionellabesmetting Westfriese Flora, Bovenkarspel], Zwaailichten disaster website (archive)

{{Legionnaires' disease}}

{{DEFAULTSORT:Bovenkarspel legionellosis outbreak}}
[[Category:Legionellosis]]

{{Sourceattribution|1999 Bovenkarspel legionellosis outbreak}}