Drinking water tainted with Salmonella spreads typhoid on Dutch ship

A curious case of typhoid aboard Liberty Ann- cruise ship turned emergency accommodation for asylum seekers in the Netherlands.
Amal Jos Chacko
Corroded water tanks on the Liberty Ann that caused an outbreak of Typhoid.
Corroded water tanks on the Liberty Ann that caused an outbreak of Typhoid.

Tanja Hartog 

In a special early press release from the European Congress of Clinical Microbiology & Infectious Diseases, a large outbreak of typhoid on a Dutch Ship was revealed to have been traced to contaminated fresh water.

When those on board the Liberty Ann- an old cruise ship turned emergency accommodation for asylum seekers in Haarlem, Netherlands- raised complaints of fever and stomach pain in spring 2022, the municipal health service in Kennemerland quickly diagnosed seventy-two cases of typhoid.

The Municipal Health Service Kennemerland put control measures in place immediately to prevent further spread and launched an investigation in collaboration with the Regional Public Health Laboratory Kennemerland.

Typhoid, a bacterial infection usually spread by food and water, is highly contagious. While typically mild and quelled with antibiotics, infection can often be fatal if untreated, with symptoms including a high temperature, headache, and constipation or diarrhea.

A steady supply of bottled water was provided and food preparation on the ship halted while asylum seekers moved to other accommodations.

Health Workers cull the culprit

The Municipal Health Service swung into action and began microbiological investigations and technical inspections. All asylum seekers and staff were asked to complete a questionnaire about their consumption of food and water on the ship along with providing fecal and blood samples.

These tests soon revealed that 349 people had potentially been exposed to the bacterium, with 50 asylum seekers and 20 staff who frequently consumed tap water on the ship confirmed to have contracted typhoid.

What was more interesting, however, was that all samples of the bacteria cultured from the cases’ blood and feces were genetically identical- indicating a common source of infection.

The investigators focused on finding the source of the infection and promptly found themselves inspecting wastewater and freshwater tanks on the Liberty Ann, adjacent to each other, and sharing a wall- a severely corroded common wall with small holes.

Drinking water tainted with Salmonella spreads typhoid on Dutch ship
Small holes in the walls of water tanks on the Liberty Ann.

“The holes 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 Dr. Anne de Vries of the Municipal Health Service Kennemerland, one of those leading the investigation.

The study’s authors further stressed the importance of supervising water quality on ships to ensure the health and safety of those on board. “Water tanks and associated equipment must be properly maintained and subject to regular inspections,” they concluded.

All of the twenty-five individuals hospitalized recovered after treatment.

Study Abstract

This study focuses on the case of a outbreak on board the Liberty Ann which saw several confirmed cases of typhoid fever. The cause of the outbreak was traced to improper maintenance of water tanks which led to corrosion and mixing of sewage and freshwater resulting in tainted drinking water.

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