Risk assessment: Outbreak of Legionnaires’ disease in a hotel in Calpe, Spain November 2011 – July 2012

Risk assessment

This is a further update of the risk assessment posted on ECDC’s website on 4 June 2012; it is in response to eight new notifications of cases associated with a hotel in Calpe, in the province of Alicante, Spain. It contains information updated up to 4 July 2012.

Executive summary

In February 2012, ECDC issued a rapid risk assessment on the outbreak of travel-associated Legionnaires’ disease that occurred in a hotel in Spain. The risk assessment was updated in May and in June. Following the notification of eight new cases, ECDC further updated its risk assessment on 4 July.

The outbreak has been ongoing since November 2011 and is associated with a hotel in Calpe, in the province of Alicante, Spain. To date (6 July), it has resulted in 38 cases, including six deaths. The thirteen new cases involved six Belgian and seven Spanish citizens.

The new cases among visitors to the hotel suggest that there is an intermittent source of Legionella contamination in association with the hotel. According to the Spanish health authorities, the hotel is complying with all relevant regulations.

As a precautionary measure, the hotel was closed on 3 July. For the time being, the risk of infection seems to have been removed. However, unless the source of the Legionella contamination is found and eliminated, the risk of future exposure cannot be ruled out. ECDC is offering support to the investigations of the Spanish authorities to prevent further cases.

Guests and staff who were in the hotel before its closure have been informed about their possible exposure to Legionella, and asked to immediately seek medical attention should they develop symptoms suggestive of legionellosis. Information is of utmost importance to enhance early diagnosis and treatment, since the disease is associated with a high case-fatality rate.