RESEARCH PAPER
Legionella risk assessment in cruise ships and ferries
More details
Hide details
1
Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
2
Ministry of Health, USM, Territorial Office of Messina, Sicily, Italy
Corresponding author
Pasqualina Laganà
Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
Ann Agric Environ Med. 2017;24(2):276-282
KEYWORDS
ABSTRACT
Introduction:
The increasing development of marine traffic has led to a rise in the incidence of legionellosis among travellers.
It occurs in similar environments, especially closed and crowded, and aboard ships Legionella survives and multiplies easily in water pipes, spreading into the environment through air conditioning systems and water distribution points. Although in recent years in the construction of cruise ships preventive measures aimed at curbing the proliferation of Legionella (design, materials, focus on the operation and maintenance of the water system), have been taken account, little or no attention has been paid to small ships which, in many cases, are old and not well maintained.
Objective:
The aim of the study was to evaluate the frequency and severity of Legionella contamination in ferries and cruise ships in order to adopt more specific control measures.
Material and Methods:
A prevalence study was carried out on 10 ferries and 6 cruise ships docking or in transit across the port of Messina (Sicily, Italy). Water and air samples collected from many critical points were tested for qualitative and quantitative identification of Legionella.
Results and conclusions:
Legionella pneumophila sg 1 was isolated from the samples of shower and tap water in 7 (70%) of the 10 ferries examined, and in 3 (33%) of the 6 cruise ships examined, and L. pneumophila sg 2–14 in 8 (80%) and 1 (16.7%) of these ships, respectively. No Legionella contamination was found in whirlpool baths, air and ice samples. In conclusion, the data obtained confirm higher levels of Legionella contamination in local ferries and cruise ships, underlining the need
to adopt corrective actions more specific for these smaller vessels.
REFERENCES (35)
1.
Passenger transport statistics. Data from July and October 2014. Most recent data: Further Eurostat information, Main tables and Database. Planned article update: October 2015.
http://ec.europa.eu/eurostat/s....
3.
Borges V, Nunes A, Sampaio DA, Vieira L, Machado J, Simões MJ, et al. Legionella pneumophila strain associated with the first evidence of person-to-person transmission of Legionnaires’ disease: a unique mosaic genetic backbone. Sci Rep. 2016; 6:26261.
4.
Centers for Disease Control and Prevention (CDC). Cruise-ship-associated Legionnaires disease, November 2003-May 2004. MMWR Morb Mortal Wkly Rep. 2005; 54(45):1153–5.
5.
Ahlén C, Aas M, Nor A, Wetteland PI, Johansen H, Sørbø T et al. Legionella pneumophila in Norwegian naval vessels. Tidsskr Nor Laegeforen. 2013; 133(14):1445–8.
6.
de Jong B, Payne Hallström L, Robesyn E, Ursut D, Zucs P, et al. Travel-associated Legionnaires’ disease in Europe, 2010. Euro Surveill. 2013; 18(23). pii: 20498.
7.
Guyard C, Low DE. Legionella infections and travel associated legionellosis. Travel Med Infect Dis. 2011; 9(4):176–86.
8.
Regan CM, McCann B, Syed Q, Christie P, Joseph C, Colligan J, et al. Outbreak of Legionnaires’ disease on a cruise ship: lessons for international surveillance and control. Commun Dis Public Health. 2003; 6(2):152–6.
9.
Castellani Pastoris M, Lo Monaco R, Goldoni P, Mentore B, Balestra G, Ciceroni L, et al. Legionnaires’ disease on a cruise ship linked to the water supply system: clinical and public health implications. Clin Infect Dis. 1999; 28(1):33–8.
10.
Rowbotham TJ. Legionellosis associated with ships: 1977 to 1997. Commun Dis Public Health. 1998; 1(3):146–51.
11.
Jernigan DB, Hofmann J, Cetron MS, Genese CA, Nuorti JP, Fields BS, et al. Outbreak of Legionnaires’ disease among cruise ship passengers exposed to a contaminated whirlpool spa. Lancet. 1996; 347(9000):494–9.
12.
Sedgwick J, Joseph C, Chandrakumar M, Harrison T, Lee J, de Jong B. Outbreak of respiratory infection on a cruise ship. Euro Surveill. 2007; 12(8): E070809.1.
13.
Beyrer K, Lai S, Dreesman J, Lee JV, Joseph C, Harrison T, et al. Legionnaires’ disease outbreak associated with a cruise liner, August 2003: epidemiological and microbiological findings. Epidemiol Infect. 2007; 135(5):802–10.
14.
Kobayashi A, Yamamoto Y, Chou S, Hashimoto S. Severe Legionella pneumophila pneumonia associated with the public bath on a cruise ship in Japan. J Anesth. 2004; 18(2): 129–31.
15.
Kruse EB, Wehner A, Wisplinghoff H. Prevalence and distribution of Legionella spp in potable water systems in Germany, risk factors associated with contamination, and effectiveness of thermal disinfection American Journal of Infection Control; 2015; 44(4): 470–474.
16.
Zbikowska E, Kletkiewicz H, Walczak M, Burkowska A. Coexistence of Legionella pneumophila Bacteria and Free-Living Amoebae in Lakes Serving as a Cooling System of a Power Plant. Water Air Soil Pollut. 2014; 225: 2066.
17.
Aaberge IS. Legionella bacteria in water supply systems. Tidsskr Nor Laegeforen. 2013; 133(14):1426.
18.
Stojek N, Dutkiewicz J. Legionella and other gram-negative bacteria in potable water from various rural and urban sources. Ann Agric Environ Med. 2006; 13(2):323–35.
19.
Laganà P, Caruso G, Piccione D, Pino R, Gioffrè ME, Delia S. Legionella spp., amoebae and not-fermenting Gram negative bacteria in an Italian university hospital water system Ann Agric Environ Med. 2014; 21(3): 489–493.
20.
Lau R, Maqsood S, Harte D, Caughley B, Deacon R. Prevalence of Legionella strains in cooling towers and legionellosis cases in New Zealand. J Environ Health 2013; 75(6):82–9.
21.
Kura F, Amemura-Maekawa J, Yagita K, Endo T, Ikeno M, Tsuji H et al. Outbreak of Legionnaires’ disease on a cruise ship linked to spa-bath filter stones contaminated with Legionella pneumophila serogroup 5. Watanabe H. Epidemiol. Infect. 2006; 134(2):385–91.
22.
Benkel DH, McClure EM, Woolard D, Rullan JV, Miller GB Jr, Jenkins SR et al. Outbreak of Legionnaires’ disease associated with a display whirlpool spa. Int J Epidemiol. 2000; 29(6):1092–8.
23.
Gambuzza ME. Environmental health and hygiene on the ships: biofilm control strategies. Shipsan Newletter. 2013; 5. Available from:
http://www.shipsan.eu/Home/New....
24.
Stewart CR, Muthye V, Nicholas P, Cianciotto P. Legionella pneumophila persists within biofilms formed by Klebsiella pneumoniae, Flavobacterium sp., and Pseudomonas fluorescens under dynamic flow conditions. Plos One. 2012; 7(11): e50560.
26.
Italian Guidelines for the prevention and control of legionellosis. Gazzetta Ufficiale della Repubblica Italiana, 2000; No.103, 5 May.
27.
Montagna MT, Cristina ML, De Giglio O, Spagnolo AM, Napoli C, Cannova L, et al. Serological and molecular identification of Legionella spp in water and surrounding air samples in Italian healthcare facilities. Environ Res. 2016; 146(4): 47–50.
28.
Montagna MT, De Giglio O, Napoli C, Cannova L, Cristina ML, Deriu MG, et al. Legionella spp. contamination in indoor air: preliminary results of an Italian multicenter study. Epidemiol Prev 2014; 38(6) Suppl 2: 62–65.
29.
Azara A, Piana A, Sotgiu G, Dettori M, Deriu MG, Masia MD et al. Prevalence study of Legionella spp. contamination in ferries and cruise ships. BMC Public Health. 2006; 6:100.
30.
Goutziana G, Mouchtouri VA, Karanika M, Kavagias A, Stathakis NE, Gourgoulianis K et al. Legionella species colonization of water distribution systems, pools and air conditioning systems in cruise ships and ferries. BMC Public Health BMC Public Health 2008; 24(8):390.
31.
Mouchtouri VA, Rudge JW. Legionnaires’ Disease in Hotels and Passenger Ships: A Systematic Review of Evidence, Sources, and Contributing Factors. J Trav Med. 2015; 22(5): 325–37.
32.
Caylà JA, Maldonado R, González J, Pellicer T, Ferrer D, Pelaz C et al. Legionellosis study group. A small outbreak of Legionnaires’ disease in a cargo ship under repair. Eur Respir J. 2001; 17(6):1322–7.
35.
Laganà P, Moscato U, Poscia A, La Milia D, Boccia S, Avventuroso E et al. The Geostatistics, tool applied to the distribution of Legionella pneumophila in a hospital water system. Ann Agric Environ Med. 2015; 22(4):749–754.