Food Poisoning – e.g. Salmonella, Dysentery, SRSV, Norovirus
Other communicable diseases such as Bilharzia, Leishmaniasis, Typhoid, Cholera, Avian Flu etc
Useful websites on health issues overseas are:
Foreign Office Travel advice: www.fco.gov.uk
National Travel Health Network and Centre: www.nathnac.org
Department of Health: www.dh.gov.uk
Health Protection Agency: www.hpa.org.uk
World Health Organisation: www.who.int
Legionnaires’ disease is a potentially fatal form of pneumonia, approximately 40 species of legionella have been identified, but Legionella pneumophilia causes 90 % of cases. There are also forms of legionellosis which do not result in pneumonia, such as Pontiac Fever.
Legionella bacteria are commonly found in environmental water sources such as rivers, lakes and reservoirs, usually in low numbers. They may then go on to colonise water systems and may be found in hot and cold water systems, cooling towers/air conditioning systems and other areas used to store and cool water.
The main source of infection within a hotel or hostel is the hot water system. Exposure to the bacteria can happen during showering or from spray from taps. Other potential sources are air conditioning systems, ornamental fountains and other water features.
The bacteria survive best in water temperatures of between 20 deg celcius to 45 deg celcius, with the optimum growth temperature being 37 deg celcius. The bacteria does not appear to grow below 20 deg celcius although they can remain dormant in cool water and start to multiply again if the temperature rises. The organism is heat sensitive and will not survive above 60 deg celcius.
Legionella also require nutrients to multiply and these include algae, amoebae and other bacteria. The presence of sludge, sediment, scale and biofilms all help to provide favourable conditions for growth.
Legionnella is affected by biocides and can be destroyed by effective use of chemicals such as chlorine.
Legionella cannot be spread from person to person, it is normally contracted by inhaling legionella bacteria in tiny droplets of water (aerosols), from showers, air-conditioning units and sometimes from taps.
There are certain groups who are at higher risk of contracting legionella and these include men rather than women, especially young people or those aged over 45, anyone with chest or respiratory problems or those who have other conditions which lower their immune system.
The incubation period is between 2 – 10 days (usually 3 – 6 days).
Initial symptoms of legionnaire’s disease include high fever, chills, headache and muscle pain. Those affected may also develop a dry cough and suffer difficulty with breathing. Other symptoms which may appear are vomiting and diarrhoea and signs of confusion or delirium.
Infection can be fatal, with approximately 12% fatality rate in reported cases.
Not everyone exposed will develop full blown symptoms, sometimes it may appear as a mild flu like infection.
The disease is usually diagnosed by a combination of tests. Testing previously took weeks before results were confirmed but new methods have resulted in this being reduced to days.
Legionnaire’s disease can be treated with antibiotics. As the disease is not spread from person to person, those in close contact with the patient are not usually treated with antibiotics, but they should be advised about the symptoms in case they too have been infected by the source.
Legionella can be controlled and proliferation prevented by:-
Avoiding water temperatures between 20 deg C and 45 deg C
Avoiding water stagnation which may encourage the growth of biofilms
Using a suitable water treatment programme i.e. chlorination
Ensuring the system is well maintained and operates safely and correctly
Notification of suspected or confirmed cases:-
Notification is likely to come from the communicable disease surveillance centre after diagnosis is made on return to the UK
Accommodation noted in suspected or confirmed cases is not necessarily the source, but investigation / action is required.
In Europe, the names of properties linked to Legionella cases are posted on the EWGLI (European Working group for Legionella Infection) website for public access under SITE UPDATES. They remain there until the property has proven that action has been taken to eradicate the presence of the bacteria.
Suppliers should be made aware of the need for Legionella prevention systems.
If we are advised of a case affecting our customers then we can issue the supplier with a copy of the attached 14 Point Plan for reducing the risk of legionnaire’s disease in the first instance
If we are aware of 2 or more cases (a cluster) affecting an accommodation, then we will discontinue use until such time as the property is given the all clear.
LEGIONELLA CONTROL - 14 POINT PLAN
GUIDELINES FOR HOTELS, HOSTELS AND TOURIST ACCOMMODATION
Have one named person responsible for legionella control.
Ensure the named person is trained in control of legionella and other staff are trained to be aware of the importance of their role in controlling legionella
Keep hot water hot and circulating at all times: 50°C - 60°C (too hot to put hands into for more than a few seconds)
Keep cold water cold at all times. It should be maintained at temperatures below 20°C (this may not be possible when the ambient temperature is high, but every effort should be made to ensure that cold water entering a property remains as cold as possible)
Run all taps and showers in any rooms for several minutes at least once a week if they are unoccupied and always prior to occupation.
Keep shower heads and taps clean and free from scale
Clean and disinfect cooling towers and associated pipes used in air conditioning systems regularly - at least twice a year
Clean and disinfect water heaters (calorifiers) once a year
Disinfect the hot water system with high level (50mg/l) chlorine for 2-4 hours after work on water heaters and before the beginning of every season
Clean and disinfect all water filters regularly - every one to three months
Inspect water storage tanks, cooling towers and visible pipe work monthly. Ensure that all coverings are intact and firmly in place
Inspect the inside of cold water tanks at least once a year and disinfect with 50mg/l chlorine and clean if containing a deposit or otherwise dirty
Ensure that system modifications or new installations do not create pipework with intermittent or no water flow
If there is a spa pool (also known as whirlpool spas, "Jacuzzis", spa baths) ensure that:
It is continuously treated with 2-3mg/l chlorine or bromine and the levels are monitored at least three times a day
At least half of the water is replaced each day
Sand filters are backwashed daily
The whole system is cleaned and disinfected once a week
Daily records of all water treatment readings such as temperature and chlorine concentrations are kept and ensure they are checked regularly by the manager.
Meningitis is an inflammation of the meninges, the lining surrounding the brain and spinal cord. It can be either bacterial meningitis or viral meningitis, bacterial being the more serious and potentially fatal form.
Bacterial meningitis lives in the nose and throat, approximately 1 in 10 people carry the bacteria with no adverse effects, occasionally the bacteria may overcome the body’s defences to cause meningitis.
The bacteria cannot survive outside the body and CANNOT be transmitted via swimming pools, towels, bed linen, surfaces, cutlery or crockery. Simply being in the same building, aircraft or ship as an infected person does not increase the risk of catching the disease unless there has been close contact.
The bacteria can be passed from person to person, but it has to be very close contact so usually the only people considered to be at risk are the immediate family and “kissing” contacts.
The most susceptible age ranges are below 5, teenagers and the elderly.
Bacterial meningitis can be fatal or can result in long term disabilities such as deafness or brain damage if the condition is not diagnosed and treated quickly.
Viral meningitis can also survive in sewage contaminated water so in addition to close family and kissing contacts, it can be passed via contaminated water. It is killed by chlorine, so swimming pools which are chlorinated to the correct levels should be free from the virus.
Viral meningitis usually has less severe symptoms and consequences than bacterial meningitis, it is only fatal in exceptional cases.
There is no greater risk of contracting bacterial or viral meningitis overseas than in the UK
Bacterial Meningitis has an incubation period of 2 – 10 days.
Viral Meningitis has an incubation period of up to three weeks.
Bacterial meningitis symptoms can include some or all of the following:-
Once diagnosed, the patient should be isolated until medical clearance is given.
If an incident or outbreak has occurred then close family members or those in “kissing” contact may be given a course of preventative antibiotics.