Island-Wide Checks as Legionnaire’s Tally Hits 14


Bali has now sent 14 foreign tourists home with Legionnaire’s disease, according to the latest available figures from the provincial health office.

And it has emerged, in remarks by Sanglah Hospital’s director of medicine and nursing, Dr Anak Agung Ngurah Jaya Kusuma, that an Australian who died of a respiratory disease at Sanglah in July last year had symptoms similar to those of Legionnaire’s.

The three new 2011 cases are all Australians. Nine of the previous 11 cases were also Australians. One was a French national and the other Dutch.
The figures came out when Bali’s chief medical officer, Dr Nyoman Sutedja, spoke at a meeting last weekend called to discuss how to combat the outbreak.

The disease, a virulent form of pneumonia first identified in 1976 at an American Legion (veterans) congress in Philadelphia, spreads via mist or spray droplets from badly maintained cooling towers, air conditions, spa and showers and swimming pools.

Legionnaire’s disease re-emerged in Bali last year with a small number of cases – all of them Australian tourists – but has now worsened, leading to health advisories being added to Australian travel advice for Bali.

The source of the present outbreak has been identified as most likely to be the Ramayana Hotel in central Kuta.

Governor I Made Mangku Pastika said there was no need to name the hotel or other places involved because remedial action was being taken to ensure utility water was free of Legionella, the virus responsible for the disease.

The meeting with tourism industry operators was called to work out how to make hotels and other places comply with maintenance and preventive health procedures.

He told the meeting a joint investigation by the Health Ministry and the World Health Organisation after the first batch of Legionnaire’s disease cases had been reported that initial investigations had identified the source of the infection to a hotel in the vicinity of Matahari Square in the tourist hub of Kuta.

Sutedja said the hotel had cooperated in checking for Legionella, including allowing checks on the hotel’s air-conditioning cooling tower, shower heads, faucets, plumbing and swimming pool.

He said there were fears Legionella could also be present in water vapour and droplets in other places around Bali, including popular tourist sites such as Tanah Lot and at Ubud, Singaraja and Karangasem.

“We’ve asked health officials in all districts to investigate cases of respiratory illnesses and report to us,” he said.

Dr Jaya Kusuma of Sanglah said at last Saturday’s meeting that cases of Legionnaires’ disease might date back to July last year, when an Australian tourist died of Legionnaire’s-like symptoms at Sanglah.

Australian authorities confirmed two months later – in September – that three Australians had tested positive for the disease after returning from trips to Bali.

Dr Jaya Kusuma said Sanglah, Bali’s main hospital and the biggest, did not have the equipment needed to detect Legionnaires’ infections.

He added it difficult even to order the diagnostic equipment because you needed to get on an import waiting list.

Sutedja called on hotel owners to take extra precautions against Legionella, including drying air conditioning cooling towers not in use, properly cleaning pools and other sources of standing water, and ensuring that all towels and linen were kept dry.

Participants at Saturday’s discussion agreed to include Legionella bacteria in the health office’s watch list for routine inspections, which also looks for salmonella and E. Coli, for which the health office charges Rp200,000 (US$22) per test.

“With the new check for Legionella, we might need to charge an extra Rp 1 million to Rp 1.2 million,” Sutedja said.

The Bali Hotels Association, which represents the 100 star-rated hotels and resorts in Bali, has already put its own measures in place.

Perry Markus, head of the Bali chapter of the Indonesian Restaurant and Hotel Association (PHRI), said the extra cost would not be a problem because they wanted to show they were about preventing the spread of Legionnaire’s disease.

He said foreign tour operators were asking questions about the presence of Legionnaire’s.

Ida Bagus Subhiksu, head of the Bali Tourism Office, said it was important to stop the outbreak from crippling the island’s all-important tourism industry.

“Bali has a very high profile, so when visitors come here we don’t want them going home sick,” he said.

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One Response to “Island-Wide Checks as Legionnaire’s Tally Hits 14”

  1. shorty Says:

    this is 14 cases too many, and obviously of concern.

    let’s put a little perspective on it.

    new south wales had 81 cases for 2010, 34 being Legionella pneumophila, the water borne strain.


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