25 May 2012
Legionnaires’ disease: Calpe, Costa Blanca, Spain (hotel)
This updates the NaTHNaC Clinical Update of 3 February, 2012
An outbreak of Legionnaire’s disease, first identified in January 2012 and associated with the Diamante Beach hotel in Calpe, Spain, has resulted in a cluster of 25 cases and six deaths [1, 2]. Travel associated cases were reported from Belgium (one), France (two), Spain (three) and the United Kingdom (16). Three cases were in hotel employees. There have been no other cases reported in the town of Calpe; this and the fact that cases either stayed or worked at the hotel, indicates the hotel (possibly a whirlpool) as the likely source of infection .
Following the confirmation of the first cases in December 2011, an extensive environmental investigation of the hotel was undertaken by Spanish health authorities. In January 2012, Legionella was confirmed in water samples taken at the hotel. Control measures were undertaken including cleaning and disinfection of the water systems. As a precautionary measure, the hotel was closed temporarily and reopened on 10 February 2012 . Investigation of this outbreak is ongoing and water quality is being monitored daily by public health authorities; between 1 March and 8 May 2012, water samples from a whirlpool at the hotel tested positive for Legionella and strict control measures, including temporary closure of the whirlpool, were implemented .
Four of the 25 cases in this outbreak stayed at the hotel in Calpe since February 2012, and presented with symptoms between March and early May. As a definite source of infection has not been identified and controlled there is a possibility of an ongoing risk of Legionella infection at this hotel .
Legionnaires’ disease is a bacterial infection usually causing pneumonia. The incubation period is 2 to 10 days. Symptoms include cough, shortness of breath, and fever; gastrointestinal upset can also occur. The disease is more frequent in the elderly, smokers and those with pre-existing lung disease or chronic medical conditions.
Legionella spp. bacteria are distributed widely in the environment. They can live in many types of water including natural sources such as rivers and streams, and in artificial sources such as water-cooling towers, hot and cold water systems and spa pools. Tourists can become exposed to the bacteria if the water systems are not properly maintained and become contaminated.
Further information about Legionnaire’s disease is available in NaTHNaC’s Health Information sheet: Legionellosis.
Advice for travellers
The risk of tourists acquiring Legionnaires’ disease in Costa Blanca is no different to that seen in other parts of Spain.
Travellers visiting Costa Blanca, or any other part of Spain, who develop an influenza-like illness (fever, cough, shortness of breath) during their stay or up to 14 days after their return home, and who believe they may be infected, should seek medical care for appropriate investigations and possible treatment. There are several effective antibiotics.
Advice for health professionals
Legionnaires’ disease should be considered as a potential diagnosis for cases of atypical pneumonia throughout the year. When appropriate symptoms are present, a history of travel should act as a specific prompt for clinicians to evaluate for Legionella infection.
Information for health professionals assessing individuals with suspected Legionnaires’ disease is available from the Health Protection Agency.
1. Health Protection Agency. Update on Legionnaires’ Cluster Associated with a Hotel in Spain. Press Release. 3 February, 2012. [Accessed 25 May, 2012]. Available at: http://www.hpa.org.uk/NewsCentre/NationalPressReleases
2. European Centres for Disease Control and Prevention. Rapid Risk Assessment. Update-Outbreak of Legionnaires’ disease in a hotel in Calpe, Spain. November 2011-May 2012; 24 May 2012 [Accessed 25 May 2012]. Available at: http://www.ecdc.europa.eu/en/publications/Publications/1205-TER-Updated-Risk-assessment-Legionnares-Spain.pdf
3. Vanaclocha H, Morera V, Calatayud MA et al. Preliminary Report: Outbreak of Legionnaires’ disease in a hotel in Calp, Spain. Eurosurveillance, 17(8); 23 February 2012. [Accessed 25 May 2012]. Available at: