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September 22nd 2021

Illness Abroad

Why it’s important to highlight the risks from Legionnaires’ disease as travel abroad increases

Anne Thomson

Anne Thomson

Litigation Executive, Travel

Why it’s important to highlight the risks from Legionnaires’ disease as travel abroad increases

With hotels back open and cruise ships sailing again following a difficult period for the travel industry due to the Covid-19 pandemic, our expert holiday claims solicitors are keen to highlight the risks from Legionnaires’ disease when travelling abroad.

With hotels back open and cruise ships sailing again following a difficult period for the travel industry due to the Covid-19 pandemic, our expert holiday claims solicitors are keen to highlight the risks from Legionnaires’ disease when travelling abroad.

To do that, Anne Thomson, Litigation Executive in our Travel team at Hudgell Solicitors, has put together this useful guide on the illness and why you should be aware of the symptoms should you be unlucky enough to become poorly while on holiday or travelling abroad.

What is Legionnaires’ disease?

UK government guidance on the lung infection states: “Legionellosis is a collective term for diseases caused by Legionella bacteria including the most serious Legionnaires’ disease… a potentially fatal form of pneumonia.

“Legionella bacteria are widespread in natural water systems, like rivers and ponds. However, the conditions are rarely right for people to catch the disease from these sources.

“Outbreaks of the illness occur from exposure to Legionella growing in purpose-built systems where water is maintained at a temperature high enough to encourage growth, for example cooling towers, evaporative condensers, hot and cold water systems and spa pools.

“People contract Legionnaires’ disease by inhaling small droplets of water (aerosols), suspended in the air, containing the bacteria.”

The guidance states that certain conditions increase the risk from Legionella if:

  • The water temperature in all or some parts of the system may be between 20-45C, which is suitable for growth
  • It is possible for breathable water droplets to be created and dispersed, eg aerosol created by a cooling tower, or water outlets
  • Water is stored and/or re-circulated
  • There are deposits that can support bacterial growth providing a source of nutrients for the organism, eg rust, sludge, scale, organic matter and biofilms.

National surveillance scheme paints picture of Legionnaires’ disease cases

Public Health England produces monthly Legionella reports as part of a national surveillance scheme for Legionnaires’ disease to detect any clusters and outbreaks of the infection.

The statistics in its latest report, covering January 1 to October 31, 2020, are skewed by restrictions on travel and activities last year.

However, there were still 295 confirmed cases of Legionellosis in this period, 220 of which were picked up in the ‘community’ and 38 from travel abroad.

The three-year mean for the same 10-month period between 2017 and 2019, however, provides a truer picture of cases in England and Wales. Of the 459 annual cases on average, 40% of these were from travel abroad (186) and 10.5% from travel in the UK (48).

The World Health Organisation (WHO), meanwhile, reports that in Europe, Australia and the USA there are about 10-15 cases detected per million in the population per year.

Risk factors and symptoms of Legionnaires’ disease

The WHO also states that, globally, 75-80% of reported cases are in those aged 50 and over, and 60-70% of infections are in males.

Other risk factors for community-acquired and travel-associated Legionellosis as reported by the WHO include:

  • Smoking
  • A history of heavy drinking
  • Pulmonary-related illness
  • Immuno-suppression
  • Chronic respiratory or renal illnesses.

It states that the incubation period of the infection is between two and 10 days, although up to 16 days has been recorded, and that left untreated Legionnaires’ disease usually worsens during the first week.

“The severity of the disease ranges from a mild cough to a rapidly fatal pneumonia. Death occurs through progressive pneumonia with respiratory failure and/or shock and multi-organ failure,” reports the WHO, which says the death rate is usually 5-10% of cases.

The initial symptoms can include:

  • Fever
  • Loss of appetite
  • Headache
  • Malaise and lethargy
  • Muscle pain
  • Diarrhoea
  • Confusion
  • Mild cough and phlegm
  • Shortness of breath

There is no vaccine available for Legionnaires’ disease, which requires antibiotic treatment following diagnosis.

Why passengers on a cruise ship need to be aware of the infection

Because the infection spreads through inhaling or aspirating contaminated water, cruise ship passengers can be at risk of Legionnaires’ disease from the drinking water that boats store onboard as well as from the air conditioning, showers, spa areas, hot tubs and swimming pools.

Over the years, cruise liners have been held liable and been the subject of claims or lawsuits for passengers becoming ill or even dying from Legionnaires’ disease contracted while onboard the ship.

When two or more cases are detected on the same cruise, it is likely that this is the source of the infection and is when legal advice should be sought to see if a passenger is eligible to make a claim.

Disease first started in a hotel – where risk of Legionnaires’ disease also exists

The infection, which existed long before it was first identified in 1977, was named after the Legionnaires that became ill following the outbreak of an infection at an American Legion conference they attended to celebrate the 200th anniversary of the signing of the US Declaration of Independence at Philadelphia in 1776.

Days after the conference, which was held at Bellevue-Stratford Hotel in Philadelphia in July 1976, the first attendee passed away and, in the end, 221 became ill and 34 died of what was later identified as Legionnaires’ disease and has been described as “one of the worst US medical tragedies of the 20th century”.

Many years have passed since then and awareness of the infection and measures to prevent it are now in place, so the overwhelming majority of hotels today will never experience an outbreak of Legionnaires’ disease. However, the risk still exists for hotel guests.

Legionella Control International, one of the world’s leading Legionella risk management specialists, says: “Since Legionella bacteria can contaminate water droplets, any part of a hotel that has water present carries a risk of people being exposed to the bacteria should it be present.

“Not all Legionella risk areas are obvious, such as shower heads and taps… others are less obvious, such as: indoor fountains and water features; whirlpool baths, spa pools, hot tubs, and similar attractions; cooling towers and air conditioning anywhere around the hotel grounds; condensers; misting and irrigation systems; and food displays that use humidified air.”

The European Centre of Disease Prevention and Control’s (ECDC) European Legionnaires’ Disease Surveillance Network (ELDSNet) is in place to minimise the risk of Legionnaires’ disease in hotels throughout the continent.

It recommends hoteliers and other accommodation providers follow a 15-point plan to reduce the risk from the Legionella bacteria. Click here to read the 15 points >>

Risk of water system stagnation increases threat of infection

However, despite increased awareness and control measures, cases still occur and holidaymakers in hotels or on cruise ships could be at risk due to the inactivity of the tourism sector since the onset of the pandemic.

Buildings, like hotels, and cruise ships were not used for months on end or had reduced occupancy during this period and this heightened the risk of water system stagnation due to lack of use – increasing the threat of Legionnaires’ disease.

If you have experienced symptoms or were diagnosed with Legionnaires’ disease while out of the country then you may be entitled to compensation.

To find out more about whether you may be eligible to make a claim, get in touch with our expert accident abroad solicitors for free, no obligation advice. Click here >> 

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