LEGIONELLA - World Health Organization

Tables
Table 1.1 Main characteristics of Legionnaires’ disease and Pontiac fever . . . . . . . . . . .2
Table 1.2 Extrapulmonary infections caused by Legionella species. . . . . . . . . . . . . . . . .7
Table 1.3 Useful definitions for epidemiological monitoring . . . . . . . . . . . . . . . . . . . .8
Table 1.4 Category of European cases, 1994–2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Table 1.5 Risk factors for Legionella infection, by category . . . . . . . . . . . . . . . . . . . . .12
Table 1.6 Risk factors for Legionella infection, by reservoir . . . . . . . . . . . . . . . . . . . . .13
Table 1.7 Risk exposures among Legionnaires’ disease declared cases in
France, 1999–2002 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
Table 1.8 Potential treatments for different patient groups . . . . . . . . . . . . . . . . . . . . .17
Table 1.9 Legionella species and serogroups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
Table 3.1 Cooling tower outbreaks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41
Table 3.2 Advantages and disadvantages of alternative methods for controlling
Legionella in piped water systems and cooling towers . . . . . . . . . . . . . . . . .50
Table 3.3 Examples of microbiological quality monitoring and action level
specifications for cooling water systems . . . . . . . . . . . . . . . . . . . . . . . . . . . .52
Table 4.1 Example of a water safety plan for potable water and in-building
distribution systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59
Table 4.2 Examples of health-based targets for Legionella in piped water systems . . . .60
Table 4.3 Examples of values used as levels for corrective action for Legionella
in piped water systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68
Table 4.4 Example of documentation for monitoring and corrective action . . . . . . . .68
Table 5.1 Water safety plan overview — cooling towers and evaporative condensers . . . .74
Table 5.2 Example documentation for monitoring and corrective action . . . . . . . . . .87
Table 6.1 Water safety plan overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .92
Table 6.2 Examples of system components to be considered in system
assessment and subsequent hazard analysis in health-care facilities . . . . . . .93
Table 6.3 Type of colonization of water distribution systems by Legionella
in health-care facilities in Germany . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .95
LEGIONELLA AND THE PREVENTION OF LEGIONELLOSIS x