Abstract
Hotel water systems colonized with Legionella spp. have been the source of travel-associated Legionnaires’ disease, and cases, clusters and outbreaks continue to be reported worldwide each year. A total of 132 hotels linked with travel-associated Legionnaires’ disease, as reported through the European Legionnaires’ Disease Surveillance Network, were inspected and tested for Legionella spp. during 2000–2019 by the public health authorities of the island of Crete (Greece). A total of 3311 samples were collected: 1885 (56.93%) from cold water supply systems, 1387 (41.89%) from hot water supply systems, 37 (1.12%) were swab samples and two (0.06%) were soil. Of those, 685 (20.69%), were collected from 83 (62.89%) hotels, testing positive (≥50 CFU/L) for Legionella pneumophila) serogroups 1–10, 12–14 and non-pneumophila species (L. anisa, L. erythra, L. tusconensis, L. taurinensis, L. birminghamensis, L. rubrilucens, L. londiniesis, L. oakridgensis, L. santicrusis, L. brunensis, L. maceacherii). The most frequently isolated L. pneumophila serogroups were 1 (27.92%) and 3 (17.08%). Significantly higher isolation rates were obtained from hot water supply systems (25.96%) versus cold water systems (16.98%) and swab samples (13.51%). A Relative Risk (R.R.) > 1 (p < 0.0001) was calculated for hot water temperature <55 °C (R.R.: 4.43), chlorine concentrations <0.2 mg/L (R.R.: 2.69), star ratings <4 (R.R.: 1.73) and absence of Water Safety Plan implementation (R.R.: 1.57).
Highlights
Hotel water systems can be colonized with Legionella spp. and can serve as a source for travel-associated Legionnaires’ disease (TALD) [1]
Public health authorities in Crete conduct an inspection, including risk assessment and water sampling, each time a case, cluster or outbreak is reported through ELDSNet among tourists who have stayed in a hotel in Crete
Our study demonstrated that approximately 63% of the hotels which were inspected following a Legionnaires’ disease case notification were found to be colonized with Legionella spp
Summary
Hotel water systems can be colonized with Legionella spp. and can serve as a source for travel-associated Legionnaires’ disease (TALD) [1]. The. European Legionnaires’ Disease Surveillance Network (ELDSNet) at the European Center for Disease Prevention and Control (ECDC) conducts surveillance of Legionnaires’ disease at the European Union level. Public health authorities in Crete conduct an inspection, including risk assessment and water sampling, each time a case, cluster or outbreak is reported through ELDSNet among tourists who have stayed in a hotel in Crete. The public health authorities, through ELDSNet, provide details about the actions taken in accordance with the operating procedures [1]. A total of 1657 cases of TALD with a date of onset in 2019 were reported to ECDC by
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