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Legionnaires’ disease is a respiratory illness often associated with hotels and travel. Spain is a major tourist destination and one of the European countries with most cases of Legionnaires’ disease , both community- and travel-associated. However, the prevalence of in tourist facilities is unknown.


The present investigation aimed to survey the tourist facilities in the Balearic Islands, Spain, for prevalence.


We visited tourist facilities in the Balearic Islands in two different periods (2006–2010 and 2015–2018) and took water samples following national and international guidelines. was investigated by culture methods following international standards (ISO 11731:1998).


We evaluated 13,472 samples from 465 facilities. Bacteria of the genus were detected in 65.4% of the surveyed facilities. Contamination of the facilities was significantly higher during the second decade (54.5 vs 78.6%). The most frequent colonisers were serogroup 2–14. We detected the pathogen in 15.9% and 6.9% of hot and cold water distribution systems samples, respectively. The contamination rate in cold water systems samples was higher when free chlorine levels were < 0.2 mg/L and at > 25 °C temperatures, while in the hot water systems samples, the contamination rate was higher at < 50 °C. Of the samples from hot tubs, 10.9% were contaminated.


prevalence in hotels in the Balearic Islands was high but the contamination rates depended on the installations. Corrective measures are still needed to improve control.


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  1. Cunha BA, Burillo A, Bouza E. Legionnaires’ disease. Lancet. 2016;387(10016):376-85.  https://doi.org/10.1016/S0140-6736(15)60078-2  PMID: 26231463 
  2. Fraser DW, Tsai TR, Orenstein W, Parkin WE, Beecham HJ, Sharrar RG, et al. Legionnaires’ disease: description of an epidemic of pneumonia. N Engl J Med. 1977;297(22):1189-97.  https://doi.org/10.1056/NEJM197712012972201  PMID: 335244 
  3. Napoli C, Fasano F, Iatta R, Barbuti G, Cuna T, Montagna MT. Legionella spp. and legionellosis in southeastern Italy: disease epidemiology and environmental surveillance in community and health care facilities. BMC Public Health. 2010;10(1):660.  https://doi.org/10.1186/1471-2458-10-660  PMID: 21044294 
  4. Hoebe CJ, Cluitmans JJ, Wagenvoort JH. Two fatal cases of nosocomial Legionella pneumophila pneumonia associated with a contaminated cold water supply. Eur J Clin Microbiol Infect Dis. 1998;17(10):740.  https://doi.org/10.1007/s100960050173  PMID: 9865992 
  5. Vanaclocha H, Guiral S, Morera V, Calatayud MA, Castellanos M, Moya V, et al. Preliminary report: outbreak of Legionnaires disease in a hotel in Calp, Spain, update on 22 February 2012. Euro Surveill. 2012;17(8):20093.  https://doi.org/10.2807/ese.17.08.20093-en  PMID: 22401506 
  6. European Centre for Disease Prevention and Control (ECDC). Legionnaires’ disease. Annual Epidemiological Report for 2019. Stockholm: ECDC; 2021. Available from: https://www.ecdc.europa.eu/en/publications-data/legionnaires-disease-annual-epidemiological-report-2019
  7. Ricketts KD, McNaught B, Joseph CA. Travel-associated legionnaires’ disease in Europe: 2004. Euro Surveill. 2006;11(4):617.  https://doi.org/10.2807/esm.11.04.00617-en 
  8. Borella P, Montagna MT, Stampi S, Stancanelli G, Romano-Spica V, Triassi M, et al. Legionella contamination in hot water of Italian hotels. Appl Environ Microbiol. 2005;71(10):5805-13.  https://doi.org/10.1128/AEM.71.10.5805-5813.2005  PMID: 16204491 
  9. Kyritsi MA, Mouchtouri VA, Katsioulis A, Kostara E, Nakoulas V, Hatzinikou M, et al. Legionella colonization of hotel water systems in touristic places of Greece: association with system characteristics and physicochemical parameters. Int J Environ Res Public Health. 2018;15(12):E2707.  https://doi.org/10.3390/ijerph15122707  PMID: 30513698 
  10. Bonetta S, Bonetta S, Ferretti E, Balocco F, Carraro E. Evaluation of Legionella pneumophila contamination in Italian hotel water systems by quantitative real-time PCR and culture methods. J Appl Microbiol. 2010;108(5):1576-83.  https://doi.org/10.1111/j.1365-2672.2009.04553.x  PMID: 19796090 
  11. Leoni E, De Luca G, Legnani PP, Sacchetti R, Stampi S, Zanetti F. Legionella waterline colonization: detection of Legionella species in domestic, hotel and hospital hot water systems. J Appl Microbiol. 2005;98(2):373-9.  https://doi.org/10.1111/j.1365-2672.2004.02458.x  PMID: 15659192 
  12. Alexiou SD, Antoniadis A, Papapaganagiotou J, Stefanou T. Isolation of Legionella pneumophila from hotels of Greece. Eur J Epidemiol. 1989;5(1):47-50.  https://doi.org/10.1007/BF00145044  PMID: 2707395 
  13. Erdogan H, Arslan H. Colonization of Legionella species in hotel water systems in Turkey. J Travel Med. 2007;14(6):369-73.  https://doi.org/10.1111/j.1708-8305.2007.00146.x  PMID: 17995531 
  14. Erdogan H, Arslan H. Colonization of Legionella species in Turkish baths in hotels in Alanya, Turkey. Environ Monit Assess. 2015;187(5):235.  https://doi.org/10.1007/s10661-015-4444-3  PMID: 25850992 
  15. Serrano-Suárez A, Dellundé J, Salvadó H, Cervero-Aragó S, Méndez J, Canals O, et al. Microbial and physicochemical parameters associated with Legionella contamination in hot water recirculation systems. Environ Sci Pollut Res Int. 2013;20(8):5534-44.  https://doi.org/10.1007/s11356-013-1557-5  PMID: 23436060 
  16. Doménech-Sánchez A, Laso E, Albertí S. Determination of Legionella spp. prevalence in Spanish hotels in five years. Are tourists really at risk? Travel Med Infect Dis. 2022;46:102269.  https://doi.org/10.1016/j.tmaid.2022.102269  PMID: 35131428 
  17. Ministerio de Sanidad. Guía técnica para la prevención y control de la legionelosis en instalaciones. [Technical guide for the prevention and control of legionellosis in facilities]. Madrid: Ministerio de Sanidad; 2005. Available from: https://www.mscbs.gob.es/ciudadanos/saludAmbLaboral/agenBiologicos/guia.htm
  18. Ministerio de Sanidad y Consumo. Real Decreto 865/2003, de 4 de julio, por el que se establecen los criterios higiénico-sanitarios para la prevención y control de la legionelosis. [Royal Decree 865/2003, of July 4, which establishes the hygienic-sanitary criteria for the prevention and control of legionellosis]. Boletín Oficial del Estado. 2003;171:28055-69. Spanish. Available from: https://www.boe.es/eli/es/rd/2003/07/04/865
  19. Lee S, Crespi S, Kusnetsov J, Lee J. de Jong Birgitta, Ricci ML, et al. European technical guidelines for the prevention, control and investigation of infections caused by Legionella species. London: Public Health Laboratory Service; 2017. Available from: https://www.ecdc.europa.eu/en/publications-data/european-technical-guidelines-prevention-control-and-investigation-infections
  20. Rosende M, Miró M, Salinas A, Palerm A, Laso E, Frau J, et al. Cost-effectiveness analysis of chlorine-based and alternative disinfection systems for pool waters. J Environ Eng. 2020;146(1):04019094.  https://doi.org/10.1061/(ASCE)EE.1943-7870.0001610 
  21. Ministerio de la Presidencia. Real Decreto 140/2003, de 7 de febrero, por el que se establecen los criterios sanitarios de la calidad del agua de consumo humano. [Royal Decree 140/2003, of February 7, which establishes the sanitary criteria for the quality of water for human consumption]. Boletín Oficial del Estado. 2003;45. Spanish. Available from: https://www.boe.es/eli/es/rd/2003/02/07/140/con
  22. Hrubá L. The colonization of hot water systems by Legionella. Ann Agric Environ Med. 2009;16(1):115-9. PMID: 19572483 
  23. International Organization for Standardization (ISO). ISO 11731:1998 Water quality — detection and enumeration of Legionella. Geneva: ISO; 1998. Available from: https://www.iso.org/standard/19653.html
  24. Felice A, Franchi M, De Martin S, Vitacolonna N, Iacumin L, Civilini M. Environmental surveillance and spatio-temporal analysis of Legionella spp. in a region of northeastern Italy (2002-2017). PLoS One. 2019;14(7):e0218687.  https://doi.org/10.1371/journal.pone.0218687  PMID: 31287819 
  25. Barna Z, Kádár M, Kálmán E, Scheirich Szax A, Vargha M. Prevalence of Legionella in premise plumbing in Hungary. Water Res. 2016;90:71-8.  https://doi.org/10.1016/j.watres.2015.12.004  PMID: 26724441 
  26. Euser SM, Bruin JP, van der Hoek W, Schop WA, den Boer JW. Wellness centres: an important but overlooked source of Legionnaires disease. Eight years of source investigation in the Netherlands, 1 August 2002 to 1 August 2010. Euro Surveill. 2012;17(8):20097.  https://doi.org/10.2807/ese.17.08.20097-en  PMID: 22401507 
  27. Rakić A, Štambuk-Giljanović N. Physical and chemical parameter correlations with technical and technological characteristics of heating systems and the presence of Legionella spp. in the hot water supply. Environ Monit Assess. 2016;188(2):73.  https://doi.org/10.1007/s10661-015-5047-8  PMID: 26733467 
  28. Uzel A, Uçar F, Esin Hameş-Kocabaş E. Prevalence of Legionella pneumophila serogroup 1 in water distribution systems in Izmir province of Turkey. Acta Pathol Microbiol Scand Suppl. 2005;113(10):664-9.  https://doi.org/10.1111/j.1600-0463.2005.apm_118.x  PMID: 16309424 
  29. Rasheduzzaman M, Singh R, Haas CN, Gurian PL. Required water temperature in hotel plumbing to control Legionella growth. Water Res. 2020;182:115943.  https://doi.org/10.1016/j.watres.2020.115943  PMID: 32590203 
  30. Arvand M, Jungkind K, Hack A. Contamination of the cold water distribution system of health care facilities by Legionella pneumophila: do we know the true dimension? Euro Surveill. 2011;16(16):19844.  https://doi.org/10.2807/ese.16.16.19844-en  PMID: 21527132 
  31. Papadakis A, Chochlakis D, Sandalakis V, Keramarou M, Tselentis Y, Psaroulaki A. Legionella spp. Risk assessment in recreational and garden areas of hotels. Int J Environ Res Public Health. 2018;15(4):E598.  https://doi.org/10.3390/ijerph15040598  PMID: 29587446 

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