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Background  In the last years, international traffic volume has significantly increased, raising the risk for acquisition of infectious diseases. Among travel-associated infections, increased incidence of legionellosis has been reported among travellers.  Aim of our study was: to describe the frequency and severity of  Legionella  spp. contamination in ferries and cruise ships; to compare the levels of contamination with those indicated by the Italian ministerial guidelines for control and prevention of legionellosis, in order to assess health risks and to adopt control measures.    Method  A prevalence study was carried out on 9 ships docked at the seaports of northern Sardinia in 2004. Water samples were collected from critical sites: passenger cabins, crew cabins, kitchens, coffee bars, rooms of the central air conditioning system. It was performed a qualitative and quantitative identification of  Legionella  spp. and a chemical, physical and bacteriological analysis of water samples.    Results  Forty-two percent (38/90) water samples were contaminated by  Legionella  spp.. Positive samples were mainly drawn from showers (24/44), washbasins (10/22).  L. pneumophila  was isolated in 42/44 samples (95.5%), followed by  L. micdadei  (4.5%).  Strains were identified as  L. pneumophila  serogroup 6 (45.2%; 19 samples), 2–14 (42.9%), 5 (7.1%) and 3 (4.8%).  Legionella  spp. load was high; 77.8% of the water samples contained > 10 4  CFU/L.  Low residual free chlorine concentration (0–0,2 mg/L) was associated to a contamination of the 50% of the water samples.    Conclusion   Legionella  is an ubiquitous bacterium that could create problems for public health.  We identified  Legionella  spp. in 6/7 ferries. Microbial load was predominantly high (> 10 4  CFU/L or ranging from 10 3  to 10 4  CFU/L). It is matter of concern when passengers are subjects at risk because of  Legionella  spp. is an opportunist that can survive in freshwater systems; high bacterial load might be an important variable related to disease's occurrence.  High level of contamination required disinfecting measures, but does not lead to a definitive solution to the problem. Therefore, it is important to identify a person responsible for health safety in order to control the risk from exposure and to apply preventive measures, according to European and Italian guidelines.

Prevalence study of Legionella spp. contamination in ferries and cruise ships