Sand, sea and high risk

Summer is the high-risk season for Legionnaire's disease. Last year the Maltese health authorities were notified that there had been two fatalities as a result of travel-related infection of travellers to Malta. An outbreak can lead to the closing of a hotel, as happened when deaths in the UK were traced to a hotel in Malta.

Legionnaire's Disease is caused by inhaling airborne bacteria contained in mist from air conditioners, showers or decorative fountains. The disease was named after the victims of the first recorded outbreak in 1975 among delegates at an American Legion Convention at a hotel in Philadelphia. The cause was found to be bacteria in the hotel's water cooling system.

Stagnant water can provide a home for the bacteria legionella which becomes active as the water warms up. Inhaling aerosol or mist containing the bacteria can cause fever with influenza symptoms, or pneumonia in its severest form. The illness most often affects middle-aged and older persons, particularly smokers or those who have chronic lung disease.

Wherever water stagnates, the bacteria may be present but it remains dormant as long as the water temperature is below 20°C. Optimum breeding conditions occur when the water reaches 35°C in rooftop water storage tanks or in water heaters allowed to drop lower than 55°C.

In their natural aquatic environment, in lakes or warm springs, these bacteria do not cause infections. But, when transferred to water supplies and air conditioning units they can become an acute health hazard.

Generally outbreaks can occur after breathing mists that come from air-conditioning, cooling towers, fountains, whirlpool spas or showers contaminated with legionella bacteria. Persons may be exposed to these mists in their workplace, hospitals and public places. There is no evidence so far of persons becoming infected from car or household air-conditioning units.

In 2002 the European Working Group for Legionella Infections set out guidelines for reporting and responding to clusters (two or more cases at the same site within a two year period). There have been at least two small outbreaks and four clusters in Malta in the past two years.

If the proper procedures and time limits are not respected there is the risk that the hotel and country are named on the public part of the EWGLI surveillance Website. Malta is listed as a collaborator in this working group.The contact point for Malta is the Disease Surveillance Unit at the Department of Public Health.

Bacteria which can cause Legionnaire's disease have been found in water distribution systems of buildings being investigated by the Health Inspectorate Services. When contacted John Attard Kingswell (manager, Health Inspectorate) explained that this is mainly due to the fact that these water systems have never been properly disinfected and maintained. It is important to introduce the right temperature controls for both cold and hot water systems adopted by hotel managements. The use of ultra-violet disinfection systems is an environment-friendly way to keep water safe at the point of input.

The legal framework for the Health Inspectorate Services is found in the Food Safety Act and the relevant legal notices. LN 23 of 2004 and LN 116 of 2004 transpose the EU Directive for water intended for human consumption and LN 357 of 2004 regulates the registration of private water supplies.

On the question of whether the use of bowser water by hotels in Malta could add to the risk of Legionnaire's disease, Mr Attard-Kingswell comments: "Water used in hotels, even that supplied for personal use, has to be of the quality stipulated by regulations and the management of hotels are responsible for the quality of water being distributed within their buildings. Anyone who is distributing water which is not being supplied by the main water distribution system, that is, water supplied by the water company (Water Services Corporation) or by a registered private water supply is breaching the above mentioned regulations."

Samples have been collected direct from water supplies, both from the main distribution system and from private water supplies (water being supplied by private bowsers), as part of investigations carried out in response to reported cases of Legionnaire's Disease. The Health Inspectorate says that to date the samples collected from these sources as part of the investigations have not yet indicated any presence of legionella.

The source of private water supplies has to be registered with the Health Authority under LN 357 of 2004. "To date we may confirm that the Health Authority has not registered any private supplies. A number of private suppliers have submitted their registration forms, but the Health Authority is still waiting for the applicants to provide the necessary laboratory results prior to proceeding with the registration."

According to Mr Attard Kingswell the risks for Legionnaire's Disease from an unknown source of water "are always high." Bowser water is half the price of mains water and easily available but the chances of finding legionella in borehole water is much higher. One only has to open the Yellow Pages to find that this illegal service is advertised by tens of illicit water suppliers.

The Health Authority is preparing new regulations for the control of Legionnaire's disease and the registration of cooling towers and evaporative condensers which are considered to be high risk if not properly maintained.

A seminar on the prevention of travel associated Legionnaire's disease planned by the enforcement directorate within the Malta Tourism Authority due to be held last April was postponed. MTA has yet to announce a new date for the event.

Blue Flag quality bathing

Securing the privilege of flying a Blue Flag at any beach in the world is something of an achievement. St George's Bay is to be Malta's first beach to display the Blue Flag emblem as long as a number of imperaive criteria can be met and maintained.

A beach which is awarded this quality logo must comply with a number of strict requirements regarding bathing water quality, cleaning of the beach, toilets, safety, information and environmental activities.

Bathing water must be continuously monitored for three different types of bacteria at least every fortnight throughout the season. Only beaches which fully comply with essential criteria are allowed to display the Blue Flag logo. Sampling must be done at fixed points where the concentration of bathers is highest.

At present the Department of Health's inspectorate is monitoring bathing water quality at two sites on either side of the bay off the rocks. In addition the Blue Flag beach operators would be obliged to monitor water off the beach where the concentration of bathers is highest.

The Environmental Health Unit sends a weekly report on the quality of bathing water for all monitored sites to the Malta Tourism Authority but says it has not yet been contacted by who ever is managing the beach regarding the Blue Flag criteria at St George's Bay.

A Blue Flag beach operator must display updated information on bathing water quality in the form of a table or figure that can be easily understood. This should give a clear indication to the public when the water has been analysed and how many bacteria were found.

When the results of the sampling raise suspicion of an increased level of pollution, it is recommended to temporarily increase the sampling frequency in order to track the pollution incident over time and establish whether or not the problem is temporary. This procedure follows the EU Bathing Water Directive and is intentionally designed to give the worst case scenario.

Another Blue Flag requirement which the beach operator must honour is the provision and public display of information on natural sensitive areas in the coastal zone including flora and fauna which should be included in tourist information. The presence of the nearby freshwater cave, Ghar Harq Hammiem, adds greatly to the ecological features of the area. This cave narrowly escaped damage when a proposed excavation for an underground car park in the area was turned down.

Although not easily accessible to the public the freshwater cave which harbours an endemic species certainly deserves a mention in any information on flora and fauna which is to be made available to tourists. Attention can also be drawn to flora and fauna found in the valley behind the Villa Rosa Hotel. These few precious green oases in the middle of our urban jungles should not be ignored.

The Blue Flag scheme recognises the importance of seaweed as a natural component of the coastal ecosystem. Recommendations include the advice that "The coastal zone must also be considered as a living and natural environment and not only as a recreational asset to be kept tidy." A balanced approach is suggested in which "the management of seaweed on the beach should be sensitive to both visitor needs and littoral biodiversity."

Sandy beach projects

Beach building looks set to spread to Bugibba after the pilot project at St George's Bay. Beach replenishment is a new form of coastal development where government shelves out half a million liri or so to develop sandy (gritty) beaches as extensions to natural strips of sand. Entrepreneurs are then offered a slice of the beach for private commercial use to help cover the cost. Xemxija and Marsalforn are among other possible locations involving the placing of imported quarry sand along the coast.

When asked to comment on further beach nourishment projects in the Maltese Islands, Dr Micallef, director of the Euro-Mediterranean Centre on Insular Coastal Dynamics in Valletta, indicated that he considered this to be positive intervention at sites which had previously supported beach systems but have subsequently eroded. He referred to beaches at Xemxija and Marsalforn as examples of this type of beach.

"More often than not such beach loss has resulted as a consequence of environmentally insensitive man-made development along the coast that must be taken into account when considering nourishment at any particular site. In addition, the existence of a variety of beach types (resort, urban, rural and remote) that require different management approaches, suggests that a careful evaluation of our bathing area resources (including those represented by rocky shores) should be carried out to identify sites suited for beach nourishment or otherwise," he said.

Dr Micallef is currently carrying out a Mediterranean-wide study of beach management on behalf of the Mediterranean Action Plan witin the United Nations Environment Programme.

Two beaches in Gozo which may be at risk, in view of ongoing golfcourse-airstrip-marina rumblings, are M©arr ix-Xini and Óondoq ir-Rummien. These beaches should be protected from any intervention involving the placing of terrestrial sand on the shoreline.

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