LEGIONELLA - World Health Organization

Table 6.4 Example of documentation for verification and corrective action
for a water system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .102
Table 7.1 Review of outbreaks (more than one case) of Legionnaires’
disease associated with ships, 1977–2004 . . . . . . . . . . . . . . . . . . . . . . . . .107
Table 8.1 Reported outbreaks of Legionnaires’ disease related to hot tubs
between 2002 and 2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .122
Table 8.2 Example of a water safety plan overview for a hot tub (commercial context) . . .124
Table 8.3 Example of documentation for monitoring and corrective action . . . . . . .135
Table 8.4 Examples of microbiological guidelines in legislation and/or
guidance for hot tub water quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .137
Table 9.1 Dataset for surveillance of legionellosis . . . . . . . . . . . . . . . . . . . . . . . . . . .141
Table 9.2 Reported cases of Legionnaires’ disease in Europe, 1993–2004 . . . . . . . . .145
Table 9.3 Data on Legionnaires disease from 33 countries, 2004 . . . . . . . . . . . . . . .146
Table 10.1 Selected European regulations developed for the control of
Legionella in water systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .170
Table 11.1 Comparison of methods for laboratory diagnosis of Legionnaires’ disease . . .178
Table 11.2 Examples of environmental sites for sampling for legionellae . . . . . . . . . .189
Figures
Figure 1.1 Life-cycle of Legionella pneumophila in protozoa and human macrophages . . .23
Figure 1.2 Acanthamoeba polyphaga isolated from a source implicated
in an outbreak of Legionnaires’ disease . . . . . . . . . . . . . . . . . . . . . . . . . . . .26
Figure 2.1 Biofilm formation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35
Figure 3.1 Framework for safe drinking-water . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39
Figure 3.2 Overview of the key steps in developing a water safety plan . . . . . . . . . . . .44
Figure 3.3 Decimal reduction times for L. pneumophila serogroup 1
at different temperatures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49
Figure 5.1 Configuration of typical cooling towers and evaporative condensers . . . . . .70
Figure 7.1 Detected and reported cases of travel-associated Legionnaires’
disease in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .105
x v LEGIONELLA AND THE PREVENTION OF LEGIONELLOSIS