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According to a BBC report, the HPA also conducted a pilot study where they found 1 in 5 cars without screenwash carried traces of Legionella while none of the cars that had screenwash had the bacteria.

Professor Hugh Pennington, a well known expert in bacteriology, told the BBC it made sense to recommend that people make sure they have screenwash in their cars. Legionella is a bug that takes advantage of warm water systems that are not cleaned out, and if something this simple can prevent people catching the disease, then “it’s a no brainer really”, he remarked.

There are more than 40 species of Legionella bacteria, with L. pneumophila most commonly associated with Legionnaires’ disease. Although naturally occuring in lakes, rivers and reservoirs, and can lie dormant at low temperatures, the bacteria thrive in temperatures between 20 and 40 degrees C and can colonise manufactured water systems, where they feed on the scale, sediment, sludge and various bio-films that build up.

To be hazardous to humans Legionella bacteria need to be present in sufficient numbers and to be pathogenic, some strains being more infectious than others. They are usually transmitted via tiny water droplets, for instance in showers and air conditioning units, and person to person transmission is not thought to be a way to catch the disease.

Symptoms usually appear between two and ten days after infection, although in rare cases it may take longer. Illness starts with fever, muscle ache, headache, dry cough, and shortness of breath, and develops into pneumonia. Some people may also experience diarrhea, vomiting, confusion and delirium.

Most patients improve with treatment which includes antibiotics, but in the more vulnerable cases, such as the elderly or the already sick, severe illness, respiratory or systemic failure and shock can happen. Among otherwishe healthy people, the death rate is between 10 and 15 per cent.

According to figures produced by the European Working Group for Legionella Infections, in 2006, there were 6,280 cases of Legionnaires’ disease reported from 35 countries in Europe.

New research from the UK suggests that as many as 1 in 5 of community-acquired sporadic cases of Legionnaires’ disease occur as a result of not adding screenwash, which normally contains anti-bacterial agents, to windscreen wiper fluid in cars and vans.

The study was the work of researchers at the UK’s Health Protection Agency (HPA), and you can read a paper about it in the 7 June online first issue of the European Journal of Epidemiology.

Legionnaires’ disease is a rare type of pneumonia caused by bacteria from the genus Legionella that live in water. In 2008, there were 359 cases reported in England and Wales, mostly in men, and 40 per cent were overseas travel-related. This study focused on Legionnaires’ disease acquired in the community, as people go about their daily lives, as opposed to cases where exposure most likely occured during foreign travel.

In their background information, co-author Dr Isabel Oliver, regional director of the HPA South West, and colleagues, wrote that it is not easy to find a source of infection of sporadic cases of Legionnaires’ disease, but they noticed that in England and Wales, professional drivers were five times more likely to have it than other people and decided to explore the possible risk of exposure for drivers and passengers.

They carried out a case control study that included all the surviving community acquired sporadic cases in England and Wales that started with symptoms between mid July 2008 and early March 2009.

They contacted the cases by phone and then from their details recruited consenting matching controls. All who consented to take part in the study filled in questionnaires about their driving habits, potential sources of infection in vehicles and other known risk factors.

When the researchers analysed the results, they had data on 75 cases and 67 controls. They found that:

• Two exposures linked vehicle use with an increased risk of Legionnaires’ disease.
• One was driving through industrialized areas (odds ratio OR 7.2, 95 per cent confidence interval CI ranged from 1.5 to 33.7).
• The other was travelling in a vehicle where no screenwash had been added to the windscreen wiper fluid (OR 47.2, 95 per cent CI 3.7 to 603.6).

The researchers concluded that:

“Not adding screenwash to windscreen wiper fluid is a previously unidentified risk factor and appears to be strongly associated with community acquired sporadic cases of Legionnaires’ disease.”

They suggested that around 1 in 5 of community acquired sporadic cases of Legionnaires’ disease could be attributed to this exposure, and a simple way to reduce the risk of transmission of Legionella bacteria in the community would be for people to make sure they add screenwash to the windscreen wiper fluid in their vehicles.

A new nationwide study in the US found that worry about costs is preventing many cancer survivors from getting the medical care they need: the researchers said the study raises concerns about the long-term health and wellbeing of cancer survivors.

You can read about the study, led by Dr Kathryn E Weaver, an assistant professor in the Division of Public Health Sciences at Wake Forest University Baptist Medical Center in Winston-Salem, North Carolina, in the 14 June online issue of Cancer, the journal of the American Cancer Society.

In their introduction the researchers pointed out that in the US, many cancer survivors now live many years after their diagnosis, emphasizing the importance of continued access to the healthcare they need, but there is not a lot of information on how easy this is for survivors.

So Weaver and colleagues decided to investigate the extent to which financial worries might play a part, and also whether cancer history and race or ethnicity also made a difference to whether people accessed care or not.

For the study they looked at US National Health Interview Survey (NHIS) data covering 2003 to 2006 on 6,602 adult cancer survivors and 104,364 people with no history of cancer. They then looked for links between self-reports of foregoing medical care because of cost against cancer history and race or ethnicity.

The results showed that:

• Overall, 18 per cent of US cancer survivors (more than 2 million people) went without one or more needed medical services because of cost concerns.
• This broke down as: 7.8 per cent of cancer survivors went without medical care, 9.9 per cent went without prescription drugs, 11.3 per cent went without dental care and 2.7 per cent went without mental health care, because of cost concerns.
• Among the under 65-year olds, cancer survivors were 1.5 to 2.0 times more likely to delay or go without all types of medical care than those with no history of cancer.
• Hispanic and black cancer survivors were more likely to forego prescription drugs and dental care than white survivors.

The authors concluded that:

“More than 2 million US cancer survivors did not get 1 or more needed medical services because of financial concerns during the studied period.”

They said more studies are needed to determine how not receiving medical care impacts the quality of life and survival of former cancer patients.

Weaver told the press that:

“Although the large number of survivors going without care was somewhat surprising, it has long been recognized that cancer can have a negative impact on the financial health of survivors.”

“”This is important because cancer survivors have many medical needs that persist for years after their diagnosis and treatment,” she added, stressing that: “the implications of this financial stress for their ongoing medical care are just beginning to be recognized”.

She said, however, the study did not look at what types of medical care were not being received and to what extent they might be cancer-related.

She also commented it will be interesting to see how the current health reforms will affect medical care access for cancer survivors in the years to come.

Couples considering undergoing assisted reproductive technology (ART) treatment should be informed about the increased risk of congenital malformation posed by the use of ART, the annual conference of the European Society of Human Genetics will hear today (Monday). Dr. Geraldine Viot, a clinical geneticist at the Maternite Port Royal hospital, Paris, France, will say that she believed that most doctors working in ART clinics in France only told couples about such risks if they were asked specific questions.

Dr. Viot and colleagues conducted a survey in 33 French centres registered for ART, around one third of the total number of clinics registered to perform ART procedures in France. All ART births from these clinics from 2003 to 2007 were included; 15 162 children in total. The study was the largest to date on this subject. Questionnaires were completed both by the parents and the paediatrician and the prevalence of malformations found compared with the data obtained from national registers and in published papers.

“We found a major congenital malformation in 4.24% of the children”, said Dr. Viot, “compared with the 2-3% that we had expected from previous published studies. This higher rate was due in part to an excess of heart diseases and malformations of the uro-genital system. This was much more common in boys. Among the minor malformations, we found a five times higher rate of angioma, benign tumours made up of small blood vessels on or near the surface of the skin. These occurred more than twice as frequently in girls than boys.”

However, the scientists say, their results are a long way from the 11% of major malformations that have been reported by some studies. “Given that our study is the largest to date, we think that our data are more likely to be statistically representative of the true picture”, said Dr. Viot.

The average age of the parents of children born with malformations was not statistically different from the other parents in the ART group. The origins of the malformations are probably multiple, says Dr. Viot. “We need more research in order to understand the relationship between embryo culture media, timing of embryo transfer, the effects of ovarian stimulation, the use of ICSI, where sperm is injected directly into the egg, freezing of gametes and embryos and these disorders.

“We estimate that in France some 200 000 children have been born after ART and therefore a malformation rate of this magnitude is a public health issue. It is important that all doctors and also politicians are informed about this. We also need to follow up all children born after ART and to put much more effort into trying to understand which of the procedures involved is implicated in this problem.”

Dr. Viot and colleagues intend to follow up their work analysing a further 4000 questionnaires, from children born in 2008, and to look at the motor development of children born in 2003, who are now aged 7. “By following all these children we hope to understand more about not only what can go wrong after ART, but why it goes wrong”, she said. “At a time when infertility is increasing and more and more couples need to use ART to conceive, it is vitally important that we find out as much as we can about what is causing malformations in these children, not only so that we can try to counteract the problem but also in order for health services to be able to plan for their future needs.”

The scientists are now trying to find out the origin of parental infertility for each child born after ART who has been affected by major malformation or epigenetic disorders. “With this knowledge, we can better establish the origin of the malformation and whether it is more likely to be related to parental infertility or the ART procedure itself”, said Dr. Viot. “We already know that imprinting disorders – where the mechanism in which gene expression depends on parental origin – are clearly more frequent in our cohort than in the general population.”

Imprinting disorders are all acquired because of either a maternal or paternal deletion on a chromosome, through inheritance of both chromosomes of a pair from only one parent, through mutations in some imprinted genes, or because of loss or gain of methylation (a process which is normally removed during zygote formation and re-established through successive cell divisions during development. “The prevalence of the imprinting disorder Beckwith Wiedemann syndrome in our cohort is six times higher than we would expect in the general population, and for retinoblastoma the prevalence among ART children is 4.5 higher than in the general population”, said Dr. Viot.

“These results could be due to the effect of a number of different mechanisms. They could be due to the infertility itself, the ovarian stimulation for supernumerary oocyte production, the in vitro maturation of oocytes, the use of ICSI (direct injection of sperm), the culture media, the cryopreservation of gametes and embryos – we just don’t know at present. Finding this out will be a major step towards improving the health of children born after ART.”