Institute of Public Health of FBiH Issues Warning and Measures on Legionella: How to Recognize Symptoms

(Patria) - The Institute of Public Health of the Federation of Bosnia and Herzegovina has issued guidelines and warnings for citizens regarding Legionnaires' disease (legionella) spreading in the region.

Legionnaires' disease is a form of pneumonia caused by the bacterium Legionella spp. It does not have specific symptoms or signs that distinguish it from other types of pneumonia, and laboratory tests are required to confirm the diagnosis.

Symptoms can appear from two days to usually five to six days after infection, but sometimes the incubation period can be longer. It often begins with a dry cough, fever, headache, and sometimes diarrhea or confusion before the onset of pneumonia, according to the Institute.

Legionnaires' disease occurs worldwide, but its incidence rate is unknown because many countries lack good surveillance systems for diagnosing and detecting the disease. In the EU, in 2021, the reporting rate of Legionnaires' disease was 2.4 cases per 100,000 inhabitants.

In the Federation of Bosnia and Herzegovina, Legionnaires' disease is detected sporadically (among local residents, as well as foreign nationals related to stays in BiH - reported through the ECDC network).

The mortality rate from Legionnaires' disease varies between five and 15 percent, depending on the age and health status of the affected person. People over 50 years of age are at higher risk than younger people, as are people with weakened immune systems or people with chronic diseases. In addition, smokers also fall into the risk category.

How it Spreads

The Institute warns that people can become infected if they inhale tiny water droplets called aerosols that carry Legionella bacteria. If these bacteria reach the lungs, they can cause infection. Legionnaires' disease cannot be transmitted by drinking water, as the bacteria must enter the respiratory system through inhalation. They emphasize that the disease is not transmitted from person to person.

Legionella bacteria are quite common in the environment and naturally exist in water sources such as rivers, lakes, and reservoirs. They can also be found in soil and compost. These bacteria can survive at various temperatures in the environment. They can also grow in engineered water systems, most commonly associated with buildings and water systems such as hot and cold water systems, cooling towers, humidifiers, fountains, and whirlpools.

If diagnosed in a timely manner, treatment is effectively carried out with antibiotics, the Institute points out.

Protective Measures

The main protective measure is to reduce the risk of Legionella growth in places that produce aerosol droplets that can be inhaled.

Regular checks for the presence of Legionella and appropriate control measures can help prevent the occurrence of Legionnaires' disease cases in places where people at higher risk of the disease might be exposed. This includes hotels, hospitals, and nursing homes.

Effective measures for controlling Legionella bacteria include:

Ensuring regular maintenance, cleaning, and disinfection of water systems, including plumbing, cooling towers, whirlpools, and decorative fountains;

Maintaining cold water systems below 20 degrees Celsius and hot water systems above 50°C to prevent bacterial growth;

Ensuring proper water flow and circulation in water systems to reduce the risk of stagnant water;

Regular cleaning and disinfection of water filters, cooling towers, and associated pipes used in air conditioning systems;

Water supply and distribution systems that have not been used for a long time (e.g., used seasonally) should be disinfected before being put into use.

No patients with Legionnaires' disease have been recorded in FBiH, and the Institute's warning comes after three people in Croatia died due to infection with the bacteria. The bacteria were found in the water system of Rebro hospital in Zagreb.