Seasonal Dynamics and Legionellosis-Associated Hospitalization in Spain: A Retrospective Study

Legionellosis is a serious respiratory disease with a high mortality rate, particularly if it is untreated or occurs in the immunocompromised. Legionellosis must be reported in the Spanish Epidemiological Surveillance System. To optimize the epidemiologic knowledge of legionellosis and improve prevention, we have investigated whether the disease is associated with seasonality. This study has described legionellosis cases, the temporal trend by seasonality, hospitalization rate, case fatality rate, and costs by autonomous community and season. We retrospectively reviewed cases of legionellosis, documented patient and clinical characteristics, diagnostics, and seasonality of infection. This study combined national legionellosis notification and hospital discharge data that were linked via the Spanish National Health Service to provide a dataset of hospitalized cases occurring between 2002 and 2021 in Spain. There was a significant increase in the number of legionellosis cases due to the season of the year in Spain. An association between legionellosis and factors related to seasonality is suggested. An increasing trend in case fatality rate, seasonality, and regionality and a decrease in legionellosis hospitalization in Spain were identified. The characterization of changes in legionellosis trend and seasonality and timely synchronization and harmonization of hospitalization records are essential to strengthen disease monitoring and inform potential interventions in an epidemiological way.