LEGIONELLA - World Health Organization

Chapter 7 Hotels and ships
Roisin Rooney, John V Lee, Sebastian Crespi, Guillaume Panie, Pierre Franck Chevet, Thierry Trouvet
and Susanne Surman-Lee
This chapter describes how a water safety plan (WSP) can be applied to assessing and managing
the risks associated with Legionella in hotels and ships.
It should be read in conjunction with Chapter 3, which discusses the different elements that
make up a WSP, and shows how a WSP fits within the framework for safe water quality
developed by the World Health Organization (WHO).
As explained in Chapter 3, a WSP has 10 steps that fit within the three main areas of system
assessment, monitoring and management and communications (see Figure 3.2). A WSP must
be comprehensive, and all 10 steps should be implemented in assessing and managing the
risks associated with Legionella. However, this chapter focuses on parts of the WSP where
information specific to hotels and ships is needed.
7.1 Background
The first detected outbreak of legionellosis occurred in a hotel in Philadelphia, United States
of America (USA) in 1976. Subsequently, many other cases of legionellosis have been associated
with hotels worldwide. Travel and hotel stays are recognized as risk factors for legionellosis
(WHO, 1990). In Europe, approximately 20% of detected legionellosis cases are considered
to be travel associated (Joseph, 2002b).
7.1.1 European initiatives
Most of the data currently available on the cases of legionellosis associated with travel and
hotel stays originate from the European Surveillance Scheme for Travel Associated Legionnaires’
Disease, established in 1987 by the European Working Group for Legionella Infections
(EWGLI). This system — now called EWGLINET — was established principally to enable
rapid identification of legionellosis outbreaks among tourists of different nationalities. Its
history and current activities are described in detail on the EWGLINET web site. 5 The need
for a specific surveillance system for travel-associated legionellosis in the USA has also been
recognized (Benin et al., 2002; Fields, Benson & Besser, 2002).
Cases of legionellosis occurring in hotels have often received extensive publicity in the mass media.
Additionally, the growing importance of international tourism, and the significance of morbidity
5 http://www.ewgli.org
LEGIONELLA AND THE PREVENTION OF LEGIONELLOSIS 0