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Background |
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On
1 July 2002 EWGLI introduced a new set of procedures for
responding to cases of travel associated legionnaires’
disease in all the participant countries. On 2 June 2003
an amended and updated edition of the guidelines was approved
and endorsed as an official document by the EU Committee
for the Epidemiological Surveillance and Control of Communicable
Diseases in the Community, instituted by Decision No 2119/98/EC
of the European Parliament and the Council. |
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A
new version dated January 2005 has now been posted on the
website. It contains revisions to Part 2, the most important
of which is the addition of an extra paragraph (no.24) which
outlines procedures for dealing with requests for information
from legal representatives and others involved in litigation
or compensation claims. A revision of the technical parts
of the guidelines is underway and it is hoped this will
be completed during 2006. |
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The
guidelines outline a standard approach to control and prevention
of travel associated Legionnaires' Disease across all European
countries. Parts 1 and 2 explain how the reporting and response
procedures for clusters of cases should now operate within
Europe. Parts 3 and 4 of the guidelines are very technical
and are written for engineers and people involved with maintenance
of water systems in hotels and other buildings. |
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How
information on clusters is managed under the new procedures |
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The
reporting and action procedures apply to legionella infections
acquired in European Union countries and other European
countries that have adopted the guidelines. Details of countries
using the guidelines can be found by viewing the list of
collaborators. |
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Countries
using the guidelines should rapidly respond to clusters
(two or more cases who stayed at the same accommodation
site within two years of each other) in a standardised way.
The EWGLINET collaborator in the country of infection should
arrange for the accommodation site to be urgently visited
and inspected for any obvious technical problems that might
be associated with the reported infection. At the same time
the accommodation site should have immediate measures taken
to ensure any risks from legionella bacteria in the water
system are minimised. |
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These
actions should be undertaken and reported back to the co-ordinating
centre in London within two weeks of the cluster report
to the country of infection. |
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If
the report is not received at the co-ordinating centre in
London, no judgement can be made about whether the hotel
has been assessed as a possible or probable health risk
to tourists. If this situation arises, the name of the hotel
will be made available in the Site
Updates section. The hotel's name will also
be disclosed if a report is received that says the hotel
remains open but that control measures are unsatisfactory
or have not been carried out. The website will explain which
reason accounts for the hotel name being made public. |
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The
guidelines also state that a more extensive investigation
should then be carried out at the accommodation site. This
will take longer to do and should include information on
whether water sampling for legionella was carried out, what
the results were and that control measures are satisfactory.
Collaborators are given a further four weeks to organise
this and report their results to the centre in London. |
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Again,
if the report is not received at the centre in London within
the allocated time period, no assessment is possible as
to whether the hotel's water system is a health risk to
the people going there. In this situation the name of the
hotel will be placed in the Site
Updates section. |
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The
hotel's name will also be made public if the hotel remains
open, and inadequate or incomplete control measures and
investigations were reported. The reason for publicity on
the website will be given. The hotel's name will be taken
off the website when it is reported that control measures
are satisfactory and any risk of legionella infection has
been minimised. |
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Your
travel plans and the public naming of hotels |
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The
published information will assist tourists to assess any
health risks that may be associated with their planned journey.
However, its important to keep any risk in perspective because
the risk of getting legionnaires' disease for most people
is extremely small. Thousands of people may stay at a hotel
during its high season and only one or two cases of legionnaires'
disease may be associated with staying there. There are
several factors to consider that may raise or lower the
risk for individuals: |
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1.
The age group and sex of people going to the hotel. Legionnaires'
disease mainly affects people in the older age groups and
men are about three times more likely to get ill than women.
Young families are less likely to be at risk and the disease
is almost unheard of in children. Smokers are at a higher
risk of the disease than non-smokers. |
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2.
The date of the booking in relation to the cluster alert.
If a booking has been made for several weeks or months after
the report of the cluster, the chances are that any potential
health risks will have been resolved before the holiday
occurs. The hotel name will only stay on the website until
the centre receives a report indicating that the local health
authorities have investigated the hotel and that they are
satisfied that the necessary precautions have been taken.
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3.
The possibility that the association of two or more cases
at one hotel could have arisen by chance and the hotel may
not be related to any health risk. Firstly, the cases in
the cluster alert may all have visited a site elsewhere
where they became infected. Secondly, as more and more people
take holidays that involve short stays at several different
hotels it is inevitable that at some time, the same hotels
will appear on different itineraries used by individual
cases. These hotels will still be investigated under the
two week and six week procedure but may have nothing to
do with the cluster. |
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4.
An alternative hotel may also carry an unrecognised risk
of legionnaires' disease. It should be recognised that all
hotels have a risk of legionnaires' disease but this can
be reduced by effective legionella control programmes. |
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