LEGIONELLA - World Health Organization

More documents

Recommendations

Info

Table . Reported outbreaks of Leg onna res’ d sease related to hot tubs between 00 and 00 Year Country/sett ng Cases Source Notes 2002 Spain 2 H/CWS Spa centre 2002 Spain 4 H/CWS Spa centre 2002 Sweden 3 Hot tub Athletic club 2002 Sweden 23 Hot tub Hotel 2002 United Kingdom (England and Wales) 3 Hot tub 2002 Czech Republic 2 Hot tub Thermal water 2002 Spain 5 Hot tub Sports centre 2003 Cruise ship 7 Hot tub 2003 England and Wales 20 Hot tub Hotel health club 2003 Germany 7 Hot tub 2003 Sweden 2 Hot tub Hotel 2003 Spain 4 Not known An outbreak at a spa 2004 Jersey 2 Hot tub Holiday apartments 2004 Austria 3 Hot tub Trade fair H/CWS = hot/cold-water systems Source: European Working Group for Legionella Infections It is of some concern that hot tubs, particularly those intended for the domestic market, are commonly found on display at exhibitions and garden centres, where they have not been adequately treated. Just being in the vicinity of a hot tub on display has resulted in cases and deaths due to legionellosis. One of the largest ever outbreaks of Legionnaires’ disease, with 21 deaths, was caused by a hot tub on display at a flower show in the Netherlands in 1999 (Den Boer et al., 2002). In the same year, a second outbreak (in Belgium) was linked to a hot tub on display at a fair (De Schrijver et al., 2000). An outbreak of Pseudomonas folliculitis, which occurred within two weeks of the installation of a domestic hot tub, was found to be due to the hot tub having been on display before purchase, without appropriate treatment. On investigation, the pool water yielded 8 × 10 4 – 5.5 × 10 5 CFU/100ml Ps. aeruginosa and 2.9 x 10 5 CFU/litre L. pneumophila serogroups 2–14. Typing of the Ps. aeruginosa isolates from patients and pool showed they were indistinguishable. <strong>LEGIONELLA</strong> AND THE PREVENTION OF LEGIONELLOSIS
Rare cases of Legionnaires’ disease have been associated with birthing pool use (Franzin et al., 2001), and one where a spa pool was used as a birthing pool (Nagai et al., 2003) (see Chapter 6). Various other types of pool are available, such as flotation tanks and small vessels used for therapeutic use. There is no evidence to date of legionellosis associated with these but, as with any water system, the potential for Legionella growth within such systems and for aerosol production should be assessed, and an appropriate WSP put in place. This chapter addresses the risk from infections caused by legionellae in recreational waters. The risks to humans from other infectious diseases and chemicals is dealt with in the WHO Guidelines for Safe Recreational Water Environments, Volume 2 (WHO, 2006). 8.2 Water safety plan overview A WSP needs to be comprehensive; however, an overview of such a plan is shown in Table 8.2, as an example of the type of information a plan might contain. As explained in Chapter 3, a WSP is part of a framework for safe water quality that also includes health-based targets and surveillance. The remainder of this chapter provides information relevant to a WSP specific for natural spas, hot tubs and swimming pools, for each of the three main areas of a WSP: • system assessment (Section 8.3) • monitoring (Section 8.4) • communication and management (Section 8.5) • surveillance (Section 8.6). Sections 8.3–8.6 should be read in conjunction with Section 3.3 from Chapter 3. <strong>LEGIONELLA</strong> AND THE PREVENTION OF LEGIONELLOSIS
Page 1 and 2:
LEGIONELLA AND THE PREVENTION OF LE
Page 3 and 4:
LEGIONELLA AND THE PREVENTION OF LE
Page 5 and 6:
Foreword Legionellosis is a collect
Page 7 and 8:
Contents Foreword . . . . . . . . .
Page 9 and 10:
Chapter 5 Cooling towers and evapor
Page 11 and 12:
Chapter 9 Disease surveillance and
Page 13 and 14:
Tables Table 1.1 Main characteristi
Page 15 and 16:
Figure 8.1 Visible biofilm on inter
Page 17 and 18:
Acknowledgements The World Health O
Page 19 and 20:
• John Newbold, Health and Safety
Page 21 and 22:
Executive summary Legionellosis is
Page 23 and 24:
• Health-care facilities — Chap
Page 25 and 26:
Chapter 1 Legionellosis Britt Horne
Page 27 and 28:
Legionnaires’ disease is often in
Page 29 and 30:
1.1.2 Pontiac fever Symptoms Pontia
Page 31 and 32:
Table . Extrapulmonary nfect ons ca
Page 33 and 34:
Proteins produced by the body’s i
Page 35 and 36:
Aspiration may occur in patients wi
Page 37 and 38:
Table . R sk factors for Legionella
Page 39 and 40:
In the outbreak of Legionnaires’
Page 41 and 42:
Table . Potent al treatments for d
Page 43 and 44:
1.4.2 Species and serogroups associ
Page 45 and 46:
Other causes of infection In Europe
Page 47 and 48:
The interaction of virulent legione
Page 49 and 50:
1.5.2 Surface structures involved i
Page 51 and 52:
1.5.4 Host defence The host defence
Page 53 and 54:
Chapter 2 Ecology and environmental
Page 55 and 56:
L. pneumophila is thermotolerant an
Page 57 and 58:
2.2.3 Environmental factors and vir
Page 59 and 60:
Figure 2.1 Biofilm formation Biofil
Page 61 and 62:
2.4 Sources of Legionella infection
Page 63 and 64:
Chapter 3 Approaches to risk manage
Page 65 and 66:
Table . Cool ng tower outbreaks Fac
Page 67 and 68:
Even when a source reaches a state
Page 69 and 70:
The WSP should be prepared in conju
Page 71 and 72:
Identify control measures Control m
Page 73 and 74:
F gure . Dec mal reduct on t mes fo
Page 75 and 76:
Method Advantages D sadvantages Dos
Page 77 and 78:
Validate effectiveness of water saf
Page 79 and 80:
• clear statements of responsibil
Page 81 and 82:
Chapter 4 Potable water and in-buil
Page 83 and 84:
The remainder of this chapter provi
Page 85 and 86:
4.3.1 Document and describe the sys
Page 87 and 88:
Construction materials — risk fac
Page 89 and 90:
Where temperature controls (discuss
Page 91 and 92:
4.4.2 Monitor control measures This
Page 93 and 94:
Chapter 5 Cooling towers and evapor
Page 95 and 96: 5.1.1 Cross-flow cooling towers As
Page 97 and 98: water treatments (including chemica
Page 99 and 100: 5.3 System assessment This section
Page 101 and 102: Spray drift — risk factors Even w
Page 103 and 104: The section on control measures for
Page 105 and 106: • periodic or continuous bleed-of
Page 107 and 108: Box . Po nts to be noted when clean
Page 109 and 110: In certain circumstances, samples m
Page 111 and 112: Table . Example documentat on for m
Page 113 and 114: Chapter 6 Health-care facilities Ma
Page 115 and 116: For 1999 and 2000, a total of 384 c
Page 117 and 118: 6.3 System assessment This section
Page 119 and 120: Table . Type of colon zat on of wat
Page 121 and 122: 6.4.1 Identify control measures Thi
Page 123 and 124: 6.5.1 Prepare management procedures
Page 125 and 126: Until the situation is under contro
Page 127 and 128: Chapter 7 Hotels and ships Roisin R
Page 129 and 130: F gure . Detected and reported case
Page 131 and 132: Table . Rev ew of outbreaks (more t
Page 133 and 134: 7.2 Water safety plan overview WSPs
Page 135 and 136: The risk of legionellosis is increa
Page 137 and 138: Kingdom to 66% in Spain (Starlinger
Page 139 and 140: Agency, Legionella Section, United
Page 141 and 142: Given the complexity of distributio
Page 143 and 144: Chapter 8 Natural spas, hot tubs an
Page 145: Spas “Natural spa”, denotes fac
Page 149 and 150: Process step P pework Water n hot t
Page 151 and 152: Hosepipes may sometimes be used to
Page 153 and 154: Hot tubs that are not effectively d
Page 155 and 156: Nutrients — control measures Bath
Page 157 and 158: Various additives may also be used
Page 159 and 160: • descriptions of any significant
Page 161 and 162: Table . Examples of m crob olog cal
Page 163 and 164: Chapter 9 Disease surveillance and
Page 165 and 166: Exposure histories allow cases to b
Page 167 and 168: F gure . Invest gat ng a s ngle cas
Page 169 and 170: Box . (cont nued) Since the incepti
Page 171 and 172: Country United Kingdom All reported
Page 173 and 174: F gure . Annual reported cases, - 0
Page 175 and 176: Training opportunities Trainees in
Page 177 and 178: Box . Example of terms of reference
Page 179 and 180: ecause doing anything more could un
Page 181 and 182: 9.4 Case studies This section descr
Page 183 and 184: 9.4.4 Concrete batcher process on a
Page 185 and 186: Chapter 10 Regulatory aspects David
Page 187 and 188: • validation of the effectiveness
Page 189 and 190: • operating conditions, such as t
Page 191 and 192: 10.4.6 Outbreak investigation and n
Page 193 and 194: hot water (e.g. health-care facilit
Page 195 and 196: General prevent on Country DW Wp SB
Page 197 and 198:
Country General prevent on DW Wp SB
Page 199 and 200:
Chapter 11 Laboratory aspects of Le
Page 201 and 202:
• detection of the bacterium in t
Page 203 and 204:
Method Sens t v ty (%) PCR • Rapi
Page 205 and 206:
11.2.2 Detecting Legionella antigen
Page 207 and 208:
DFA has been used successfully with
Page 209 and 210:
• Serologic testing can be used f
Page 211 and 212:
Although not all strains can be rel
Page 213 and 214:
Generally, any water source that ma
Page 215 and 216:
During outbreak investigations, swa
Page 217 and 218:
• other Legionella species that d
Page 219 and 220:
Appendix 1 Example of a water syste
Page 221 and 222:
Weekly water system check list Week
Page 223 and 224:
Appendix 2 Example of a 2-week foll
Page 225 and 226:
Travel Work/travel in the UK: ❑ Y
Page 227 and 228:
Checklist of local places Health/sp
Page 229 and 230:
Appendix 3 Example of a national su
Page 231 and 232:
Strictly Confidential 2 Hospital Ac
Page 233 and 234:
Glossary aerobic bacteria Bacteria
Page 235 and 236:
health-care acquired Legionellosis
Page 237 and 238:
surveillance The process of systema
Page 239 and 240:
References Abu KY, Eisenstein BI, E
Page 241 and 242:
Barbaree JM et al. (1987). Protocol
Page 243 and 244:
Blatt SP et al. (1994). Legionnaire
Page 245 and 246:
Byrne B, Swanson MS (1998). Express
Page 247 and 248:
Crespi S (1993). Legionella y legio
Page 249 and 250:
Edelstein PH (1982b). Comparative s
Page 251 and 252:
Falguera M et al. (2001). Nonsevere
Page 253 and 254:
Gaia V et al. (2003). Sequence-base
Page 255 and 256:
Hayden RT et al. (2001). Direct det
Page 257 and 258:
Ingram JG, Plouffe JF (1994). Dange
Page 259 and 260:
Ko KS et al. (2003). Molecular evol
Page 261 and 262:
Loret JF et al. (2003). Comparison
Page 263 and 264:
McEvoy M et al. (2000). A cluster o
Page 265 and 266:
Olaechea PM et al. (1996). A predic
Page 267 and 268:
Regan CM et al. (2003). Outbreak of
Page 269 and 270:
Schulze-Robbecke R, Rodder M, Exner
Page 271 and 272:
Surman SB, Morton LHG, Keevil CW (1
Page 273 and 274:
Tully M, Williams A, Fitzgeorge RB
Page 275 and 276:
Welti M et al. (2003). Development
show all

LEGIONELLA - World Health Organization

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?