6th June, 2012

Legionnaires’ disease: Calpe, Costa Blanca, Spain (hotel)

Revised risk assessment

This updates the NaTHNaC News item of 25th May, 2012

An extensive environmental investigation has been undertaken into an outbreak of Legionnaires’ disease, first identified in January 2012 and associated with the Diamante Beach hotel, Calpe, Spain [1]; the outbreak resulted in a cluster of 25 cases and six deaths.  The last case date of onset was 11 May 2012 [2]

Spanish authorities have confirmed that the hotel has undertaken control measures and is complying with regulations required to prevent further cases. As of 29 May 2012, the Spanish Ministry of Health reports that environmental samples from the hotel, including samples from the whirlpool suggested as a possible source of the infection in May 2012 [2], have been reported as negative [3]. These results, together with strict control measures implemented by the hotel, have resulted in a revised risk assessment by authorities. As of 4 June the European Centre for Disease Prevention and Control advises that this hotel may not currently represent a significant risk of Legionnaires’ disease for visitors [3].  

Legionnaires' disease

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.

 

References  

1. Health Protection Agency. Update on Legionnaires’ Cluster Associated with a Hotel in Spain. Press Release. 3 February, 2012. [Accessed 6 June, 2012]. Available at: http://www.hpa.org.uk/NewsCentre/NationalPressReleases/

2012PressReleases/120203Legionnairesinspainishhotel/

2. European Centre for Disease Prevention and Control. Rapid Risk Assessment. Update-Outbreak of Legionnaires’ disease in a hotel in Calpe, Spain. November 2011-May 2012; 24 May 2012 [Accessed 6June, 2012]. Available at: http://ecdc.europa.eu/en/publications/Publications/1205-TER-Updated-Risk-assessment-Legionnares-Spain.pdf  

3. European Centre for Disease Prevention and Control. Rapid Risk Assessment. Update – Outbreak of Legionnaires’ disease in a hotel in Calpe, Spain. November 2011-May 2012; 4 June 2012. [Accessed 6 June, 2012]. Available at: http://ecdc.europa.eu/en/publications/Publications/1206-TER-Updated-Risk-assessment-Legionnares-Spain.pdf

Links

European Legionnaires’ Disease Surveillance Network (ELDSNet) 

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

NaTHNaC Health Information Sheet: Legionellosis