- Seventy-two cases of typhoid were confirmed in the spring 2022 outbreak on the Liberty Ann, an old cruise ship.
- The Municipal Health Service was notified about an ongoing outbreak of fever and abdominal complaints on the Liberty Ann.
- S. typhi was detected in the wastewater tank and Salmonella in the fresh water tanks, which shared a severely corroded common wall.
A large outbreak of typhoid on a ship in the Netherlands, which was used to house asylum seekers, was traced to contaminated drinking water, according to data that will be presented at this year’s European Congress of Clinical Microbiology & Infectious Diseases (ECCMID 2023), to be held in Copenhagen, April 15-19 (abstract 01241).
Typhoid cases
Seventy-two cases of typhoid were confirmed in the spring 2022 outbreak on the Liberty Ann, an old cruise ship, which was being used as emergency accommodations in Haarlem for the refugees.
An extensive investigation by the Municipal Health Service Kennemerland and the Regional Public Health Laboratory Kennemerland and others traced the source of the outbreak to the water tanks on the ship.
Contaminated drinking water
“The fresh water and wastewater tanks shared a common wall which was severely corroded, with small holes.
This allowed sewage containing Salmonella typhi, the bacterium which causes typhoid fever, to leak into the freshwater, which was then used as drinking water and to prepare food,” said Anne de Vries, of the Municipal Health Service Kennemerland, Haarlem, the Netherlands.
S. typhi is highly contagious. When treated promptly with antibiotics, the infection is usually mild, but without treatment, it can be fatal. Symptoms include a high temperature, headache, stomach pain, and constipation or diarrhea.
Typhoid outbreak
On April 6, 2022, the Municipal Health Service was notified about an ongoing outbreak of fever and abdominal complaints on the Liberty Ann. Typhoid fever was diagnosed and control measures were put in place to prevent further spread.
Bottled water was provided, food preparation on the ship halted, and all the asylum seekers were moved to other accommodations.
A total of 349 people had potentially been exposed to the bacterium and 72 cases of typhoid were confirmed by culture among asylum seekers (50/72) and staff (20/72) between April 7 and May 24. The samples were genetically linked, pointing to a common source.
All cases occurred in adults. All of the asylum seekers, and most of the staff members, were men.
All cases were in people who had been on the ship. Twenty-five individuals were hospitalized, and all recovered after treatment.
Reason for typhoid outbreak
The Municipal Health Service visited the ship six times to carry out microbiological investigations and technical inspections.
To identify the source of the outbreak and mode of transmission, all asylum seekers and staff members were asked to complete a questionnaire about their consumption of tap water and meals on the ship. They were also asked to provide fecal and blood samples.
Frequent consumption of food and tap water on the ship was associated with developing typhoid.
Water quality and safety
S. typhi was detected in the wastewater tank and Salmonella in the fresh water tanks, which shared a severely corroded common wall.
“Strict supervision of water quality is key to the health and safety of those on board ships. Water tanks and associated equipment must be properly maintained and subject to regular inspections,” the writers said in their abstract.
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Source: IDSE
