Environmental surveillance of Legionella in tourist facilities of the Balearic Islands, Spain, 2006 to 2010 and 2015 to 2018.

BackgroundLegionnaires' disease is a respiratory illness often associated with hotels and travel. Spain is a major tourist destination and one of the European countries with most cases of Legionnaires' disease , both community- and travel-associated. However, the prevalence of Legionella in tourist facilities is unknown.AimThe present investigation aimed to survey the tourist facilities in the Balearic Islands, Spain, for Legionella prevalence.MethodsWe visited tourist facilities in the Balearic Islands in two different periods (2006-2010 and 2015-2018) and took water samples following national and international guidelines. Legionella was investigated by culture methods following international standards (ISO 11731:1998).ResultsWe evaluated 13,472 samples from 465 facilities. Bacteria of the Legionella genus were detected in 65.4% of the surveyed facilities. Contamination of the facilities was significantly higher during the second decade (54.5 vs 78.6%). The most frequent colonisers were L. pneumophila serogroup 2-14. We detected the pathogen in 15.9% and 6.9% of hot and cold water distribution systems samples, respectively. The Legionella contamination rate in cold water systems samples was higher when free chlorine levels were < 0.2 mg/L and at > 25 °C temperatures, while in the hot water systems samples, the contamination rate was higher at < 50 °C. Of the samples from hot tubs, 10.9% were contaminated.ConclusionLegionella prevalence in hotels in the Balearic Islands was high but the contamination rates depended on the installations. Corrective measures are still needed to improve Legionella control.

Brote de gastroenteritis causado por norovirus en un hotel de Menorca, España / Norovirus outbreak causing gastroenteritis in a hotel in Menorca, Spain

OBJETIVO: Determinar el agente responsable de un brote de gastroenteritis ocurrido en un hotel de Menorca en septiembre de 2016. MÉTODOS: Se estudió la epidemiología de los casos y se investigaron muestras ambientales y clínicas para la presencia de microorganismos indicadores y patógenos. RESULTADOS: Se detectaron 151 casos: 123 afectaron a clientes y 28 a personal. Los análisis microbiológicos detectaron la presencia de norovirus genotipo II en heces de pacientes, así como en habitaciones y zonas comunes. El plan de control implementado permitió la erradicación del brote. CONCLUSIONES: Este estudio del brote causado por norovirus del genotipo II demuestra que una rápida actuación es crítica para controlar este tipo de brotes

OBJECTIVES: To establish the agent responsible for a gastroenteritis outbreak in a hotel in Menorca (Spain) in September 2016. METHODS: The study included epidemiological and laboratory analysis. Environmental and stool samples were examined for bacterial and viral pathogens. RESULTS: One hundred and fifty-one cases were detected, 123 among the tourists staying in the hotel and 28 affecting the staff. The presence of genotypeII norovirus was discovered in the microbiological studies of patient's faeces, as well as in the surface samples of rooms and common areas. The control plan implemented allowed for control of the outbreak. CONCLUSIONS: This study on a genotypeII norovirus outbreak reveals the importance of a rapid response for controlling these types of outbreaks

Norovirus outbreak causing gastroenteritis in a hotel in Menorca, Spain. / Brote de gastroenteritis causado por norovirus en un hotel de Menorca, España.

OBJECTIVES: To establish the agent responsible for a gastroenteritis outbreak in a hotel in Menorca (Spain) in September 2016. METHODS: The study included epidemiological and laboratory analysis. Environmental and stool samples were examined for bacterial and viral pathogens. RESULTS: One hundred and fifty-one cases were detected, 123 among the tourists staying in the hotel and 28 affecting the staff. The presence of genotypeII norovirus was discovered in the microbiological studies of patient's faeces, as well as in the surface samples of rooms and common areas. The control plan implemented allowed for control of the outbreak. CONCLUSIONS: This study on a genotypeII norovirus outbreak reveals the importance of a rapid response for controlling these types of outbreaks.

Efficient management of a norovirus outbreak causing gastroenteritis in two hotels in Spain, 2014 / Control de un brote de gastroenteritis causado por norovirus en 2 hoteles en España, 2014

OBJECTIVES: To determine the aetiological agent causing a gastroenteritis outbreak in two hotels in Majorca (Spain) on August and September 2014. METHODS: An epidemiological study was carried out. Environmental and stool samples were analyzed for different pathogens, including norovirus. RESULTS: Epidemiological analysis detected 79 cases among the tourists hosted in the affected hotels over the period 18th August to 3rd September. They included 52 (attack rate: 6.4%) and 27 (attack rate: 3.0%) cases in hotel A and B, respectively. Seven of the staff members were also affected. Microbiological analyses detected genotype 2 norovirus in patient's stool samples, in rooms and in common areas' surfaces. The specific control plan rapidly implemented at the beginning of the outbreak, and further adapted for norovirus elimination, allowed to control the outbreak. CONCLUSIONS: Our study demonstrates that the outbreak was caused by genotype 2 norovirus, and reflects the importance of a rapid analysis and response for its control

OBJETIVOS: Determinar el agente etiológico responsable del brote de gastroenteritis producido en 2 hoteles de Mallorca (España) en agosto y septiembre de 2014. MÉTODOS: Se realizó un estudio epidemiológico y se analizaron muestras ambientales y de heces para la presencia de patógenos, incluyendo norovirus. RESULTADOS: El análisis epidemiológico detectó 79 casos entre los clientes hospedados en los hoteles desde el 18 de agosto al 3 de septiembre: 52 en el hotel A (tasa de ataque: 6,4%) y 27 en el B (tasa de ataque: 3,0%), así como en 7 miembros del personal. Los análisis microbiológicos detectaron norovirus genotipo 2 en las heces de los pacientes y en las superficies de las habitaciones y zonas comunes. El plan específico implementado rápidamente y adaptado para la eliminación de norovirus permitió el control del brote. CONCLUSIONES: En este brote causado por norovirus del genotipo 2 se refleja la importancia de un análisis y una respuesta rápida para su control

Efficient management of a norovirus outbreak causing gastroenteritis in two hotels in Spain, 2014.

OBJECTIVES: To determine the aetiological agent causing a gastroenteritis outbreak in two hotels in Majorca (Spain) on August and September 2014. METHODS: An epidemiological study was carried out. Environmental and stool samples were analyzed for different pathogens, including norovirus. RESULTS: Epidemiological analysis detected 79 cases among the tourists hosted in the affected hotels over the period 18th August to 3rd September. They included 52 (attack rate: 6.4%) and 27 (attack rate: 3.0%) cases in hotel A and B, respectively. Seven of the staff members were also affected. Microbiological analyses detected genotype 2 norovirus in patient's stool samples, in rooms and in common areas' surfaces. The specific control plan rapidly implemented at the beginning of the outbreak, and further adapted for norovirus elimination, allowed to control the outbreak. CONCLUSIONS: Our study demonstrates that the outbreak was caused by genotype 2 norovirus, and reflects the importance of a rapid analysis and response for its control.

[Infections related to recreational waters]. / Infecciones relacionadas con las aguas de recreo.

Recreational waters are a source of infection by several microorganisms causing acute gastrointestinal, cutaneous and respiratory illnesses. Cryptosporidium, noroviruses and enteropathogenic Escherichia coli strains are the most important causes of diarrhea, while Pseudomonas and Staphylococcus aureus are the main causes of cutaneous infections, and Legionella is the major cause of acute lower respiratory disease. Approximately 90% of outbreaks occur in treated recreational waters (swimming pools, spas and recreational parks), while the remaining 10% arise from natural waters used for leisure (bathing in rivers, beaches, etc). In spas, most infections are caused by thermophilic bacteria, such as Pseudomonas and Legionella, since overgrowth of these bacteria is facilitated by the direct effect of temperature and, indirectly, by the evaporation of the disinfectant. Outbreaks related to recreational waters usually reflect deficient control of the system: a low level of disinfectant, or the use of an inappropriate disinfectant, insufficient maintenance and cleaning of the installation, higher than recommended usage, and failure of the disinfectant dosage system. The correct design, maintenance and use of these facilities drastically lower the risk of infections from recreational waters. Thus, other key actions to minimize this risk are the existence of, and compliance with, regulatory rules, as well as educational campaigns on good hygiene practices directed at users. Rapid etiologic diagnosis of affected patients, together with an epidemiological survey and detection of the pathogen implicated in water samples are the keys to outbreak control.

Infecciones relacionadas con las aguas de recreo / Infections related to recreational waters

El uso recreativo del agua implica un riesgo de contagiopor parte de microorganismos responsables degastroenteritis, dermatitis y patología respiratoria.Cryptosporidium, norovirus y cepas de Escherichia colienteropatógenas son las causas más importantes debrotes de diarrea, mientras que Pseudomonas yStaphylococcus aureus son los principales agentes deinfecciones cutáneas, y Legionella de infecciónrespiratoria. Aproximadamente, el 90% de los brotes quese producen son en aguas de recreo tratadas (piscinas,balnearios, parques recreativos), frente a un 10% en aguasnaturales (ríos, playas, etc.). En los balnearios, lasinfecciones más frecuentes son debidas a bacteriastermófilas (Pseudomonas y Legionella), puesto que latemperatura y la consiguiente evaporación deldesinfectante contribuyen a facilitar su multiplicación.Los brotes siempre se deben a deficiencias en el controldel sistema: bajo nivel de desinfectante o utilización deuno inadecuado, mantenimiento y limpieza insuficientes,alto nivel de ocupación y averías en los equipos dedosificación. El diseño, mantenimiento y uso adecuado deestas instalaciones disminuyen este riesgo, y esfundamental la existencia de una normativa reguladora,así como campañas de concienciación a los usuarios paraque se cumplan las normas de higiene básicas. Eldiagnóstico etiológico del cuadro clínico, complementadocon la encuesta epidemiológica y la detección sanitaria enlas aguas, todos ellos realizados con rapidez, constituye laclave para el control de estos brotes(AU)

Recreational waters are a source of infection by severalmicroorganisms causing acute gastrointestinal, cutaneousand respiratory illnesses. Cryptosporidium, noroviruses and enteropathogenic Escherichia coli strains are the mostimportant causes of diarrhea, while Pseudomonas andStaphylococcus aureus are the main causes of cutaneousinfections, and Legionella is the major cause of acutelower respiratory disease. Approximately 90% ofoutbreaks occur in treated recreational waters (swimmingpools, spas and recreational parks), while the remaining10% arise from natural waters used for leisure (bathing inrivers, beaches, etc). In spas, most infections are caused bythermophilic bacteria, such as Pseudomonas andLegionella, since overgrowth of these bacteria is facilitatedby the direct effect of temperature and, indirectly, by theevaporation of the disinfectant.Outbreaks related to recreational waters usually reflectdeficient control of the system: a low level of disinfectant,or the use of an inappropriate disinfectant, insufficientmaintenance and cleaning of the installation, higher thanrecommended usage, and failure of the disinfectantdosage system. The correct design, maintenance and useof these facilities drastically lower the risk of infectionsfrom recreational waters. Thus, other key actions tominimize this risk are the existence of, and compliancewith, regulatory rules, as well as educational campaignson good hygiene practices directed at users. Rapidetiologic diagnosis of affected patients, together with anepidemiological survey and detection of the pathogenimplicated in water samples are the keys to outbreakcontrol(AU)

Infecciones relacionadas con las aguas de recreo / Infections related to recreational waters

El uso recreativo del agua implica un riesgo de contagiopor parte de microorganismos responsables degastroenteritis, dermatitis y patología respiratoria.Cryptosporidium, norovirus y cepas de Escherichia colienteropatógenas son las causas más importantes debrotes de diarrea, mientras que Pseudomonas yStaphylococcus aureus son los principales agentes deinfecciones cutáneas, y Legionella de infecciónrespiratoria. Aproximadamente, el 90% de los brotes quese producen son en aguas de recreo tratadas (piscinas,balnearios, parques recreativos), frente a un 10% en aguas naturales (ríos, playas, etc.). En los balnearios, las infecciones más frecuentes son debidas a bacteriastermófilas (Pseudomonas y Legionella), puesto que latemperatura y la consiguiente evaporación deldesinfectante contribuyen a facilitar su multiplicación.Los brotes siempre se deben a deficiencias en el controldel sistema: bajo nivel de desinfectante o utilización deuno inadecuado, mantenimiento y limpieza insuficientes,alto nivel de ocupación y averías en los equipos dedosificación. El diseño, mantenimiento y uso adecuado deestas instalaciones disminuyen este riesgo, y esfundamental la existencia de una normativa reguladora,así como campañas de concienciación a los usuarios paraque se cumplan las normas de higiene básicas. Eldiagnóstico etiológico del cuadro clínico, complementadocon la encuesta epidemiológica y la detección sanitaria en las aguas, todos ellos realizados con rapidez, constituye la clave para el control de estos brotes

Recreational waters are a source of infection by severalmicroorganisms causing acute gastrointestinal, cutaneousand respiratory illnesses. Cryptosporidium, norovirusesand enteropathogenic Escherichia coli strains are the most important causes of diarrhea, while Pseudomonas andStaphylococcus aureus are the main causes of cutaneousinfections, and Legionella is the major cause of acutelower respiratory disease. Approximately 90% ofoutbreaks occur in treated recreational waters (swimmingpools, spas and recreational parks), while the remaining10% arise from natural waters used for leisure (bathing in rivers, beaches, etc). In spas, most infections are caused by thermophilic bacteria, such as Pseudomonas andLegionella, since overgrowth of these bacteria is facilitated by the direct effect of temperature and, indirectly, by the evaporation of the disinfectant.Outbreaks related to recreational waters usually reflectdeficient control of the system: a low level of disinfectant, or the use of an inappropriate disinfectant, insufficient maintenance and cleaning of the installation, higher than recommended usage, and failure of the disinfectant dosage system. The correct design, maintenance and use of these facilities drastically lower the risk of infectionsfrom recreational waters. Thus, other key actions tominimize this risk are the existence of, and compliancewith, regulatory rules, as well as educational campaignson good hygiene practices directed at users. Rapidetiologic diagnosis of affected patients, together with an epidemiological survey and detection of the pathogen implicated in water samples are the keys to outbreakcontrol (AU)