Epidemiology and control of water borne diseases in tourists using a novel surveillance system

Water borne infections acquired during a holiday may result in a mild illness lasting a day or so, be a major disturbance to the holiday and the health of the individual or may be fatal. Such infections are frequently associated with adventure holidays and are also a significant cause of illness in tourists staying in hotels in countries with a developed public health infrastructure. These infections are frequently unrecognized by the health authorities in the countries concerned, either because they do not feature in the surveillance systems, or because the diagnosis is made in the home country of the tourist. Travellers' diarrhoea of unknown aetiology may well be suspected to be drinking water borne when the affected tourists are staying in different hotels in a locality. Water borne illnesses specific to a hotel include Cryptosporidiosis from the swimming pool and Legionnaires' disease from the hot water system.

The major British tour operators have, over twenty five years, developed an ongoing surveillance system for travellers' diarrhoea and Cryptosporidiosis. The ensuing results enable them to alert public health authorities and the hoteliers so that appropriate actions can be taken. They also worked with health authorities in the development of the European Working Group for Legionella Infections protocol for travel associated infections. The systems will be described with examples of how the results have been beneficial to the health of tourists and the in-resort indigenous population.