Killer microbe kills tourist in unnamed hotel

“The case occurred in a local hotel and Legionella infection contributed to his death,” a spokesperson for the Infectious Disease Prevention and Control Unit said.

As happened in previous occasions, the health authorities have refused to name the hotel involved. When asked where the case occurred, the unit’s spokesperson insisted that “this information is not in the public domain.”

“However I can assure you that all the hotels were investigated and where indicated, action was taken in line with international protocols for investigation of cases of legionella,” the spokesperson said.

A total of 11 cases of Legionnaire disease were reported in 2010. Only one of the cases resulted in the death of the patient.

Six of the 11 cases occurred in private homes, two occurred in local hotels and three involved  persons who contracted the disease while travelling abroad.

Three hotels were the suspected source of Legionnaires disease in 2009 – luckily none of the four patients who contracted it died from the potentially lethal disease.

In one of these cases two persons contracted the disease from the same hotel.

Hotels have been the suspected source of the microbe in most cases occurring in the past years, although cases in households have also been increasing.

In 2006, three of the five cases of the disease also occurred in hotels. Likewise, hotels were the suspected source of infection in all five cases of the disease occurring in 2005, and in 13 out of 14 cases occurring in 2004. This sharp increase had prompted the Health Department to issue a circular to all doctors working in hospital advising them on how to tackle the disease.

In order to decrease the occurrence of the lethal disease, a code of practice was distributed to all hoteliers in Malta. A legal notice was issued in January 2006.

According to the law, owners are obliged to test a sample of water circulating in the cooling tower system, fountains and indoor water systems every six months to detect bacteria causing Legionnaires’s disease.

The health department has also carried out an audit of all hotels to ensure that they all fully abide by the law. But even in 2007, six cases occurred in a hotel.

Legionnaires’s is a type of pneumonia caused by bacteria, with an overall fatality rate of about 15% which increases among smokers and those with underlying diseases. It is usually contracted by inhaling water vapour that contains the bacteria from hot tubs, showers or A/C units, but not person to person.

Households are advised to regularly check water tanks and insulate them to prevent the temperature of the water from warming up, and to keep geysers at a constant temperature above 60ºC. They are also advised not to buy water from bowsers not certified by the Health Department.

In 2010, Malta also registered a death caused by Dengue fever – a viral infection which is transmitted by mosquitoes. But the case was imported and not acquired locally.

“It is thought that the foreign mariner had acquired the infection after travelling to an endemic area in the previous 14 days”.

Profile of a deadly disease

Legionnaires’s disease is a type of pneumonia caused by bacteria. You usually get it by inhaling water vapour that contains the bacteria. The vapour may come from hot tubs, showers or air-conditioning units for large buildings. The bacteria does not spread from person to person.

The overall fatality rate is about 15%, but this increases in those with underlying diseases.

Symptoms of Legionnaires’s disease include fever, chills, a cough and sometimes muscle aches and headaches. You will probably need a chest X-ray to diagnose the pneumonia.

Lab tests can detect the specific bacteria that cause Legionnaires’s disease.

The bacteria are more likely to make you sick if you are older than 65, smoke, have a lung disease and a weak immune system.

The disease is treated by antibiotics, which are effective when the disease is detected early. As with any acute illness, patients who recover from Legionnaires’s disease can suffer long term side effects. The most common are fatigue and lack of energy for several months.

The disease owes its name to the victims of the first recorded outbreak of the disease in 1976 at the Bellevue Stratford Hotel in Philadelphia, Pennsylvania, where members of the American Legion, a United States military veterans association, had gathered for the American Bicentennial.

Within two days of the event’s start, veterans began falling ill with a then unidentified pneumonia. As many as 221 people were given medical treatment and 34 deaths occurred.

The world’s largest outbreak of Legionnaires’s disease happened in July 2001 in Murcia, Spain, where 800 cases were reported after the legionella microbe found its way in the cooling towers of a hospital.

Cases of legionnaire disease in Malta

2001                                    4

2002                                    0

2003                                    10

2004                                    14

2005                                    5

2006                                    5

2007                                    19

2008                                    3

2009                                    8

2010                                    11

Total                                    79