LEGIONELLA - World Health Organization

Chapter 9 Disease surveillance and public health
management of outbreaks . . . . . . . . . . . . . . . . . . . . . . . . . .139
9.1 Surveillance systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .139
9.1.1 Standardized case definitions . . . . . . . . . . . . . . . . . . . . . . . .140
9.1.2 Defined datasets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .140
9.2 International surveillance of legionellosis . . . . . . . . . . . . . . . . . . . . .144
9.2.1 Effect of improved surveillance . . . . . . . . . . . . . . . . . . . . . .147
9.3 Management of outbreaks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .149
9.3.1 Confirmation of an outbreak . . . . . . . . . . . . . . . . . . . . . . . .150
9.3.2 Outbreak control team . . . . . . . . . . . . . . . . . . . . . . . . . . . .150
9.3.3 Policies and practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .151
9.3.4 Roles and responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . .152
9.3.5 Engineering and environmental investigations. . . . . . . . . . .154
9.3.6 High-profile outbreaks . . . . . . . . . . . . . . . . . . . . . . . . . . . .156
9.4 Case studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .157
9.4.1 Community outbreak — England . . . . . . . . . . . . . . . . . . . .157
9.4.2 Nosocomial outbreak — Israel . . . . . . . . . . . . . . . . . . . . . .157
9.4.3 Hot tub outbreak — Austria . . . . . . . . . . . . . . . . . . . . . . . .158
9.4.4 Concrete batcher process on a construction site — UK . . . .159
Chapter 10 Regulatory aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .161
10.1 Existing guidelines and regulations for risk prevention . . . . . . . . . . .161
10.2 Legionella testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .162
10.3 Scope of regulations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .163
10.4 Designing regulations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .164
10.4.1 Managerial responsibilities, registration and notification . . .164
10.4.2 System assessment and design . . . . . . . . . . . . . . . . . . . . . . .164
10.4.3 Operational monitoring and verification . . . . . . . . . . . . . . .164
10.4.4 Documentation of management plans and record keeping . . .166
10.4.5 Surveillance and audit . . . . . . . . . . . . . . . . . . . . . . . . . . . . .166
10.4.6 Outbreak investigation and notification of disease . . . . . . . .167
10.5 Outbreak impact and economic consequences . . . . . . . . . . . . . . . . .167
LEGIONELLA AND THE PREVENTION OF LEGIONELLOSIS x