Legionnaires' disease in Bali - Frequently Asked Questions

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The Department of Health has released information to those travelling to, or returning from, Bali. The release of this information follows notification of further cases of Legionnaires’ disease in Australians following travel to Kuta, Bali in May 2011. Fifteen Australians, including 10 from Western Australia, have been diagnosed with Legionnaires’ disease following Bali travel since August 2010.

What is Legionnaires' disease and how is it caused?

Legionnaires’ disease is a severe form of pneumonia caused by a type of bacteria known as Legionella pneumophilia (often referred to as Legionella).

You may catch Legionnaires’ disease by breathing in water droplets from contaminated warm water environments such as:

  • air conditioning cooling towers in large buildings and evaporative air conditioners
  • showers and warm water systems
  • spa pools
  • misting or droplet sprays
  • fountains
Legionnaires' disease cannot be caught from other people or from animal contact.

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What are the symptoms of Legionnaires' disease?

The early symptoms of Legionnaires’ disease are typically similar to severe ‘flu-like’ illness, and may include:

  • fever
  • chills
  • muscle soreness
  • headaches
  • tiredness
  • reduced appetite
  • dry cough and shortness of breath

Sometimes other bodily systems may be affected, which can lead to:

  • diarrhoea
  • vomiting
  • mental confusion
  • kidney failure

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Who is most at risk of contracting this disease?

People who are at greater risk of contracting Legionnaires’ disease include:

  • people over 50 years of age
  • smokers
  • people with chronic health conditions such as lung disease, diabetes, kidney disease
  • people with weakened immune systems

Middle-aged and older people, and especially those who smoke or have chronic health conditions, should consult their General Practitioner if they are planning travel to Bali. They should also monitor the Smart Traveller (external site) website.

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How long does it take for Legionella infections to develop?

It usually takes two to 10 days after exposure for Legionnaires’ disease to develop. In most cases symptoms appear after five to six days.

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What should I do if I return from Bali and develop flu-like illness?

If you develop severe flu-like illness after returning from Bali, you should seek urgent medical advice, and notify your doctor of your recent travel.

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What is the treatment for Legionnaires' disease?

There is no vaccine currently available for the prevention of Legionnaires’ disease.

Most people who are diagnosed with the disease will need to be treated with antibiotics such as erythromycin and ciprofloxacin.

Most patients who receive early antibiotic treatment begin to improve within three to five days but usually require treatment for 10 to 14 days.

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Can you die from Legionnaires' disease?

Yes. Legionnaires’ disease is a serious illness that requires urgent medical attention. The most susceptible are those over 50, smokers, people with chronic health conditions, such as lung disease, diabetes and kidney disease and people with weakened immune systems. The majority of Western Australians who have contracted Legionnaires’ disease have required treatment in intensive care.

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Where is the Legionnaires' disease coming from?

The exact environmental source of the bacteria that are causing the Legionnaires' disease is unknown, however, all the Western Australians (and the other Australians) who have been diagnosed with the disease stayed in hotels in central Kuta and visited a nearby shopping centre.

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Is the Department of Health advising people to avoid this location at the moment?

While the exact source of the disease remains unknown, WA Health is advising people that the majority of those who contracted Legionnaires' disease stayed in hotels in central Kuta and visited the same local shopping centre. People with risk factors for Legionnaires' disease who visit Bali should avoid the central area of Kuta in the near vicinity of the intersection of Jalan Singosari and Jalan Kartika Plasa.

Western Australians, particularly the middle-aged and elderly with medical conditions, should consult their GP and the Australian Government's Smart Traveller website before they make a decision to travel to Bali.

It is understood that investigations undertaken by Indonesian authorities in 2010 and this year have not been able to identify the environmental source of the Legionella bacteria that have caused the infections. Disinfection of potential sources in the area has been undertaken, and monitoring continues. The fact that two new cases have occurred in late May 2011 indicates that the source of the bacteria remains active.

Also see: Who is investigating this issue?

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How many Australians have been diagnosed with the disease following travel to Bali?

Between August 2010 and June 2011, fifteen Australians (including ten Western Australians), have been diagnosed with Legionnaires’ disease after returning from Kuta, Bali.

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Who is investigating this issue?

The WA Department of Health has provided the Commonwealth Department of Health and Ageing with all details relating to the recent Legionnaires’ cases to assist with the investigation into the possible source of the disease.

The Australian Federal Government is liaising with the Indonesian Government to assist with their investigation. 

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Further Information

Legionnaires' disease fact sheet (external site)

If you develop severe flu-like illness after returning from Bali, you should seek medical advice, and notify your doctor of your recent travel.

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