21 Feb 2019

Travel associated Legionnaires’ disease: Goa, India

A small number of Legionnaires’ disease cases have been reported in travellers who recently visited Goa in India Travel associated Legionnaires’ disease: Goa, India

Since November 2018, a total of seven cases of Legionnaires’ disease (LD) in UK travellers who visited Goa have been reported to Public Health England. This is a small increase in traveller cases compared to previous years [1].

Although the risk is low, travellers should be aware of the symptoms of Legionnaires’ disease.

About Legionnaires’ disease

LD is a bacterial infection of the lungs that develops into pneumonia. Most people become infected by breathing in small droplets of contaminated water suspended in air.

Symptoms include 'flu-like' illness with muscle ache, tiredness, headache, dry cough, shortness of breath and fever. Sometimes diarrhoea occurs and confusion may develop.

Legionella bacteria are distributed widely in the environment. They can live in many types of water including natural sources such as rivers and streams, artificial sources such as water-cooling towers, hot and cold-water systems and spa pools. People can become exposed to the bacteria if water systems are not properly maintained and become contaminated.

Advice for travellers

All travellers should be aware of the symptoms of LD as described above. You may be at increased risk of LD if you:

  • are aged over 50 years
  • smoke
  • have an existing underlying medical condition
  • are immunosuppressed

If you develop symptoms, particularly a cough and/or shortness of breath within 10 days of travelling to Goa, you should seek medical attention, ask about LD and tell your doctor/health professional where you have travelled.

This helps them make an appropriate assessment of your symptoms and clinical condition, so that appropriate testing can be undertaken. If you develop these symptoms while abroad, you should seek medical attention locally, as directed by your travel insurance provider.

If you do not develop symptoms, then you do not need to see a health professional.

Advice for health professionals

Health professionals in the UK should consider LD in anyone with clinical or radiological evidence of pneumonia and a travel history to Goa in India in two to 10 days preceding symptom onset. LD testing should be considered; a urinary antigen test or a legionella PCR test on a lower respiratory specimen may be conducted for an initial diagnosis to be made.

Information for health professionals managing individuals with LD identified following local microbiological testing is available from Public Health England. All cases of LD (regardless of travel history) should be reported to the local health protection team (or equivalent in devolved administrations).

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