01 June 1997
Travel associated legionellosis among European tourists in Spain - a comment from the EWGLI coordinating centre
Citation style for this article: Joseph C. Travel associated legionellosis among European tourists in Spain - a comment from the EWGLI coordinating centre . Euro Surveill. 1997;2(6):pii=156. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=156
Date of submission:
C A Joseph, PHLS Communicable Disease Surveillance Centre, London,
This interesting paper has analysed the data on cases of legionellosis
associated with travel to Spain and highlighted some issues which
are relevant to the European Working Group for Legionella Infections
(EWGLI) surveillance system, eg the reporting of cases with missing
information, particularly in the early years when the scheme first
started and the difficulty of interpreting data when information
is incomplete. EWGLI's software is currently being rewritten
to take account of further developments in the scheme and to include
improved methods for analysis. The new software will be distributed
to all centres later this year.
The authors argue that the names of hotels should be removed from
the database when there is no evidence to link them to a case
of legionnaires' disease. This issue has been raised in the past
and discussed at length at annual EWGLI meetings. The consensus
view of the group has been that such deletion of hotel names would
severely limit the scheme's ability to fulfil its objective of
detecting hotel outbreaks and clusters. The name and address of
any accommodation where a case stayed during the second to tenth
day before they became ill should remain on the database indefinitely.
The database is dynamic and includes travel histories of all
reported cases, not just hotels that have been epidemiologically
or environmentally implicated in an episode of legionella infection.
For single cases of legionnaires' disease (which make up the
majority of cases on the database) it is not recommended that
environmental investigations be carried out at the hotel of stay
unless the database shows that previous cases have stayed there.
The chance of the hotel being the source of infection increases
when two or more cases are known to have stayed there during the
ten days before becoming ill. Links can be made to hotels where
cases have stayed during their incubation period only if they
are on the database. Furthermore, pointing out to the country
concerned that more than one case has stayed at a particular hotel
over a period of time, strengthens the request of the collaborator
in that country that the hotel be investigated and its control
measures monitored. There are several examples on the database
of outbreaks occurring at particular hotels, investigations being
carried out and control measures applied, only to be followed
by further cases or outbreaks at the same hotel one or two years
later. Any subsequent cases are a measure of the success or otherwise
of control measures taken by individual hotels in tourist resorts.
The publication of this paper is timely and will encourage debate
of these issues when the EWGLI group next meets in June 1997.