Psychosocial impact of the summer 2007 floods in England

Background The summer of 2007 was the wettest in the UK since records began in 1914 and resulted in severe flooding in several regions. We carried out a health impact assessment using population-based surveys to assess the prevalence of and risk factors for the psychosocial consequences of this flooding in the United Kingdom. Methods Surveys were conducted in two regions using postal, online, telephone questionnaires and face-to-face interviews. Exposure variables included the presence of flood water in the home, evacuation and disruption to essential services (incident management variables), perceived impact of the floods on finances, house values and perceived health concerns. Validated tools were used to assess psychosocial outcome (mental health symptoms): psychological distress (GHQ-12), anxiety (GAD-7), depression (PHQ-9) and probable post-traumatic stress disorder (PTSD checklist-shortform). Multivariable logistic regression was used to describe the association between water level in the home, psychological exposure variables and incident management variables, and each mental health symptom, adjusted for age, sex, presence of an existing medical condition, employment status, area and data collection method. Results The prevalence of all mental health symptoms was two to five-fold higher among individuals affected by flood water in the home. People who perceived negative impact on finances were more likely to report psychological distress (OR 2.5, 1.8-3.4), probable anxiety (OR 1.8, 1.3-2.7) probable depression (OR 2.0, 1.3-2.9) and probable PTSD (OR 3.2, 2.0-5.2). Disruption to essential services increased adverse psychological outcomes by two to three-fold. Evacuation was associated with some increase in psychological distress but not significantly for the other three measures. Conclusion The psychosocial and mental health impact of flooding is a growing public health concern and improved strategies for minimising disruption to essential services and financial worries need to be built in to emergency preparedness and response systems. Public Health Agencies should address the underlying predictors of adverse psychosocial and mental health when providing information and advice to people who are or are likely to be affected by flooding

Lessons learned from handling a large rural outbreak of Legionnaires’ disease: Hereford, UK 2003

SummaryThe outbreak of Legionnaires’ disease that occurred in Hereford, West Midlands UK in 2003 was the single largest outbreak of Legionnaires’ in Hereford and one of the first to challenge the newly formed Health Protection Agency. This was, de facto a ‘public health incident’ requiring not only the investigation and management of a community outbreak of infectious disease, but also one that had to take into account other issues including: uncertainty regarding roles and responsibilities, political considerations and communication needs including sustained media attention. The incident also demonstrated the ‘added value’ of an integrated health protection response. The practical lessons learned from outbreaks are rarely described, particularly operational aspects. This paper summarises the outbreak, outlines specific elements of the response and identifies some of the key learning points for the new Agency and its partners. A number of these lessons have a generic applicability to the handling of public health incidents

Clusters of Legionnaires' disease in period hotels with complex water systems: lessons learnt in the West Midlands, UK

BackgroundIn 2017 there were two distinct clusters of local travel-associated Legionnaires' disease associated with period hotels built in the 17th and 18th centuries in the West Midlands, UK. Both hotels had undergone frequent structural modifications. Five cases occurred 3 months to 2 years apart. The aim of this report is to share the learning from the investigations and challenges faced in achieving control of Legionella pneumophila in the water systems of dated buildings.MethodsEpidemiological information was obtained through structured cases interviews and through linked cases by the national surveillance scheme database. Hotel water system maintenance records were reviewed, and samples were taken at numerous timepoints and different locations, with an initial focus on facilities and rooms used by the cases. Sputum and environmental samples were tested in the reference laboratory and sequence-based typing was undertaken.FindingsUnsatisfactory levels of L pneumophila serogroup 1 were detected from hot and cold water outlets in both hotels. At one of the hotels L pneumophila serogroup 1, sequence type ST62 subtypes in clinical and environmental samples were indistinguishable. Both hotels were closed for business for months to undertake extensive remediation work. This closure was temporarily effective in achieving adequate control of legionella but 6 months later routine monitoring detected unsatisfactory levels. Achieving sustained legionella control in dated water systems and verifying safe endpoints for hotel re-opening has proven challenging for the regulatory bodies.InterpretationSustaining legionella control in the dated water systems of period buildings was demanding, and public confidence in the effectiveness of control measures was compromised. There were four key challenges: defining a cluster and the timely confirmation of when an outbreak has developed; using the cluster and outbreak definitions to inform the risk assessments and review of control measures in the environmental investigations; communicating the risk to the public and the media through clear messages; and seeking assurance on safety of water management systems in defining the endpoint for a cluster or outbreak investigation