Page 125 - Petelin, Ana, et al. 2019. Eds. Zdravje otrok in mladostnikov / Health of Children and Adolescents. Proceedings. Koper: University of Primorska Press
P. 125
opean Union (EU), the incidence is 1.4 cases per 100 000 inhabitants. Most public health measures for managing pollution with legionella in slovenian swimming pools 123
of the reports came from France, Germany, Italy and Spain, 69% of all reports
in EU. Every year about 1000 passengers in Europe are infected and suffered
legionnaire’s disease (European Centre for Disease Prevention and Control,
2015). According to the epidemiological surveillance of communicable diseases
in Slovenia for 2016, exactly, 93 cases were reported (62 men and 31 women) to
develope Legionnaires’ disease, of which 5.4% of patients died (Nacionalni in�-
štitut za javno zdravje, 2016).
Risk Characterization
We focus on the problem of Legionella in swimming pools, only because, the
swimming pool areas shown increased risk for the propagation of the Legionel-
la. The risk of infection with Legionella spp. is difficult to assess. Specifically,
the risk is elevated in the pools with the circulating warm water, which creates
an aerosol. So far if Legionella is present, it can be transmitted to the humans.
Risk factors are specific biological characteristics of Legionella strains, vulner-
able subjects, the technical characteristics of swimming pools, and the techni-
cal characteristics of installations for hot water (Pond, 2005; World Health Or-�
ganisation, 2007; World Health Organisantion, 2006; Hojs et al., 2002).
Risk factors
Biological and immunological factors of Legionella virulence
Biological and immunological factors of Legionella virulence are not fully
known. In particular, it is important to know how Legionella enters the phago-
cytes in the lungs and multiplies in them. Virulent factors in this case are:
the expression of multiple proteins during infection of macrophages (MIPS,
protein, etc.), the expression of specific proteases and plasmids of Legionella
(Pond, 2005 Gubina and Ihan, 2002; Brooks et al., 2010; Greenwood et al., 1997).
Legionella is transmitted by aerosols. Virulence is important for the survival
of the Legionella in the aerosol. Legionella is more virulent, if it persist longer
in the aerosol (Pond, 2005; Gubina and Ihan, 2002; Brooks et al., 2010; Green�-
wood et al., 1997).
Risk factors – humans
Humans are defended against Legionella by cell-mediated immunity. Man can
be exposed to Legionella by whirlpool tubs, but most of them do not develop
signs of infection, they show only asymptomatic infection with increased level
of specific antibodies. Milder, influenza-like infection, called Pontiac fever can
be manifested. Severe pneumonia called Legionnaire’s disease is not manifest-
ed so often (Pond, 2005). Particularly vulnerable for infection are the elderly,
tobacco smokers, patients with pulmonary disease and subjects with impaired
immunity, due to illness or medication. There are more infections detected in
men (Pond, 2005; World Health Organisation, 2007; World Health Organisan�-
of the reports came from France, Germany, Italy and Spain, 69% of all reports
in EU. Every year about 1000 passengers in Europe are infected and suffered
legionnaire’s disease (European Centre for Disease Prevention and Control,
2015). According to the epidemiological surveillance of communicable diseases
in Slovenia for 2016, exactly, 93 cases were reported (62 men and 31 women) to
develope Legionnaires’ disease, of which 5.4% of patients died (Nacionalni in�-
štitut za javno zdravje, 2016).
Risk Characterization
We focus on the problem of Legionella in swimming pools, only because, the
swimming pool areas shown increased risk for the propagation of the Legionel-
la. The risk of infection with Legionella spp. is difficult to assess. Specifically,
the risk is elevated in the pools with the circulating warm water, which creates
an aerosol. So far if Legionella is present, it can be transmitted to the humans.
Risk factors are specific biological characteristics of Legionella strains, vulner-
able subjects, the technical characteristics of swimming pools, and the techni-
cal characteristics of installations for hot water (Pond, 2005; World Health Or-�
ganisation, 2007; World Health Organisantion, 2006; Hojs et al., 2002).
Risk factors
Biological and immunological factors of Legionella virulence
Biological and immunological factors of Legionella virulence are not fully
known. In particular, it is important to know how Legionella enters the phago-
cytes in the lungs and multiplies in them. Virulent factors in this case are:
the expression of multiple proteins during infection of macrophages (MIPS,
protein, etc.), the expression of specific proteases and plasmids of Legionella
(Pond, 2005 Gubina and Ihan, 2002; Brooks et al., 2010; Greenwood et al., 1997).
Legionella is transmitted by aerosols. Virulence is important for the survival
of the Legionella in the aerosol. Legionella is more virulent, if it persist longer
in the aerosol (Pond, 2005; Gubina and Ihan, 2002; Brooks et al., 2010; Green�-
wood et al., 1997).
Risk factors – humans
Humans are defended against Legionella by cell-mediated immunity. Man can
be exposed to Legionella by whirlpool tubs, but most of them do not develop
signs of infection, they show only asymptomatic infection with increased level
of specific antibodies. Milder, influenza-like infection, called Pontiac fever can
be manifested. Severe pneumonia called Legionnaire’s disease is not manifest-
ed so often (Pond, 2005). Particularly vulnerable for infection are the elderly,
tobacco smokers, patients with pulmonary disease and subjects with impaired
immunity, due to illness or medication. There are more infections detected in
men (Pond, 2005; World Health Organisation, 2007; World Health Organisan�-
