On 1 July 2002 new European guidelines1, under which the European Working Group for Legionella Infections (EWGLI) will operate, were introduced, as was a new identity for the scheme - EWGLINET. A working group from the surveillance scheme produced the guidelines after wide consultation with all collaborating countries, national and international tour operator bodies and other professional groups.
EWGLI was formed in 1986 and established a European surveillance scheme for travel associated legionnaires' disease the following year. Since 1993, funding of the scheme has come from the European Commission's Directorate-General for Health and Consumer Protection (DG SANCO) and the PHLS Communicable Disease Surveillance Centre in London manages its coordination. The scheme now functions as a disease specific network and over 30 countries participate.
The European surveillance scheme has been highly successful in identifying and controlling outbreaks of travel associated legionnaires' disease. However, it has been recognised that the public health response to outbreaks has not been consistent across countries in the scheme. Therefore, the major change to the scheme's operational procedures is associated with ensuring a consistent, rapid and appropriate public health response in the countries of infection when notified of a cluster. Clusters (two or more cases associated with the same accommodation site and with onset of illness within two years of each other) occur in European holiday resorts on a regular basis. Over 70 were detected last year by EWGLINET.
Under very specific circumstances, and associated with the public health response in the relevant country of infection, the new procedures involve making certain information available to the public about hotels or other tourist accommodation sites associated with clusters. They are outlined as follows:
- When a cluster is reported, the collaborator in the country of infection is requested to organise an immediate risk assessment and measures to minimise any risk of legionella infection at the accommodation site. Within two weeks of the cluster alert, the collaborator is expected to report back to the coordinating centre in London that these actions were carried out. After a further four weeks a fuller report is expected from the collaborator and should specify the range of investigations taken, any results of sampling and confirmation that all control measures are satisfactory (or unsatisfactory) at the accommodation site.
- If either the two week or six week report is not returned within the specified time, it will not be known whether the hotel has been assessed as a possible health risk and this information will be made public on the EWGLI website. The name of the hotel will also be made public if the reports are returned but state that control measures are inadequate. The reasons for the public disclosure will be clearly stated. The name of the hotel will be removed from the website when information that control measures are satisfactory has been received at the coordinating centre.
These procedures are being introduced in the EWGLINET countries that have so far agreed to work to the new guidelines. Through rapid response and exchange of information between public health specialists, the public is increasingly protected from acquiring travel associated legionnaires' disease. Collaborators should ensure that the hotel is fully aware of the cluster report and the steps that are being carried out to resolve the situation. Public health authorities in European holiday resorts are very aware of the potential risks to their tourist industry if action is not carried out swiftly when clusters are detected.
In the event of public disclosure, the information will objectively state that cases have occurred in people who stayed at the hotel and that no information (or an adverse report on the control measures taken), has been received. The report does not imply that the hotel is the source of infection. Members of the public and tour operators in all countries will be able to view this information and make their own decisions about booking hotels with unknown or unresolved health risks.
Implementation of the guidelines will be carefully monitored. It is anticipated that collaborating countries may require up to six months to introduce the new procedures during which time public health actions in their country should not be compromised. The EWGLI website (http://www.ewgli.org) is currently under development and from the end of July will contain further information about the surveillance scheme and the guidelines. The legal status of these guidelines produced by the EWGLI working group is still to be determined at the Community level.
- The European Working Group for Legionella Infections, European Guidelines for the Control and Prevention of Travel Associated Legionnaires' Disease. The European Working Group for Legionella Infections, London, July 2002.
[This article was also published in Eurosurveillance Weekly and CDR Weekly]
Carol Joseph, EWGLI surveillance scheme project coordinator, Public Health Laboratory Service Communicable Disease Surveillance Centre, London