20 January 2011

Legionnaires’ disease reported in Australian travellers to Bali.

On 19 January 2011, Australia’s Chief Medical Officer issued an alert to travellers to the Indonesian island of Bali to be aware of ‘flu-like’ symptoms, after reports of Legionnaires’ disease. Eleven confirmed cases of Legionnaires’ disease have occurred in Australian tourists between August 2010 and January 2011 [1].

Whilst the exact exposure source of the disease is not known [1] all the affected travellers stayed in the coastal area of Kuta in southern Bali [1, 2].

The Indonesian Government is working with the World Health Organization to investigate the outbreak and institute measures to treat possible sources of the Legionella bacteria [1].

Advice for travellers

Legionnaires’ disease is a bacterial infection usually causing pneumonia. 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.

Any individual with an influenza-like illness (fever, cough, shortness of breath) who believes they may be infected should seek medical care for appropriate investigations and possible treatment. There are several effective antibiotics, including azithromycin, or a fluoroquinolone.

Further information about Legionnaire’s disease is available in NaTHNaC’s Health Information sheet: Legionellosis.

Country-specific health advice for Bali can be found on the NaTHNaC Country Information Page for Indonesia.

Advice for health professionals: returned travellers

Legionnaires’ disease should be considered as a potential diagnosis for cases of atypical pneumonia throughout the year. A history of travel should act as a specific prompt for clinicians to evaluate for Legionella infection, when appropriate symptoms are present.

Information for health professionals assessing individuals with suspected Legionnaires’ disease is available from the Health Protection Agency.

References

1. Australian Government Department of Health and Ageing. Legionnaire’s disease alert to travellers from Bali. 19 January 2011. [Accessed 20 January 2011]. Available at: http://www.health.gov.au/internet/main/publishing.nsf/Content/mr-yr11-dept-dept190111

2. State Government of Victoria, Australia, Department of Health. Chief Health Officer Alert: Legionnaires’ disease cluster associated with travellers to Bali - January 2011. 14 January 2011. [Accessed 20 January 2011]. Available at: http://www.health.vic.gov.au/chiefhealthofficer/alerts/alert-2011-01-legionnaires.htm#

Links:

UK Health and Safety Executive: Legionnaires’ disease

Health Protection Agency: Guidelines for investigating single cases of Legionnaires’ disease.

NaTHNaC Health Information Sheet: Legionellosis

World Health Organization: Legionella and the prevention of Legionellosis