LEGIONELLA - World Health Organization

European guidelines
European guidelines for the control and prevention of travel-associated Legionnaires’ disease
came into use in July 2002. These guidelines, produced by EWGLI, were endorsed by the
European Commission in June 2003. The guidelines formalize the procedures for responding
to clusters of Legionnaires’ disease in the country of infection.
Within two weeks of the cluster alert, the collaborator in the country of infection is required
to inform the hotel, arrange for an immediate risk assessment, and arrange for control measures
to be implemented. Within six weeks, the results of a full environmental investigation must
be reported, including the results of any sampling that has taken place and information on
whether the hotel remains open or closed. If this information is not received within the
specified time, or control measures are found to be unsatisfactory, the name of the hotel associated
with the cluster is posted on the EWGLI web site, where it remains until the relevant information
is received at the coordinating centre.
The average number of cases in a travel-associated outbreak has declined in the past two years,
because of rapid and effective interventions by the participating countries.
International travel-associated outbreaks
Occasionally, countries will request international collaboration, as happened after travelassociated
outbreaks in Turkey (Joseph & Lee, 1996; Brand et al., 2000), Antigua (Hospedales
et al., 1996), Spain (Garcia-Fulgueiras et al., 2003) and elsewhere. Increasingly, more than
one country may participate in an investigation through exchange of clinical and environmental
specimens or sequence typing data from an outbreak (Joseph et al., 1996; Gaia et al., 2003).
International collaborations help to validate diagnostic tests and the microbiological association
between cases and sources of infection.
A major outbreak of legionellosis, particularly an outbreak considered to have international public
health importance, would warrant notification under the International Health Regulations
(2005) and, when requested, a WHO coordinated response, including support to the affected
country and information to alert other countries of a potential health threat.
9.3.4 Roles and responsibilities
The control team should have terms of reference that clarify the roles and responsibilities of
the relevant partner agencies and disciplines, and that cover all identified tasks. This is critical
to the smooth management of an outbreak. A sample checklist is given in Box 9.5, and
further information on some of these issues is given below.
LEGIONELLA AND THE PREVENTION OF LEGIONELLOSIS