Valencia, Spain, 25 Cases, 1 death, June 2003

In two or more separate outbreaks occurring in May and June in Valencia , 25 cases of legionellosis have been identified, one of which resulted in death. The first was a community outbreak in Alcoy and nearby areas. The second outbreak was associated with the oncology unit and adjacent rehabilitation area of a hospital; seven cases were identified, four patients and three visitors. One of the patients died. Investigators quickly traced the infections to the hospital's hot water system, blaming two showers as the particular source of contamination. The health department reported that the hospital collected environmental samples, hyperchlorinated the domestic water system, disinfected the rehabilitation pool, and began distributing higher water temperatures to faucets and showers.