LEGIONNAIRES` DISEASE
SPANISH HOTELS
September 28th 2000
The Dutch newspaper NRC Handelsblad has published a list of European hotels and other tourist
accommodations, which have recently suffered outbreaks of legionnaires' disease. Not surprisingly, the
publication of the list has also had diplomatic repercussions. In particular it upset the Greek government, who
claim the disclosure contravenes competition rules within the EU: French, Greek, Spanish and Turkish hotels
figure prominently in that list. For its part the Dutch government was compelled to release this data under a
public information law, which states that if two or more individuals are harmed while staying in commercially
operated accommodation, and one of those individuals is Dutch, the public have a right to know.
The Handelsblad has augmented the list with other information drawn from EWGLI, the European Working Group for Legionella Infections.
Legionella bacteria are carried by tiny water droplets (e.g. in air-conditioning systems, showers, swimming
pools etc.), and are most likely to cause infection when inhaled at temperatures ranging between 20° and
45°C and in the presence of sludge, scale, algae and organic matter. Although outbreaks are relatively rare,
they tend to occur in areas where people congregate, such as hotels, hospitals and offices etc. Indeed,
according to EWGLI statistics, the number of incidents in many European countries increased in recent years:
approximately 2000 cases have been reported since 1987.
Fariones Apartments and Hotel, Puerto del Carmen,
Lanzarote (2000).
Bermudas Apartments, Benidorm (2000).
Motel Picon del Conde, Monasterio de Rodilla (2000).
Bermudas Apartments, Benidorm (2000).
Hotel Victora, Rosas (2000).
Hotel Pionerp, Santa Ponsa, Mallorca (2000).
La Brujula Hotel, Monasterio de Rodilla, Castille y Leon
(2000).
Hotel Cambrills Princess, Salou (1997).
Cye Hotel, Salou (1995).
Estrella Del Mar, Alcudia, Mallorca (2000).
Hotel Fiësta Park, Benidorm (1998).
Hotel Nautilus, Rosas (1999).
Presidente Hotel, Benidorm (1998).
Rey Don Jaime, Santa Ponsa, Mallorca (2000).
Hotel Tropic Parc, Malgrat de Mar (1997).
OUTBREAK OF LEGIONNAIRES' DISEASE IN SPAIN
Jan. 23 /98
Eurosurveillance Weekly
Three cases of legionnaires' disease in tourists who all stayed at the same hotel in Benidorm, Spain have been reported to the surveillance scheme of the European Working Group on Legionella Infections (EWGLI).
Two of the cases were British and one was Dutch. The cases (one man and two women aged
between 46 and 67 years) became ill on 20th December, 29th December 1997, and 3rd
January 1998. One case has died and the other two remain ill.
Legionella pneumophila serogroup 1 has been diagnosed by culture from all
three cases and also by urinary antigen detection from two of the cases.
The hotel has around 350 rooms and is used mainly by tour operators from
Britain and northern Europe.
Seven other cases of legionnaires' disease have been linked to the hotel in previous years; three in 1989, one in 1990, two in 1995, and one in 1996.
The PHLS Communicable Disease Surveillance Centre (CDSC) in London reported the current outbreak to the
Federation of Tour Operators and the Association of Travel Agents, who informed tour operators (1). On 16 January, all major British and Dutch
tour operators agreed to withdraw their clients from the hotel until investigations and control measures have been implemented by the local
health authorities in Spain.
On 20th January, an environmental investigation of the hotel was carried out
by local health authorities. Samples from the hot and cold water supplies
and the air conditioning system were taken for the detection of legionellas. Control measures were implemented.
EWGLI would be grateful to receive information on other cases of legionnaires disease that might be associated with this outbreak.
Please contact Carol Joseph, EWGLI coordinator, at CDSC.
References:
1. Joseph CA, Harrison TG, Ilijic-Car D, Bartlett CLR. Legionnaires
disease in residents of England and Wales: 1996.
Comm Dis Rep CDR Rev 1997; 7: R153-9
Reported by Carol Joseph (cjoseph@phls.co.uk) on behalf of the European
Working Group on Legionella Infections (EWGLI)
European holiday resorts at risk for Legionella
Hundreds of hotels and holiday apartments in Europe are known to be high-risk buildings for
Legionella infection, but this information is kept secret by European health authorities, according to the Dutch newspaper NRC Handelsblad in a story published on Sept
21st. During the past 5 years the newspaper reports that 12 000 European tourists have been infected with Legionella pneumophila at holiday resorts across Europe and an estimated 1200 have died.
The newspaper gained access to data collected by the European Working Group on Legionella Infections
(EWGLI). EWGLI is a consortium of epidemiologists, microbiologists, and national health authorities, funded by the European Union (EU) and based in London.
One of the main activities of its 35 collaborating centres in 31 European countries is a surveillance scheme to monitor all cases of travel-associated legionnaires' disease occurring in European nationals.
During the past 5 years EWGLI received 1200 reports of Legionella infections in 31 countries.
According to Carl Joseph, coordinator of EWGLI in London, who was interviewed by the newspaper, the actual number of infections is ten times higher, "than research in UK and the US has shown", he says. "It is known that 10% of infected patients die, making the annual number [of fatal cases in European tourists] 240", he explains.
EWGLI data shows that some hundred hotels and holiday apartments, mainly in southern Europe, have been linked to multiple outbreaks of Legionella during the past few years.
The identity of these facilities remains unknown by special request of the southern European countries.
According to a spokesman from EWGLI, "These countries resist publication, anonymity is their condition for co-operation with EWGLI". Nine European countries, however, do notify their national travel industry
organisation. Research by the newspaper, however, has shown that not all travel
organisations, after being warned, stopped booking suspect hotels.
The Dutch Health Inspection has now announced that it will no longer accept that Dutch tourists are unknowingly accommodated in at-risk holiday resorts. Names of hotels which are unable to contain their Legionella problem within 4 weeks of an outbreak will be made public on the EWGLI website.
| España encabeza una lista de
hoteles con legionella
Varios hoteles españoles figuran en una lista negra de establecimientos turísticos europeos que, en más de una ocasión, han sufrido infecciones de legionella. Esta bacteria ha causado la muerte de unos 1.200 turistas en los últimos cinco años. La lista, que hasta ahora ha sido mantenida en secreto por las autoridades sanitarias de todos los países implicados, será publicada el próximo mes de octubre en Internet por el Ministerio de Sanidad de Holanda. Con ella se quiere avisar a los turistas sobre el peligro que podría correr su salud en estos hoteles.
La Inspección de la Salud, que depende del Ministerio de Sanidad holandés, ha decidido denunciar públicamente a todos los hoteles, la mayoría de los cuales se encuentran en los países mediterráneos, para romper el silencio administrativo y evitar que sigan produciéndose tantos casos. En Londres, el denominado Grupo de Trabajo Europeo para Infecciones de Legionella (EWGLI) registra los datos que le son proporcionados por las autoridades de 31 países. En los últimos cinco años, sólo se ha informado de 1.200 casos de legionella en estos países. Pero según los cálculos de este organismo se podría multiplicar esta cifra por 10. Y de las 12.000 infecciones de legionella, un 10% habrían provocado la muerte del paciente. Según un reportaje publicado este fin de semana en el periódico holandés NRC Handelsblad , el EWGLI recibió el año pasado 288 notificaciones oficiales de legionella. La lista fue encabezada por España, con 51 casos, seguida por Italia (41), Francia (39), Grecia (21), Turquía (19) y Portugal (6). El EWGLI fue fundado a finales de los años 80 por científicos que intercambiaban información sobre la legionella. En los últimos años ha sido profesionalizado con ayuda económica de la Comisión Europea, aunque no le llega toda la información necesaria.
Incidentes repetidos Según las autoridades holandesas, en unos 100 hoteles europeos la infección no ha sido un incidente aislado, sino que se ha repetido más de una vez. Estos establecimientos podrían tener problemas en sus conductos de agua o de aire acondicionado, ya que éstos suelen ser los causantes de la propagación de la bacteria de legionella. Los grandes turoperadores en Holanda conocen exactamente el nombre de los hoteles que se encuentran en la lista negra, pero no informan a sus clientes de este tipo de datos. Con la divulgación por Internet de los nombres y direcciones del centenar de hoteles afectados, el Ministerio de Sanidad de Holanda corre el riesgo de que los propietarios los denuncien. Cuando se fundó el EWGLI, todos los países se comprometieron a no hacer públicos los nombres de los establecimientos, para que éstos no tuvieran miedo de informar fielmente de casos sobre legionella.
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English Translation of the above article |
THE NEWSPAPER
| TOURISM Spain heads a list of hotels with legionella
Several Spanish hotels appear in a black list of European tourist establishments that, in more than an occasion, have undergone infections of legionella. This bacterium has caused to the death of about 1,200 tourists in the last five years. The list, that until now has been maintained privily by the sanitary authorities of all the implied countries, will be published the next month of October in Internet by the Ministry of Health of Holland. With her it is wanted to warn the tourists on the danger that could run its health in these hotels.
The Inspection of the Health, that depends on the Dutch Ministry of Health, has decided to denounce publicly to all the hotels, most of which they are in the Mediterranean countries, to break administrative silence and to avoid that they continue taking place so many cases. In London, the denominated European Work group for Infections of Legionella (EWGLI) registers the data that are provided to him by the authorities of 31 countries. In the last five years, one has only inquired into 1,200 cases of legionella in these countries. But according to the calculations of this organism this number by 10 could be multiplied. And of the 12,000 infections of legionella, a 10% would have caused the death of the patient. According to a published news article east weekend in Dutch newspaper NRC Handelsblad , the EWGLI received the last year 288 official notifications of legionella. The list was headed by Spain, with 51 cases, followed by Italy (41), France (39), Greece (21), Turkey (19) and Portugal (6). The EWGLI was founded at the end of years 80 by scientists who interchanged information on legionella. In the last years it has been professionalized with economic aid of the European Commission, although it does not get all the necessary information to him. Repeated incidents According to the Dutch authorities, in about 100 European hotels the infection has not been an isolated incident, but that has been repeated more of once. These establishments could have problems in their conditioned air or water conduits, since these usually are the causes of the propagation of the bacterium of legionella. The great turoperadores in Holland exactly know the name the hotels that are in the black list, but do not inform to their clients of this data type. With the spreading by Internet of the names and directions of the hundred of affected hotels, the Ministry of Health of Holland runs the risk of which the proprietors denounce them. When the EWGLI was based, all the countries were committed not to make public the names of the establishments, so that these were not scared to inform faithfully into cases on legionella.
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