In 1999, an outbreak of Legionnaires' disease affected many visitors to a flower show in the Netherlands. To identify the source of the outbreak, we performed an environmental investigation, as well as a case-control study among visitors and a serologic cohort study among exhibitors to measure exposure to possible sources. Of 77,061 visitors, 188 became ill (133 confirmed and 55 probable cases), for an attack rate of 0.23% for visitors and 0.61% for exhibitors. Two whirlpool spas in halls 3 and 4 of the exhibition and a sprinkler in hall 8 were culture positive for Legionella ...

<0.001). Since no other environmental risk factor was identified, the outbreak investigation focused on the flower show. This show is an annual event that includes an agricultural and consumer products exhibition, located in the nearby town of Bovenkarspel. Held from February 19 to 28, the flower show attracted 77,061 visitors. After a nationwide warning was issued to ensure detection and appropriate treatment of any additional cases, it became clear that>

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