A small outbreak of Legionnaires' disease in a cargo ship under repair

Abstract

It was reported that two mechanics working on a cargo ship under repair in the port of Barcelona had died after having fever.An investigation was made into the possibility of any additional cases and the presence ofLegionella pneumophilain the ship they were repairing and in their hotel. The contaminated water system was treated with sodium hypochlorite.Both patients died after having been repeatedly diagnosed as having influenza. The two cases occurred among those who had been working with the pump of the ship's water system, while no cases were observed among the other workers (p=0.02). Various serogroups ofL. pneumophilawere isolated from the ship's water pump and distribution system. However, organism of serogroup 1, subgroup Pontiac (Knoxville) were identified with identical deoxyribonucleic acid (DNA) patterns in the lung tissue of one patient and in the cooling water circuit valve of the ship's water pump. The first postintervention control water samples showed no further growth of legionella, but serogrups 4 and 8 were identified 8 months later.This legionellosis outbreak, although small, was highly lethal, probably due to the high levels of bacteria to which the patients were exposed and also because of the failure of correct diagnosis. International recommendations on prevention and control of legionellosis, which include ships under repair, are required.

An outbreak of Legionella pneumonia originating from a cooling tower

“…Internationally, the reported outbreaks of legionellosis at workplaces include an automobile engine manufacturing plant [6], a cargo ship under repair [7], a sewage treatment plant [8] and a plastic plant [9]. In the outbreak at the sewage treatment plant, 5 workers developed Pontiac fever after exposure to aerosols emitted during the sludge concentration [8].…”

Current and Emerging Legionella Diagnostics for Laboratory and Outbreak Investigations

“…Legionella contamination onboard passenger and cargo vessels may be an unappreciated hazard, as detailed here and as documented in sporadic cases and outbreaks on smaller scales (531,(539)(540)(541)(542)(543)(544)(545)(546)(547). A recent survey of Norwegian naval vessels suggests that Legionella contamination is not isolated to passenger ships: researchers found Legionella species DNA in the onboard potable water of approximately one-half the naval vessels sampled, and they were able to culture L. pneumophila from a smaller subset of these ships (548).…”

Occupational Risks and Challenges of Seafaring

“…A main cause for the spread of communicable diseases onboard is that crew members with different susceptibility to infection share living quarters, common food and water supplies as well as sanitation and air-conditioning systems 44) . At present, onboard food and water hygiene is highly variable and may be a source of disease, such as gastrointestinal or legionnaire's disease 45,46) . Recommendations: Preventive measures such as proper water and food sanitation, access to safe medical care in ports (with anonymous testing of sexual transmitted diseases and health counselling), vaccination of crew, allocation of seafarers to single cabins, early treatment and isolation of infectious/respiratory diseases may be useful tools for safeguarding ship operation.…”