LEGIONELLA - World Health Organization
LEGIONELLA - World Health Organization LEGIONELLA - World Health Organization
7.5 Surveillance Outbreaks could be detected at a very early stage on ships, if a routine surveillance system for respiratory illness were implemented and if procedures for taking action when the number of cases increases above a certain threshold were followed. As the incubation period of the disease could be longer than the length of a cruise, outbreaks could go undetected, even if the ship has a surveillance system in place. Thus, it is important for community physicians to enquire about recent cruise ship travel if patients present with symptoms of pneumonic illness. Routine surveillance by external authorities, such as through public health inspections of ships by environmental health officers, should also be conducted, to pre-empt disease outbreaks. LEGIONELLA AND THE PREVENTION OF LEGIONELLOSIS
Chapter 8 Natural spas, hot tubs and swimming pools Susanne Surman-Lee, Vladimir Drasar, John V Lee This chapter describes how a water safety plan (WSP) can be applied to assessing and managing the risks associated with Legionella in natural spas, hot tubs and swimming pools. 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 natural spas, hot tubs and swimming pools is needed. 8.1 Background Bathing has been recognized as a source of infectious disease for centuries; in the 16th century, it was thought that syphilis, plague and leprosy were linked to bathing, and many public pools were closed as a result. Today, there continue to be reports of outbreaks of infectious disease linked to swimming pools, but these can be avoided by: • good pool management, including adequate filtration and disinfection • bathers observing advice to shower before entering pools • bathers refraining from bathing if unwell with diarrhoeal disease. Immersion in water can be both pleasant and therapeutic, and various techniques have been used over centuries for a diverse range of physiological effects, such as healing injuries, reducing swelling and cooling burns, and for psychological effects, such as calming psychiatric patients (de Jong, 1997). The risk of Legionnaires’ disease from swimming pools, spas and hot tubs is low if they are well managed. This chapter covers swimming pools, spas and hot tubs; Box 8.1 explains what is meant by each of these terms. LEGIONELLA AND THE PREVENTION OF LEGIONELLOSIS
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7.5 Surveillance<br />
Outbreaks could be detected at a very early stage on ships, if a routine surveillance system for<br />
respiratory illness were implemented and if procedures for taking action when the number of<br />
cases increases above a certain threshold were followed. As the incubation period of the disease<br />
could be longer than the length of a cruise, outbreaks could go undetected, even if the ship<br />
has a surveillance system in place. Thus, it is important for community physicians to enquire<br />
about recent cruise ship travel if patients present with symptoms of pneumonic illness.<br />
Routine surveillance by external authorities, such as through public health inspections of ships<br />
by environmental health officers, should also be conducted, to pre-empt disease outbreaks.<br />
<strong>LEGIONELLA</strong> AND THE PREVENTION OF LEGIONELLOSIS
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